Last week I watched the first part of another series by Sir Gerry Robinson. This time he was trying to fix Dementia care homes.
Nightmare
He mentioned that his own father had suffered from this awful disease. We were taken to the kind of home we imagine in our worst nightmares; elderly people sat in a lounge staring bleakly into space in silence for hours.
At one point a woman cried out for help for half an hour, and nobody came. Another issue was the way the owners had taken away meals from the staff. The staff are people on almost the minimum wage who work 10 hour shifts.
Let Them Eat Cake
We saw one scene where the particular owner grilled a member of the kitchen staff on half a loaf of bread she had found that had been labelled apparently for the night shift. She was clearly convinced that the crime committed was that this bread had been left for the member of staff not the residents.
Another owner spoke indignantly saying he didn’t want the kitchen staff having to bother with food for the carers when they were supposed to be looking after the residents. This was a man living in a £4m home.
It Doesn’t Have To Be Like This
We then saw a very different home in Warwickshire. The residents were taking part in all kinds of activities; many of the normal daily routines that keep any house going: ironing, setting the tables and so on. It was a huge difference.
We must always bear in mind that this is TV, but even so, as my old friend Elaine would say ‘A blind man on a galloping horse could see that,’
The Manager
We met the manager, a cheerful friendly but above all enthusiastic man, who clearly cared. His approach seemed simple and straightforward.
We compared this to the poor woman managing one of the previous homes. She had had no training in this kind of care. She showed Sir Gerry the forms and files she had to keep on all the residents. These listed out all kinds of statistics designed to make sure they were safe. But as he pointed out, there was nothing about the quality of life.
There seemed to be no notes on the previous lives of the residents – nothing to give the staff clues that they could use in talking to the residents.
Quality of life
There was none. It had been sacrificed on the altar of safety. On a lovely sunny day the residents were all locked inside, for their own safety and we heard that you just couldn’t let them out.
As you can imagine, in the Warwickshire home, things were different. We saw the residents planting pansies and a man who was clearly very disabled in some kind of chair using what seemed to be his only working limb to paint a piece of furniture. He was clearly very happy to be doing something useful.
We saw lunchtime in Warwickshire where staff were sat enjoying their lunch with the residents. At the other homes we saw people being fed.
No Such Thing As A Free Lunch?
When Sir Gerry asked some of the disgruntled staff whose lunches had been withdrawn why they stayed, the answer was simple. It was because they really cared for the residents, in spite of the way they had been treated themselves.
What was heart-rending to me was that these very dedicated people were not given the skills or the opportunities to look after the people they cared so much about in a way that would really make those people happy.
A Free Lunch
We learned that it was no more expensive to run the home in this much more effective way.
And it’s so often the case. In fact, I would go as far as to say that running things well is almost always cheaper than doing it badly. If you find yourself cutting lunches and arguing over half a loaf of bread you really need to question what is going on.
When Gerry suggested to the ‘bread woman’ that she get some tips from the Warwickshire home it did not go down well. She responded aggressively and clearly felt threatened. She didn’t want to be ‘told what to do’.
Sometimes when people are in this situation they just can’t believe there is a solution and assume people are out to get them. Whereas Sir Gerry was just trying to help.
Dementia
As yet there is no cure. But there are things you can do to reduce the risks of getting dementia. Getting exercise, eating fresh fruit, vegetables and fish are all linked to lower risk of dementia. Vitamins C and E also reduce it.
Looking after your brain is another way to slow the onset of dementia. This means you need to keep mentally and physically active. This is not particularly recent research, yet the people in two of the homes featured on the programme were left with nothing to do and no stimulation at all for hours every day.
We know that, when you do this to any brain, within a matter of hours there is deterioration. This is why it’s so important to keep people active after operations and brain damage. Yes, they need lots of rest, but they also need to get their brains working.
Marian Diamond
In her groundbreaking research of many years ago now, Marian Diamond took some rats and put them into different environments. One group of 12 rats had toys to play with and other rats to communicate with in their cage. Another group of rats was put in isolation with nothing to do.
At the end of the experiment, there was a measurable difference in their brains. Those of the rats in the groups (the ‘enriched environment’) had more connections between the neurons than the rats that had been kept on their own.
I remember seeing Marian Diamond, who is Professor of Anatomy at Berkeley, show us diagrams of the neurons from the ‘enriched’ brains and the ‘impoverished’ brains. The difference was quite astonishing. The ‘enriched’ neurons had a forest of branches linking them. The others had a few twigs.
I met Marian Diamond several times at various conferences. One time, I went down to the gym early in the morning (about 6am) and there she was, already powering up and down the lanes in the pool. She then leapt out and did her weight training. She was easily 70 at that time.
