How to make sure all engagement is meaningful.
Click here for the Managers Best Practice Guide to Engagement and Activity
Life Story Books
Identifying each person’s current abilities and needs, along with understanding their life history, is crucial for matching activities appropriately. It is essential to get to know the resident and their unique background, as this knowledge is invaluable. Although it might seem time-consuming initially, it ultimately saves time and ensures a person-centred approach.
These:
- Provide a comprehensive view of an individual’s life, aiding in the care planning process and enabling the selection of suitable activities and personalised care.
- Can be enjoyable and stimulating. Some people may engage with their book independently, while others might need assistance with turning pages, or to focus on each photo.
- Are particularly beneficial for new staff working with people who have communication impairments.
- Ensure continuity of care if the person needs to transfer temporarily (e.g., to a hospital) or permanently (e.g., to another care setting).
- Can be an enjoyable project that individuals, staff, relatives, and visitors can collaborate on.
- Encourage life review and reminiscence.
You may already have a process of gathering this information and this may be in the care plan, but a life story book is really used to share with the resident and other people, including professionals or anyone else who wants to get to know them (Of course, this would need to be with their consent if they have capacity to consent, or in their Best Interests if they lack capacity for this decision). Sometimes however this may need extra consideration, for example where electronic care plans, or the format of the paper care plans means that this is not easy. As the person’s life continues, you can add to the book, and it should be seen as an ongoing project.
A questionnaire can be a useful tool to start a life history profile. You can ask the person or a relative to complete it, or use it as a basis for informal discussions. Creating your own questionnaire is an option, or you might find a lifeline helpful for identifying significant events in the person’s life. Additionally, several commercial formats are available, such as The Pool Activity Level (PAL) Instrument for Occupational Profiling (Pool 2011), which was designed for individuals with cognitive impairments and includes a personal history profile. Always ensure that where the person has capacity to make this decision, they are happy to share the information as they may feel it is quite personal.
Format of Life Story Books
There are different formats, and you need to decide which suits your individuals and care setting best.
You can use:
- A ring binder with a combination of card, plastic pockets and self-adhesive photo album sheets.
- A scrapbook
- Commercially available formats
- Objects / rummage boxes, which are good for people affected by dementia as using the boxes allows a sensory experience.
Roles For Individuals Receiving Care in a Care Home
Engaging residents in various roles and tasks within care homes is crucial for maintaining their independence and enhancing their health and quality of life. Some of these may not be appropriate for all individuals, and a risk assessment would benefit to carefully match the person’s strengths and skills to the demands of each role.
- Tour guide to visitors, potential new individuals, and new staff
- Assisting on interviews (providing questions or sitting on the panel) and inducting staff
- Chairing residents’ meetings
- Minuting residents’ meetings
- Assisting with audits and surveys
- Visitor to other residents that may be room bound
- Reading out loud to other residents
- Delivering newspapers and post
- Monitoring and topping up bird feeder
- Watering and maintaining house plants
- Flower arranger
- Housekeeping – work alongside housekeeping staff to clean and maintain communal rooms
- Kitchen assistant – food preparation, laying out the dining room, supporting clearing away. Helping with morning coffee and afternoon tea
- Helping in the shop or pub, or with the sweets trolley
- Laundry assistant – assisting laundry staff to fold bed linen, tablecloths, etc.
- Gardener – watering and maintaining outdoor pot plants and beds
- Social planner– assisting staff to plan social events, themed weeks, public holidays etc
- Editor or contributor to newsletter
Maintaining Independence
It is a key part of our role to maintain independence. The roles mentioned above do support with this, however some people’s level of cognitive health may not allow them to fully participate.
Below are some suggestions:
Hand-over-hand Care
Hand-over-hand enabling techniques are used to assist individuals in learning new skills, (or ‘re-learning’ old ones) by physically guiding their movements. Hand-over-hand enabling techniques are valuable for fostering independence and confidence, especially in individuals with disabilities or motor impairments.
Here are some key aspects of this technique:
Physical Guidance: The instructor places their hand over the learner’s hand to guide them through the motions of a task. This helps the learner feel the correct movements and understand how to perform the activity. In order for this to be most effective, the instructor needs to use their own hand exactly as they would if they were doing the task themselves.
Skill Development: This technique is particularly useful for teaching fine motor skills, such as using scissors, writing, or brushing teeth. It provides direct, tactile feedback that can be more effective than verbal instructions alone1.
Supportive Positioning: It is often recommended to work from behind the learner so that your hands and arms move in the same direction as theirs. This positioning helps the learner better feel and understand the movements required.
Gradual Independence: Hand-over-hand prompting should be used sparingly and phased out as the learner becomes more proficient. The goal is to reduce physical assistance over time, transitioning to less dependent strategies, such as prompts like verbal cues or visual aids.
Personalised: The technique should be tailored to the individual’s needs and abilities. It’s important to consider the learner’s comfort and to use this method in a way that supports their learning style and pace. The instructor should ensure that they are assisting with the hand that was dominant for that activity when the person was able to do it independently. It is also important that the instructor pays attention to whether the person is comfortable during this activity, as for example, if they experienced shoulder pain, they may need more support to facilitate shoulder movement. In this case, if this cannot be resolved, it would be wise to refer to a Physiotherapist for their opinion.
HAND OVER HAND EXAMPLE: Mr Roberts has dementia; he has always taken pride in grooming smelling good and brushing his hair. Staff complete all personal care for Mr Roberts but facilitate hand over hand care when assisting him to brush his own teeth, his hair and to rub his talc onto his chest before he puts his top on.
