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Bringing the outside in to bring the inside out
Supporting activities outside the care setting

Ben Benson-Breen explores ways to overcome barriers to activities outside the traditional care setting.

How often do you find yourself beginning the week by asking your colleagues what they got up to over the weekend? Most Monday mornings in the Oomph! offices you’ll find people catching up over a coffee, swapping stories and sharing general chit chat as people ease back into the working week.

Though a very simple question, asking ‘what have you been up to?’ can be harder to ask when visiting a care home, as often we already know the answer. Care homes can sometimes represent closed loops as care schedules and programmes of activity can seem repetitive, so the question of ‘what have you been up to?’ can serve to reinforce that repetition.

This is the reason why running activities away from the care environment can have such a constructive impact; not only for the individuals attending the trips but also on the staff, family members and residents staying at home, who will now get to ask that very simple question, but get a very different answer in return.

In my last article for CMM, I wrote of the importance of developing the community within the home, and the need for harnessing the relationships between staff and resident to create a communal ethic that distinguishes each setting from any other by that within.

Here, I discuss the need for maintaining links with the wider world, the importance of getting out and about and the need for bringing the outside in.

By developing a programme that links people living within a care setting not only to each other but also to those further afield, we can expect to see a deeper level of care that nurtures individuality and supports responsive and effective interactions.

In my experience, I have found that activity co-ordinators are often good at utilising their local resources to support activities in the home, whether it is bringing in school choirs for Christmas or managing to arrange a donation from the local butchers for the summer BBQ, it seems that there are ready-made partners out there who are willing to support care homes in their area. However, it should be noted that all too often these are singular events that don’t result in an ongoing and regular relationship.

When talking to these same activity leaders, there is often an expression for the need to run further activities outside of the care setting. There is a ready acceptance that if residents could get out of the home more they would better maintain a sense of identity and personhood through opportunities to relive past experiences and the freedom to take on new challenges.

What do we lose by living in care?

To better understand what we could gain from running activities away from the home, it is worth considering what we might potentially lose when moving into care. The core elements to our identity are primarily built up through our relationships with the people and spaces around us. It is losing access to these things that people associate with coming to the end of life. Whether it is the fear of a diminished connection to family, friends and social groups, or losing our position within society in which we are relied upon to fulfil a function, for many people moving into care can raise mixed emotions. This is especially true as anxiety grows around the thought that by losing our sphere of influence, we may become less of ourselves.

For this reason, the act of moving into care can be a shock to the system. It is normally seen as a last resort. Therefore, to set up the care home as a welcoming environment, there are some immediate factors that should be considered and included as part of a person’s induction process. Identifying what a person might be leaving behind and then moving to mitigate against as many of those losses as possible is one of the ways we can move to a more creative course of person-led care. This should result in a list of proactive actions that can be taken once the individual has become a resident of the home.

Barriers to getting out and about

Why is it that, although we are aware of a clear need, and often have willing external bodies, we still have such a large gap between our care home population who are isolated from their local communities and achieving relationships that we know would be beneficial to all parties concerned? What are the barriers facing us? There are, of course, many factors that influence whether a care home can successfully connect with the community around it. However, they broadly fall into two categories. Do they have the means necessary to access the community? And, do they have staff with the inclination to do so?

The means to do it

The first category is the one we are presented with most often and is probably the more difficult to solve. Many activity co-ordinators complain of a lack of transport options as homes often don’t have their own minibus. This is understandable as they are a very expensive asset to maintain.

When a home does have a minibus, we often find that other issues arise, such as the lack of trained staff or available persons who are insured to drive the bus. This means that outings are infrequent and, as such, activities outside the home become ad-hoc. To draw any significant benefit from doing activities outside the home, there needs to be an element of routine. The success of a trip away from the home is often prefaced by the anticipation or the knowledge of what is going to happen, when this is stripped away a sense of anxiety can build and people who would otherwise have benefitted are now uncertain that they want to go at all.

As this is an issue that we have come across so regularly that we have taken direct steps to help homes overcome it. We have recently launched a service to work with homes who are facing these issues. Oomph! Out & About runs outings and trips on a home’s behalf, with our own buses, staff and timetable of activities that mean we can keep people in regular contact with their local areas.

In my last article, I wrote about how we had supported a lady living in Hereford to start horse riding again after many years. The home now regularly sends a small group of residents to the stables to feed and groom the horses and spend time with the stable hands.

The value of building connections with people who are otherwise unconnected to the care home has proved to be of massive benefit to this group of residents, teaching them new skills and providing a chance for friendships to grow. Part of the success of this relationship has hinged on the home’s ability to travel. For homes that don’t have this freedom, the service accounts for all the barriers that frequently prevent successful outings by bringing down costs and introducing a reliable consistent service that residents can look forward to.

The desire to do it

The second category is more concerning, but is potentially more straightforward to solve. When staff in a care setting see activities as a ring-fenced responsibility, they are unlikely to contribute either their opinion on what could be done or the resultant action to do it. Activity co-ordinators often perform an admirable service to ensure that all residents are included and catered for, but how can we expect one individual to maintain links with the community for all the residents in a home? The truth is we cannot, something must give, and the solution to this is simple.

The introduction of a befriending system built on shared interests will support meaningful engagement within the home as well as outside it. I was recently running a workshop for managers on the benefits of activity to an individual’s wellbeing when I was told a story which supports this idea.

One of the managers had recently employed a young male member of staff into his care team. The young man had never worked in care before and so had spent the first couple of weeks finding his feet and learning his duties. During this short period, he had connected with a gentleman in the home and they bonded immediately over their mutual love of the local football club.

Without hesitation, the young care worker called the club to see if he could arrange a ticket for the gentlemen who used a wheelchair and hadn’t been to a game in years. The club were more than happy to give both men a ticket and the care worker came in on the day of the game, which was also his day off, to pick up the gentleman and they went out together.

This is not a unique case and I’m sure many of us can recall similar instances where bonds have been formed in this way. However, what struck me as different here was that this young care worker had never been educated away from the fact that this was a natural, caring thing to do that formed part of his role. If we want to replicate anything here it is the ease with which this interaction occurred, and the sense of personal benefit for both parties.

A 2013 study called Greening Dementia looked at the benefits and the barriers that people living with dementia face when getting out and about. One of the things it found was that only 20% of the people living with dementia considered that their condition was a barrier to using outdoor spaces, whereas 83% of care staff believed that dementia limited the person’s ability to do so.

What this means is that most of the barriers to accessing space away from the care setting are barriers of our own making. Whether it is the expectation of what’s possible, or the lack of accountability to do it, there are things we could do to expand the tangible areas in which we can attend to people’s needs.

Breaking down the fourth wall

In the theatre, there is a term ‘bringing down the fourth wall’, the idea here is to let the audience in so that they can better interact with the story-telling. When we think about the story of care, maybe breaking down the forth wall could mean that that story could be told just as well in numerous other settings.

When considering what excellent care should look like, we shouldn’t just think about the controllable space of our immediate surroundings, we should also include the spaces away from our homes. This could mean dropping into a museum or gallery exhibition to learn something new, frequenting a local café with a book club or simply getting out into the fresh air for a short period to feel the touch of the elements.

These moments enrich the whole care experience by broadening the perspective of both care staff and residents. When this balance happens, we find we are providing more than just a care home, it becomes a more encompassing habitat of care.

Ben Benson-Breen is Head of Activities and Wellbeing at Oomph! Email: benjamin@oomph-wellness.org Twitter: @OomphWellness

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