The 5 pillars of Comfort in Dementia Care

Comfort is defined as A state of physical ease, free from pain or constraint.

Comfort is also one of the six emotional and psychological needs highlighted by Professor Tom Kitwood, to maintain a sense of well-being for anyone living with dementia.

For a medium sized care organisation such as Evolve Care Group, keeping over 300 residents, whom they refer to as family members, living comfortably in their care homes, is a job that is not without its challenges. They advocate following 5 pillars of comfort.

1 Comfortably warm

The World Health Organisation’s standard for comfortable warmth for the elderly is at least 20 °C, but there is a certain amount of subjectivity with temperature preferences. Some choose to sit closer to a heat source, whereas some may opt to sit near a doorway or window, preferring cooler climes. To be a comfortable home, family members need access to both warm and cool locations.

2 Comfortably Sated

In the UK an adult eats an average of 3413 calories a day (approx. 1.8kg of food) but for somebody with dementia, this is likely to be lower, since eating difficulties are more noticeable as the dementia progresses and a reduced ability to taste or smell becomes evident, which reduces appetite. Desserts are often favoured over savoury foods, so, adding small amounts of honey or glucose to main courses can sometimes result in entire meals being consumed, as well as increasing the carbohydrate level of the food.

In later stages of dementia, chewing and swallowing can become difficult. Ben Kerslake, Evolve’s chef in their Frome Nursing Home, offers purees, moulded from casts of the food they are reconstituting, so that pureed carrots are served in a shape of a carrot. This has resulted in an increase in vegetable consumption. Eventually though, food may be refused entirely, in which case there is a difficult balance to be found between continuing to offer sustenance whilst maintaining that person’s dignity.

3 Comfortable Environment

To offer excellent dementia care, a calm environment is needed to help family members relax and rest.

Care homes need to be carefully designed and attention paid to noise levels, intensity of lighting and the décor of rooms, including colour and patterns on walls and carpets. Quiet areas need to be offered, for those that need a peaceful spot and the use of Bluetooth headphones can ensure those wanting to listen to music or watch television, can do so without disturbing those around them. In terms of lighting, minimising shadows and bright reflections can enable family members to relax more.

The Group’s Sundial Care Home uses the skills of an interior designer to make sure anyone living there is as comfortable as possible and this may have helped them in a recent inspection by CGC who rated the home as Outstanding.

4 Comfortably Occupied

Keeping those with dementia, occupied is an important part of care.  Activities improve self-esteem and can reduce loneliness. Walks around the garden or day- trips outside are recommended in the earlier stages of dementia. They are healthy activities and even when later stages have been reached, music is an entertaining way to stay occupied. The part of the brain that deals with the recognition of songs, thankfully remains comparatively unaffected by the condition. Music can still bring pleasure, even when vocal communication is no longer possible.

Person centred care is offered because it increases well-being. The key is being adaptive and observing situations from the resident’s point of view which means problems can often be avoided. If, as happened recently, a family member entered a dining room at 11:30pm, asking for breakfast, the Night Care Team sat them down and offered them breakfast.  Had they tried explaining that it wasn’t breakfast time, and offered a cup of cocoa instead, this would have caused confusion and been disorientating.

 

 

 

 

 

5 Comfortably Housed

Making a living area dementia friendly is not a science. Bringing in personal items from former homes is important, such as photos, or a favourite blanket, or even favoured items of furniture that have a long family history, can be moved in. These can provide reassurance and remind the person which room they are in. Making a care home comfortable also means anticipating needs. It means managing pain before it is out of control, it means encouraging someone to rest before fatigue sets in and engaging with someone before they become bored or lonely.

Team Work

This sort of care operation relies on up to 450 skilled care staff and is a 24 hour a day ministration, so the fees charged can be high, but comfort, dementia expertise and safety do not come cheaply. The company spends around £80,000 a year, just on gas. It is not surprising to learn that the number of residential care businesses that went out of business, almost doubled last year, with 148 closures. Accountants have said the introduction of the national living wage has driven up the cost of providing care, but what is the alternative? Uncomfortable and unsafe care?

