This paper describes workshop contents conducted using Many Happy Returns cards with residents and staff from two care homes and children and teachers from two schools, around reminiscence. Participants: Care home residents and staff, Year 5/6 school children and teachers; age range: 10 - 99 years.; approximately 50 residents, 16 care staff, 60 children, 5 teachers
Many Happy Returns 1940s is a box of 24 large reminiscence cards, researched among over 120 people 75 years and older and designed for high appeal and usability to help people to re-find forgotten, happy memories and prompt conversations across the generations.
On one side, a variety of images of everyday subjects from the 1940s act as visual reminders to those who were young during the period. On the other side, background information, questions and conversational prompts provide younger people with enough historical knowledge to have rich conversations. They can be used by anyone aged 10 and over, without training. They help people over 75 years old to reveal their life experiences and histories for their own benefit whilst also helping to develop more meaningful relationships with younger people in general – and their carers in particular.
We wanted to introduce the product to all the groups and help carers to understand better the power and therapeutic value of reminiscence and how using it on a regular basis can help them to provide better person-centred care and get more from their peer group relationships as well.
Reminiscence plays a part in all our lives, and while older people enjoy remembering and may sometimes share their stories with one another, connecting with younger generations can be as – or more meaningful, revealing and satisfying for them as it provides evidence of their self-worth not only to themselves, but also their families and friends and society in general.
There are substantial benefits for younger people and children in learning about life and living social history through sharing and exchange of views and ideas, and by comparing and contrasting their experiences.
For carers, reminiscence can connect them better to those in their care and this helps to improve their performance as well as enhancing their teamwork, job motivation and job satisfaction. However, one of the central issues for care homes nowadays is that staff team are often mostly task-focused. This means that interaction between them and residents may be limited at best and sometimes cursory. Many residents in care homes can be isolated and lonely despite being surrounded by people (and the same is true for those living alone in receipt of Social Care, of course.) Reminiscence is a powerful way to engage with residents during even incidental or personal care, which may typically be carried out in near silence. There is currently little formal training available for carers in reminiscence, and less still in enquiry, active listening and conversation – skills that are so essential for meaningful relationships with and the well-being of older people. This work is being developed further by Many Happy Returns.
The card subjects are matched to the National Curriculum at Key Stage Two in History and PSHE. Firstly, a total of seven separate Children’s Workshops were run for two hours each at both homes, with local primary school children at Key Stage Two (10 – 11 year-olds). Many of the residents in both homes have varying degrees of dementia but they were able to converse with the children using the Many Happy Returns cards.
Three, two-hour REAL Communication workshops in reminiscence, enquiry and active listening were then conducted with care staff in both homes, each one being held ten days apart. The workshops involved learning games, experiential activities, sharing acquired knowledge and discussion. experience of being moved into a care home was discussed, which exposed staff to some surprising revelations about their own perceptions of those in their care.
Additional information was provided for each workshop and simple homework tasks were also set.
In order to allow staff to settle in to the new ways of engaging with the residents, a two-hour feedback session was held one month later.
At Queens Court, an observation session prior to the REAL Communications workshops was also conducted, to note how the staff used the cards to trigger memories and inter-relate with the residents. Ten staff members attended the workshops. At Randell House, five staff members and the Home’s Manager participated.
The aim of the children’s workshops was to introduce them to people who in most cases, are a full generation older than their own grandparents and to give the residents the chance to interact with very young people – who are mostly absent from care home life. It was hoped that these workshops would lead to deeper and continuing relationships between the homes and the schools. The three, two-hour interactive, experiential workshops for staff focussed on three issues: empathising with the residents’ physical and mental condition better; developing their listening and enquiry skills and knowledge of ‘unspoken’ messages; helping them understand better the therapeutic value of reminiscence. In so doing, it was hoped that the teams’ relationships would improve and through this, their job motivation and satisfaction. Above all, the objective was to show how important people’s life experiences are to them and also consider how their current behaviours may be affected by them.
The children were prepared for their visits with discussions about childhood in the 1940s, how to inter-relate with people who might have communication difficulties, how to be a ‘detective’ and interview people and a brief overview about dementia. Up to 10 children at a time visited the care homes. Using the Many Happy Returns cards as prompts, they initiated one-to-one conversations with the older people. This was a new experience for nearly all of the children.
