It takes time to grow a marrow / Outstanding Activities gave a seed to Forest Healthcare and their glorious harvest continues to improve quality of life!

It’s been my pleasure recently to hear some wonderful examples of the enduring impact of change in services working with Ladder to the Moon’s Outstanding Activities programme. As our company name suggests, you can’t get to the Moon in a single step. Change takes time. It takes effort and it takes intentionality. I’d like to share a recent story of success in one of our participating services and look at the steps that were taken to create such good news.

For those of you who don’t know, our Outstanding Activities programme develops and supports participants to become leaders of outstanding social engagement in their services. The programme supports a whole service approach to life enrichment, using creative approaches to improve the quality of life for people working and living in care.

Every month, participating services receive a creative resources box. Earlier this year one such box was the Bird Box Bonanza! Forest Healthcare’s The Grange recently won our Evidence of Outstanding Activities Competition with an entry in which use of this box led to the creation of a vegetable patch in the back garden.

Since then, a Gardening Club has been established, run by the Maintenance team, which led to a meal using a stuffed marrow grown on the premises - a resident chose the meal, grew the marrow in the garden and the kitchen cooked it!

This wonderful example of whole service approach and personalisation has led to menus being based on what the residents want - they've chosen the entire list.  And a Cookery club is about to start.

What fantastic developments! If a home grown food and cookery club sounds like quite a step from a creative resource box called ‘Bird Box Bonanza!’ you’d be right. It’s many more than one step - you can’t get to the moon in a single step - but the steps are linked. And every idea has a seed.

Let’s have a look at the steps:

  1. The Bird Box Bonanza box arrives at the Grange (a seed is offered!)
  2. Inspired by the box, bird feeders are made by residents and staff
  3. The residents pick a place in the rear of the garden for the bird feeders that could be seen from the lounge
  4. “The residents loved doing this activity so much that they asked to use the rest of the garden at the back for a vegetable patch”
  5. “Betty and Dorothy had been observers at the making of the bird feeders as they did not want to get involved but decided to join us when we placed them in the garden - they led the discussion about the vegetable patch and they are now keeping this going and watering it regularly and keeping an eye on its progress”
  6. A weekly Gardening club is established, run by the Maintenance team
  7. A stuffed marrow recipe is requested and a marrow is grown by the Gardening Club.
  8. Kitchen staff are enrolled and the stuffed marrow recipe is cooked
  9. The stuffed marrow is eaten
  10. Residents are offered greater choice over menus

By way of disclaimer, I ought to point out that there are many more steps here not illustrated. Not least the fact that The Grange began participating in the Outstanding Activities programme some four months before they received the Bird Box Bonanza! box. Every step also has the potential to be a first step on a different line of development.

Outstanding Activities participant Naomi Mead observed “The vegetable patch seemed to just happen as a result of the bird feeder activity and it was a surprise to us all when this activity grew in to something different.”

The staff at The Grange were open to this surprise and responsive to letting these steps develop. They protected new ideas and gave them the space to grow and develop. Residents were involved at every step. You can’t get to the Moon in a single step. You can’t grow a marrow in a day. But, given a seed, amazing results are possible in time!

Ladder to the Moon’s creative approaches help Notting Hill Housing provide “the best job in the world!”

“After years battling to get the staff more involved in activities, I've now got the best job in the world!” Chloe Burrow, Activities Officer, Notting Hill Housing

What a thrilling thing to hear on a Coaching Call! Our Outstanding Activities programme provides a number of creative tools to support positive change in participating services. Coaching Calls and Development Days provide the Continuous Professional Development which deliver lasting results.

Chloe went on to reflect:

“I've realised that gaining support informally is a skill in itself. There are many ways to make everybody like you. It's not about getting what you want - you need to find their lemons!

