Using art to create outstanding care
Des Kelly OBE reflects on the contribution of the array of creative arts to improving quality in care
There is a growing literature that shows the benefit that can be derived from engaging with art –both as a maker and as a viewer – across all ages. And that using our creativity enhances well-being and the quality of our lives. This was the premise behind the publication of ‘Creative Homes: how the arts can contribute to quality of life in residential care’ (2011) which resulted from a collaboration between National Care Forum (NCF), The Baring Foundation, and the National Association of Activity Providers for Older People (NAPA).
In ‘Creative Homes’ we argued that appreciating the arts throughout every stage of our lives has significance for “our subjective sense of well-being, our cultural identity, our sensory pleasures and even our ability to face the end of life”. We wanted to highlight the inspirational work being undertaken in the best care homes by raising awareness and celebrating examples of excellence in the use of a wide range of art in care settings.
The publication proved to be very popular both as a published report and as an online resource although much has happened since ‘Creative Homes’ was distributed to the care sector. Despite the challenges of a programme of severe austerity in the public sector, which has had a bearing on funding for the arts as well as funding for care, there has been a growing awareness of the value and contribution of arts activity to enhancing quality of life. As a result, new offers have emerged as well as new activity providers. Arts organisations have begun to recognise the contribution they can make to care and support services. Care providers have had to get used to a new regulatory framework and inspection methodology which includes the introduction of a new quality ratings system. This new system, from the Care Quality Commission (CQC) in England, introduces four levels of assessment – outstanding, good, requires improvement and inadequate – driven by judgements to five questions: is the service caring? safe? effective? responsive? and well-led? Although the new inspection regime is not yet fully implemented, and won’t be until early 2017, it is already clear that there will be a relationship between services judged to be good and outstanding and the evidence of embedded art-related activity.
Finding meaning and purpose: ‘art keeps us going’
Dr Barbara Bagan argues “therapeutic art experiences can supply meaning and purpose to the lives of older adults in supportive, none-threatening ways”, and that furthermore “making art, or even viewing art, causes the brain to continue to reshape, adapt and restructure, thus expanding the potential to increase brain reserve capacity.” She cites the exciting ground-breaking work of Gene Cohen (George Washington University) to list the many benefits of expressive art activities as:
- Helping individuals relax
- Providing a sense of control
- Reducing depression and anxiety
- Assisting in socialisation
- Promoting self-expression
- Encouraging playfulness and a sense of humour
- Improving cognition
- Offering sensory stimulation
- Fostering a stronger sense of identity
- Increasing self-esteem
- Improving communication
- Nurturing spirituality, and
- Reducing boredom.
It is useful to be reminded of the potential of art – for all of us!
The work that NCF has done on relationships and quality of life, particularly with the creation of My Home Life, to improve communication between people receiving care, their relatives and carers, is also relevant.
It is encouraging that good work on using creative arts to support care is becoming firmly embedded in ways that enhance quality of life. Not least because expressive art activity, (in all its many forms), should not simply be intended as a way of filling time.
There are many care providers that can serve as exemplars for best practice in making use of the arts to enhance care and support. They serve as beacons for what is possible and the significance that they can make to the lives of individuals. Ideally this would be the norm for all care services but we don’t yet know how many care homes routinely embrace art and art activity. All we really know it that it is not yet enough … and probably won’t be until opportunities for creative expression are a natural part of the rhythm and life in every care home.
Change is occurring incrementally. The recent BP portrait prize featured a significant proportion of pictures of older people amongst those exhibited by the National Portrait Gallery in London. Of course, this is mainstream art but it included images of older people in care settings which I would suggest represents progress in acknowledging care and support as a natural part of life and living.
Celebrating the arts and care
The following examples are from an array of programmes and projects currently taking place in care homes – they are intended as illustrations only. Today (24 May) NCF and Care England, thanks to the support of The Baring Foundation, are holding a national conference ‘Celebrating the arts on care homes’ which will showcase best practice.
Thanks to Kate Organ, who was arts advisor to The Baring Foundation, for her help in identifying exciting arts projects currently taking place that could be used as learning for other care home providers.
Making creative spaces
Preparing for Transitions to new homes
The Yma a Nawr project engaged older people in arts activities as they underwent the big transition of moving in to a new care home facility ‘Mynydd Mawr’ in Tumble – a small village in South West Wales. Over a two-year programme a range of creative activities, facilitated by professional artists, engaged residents and the local community in creating art works to adorn the walls of their new home and enjoy regular arts based interactions as part of a settling-in period. The inspirations for the art works were the residents’ stories, which led to a range of creations such as ceramic garden sculpture, prints and interactive sensory stimuli. Links were made between the home and the local schools for the mutual benefit of the residents and the younger generations in the community.