The older people were surprised that, contrary to their perceived image, (driven by the media, they felt) the children were polite, well behaved and fun to talk to. They really enjoyed the company of the children and reported that they looked forward to their visits.
Using ‘inhibitors’ to mimic a variety of different physical conditions, the first workshop helped staff to understand and empathise better with people whose physical and physiological state is very different from their own. In one exercise, the
Active listening, enquiry and questioning techniques were demonstrated to show the importance of real engagement between people. Participants played ‘question-and-answer-scramble’ word games to show how the structure of conversations work. Body language and tone-of-voice issues were also explored.
The third workshop focused on reminiscence and the importance of allowing people to be heard. The staff did their own reminiscing to understand better that triggers for reminiscence can come from a wide variety of objects – even ostensibly ‘abstract’ things. One exercise showed how to be alert to those who may ‘drown out’ the voices of more reticent personalities.
Approximately one month later the groups came together again to discuss the workshops, their evaluations and the learning outcomes; and to consider how/if their behaviours had altered. All participants had completed questionnaires after each workshop, and also a detailed survey of the learning outcomes at the end.
There were many learning outcomes for the children. The workshops brought life in the 1940s alive for them, they discovered how children played and spent their free time, living in circumstances of what they considered to be surprising poverty, made contrasts between life then and now; and learned how to speak with people with a variety of sensory impairments. The staff commented that the children were sensitive to the older people, empathised well and clearly enjoyed the interaction. One boy with Aspergers Syndrome responded to the work particularly well, asking to look around the home and whether he “could start working here now”.
The teachers noted that the children “had really enjoyed using the Many Happy Returns cards as well as spending time with the residents and want to use them with their own grandparents now – as well as returning for more”.
Residents were also encouraged to provide feedback through simplified forms. Observation of the residents showed how the cards reduced social awkwardness between the age groups and created higher levels of attention and more engagement. One resident said, “It certainly stimulated me! When youth and old age can talk together, it goes a long way to understanding both stages of life.” Another said, “I enjoyed talking about doing the washing… old places like sculleries… doing the laundry… putting it through the mangle… it was very hard work!” The Randell House Home Manager reported that even for those with dementia so deep that they could not retain any information afterwards, “their levels of attention, participation and enjoyment at the time alone, meant the sessions made a difference to people’s lives. The cards are a valuable asset to the home and are used all the time” Although initially mildly embarrassed by the inhibitors, even the most experienced carers said that they were surprised by what they went through, and that it was good to get “first-hand experience of what our residents have to deal with everyday”. One member of staff commented that “the enquiry techniques I learned have helped with a couple of residents in particular.” Another said that benefits of the workshop included “understanding the person’s background and awareness of them as an individual”. “I can hold more in-depth conversations with residents as a result of the workshop”, said another. The staff found this session the most challenging. Two younger ones complained (much like older people sometimes do) that they “couldn’t remember anything”. But given encouragement, both went on to share a range of rich personal memories without difficulty. Subsequently, they said that they had been able to use what they had learnt in their day-to-day interaction with residents.
“I’ve come to understand that the way you phrase a question can make a big difference and I am a better listener now. Greater awareness has affected me not only at work but at home too and made me realise how bad I was at listening before!”
“Recently what I learnt made a real difference in building a Care Plan for a new resident with dementia who we knew very little about. Using the techniques I had learned I gathered tiny pieces of disconnected information about her experiences and history to begin to build a “jigsaw” of her life and background.” Abbigail (Queens Court) said “The workshops have really changed the way the team works together. Recently, when we were very short-staffed over a weekend, the staff pulled together as a team in a way we have never before. Despite the difficulties we faced, we communicated more openly and supported one another better – and managed to share a laugh as well. It has never been like that before.” 10. PROJECT OUTPUTS All younger participants completed detailed evaluations for all the workshops. About half the residents completed forms or were interviewed about their experiences. Videos of the Children’s Workshops in both homes were produced. All participating members of staff at Queens Court were made “Reminiscence Champions” to pass on their learning experiences to other staff in the home. 11. MOVING FORWARDS A further workshop set has been commissioned for another Barchester care home. The content will remain broadly the same but alternative and additional games and activities will be tried as it develops. Longer time will be allowed for discussion and evaluation will be deeper. 12. OTHER DEVELOPMENTS: “COLLECTED SHORT STORIES” A new project at Queens Court working with staff and residents’ families to collect and record residents’ life stories, will be presented at the 2009 Dementia Congress in November.