LIVING WELL WITH DEMENTIA APRIL 2021 - FONS CENTRE FOR ...
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Living Well with
Dementia
April 2021
Introduction
This report provides an overview of a project undertaken by the care home team at Kineton Manor Nursing
Home as part of the Care England and Foundation of Nursing Studies Teaching Care Homes (TCH) Programme
in 2019/2020. The report will highlight the key elements and outcomes of the project to improve the
experience of living well with dementia for the nursing home residents, staff, families and the wider
community.
Background
Kineton Manor Nursing Home is a 52-bed nursing home situated in the heart of a small Warwickshire village.
The team at Kineton Manor strive to provide outstanding compassionate care for local older people who have
a variety of care needs. In 2019 the home was rated Outstanding for the second time by the Care Quality
Commission and the team were also reaccredited by the Gold Standard Framework for end-of-life care for the
second time. The home is also a very active member of the local community, having close relationships with
the village GP surgery and Community Nurse, all local churches, schools and the Parish Council.
The past decade has seen a significant increase in the number of people who are living with dementia. The
Alzheimer’s Society estimates that there are 850,000 people who are living with dementia in the UK and this
figure will rise to more than 1.1 million by 2025 (Prince et al., 2013). The Prime Minister’s challenge on
dementia 2020 was first launched in 2012 (Department of Health, 2015). Within this challenge are a number
of key priorities including increasing awareness of dementia; health and care staff receiving appropriate
training on dementia; increasing the number of dementia friends and communities; and creating dementia
friendly health and care settings. Kineton Manor Nursing Home based their 2019/2020 project on these
priorities.
The aim of the project was to improve the experience of living well with dementia for residents, staff, families
and the wider community. To achieve this aim, objectives relating to both the home and community were
identified to: raise awareness about dementia; enhance care for persons with dementia; and enhance the care
environment.
The project was led by a small team including the manager, deputy manager, an administrator, a nursing
associate student, a senior lecturer from Kingston University, London and a senior research fellow from
Warwick University Medical School. The team were supported by a FoNS Practice Development Facilitator.
From the outset, the team aimed to adopt a whole team approach. To achieve this the TCH project was
discussed at the monthly staff meetings to inform them of the proposed plans and how they could be involved.
Throughout the project, staff have been invited to participate in a variety of training opportunities to develop
their awareness about dementia and to develop new knowledge and skills (see below). The team tried to
encourage staff to lead on their own ideas and suggestions, but this did not work effectively. In the future, the
team will be more directive initially to encourage engagement and support staff to take responsibility for
specific initiatives.
© Care England/FoNS/TCH programme 2021 1
Outcomes and impacts:
• 75 new dementia friends have been trained (staff, relatives, members of the community) improving
communication
• 60% of Kineton Manor staff have been trained in Namaste Care
• Namaste Care and individualised activity is reported to be positively impacting on both residents and
staff in terms of fulfilment, engagement and relationships
• Residents’ independence and dignity has been enhanced and the risk of falls reduced by designing and
introducing new toilet signs
• Environmental changes in residents' rooms have increased engagement opportunities for people living
with advanced dementia
• £300 was raised to support the Alzheimer’s Society
• 1000 newsletters raising awareness about dementia were disseminated across the community
• More than 70 people attended events to raise awareness about dementia (staff, relatives, members of
the community)
• There is greater community awareness about Kineton Manor contributing to full occupancy
• A Dementia Café is opening in 2021 - a collaboration between Kineton Manor and a local business
A Dementia Friendly Care Home
The Dementia Friendly Community Guide (Alzheimer's Society of Ireland, 2016) describes a dementia friendly
community as a place where persons living with dementia are understood, respected and supported; where
they can continue to live in the way they want to and in the community they choose; and where both they
and their carers feel safe and included in society. The following sections provide an overview of the actions
taken towards developing a dementia friendly care home.
Creating 'dementia friends'
The purpose of dementia friends training is to learn more about dementia and the ways to help people to live
well with dementia. Three training sessions were held in the home involving 45 members of staff, 20 relatives
and 10 members of the community, supported by the Alzheimer’s Society, a training consultant and senior
lecturer from Kingston University. The team noticed how the training subsequently impacted on both staff
and relatives; particularly in the way in which they communicated with those residents who are living with
dementia. For example, they recognised the importance of not asking residents too many questions which
would put them under pressure. Access to dementia friends training will be ongoing.
