This Shared Learning example describes how the charity Alive! has developed its innovative activity sessions for older people living in care. It explains how we have created a range of session types and their content. We show how our approach enables older people, and people living with dementia in particular, to shape the content and direction of sessions so that they are meaningful and interesting.
We describe how we model good practice as set out by NICE and how carers who participate in sessions can use them for professional development. We also describe how we are improving the way we monitor and evaluate our work.
Our example demonstrates how we use Quality Statement 4 in NICE QS30 (People with dementia are enabled, with the involvement of their carers, to take part in leisure activities during their day based on individual interest and choice). The rest of QS30 and also QS50 (Mental wellbeing of older people in care homes) are also of direct relevance.
Aims & Objectives
Alive! is a charity dedicated to improving the quality of life of older people in residential care (or otherwise isolated in the community) through meaningful activity which meets their social, emotional and intellectual needs. This shared learning example describes our aim to improve the wellbeing of older people, particularly those living with dementia, by providing stimulating activity sessions in their care homes and day centres.
The main objectives of this initiative are:
- To increase opportunities for older people living in care, particularly those living with dementia, to take part in leisure activities that are meaningful to them.
- To design and deliver a wide range of activity sessions for care homes and day care centres that allow older people, regardless of their cognitive ability, to participate actively in leisure activities based on their own individual interests and guided by their choices.
- To model good practice in delivering meaningful activity sessions, contributing to the continuing professional development of carers working in care settings.
- To develop ways of evaluating the impact of our activities sessions on the wellbeing of those who participate in them.
Care providers increasingly recognise the benefits of providing meaningful activities. However, finding time and equipping staff to deliver these activities is extremely challenging. When Alive! first started delivering sessions in 2009, there was far less recognition of the health and wellbeing benefits of creative approaches to activities. The barriers we faced included:
- A lack of high quality activity provision in the sector - existing provision was often generic rather than personalised
- Dealing with the sheer variety of interests that individuals have
- Communicating with people living with dementia in order to identify their interests
- A gap in professional development for care staff in how to deliver meaningful activity, particularly for people with dementia
- Small activity budgets in care settings
In our first year we delivered around 300 activity sessions in 35 care settings in the Bristol area. We crafted these activity sessions around the interests and personalities of the people who participated in them and their success drew heavily on the creative ingenuity and intuition of our first activities presenter and founder, Tim Lloyd-Yeates.
In one of these early sessions, Tim met a lady called Dorothy who was living with dementia. She was very distant and distracted. Tim pulled out his smart phone and asked her what she would like to see. “The Bay View Hotel in Scarborough” she said. After they found an image of the hotel on the Internet together, she suddenly came “alive”. She told him all about her life there - the staff, the deliveries, even the hats people had worn. This gave us our first glimpse of how we could connect with people using touchscreen technology.
We have grown our service rapidly since then consistently drawing on NICE guidance and research. By demonstrating how we put NICE principles into practice we have been able to attract funding from the most demanding funding bodies. When we approach new care homes we are able to demonstrate how our activity sessions model NICE principles and quality standards. We started monitoring our work more formally in 2012 by introducing an annual care home survey, presenter feedback on sessions and a quarterly advisory group, which includes residents and care staff.
There have been challenging aspects to putting NICE guidance into practice but overcoming the barriers identified above has bolstered the development of our activity sessions.
Personalised provision: To ensure our sessions are meaningful and person-centred, we draw on models used in therapeutic reminiscence, life story work and cognitive stimulation therapy. We train presenters to connect with participants, enabling them to shape the content of sessions. and stimulate memories and discussions, and props to add playfulness. Guided Reminiscence Using iPads we access and share music, film clips, poems and images, allowing older people to make personal requests and choices and relive important memories. Participatory creative activities such as dance, movement and arts encourage participants to make choices and learn new skills.
