Jewish Care's Arts and Montessori Programme

06 Aug 2019

Jewish Care has gone back to school. Emma Shrimsley reports on a new approach that’s being piloted to increasing independence, self-esteem and meaning in the lives of residents living with dementia in our homes

The charity is one of the first UK care home providers to join a global movement who are adopting Montessori principles, a teaching method first developed in 1897 to support children with special needs.

With it focus on independence, freedom within limits, and respect for a person's natural psychological, physical, and social development, it is not surprising that the Montessori philosophy and principles have been found to translate very effectively to support people living with dementia.

Jewish Care occupational therapist Romy Pikoos who joined Jewish Care in 2017, is now working with managers and frontline staff, exploring the effectiveness of this approach.

She believes it reflects exactly what Jewish Care has always prioritised in the day-to-day care it provides in the homes: “Montessori philosophy seeks to enable individuals to ‘have high self-esteem, and to have the chance to make choices and meaningful contributions to their community’,” says Romy.

Initially Jewish Care began applying a few Montessori principles – all encouraging independence - into the home environments.

These simple adaptations, which included better signage; badges for all staff, residents and volunteers; games and books in open shelves on display for all to use, and the establishment of themed ‘activity areas’ near where the residents sit seemed to have a real impact.

Even something as simple as giving out name badges during lunch made an immediate difference.

Staff reported that one resident, upon finishing her meal, walked to the table next to her, read out each of the ladies’ names and finished with a particular resident, who has lived there for many years, exclaiming: “So you’re Marian!”.

By encouraging residents to play a bigger role in the homes, the hope is to make life more purposeful. “People need to feel they are contributing, that they are of value,” says Romy.

“Now we are training managers and frontline staff, with the hope that this approach will be owned by the individual homes, giving staff lee-way to be creative and decide what they feel their residents will enjoy and respond to. In many cases people living with dementia have well-preserved long-term memories. The Montessori Method is about providing ways to connect with those memories.

“It’s a big culture change but staff are really responding to it and coming up with different ways that this will suit their residents.

“At Princess Alexandra Home in Stanmore, the handyman sat in on a training session, brainstorming ways he can involve residents. It’s their home and that is how we want them to feel."

“At Rubens House in Finchley, the services manager heard that two residents had fed back that the chicken soup ‘wasn’t very tasty’. So, they sat down together, and the residents told them what their recipe was and then one supervised it being made. They felt valued and they thought the soup was better too! It’s a great illustration of what we want to do – which is make people see the value they can still offer.”

In another home, Bertha* one of Jewish Care’s 91-year-old residents, is able to walk independently but has advanced dementia. She often declines to take part in planned activities so spends considerable time sleeping or sitting in an arm chair not engaged. Knowing that Bertha was a proud home-maker, staff asked her to assist with setting the table. Without any instruction she effortlessly and expertly rolled out the table cloths in one swift move.

Care home staff said you could see the pride on her face knowing what she had accomplished. She is now regularly asked for help to lay the table cloths.

A range of Montessori-based activities have been introduced in all the homes, from category sorting to memory games, reading and word games. All of these were produced to meet the needs of residents, using familiar material and varying from very simple to more complex.

“In some cases, these activities been found to be an effective way to help when residents become agitated,” says Romy.

The Montessori approach – and its day to day applications - fits into a wider range of arts and culture brought into the homes to enrich the lives of residents.

Helen Preddy, Jewish Care’s Creative Arts Development Coordinator explains: “We have a large pool of freelance artists - musicians, writers, visual artists, dancers, performers, puppeteers.

“I work closely with the teams in the homes, who will identify people that will benefit from engaging in participatory arts sessions; thinking about what they enjoy doing and finding a match to support their needs.

Jewish Care understands that creative activities bring opportunities to reignite past passions, as well as nurturing new ones, sparking responses in people living with dementia.

“Everything we do is responsive and, where possible, multisensory. It’s important to try to engage the imagination, it is a strong and powerful way to celebrate the here-and-now and to connect people with both their past and present selves.” says Helen.

“Chloe, one of our performers, does creative storytelling, taking residents on a ‘journey’. She brings a wheelbarrow with props to bring the story to life. She’s very good at leading people to play - she looks at their strengths, incorporating their stories, suggestions and actions into the piece by making gentle associations and references.”

Jewish Care also works with various arts partners who come in and deliver programmes in the homes.

“One of these, The Reader Organisation, is a national organisation which trains volunteers to run reading groups in all sorts of settings, from care homes to prisons,” says Helen. “The sessions are all about personal responses to material, a lot look at poetry but there is a wide-range of material. There are six groups in Jewish Care homes that run weekly throughout the year.