Creating an immersive experience of drama and play
Residents at a Sanctuary Care home in Watlington transported themselves into a scene of their favourite film as part of an interactive film shoot. The team and residents at Watlington and District Nursing Home in Oxfordshire donned their dirndl dresses and nun costumes to act out popular scenes and songs from the well-known production,’The Sound of Music’. The event was supported by creative facilitators from community interest company, Ladder to the Moon. The programme is funded through Sanctuary Care’s parent company is part of Sanctuary’s commitment to highlight the potential and talents of older people through quality arts experiences.
Original artworks in the home
There a long and rich tradition in the UK of participatory arts – professional artists working alongside all kinds of communities to co-create new artworks which are meaningful for those communities, their contexts and concerns. Listening to participants, adapting to the context and enabling new relationships to emerge creates exciting and unusual new works. Not all participatory arts results in an end product, here are a few that did.
Artist, Jonty Lees, spent time at Crossroads House Care Home in Scorrier, Cornwall, which specialises in caring for people with various forms of dementia. He explored ideas for an original and practical art intervention to enrich the lives of older people living in care homes. In collaboration with residents and staff, he designed a range of crockery, with each cup and saucer identified by a different word, which helps spark conversation amongst the residents at the home.
A place for art
The Orders of St John Care Trust (in partnership with New Brewery Arts, and supported through Baring Foundation’s ‘Late Style’ Commissions Programme) commissioned and launched a new piece of public art, created by artist, Robert Race. Residents, staff and volunteers at Millbrook Lodge care home in Gloucestershire enjoyed workshops led by Robert and inspired many of the ideas which went into his unique and playful creation – an ingenious automaton entitled Getting On. A film of the proect can be viewed here
Care homes in Warwickshire and Worcestershire have had visits from Orchestra of The Swan, following the Three Choirs Festival’s determination to enable the Festival to reach all parts of the community. Principal players play and interact with small groups or provide personal sessions for people in their own rooms. Listening to exquisite live music with a family member or partner can be a powerful and lasting experience.
Too often the voice of the resident is unheard in public and their existence hidden or only represented by other people. The original creativity and expression of care home residents deserves its own platforms in public spaces. Pride and engagement in community events can be very important for all concerned.
Creative Times 2015 art festival – time to stop and stare
Guinness Care and Support held their Creative Times 2015 art exhibition of artwork by customers, staff and local artists at The Guildhall in Bath. The festival explored the theme of Time. Guinness Care and Support believe in supporting people to live happy and fulfilled lives. Creative Times reflects the belief that care and support customers are more than the sum total of their care plan and artistic, innovative activity has an enriching effect – helping people improve confidence, self-esteem, health and wellbeing.
Wiener library art exhibition brings survivors into the light
An inspiring new art collection, entitled ‘Into the Light, The Joy of Painting’, has been created by the weekly art group at Jewish Care’s Holocaust Survivors Centre. The participants focused on everyday experiences, using light and colour to provide powerful relief and comfort from their past traumas. Art teacher and London-based artist, Barbara Jackson, who has exhibited her own works both in the UK and internationally, worked with the group of artists at the Holocaust Survivors’ Centre to form the collection for exhibition at The Weiner Library.
Digital self-portraits exhibition
Central & Cecil Creative Arts Department and Salmagundi Films held an exhibition at The Menier Gallery near London Bridge. Residents and staff from the homes were encouraged to create digital self-portraits using tablets. They were asked to answer some questions about themselves and their interests and to include elements of their answers in the portraits, making them more than just a physical representation of themselves. The exhibition consisted of over 30 wonderful self-portraits created by residents from C&C’s care homes.
Central &Cecil established a Creative Arts department 30 years ago and maintains an online window onto their residents’ and staff’s creative works in all kinds of media. It shows how much people who are involved in this organisation love spreading their creativity and their inspiration to a wider pubic audience.
Getting out there
In 2014, residents at Radford Care home in Nottingham took part in arts workshops which led to the creation by Tony Mason (a renowned puppet maker) of a giant parrot. The parrot was paraded in the Nottingham Carnival and later exhibited back at Radford and other care homes. This was important in many ways – the imaginative experiences and stimulation of the workshop process, the pride of residents and staff in having their creation become part of a big public and popular City event, the pride for families and friends of seeing their loved one making a current public contribution to a community event and the raising of awareness of the often hidden existence of people in care homes to the general public. The bird itself had a multi-layered symbolic story to tell everyone – about age and imagination and the possibilities of new experiences in old age, rather than simply the usual story of loss and decline. In 2015 Betty, a resident from Millbeck House joined the Carnival parade, with her mobility scooter dressed as a mini carnival float. Her energy and enthusiasm for the creative opportunities of the programme shining through.
