374 D. J. Brooker & R. J. WoolleyTable I. Summary of the Enriched Opportunities Programme assessment process.What is the Locksmithlooking <strong>for</strong>? Questions that are asked Why is this important? Tools that were helpful How was this used?Cognitive ability andengagement capacityHow does this person think? How do theycommunicate? How do they relate tothe world? How do they relate toobjects?Life history What are experiences from the personspast that could hold clues to improvingand maintaining well-being now?Personality What is this person like? What motivatesthem? What influences their mood?Current interests What happens in the home that bringsthis person to life? What delightsthem?This helps in planning the level that aperson can engage <strong>with</strong> activities andwhat type of support they will need.This provides clues as to what activitieswill be familiar and enjoyed. Also whatobjects could trigger positive memoriesand actions.This provides clues as to what the personenjoys and doesn’t enjoy.This provides the establishment ofeveryday <strong>opportunities</strong> that can bringreal joy.Milestones Assessment of capacity <strong>for</strong>engagement and cognitive ability.(May & Edwards, in press)Filled out through observation of theresident in every day situations.Life story books and life boxes. Completed <strong>with</strong> person themselves orsometimes family members. Readingand sifting through existingin<strong>for</strong>mation.Well- and Ill-being Profile likes anddislikes and routines checklist.Completed by Locksmiths’ own observationsand by discussion <strong>with</strong> keyworker and family.Magic moment cards key cards <strong>The</strong>se were developed as part of theprogramme and completed by staffand Locksmiths.
<strong>Enriching</strong> <strong>opportunities</strong> <strong>for</strong> <strong>people</strong> <strong>living</strong> <strong>with</strong> <strong>dementia</strong> 375<strong>The</strong> assessment process was low-key andnon-stressful <strong>for</strong> participants. It involved theLocksmith reviewing existing in<strong>for</strong>mation, observingthe participants in many situations, talking toparticipants, families and staff. None of theLocksmiths carried out <strong>for</strong>malised pen and paperassessments directly <strong>with</strong> the residents – although allhad some of these in mind when making theirassessments. This process was individualised andcontinuous. <strong>The</strong> Locksmiths commented on seeingthings from the point of view of the service user asthis quote illustrates:‘‘I think my whole understanding and my practice,my skills, have vastly changed from this idea thatwe really want <strong>people</strong> <strong>with</strong> <strong>dementia</strong> doing whatwe’re doing ...or stuff that looks good <strong>for</strong> us. Andsaying, ‘Well, okay, what we really, really needto do, the real nitty-gritty, is to get alongside<strong>people</strong>, really understand where they’re comingfrom and then try to work round that. Andconnect <strong>with</strong> that.’’‘Magic moment cards’ were used by all staff if theyspotted an activity or a trigger that appeared toenhance the well-being of an individual to asignificant extent. <strong>The</strong>se triggers could then beinvestigated further by the Locksmith, to see if theycould be turned into a ‘key-card’. Key cards wereideas that had been found to work in a consistentway to bring pleasure to individuals.<strong>The</strong>re were many staff comments on how usefulaspects of the assessments had been <strong>for</strong> individualsand how the findings were incorporated into everydayactivities:‘‘Just having those (magic moment) cards, Imean in lounge four the other day the gentlemanthat does a lot of shouting he was looking througha magazine and he sort of came out <strong>with</strong> twowords you know, and I though oh my gosh,you know, I’ve never heard him speak like thatbe<strong>for</strong>e, you know, so you write that down on amagic moment card, you know, but it’s one ofthose things.’’<strong>The</strong>re had been a well established practice of LifeStory work in most of the nursing home sites. <strong>The</strong>idea of developing these into ‘Life-Boxes’ whichcontained objects and pictures that had meaning toparticipants, that staff could use to help maintain apositive identity <strong>for</strong> the participant, developed aspart of the programme. One member of staffcommented:‘‘<strong>The</strong> Life Boxes help don’t they because they’veall got something in their life box? So we’velearned new stuff where they’ve got ...and that’sgood if you’re on a different House Group andresidents you’re not familiar <strong>with</strong>.’’Element 3: Activities and occupation<strong>The</strong>re are an increasing number of structured ortherapeutic activity-based interventions that havebeen utilised <strong>with</strong> <strong>people</strong> <strong>with</strong> <strong>dementia</strong>, on bothgroup and individual bases, <strong>with</strong> a wide range ofaims. <strong>The</strong>se include reality orientation (Spectoret al., 2000a, 2000b); cognitive stimulation therapy(Orrell, Spector, Thorgrimsen, & Woods, 2005);reminiscence and life review (Woods et al., 2005;McKee et al., 2005); music therapy (Aldridge, 2000;Sherratt, Thornton, & Hatton, 2004a); art, writing,dance and movement (Allan & Killick, 2000;Coaten, 2001); drama (Batson, 1998; Chaudhury,2003); aromatherapy and sensory stimulation(Ballard et al., 2002; Holmes et al., 2002;Smallwood, Brown, Coulter, Irvine, & Copland,2001); Multi-Sensory gentle stimulation (Snoezelen)(Baker et al., 2003); intergenerational programmes(Jarrott & Bruno, 2003); Montessori-based methods(Camp & Skrajner 2004); doll therapy (James et al.,2005); the SPECAL approach (Garner, 2004);emotion-oriented care (Finnema, Dröes, Ribbe, &Van Tilburg, 2000; Finnema et al., 2005); horticulturaltherapy (Gigliotti, Jarrott, & Yorgason, 2004)and woodlands therapy (Puls<strong>for</strong>d, Rush<strong>for</strong>th, &Connor, 2000). <strong>The</strong> research evidence <strong>for</strong> most ofthese activities appears weak (see reviews by Beck,2001; Cohen-Mansfield, 2005; Gitlin, Liebman, &Winter, 2003; Marshall & Hutchinson 2001;Sherratt, Thornton, & Hatton, 2004b;Thorgrimsen, Spector, Wiles, & Orrell, 2004;Verkaik et al., 2005). Nonetheless, from a practiceperspective, seeing someone light up <strong>with</strong> delightwhen engaged in an activity that has meaning <strong>for</strong>them, indicates that this is a worthwhile endeavour.It is applying occupation and activity as part ofregular care practice that poses the real challenge.<strong>The</strong> EWG identified that the programme ofactivity should be rich, integrated <strong>with</strong> the localcommunity, variable, flexible and practical toprovide opportunity <strong>for</strong> vulnerable individualsto experience optimum well-being. <strong>The</strong>re wasconsensus that the provision of activities andoccupation were the responsibility of the wholestaff team not just the Locksmith. <strong>The</strong> keycomponents and the different roles of the team areshown in Table II.Staff remarked on the difference that knowingmore about their residents helped <strong>with</strong> theireveryday interactions, that their care was moreperson-centred than task centred.‘‘If you can empathise <strong>with</strong> the resident and putyourself in that resident’s shoes – how must theybe feeling? <strong>The</strong>y have been sat in that chair all day,they have not moved. How do they feel? Howwould I feel if I’d been there? If you can putyourself in their position then you can do the jobproperly.’’
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