Care quality


specific.” Another manager said: “Everyone is entitled to take some risk, the residents would be in bubble wrap if it was up to health and safety”.


The Montessori method In fact, far from becoming a stultifying bubble wrap, the physical environment can be adapted not only to nurture relationships, but also to actively promote greater autonomy. An excellent example of innovation in this respect is the introduction of Montessori principles into elderly care.


Many people are familiar with the Montessori approach in the context of childhood education - it espouses independence, autonomy of choice, meaningful engagement and creating an environment where everyone is valued and has a role. Montessori is about empowering people to contribute to their community as far as they are able and can be applied equally well to older people as younger, complementing and supporting relational care.


Anne Kelly, director of Australia-based Montessori Consulting, has pioneered this approach to aged care, particularly for those living with dementia. The first UK care home group to implement the principles was Milford Care, a smaller privately owned business in the East Midlands, and the idea they have helped develop is now being instituted or actively considered by others. The Montessori method appeals to


A three-month pilot in four Hallmark care homes revealed the potential for real change. The greatest behavioural changes noted were in factors such as restlessness, verbal aggression and calling out


owners who already see the value of relational care. Another early adopter is Hallmark Care Homes, and I visited properties belonging to both groups while researching my book.


A key factor in realising the benefits of Montessori is implementation of techniques to retrain the brain such that an individual can re-start doing simple tasks by improving motor skills rooted in the unconscious memory. At the same time, tasks need to be broken down into smaller, manageable parts. This is where the role of the


environment comes into play. It has to be made clear exactly what each item and room are intended for, by labelling with writing and graphics, using strong contrast between image and background. For example, if someone can easily identify what is in each of their drawers, then they can more readily choose clothes for themselves. The environment must also be inviting in the sense that stimulating older people to act for themselves by choice. Signage, for example, must therefore encourage residents to take some fruit for themselves, or pick up a length of knitting to work on. ‘Can you help us get this finished?’ etc.


The major but essential cost of introducing Montessori practice into a care home is that of staff training, the environmental adaptations often being modestly priced but having a profound impact. However, that impact can only be realised by changes of practice and understanding on the part of managers and care workers, with the support of relatives as much as possible.


Hallmark puts stamp on method A three-month pilot in four Hallmark care homes revealed the potential for real change. Behaviour of older people with dementia was tracked before and after the pilots, using the Colne-Mansfield Agitation Inventory.


Alterations to the environment, making it more enabling, positive and supportive were tracked through regular photographic recording. The greatest behavioural changes noted - reductions


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of between 22 per cent and 32 per cent - were in factors such as restlessness, verbal aggression and calling out. Montessori Consulting have also evidenced fewer falls, less use of drugs and greater carer satisfaction in environments where they have been involved in implementing the scheme. Carers who I interviewed during my visits spoke of older people being enabled and happier to contribute more to their home, with jobs such as collecting coffee cups, peeling potatoes and clearing tables being cited. “We encourage residents to take a little bit of risk by supporting them. We are about protecting, not restricting,” said one manager. Another said, simply, “People like to contribute.” Managers also noted benefits to staff, and had made changes to recruitment practice, advertising for workers who want to come into the home and be part of the residents’ lives. So in environmental terms, the physical space needs to be re-imagined by continually posing this question: is it easy and inviting to access the items and information that residents need, to maximise the possibilities for self-care? The resulting changes, coupled with specialist staff training, will offer a significant impact.


The joy of tech


A third consideration that this article will now address is the use of technology to assist in adapting environments to optimise relational care. This is a subject to which one of the chapters in Making Relational Care Work for Older People is devoted, where Dr. Lorraine Morley, lead for AgeTech Accelerator surveys the potential of innovations in formal, informal and health care for older people. The critical factor when judging technologies for use in the care home is whether they can free up the time and energy of care staff, and support older people such that both sides can commit more freely to building relationships. Or whether the innovation gets in the way of bonding by demanding too much attention or input from carers, and irritating or confusing residents.


www.thecarehomeenvironment.com • January 2021


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