It’s one of the most important events on the Care Home calendar, yet for the 70 percent of care home residents in the UK, who live with some form of Dementia or suffer with severe memory problems, Christmas can be particularly challenging.
Katie Farrar, a Dementia specialist, knows this more than most. She has delivered Dementia awareness training to care homes in Yorkshire and Humberside. Mrs Farrar, who also writes expert insights on Dementia for Quality Compliance Systems (QCS), has the following advice for carers and families.
Q). Why do some residents with Dementia find Christmas such a challenging time?
KF). “I think it’s important to begin by saying that the festive season can be a difficult time for anyone in a care home. It’s a time of reflection when service users remember loved ones who may have passed away or yearn to be with their families who may live hundreds of miles away.
But for those with Dementia, there’s an added complication in that they may not be able to vocalise their thoughts. The only clue that something might be amiss is their mood. They may, for example, become more introverted, withdrawn or even reclusive. Another warning sign might be a tendency to become nervy or agitated. It’s important for carers to spot the early signs that a resident might be struggling and act quickly.”
Q). What steps can care homes take to ensure that residents with Dementia don’t become unsettled?
KF). “Firstly, it’s vital that all staff working in a home, whether they be carers, administrators or caterers, adopt a person-centred approach to care. It’s key, therefore, that they talk to relatives to try to find out how they used to spend Christmas with their families. What films did they watch? What music did they listen to? What did they eat? What were their hobbies? Building up a clear picture of Christmas’s gone by and then incorporating some of this into their daily routine often goes a long way to reducing stress levels – both for the resident and their loved ones.
Often though carers don’t have time to do this. Or, if they do find the time, they think that they are giving those with Dementia the Christmas that they want in the care home. Cue party games, a concert, or a Christmas blockbuster on TV.
To the untrained eye, it may seem that elderly service users are having a great time. But someone with Dementia may have difficulty processing so much information at once. There’s a real danger, therefore, that they will become over-stimulated, which can lead to increased agitation and unsettled behaviour later in the day.”
Q). When it comes to creating a relaxed environment for residents with Dementia, how important is a structured routine at Christmas?
KF). “The ability to maintain a comforting set routine at Christmas can significantly reduce levels of stress because it makes residents feel safe and secure. In addition to my role as an occupational therapist, I also work as a Best Interest Assessor and regularly carry out Deprivation of Liberty Safeguards Assessments (DoLS).
While I cannot go into too much detail, I recently assessed an elderly gentleman who has advanced dementia but is in fairly good physically shape. He had struggled to settle at the care home and was prone to outbursts of aggression and agitation.
The question was how could the care home help him to settle in? The solution was encouraging to follow a well-established and meaningful routine that he had always enjoyed. The resident in question had a familiar routine which involved him regularly socialising in his local pub which he has visited all his life. Don’t get me wrong though. He didn’t go to the pub to drink. In fact, he’d only drink one or two pints. Instead, it was the social aspect that is the most valuable.
In the care plan, it was recommended after a series of full risk assessments were conducted, that he keep this custom alive. So, the care home found a helpful and understanding taxi driver. He now takes him to the pub, picks him up a couple of hours later and returns him to the care home where he is now happy to be. This valued routine has helped to maintain his emotional wellbeing and has reduced stress for all concerned.”
Q). When residents visit family outside of a care home, it is very easy for customary routines to be broken over at Christmas and New Year. What advice should carers give to families?
KF). “I think there needs to be more education in this area. It depends largely on the individual as to how they will cope, but, often, when a family takes a relative with Dementia out of the care home environment, then their practiced routine goes out of the window. This can lead to increased agitation and can cause upset in the family, as the family naturally think that their loved one’s mental health condition is much worse than it actually is. Equally, when a familiar cycle is broken, service users may display signs of distress when they’re back in the care home. So, it’s really important that the care team and the family work in close partnership to put a care plan in place that clearly communicates a tried and trusted routine that gives the service user the best chance of maintaining a calm and comfortable environment.”