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

Afternoon Tea Week at Gibraltar Care Home, Monmouth

Gibraltar Nursing Home, in Monmouth, 79yr-old Michael Green.
Gibraltar Nursing Home, in Monmouth, 79yr-old Michael Green.

Afternoon Tea Week starts on 14th August and is simple to join in. Just pause for afternoon tea as part of your day, sit back and enjoy a nice cuppa which, according the Tea and Infusions Association, will help lift your spirits and keep you going.

Gibraltar Nursing home in Monmouth drink around 150 cups of tea a day and are planning to continue brewing throughout the Afternoon Tea Week. On average in the UK, we each consume 2kg of tea a year, but it hasn’t always been used as a drink.

For centuries, tea was used mainly as a medicine to reduce fevers. It took 3000 years to become an everyday drink and after water, it is the most widely drunk beverage in the world.

The UK consumes 165 million cups of tea each day which is 2000 cups every second. In Gibraltar Nursing Home, the tea drinkers’ favourite brews include English Breakfast and Yorkshire Tea

Some of the Home’s tea drinkers live with dementia and to make their own tea, they are carefully assessed as there are some risks associated with kettle use. Where possible, though, tea making is seen as a positive risk since it maintains an individual’s independence and continues former routines if they made tea for themselves before moving into care. Gibraltar aim to be a Home from home and have small kitchens equipped to look like normal family kitchens.

Research says that Tea is good for you as it contains “polyphenols” — antioxidants that help our bodies fight off disease.

Afternoon Tea Week taps into a British tradition, helping to bring a bit of elegance to an otherwise unremarkable time of day. And, if reading all this has made you thirsty, Gibraltar Nursing Home invite anyone who wants to find out more about what they do and fancies a cuppa, to drop by for a chat and a cup of coffee. Or tea.

Tea Facts

  1. In the UK we drink more tea than water.
  2. Tea bags were first made of silk and were invented to carry samples of tea.
  3. In 1999, 37 people were treated in hospital for injuries caused by tea cosies!

Jerry Short 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

The Positive Risks of Having a Cuppa

For somebody living with Dementia, you may think that making a cup of tea is possibly a risky venture, but always putting safety first denies that person the right of choice and self-determination, which can lead to a loss of self-esteem, increased dependence, and does not support the principles of person-centred care.

At Gibraltar Nursing Home, one of twelve care homes run by the Evolve Care Group, they specialise in both retirement homes and in offering person-centred care for people living with dementia. Part of this is using positive risk acceptance as part of that care.

Visitors could be forgiven for thinking the Home is more like a boutique hotel than a care organisation yet 10% of the home’s residents live with dementia. There is a restaurant, cinema, library, beauty salon, hydro-therapy pool and internet café, all set within the heart of breath-taking Welsh scenery.

They do things a little differently at Gibraltar, compared to more traditional care homes. For instance, they call their residents, Family Members, and have a no uniform policy which has a positive effect on the dynamics in each home.

When new Family Members arrive, they are allocated into small groups with other Family Members. These groups are as much like a home environment as possible. The kitchens look like many you would find in any comfortable, family home across the country.

Here, the Care Team know that changes to a former breakfast routine for instance, can cause confusion and consternation. This is where positive risk acceptance comes in.  Making a cup of tea, with a kettle of boiling water, has obvious risks associated with it. It is easy to see the negatives around people in care being given free range in a modern kitchen, but the benefits of ‘positive risk-taking’ often outweigh the harmful consequences of avoiding risk, altogether.

Nationally, kitchen accidents injure 250,000 each year. Most assume the kitchen is the most dangerous room in a house, but surprisingly, statistics show that more accidents occur on the stairs and in the lounge, than the kitchen. The most common kitchen accidents are knife cuts, followed by slipping on the floor, and thirdly, accidents involving kettles. But any risks undertaken in Gibraltar Care Home, are carefully assessed.