Our museum collection sessions enable them to enjoy great works of art. lnter-generational projects connect older people and children. Paint Pals connects older people with local primary school children through collaborative painting workshops. In facilitated iPals workshops children and residents use iPads together to create collages of their lives and interests, record music, make films, share poems, create playlists of favourite film clips and music. Matching schools and care settings well takes time but is critical.
Dementia: All our sessions are dementia friendly. We encourage gentle movement with activities that are energising and relaxing, we support hands-on use of specialist apps to make music, create art, or revisit a hobby and enable people who struggle with verbal communication to express themselves through movement and experience comforting touch. We also offer highly responsive one-to-one sessions.
Professional development: An important part of all our activity sessions is to motivate staff to use new ideas in their own approaches to developing person-centred activities. Our sessions model positive ways to engage people with dementia.
Budgets: Our costs in y/e Oct 2015 were £455k and income was £499k (67% was voluntary, mostly from grants, and 33% from session and training fees). We keep rates for care homes affordable and use our own equipment in sessions. Investment in training our presenters and buying iPads has been vital.
Results and evaluation
We constantly develop the way we monitor and evaluate our work. Since 2009, Alive! has trained over 1,000 care home staff and delivered 9,000 activity sessions regularly benefiting over 10,000 older people in around 400 care homes and other care settings in nine counties across South and South West England.
Our presenters deliver an ever-expanding repertoire of activities that now include themed variety hour sessions such as Deep Blue Sea where participants share songs, poems, memories and feelings about the ocean, and movement-based workshops in Tai Chi, Yoga, and Biodanza. Based on its popularity, we have developed and extended our Paint Pals project. Our innovative iPals project is nearing the end of its pilot phase. Its huge success means that we will expand it next year.
A key development has been the completion of a robust external evaluation of our work by Willis Newson and Prof Norma Daykin from the University of the West of England. It examines the breadth and depth of our activities, how they enhance care by building relationships, supporting staff and offering value for money. It states that "Alive! activities impact positively on the mental and emotional wellbeing of those who participate. [They] provide enjoyable activity, enabling social connections between residents and staff within the care settings, and giving participants opportunities to demonstrate skills, knowledge and to experience a sense of pride and achievement. Activities are observed to provide a ‘lift’ to the physical and mental energy levels of the older people who take part."
We are now implementing a new evaluation framework that will improve how we measure progress towards achieving our intended outcomes and impact. We are using the ArtsObS tool, cited by Public Health England. Prof Daykin is a Project Partner in PHE’s new guidance on evaluating arts projects and programmes that seek to improve health and wellbeing. This will give us richer feedback from participants.
We regularly seek feedback from care home managers and use it to develop content and delivery. The independent evaluation states that "Alive! is valued by care managers and staff for the impact it has upon individuals in their care and for the sensitivity it displays towards them." Staff members tell us they gain inspiration by participating as well as the confidence to provide more activity as part of residents’ everyday lives.
Key learning points
Our key learning point has been to start with the individuals we are serving. Whatever type of session we are delivering or developing we always put participant involvement and choice at the centre of sessions. We spend time at the beginning and end of every session introducing ourselves to the individual participants, learning their names and using touch to connect with them. All our sessions focus on strengthening older people’s personal identities by connecting meaningful activities with their individual life stories and experiences.
Alongside this we have learned how critical it is to be rigorous in our selection of presenters and to provide them with opportunities to continue to develop and share ideas and approaches with each other.
As increasing numbers of session participants are living with dementia we work to ensure that the activities we develop are suitable for them. Our presenters are trained to understand how dementia may affect someone’s cognitive abilities and how non-verbal communication and cues can enhance and support meaningful interaction. They understand how to “be with” rather than “do to” someone who is living with dementia and are able to engage, spark conversation and support individuals to connect with what is important for them now.
We have also learned the value of building relationships with the managers and staff at each care setting. This has enabled us to boost the morale of staff responsible for providing activities, who are frequently isolated and under-resourced. We are regularly told by care home managers and staff that we are able to connect with people who are normally very hard to reach, that people who do not normally interact at all thoroughly enjoy our sessions, and that the effects of our sessions can last for days.