The impact of the pandemic on care homes has been widely commented on and does not need repeating here. However, it is true that, whilst much of society is returning to a ‘new normal’, the care sector still faces various restrictions.
The sector is constantly checking the latest updates related to Infection Prevention Control (IPC) measures and Personal Protective Equipment (PPE) requirements and, whilst some guidance has been updated, such as visiting rules, some has not.
So, what have providers been doing and what should they be doing at this dichotomous juncture?
It is fully appreciated that, as the close input, support and contribution of loving family and friends has been so dramatically curtailed, this has significantly impacted on the wellbeing of many residents (and relatives).
Each resident (and relative) is unique and will respond differently to any given situation but, overall, there can be no substitute for the love of a caring spouse, child, close relative or contact.
One positive take away has been the extent to which this void has been improved by the significant, selfless and driven contribution of the workforce. Teams of dedicated staff, whose holistic approach during these times has been significant, have been greatly appreciated by residents, families and friends. This appreciation for a united workforce approach is likely to continue.
Quality of relationships
This ‘loving companionship’, ‘family orientation’ and/or ‘partnership approach’ is within a very special set of skills that has been significant, but also honed, recognised and appreciated throughout the pandemic. This has been particularly important over the last 18 months but, furthermore, will always be and this is probably amongst the key learnings moving forward.
Quality of life
Whilst there will be differences from one home to another, and one organisation to another, there has also been something of a critical cultural evolution of homes and their staff towards a quality-of-life focus in partnership with families and loved ones. This shift has been critically important. This work has accelerated during the pandemic and, predominantly, in the worst of times we have seen the very best in our teams, often taking on more responsibility, covering for others and still delivering on a quality-of-life focus.
‘Meaningful activity’ mindset
By way of illustration, increasingly care homes are not just focused on running ‘activities’ as an optional extra but more in terms of developing a vibrant, engaging and joyous environment where activities are just one component of a culture that abounds with fun, meaning and spontaneity. This is another trend that will not change.
Beyond internally generated activities, which most homes have accelerated over the last 18 months, the bringing in of professional entertainers during the pandemic has been severely limited due to restrictions on access. However, for a combination of reasons, such as the success of the IPC measures and the vaccination programme, the current evolving circumstances have brought gradual changes
Although there is no specific guidance for (external) activities in the current circumstances, it is clear that providers are now considered best placed to assess the risks presented to a home, such as with an entertainer attending, and many are now bringing entertainers in.
The regulator, Care Quality Commission (CQC), has expected to see meaningful occupation of residents and to see the increased entry of visitors (which had previously been tightly prescribed). Providers are sharing their approaches with inspectors and it is clear that a different approach is now expected by the regulator, which is particularly important as the options for meaningful occupation in the safer fresh air of the outdoors will largely no longer be the option it was
Providers and commentators are still concerned over this coming winter and emerging statistics and expert opinions are observed closely. Yet, despite this, providers are not seeing the infection rates leading to serious illness that we saw in the first and second waves of the pandemic. This suggests the vaccination, IPC, testing and PPE regimes are working.
Typically, entertainers are increasingly deployed but are expected to be double vaccinated, undertake LFT tests, wear a surgical facemask and maintain social distancing. (Some, but not many, are unable/unwilling to comply with this as of the 11th November deadline.)
In terms of other things homes can do, even without going outside (often, older people are reluctant unless the weather is ideal), there are still plenty of options.
Music is extremely important. It is unwise to assume what people like or may like; experience suggests trial and error is the best way, as different artists capture emotion differently at different times. Music can be a lifelong joy, be it live, on screen, on DVD, listening to professional singing (with singers wearing masks currently) or participating in karaoke, etc. Many providers will bring in a band regularly and, when COVID-19 was in its second wave, our band recorded favourite songs onto video/YouTube to be played at will.
Here are some other ways to connect people and enhance wellbeing through activity:
- Arts and crafts – painting, drawing, making cards, etc., are still as popular as ever.
- Games/quizzes – from bingo to snakes and ladders, the list is endless.
- Indoor hospitality – many homes have additional facilities, such as bars or cafés, and these have been popular to create a more diverse environment. Staff at Wood Hill Lodge care home in Sheffield transformed their daytime seating area into an all-singing and dancing café and bar during the pandemic and some care homes are considering private dining spaces for residents to enjoy a meal with visitors.
- Sports, games and wacky races – whether it’s a (safe) wheelchair race, soft ball games, gentle exercise or something more adventurous, the key is having fun, building laughter and being spontaneous. There are some great initiatives – Motitech’s annual cycling competition for older people and people with dementia saw the largest ever number of people virtually cycle more than 156,000km. This year’s oldest competitor was 106-year-old Irene Sewlyn from North London’s Mornington Hall. Also, Oakham Grange in Rutland has created an artificial putting green for residents to enjoy all year round.
- Spontaneity – historically, activities have always been scheduled. It can help to schedule an activity and let residents decide what they want. It can be wonderful to find the different ideas that come up, from music and films to reminiscence, people or place. Learning about each other is something we rarely get to do and opens up a new dimension.
- Bringing the outside in – Planting from seed, growing plants and arranging flowers. Growing Support, a not-for-profit community interest group, based in the south west, creates gardening clubs and activities in care homes. The founders began the concept after visiting older relatives living in residential care and finding them lonely and bored, despite being surrounded by people. Residents and carers at Townend Close care home in Keighley were able to use their green thumbs planting flowers, herbs and beebombs in the walled gardens of the home for this year’s national gardening week. Residents who didn’t want to get their hands dirty still participated in the fun by decorating planting pots, gnomes and bird boxes with unique designs to use in the care home’s garden.
- Making outside activities an option – Every January for the past five years, residents and team members in Care UK homes have run events to celebrate birds. Activities include making care home gardens more wildlife-friendly, creating and decorating nest boxes, bird song reminiscence sessions, talks from bird experts and visits from rescued birds of prey and owls. Some intrepid care home residents have even braved the chill of January to visit their local nature reserves.
- Keeping an eye on upcoming community events – Harvest festival, Hallowe’en, firework displays on YouTube that are projected onto a big screen with a reasonable sound system, the build-up to Christmas, going to the Christmas lights, making cards, celebrating famous birthdays (these can happen most days). Keeping connected with the wider world is critically important these days.
Feels like home
Providers should aim to build an environment of loving companionship and of a partnership or inclusive culture with everyone, especially with family and loved ones. I would encourage providers to develop a quality-of-life mindset, where care is delivered around the individual, as opposed to the individual being forced to comply with the care regimes and routines. It’s also about keeping an activity mindset for everything, from helping to get dressed, to developing engaging meal-time experiences, to something to help occupy the mornings, afternoons and evenings, seven days a week (and yes, this is quite a stretch).
Maximising opportunities means recalling individual life moments, special dates, likes, dislikes, hopes and dreams, and planning things, maintaining a degree of spontaneity and wrapping this around an environment with heart, loving companionship and partnership working, encouraging people to participate in their care, their choices and decisions.
It seems there is a yawning gap between the perception and reality of residential care today, particularly over the last 18 months. Perhaps that is historic; it will take time and is understandable. What we must do now is continue the excellent work of our workforce and be dynamic in our approach to activities, to give those we care for the best possible opportunities which they truly deserve. The opportunities are endless – let’s not allow the pandemic to halt our delivery and commitment to ensuring people in care have access to memorable experiences.
Geoffrey Cox is Managing Director at Southern Healthcare (West Sussex) and The Eden Alternative UK.