Care homes: how to protect people’s individuality

Amid the rhetoric about privacy, dignity and respect, we may overlook the deep anxiety of losing one’s identity in a care home. What makes us tick – each person’s identity – is made up of thousands of apparently small events, relationships and preferences. The way we dress, our odd little habits and pleasures, the music we like and the books we read, the way we eat and sleep, how we make a cup of tea, how we wash and clean our teeth, our “funny ways” – all the idiosyncrasies that, when put together, make up our everyday lives and make each of us unique.

Many of the underlying fears associated with moving into a care home are to do with losing identity and selfhood. While the national minimum standards set out the importance of treating everyone as an individual, there is an inescapable contradiction in the need (and there is a real need) to have “national standards” for the care of individuals. Setting standards implies a conformity that is at odds with the promise that each resident will be able to retain that unique and complex mix of “me-ness” which makes us who we are.

The true measure of a good care home will be found in to what extent these contradictory demands – standards and individuality – can be happily reconciled.

The manager usually sets the tone the staff are likely to adopt it and the residents live with the results. A manager who is happy to be different will encourage staff to be themselves and to identify with residents’ individuality.

At care home Ivybank House in Bath, manager Karen Webb asked the residents what little things made a big difference to their lives and they came up with this list:

Good relationships with care staff and the small things they do for me.
Friendships with other residents.
Walking in the garden.
The daily newspaper.
Activities, exercise, the theatre, bingo and pub lunches.
My favourite TV programmes.
Having a drink.
Massage, make-up and hairdressing.

These were summed up as “the freedom to do as one pleases”.

With a multi-racial staff team at Ivybank, Webb says it is essential to promote and value the different identities of staff and that in turn allows them to treat residents as individuals and really get to know them.

One of the most obvious and deliberate expressions of individuality is in the clothes we wear. Residents do notice what staff wear, except when they are wearing uniforms, when there is nothing to notice. Clothing does much more than just keep us warm and cover us. Clothes express our personality and mood. They enhance and attract. And they have strong personal – and sometimes intimate – emotional significance. This is why looking after residents’ clothing, washing, mending, ironing and folding – and not losing items – is of far greater importance than it might appear.

Residential care staff also need to remember that many female residents want to continue wearing make-up and like to choose a brooch, necklace or earrings before they leave their rooms in the morning. Staff will often need to help. Again, this will be the subject of sensitive discussion and choice with a care worker. Jewellery in particular usually has important emotional connections with the past, relationships and events, and can lead to conversations about the people and places in residents’ lives. As one relative told me: “My grandmother always reapplied her lipstick before she went to bed in case she died in the night, she wanted to look nice.”

Hairdressers who visit care homes have a special insight into residents’ lives because having your hair done is one of the great pleasures for many older women. But it’s important that residents feel in control rather than being “wheeled in” for their hair-do. Even if they don’t usually keep money on them, they should be allowed to pay the hairdresser themselves just as they always used to.

Another relative said: “My father and his partner had the same hairdresser they had before they moved into the home. She was a friend and they looked forward to her visits. She was part of their lives but nothing to do with the home.”

It’s not easy to change a home from being an institution, however well run, to a real “home” where the people who live and work there are not subservient to the organisation but feel that they can be themselves and take charge of their own lives. Maintaining a strong sense of identity and individuality is crucial, whether you are someone with dementia, a member of staff or the manager.

Speirs House, New Malden Residential care home

Courtesy titles and mutual respect give residents their dignity

At Speirs House in New Malden, south London, Mrs Cox runs the shop for other residents so they can buy everyday necessities such as stamps, cards and toothpaste. “I’m not so sure about green toothpaste,” jokes resident Tom Ham. “Won’t it turn my teeth green?”

Tom takes it in turn with other residents to post a “thought for the week” on three noticeboards around the home. Then residents laugh, discuss and think about it. This week’s is “There is still no cure for the common birthday,” from resident John Glen.

Linda, the home’s gardener, is a popular member of staff because she involves residents as much as possible. Most residents have tended their own gardens in the past, and they are delighted by Linda’s willingness to listen to them and design the garden according to their special wishes. Mrs Maxwell, a 99-year-old resident, orders her plants from a catalogue. Others will make requests to Linda, and when they are planted Mrs Maxwell knows they are the plants she ordered but they are for everyone’s enjoyment.

Mrs Maxwell is called by her surname and courtesy title by staff and residents alike, because Speirs House recognises that people like to be called by different names – just like ordinary life.

This approach is typical of the home which recognises that all residents are different and so one size doesn’t fit all. Speirs House manager Dee Lall is currently organising a carer to accompany a resident on holiday in Ireland. She says the secret to maintaining residents’ identity and autonomy is to know your staff well and give them the respect that you want them to give to residents.

Most residents look forward to their daily newspaper. One relative runs a film club and several residents host activities including quizzes and music evenings.

A beauty therapist provides a range of treatments, such as facials, manicures, pedicures and massages.

But possibly one of the most important services in the home is the laundry provided by Annie. Everyone’s clothes are individual. Some people like their clothes ironed and folded one way, some another, and some like their shirts or blouses on hangers. Even when residents can’t physically put their clothes away in drawers and wardrobes, they all like to take control of their own clothes and have them kept exactly where they want them.

Great care is taken over each precious item. Many clothes are handwashed, some are mended, but all are returned to the resident personally. Annie always tells residents when they will get their laundry back and she never lets them down.

This article appeared in the 21 June issue under the headline “It’s the little things”

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