Living not existing: The importance of meaningful activities in care homes

Healthwatch Staffordshire undertook research into meaningful activities in Staffordshire care homes over a year and produced a report on its findings. The provision of meaningful activities in care homes has been shown to have a positive impact on residents’ mental and physical well-being - through Enter and View visits, Healthwatch Staffordshire identified there was a variation in the provision of meaningful activities which warranted a closer look.

The purpose of the project was:

• To have a better understanding of the range of meaningful activity provision in Staffordshire care homes

• To identify areas of good and innovative practice

• To identify the barriers to meaningful activity

• To make recommendations for the attention of service providers and commissioners, in order that best practice can be shared and to stimulate more interest in this aspect of care.

• To enable the care homes in Staffordshire to achieve better outcomes in terms of the health and well-being of their residents

The research involved the use of questionnaires distributed to managers, activity coordinators, residents and relatives; observation of activities in progress; review of documentary evidence e.g. activity programmes, records of participation, training in activity provision; and online research. 25 care homes were visited as part of the research:

1. Abacus House

2. Abbey Court Nursing Home

3. Barrowhill Hall

4. Bearwood House Residential Care Home

5. Bradwell Hall Nursing Home Chatterley Unit

6. Branston Court Nursing Home

7. Briar Hill House

8. Chase View Care Home

9. Church Terrace Nursing Home

10. Fauld House Nursing Home

11. Highfield Hall Care Home

12. Horse Fair Care Home

13. Kings Bromley Care Home

14. Limewood Nursing and Residential Home

15. Manor House

16. Maple Lodge Care Home

17. Needwood House Care Home Rock

18. Cottage Nursing Home

19. Rowan Court Care Home

20. Sister Dora Nursing Home

21. The Old Rectory

22. Tudor House Care Home

23. Wall Hill Care Home

24. Weston House Care Home

25. Windsor House Care Home

The key findings from the research are as follows:

- A person-centred approach was more apparent in some homes.

- Some homes more readily involved families in the care of residents – this helped to support family members and also made it easier to obtain personalised information. Involvement could include regular reviews of care plans with family members, residents and relative meetings and/or surveys. Most relatives had a positive view of the activities offered but there was a concern that activities or forms of stimulation on offer for residents with advanced dementia or frailty were limited.

- The homes vary in terms of the number of links they have with the local community e.g. churches, schools etc. The links can be affected by the location of the care home and the accessibility of transport links - some homes may need to be more pro-active, and need more resources, to connect their residents with the outside community.

- Female residents tend to outnumber male residents and this was reflected in the care staff gender balance; most Activity Coordinators were female also. There is a need to ensure that the interests and activity needs of male residents are fully accounted for.

- Generally the impact of a “significant sensory impairment” is not fully appreciated and very few staff had received training on sensory impairment.

- All homes expected care staff to support the activities programme but this was often limited because of the pressures of the job and a task-orientated bias, which is understandable when working with people who need a lot of physical care. Activities were limited when Activity Coordinators were off-duty e.g. at weekends. Employing more than one Activity Coordinator would help to ensure activities are continued if the Coordinator is on leave. There was no correlation between the size of the care home and the number of Activity Coordinators employed. The range of duties carried out by Activity Coordinators varied with some expected to carry out fundraising activities which meant less contact time with residents.

- Two care homes used a different model of activity provision where all care staff were expected to be involved as a key part of their job and Activity Coordinators were not employed.

- There is no statutory requirement for Activity Coordinators to be trained in activity provision. The skill base of the Coordinators was varied – those with limited training performed well where there was the right value base, enthusiasm, maturity and strength of personality to motivate the remaining care staff to get involved.

- Most Activity Coordinators received basic dementia awareness training but this may not be intense enough to ensure meaningful interactions with residents with dementia or to manage any resulting behaviour problems.

- Workshops for Activity Coordinators held by Staffordshire County Council ceased a few years ago. The Council runs a dedicated website for Activity Coordinators.

- The way activities are funded varies - dedicated budgets were not always available to Activity Coordinators. 14 out of the 25 homes did not have ring-fenced budgets. Dedicated budgets ranged from £50 to £500 per month.

- Availability of transport affects how often care homes could take out residents – some homes had their own minibus but a lack of licensed drivers. Community Transport schemes were seen as costly and the advanced booking requirement did not allow for spontaneity. A pilot scheme being run by OOMPH called “Out and About” – where Oomph purchase suitable vehicles and rent out the vehicles to care homes plus a driver, for a set fee – could be a potential solution to this problem.

- The range of activities provided in the homes visited included: arts and crafts activities, outings, exercise and music to movement sessions, music therapy, visits by entertainers, reminiscence therapy, animal therapy, doll therapy, themed days/seasonal activities, baking/cooking, outdoor activities, purposeful activities (duties around the home/outdoors e.g. laying tables), recreational therapy (e.g. board games, bingo).

- The barriers to providing meaningful activities were found to include: time constraints, only having one Activity Coordinator, unwillingness of care staff to be involved, health and safety fears, lack of training and understanding of the importance of meaningful activities, high staff turnover.

The report makes 11 recommendations:

1) Meaningful activity should be embedded in the culture of the care home via policy documents, training, induction processes.

2) Strong managerial support for Activity Coordinators is essential including supervision and measuring the impact of activity programmes.

3) Partnership-working with families – involving families in the provision of care and in activities and outings where possible.

4) A review of the Activity Coordinator role should be undertaken to determine how activities can be provided 7 days a week, what role other care staff should play, how many Activity Coordinators are needed.

5) The status of Activity Coordinator needs greater recognition to reflect the range of skills required.

6) Further training for all staff is often needed - training should go beyond basic awareness, to cover person-centred care, dementia, sensory impairments, etc.

7) It is important to be mindful of the diversity of needs of residents especially in ensuring there is a range of activities for men and well as women.

8) Good recording systems are needed to measure the success of specific activities and the impact on resident’s well-being.

9) Utilising volunteers in the provision of everyday activities when possible is recommended.

10) A dedicated budget for Activity Coordinators should be provided if possible to empower them and help with forward planning.

11) Having a comprehensive Activities Programme should be a contractual requirement.