The meaning of home
The meaning of home

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The meaning of home

1.3.4 Change on a daily basis: Day unit care

The importance of maintaining continuity of people and places is important in both cases. Many people attend day care services and find that the change is a stimulating experience, widening their daily contacts and allowing them to become part of another group. The issues of continuity of experience raised here will be familiar to day care workers.

Click below to hear an audio clip describing Redwood Day Unit.

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Transcript: Redwood Day Unit

HELEN MADDEN
Mr Bright spends his day at the Redwood Day Unit. Brenda and Ceinwen work there and talk about the job.
BRENDA MASTERS
It was felt round about nine years ago that people experiencing dementia couldn’t tolerate the larger day care setting, so after carrying out a survey by the powers to be of the time, they thought that a few rooms here, or part of the ground floor here were to be given over to develop a project for older people.
The unit actually consists of two lounges, one lounge is smaller than the other, and the smaller lounge people come who can tolerate a a smaller group setting, the other lounge erm is much bigger and has other rooms attached to it where people who who need more space are happier.
CEINWEN CONROY
Well we tend to get referrals and as they go through from the manager receives them and then they’re passed on to the key worker, and we take a bit of background history from the referral there’s always a little bit of background history, from there if possible we will go out and meet with the carer, or we invite the carer and the client in, and we will discuss likes, dislikes, past life, what their abilities have been the kind of lifestyle they’ve had, and then generally get to know a bit of their background and observe them on the first few days here and get to know a bit about their character. We’d be very aware of of what something they were once very skilful in and now can no longer manage, we’ve had people that have been Saville Row tailors or have worked in theatre, you’re not going to say oh look let’s do some sewing or some embroidery and and enhance the fact that they can’t do that any longer if they they’ve lost that ability, so you’d be very aware and take it very slowly, find out if they still do any craftwork or anything in that line, and and try not to reinforce the fact that this is something they can’t do any more, so you you’re trying to do something with them to encourage them to talk about it rather than them do it.
BRENDA MASTERS
Activities here tend to be spontaneous. We have to bear in mind the level of abilities, and that varies day to day and area to area really. We may do some work on a one to one level, we may have a small group, somebody may say something and we may decide to have a bit of a reminiscence session. Another time we may have newspaper and there may be a a feature that er seems quite topical and interesting. We the weather may be nice and sunny may be warm so we may go out and have a walk around and just being in an open environment will set people off talking, people who don’t talk very much in the unit, and rather just sit back come into being you know.
HELEN MADDEN
Moving in and out of the unit is controlled.
CEINWEN CONROY
This unit is reasonably secure as it can be, we have to keep the unit secure because of the types of clients, or some of the clients we get. We tend to have people that like to wander and will try to get home if they can. Some of the clients really would rather be at home with their spouses but we’re having to give them care to give their spouses or carers some respite, and they’re not happy initially about attending. Gradually that actually subsides and they become very comfortable in the unit but to start with we find that that can be a problem, so we have to have the doors secured otherwise we tend to find them wandering, and a lot of staff time can be taken trying to get people back into the unit and contain them. But it’s not a secure unit in as much as people are now allowed to go, if if somebody needs to go then staff will facilitate that and take them out even take them for a walk.
HELEN MADDEN
Care goes beyond the walls of the unit to encompass carers and clients at home.
BRENDA MASTERS
We always encourage our carers if things are getting too much for them at home to give us a ring, and we can provide them with emotional support. On occasions we try to get out to them, we encourage them to come and see us if necessary, and we can talk things over. There is a carers group which carers are encouraged to to go to, they can meet other people that are experiencing the same problems and difficulties. The difficulties which we experience and we think perhaps something is going wrong at home, or if the carer needs some help in any way, we do sort of liaise anyway. We have reviews here periodically, so that a car plan is looked at, and reviewed, monitored and altered accordingly as need arises. It was very obvious right from the beginning that nine to three thirty four thirty was not a long enough care, and there was always an add on need for an out of hours so called service where people that are working could have a little bit of extra time in the evening they could leave them longer, weekends, they needed some respite to do shopping, other personal things in their life for them to go out, that was always identified right from the start, but it was never very feasible because we didn’t have a big enough staff team you needed lots of extra resources to be able to give that function. So from there it’s decided that we couldn’t do it at the initially, but there was then a thing call the Mental Illness Specific Grant which was granted by government to give extra services for specific needs, and it was one need that we’d already identified and so we managed to get some money from this grant to provide an out of hours service. This service was initially thought about being done within the unit but again because of staffing and costs it wasn’t felt that it was appropriate, so two staff members were employed part-time and they worked in the community with people in their own homes. We don’t overlap with the other care services in the community i.e. home care so we don’t go in and perform a service for the person, we try and encourage them to do things for themselves, sometimes it might be just encouraging somebody to eat their lunch because they’re not eating properly, encouraging somebody to prepare their own lunch if it’s appropriate, giving them the choice, taking them out to buy a few bits of groceries, choose their own clothing, giving respite to their carers so the carer can have a break and maybe go out and do some shopping and personal things for themselves.
HELEN MADDEN
Working in this environment demands certain skills
BRENDA MASTERS
It doesn’t come immediately, that’s pretty evident by some of the visitors that we’ve had and students so on so forth, that is usually the first thing is complained about is the slowness of the pace, and wanting to do things. The job entails sitting with people, talking, not putting pressure of any sort on on a clients. Make use of what abilities and whatever is projected by the client, so we’re enhancing a little bit of confidence perhaps.
CEINWEN CONROY
I think an understanding of dementia for a start, and the kinds of effects it has on on the sufferer. The ability to slow down and become a relaxed and calm as possible in situations, and not to rush around and get excited, because it has a knock on effect on the client. Patience, and tolerance, definitely, and to be flexible.
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Redwood Day Unit
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Activity 6: The Redwood Day Unit