Chloe refers here to an anecdote shared on the most recent Outstanding Activities Development Day. My colleague Jude, Director of Quality and Enjoyment, has observed that it could be easy to move into a care setting and never see a lemon again. However you respond to this prospect, for Jude, this would be a significant missing. She likes the taste and smell of lemons, she appreciates a slice in a good gin and tonic. But they also hold personal associations and significance, a single lemon linking her to a specific lemon tree in a certain garden in Crete.

On the Development Day we considered that bringing a lemon to Jude would create a very different connection and opportunities than to the next individual. And that every individual, client, resident or colleague, has their own items of significance. To quote Chloe again, “You need to find their lemons!”

The tool shared on this Development Day – the Creative Teams Framework - supports making requests of colleagues to shift their contribution by reframing perception of colleague disengagement. The tool demonstrates that all individuals have different responses and behaviours in different contexts… and that behaviour can change! 

Using this Creative Teams Framework, Chloe has supported staff members to move from inaction and a lack of ideas to providing ideas, offering solutions, and putting creative ideas into action. Innovation!

This contribution from staff is already supporting an improved sense of home identity and gives Chloe an additional connection with her colleagues:

“It's nice to have that extra thing to talk about. Staff are thinking about me in terms of their wider personal network. I have allies in the care team.”
“After years battling to get the staff more involved in activities, I've now got the best job in the world!”
Chloe Burrow, Activities Officer, Notting Hill Housing

Technology and punching things: Ladder competition winnings spent on 3 top purchases to enhance social engagement

Technology and punching things: Ladder competition winnings spent on 3 top purchases to enhance social engagement

All participants in our ongoing Outstanding Activities development programme are invited to make contribution to our quarterly Evidence of Outstanding Activities Competition by sharing evidence of vibrancy, creativity, wellbeing or personalised social engagement which has been caused by their involvement with Ladder to the Moon.

Last Autumn's winner, Sharnbrook House, won £140 Amazon voucher for their care service to help them continue to enhance their activities provision and used it to purchase three things...

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Use of Outstanding Activities’ Monthly Boxes enable connections with residents at risk of isolation

The Outstanding Activities programme provides a monthly box of resources to participating homes. Here are some recent good news stories about how use of the boxes have reached individuals at risk of isolation. 

Storytelling Café Box

The Activity Leader at Cedar Court (Healthcare Homes) used a Ladder to the Moon box to engage a resident who never normally communicates (she usually just mimics). Staff were initially unconvinced that anything was possible: at the door to the resident’s room, the Activity Leader was told "It won't work with her." Rachel was resilient and went in anyway. She was non-confrontational and lived in belief rather than expectation, placing the box on the bed. When the resident became curious, Rachel was gently encouraging. They explored the items in the Activity Box, which led to a lengthy discussion about the resident’s husband. Rachel discovered lots! This from an individual who normally 'frisbe's her dinner' and considers all interaction interference. The staff were "OMG!"

The Activity Leader from The Poplars (Forest Healthcare) took a box to a resident who had been accompanied back to bed by care staff. Jackie spent well over hour with her in her room using objects and media to generate conversation and share stories, real life and fictional. Two carers popped in and participated briefly. “Audrey would have been tearful and upset at having to go back to bed. Instead she was calm, engaged and appreciative.”

Icons Photo Shoot box

Elsewhere:

“Harold doesn't want to eat. Or drink. Can't get him to talk.”

When the box was opened, Harold straight away grabbed the bowler hat. Started spinning it, starring at it, looking inside...

"It's been transforming him"

Staff have followed up the initial engagement, taking Harold the bowler hat everyday.

“And now we can get him to eat!”

In another home, a resident, living with dementia, had become more isolated and anxious.