Jewish Care also works closely with the City of London Sinfonia.

Helen explains: “They tailor each project to the specific needs of each setting, but will typically visit homes weekly over about a four-week period, doing relaxed rehearsals and lounge visits, interacting, playing music and improvising, as well as 1:1 room visits with residents who are less able to leave their rooms.”

At Vi and John Rubens House in Essex, The Wigmore Hall Music for Life Programme sees musicians coming in weekly, as part of a two-year residency. 

“This is an opportunity to really embed music into the home and reach everyone who is part of the Vi and John community.  Players use their skills to connect through music and gain a huge amount in return.  One musician, Luke Newby, has been working with one of our residents who is teaching him all about Jewish festivals and prayers; she tells us how glad she is to work with Luke, using her knowledge for the benefit of other residents -  who Luke will be able to play prayers with too.”

Research suggests that music connects with key areas of the brain, crucially including those concerning procedural or implicit memory, reawakening people and bringing back memories or abilities that may have been dormant for some time, often breaking through communication barriers. For this reason - in a variety of formats, from visiting musicians to singers and choirs - music plays its part of life in all the homes.   

“But what brings all our different activities together is that they are about making space for our residents to feel valued as people,” explains Helen. “And they not only benefit residents, but staff, volunteers and relatives too, encouraging communication, understanding, and building community.”

*Some names in this article have been changed

CARING IN THE COMMUNITY

A report on the support services Jewish Care offer people living with dementia and their carers

Carers of people living with dementia often talk about their world shrinking after a diagnosis.

Friends and relatives can start to disappear, unable to deal with the change in the person and unsure what to do. Jewish Care understands that carers need a wide range of support and has a dedicated Family Carers team to provide this.

Wendy Stolerman, Senior Community Support & Advice Worker for the Family Carers Team, explains: “We work with the carer of the person living with dementia, even if that person is not a Jewish Care client. We offer 1:1 support, both emotional and practical; advice and coping strategies and information about benefits and other services both within and outside Jewish Care. We can liaise with other authorities if necessary and can advocate.

“Jewish Care also has its own dementia team so our family carers will always have access to specialists in dementia who can offer advice. In that way it is very much a ‘one stop shop’, via each client’s own Family Carers Worker.”

As well as the 1:1 support, there is an opportunity for respite in the form of Jewish Care’s dedicated Dementia Day Centres at the Sam Beckman Centre in Friern Barnet; the Leonard Sainer Centre in Edgware and the Dennis Centre in Redbridge. All of them run a therapeutic programme to stimulate and enhance wellbeing.

In addition, Jewish Care’s Active Minds programme runs group sessions and also home visits using Cognitive Stimulation Therapy, an evidence-based treatment for people living with dementia, structured through a series of different activities.

“We also have our support groups for carers and our Memory Way Cafes which are for the person living with dementia and their carer to come to together,” says Wendy.

“Memory Way Cafes are primarily social but there is always a speaker or an activity, which we hope will be of interest to both. We have had Magic Lantern art, a talk on clock-making, a Rabbi talking about Pesach; ballet and seated exercises. The programme is designed to enhance people’s wellbeing and give them a social outlet to meet others in the same situation – particularly for people whose social life might have shrunk. It has resulted in some lovely friendships.”

Irene Segal first started coming to the Memory Way Café at the Otto Schiff Care Home with her husband Bill eight years ago.

“Bill had dementia. It was a very good environment because when one person has dementia, the social aspects of life change too. Friends drop away; people don’t understand. I think things are better now, it’s more widely discussed but this was eight years ago.

“We first went along when Bill was not too bad, but he was not as he used to be. What was nice was that I met other couples in the same situation.

“You are in a safe environment, able to talk to other carers. It’s an opportunity to make friends, people you can then see outside. As a couple it was good for both of us and if my husband did something inappropriate, there was understanding. You don’t feel any judgement, not like in a normal social situation.

“Even when he got worse, I still took him. Although it became harder, there was still something about being able to do this as a couple that I wanted to keep hold of.

“I wanted to keep him active, it felt like we were doing something for him as well. There came a point when we couldn’t really go together anymore because he was too ill, but after he passed, I felt I had something to offer as a volunteer – to give back. So now I go along in that capacity.

“I feel I can empathise and can talk to people (living) with dementia. So, from both points of view I think it’s been really good for me.”

To find out more about support services on offer call Jewish Care on 0208 922 2222 or email helpline@jcare.org