ROUNDTABLE: The Future of Dementia Care

We recently sponsored a roundtable in collaboration with Care Home Professional, where a panel of industry leaders discussed what they believe the future of dementia care will look like with regards to design and the environment, care models, the workforce, technology and innovation, and funding.

The attendees of the roundtable were:

• Mala Agarwal, MD, Athena Care Homes
• Joyce Clutton, Senior Interior Designer, Blueleaf
• Sanjeev Kanoria, Chairman, Advinia Healthcare
• Tony Stein, CEO, Healthcare Management Solutions
• Liz Wardell, Head of Dementia, Signature Senior Lifestyle

Design and the environment

Liz Wardell (LW): In my opinion, unless you are end of life, then everyone should be enabled, especially people who are living with dementia. So many people who are living with the disease say that if you do everything for them, they’ll forget to do it. I just don’t think that things like signage and gimmicky mock murals or mock pubs are necessary. In fact, they’re treating people like infants instead of enabling them.

For example, in our buildings, there were so many Singer sewing machines, yet half of our residents didn’t use them. So, do a risk assessment and get a proper sewing machine that you can either use with them, or enable them to use.

Mala Agarwal (MA): I think there are lots of misconceptions about what a facility requires, and this leads to copycat behaviour. What we should actually be doing, is looking at individual care homes and ensuring that they are bespoke to their residents – whether they’re living with dementia or another condition.

This means that while your care home may look different to others, if you can prove that the outcome is positive, then the CQC will see that when they visit. I know that when I walk into one of my homes, I can see whether it has a positive feel.

Joyce Clutton (JC): It’s about helping to create innovation that works, and we meet with care home managers to discuss this.

You need to get everyone involved so it doesn’t become a self-focused ‘I’m doing this for the sake of design’ approach. If you involve residents, then your outcome may be ‘we’re going to put this into our plan so the room gets used, because sometimes the staff don’t know how to use it and it gets forgotten about’. When it comes to technology, then it goes without saying you should get everyone involved as a team.

Sanjeev Kanoria (SK): Murals aren’t a waste of money in dementia care, as they really do help in outcomes. In some of our care homes we have woodland themed areas that have trees and bird calls, and we find they calm residents down.

People living with dementia forget things, and can become very anxious, and distrust the people around them. While I’m not sure about the benefits of sensory rooms, we do find that our hairdressing salons and cinema rooms are very useful.

Tony Stein (TS): It’s interesting you said that you find murals useful and are judging their outcomes. You might be finding that murals are simply stimulating residents’ interests, distracting them for the circular thinking occurring in their minds. Some care homes might take a different approach, such as creating a comfortable environment or playing calming music, and find that works better for them.

The problem with care homes is that by nature, they’re more institutional as opposed to reflecting the normal domestic living arrangement. The question is, how do you make them feel more homely and familiar?

Technology and innovation

TS: When we learn how to monitor outcomes that will determine what we do and how we do it; and in terms of staffing, who we staff it with, how we document that and what technology we use. We won’t get to that point unless we invest huge amounts into how we manage and assess those outcomes.

How about putting a wearable watch on a resident to measure their physical signs? Some people complain that’s intrusive, which brings about problems of consent. If we could move towards something like that, it would tick a lot boxes, but we need to be flexible.

Instead, why not monitor residents’ health remotely and concentrate more on their emotional and psychological wellbeing? If we could use a strap-on device to indicate when a resident has had a fall, or they’re dehydrated or their pulse is racing, then we can monitor that automatically, so staff are freed up to make sure that all residents are happy.

SK: We are coming to this new era because people are getting used to wearing technology – we wear Apple watches and are used to our health vitals being measured. Over the last five years, we’ve been trialling robots in our homes and while we were a bit apprehensive as to how residents would feel, we’ve found them to be fantastic.

The software has taken five years to design, embraces three cultures – Western, Japanese and Asian – and is dementia competent.

The Institute of Social and Public Health, the University of Bedfordshire and the Japanese government have worked hard on the software, and the University of Genoa put the technology together. The robots recognise behavioural changes, and the interaction with residents has been absolutely astonishing.

CHP: Have you seen any negative reactions to the robots?

SK: None at all.

LW: I heard Wendy Mitchell say at last year’s Doncaster Dementia Conference how she was dependent on Alexa, and hadn’t used an app before she had dementia. The point she made was how can we get people who are living with dementia to be involved with the research right from the beginning? We are able to gain so much insight from people who are actually living with it.

Care models

LW: My personal view is that the care home per se is still very institutionalised, and it’s because of all the reasons we’re talking about. In terms of orientation, culture, staffing and funding, it’s a hard nut to crack. Anything we do is going to cost money – even if people in the community help.

Where there are specific dementia villages, the argument would then be ‘are we stigmatising these people?’. None of us want to be in an institution.

MA: I think it’s always about talking to each individual and asking what they want. Inevitably, the two things people want are safety and security. Sometimes they just want to be left alone. So we should ask the question: ‘What does that environment look like? Whether that’s residing in a care home, a village or staying in your own home; it will be different for everyone.

