Living not existing: The importance of meaningful activities in care homes

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Summary of report content

Healthwatch Staffordshire undertook research into meaningful activities in Staffordshire care homes over a year and produced a report on its findings. The provision of meaningful activities in care homes has been shown to have a positive impact on residents’ mental and physical well-being - through Enter and View visits, Healthwatch Staffordshire identified there was a variation in the provision of meaningful activities which warranted a closer look. The purpose of the project was: • To have a better understanding of the range of meaningful activity provision in Staffordshire care homes • To identify areas of good and innovative practice • To identify the barriers to meaningful activity • To make recommendations for the attention of service providers and commissioners, in order that best practice can be shared and to stimulate more interest in this aspect of care. • To enable the care homes in Staffordshire to achieve better outcomes in terms of the health and well-being of their residents The research involved the use of questionnaires distributed to managers, activity coordinators, residents and relatives; observation of activities in progress; review of documentary evidence e.g. activity programmes, records of participation, training in activity provision; and online research. 25 care homes were visited as part of the research: 1. Abacus House 2. Abbey Court Nursing Home 3. Barrowhill Hall 4. Bearwood House Residential Care Home 5. Bradwell Hall Nursing Home Chatterley Unit 6. Branston Court Nursing Home 7. Briar Hill House 8. Chase View Care Home 9. Church Terrace Nursing Home 10. Fauld House Nursing Home 11. Highfield Hall Care Home 12. Horse Fair Care Home 13. Kings Bromley Care Home 14. Limewood Nursing and Residential Home 15. Manor House 16. Maple Lodge Care Home 17. Needwood House Care Home Rock 18. Cottage Nursing Home 19. Rowan Court Care Home 20. Sister Dora Nursing Home 21. The Old Rectory 22. Tudor House Care Home 23. Wall Hill Care Home 24. Weston House Care Home 25. Windsor House Care Home The key findings from the research are as follows: - A person-centred approach was more apparent in some homes. - Some homes more readily involved families in the care of residents – this helped to support family members and also made it easier to obtain personalised information. Involvement could include regular reviews of care plans with family members, residents and relative meetings and/or surveys. Most relatives had a positive view of the activities offered but there was a concern that activities or forms of stimulation on offer for residents with advanced dementia or frailty were limited. - The homes vary in terms of the number of links they have with the local community e.g. churches, schools etc. The links can be affected by the location of the care home and the accessibility of transport links - some homes may need to be more pro-active, and need more resources, to connect their residents with the outside community. - Female residents tend to outnumber male residents and this was reflected in the care staff gender balance; most Activity Coordinators were female also. There is a need to ensure that the interests and activity needs of male residents are fully accounted for. - Generally the impact of a “significant sensory impairment” is not fully appreciated and very few staff had received training on sensory impairment. - All homes expected care staff to support the activities programme but this was often limited because of the pressures of the job and a task-orientated bias, which is understandable when working with people who need a lot of physical care. Activities were limited when Activity Coordinators were off-duty e.g. at weekends. Employing more than one Activity Coordinator would help to ensure activities are continued if the Coordinator is on leave. There was no correlation between the size of the care home and the number of Activity Coordinators employed. The range of duties carried out by Activity Coordinators varied with some expected to carry out fundraising activities which meant less contact time with residents. - Two care homes used a different model of activity provision where all care staff were expected to be involved as a key part of their job and Activity Coordinators were not employed. - There is no statutory requirement for Activity Coordinators to be trained in activity provision. The skill base of the Coordinators was varied – those with limited training performed well where there was the right value base, enthusiasm, maturity and strength of personality to motivate the remaining care staff to get involved. - Most Activity Coordinators received basic dementia awareness training but this may not be intense enough to ensure meaningful interactions with residents with dementia or to manage any resulting behaviour problems. - Workshops for Activity Coordinators held by Staffordshire County Council ceased a few years ago. The Council runs a dedicated website for Activity Coordinators. - The way activities are funded varies - dedicated budgets were not always available to Activity Coordinators. 14 out of the 25 homes did not have ring-fenced budgets. Dedicated budgets ranged from £50 to £500 per month. - Availability of transport affects how often care homes could take out residents – some homes had their own minibus but a lack of licensed drivers. Community Transport schemes were seen as costly and the advanced booking requirement did not allow for spontaneity. A pilot scheme being run by OOMPH called “Out and About” – where Oomph purchase suitable vehicles and rent out the vehicles to care homes plus a driver, for a set fee – could be a potential solution to this problem. - The range of activities provided in the homes visited included: arts and crafts activities, outings, exercise and music to movement sessions, music therapy, visits by entertainers, reminiscence therapy, animal therapy, doll therapy, themed days/seasonal activities, baking/cooking, outdoor activities, purposeful activities (duties around the home/outdoors e.g. laying tables), recreational therapy (e.g. board games, bingo). - The barriers to providing meaningful activities were found to include: time constraints, only having one Activity Coordinator, unwillingness of care staff to be involved, health and safety fears, lack of training and understanding of the importance of meaningful activities, high staff turnover. The report makes 11 recommendations: 1) Meaningful activity should be embedded in the culture of the care home via policy documents, training, induction processes. 2) Strong managerial support for Activity Coordinators is essential including supervision and measuring the impact of activity programmes. 3) Partnership-working with families – involving families in the provision of care and in activities and outings where possible. 4) A review of the Activity Coordinator role should be undertaken to determine how activities can be provided 7 days a week, what role other care staff should play, how many Activity Coordinators are needed. 5) The status of Activity Coordinator needs greater recognition to reflect the range of skills required. 6) Further training for all staff is often needed - training should go beyond basic awareness, to cover person-centred care, dementia, sensory impairments, etc. 7) It is important to be mindful of the diversity of needs of residents especially in ensuring there is a range of activities for men and well as women. 8) Good recording systems are needed to measure the success of specific activities and the impact on resident’s well-being. 9) Utilising volunteers in the provision of everyday activities when possible is recommended. 10) A dedicated budget for Activity Coordinators should be provided if possible to empower them and help with forward planning. 11) Having a comprehensive Activities Programme should be a contractual requirement.