Connecting people and places
As well as offering a reason to enjoy the outside world, through trips to see or take part in cultural events, the arts can offer a great way of inviting the wider community to come in and see this as an extension of the community and join in. It is especially enjoyable for residents to have the company of children and young people, and schools are often very keen to enable that to happen especially through joint creative projects, which demonstrate benefits for old and young alike.
Care Home Open Day
Over 4,000 care homes participated in the third Care Home Open Day 2015. A publication Connecting Caring Communities was produced to commemorate the initiative. It summarised the activities this year to act as an incentive for care homes to participate in 2016 when the event will take place on 17 June 2016. Participation is expanding each year and it is clearly an opportunity for creativity in planning the events and in showcasing the creativity of the sector.
Arts and creativity were at the forefront for many homes- with prolific numbers of exhibitions of residents’ artworks, visiting performances – from Indian dance to puppet shows and choral concerts, shows created in-house, and many events such as 50s rock ‘n roll day at Drayton Court, and swinging 60s shindig at Stepney’s Hawthorn Green care home.
Community Care’s third ‘Inspiring Images of Social Care’ photography competition is sponsored by Caritas recruitment, to recognise the dedication of professionals working across the sector and the achievements of people they support. This year’s judging panel voted the image of a weekly transgenerational session at Cranlea Care Home in Newcastle as the overall winner. The winning pic was snapped by older people’s charity, Equal Arts.
Photography student works with care home residents
A student at the University of Greenwich has photographed residents at Abbeyfield Kent Society’s The Dynes in Kemsing for a documentary style project. Sarah Sartori visited the residential home for an afternoon of photographing residents and chatting to them about their lives. Tasked with an assignment based around documentary style
photography, Sarah chose to visit a residential home for her project, as she wanted to find out more about the older generation.
Artists among the residents
For many artists, professional or amateur, their working life does not end at a fixed retirement point. Amongst the residents of many care homes are artists of considerable past achievement and continuing powers to communicate and create through their artforms.
Care home resident publishes new book of poetry
Jean Chesterman, a resident at Care UK’s Kingsfield care home in Faversham, Kent, published a book of poems for children.
Roundabout, written under her married name of Jean Kenward, is the latest work in a writing career that has spanned nine decades. Jean has written more than 18 books and over 250 poetry anthologies but she is perhaps best known for her creation Ragdolly Anna, which was made into a children’s TV series in the 1980s.
A Window in the Home
Access to the outside world, experience of weather, and the sounds sights and smells of the changing seasons, are sometimes limited in care settings. Healing Arts on the Isle of Wight are seeking to bring these elements from the outside in. They have commissioned Eric Geddes, a sculptor, photographer and film-maker, whose renowned artworks have been inspired by the shore lines and its natural found objects. His work often consisted of sculptures of found stones clay or seaweed or flotsam [wood, metal, plastic] assembled on the shore, photographed and recorded before being washed away by natural elements. Supported by sculptor Colin Riches and poet Robin Forde, (as Eric is himself living with a dementia diagnosis), together they are creating a series of photographs and texts of to build a digital installation which will change hourly, to mark the times and seasons. Eric’s work is not simply a representation of the outside world but also conveys the symbolic and poetic ideas of impermanence and change in the natural environment.
Diana Athill OBE worked as a literary editor for 50 years until the age of 75. Following her move into a residential home she remains highly active in her literary career, publishing her Costa award-winning memoirs, a reflection on ageing and death, at the age of 90. Her 7th volume of memoirs, ‘Alive Alive Oh!’ is due for publication by Granta for her 99th birthday in autumn 2016.
Public spaces and public resources
Many of our local and national museums, theatres, galleries and arts centres are getting geared up to cater for visits by residents and carers from care homes. Dementia Awareness training is increasingly widespread in the cultural sector, through work such as the Museums Association’s dementia friendly initiative and similar programmes at other arts venues. The logistics of organising trips out can be challenging but the rewards for residents and staff can be great.
House of Memories is an award winning training programme, run by National Museums Liverpool, for the carers of people living with dementia. It provides participants with information about dementia and equips them with the practical skills and knowledge to facilitate a positive quality of life experience for people living with dementia. They also provide access to a number of memory resources, activities and events. Their My House of Memories allows you to explore objects from the past and share memories together. It has been designed for, and with, people living with dementia and their carers. You can save objects to your own memory tree, memory box or memory timeline and create personal profiles for different people; so that they can save their favourite objects and look at them again.
