Comfort is also one of the six emotional and psychological needs highlighted by Professor Tom Kitwood, to maintain a sense of well-being for anyone living with dementia.
For a medium-sized care organisation such as Evolve Care Group, which our Devon Nursing Home is part of, keeping over 300 residents, whom they refer to as family members, living comfortably in their care homes, is a job that is not without its challenges. They advocate following 5 pillars of comfort.
The World Health Organisation’s standard for comfortable warmth for the elderly is at least 20 °C, but there is a certain amount of subjectivity with temperature preferences. Some choose to sit closer to a heat source, whereas some may opt to sit near a doorway or window, preferring cooler climes. To be a comfortable home, family members need access to both warm and cool locations.
In the UK an adult eats an average of 3413 calories a day (approx. 1.8kg of food) but for somebody with dementia, this is likely to be lower, since eating difficulties are more noticeable as the dementia progresses and a reduced ability to taste or smell becomes evident, which reduces appetite. Desserts are often favoured over savoury foods, so, adding small amounts of honey or glucose to main courses can sometimes result in entire meals being consumed, as well as increasing the carbohydrate level of the food.
In later stages of dementia, chewing and swallowing can become difficult. Ben Kerslake, Evolve’s chef in their Frome Nursing Home, offers purees, moulded from casts of the food they are reconstituting, so that pureed carrots are served in a shape of a carrot. This has resulted in an increase in vegetable consumption. Eventually though, food may be refused entirely, in which case there is a difficult balance to be found between continuing to offer sustenance whilst maintaining that person’s dignity.
To offer excellent dementia care, a calm environment is needed to help family members relax and rest.
Care homes need to be carefully designed and attention paid to noise levels, intensity of lighting and the décor of rooms, including colour and patterns on walls and carpets. Quiet areas need to be offered, for those that need a peaceful spot and the use of Bluetooth headphones can ensure those wanting to listen to music or watch television, can do so without disturbing those around them. In terms of lighting, minimising shadows and bright reflections can enable family members to relax more.
The Group’s Sundial Care Home uses the skills of an interior designer to make sure anyone living there is as comfortable as possible and this may have helped them in a recent inspection by CGC who rated the home as Outstanding.
Keeping those with dementia, occupied is an important part of care. Activities improve self-esteem and can reduce loneliness. Walks around the garden or day- trips outside are recommended in the earlier stages of dementia. They are healthy activities and even when later stages have been reached, music is an entertaining way to stay occupied. The part of the brain that deals with the recognition of songs, thankfully remains comparatively unaffected by the condition. Music can still bring pleasure, even when vocal communication is no longer possible.
Person centred care is offered because it increases well-being. The key is being adaptive and observing situations from the resident’s point of view which means problems can often be avoided. If, as happened recently, a family member entered a dining room at 11:30pm, asking for breakfast, the Night Care Team sat them down and offered them breakfast. Had they tried explaining that it wasn’t breakfast time, and offered a cup of cocoa instead, this would have caused confusion and been disorientating.
Making a living area dementia friendly is not a science. Bringing in personal items from former homes is important, such as photos, or a favourite blanket, or even favoured items of furniture that have a long family history, can be moved in. These can provide reassurance and remind the person which room they are in. Making a care home comfortable also means anticipating needs. It means managing pain before it is out of control, it means encouraging someone to rest before fatigue sets in and engaging with someone before they become bored or lonely.
This sort of care operation relies on up to 450 skilled care staff and is a 24 hour a day ministration, so the fees charged can be high, but comfort, dementia expertise and safety do not come cheaply. The company spends around £80,000 a year, just on gas. It is not surprising to learn that the number of residential care businesses that went out of business, almost doubled last year, with 148 closures. Accountants have said the introduction of the national living wage has driven up the cost of providing care, but what is the alternative? Uncomfortable and unsafe care?
Comfort in a care environment is about carefully listening and observing to ensure the well-being of everyone is maintained. Or, put another way, it can mean breakfast at 11:30pm sat on a favourite sofa in a home from home.