Michael Spellman runs the inspirational ExtraCare Charitable Trust. In this exclusive feature for The Daily Sparkle, he talks to us about his Locksmiths programme, which aims to focus individually on how each person experiences their dementia, and provide care that responds to this specific knowledge
In the care industry, we can often think of residents as ‘closed books’ or ‘locked doors’ because we feel they hold the secrets of their minds and personalities behind a locked door. A locked door created by dementia. There is always something about the person that others do not understand. Why, for example, do they get agitated every day after lunch? And how can we support that person better? Our Locksmiths look to answer these questions. We want to know our residents better, to understand the uniqueness of each of them so we can improve the person’s wellbeing and ensure that everyone involved in their care can support and understand their behaviour.
The title of ‘Locksmith’ came from the original research steering group set up in 2007 to look at improving care standards, headed up by the incredible Professor Dawn Brooker, then at Bradford Dementia Group. Dawn (who later joined the Association for Dementia studies at Worcester University, and also published a veritable dementia bible ‘Person-Centred Dementia Care: Making services better’) and her team still train Locksmiths to this day, as well as providing us with a wealth of support. For me, even though the research was before my time, Dawn’s work has been my touch point for learning and understanding dementia generally.
The 2007 research group wanted a title which did not immediately say ‘dementia’ or ‘mental health’, as these are scary words for many of our residents. Titles such as ‘dementia carer’ or ‘dementia support worker’ where the word dementia so prominently features puts so much emphasis on the condition itself. Instead, the Locksmiths role is to put dementia to one side for a moment and to get to know the person. To really understand who it is they are meeting and supporting. Once the Locksmith has a sense of who the person is, they can start to understand how that individual experiences their condition.
Part of understanding a person is taking the time to find out the answers to numerous questions. It’s vital we understand how the dementia has affected the person’s neurological impairment. Some of the things we consider include: how does dementia affect the person’s cognitive abilities? What are their strengths and weaknesses? Does the person have any long term conditions, or pain? How do these things impact on their experience of life? Are they able to verbalise things like pain? If not how do we know they are in pain? Do we need to think of this on their behalf? What is the person’s life history? Where have they been, and worked? What challenges have they faced? What are their innate characteristics? What are the person’s connections and attachments? Who and what is in the person’s life and what impact do they have on the person? What does the person need to do to stay connected to these things? All these things help us to separate the behaviours which are associated with their experience of dementia and behaviours which are quintessentially them, as the two can sometimes be confused. A Locksmith spends their time finding out this information, and then using it. I think it’s a bit like a dot-to-dot or jigsaw, you are building a picture, but with lots of facts, feelings and observations.
Unlocking the mystery of why a person becomes agitated each day after lunch, for instance, means the Locksmith will need to observe their behaviour, and spend quality time getting to know the person. Is there any trend in the day or time? What is the resident’s point of view? Are they aware they are in a care setting, or do they believe that they are somewhere else? If so, what may they have been doing at this time of day? It may be that the resident was a homemaker and that the afternoon was a very active part of their day, as they prepared for family coming home or collecting children. The person experiencing this issue may benefit from meaningful activity that reflects this very active part of their day; the activity can’t just be about keeping the person quiet or superficially occupying them, interventions need meaning and must be based on an in-depth understanding of the person.
As you can see, our approach is all about focusing on the individual, who they are, what their preferences are, what matters to them, what they have experienced in the past and how that affects their behaviour in the here and now. And I think this is why it has been so successful. When you learn all of these things, and the people caring for the person takes the time to tailor care and support based on this learning, the person will always benefit, because they are living in an environment with them and their needs at the centre. In fact, whoever we are and whatever service we are receiving, wouldn’t we all want the people interacting with us to really ‘get us’ and avoid us being misunderstood, undermined, or challenged? The approach works because it’s something that we all want, whether we are living with dementia or not.
Michael Spellman is the EOP (Enriched Opportunities Programme) Lead for The ExtraCare Charitable Trust. For more information on Locksmithing, click here.