Comfort in a care environment is about carefully listening and observing to ensure the well-being of everyone is maintained. Or, put another way, it can mean breakfast at 11:30pm sat on a favourite sofa in a home from home.

Jerry Short, Content writer, Evolve Care Group

Undressing the Uniform Debate

In a Nursing Times survey in 2014, almost 60% of staff consulted, indicated that they thought uniforms were an important part of the job. It is, like the uniforms, a multi-layered topic that generates strong opinions.

The Evolve Care Group run 6 care and nursing homes across the South West of the UK, employing some 450 carers and offering over a million hours of specialist care, over the last 14 months.

Four years ago, they started discussing the pros and cons of not wearing uniforms. After careful consideration, they decided that this was a good idea because it was in line with their Household Model of Care and would help them minimise the institutionalisation seen in their care homes.

 

They announced to their Care Teams across the company, that they no longer needed to wear a uniform. By and large, the teams were delighted, but a few carers argued against it. One said that she thought that uniforms were important because they were respected, and it simplified identifying senior carers.

At the time, Health Care Assistant, Rose Pearce, from the group’s Gibraltar Nursing Home in Monmouth, said visitors needed to quickly identify who they could talk to about important care issues and argued to keep the wearing of uniforms.

Talking with her recently, however, she has changed her mind, completely.

She said “It’s not often that I admit that I was wrong, but I was”

She went on to say that within the first few weeks of giving up uniforms, she began to notice the people she cared for, who are referred to as family members by the care teams, started commenting on the clothes she and the other team members wore to work. Nobody had ever commented on the uniforms, before, she said, but since but the change, they were regularly hearing comments such as “I love that top” and “That colour really suits you, dear”

She also noted that the care staff and family members seemed more relaxed and began to realise how divisive uniforms had been, drawing a line between the carers and the cared for.

Being able to choose what to wear for work also meant that staff were able to choose clothes to wear that would be more likely to generate a positive reaction, such as wearing a particular football top when working with a family member who supported that team, or wearing a T-shirt with a picture of a horse, and asking if anyone had ever been horse riding.

Communication levels between carer and cared for, increased, as did the level of wellbeing.

Although uniforms made it easier to recognise care staff, this was primarily benefitting visitors to the Home. For the family members, especially if they were living with dementia, seeing a uniform was not something they were used to seeing in their own homes and could increase levels of anxiety. Also, from the Care Teams’ point of view, uniforms could be uncomfortable and poorly designed, or cheaply made. It also seemed that some people had an antipathy towards uniforms. This may have its roots in our history of associating them with war or the emergency services or even school bullies.

Nocturnally, the care teams were encouraged to wear night attire, such as dressing gowns and pyjamas, so that if a family member rose in the night and saw a carer in a nightie or pyjamas, this seemed normal, but had the carer been wearing a uniform, this could have become problematic.

Evolve’s bold policy change has won favour with the CQC which recently rated one of its homes as Outstanding. Inspectors found that no uniforms promoted an “inclusive family environment” and minimised confusion for people living with dementia.

Having received top marks and approval from CQC, the Group now plans to roll out its innovative model of care with an ambitious £75m acquisition and new development plan.”  Jerry Short

Q: What eats 28,000kg of strawberries and drinks 330,000 cups of tea? A: The crowds at Wimbledon and at Edenmore Nursing Home, Ilfracombe

Watched by 300 million viewers in 200 countries, and with 500,000 spectators in attendance over the 2-week period, Wimbledon is the largest annual sporting event in Europe, with the cheapest seats for the finals currently costing around £4000, if you can get them!

It is much loved by audiences in the UK’s 11,300 Care Homes, too, with packed seats watching the matches in the build up to the Women’s final on 14th July and the men’s final on 15th.

At Edenmore Care Home, near Ilfracombe, the residents, are referred to as Family Members, and have matches viewable in numerous lounges and may be served traditional strawberries and cream and perhaps even a glass of something stronger than tea, to celebrate the finalists’ successes. The home has a speciality in caring for those living with dementia, and watching sport is thought to have a beneficial effect on that condition.

