Enriching opportunities for people living with dementia: The ...

380 D. J. Brooker & R. J. WoolleyAnother manager of one of the homes emphasisedthe necessity for regular communication betweenthe Locksmith and the manager:‘‘I think there needs to be a structured periodof ...supervision. You need to have that importantlinking together, whether it be just for an hour oran afternoon together to work on something. Butinvaluable I would say, keep your Locksmithonboard, keep you onboard, work together at theteam ...’’Part of the reason that the Enriched OpportunitiesProgramme remained high on the managementagenda was the fact that it was a research projectand that a lot of attention was focused on the results.The challenge is how Enriched Opportunitiesmaintains management focus without this. Theidea of having a senior coach specifically identifiedwithin the organisation who could mentor theprocess at a management level and provide someof the arms length supervision to the Locksmithwas seen as a possible solution to keeping thefocus on this programme once the research phasehas ended.By and large there was recognition at finalmeasures that the management and organisation ofcare meant that staff felt proud to part of a cuttingedgeorganisation. This is a positive spin-off formanagement who want to improve job satisfactionand retain staff. One member of staff said:‘‘Compared to other places I’ve worked theresidents seem more happy here than anywhereelse I’ve worked. And the staff seem to knowthem better as well; they know them asindividuals and not as a resident or a problem,or whatever.’’The EWG thought there needed to be anexternal recognition through the inspection processof the impact of this work on the lives of veryvulnerable residents, if it were to be maintainedin the long term. It has already achieved positivespin offs for inspections, particularly in onenursing home when the manager was describingtheir latest inspection:‘‘It was absolutely fantastic, she said, yeah. She’dmet with the residents, she met with the staff,she met with the volunteers, she’d looked atour paperwork and she just couldn’t believehow good it was. She just said, ‘‘What I’m actuallymeasuring now for my documentation is justso trivial.’’ You know, she said, ‘‘I don’t reallythink that this is probably going to be appropriatefor here.’’ChallengesThere are a number of challenges that remainabout the Enriched Opportunities Programme.Involving family carers in the process of EnrichedOpportunities was something that was seen asan important aspect from the outset andsomething that requires further development. Aswith engaging family members, working withvolunteers was an aspect of the programme thatrequired further work. There was a wish for morevolunteers to spend more one-on-one time withpeople with dementia.There was a theme about ensuring that managementand staff teams shared the same vision for theprogramme. There were still concerns at the end ofthe intervention that the emphasis on activity meantthat some of those with more advanced dementiamight be given inappropriate things to do.One of the challenges in the extra carehousing scheme was ensuring that those on theEnriched Opportunities Programme were not stigmatised.This quote from the Locksmith about howtenants viewed her, suggests this was achievedalthough the mechanisms for this need clarifying.‘‘They just see me as a staff member, it’s, I have tosay I’m amazed at the amount of people thathaven’t actually said, ‘‘What do you do?’’ BecauseI think that’s all to do with the approach I had atthe beginning, that I worked with the staff team, Iwent on the floor as a carer. They see me as anoffice person, because I’ve been in the office doingpaperwork and stuff, so nobody’s quite sure,I don’t think. And they’ve never tackled me as‘‘Why, why are you here? Why you do the thingswith us?’’ I just say, ‘‘I’m here and I’m doing allthe fun things.’’ And I have made it fun.’’The manager commented on how it appeared tovisitors:‘‘We’ve had some visitors here this morning andwe’ve been down there. And the one visitor didask about dementia and how we cope, you know,but he wasn’t aware that there was anybody in thatgroup who was part of a project group who hadbeen, who’d got dementia or, you know, just atotal integration, merger, nothing stood out. Andit wasn’t introduced as anything special, youknow, this is an ordinary Thursday at MapleCourt and this is an ordinary range of activitiesthat are going on.’’One of the major challenges was in helping the teamdeal with competing priorities on their time. Staffwere aware of competing demands and sometimesfelt unclear about their priorities. Lack of staff timewas mentioned at all stages of the project and inevery facility as being a barrier to achieving fulfilledlives for people with dementia.It is a long day, it is a long day, there are notenough hours in that day to try and fit everythingin that you would like because it is just a routineisn’t it?