TS: We’re in great danger of trying to find one size fits all. It’s going to be a mixed economy of solutions. We’re currently working with Stirling University on a new project in Pitcrocknie near Alyth in Scotland. A gentleman came to see me 18 months ago and said: ‘We have a nine-hole golf course and a clubhouse and we want to build a dementia village.’ I said: ‘Don’t do it.’

Personally, I can’t conscience the idea of ‘ghettoising’ people with conditions, whatever they might be. Instead, they’ve built housing for families and individuals, in addition to a crèche facility, some light industrial units and a care home specifically designed around dementia. It’s a village – not a care village or a dementia village. There’s a play area within sight of the home so that people within the home can see the children playing. That’s the sort of mixed economy solution we ought to be going for.

In Florida, they are world leaders in retirement villages, and now they’re paying the price because 30 or 40 years ago, the people who had moved in were playing golf and attending social events. Now, at the age of 90, places are dead and no one wants to move in. There is no activity and no life, and we need to avoid that.

SK: I’ve seen in Germany that they’ve integrated some of their dementia care homes into a shopping centre. This means residents can walk around wearing their tracker bands, and all of the shopkeepers know them. Being free to roam was healing for them, and the shopping centres were designed as a circular path that came back to the care home.

JC: I think that this is where the funding and the design is going to have to step up. A lot of design briefs we hear are for homes that not only have safe amenities but also bring in the community so that residents feel part. A lot of people are opening cafes that the public can visit – they look a bit like Harvester. Design expectations are growing all the time, and we need to create areas that will draw the public in.

Workforce

MA: We’ve recently done some work with Neil Eastwood, looking at our workforce ratios and how we create. In the past, we’ve advertised with Indeed but we’ve found that actually, 70% of our workforce were either referred to us, or had previously worked as unpaid carers. So now we’re changing the way we recruit staff.

For example, we asked all of our managers to identify their three best staff members, and with Neil, we were able to analyse how they were recruited, and discover what we need to do in the future to improve our practices.

LW: Signature has just started using the Judgement Index, and it’s quite insightful. We’ve all been through it. It shows the two sides of your being – your work ethic and your personality. You can over analyse everything, but I personally think there needs to be something far more scientific about recruiting the right people. There’s a high turnover and we all know how hard it is to recruit someone.

TS: I’m a big fan of Neil. He’s done some research and found that the best people who have come into the care industry are those who are introduced, and have previous experience in their lives caring for people. Our population is ageing, and more people are becoming exposed to the care needs of their elderly relatives. Do you think we’re going to have a bigger pool to fish in because of this?

MA: Traditionally, the onus of looking after a loved one has always fallen on the family. I’m not so sure that new generations are as willing or able to take on such a big responsibility.

TS: I am not necessarily saying they will have taken responsibility for it, but they may have had exposure to it.

MA: If that’s the case, then there is light at the end of the tunnel. My mum has been unwell over the last year and all three of my children have actively helped to look after her.

LW: It would be nice to know that’s true, but on the other hand, the extended family has been steadily declining over the decades. Even if you do have a frail family member, you may not have exposure to them if you live far away.

Funding

LW: There is not going to be one funding model. Instead, I think there will be a variety of models, all of which will need to be funded in order for them to be effective. The Alzheimer’s Society are going hell for leather to get the funding that David Cameron promised them. The disease is so complex, we need more money in a variety of models.

MA: If we consider dementia 10 years ago compared to where we are now, then we can’t deny that there is a lot more research being done. But as Liz said, I think we need to look at a variety of models which are bespoke to the individual.

SK: Technology will play a big role in keeping people in their homes. I think it will only be people who are harming themselves or have medical conditions who will be looked after in an institutional setting. I think in the future, this will become a village-type setting where residents’ psychological and mental wellbeing is looked after, and where people are allowed to venture out and interact with other people.

TS: I think the sad reality is, that the NHS is so big and well-entrenched that it’s become the sacred cow in the national psyche that no one can touch – there’s always an outcry, even if what’s proposed is completely reasonable.

The only sensible solution for care in general, is to combine both health and care budgets so decisions can be made for individuals as opposed to institutions. In Manchester, they tried to combine the NHS and social care, and people are now despairing that it doesn’t work. If you try to take two huge institutions and mash them together, then it won’t work. The question is: how do you fix that?

One way is to privatise the healthcare market, because I can tell you that the private sector will fix it. Simple commercial pressure drives change in the private sector in a way that it never will in the NHS – but I don’t believe that’s a good solution because I’m a big fan of having a socially funded safety net.

But until we have an answer, someone has to get a grip of providing some hypothecated funding to local authorities that will provide a bridge to where we end up. One of my big campaigns is properly funded social care. I believe that people who have worked and paid taxes all of their lives should expect to be looked after properly when they reach old age. If you’re rich then you can look after yourself, but for the working-class people, someone needs to look out for them. We can’t let them slip by the wayside.

Final thoughts

Thank you to CHP for hosting our roundtable discussion about ‘The Future of Dementia Care’. As we’re in business to create compassionate, sustainable care for every future generation, this means we need to create discussions like this to stay one step ahead.

If you’d like to find out more about our consultative or interior design services, then get in touch. Alternatively, you can read our future of care homes whitepaper, or head on over to our blog for the latest news in the sector.

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