We left the gym together and climbed up the stairs (about five floors) to our rooms. You can see some excerpts of her being interviewed here:
The Good Home
At the home in Warwickshire, they are helping their residents to keep those connections between neurons going in spite of their illness. In the other homes the problems are just compounded. But it’s not that difficult to do better.
And that’s the key point from Sir Gerry. You don’t have to be unpleasant or mean. Running things well, and making a profit can be done in a way that is fun and good for everyone. And it’s not hard. Sometimes it’s just a question of having the courage to ask for and accept some help.
If you are in the UK, and would like to watch it, the second and final episode of ‘Can Gerry Robinson Fix Dementia Care Homes?’ is on BBC2 tonight at 9pm (15 Dec). Enjoy. Let me know what you thin.
Tags: Dementia, Efficiency
Hi Nancy
I was very interested in your piece about the recent programme on dementia care, with Sir Gerry Robinson, whom I have considerable admiration for. Needless to say, I particularly like the fact that he doesn’t seem to feel the need to humiliate almost everyone around him, unlike a certain television ‘personality’ who has recently been ennobled!
However, I must say that as this is a TV programme, they would feel the need to focus on a poor environment wouldn’t they?! In addition to the ‘good’ home of course.
There is a simple answer to the dilemma of where to place your loved ones who have developed this dreadful medical condition to ensure they get the love and care they deserve. In addition to, visiting homes unannounced, seeking recommendations and sniffing the air!
I have worked with the Investors in People national standard now for nearly twenty years, both here in the UK and in some of the 50 plus countries we have sold the standard to, under licence. Ask the care home’s representatives if they have obtained, and maintained, the Investors in People standard.
The organisations that I visit to assess and review for the Investors in People standard include care homes, schools, commercial organisations of every kind from 2 employees to many thousands. I have also assessed parts of the military, the civil service, police services, local authorities … on and on!
The care homes that I visit are absolutely fantastic! Unfortunately, my own parents died comparatively young, so I have not had to make this choice, but tell you what, I am seriously thinking of getting my name down on some of their waiting lists!
Its not just the fact that these homes have met the standard, and are working towards the additional challenges of the wider framework, although this clearly helps. Its also the fact that the owners and staff realise the benefits of working towards, being assessed, meeting and maintaining the standard. Organisations like the ‘bad’ home featured in the programme, are probably not even aware that there is such a thing as a standard that assesses and evaluates the ways in which employers create and maintain a culture of reward, recognition, engagement and involvement. Who work towards continuous improvement, effective communication, valuing and respecting their staff, creating a culture of teamwork and supportive and effective leadership and management. Together with a planned programme of learning and development for ALL staff.
They do this by making sure they effectively PLAN and get everyone involved in the planning (residents and families also if they wish to be involved), DO, that is carry out the plan with everyone’s involvement and, most importantly, monitor, REVIEW and evaluate the outcomes and impact of the plan and the actions taken.
If homes like the ‘bad’ one, do realise that there is such a thing as a voluntary standard, its very unlikely indeed that they would invite someone like me into the home to ask the staff, in total confidence, what they think of their employers!!
Happy Christmas holiday to everyone!
Jennifer, thank you for that useful tip. I also watched the programmes with a sense of gloom and a fervent prayer that I never find myself in the position of needing dementia care for myself or any relatives. Glad to know that should this be necessary there are ways of spotting the better places.
An interesting feature of the approach of the different homes which is pertinent to Nancy’s work is how different the objectives and hence priorities were. In one home the objectives focussed on meeting regulations and cost constraints. In the other, on providing a homely environment for residents (although within a budget and the regulatory framework). What a difference this made. Both homes were successfully meeting their objectives but I’m sure everyone watching would have had a clear idea which was the better home from a resident’s perspective.
Hi Caroline
Its a pleasure! Yes indeed, objectives are key aren’t they? Sorry to bang on about Investors in People but again, jointly (and clearly that’s also key) setting realistic but challenging objectives in line with, the vision, mission or purpose, and above all, the core values of the organisations – in this case care homes, is essential.
When I am working with the staff during an assessment, I never ask anyone to quote anything ‘parrot fashion.’ However, I am looking for the people who care for the elderly, disabled, people with dementia, whatever – to tell me about how they preserve and guard the dignity and independence of the individual person and how they respect them. I hear some lovely stories, one recent one was about an elderly lady who, being of the WW11 generation, wanted some tripe and onions – apparently part of the staple diet of that time. As if they didn’t have enough to put up with! Off went the home’s deputy manager to ‘bully’ a local butcher into providing some, which was duly stewed (stinking the kitchen out!) by the home’s cook, while holding her nose, and thoroughly enjoyed by many of the residents!
Many care workers explain to me that the care home is the home of the residents and they the staff are only visiting. I am often particularly impressed by the dedication of very young people working with the elderly.
Not all bad news by any means!
Have a lovely Christmas.