Wherever possible, if Family Members are considered able to make hot drinks themselves, that is encouraged. Care Team members observe this from a respectful distance, to keep an eye on things. Using a kettle or spreading jam with a butter knife, are considered risks that enable older people to have more control and therefore, more choice in their lives. This maintains Family Members’ independence for as long as possible and for anyone living with dementia, this is important feel-good factor.

Michael Greene resides at Gibraltar Gare Home and says that being able to make a cuppa whenever he wants, makes living in Gibraltar much more like living at home and that is the ethos of the Home’s care policy. They use what they call a “Household Model” of care, so named because they’re aiming to create a true continuation of life at home. They thoroughly research each life history, getting to know likes, interests and abilities – Only by knowing this, can they understand who each person is, and assess the positive risks that can be taken to help them. Gibraltar say care homes are an extension of life, not an end to it.

Gibraltar Nursing Home, Monmouth, and the World Cup

All over the UK, football fans are glued to their screens, watching the drama unfold in high definition. At Gibraltar Care Home, in Monmouth, it is no different. They call their residents, Family Members, and in numerous lounges, they have TVs on, showing the World Cup matches.

One of those Family Members is 80-year-old, George Jarvis, known as John to his friends. He is an ardent West Ham and England fan, and lives in care at the home and his long-term football memories are still strong.

In 1949 he played for West Ham Boys after a scout noticed him kicking a ball around. When asked what position he played, George had said “All of them”

The scout smiled down at him saying “We’ve got a right cocky one ‘ere. You can start next week!”

When asked why football was so popular in this country, George didn’t hesitate.

“Because it’s so easy to play. All you need is a ball and some friends to play with. You don’t need proper equipment – You just make goalposts from coats”

The fact that a third of England’s 1966 World Cup team, including Martin Peters, Jack Charlton and Nobby Stiles, now have dementia and Ray Wilson recently passed away with it, highlights how common the condition is, affecting 1 in 6 people over 80. Happily, George is unaffected by it.

I asked him who he thought would win. He paused and smiled as if to make sure he’d heard me correctly. His voice was soft and clear.

“There’s no choice is there? England. It’s got to be England”

He turned to look at me.

“I mean, we invented the game, didn’t we?”

Gibraltar Nursing Home in Monmouth are Jumping For Dementia

Two of the marketing team from Gibraltar Nursing Home, in Monmouth, have just raised around £1000 for the Alzheimer’s Society in two sponsored parachute jumps. 10% of those being cared for at Gibraltar, 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 require oxygen tanks, 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 their chosen charity.

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 Gibraltar 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

What makes us different?

Have you heard about our way of providing care at Gibraltar Nursing Home that truly makes us stand out from other care homes?
Gibraltar Nursing Home has designed a model of care called the “Evolve Household Model of Care”. This is our way of providing individually tailored, person-centred care and support to our family members.

Our model’s principal focus is on wellbeing and, to ensure a sense of family and belonging is felt at all times. We believe that when someone chooses to live with us that this becomes their home and we are privileged to be here supporting them.
Alongside our principal focus, we also look to create that “home from home” feel and below are just some of the changes we have made to achieve this:
Uniforms are not worn, nor name badges as we feel this can create barriers to providing person-centred care. Uniforms can create a “them and us” culture which here at Gibraltar goes against everything we strive to achieve.

Family members are treated with respect, love and dignity. Everyone is treated as an individual and our care and support is tailored to that person—we are not one size fits all! We see the person, not the diagnosis.

Gibraltar is beautifully decorated and a purpose-built home, where we have created “streets” and “houses” not wards, sections or units. We offer a sense of belonging and identity where individuality is praised and encouraged, for example, if having a glossy blue front door to your room is important because that was the colour of your door at home, or simply because blue is your favourite colour, then this is important to us too.

Taking the time to gather life histories of our family members is paramount, we use this to support and encourage people to carry on doing what they love to do. We then create meaningful occupation based on this history which can include interests, passions, past occupation, hobbies. We also provide a safe and supportive environment to try new activities – you are never too old to try something new!