Person-centred Care
Being person-centred involves focussing care on the needs of the individual (Kitwood, 1997) and this is always
a priority in the home. During the project the team focussed on additional ways of enabling residents to live
well, including opportunities for staff to enhance their knowledge and skills in caring for people with dementia
and supporting them to implement what they learn into practice (National Audit Office, 2007).
Namaste Care, originally developed by Joyce Simard (2013), can further increase the quality of life for persons
living with dementia and those who are at the end of life by offering individualised activities. Namaste means
‘to honour the spirit within’ and it focuses on engaging the senses - sound, touch, smell, taste and sight. With
the support of the home's training coordinator, 60% of staff were involved in Namaste Care training over three
sessions. Feedback from staff was very positive. They appreciated the more personal approach to providing
care, recognising the opportunities to include activities that engage the senses of residents. A staff member
commented that Namaste Care made her realise that caring 'is not tasks, but to give warm attention, and to
make it pleasant for the resident'. Additionally, the home manager has observed staff massaging residents
© Care England/FoNS/TCH programme 2021 2
when applying creams; spending more time brushing residents' hair; offering residents a bowl of warm water
to soak their feet; and helping residents to exercise arms and legs.
Two members of staff lead the implementation of Namaste Care on a more formal and regular basis. Pre-Covid
this was scheduled with individuals or in groups of two, four-five times a week. The staff involved report that
offering this type of care gives them a sense of fulfilment. Feedback from relatives and staff include:
'I could see a difference in my loved one’s behaviour – from anxious to more calm' (relative)
'The resident's muscles were more relaxed after Namaste' (nurse)
'When I offer Namaste Care I know that the residents live, not only exist' (nursing associate student)
Whilst Namaste Care is recommended to be implemented for groups on a twice daily basis, in reality this is
often difficult for care home teams to achieve (Latham et al., 2020). Despite this, the positive outcomes for
staff and residents at Kineton Minor resonated with those who engaged in a UK-wide study of its
implementation including enhanced well-being, responsiveness, communication and relationships, care
experience and sense of purpose.
Another development has been the implementation of LSD (Love, Stimulation and Dignity), an individualised
approach to offer individual attention to residents who are unable to attend group activities due to frailty or
as a personal preference. LSD was designed by the
care team based on the different threads of person-
centred care (Brooker, 2003); namely to value of all
human lives; to have an individualised approach; to
understand the world from the perspective of the
person; and to provide social environment that
supports psychological needs. It involves a carer
spending time with a resident in their room to
facilitate activities they choose and enjoy; for
example, reading poems, looking at photographs,
trying on jewellery, doing exercises, listening to music
or simply offering companionship by holding the
resident’s hand and talking to them. Care staff have
shared how they find this approach fulfilling and they
can use their initiative to enable the residents to become engaged in meaningful activity. The team have
discovered that LSD is best facilitated if it is scheduled into the rota daily for one member of staff.
A Tovertafel (magic table) was also introduced. This is a ceiling-based projector that shines multicoloured lights
onto a table to encourage interaction, enhance hand-eye coordination, recall memories. For example, there
are autumn leaves to clear, fish to catch, jigsaw puzzles etc. Staff have seen how these activities can contribute
to the health and quality of life of persons living within the home because of the possibilities of amazement,
engagement and physical activity. However, not all residents want to take part in the interactive games; use
of the table needs to be well planned to ensure there are enough staff to enable residents to become involved;
residents need to be given a choice of the activities that they want to participate in; and further staff training
in the use of the table is required as some have expressed that they do not feel confident to use it. More
training is planned as well as the fitting of black-out blinds to maximise the effect of the visual images.
Other ideas such as 'Pets as Therapy' and the Trolley of Fun have also engaged staff in the delivery of activities
to enhance the lives of residents; which has been even more important due to the significant restrictions that
Covid-19 has placed on family and friends visiting the home.