Now listen to the audio clip. In the remaining part of the tape you will hear Brenda Masters and Ceinwen Conroy talking about the Redwood Day Unit. As you listen, think about how the environment of the unit and the way the staff work help to minimise the dislocation someone like Mr Bright might feel.

Make some notes about (a) the ways of working discussed here and (b) the environment.

Discussion

  1. Ways of working. The whole ethos of the Redwood Unit is one of maintaining a calm environment where people can be themselves. Pressure is not put upon people to take part in activities. There is even something rather calming about the way Brenda and Ceinwen speak. Brenda says ‘activities are spontaneous here’ and that ‘levels of ability vary from day to day’. The key to working here is flexibility. Enhancing ability rather than focusing on disability is important, and part of this comes from getting to know people and their past lives. This also involves those at the day unit in reaching out into the community and not seeing themselves as a separate service.

  2. The environment. There are a number of things which are raised about the environment, especially orientation, use of space and safety. The unit was set up partly because another day centre used by older people was felt to be too big for people with dementia. Some settings can produce disorientation or make a condition even worse. Did you notice how Brenda says that there are two lounges and these are used by different groups of people – those who ‘can tolerate small groups’ and those who ‘need more space'?

    The open plan nature of part of the unit allows some people to wander in safety. You will have also heard Ceinwen talk about the secure nature of the unit and the way in which they manage wandering. A tension exists here between the needs of people to wander – even to get back home – the needs of carers for respite and the needs of staff to be able to manage how they work in the unit with the resources they have available. How these various interests are balanced becomes crucial in many care settings.

Ceinwen and Mr Bright sharing memories

The design of units for people with dementia has become a particular area of interest in recent years as designers and architects have been concerned to create environments which help people to maintain the abilities that they have, for example colour coding of floors or walls to assist orientation, and to help manage certain kinds of behaviour, for example a wanderer's garden or route layout (Marshall, 1993, 2001; Dunlop, 1994).

In this case we have been able to look at how shared care has implications in terms of time, space and place for all the people involved. Mr Bright's illness has led to decisions being made about the place of care. The aim is to enable him to retain his home base and this means supporting Mrs Bright by giving her some respite from caring. This has meant that Mr Bright has less control over where he spends part of his time and he has to adapt to relocation in time and space and to changes from individual to group settings.

Having home care has also meant allowing other people to have access to their home. For Mrs Bright this level of access has been accepted as it means that Mr Bright can continue to live at home. In this case the change of place has been daily and always involves a return to home, but for other people receiving care the change may be more long term and of greater permanency.

Key points

  • Receiving care can involve changes of place for different periods of time from daily changes to long-term changes.

  • Sharing care between informal and formal carers can mean that those on the receiving end of care have to accept changes in time, space and place. This can be disorienting for some people and stimulating for others.

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