378 D. J. Brooker & R. J. WoolleyTable III. Involving others in the Enriched Activity Programme.Core <strong>people</strong> & agencies Function Locksmith role Staff role Management roleOutside therapistsand entertainersMaintains feeling part of the world andexcitement. Brings in expertise that isnot present in the staff group e.g.dancing, aromatherapy.Working <strong>with</strong> volunteers Brings in time and expertise that mightnot otherwise be available.Working <strong>with</strong> families To ensure key relationships are maintainedand that family expertise is fullyutilised.Involvement <strong>with</strong> localmental health team orspecialist statutoryservicesTo ensure that health and well-beingis maintained at the optimal level.Organises and liases <strong>with</strong> appropriateplaces and <strong>people</strong>. Assesses suitability.Organises roles <strong>for</strong> volunteers, supervisionand support.Forms relationship <strong>with</strong> key familymembers to facilitate life story workand ensure personal preferences areknown.Liaison <strong>with</strong> health and social careprofessionals if problems <strong>with</strong> significantdeterioration.Ensure tenants/residents are preparedbe<strong>for</strong>ehand and supported to get themost out of the therapy orentertainment.Ensure volunteers are welcome and beclear of their role.Be welcoming of family carers and sharecare where possible.To be alert to worsening confusion ordepression.Provide staff resources and planningsupport.Oversee the engagement and supervisionof volunteers in the home.To model and facilitate the involvementof family carers in the general life ofthe home.To facilitate good relationships <strong>with</strong> localteams.
<strong>Enriching</strong> <strong>opportunities</strong> <strong>for</strong> <strong>people</strong> <strong>living</strong> <strong>with</strong> <strong>dementia</strong> 379. Communication – Effective communication <strong>with</strong>each other and <strong>with</strong> residents, observation skillsof non-verbal communication.It was recommended that selected direct care staffshould receive training on specific activities andcreative therapies to enable them to participate morefreely in fun activities <strong>with</strong> residents.<strong>The</strong> following comments on training illustrateits power to create a new way of looking at theirwork even <strong>for</strong> staff who had been employed <strong>for</strong>many years:‘‘It gives you more confidence as well andyou looked at it in a different way. You mayhave looked at it in that way be<strong>for</strong>e but it feelsdifferent now.’’One of the study practice development sites tooka different approach to training and invested in two3-day training courses <strong>with</strong> their mentor from theExpert Working Group on Essential LifestylePlanning (Smull & Sanderson, 2005). This wasan intensive experiential course, <strong>with</strong> its rootsin learning disabilities services, that all staffattended. Initial feedback was extremely positiveand, at the final focus groups and interviews, theimpact the training had had on staff was in no doubt.Staff commented:‘‘You couldn’t not be affected by the course itselfbecause the course was very emotional. We allcame out of it feeling totally changed towardseverybody, you know, you see everybody, even thechildren and your own relations, <strong>people</strong> on thestreet, I see them totally different now to whatI did be<strong>for</strong>e. You know, so it was very powerful initself, wasn’t it?’’Element 5: Management and leadership<strong>The</strong> organisational, professional and managementcontext is particularly influential on <strong>dementia</strong> careand is crucial to effecting and sustaining change(Cody, Beck, & Svarstad, 2002; Lintern, Woods,& Phair, 2000b). However, there is little researchto tell us about managers in <strong>dementia</strong> care or onthe specific leadership qualities and managementskills that will have a positive impact on the livesof <strong>people</strong> <strong>with</strong> <strong>dementia</strong> (Cantley, 2001). Poorleadership has consequences <strong>for</strong> staff in terms ofdemoralisation, burnout and stress, lower worksatisfaction or job clarity, lower psychological wellbeingand high work<strong>for</strong>ce turnover (Cole, Scott, &Skelton-Robinson, 2000; Moniz-Cook et al., 1997,2001). Staff burnout has been shown to beassociated <strong>with</strong> less willingness to help residents,low optimism and negative emotional responses totheir behaviour (Todd & Watts, 2005). Withmany care environments still emphasising primaryfulfilment of a custodial function, it is unsurprisingthat staff often feel unable to provide therapeuticactivities <strong>for</strong> their residents (e.g. Puls<strong>for</strong>d, 1997).By its nature, management is a dynamic processand it is this area more than any other whereit is difficult to be prescriptive. <strong>The</strong>mes thatemerged from the EWG and the focus groupsand interviews were:. Change management – taking the whole organisationfrom task-focused to Enriched OpportunitiesProgramme-based care.. Ownership at the highest level – given the list ofcompeting demands this would have to beprioritised at Executive Board level and at localmanagement levels if it were to become embeddedpractice. This programme had, leadership fromthe highest level <strong>with</strong>in the organisation and aclear directive that it should be a priority area to bedeveloped.. Open and inclusive management style – thisenables front-line staff to be responsive tochanging needs of residents. Both Locksmith andcare staff need to feel that they contribute todecision-making and to productive work <strong>with</strong>the residents.. Seniority and authority of Locksmith – this wasessential <strong>for</strong> giving the programme status andenabling Locksmiths to fulfil a leadership andmentorship role. <strong>The</strong> leadership function of theLocksmith was acknowledged from the start <strong>with</strong>the Locksmith being employed as one of the seniorteam <strong>with</strong> a salary commensurate <strong>with</strong> thatposition.. Supervision and mentoring <strong>for</strong> Locksmith – fromits inception the EWG was very active in itssupport and guidance. All Locksmiths valuedhaving support and mentorship from the ExpertWorking Group. This ‘arms length’ supervisionelement was important <strong>for</strong> Locksmiths and issomething that may need to be in place given thecomplex nature of the work. Locksmiths also hadto have the skill at seeking out and using thissupport.All Locksmiths reported a dual need both to feelsupported by the manager of the facility but also tohave the authority of being a senior member of staff.This presented a challenge <strong>for</strong> management. Onemanager commented:‘‘On the one hand you’re trying to drive theproject <strong>for</strong>ward, keep the profile, all the rest of it.You’re trying to encourage support, the perceptionthat the Locksmith is senior and all the rest ofit. But you’re trying to encourage the Locksmithto get in at a very low level, very basic level, handsonlevel, you know, not to become elitist, not to beseen just as another activity organiser, not to beseen as just an extra member of staff in the socialclub. So yeah, you’ve ‘gotta guard against all thosedangers as you go along. And that’s not easysometimes. Not easy.’’
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