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Care home's sunny outlook

Care home's sunny outlook…21st October 2009


The Guardian
By Mark Gould


The innovative redesign of a home helping men who have potentially dangerous dementia is benefiting staff as well as the residents

Peppermill Court's riot of flowers provide a welcome in hyper-real colours. The reception area's rustic cottage walls, garden shed, big shrubby tree and window boxes give it the cartoonish feel of Teletubbyland, or a Pixar depiction of a rustic village, even down to the Old Bull pub. But its acclaimed design and ethos is to provide a therapeutic environment for older men with dementia whose behaviour is described as "challenging".

Although still physically able, their illness has progressed in a way that leaves them prone to violence, aggression or total lack of sexual inhibition. Left on their own in the outside world, they could be a potential danger to their families, themselves or anyone else.

The idea behind Peppermill Court, in York, is to provide meaningful and engaging activities that help reduce this kind of behaviour.

The national dementia strategy focuses on early diagnosis and support for patients and carers to keep people at home. Peppermill Court manager Jude Timmis says that the unit can provide a temporary relief if things get too much. "People stay for as long as their symptoms require, and then they can go home or on to a residential unit," she says. "We do also provide palliative care, though. One resident was a challenge even up to the last 24 hours of his life."

The unit, run by North Yorkshire and York primary care trust, was not always like this. Built in the 1990s, with rooms leading off a central circular "racetrack" corridor, it was just another drab, gloomy institution, with little light, space or inspiration.

Timmis says the idea to revamp the place came from staff themselves, who chose the theme of the sun, moon and stars. Funded by a £35,000 grant (matched by the NHS) from the King's Fund health thinktank's Enhancing the Healing Environment programme, the unit has been praised by the national director for mental health, Louis Appleby.

The sun is represented by the reception area, with its centrepiece shrubby tree, large circular seat and real garden shed, somewhere colourful to sit and enjoy the plants and art works. Timmis says the Old Bull pub, where alcohol-free lager and beer is served, is named in honour of a former resident who described most things as "old bullshit".

The moon is a quieter space, where residents can enjoy classic John Wayne films or a re-run of the 1966 World Cup final on a large central DVD player.

The stars, Timmis says, are the residents themselves. One of the larger, more uninspiring sections of corridor has been transformed into an elegiac timeline of photographs of residents. They start with a grinning schoolboy holding two ice-cream cones, then move on to national service in the tropics, romance, weddings, long-haired postmen having a kickabout, parenthood, retirement, and ending with a man sitting blissfully in a garden shed.

Timmis, a mental health nurse by training, and Katie Howie, the PCT's head occupational therapist, say the photographs help staff focus on the fact that these men are individuals. Importantly, Timmis adds, it also gives relatives peace of mind in knowing that their menfolk are in a place where they are seen as real people with past lives and achievements.

Go up close and you can see that the dartboard in the Old Bull is actually a painting on canvas, the window boxes are full of plastic flowers, and what appears to be a skylight, allowing views of a clear blue sky and fluffy clouds, is a lightbox.

Is it acceptable to provide this simulacrum of reality? Timmis has no problem with that, given the illness these men have. She says: "One patient tore fake leaves off the fake tree to feed his pet plastic tortoise; others water the plastic plants. They think their world is real and that I am the one who is odd."

The emphasis is also on low confrontation to reduce the potential for aggression. Timmis says: "Of course, we will challenge somebody when we need to, but if somebody just wanders off with something, nobody is going to say, 'You mustn't have that – put it back.'" Likewise, she says, attitudes to food are also pretty relaxed. "If someone wants apple pie and ice-cream for breakfast, or porridge for tea, that's fine."

Improved wellbeing

But how can they actually measure if these changes have improved the wellbeing of patients? Timmis explains: "It's about seeing how engaged people are in activities, rather than sitting alone in their rooms or staring doing nothing, and how much people are eating." Another indicator is violence or aggression, signified by the number of formal "adverse incident" reports.

Assistant director of mental health John Clare believes that the improved environment has also improved staff morale. "It's the staff who provide the atmosphere for a place, and that feeds back to residents," he says.

As lots of the men did their national service after the second world war, Elvis is more popular than the wartime classics at singalongs. It's interesting to speculate what might be on offer in 30 years. The Ramones, perhaps, or renditions of Anarchy in the UK?

"You can just imagine the look on the face of a teenage healthcare assistant trying to join in and sing along," Clare says.

 

 
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