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General details

Report title 
Living not existing: The importance of meaningful activities in care homes
Local Healthwatch 
Healthwatch Staffordshire
Date of publication 
Wednesday, 19 July, 2017
Type of report 
Key themes 
Communication between staff and patients
Lifestyle and wellbeing
Quality of care
Staff attitudes
Staff training
Other information of note about this report 
Meaningful Activities
Activity Coordinator
Good Practice
Healthwatch reference number 

Methodology and approach

Was the work undertaken at the request of another organisation? 
What type of organisation requested the work 
If this work has been done in partnership, who is the partner? 
Primary research method used 
Unstructured Interview
How was the information collected? 
Visit to provider
If an Enter and View methodology was applied, was the visit announced or unannounced? 

Details of health and care services included in the report

Secondary care services 
Care of the elderly
Social care services 
Adult social care
Nursing care home
Residential care home

Details about conditions and diseases

Types of disabilities 
Learning or understanding or concentrating
Types of long term conditions 
Alzheimer’s disease or dementia
Learning disability

Details of people who shared their views

Number of people who shared their views 
Age group 
Not known
Not known
Not known
Sexual orientation 
Not known
Does the information include public's views? 
Does the information include carer's, friend's or relative's views? 
Does the information include staff's views? 
Types of health and care professionals engaged 
Care / support workers
Service manager
Does the information include other people's views? 
What was the main sentiment of the people who shared their views? 

Outcomes and impact

Were recommendations made by local Healthwatch in the report? 
Does the information contain a response from a provider? 
Not applicable
Is there evidence of impact in the report? 
Is there evidence of impact external to the report? 
What type of impact was determined? 
Network related impact

Network Impact
Relationships that exist locally, regionally, nationally have benefited from the work undertaken in the report
Implied Impact
Where it is implied that change may occur in the future as a result of Healthwatch work. This can be implied in a provider  response, press release or other source. Implied impact can become tangible impact once change has occurred.
Tangible Impact
There is evidence of change that can be directly attributed to Healthwatch work undertaken in the report.