© Care England/FoNS/TCH programme 2021 3
The Environment
Many new care homes are being designed with dementia in mind but care homes that are not purpose-built
buildings can also make adaptations to create environments that are more dementia friendly. Led by the
home's dementia champion and the senior research fellow, the King’s Fund Environmental Assessment Tools
(2020) were used to audit the environment. Their findings were shared with the project team so that actions
could be discussed and agreed. These are outlined below and resonate with many of the recommendations
made by Alzheimer’s UK (n.d.a):
• It was observed that some residents who are living with dementia were finding it difficult to find their
personal toilets at night and were incontinent as a consequence, impacting on their dignity and
independence. Additionally, there was a risk of falls as residents were walking in the dark. To help to
create a more easily understood environment, the project team designed and sourced some luminous
signs which are the image of a toilet. These have been installed on bathroom doors and in the
downstairs corridors. The images are not visible during the day but illuminate at night to help residents
to find the toilet independently. Staff report that the signs have had a positive impact for residents.
• In an attempt to make the white toilet seat stand out, the walls behind the toilet bowls were painted
a darker colour
• In consultation with staff and relatives, a new sign has been installed to direct residents and visitors
to the main entrance and reception of the home
Additionally, the project team explored the opportunities to enhance the care environment in one of the
bedrooms, where two residents with advanced dementia are cared for. These changes intended to offer more
external stimuli, recognising that lack of engagement for persons living with dementia can lead to apathy,
boredom, depression and loneliness (Cohen-Mansfield et al., 2009). This included:
• Adjusting bed positions and heights to ensure that the residents have a good view through the window
and of the pictures on the wall
• Enhancing stimulation by introducing a bedside table so that residents can easily reach objects that
can stimulate their sense of touch, for example, a soft blanket, or soft toy
• Introducing a smart speaker to provide a variety of stimuli for example, the news, relaxing music and
other sounds etc. according to the resident’s preferences
Staff felt that these adjustments were having a positive impact on the residents' quality of life. For example,
they noticed facial changes or hand movements when music that they liked was played. They also got a sense
that the residents didn't feel like they were in the room on their own. As a result of the positive feedback, a
further room was enhanced, and more are planned.
Dementia Friendly Christmas
Christmas can be an exciting time for many, but it can also be extremely difficult for those living with dementia.
The hustle and bustle and change in routine can often be overwhelming (Alzheimer's Society, n.d.b?). The
team therefore planned Christmas in the following ways to make it more dementia friendly:
• Decorating the home gradually over a few days to avoid big changes and encouraging residents to get
involved
• Keeping Christmas day activities low key
• Ensuring residents’ choices and wishes on how they wanted to spend their day were respected
• Maintaining familiar routines
• Creating a quiet room for residents to go to, to relax, if festive activities got overwhelming
Feedback from residents, relatives and staff was positive, stating that the festive period was enjoyable and
felt calmer and more relaxed.
© Care England/FoNS/TCH programme 2021 4Dementia awareness fundraising
Dementia awareness continued through a fundraising project, steered by a committee of enthusiastic staff
who during 2019 raised £300.00 for the Alzheimer’s Society.
A Dementia Friendly Community
Involvement with the Wider Community
Early into the project, the team connected with the local council and Member of Parliament to inform them
about and seek support for the project to encourage wider engagement. Following this, the team developed
a 'dementia friendly' edition of the Kineton Manor newsletter which was distributed to the local community,
schools, businesses, GP services and nursing homes. This shared the project aims and objectives, information
about dementia and some of the planned activities. The newsletter was well received. Although a few people
mentioned it contained too much information, there were clear signs of community interest. For example:
two businesses approached the home to enquire about guidance re dementia friendly communities; one local
school arranged for children to visit the home weekly to reminisce on a one-to-one basis with residents. The
children compiled a life story and with the residents’ permission, these were published in the school magazine.
Additionally, in January 2020, Kineton Manor hosted the quarterly Kineton Business Breakfast event, providing
an opportunity to further raise awareness about dementia and inform nearly 60 local business people about
the project activities, achievements and future plans.
Raising community awareness
Two events were hosted by Kineton Manor within the community to raise awareness of dementia. The first
event, which was held in the community hall, was an interactive dementia workshop entitled 'Listening with
your Eyes'. An invitation to attend was shared by email, using posters and leaflets in local shops and Warwick
County Council shared it with other local care homes. The event provided the opportunity to explore the ways
we make connections with others, and to see the powerful effect of non-verbal communication, helping us to
empathise and connect with persons living with dementia.
