Dementia care


Table 1. A break down of ‘what worked’ and ‘what didn’t work’ What worked for Tom


What didn’t work for Tom He was watching his favourite film What worked for others They were sitting with staff and loved ones. What worked for staff


People were together, making it easier to allocate staff and ‘keep an eye’ on Tom.The TV lounge is close to the


dining room, toilets and kitchen, making it a convenient place for people to be at the centre of the setting. There are lots of chairs and space for people to sit.


service felt it could no longer meet his needs. Tom has recently had a hip replacement and is now able to walk slowly but independently using a walking stick. When I arrive staff ask me to observe Tom, saying that they “need help because he can be so difficult”. Staff proceed to tell me that Tom has been described as ‘unsociable’ and ‘a loner’ by his previous care service. Just then Tom arrives. He is a slight


man with an easy smile. He winks at me as he walks slowly and with care into the large open lounge. He is directed by staff to sit in the new TV space where comfortable chairs are clustered in a semicircle around a fireplace and a wall mounted TV. As Tom sits he is offered some


breakfast, which he eats alone. The dining room is located at one end of the open lounge space and some of the dining tables have been set for breakfast. Staff and people living in the setting gather over the next hour or so to share breakfast together. Tom’s chair has its back to the dining area. He has finished his breakfast before a staff member joins him. The staff member asks if he would like to watch a film. An ex-boxer, Tom is an avid Mohammed Ali fan and a friend has brought in a DVD biopic of the boxer’s life. The DVD is put on to play and Tom and the staff member sit together in companionable silence to watch it. Tom is clearly enjoying the film. He is leaning forward in his chair and making the occasional comment to himself as the film triggers memories. All is good for a short time until people


finish their breakfast. Jane, a lady in her late 80s is supported by staff to leave the dining table and is directed to sit in the TV space. Jane requires support to eat


Staff and people living in the setting gather to share breakfast January 2017 • www.thecarehomeenvi ronment .com 23


and drink and a staff member settles into the chair beside Jane to help her with her post breakfast coffee. They chat together. As Jane has been sat just a few chairs away from Tom their conversation can be heard over the film track. Tom can be seen to lean further forward towards the television as if straining to hear. A vacuum cleaner is turned on. Tom


tenses his shoulders and leans further forward. A passing staff member points to the TV and shouts at Tom “Sonny Liston fight?” Tom puts his thumb up. As the vacuum cleaner is turned off Tom can be seen to relax a little, but is still leaning towards the TV. Ten minutes later Angela is brought to


join the group. Angela is a frail lady in her 90s and has poor hearing and vision. She


requires a hoist for transfers, so settling her into a chair takes several minutes and three members of staff. She is sat a few chairs away on the other side of Tom. At some point every member of staff has had to move or stand between Tom and the television to support Angela. Another five minutes pass before a


new staff member asks Angela if she can move her chair so that “Jane can squeeze through”. Jane, using a walking frame, moves very slowly through the group, and in front of the television, to a chair at the far side of the cluster. There are now three ladies sat with


Tom. None have expressed an interest in the film. All have needs that require care workers to be present, chatting,


He had not been asked where he would like to watch the film. When others entered the lounge they broke his concentration, disturbed his peace and blocked his view of the television.


What didn’t work for others


They had not been asked if they wanted to watch the film. They had not been asked if they wanted to join Tom in the TV lounge.They did not have an interest in boxing.


What didn’t work for staff


It is crowded at times making it hard to fit hoists through Tom becomes angry and disrupts the space.


©ilolab/Fotolia


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