Reimaging care home life through everyday objects

Dr Kellyn Lee is a Chartered Psychologist, Academic and Founder of WISER Health and Social Care Ltd www.materialcitizenship.com In this blog Kellyn discusses why everyday objects are crucial for reimaging dementia care. She introduces the concept of Material Citizenship and shows some results from its application in care homes in the UK.

Imagine this……..

When you woke this morning:

the clothing you planned to wear today has gone
the shower gel didn’t have the smell you like
there was no hairdryer to dry your hair
you had no access to a kettle so couldn’t make a hot drink
you want to phone someone to talk about this, but you haven’t got your mobile phone either
You can’t find your keys

How is your day going? How do you feel?

Welcome to the lives of many people with dementia living in care homes

Material Citizenship

Material Citizenship is a concept I developed in my PhD exploring risk enablement in care homes for people living with a dementia. I examined how decisions were made about personal possessions and who was involved. I also explored how everyday objects, to carry out tasks, were used in care homes and by whom.

I found that although it was widely believed personal possessions were encouraged, this belief was inaccurate. Once I began listing the objects I might like and getting staff to think about the objects they might like, it became clear that many objects were not deemed necessary, or would carry too much risk. It was only certain objects that were encouraged in care homes and even those carried caveats. The importance of every day functional objects such as a certain coffee cup, a pair of curling tongs or a handheld vacuum cleaner were overlooked for two main reasons:

Care homes are set up to care for people, this often means care home staff doing to people rather than enabling people to live their life their way
Care homes are complex settings that often follow risk averse practices which effectively caps what can take place within them.

Material Citizenship sets out to reimagine what dementia care looks like, by focusing on the objects that maintain routines and rituals at a time of significant change. We know that personal possessions can make this life changing transition easier but until now have failed to provide care homes with a framework in which to do this safely.

Since my doctoral study Material Citizenship has been developed into a training programme and rolled out in care homes in England, Wales and Scotland. Reports have shown improved levels of wellbeing for residents and increased confidence in care home staff. Below are some examples:

Impact of Material Citizenship on residents

Object	Scenerio	After Material Citizenship training
Newspapers	A resident wanted to deliver newspapers to other residents, however staff said ‘it wasn’t her job’	She now delivers newspapers to residents each morning. Staff reported improved levels of well-being for her, and residents enjoy her visits
The blue chair	A woman recently moved in and was refusing staff access to her room and relationships were difficult	The blue chair was brought in from home. She enjoys this chair it reminds her of her husband. She now allows staff into her room and relationships are more positive
Bread maker	Woman refusing to get out of bed, staff concerned over mental health and physical health, such as bed sores and mobility. This used a lot of staff resource	Staff identified the woman loved to bake bread, staff bought her a bread maker, she now bakes for the home – this gives a reason to get out of bed

Impact of Material Citizenship on care home staff

Prior to Material Citizenship training	After Material Citizenship training
Staff would often feel uneasy about positive risk-taking	Management reported staff were now working with a “can do attitude” in the home
Staff often worked on the basis of assessing physical harm and overlooked psychological harm	Material Citizenship provided staff with a safety net enabling them to weigh up physical and psychological risk
The home had task orientated routines	One manager said, “it has transformed how we work, residents can eat when they choose rather than meal times, and are enabled to do more when they want to”
Staff did not notice some of the great work they already do “I just do it”	Staff began to notice the great work they were already doing. They began to record it in care plans and encouraged other staff who hadn’t attended the training to adopt this approach
Staff lacked confidence	Staff are more confident in the way they work with other members of staff, residents, relatives and external health professionals
Staff were uninspired and fed-up with e-learning	Staff left feeling inspired, valued and wanted more of this type of training

These are just a few examples of how Material Citizenship is changing the way in which we deliver dementia care in a care home setting. And whilst it may not be ‘rocket science’ as was pointed out on Twitter following coverage in the guardian, it is often the small stuff that makes the biggest difference.

For more information www.materialcitizenship.com