We design our mealtimes around each person’s individual taste – if someone prefers to eat their lunch at a certain time or in a particular room, we make sure this happens.  We turn a mealtime into a memorable experience, such as holding afternoon tea or always ensuring the table is laid with a tablecloth and fresh flowers.  Going that extra mile and looking at attention to detail means we can create special moments in something as simple as enjoying dinner.

We do encourage you to visit and see first-hand our “Evolve Household Model of Care” - not only in our home but also in our Pillars restaurant, gym or swimming pool .
To this end, we simply finish off by pledging “Gibraltar Nursing Home is a family home, not just a care home.”
For further information please call 01600 775 880 or email info@gibraltarnursinghome.com.

Dora celebrates her 100th birthday!

Everyone at Gibraltar Nursing Home joined in celebrating an incredible 100th birthday recently! A big party was thrown for Dora, who enjoyed turning 100 years young at the end of November, and everybody came together for the festivities.
Tanya Hannant, Manager of Gibraltar Nursing Home, commented: “Dora is an incredible lady and has led a wonderfully long and varied life. We were so pleased that our whole team, our other family members living here, and Dora’s loved ones, could come together and celebrate her.”
A big party was enjoyed by all, complete with balloons, birthday cake and lots of happy music and dancing!

If you would like to find out more about living or working at Gibraltar Nursing Home, please call us on 01600 775880 or email us at info@gibraltarnursinghome.com

Monmouth Care Home awarded Five Stars and commendation by MP

 

Gibraltar Nursing Home, a purpose-built care home located in Monmouth, has been awarded the maximum five stars in their latest food hygiene rating.
The nursing home is situated within the grounds of Gibraltar Care Village, comprising the 95-bedded care home and 36 independent living apartments.
Gibraltar Nursing Home’s Home Manager, Tanya Hannant, was bursting with pride when she told us: “achieving the five stars is an amazing achievement and a true testament to the continuous hard work of our culinary team. They ensure that everyone living with us enjoys their favourite home cooked meals as they would at their own home. Our trained chefs aim to make all meals nutritious and well presented, but also fun and exciting, using local produce where possible.”
The team at Gibraltar Nursing Home have innovated special meals for individuals who might have difficulty swallowing. To make pureed meals look more appetizing they often put pureed foods into specialised moulds, or pipe them into shapes to make them look as good as they taste; it’s possible to make mushy peas look like fresh peas straight from the pod.
Local MP, David Davies, visited the home recently, in order to meet its oldest family member. Ellen, who recently celebrated her 100th birthday, chatted to David about her life and living at the nursing home.
He told us: “it was great to meet Ellen and hear about her fascinating life. Gibraltar Nursing Home are doing a brilliant job providing great quality care, and their newest achievement of gaining the five star food hygiene rating is a shining example of this.”

To find out more about Gibraltar Nursing Home please call 01600 775 880 or email info@gibraltarnursinghome.com

Why we don’t wear uniforms

In most care homes you would probably see staff members in uniforms and nurse staff in scrubs, and this is just one of many reasons why our care homes aren’t like the rest.

In our homes our staff don’t wear uniforms and we even encourage our night staff to wear their pyjamas. This is all part of our household model of care, which is highly individualised and focuses on person-centred care. We have tried to remove the institutional feel that you sometimes get in care homes and make ours more like real homes.

We’ve found that the no uniforms policy has helped the people that live with us feel more relaxed, more comfortable and more like they are truly in their own home. Our staff are there to provide them with support, not to control them in any way, and the lack of uniforms helps to reinforce this.

Think about it, if you woke up in the middle of the night and saw somebody in a formal uniform you would most likely be confused. Whereas if you saw somebody else in their pyjamas; it would seem more normal and you’d be able to go back to sleep.

The most important thing to us is that our residents feel safe, happy and relaxed in their home, and not having uniforms helps us to achieve all of this.

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