The Reader Organisation has been training volunteers (and care staff in some homes) to carry out their Lead Read programme. It is a shared reading model, which has been shown to be of great benefit for people with mild to moderate dementia, stimulating engagement with and personal responses to poetry. Poetry is chosen as it is less dependent on following a narrative and stimulates new thoughts and creative imagination. As an aural medium it offers people with visual impairment a valuable chance to be part of a group. Even for those with hearing loss, the chance to read aloud and experience the words on the page brought a change of mood and sense of purpose. Those engaged in this model have found it enables relationships to develop and conversations to continue outside the group activity.
West Yorkshire Playhouse has had a long commitment to welcoming older people to engage with theatre and has recently been pioneering “Dementia- friendly performances”. These adapted shows are becoming a regular part of their programme. They have worked with people with dementia and those who support them to address the potential barriers to coming to see a show. They provide clear signage and visual markers, quiet spaces and additional trained staff and volunteers to support visitors. They also adapt sound and lighting cues and stage action where necessary and offer pre-show creative sessions to prepare people for the show, at the Playhouse or in the community. Many other theatres and cinemas are offering similar opportunities for people with a need for special support or adaptations to enjoy a performance, concert or screening.
Evidence and research
Can art improve life for people in residential care?
Many arts projects are being studied and evaluated by researchers, looking for the evidence of impact on health and well-being. Researchers across many disciplines – psychiatry, psychology, social gerontology, as well as business studies and economics, are looking at the arts and creative processes and outcomes that may assist in improving the lives of people into older age. This does not mean that art can only be valued in a care home in relation to its measurable therapeutic or economic outcomes. After all, most of us don’t usually measure our blood pressure before and after reading a poem consider our contribution to the economy when visiting an art gallery – we simply enjoy and find meaning in the experience for its own sake.
The most prolific area of research has been in the fields of music and the brain. The effect it has on the developing brain has driven the argument for children learning to sing and play instruments from a young age, as a crucial part of literacy numeracy, social skills, and physical coordination. Now the studies which demonstrate the powers of music in relation to recovery from brain injuries are leading the way towards studies in its relationship to dementias.
The effect of dance on motor skills, balance and strength are perhaps well known, but it is the emotional and social aspects of dance which may be the real key – providing meaning, self-expression, a sense of cultural belonging and identity, social interaction and friendship – above the benefits of physiotherapy.
University of Worcester Association for Dementia Studies is studying the Making Of Me Programme managed by The Courtyard Arts Centre in Hereford. This programme is providing artists in Dance, Poetry and Drama in residencies in care homes run by Orders of St John Care Trust. The study will look at the role of mentors for artists and the impact on care staff involved in the programme.
Live Music Now with Sound Sense and The Sidney De Haan Research Centre funded by the Baring Foundation and supported by 22 other national organisations. Launched in May 2015, ‘A Choir in Every Care Home’ is an ambitious initiative to explore how singing can feature regularly in care homes across the country. Funded and initiated by the Baring Foundation, it is a unique collaboration between 25 leading national organisations from the worlds of adult social care, music and healthcare research.
Art speaks where words fail
The Creative Dementia Arts Network which links arts and music specialists with those caring for people with dementia in the UK, says that while people with dementia often have trouble finding their way, or remembering names and places, their capacity to respond to music, colour and texture remains intact, providing them with a means to communicate when words fail. Published research has found that exposure to music can help people with dementia to respond and communicate. And even to improve memory. One American study of people with an average age of 87 found that older people engaged in arts and crafts were 73% less likely to develop mild cognitive impairment than those not exposed to it.
Value for Money
Creative Carers is a training programme, devised by Suffolk Artlink in partnership with lead artists Caroline Wright and Helen Rousseau, which teaches care homes to use creativity every day to improve the mood, health and wellbeing of residents in care settings. The idea at the heart of Creative Carers is that creativity creates more caring, by getting people involved and interacting with each other. The programme is delivered by professional artists to the whole home so that all carers are able to deliver creative activities. These can be anything, and have included drawing, photography, creative writing and crafting. Following 7 years of development, a Social Return on Investment (SROI) Report was produced in 2013, analysing the impact of Creative Carers. It found that Creative Carers had a positive impact on the lives of residents and delivered an overall return of one to three. i.e. for every £1 invested in the programme £3 of impact was generated.
Many care homes, across the UK, are involved in arts activities, bringing all kinds of benefits to residents, staff and the wider community. The arts are a powerful way of connecting people to a sense of their personal identity and sharing experiences and insights with others. Sometimes they create a special and memorable occasion although often they are simply a part of everyday life. Whether through personal creativity, visits from artists or trips out to enjoy the galleries, museums, theatres and arts events that are part of public life – the arts are an essential part of life for many care home residents.
This is the very theme that we will be exploring with care providers and arts professionals at our conference today in the hope that we can spread such creativity further still.
Des Kelly OBE | Executive Director | National Care Forum www.nationalcareforum.org.uk
Views expressed in this post do not necessarily reflect those of the Baring Foundation