But what is it about this fascinating game that attracts so many viewers?

Perhaps it’s our pride in our own tennis stars, or the fact that it is the most famous tennis tournament in the world. Or is it the out-and out “Britishness” of it all with the strict, all-white uniforms, Henman Hill, and of course, the Royal Box?

When asked why they liked watching tennis, family members often cited the classic 1980 final between Borg and MacEnroe as the ultimate Wimbledon Final. MacEnroe saved 7 match points before finally losing to Borg in the 5th set.

This year, the only break in excitement levels at the Home­­­­­­­ is going to be when the call, “New balls please” is heard

Roll on Wimbledon. Now where’s my scone gone?

Jerry Short

Having her Jam and Eating it

For most people, spreading a slice of toast with jam is a task that takes but a moment from our busy lives, but for Audrey Payne, an 85 year old, living with dementia, this prosaic act is unusual as is frowned upon by some care homes. Audrey resides at the Edenmore Nursing Home in Ilfracombe, where they provide award winning nursing and dementia care for 47 older people. They are part of the Bristol based, Evolve Care Group.

They refer to their residents as “family members” and treatment is based on the six paragons of Comfort, Identity, Occupation, Attachment, Inclusion and Love. These are part of their “Household Model of Care” which aims to promote enablement wherever possible. One of the most confusing aspects that make living with dementia difficult, are changes to routines.

Audrey came to Edenmore, in March, after living on her own for many years, and her former breakfast routine always included tea, jam and toast. Minimising change was considered essential if her care was to be effective, so she was carefully assessed to be capable of making toast and using a butter knife, without posing a risk to herself or to others. A staff member is always on hand, keeping a respectful distance away, but giving Audrey enough space to feel like her routine is unchanged.

To foster inclusion, “Family members” are encouraged to eat together, sat around family style tables, in a relaxed way. To an observer, anyone watching Audrey’s slight smile as she carries her breakfast plate to her chosen table, her expression may not seem important, but it is not the look of somebody worrying about changes they do not understand. It is the smile of somebody looking forward to nicely browned toast, laden with scarlet raspberry jam.

Edenmore Nursing Home, Ilfracombe are Jumping For Dementia

Two of the marketing team from Edenmore Nursing Home, in Ilfracombe, Devon, have just raised around £1000 for the Alzheimer’s Society in two sponsored tandem parachute jumps. 99% of those being cared for at Edenmore live with dementia and Alzheimer’s is the most common cause of dementia among older adults.

Jessica Caine and Luke Barnett took to the sky on Sunday 5th August, from Dunkeswell Airfield in Devon, and jumped, each attached to their instructors.

Jessica had parachuted once before and said the views were incredible, but it was Luke’s first jump. Prior to taking off, he admitted to being terrified of heights, preferring his feet planted firmly on the ground. Shortly after landing he said “It was all over so quickly, I didn’t have time to be scared”

They jumped from 15,000 feet, any higher would need an oxygen supply, and within seconds, they were plummeting downwards at 120mph, in a tandem jump, which is the easiest of all skydives. It requires only 30 minutes of training before jumping, each strapped to a British Parachute Association Tandem Instructor. Jessica and Luke said that jumping was a truly unforgettable experience, and a fantastic way to raise funds for Alzheimer’s Society

They raised enough money to pay for 2 years’ worth of clinical trial drugs to search for an effective treatment for vascular dementia. Speaking afterwards, they said the day was a total success for both Edenmore Nursing Home, and for Alzheimer’s Society.

Jerry Short, Evolve Care Group

3 Surprising Parachuting Facts

  • There is a sport called Banzai Skydiving. You throw the parachute out of the airplane first and then jump out after it and put it on whilst freefalling. The world-record wait before jumping out is 50 seconds!
  • Afraid of flying, Muhammad Ali spent his first flight praying with a parachute strapped to his back. He was heading to Rome
  • In the 1940s the Idaho Fish and Game Dept relocated beavers into the wilderness by dropping them out of airplanes with parachutes

Julie celebrates 30 years at Edenmore!