“We've struggled with Violet. She's got a lovely character, but she’s gone into her shell lately. Lost her confidence. She used to get involved, but finding things to interest her has become more difficult. Using the box worked really well for her.”
“The first day, we took the box and made a fuss of her. Her eyesight's quite bad so we gave her the items to hold. Violet was really interested in looking inside and talking about the film icons, on a one to one basis.
We built on this and took it to the next step. Violet became Audrey Hepburn. She modeled with the props and enjoyed having her picture taken. She said she felt really important.
Giggles started and we got the ol’ Violet back. Violet had been quite reluctant to join in or have her photo taken recently, so this was a very positive moment for her and us.... This box resulted in her being very happy and relaxed and engaged with other residents all afternoon.”        

Ladder to the Moon: support to meet our higher needs

Once you’re out of bed in the morning, what do you do? Actually, let’s fast forward a bit. Once you’ve washed, dressed and fed yourself, what do you do? (I’m making assumptions here, you may not be a ‘breakfast person’). What I’m driving at is once your basic physiological needs are met, you don’t consider the day ‘done’. Maslow’s hierarchy doesn’t stop at the bottom level. 

Maslow's Hierarchy of Needs, cut off at Level 1 (essential, but boring!)

Maslow's Hierarchy of Needs, cut off at Level 1 (essential, but boring!)

Some Activity Leaders – aiming for those higher steps - complain that their colleagues are disproportionately focussed on basic needs. The thing is, an individual’s physiological needs - air, food, drink, shelter, warmth, sleep – are essential. Maslow posited that these needs motivate people when they are unmet and that one must satisfy these lower level basic needs before progressing on to meet higher level growth needs. The pursuit of life enrichment would be very difficult with basic needs unmet. 

That care home staff should be supporting people to meet their physiological needs is not under debate. The question is: having met these basic needs, what next? 

Having been provided with safety and clothes and food and a seat in the lounge, why bother? See the higher levels of Maslow's Hierarchy for our answer: friendship, intimacy, affection and love; achievement, mastery, independence, status, dominance, prestige, self-respect, respect from others, self-fulfilment and seeking personal growth. That's what.  

When Activity Leaders complain about ‘task orientated’ colleagues, focused on basic needs, the complaint resides in a lack of vision beyond basic needs. The Moon we’re heading for is one where all staff in all care settings pursue all the levels of Maslow’s Hierarchy. Join me on the Ladder to the Moon!

Maslow's Hierarchy of Needs (with all it's aspirational higher steps!)

Maslow's Hierarchy of Needs (with all it's aspirational higher steps!)

Curiosity and Openness enable a shift from 'Challenging' to ‘Contributing’

I was told a wonderful tale about a ‘challenging’ resident recently.

He would lash out at fellow residents, appear beside people’s beds at night, harass, shout, struggle and object. He was quickly labeled ‘challenging’ and given medication to calm him.

Enter one of the participants from our Outstanding Activities programme, let’s call her Anne-Marie. One of the aims of the programme is to create leaders who involve colleagues and foster a culture of enjoyment of life in care settings. How could this ‘challenging’ individual enjoy life? The answer of course depends on the individual. Anne-Marie embraced two of Ladder to the Moon’s core values: openness and curiosity.

The gentleman in question – call him Robert - had been taken into hospital for a routine operation. Whilst in hospital, his wife (and primary carer) became ill. Shortly after he arrived at the care home for respite, she died. So he stayed.

Due to the nature of this admission process, very little was known about the new arrival. Including his very poor eyesight. So when Robert didn’t recognise individuals around him, he would get very close to try and find out who they were. If Robert saw a woman lying in bed he would assume it was his wife, and approach her. If Robert was man-handled away from someone he hoped was his wife, he would become upset.

With a little open-mindedness, it was clear to see that this gentleman was in a horribly stressful and confusing place. Anne-Marie communicated with staff about Robert’s eyesight. She encouraged regular, repeated and patient assistance to support Robert understand his new environment. And continued to discover more about Robert.

Although he required a carer, Robert had looked after many of his own needs, including preparing breakfast. A team leader accompanied Robert on a few occasions to the kitchen to prepare his own breakfast. Now he helps every morning, preparing tables.