Despite an open invitation, the majority of participants were staff from Kineton Manor. The team were a little
disappointed as attendance from the wider community was low and no one from other local care homes
attended. This raises questions about how to engage with other providers to share learning experiences.
Feedback about the event was however very positive, for example:
'Amazed by exercise together, unexpected response to input, touch and sound. Perception, sensitive
and reactions'
'Very helpful and interesting workshop. Will help me with communication with my Gran and
understanding her better'
'Learnt how to use body language to communicate. Felt how it feels to be vulnerable and totally rely
on another person. Thank you'
The second event, 'Grandma Remember Me',
took place at Kineton High School. This was
advertised in the community and invitations
were sent to relatives and other nursing
homes, the NHS, local schools, and churches.
Two performances were held (morning and
afternoon) with approximately 60 people
(community, staff, relatives’ family, and
residents) attending across the two sessions.
The drama performance is written from the
perspective of a young child, Lily, whose
Grandma develops Alzheimer’s. It explores
their changing relationship, the wider impact
© Care England/FoNS/TCH programme 2021 5on her family, and the need for support and understanding within our communities. The impact of the
performance is captured in the following feedback:
'Such a powerful way of sharing the impact of dementia. Every community should watch it! Thank you'
'Very moving, very emotional. It puts everything into perspective'
'Very powerful and meaningful. Gets you in the heart and makes you think how difficult it is for families'
Dementia Café
Plans are in place to open a free Dementia Café (a place to socialise, learn more about dementia and local
services, and enjoy activities) in Kineton for residents of Kineton Manor and the wider community in 2021.
This will be a partnership between the local café and Kineton Manor. The café owner is offering the space
and drinks, whilst staff from Kineton Manor will facilitate activities. A number of volunteers have also been
identified to support the café.
References
Alzheimer's Society (n.d.a) Dementia Friendly Environment Checklist. Available from:
https://www.alzheimers.org.uk/get-involved/dementia-friendly-communities/organisations/dementia-
friendly-environment-checklist. Last accessed 3rd February 2021.
Alzheimer's Society (n.d.b) How to Support Someone with Dementia at Christmas. Available from:
https://www.alzheimers.org.uk/blog/how-support-somebody-dementia-christmas. Last accessed 1st
February 2021.
Alzheimer Society of Ireland (2016) Creating Dementia Friendly Communities: A Guide. Available from:
https://alzheimer.ie/wp-content/uploads/2018/12/G0YAZZC.pdf. Last accessed 20th January 2021.
Brooker, D. (2003) What is person-centred care for people with dementia? Reviews in Clinical Gerontology.
Vol. 13. No. 3. pp 215-222.
Cohen-Mansfield, J., Dakheel-Ali, M. and Marx, M.S. (2009) Engagement in persons with dementia: the
concept and its measurement. American Journal of Geriatric Psychiatry. Vol. 17. No. 4. pp. 299–307.
Department of Health (2015) Prime Minister’s Challenge on Dementia 2020: Executive Summary. London:
Department of Health. Available from:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/414
344/pm-dementia2020.pdf. Accessed 13th January 2021.
King’s Fund (2020) The King’s Fund Environmental Assessment Tools. Available from:
https://www.worcester.ac.uk/about/academic-schools/school-of-allied-health-and-community/allied-
health-research/association-for-dementia-studies/ads-consultancy/the-kings-fund-environmental-
assessment-tools/home.aspx. Last accessed 20th January 2021.
Kitwood, T. (1997) Dementia Reconsidered: The Person Comes First. Buckingham: Open University Press.
National Audit Office (2007) Improving Services and Support for People with Dementia. London: The
Stationary Office.
Prince, M. et al. (2013) The global prevalence of dementia: a systematic review and metaanalysis.
Alzheimer’s and Dementia. Vol. 9. No. 1. pp. 63-75.e2.
Ratnaike, D. (2019) A voice in research. Dementia Together Magazine. Alzheimer’s Society.
Simard, J. (2013). The End-of-Life Namaste Care Programme for People with Dementia. 2nd edition.
Baltimore: Maryland: Health Professions Press.
For further information, visit: https://www.fons.org/programmes/teaching-care-homes/current-
homes/kineton-manor or contact, Dr Paula du Rand: info@kineton-manor.co.uk
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