Mental wellbeing of older people in care homes: statements 1 and 2

Knowing and understanding the person

Quality statements 1 and 2 are about:

  • seeing older people as unique individuals
  • supporting them to develop and maintain their personal identity.

People should be able to take part in activities that are meaningful to them and stay connected to the world.

Quality statement 1

Older people in care homes are offered opportunities during their day to participate in meaningful activity that promotes their health and mental wellbeing. Read quality statement 1 in full.

Why this is an area for quality improvement

Activity helps to sustain both physical and mental health. It is important that older people living in care homes are able to maintain their interests and have opportunities to develop new ones.

The challenges of caring for older people with complex needs in care homes, as well as the culture of the home, can result in staff prioritising practical tasks above supporting people to take part in meaningful activities.

Risk management can also be an issue, with staff not feeling empowered to support people if there is an element of risk involved in activities.

How care homes can improve quality of care

Understand that activity doesn't have to be organised

Activity doesn't have to mean organised activity. It is a myth that:

  • the Care Quality Commission (CQC) expects there to be an activities programme
  • delivering such a programme is the sole responsibility of the activities coordinator.

Activities coordinators play an important role, but ensuring that people can spend their time doing things that are meaningful to them is the responsibility of all staff.

Encourage people to be involved in daily activity

Care homes can improve levels of activity by making sure the people living there have opportunities to take part in the daily life of the home. To achieve this, staff need to know that engaging with people and encouraging activity is central to their caring role.

SCIE's film Achieving excellence in care homes for older people demonstrates the success of this approach.

Meaningful activity can include routine personal care tasks, such as getting dressed and brushing teeth. If older people are encouraged to do these tasks themselves, it will contribute to their sense of wellbeing.

Offer a range of activities

Organised activities contribute to the sense of community in a home, but they are not for everyone. Some people prefer activities that they can do on their own, such as reading or listening to the radio. Other people prefer group activities.

An activity that is enjoyable and meaningful to one person may be of no interest to another. People need a range of activities to choose from and support to maintain existing interests.

The College of Occupational Therapy has ideas for building meaningful activity into the daily life of a care home. And the Alzheimer's Society provides tips for keeping people who have dementia active and involved.

Understand risk

Some activities involve an element of risk and care home staff may be concerned about health and safety regulations and organisational policy. However, older people need the freedom to choose to take some risk if they want to.

Care staff should feel confident about supporting people to take risks and know how to manage and monitor risk.

Empower and authorise staff to take risks, to actually do things that are out of the ordinary.

Ian Turner, chair of the Registered Nursing Homes Association

Case study: football memories

John (not his real name) had difficulty taking part in any activity other than walking in the secure gardens of his care home. His attention span was limited and his concentration appeared to be poor. Staff tried to engage him in games of bingo or cards with people living in the home, but he would quickly get bored and walk away.

John's short-term memory was impaired; his wife thought his memory was focused at some point in the 1970s. A member of staff spoke to his wife about what was important to him at this time and she mentioned that he was passionate about football. They printed out some names and pictures of football players from the 1960s and 1970s and created a game for him to match the names to faces. John engaged well in this game, which held his concentration. It also contributed to a friendship with another resident, who came over to join in with a common interest.

Following this success, a variety of other games with different sporting heroes were devised. John became much more settled around others. He formed some good friendships, including a particularly good relationship with the member of staff who created the game.

Source: supplied by the College of Occupational Therapists, based on a member's experience.

Quality statement 2

Older people in care homes are enabled to maintain and develop their personal identity. Read quality statement 2 in full.

Why is this an area for quality improvement?

When an older person moves into a care home, it can be difficult for them to adjust and maintain a sense of identity. They may have experienced many losses and their transition into the home means adapting to a new way of life.

People need a supportive environment where:

  • they have opportunities to continue their own interests
  • other people take an interest in their lives.

They also need to feel that they can make decisions for themselves, maintain existing relationships and make new connections.

The challenges and competing demands on staff in a busy care home may make it difficult for them to respond to individual needs and aspirations. People living and working in care homes can often feel caught up in a rigid routine. This can hamper how they relate to one another as human beings.

If people are not able to preserve their sense of self and make a contribution to their new community, it will have a detrimental effect on their wellbeing.

How can care homes improve quality of care?

Build a picture of the person

Enabling an older person to maintain and develop their identity starts from the first contact with them. It is vital to build a picture of the person and to get to know their needs and preferences.

Care staff should understand the importance of seeing the person as an individual, talking to them and finding out about their life, so that they feel a sense of belonging in their new community.

The people in SCIE's film Older people and quality of life: better life in residential care ask to be 'seen as how we see ourselves'. Their experiences show how much can be achieved and enjoyed with the support of committed care staff.

Developing a personal profile or taking part in life story work can help with this process. Useful resources include:

Support decision making

Being able to make decisions about how to live your life contributes to good mental wellbeing. Sometimes people need support to make bigger decisions, but they can still make decisions about everyday matters. For example, what to wear and where to sit for meals.

The Freedom to choose section of SCIE's 'Dignity in care' guide provides advice on supporting people to make decisions. The Making decisions section of SCIE's Dementia Gateway has information on decision-making for people who no longer have capacity.

Create a community

Strong personal relationships are important for good mental wellbeing. This includes relationships with:

  • staff at the care home
  • other people living there
  • family and friends.

People need relationships that make them feel part of the care home community and the wider community.

Creating community within care homes (PDF) from My Home Life has advice on building a community in the home and making connections with the local community.

Help people learn new skills

Our personal identities continue to develop throughout our lives. By learning new skills, older people can feel a sense of achievement and personal progress.

Enhancing informal adult learning for older people in care settings, a video from the Learning and Work Institute, shows some people who live in a care home learning new skills. For example, playing musical instruments, learning Welsh, and using a computer.

People need to be understood as individuals. We need to understand their personal history, what makes them tick, what they remember, what makes them happy, what makes them sad… to make people understand that they still matter and that they are recognised and treated as individuals who can still contribute to society.

Laura Bale, matron and director of care at the Royal Hospital Chelsea

Case study: Home decorating

Des, a resident at Ashley House Care Home, has dementia. He was seen as a problem by staff because of his angry and challenging behaviour. He was on antipsychotic medication, but this had little effect on his behaviour. It was beginning to look as if he would not be able to stay at the home.

Des often tried to move the furniture into the middle of a room. He would strip his bed and cover up the television with a sheet. Des was, in fact, preparing to decorate. He had worked as a painter and decorator and was now repeating actions that he had performed regularly during his working life.

Rather than trying to stop these activities, the care home recognised that Des's work was central to his identity and encouraged him to continue. Des was given paint brushes, a roller and a paint tin filled with water so that he could decorate without causing any disruption.

Des became much calmer and was able to come off the antipsychotic medication.

Source: Minimising the use of restraint in care homes for older people: creative approaches (SCIE).