Activity BOXES
Activity boxes or bags are portable collections of themed items (e.g., sensory, games, beauty) left in communal areas or in accessible places for individuals receiving care, staff, volunteers, and visitors.
They can be rotated between units in a care home to maintain interest, and are useful for people with limited mobility or health issues. Individuals and relatives can help create them, and for example, when there are various textures these can be great for people with dementia. Regular checks ensure they are well-stocked and in good condition. Even those with complex health needs, or on end-of-life care should have opportunities to engage in activities like sensory experiences such as this, and additionally listening to music, or being engaged in spiritual conversations.
Smart Goals And Documentation
SMART goals are a way of setting objectives that are clear, trackable, and achievable. The acronym SMART stands for:
Specific: Clearly define what you want to achieve. The goal should be precise and unambiguous
Measurable: Ensure that you can track your progress and measure the outcome. This helps in knowing when the goal has been achieved
Achievable: Set a goal that is realistic and attainable, considering your/the person’s resources and constraints
Relevant: The goal should matter to you and align with other relevant objectives
Time-bound: Set a deadline or a specific time frame to achieve the goal, creating a sense of urgency
Benefits of Goal Setting in Activities
Unified Approach: Setting clear goals ensures that all staff members are on the same page, providing consistent care and support for each person
Enhanced Engagement: Regularly reviewing and adapting activities based on the person’s responses helps keep them engaged and interested
Improved Wellbeing: Personalised and goal-oriented activities can significantly enhance people’s physical, cognitive, and emotional wellbeing
SMART GOAL EXAMPLE: For Mrs Potts to walk back from the toilet to her armchair using a rollator frame (zimmer frame with wheels) and supervision of one member of staff once a day by 6 weeks’ time
DOCUMENTATION
With all the documentation in the care plans that require updating, it can be easy for documenting activities to go undocumented, particularly when a person usually participates in an activity, as staff may not see it as a form of engagement.
The following may help:
Accountability: Keeping records ensures that everyone involved is accountable for their actions and decisions. It helps track who did what and when, which can be essential for audits and reviews
Transparency: Documentation provides a clear and transparent record of activities, making it easier to understand processes and decisions. This transparency can build trust among team members and stakeholders, even if the documentation is about something that did not go as well as hoped or expected
Consistency: Having documented procedures and activities ensures that tasks are performed consistently. This is particularly important in maintaining quality and standards across projects or operations
Learning and Improvement: Documenting activities allows for reflection and analysis. By reviewing what was done, you can identify what worked well and what didn’t, leading to continuous improvement
Communication: Clear documentation helps in communicating processes, progress, and outcomes to others. It ensures that everyone is on the same page and can follow the same guidelines
Legal and Compliance: In many industries, documentation is required to comply with legal and regulatory standards. Proper records can protect an organisation in case of disputes or audits
Knowledge Preservation: Documentation captures valuable knowledge and expertise that can be used for training new employees or for future reference. It prevents the loss of critical information when team members leave
When using an electronic system, management should agree on how you will document events either in the daily notes section or whether it will be in a separate section.
WHERE TO START?
TO DO LIST
Incorporating activities in a care home by setting goals is a structured approach that ensures all staff are aligned and can effectively monitor and adapt to individuals’ needs. With all the information it can be difficult to know where to start. Here’s how your home can start this process:
1. Assessment and Goal Setting
Initial Assessment: Begin with a comprehensive assessment of each person’s abilities, interests, and needs. This can involve discussions with the person, their family, and healthcare professionals.
Set SMART Goals: Establish Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) goals for each resident. For example, a goal might be for a resident to participate in a 10-minute daily exercise session by the end of the week. You can make this purposeful by making it in line with an activity of daily living goal such as walking to the toilet independently by 4 weeks’ time.
Ensure the goal is available for ALL staff to see, not just activity co-ordinators!
2. Activity Planning
Personalised Activities: Design activities that align with the person’s interests and abilities. This could include physical exercises, cognitive games, social events, or creative projects.
Daily and Weekly Schedules: Create a schedule that incorporates these activities, ensuring a balance of different types of engagement throughout the week.
3. Implementation
Staff Training: Train staff on how to facilitate these activities and the importance of encouraging participation.
Resource Allocation: Ensure that necessary resources (e.g., materials for crafts, exercise equipment) are available and accessible.
4. Monitoring and Documentation
Regular Check-ins: Have staff regularly check in with individuals to see how they are engaging with the activities and if they are meeting their goals.
Documentation: Keep detailed records of each person’s participation and progress. This can be done through daily logs or digital tracking systems.
5. Review and Adaptation
Monthly Reviews: Conduct monthly reviews of each person’s activity goals and progress. This can be done in team meetings where staff discuss what’s working and what’s not.
Feedback Loop: Encourage feedback from individuals and their families to understand their experiences and preferences.
Adjust Goals and Activities: Based on the reviews and feedback, adjust the goals and activities as needed. If a person is not engaging well with a particular activity, try introducing new options that might be more appealing.
6. Communication and Consistency
Team Communication: Ensure that all staff members are aware of each person’s goals and progress. This can be facilitated through regular team meetings and shared documentation.
Consistency in Approach: Maintain a consistent approach to activity facilitation across all staff members to ensure that individuals receive sufficient support and encouragement.
By following these steps, care homes can create a dynamic and responsive activity program that not only meets the needs of individuals, but also fosters a cohesive and supportive environment for both individuals and staff.
REFERENCES
About Occupational Therapy | WFOT– www.wfot.org -Occupational Therapy and Occupation
Occupations and everyday activities | AOTA
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