Romy Pikoos, Senior Occupational Therapist on the Montessori approach05 Oct 2020
I qualified as an Occupational Therapist in 2009 and have worked with people living with dementia since then. In 2017, I joined Jewish Care, the largest health and social care organisation for the Jewish community in London and the South East. Until then I thought I knew most of what there is to know about people living with dementia. Then I came across Dr Cameron Camp and the Montessori approach to dementia. This approach spoke to me because of the way it put the person and their humanity first, and not dementia. This, for me, is occupational therapy in its purest form.
Quality of life is largely defined by activities that are available and the Montessori approach places a huge emphasis on doing; activities are therapeutic, not because they keep people busy, but because they have perceived value in the eyes of that person and they quickly transform negative emotions into positive ones. We know that when people are meaningfully engaged, with roles and responsibilities within a community, their behaviour changes.
Maria Montessori said, “Everything you do for me, you take from me”.
For most of us, our everyday lives are filled with day-to-day tasks and activities that we have to do and that give us a sense of purpose. So, why should it be different for care home residents? It’s easy to forget, especially in a care setting, that everyone, including in the advanced stages of dementia, wants to feel useful and to do things that have a purpose in this world and in their environment.
The Montessori approach sees activity and engagement as treatment for dementia. No one wants to be bored and Montessori training is about enabling staff to change their perceptions of clients and their abilities, which in turn changes behaviour and improves wellbeing.
By encouraging a resident to do more for themselves and continue to do everyday tasks; make their own tea, set the tables, fold napkins, sort cutlery and laundry – we ensure they have the opportunity to do activities they value. In addition, benefits include maintaining motor function and muscle mass as well as keeping the mind active with problem solving and visual processing. Additionally, the more they do, the better they get at it, and more importantly the better they feel about themselves and the higher their self-esteem goes.
Montessori is all about a can-do approach. When I deliver Montessori training, for example for staff, I support the group to begin by looking at what abilities a person has, I try to equip them with tools to identify what a person can do and support them to do more.
When someone is behaving in a way that’s ‘responsive’, it’s easy to attribute a person’s dementia to the cause of a behaviour. However, it helps to ask carers to put themselves in the shoes of someone with cognitive impairment so they can understand that perhaps they would act in a similar way in similar circumstances.
The responsive person, living with dementia, is responding to something just as anyone would. It could be physical or emotional pain, feelings of fear, frustration, anger or boredom. When we respond to their behaviour and try to identify what they are communicating, we can adapt their environment and engage the person more appropriately. This can have transformative results so that their behaviour changes as their needs are met.
In one care home, staff were feeding one particular resident at mealtimes. However, working with the resident and staff, as an Occupational Therapist and using the Montessori approach, showed that when the resident was given the right utensils; a small spoon and bowl, that she could hold – she preferred to feed herself at mealtimes. This also gave staff time for other duties.
We’ve found that when staff see this approach working for one resident, they start to be able to focus on other people’s abilities in a more positive way as well.
So please, next time you go to make a decision about doing something for a client, resident or tenant I hope you will ask yourself: who are you doing it for?