Robert wasn’t ‘challenging’, he was ‘having a challenging time’. Thanks to an open-minded and curious mindset and some creative actions, he doesn’t require medication to alter his behaviour now (did he ever?) He is socially engaged and contributing to his new community.

The naturist key worker hero

I was visiting Warren Lodge, as part of a roadshow introducing staff to Ladder to the Moon and preparing them for the work we are doing with Forest Healthcare. Towards the end of the meeting, the conversation turned to key workers, and naturists, and I felt I had to share the great work.

I’m not a naturist… 

… and nor was the key worker I was speaking to. The key role of the key worker is to establish a relationship with the individual they’ve been assigned. To see the individual for who they are, to build trust and develop a rapport. And then to offer personalised opportunities. 

Though I'm please to see centenarians skydiving, skiing and running marathons, I’m also happy to accept, that there are activities which can be more challenging as you age. I have to be honest that I hadn’t previously considered getting naked to be one of them. As challenging as this may become, of course, nudity is only half the challenge to a naturist. It’s the designated areas which could easily be inaccessible once living in a care setting that make it really challenging. 

Enter the key worker, our hero, who built rapport, expressed curiosity in this resident’s interests and discovered there was a naturist club which the they had been a member of for years, but were no longer able to get to. And so our hero accompanied and joined them at the naturist club.  

And that’s what I call a job well done.  

Now here’s a quote from an activity leader who has been attending our Outstanding Activities programme: 

“When I started doing activities, I was very fearful.  Now, my relationship with the residents, I sometimes can't believe how happy and joyful they are. [Outstanding Activities] has been one of the greatest experiences: communication, confidence, inspiration. The way you say 'Good Morning', the way you greet people. I was so shy. In the lounge, there were no people. I didn't know how to connect. Now people want to be involved. People are in the lounge at 10 o’clock, 9.30, asking 'What are you going to do today?’ I’m so grateful for it.” 

What are you going to do today to bring happiness and joy?

Whole staff team gets involved with a culture of activities

One of the initial difficulties with creative practice lies in the amorphous nature of creativity itself. The limitless possibility of a broad request - ‘do something creative’ ‘draw me a picture’ ‘write a blog’ – is at best challenging and at worst immobilising. 

I was speaking to Marie, an Activities Coordinator the other day. Marie is a participant on Ladder to the Moon’s Outstanding Activities programme, and receives a monthly Activity Box of resources, instructions and inspiration. We were talking about the ‘Coat of Arms’ box, which invites homes to design and fashion a Coat of Arms, with symbols representing what people value most at the home. By a variety of means, Marie asked residents, staff and family members to contribute and…

‘I waited for some feedback from everyone but realised that no one could think of a symbol representing their categories’

Initial uncertainty and hesitancy across the interest groups... at best challenging, at worst, immobilising. Resolute, Marie used her coaching call support with Ben (Ladder’s Head of Creativity and Connection) to discuss a reconsidered approach. The box contained the answer!

‘He suggested that I give each group some ideas by showing them symbols and examples [in the Activity Box] that could be relevant to the task. I did exactly that and was given so many suggestions by staff, relatives and residents that having to make the Coat of Arms become really easy.’

By providing context and parameters, Marie had removed the unintentionally obstructive effect of her initial requests and instead inspired contribution.

‘The result was that it was easy for everyone to get involved.
Our coat of Arms was cut by a relative using a piece of wood from an old wardrobe. The paints and brushes came from our gardener for our residents to use. The handyman fixed it to the wall and our residents cut the symbols and chose where they were going. Even our bookkeeper helped choose a symbol for our location.
It was a real team effort.’

Transformations such as this one occur frequently and can often be inspired by minimal, subtle interventions. Hesitancy which at times can be seen as a reluctance to engage may just be the result of uncertainty and an unclear understanding of the request. The recipe for achieving positive results within creative practice, however, remains consistent with Marie’s practice: persistence, awareness and a willingness to assess and, if necessary, change one’s approach.