Edenmore Nursing Home, recently celebrated it’s longest serving team member, Julie Balment. Julie joined the Edenmore care team on Christmas Eve in 1987 and has spent the last 30 years taking care of family members living at Edenmore.

Home Manager, Tina Edwards, told us: “We are so grateful for Julie’s 30 years of service; she is an integral part of our Edenmore family and it is my pleasure to work alongside her.”

Julie originally came to work at Edenmore on night shifts when her children were young, and in 1989 her mum Carol joined the team and has also worked there ever since. At one point in time Julie’s daughter Hannah worked at Edenmore as well.

Julie commented: “I have very much enjoyed my 30 years here at Edenmore. We truly are one big family, and I can’t imagine going to work every day, anywhere else.”

If you would be interested in learning more about coming to work or live at Edenmore Nursing Home, please call 01271 865 544 or email beds@edenmorenursinghome.com

“Full marks” for Edenmore Nursing Home

Edenmore Nursing Home in Ilfracombe, which provides award winning nursing and dementia care for 47 older people, has recently been highly rated by the Care Quality Commission, which inspects health and social care services.

Inspectors found that "people were protected because risks for each person were identified and managed" and that there were "sufficient staff on duty...to keep people safe.”

The inspection report goes on to note that  "staff were sitting and chatting with people and some were holding people's hands...they were supporting people, who sometimes had challenging behaviour, in a safe way which respected their dignity and protected their rights. When people became distressed or agitated, staff responded promptly and dealt with this in a calm, skilled and respectful way."

"When one person became agitated staff quickly went to reassure them, sat with them and were calm and non-confrontational in their manner.”

One relative of someone living at Edenmore told inspectors "I would give them full marks!"

The home manager, Liz Thompson, told us "we love the people that live with us and we try our best to ensure that they are happy. We have developed an amazing new dementia training programme which is free for local nurses, care workers and families who are interested in learning more about how to provide better care for someone living with dementia.”

If you would like to find out more about this training or more about Edenmore Nursing Home please call 01271 865 544 or email us at beds@edenmorenursinghome.com

Care group offers best possible support to those in need

It has been estimated that more than 900,000 individuals live with dementia in the UK, and this number is anticipated to more than triple in the next decade. Studies also show the economic costs to the UK alone are upwards of £26 billion, which is more than the costs associated with stroke, heart disease and cancer combined. This means that, for those who live with dementia and their families, finding the best quality care is is often stressful and costly.

With this in light, Edenmore Nursing Home & Heanton Nursing Home have been offered access to a unique subsidy fund by Evolve Care Group. The group has always worked with the community, such as its donations to the homeless over the festive season and special events for members of North Devon’s aging community. They hope the special fund will dramatically reduce the cost of care to those most in need. As part of the fund, healthcare experts will be on hand to conduct a free clinical assessment with those interested in accessing the fund to ensure the best possible support is on offer.

Helping individuals with cases like this is at the very heart of what Evolve Care Group, Heanton Nursing Home and Edenmore Nursing Home offer. A revolutionary new model of care offers those that live in the home services that recapture their home environments, rather than just providing them an institutional service. There are individualised fresh produce menus, luxurious décors and occupations centred around what those in the home want to do.

Cake contest!

A cake baking competition was held this week at Edenmore Nursing Home for everyone to show off their culinary skills. Those who live in the home made the cakes with a little help and advice from those that live there. The competition was judged by Liz Thompson, the home’s manager, and the winner was XXX’s delicious chocolate orange sponge. There were all kinds of other entries, from a rich chocolate and cherry cake to the classic Victoria sponge.

Liz commented “making cakes is a popular past time for virtually everyone who lives in the home. Many good stories were shared of individuals baking with their parents or even their own children. We were all very keen to see this continue when they’ve moved into their new home, so decided to have a friendly competition. We were definitely all winners in the end as we all got to enjoy some delicious homemade cakes!

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