Washington DC - A Fitting Finish

Washington DC

Jenny comes to the end of her Travelling Fellowship adventure

So this is it, my final blog. Having never written blogs before I think I’m finally getting used to documenting my life just as my fellowship comes to an end! It’s been an amazing 6 weeks but I’m definitely looking forward to getting back home. 

So what have I been doing in Washington DC? After a brutal 1:30am wake up call to catch the flight from Boston I arrived in a somewhat confused state, but an early night set me to rights for the first visit on Monday morning. I spent most of the week with Iona Senior Services whose primary aim is to help people ‘age well and live well’. Within their building, they have Iona's Weinberg Wellness & Arts Center, a day centre offering support for individuals with memory loss and other conditions as well as a gallery space that rotates exhibitions 3 or 4 times a year. The artists in residence who are chosen must be 60+ years young (love that phrase!) and have the capacity to provide 75 to 100 pieces, depending on size. The size and significance of the show really encourages artists to push themselves, particularly if they haven’t made a big collection for a while. During the exhibition time, each artist also facilitates three key events:

1. Meet the Artist Reception: this is an introduction to their life and work. Anyone can attend and food and drinks are provided, similar to a gallery opening.
2. Lunch and Learn: over lunch there is a tour of the artwork and lecture from the artist about the pieces and process. Both the public and staff members are encouraged to attend.
3. Workshop: a workshop is facilitated by the artist for service users from Iona’s own Wellness and Arts Centre.

Once their exhibition is completed, artists in residence become an ambassador for the centre and usually donate a piece to the permanent collection, including a self-portrait box that they make for Iona to keep. On my first day, after spending the morning with Patricia Dubroof, Gallery Director for IONA Senior Services, I accompanied her to a home visit for a potential future artist in residence. Jim’s collection was absolutely fabulous and it was amazing to see the transitions between different mediums and styles throughout his life as an artist. Patricia explained more about what was involved, including training for the artist to enable them to work effectively with service users in workshops and preferred delivery methods for the lunch and learn sessions.

Jenny and a 107 yr old lady at the Veterans Affairs Medical Centre

Over the next few days Patricia and I visited two other facilities in which she worked. The first was the DC Veterans Affairs Medical Center, which offers long term palliative care, hospice and rehabilitation for veterans. Although the settings feel quite clinical, as part of the main hospital, they have done great things with the space. Patricia has developed an art gallery throughout the center with art work from local veteran artists and individuals within the center itself, transitioning every 3-4 months. Their creativity and healing programmes also include music, tai chi, visual art classes and museum partnerships. I observed an art session and then sat in on a team planning meeting to discuss exhibition schedules and the ongoing projects. The next morning we also visited the second Iona site at St Albans Church, who had a group of corporate volunteers from AARP in to help for the day. One of the service users, Barbara, was particularly inspirational. Having participated in many initiatives, she had recently started her own - ‘Introduction to Quilt Making with Barbara’. Participants can either work on their own projects or help make baby quilts for the St Albans Outreach Ministries and the session has been extremely popular.

My next visit was to the National Center for Creative Aging (NCCA). When I first started contacting organisations in the area and receiving times and locations I began to get slightly confused. Three out of the four people I contacted all gave the same address and I felt that there was some kind of conspiracy going on! As it turns out, there are a number of other likeminded organisations that share Iona’s workspace, including the NCCA. I met with Dorothy Wohlslagel, Director of Education Services, and Gay Hanna, Executive Director, to talk about the organisation’s primary services. Dorothy took me through their Online Artist Training in Arts and Aging, an e-learning training package that teaches artists how to lead lifelong learning arts programmes that engage older people. While not an ideal method, the organisation has successfully provided flexible training for large numbers of professionals within tight budget constraints. They are also aiming to develop it by adding more media forms, for example video clips, to help increase interaction and engagement.

National Museum of American History

On my final day in Washington I was back with Iona’s Wellness & Arts Center under the guidance of Jackie Sargent, the centre’s art therapist. After accompanying an outing to the National Museum of American History in the morning, I had an opportunity in observe a group art therapy session and then talk through staff training with Jackie in more detail. One of the key things she highlighted as important for staff to understand is the boundary between art making and art therapy. Knowing how to interact and react to art work appropriately, so that the process and product is validated is important for the individuals involved. One of the ways that this understanding is developed is through group art sessions for staff. Creativity evenings, where staff make art work together, are held in the studio once a month. They have a different theme each year and the resulting work is displayed in a yearly exhibition in Iona alongside the resident’s pieces. This focus on staff self-care is extremely important and also offers them first-hand experience of the process that the individuals they support go through. It was lovely to see how Iona use art for the benefit of staff, helping to develop empathy and respect for service users and what they do when at the centre.

And that was my last visit! I think that I have developed a clear vision for the key points I’m going to talk about in my report, but a bit anxious about the write up! I have three months so once it’s done I’ll keep you posted. I think I’m going to have a few weeks off and then come back to everything I have learnt with a fresh pair of eyes… Wish me luck!

"A note from Insight - thank you for reading Jenny's blog, she had an inspirational time, but we did miss her and we're keen to see how she incorporates her experiences into Leadership and Management Training."

Boston Beautiful

Alzheimer Care in Boston

by Jenny Garratt

It’s been an interesting week in Boston. I decided to rent a car as my visits were so dispersed that public transport didn’t seem to be a viable option.  Having never driven outside of the UK, by the time I reached the rental desk at the airport I was decidedly nervous. After navigating through what is apparently one of the worst cities in the US to drive around I was relieved to finally reach my accommodation with only a minor curb bump! However, the excitement of my first day in Boston wasn’t over yet. After unpacking I came downstairs to find my hostess had left the house without giving me the code to the front door, effectively locking me in. Before you imagine my annoyance, let me first describe her... A single mum with triplet 8 year old boys (I repeat, TRIPLETS) who has a full time job, hosts 4 guests through airbnb, writes books in her spare time and is about to start a PhD. When she got back a few hours later I decided to let the front door situation go. She had enough on her plate.

My primary contact for the week was Hearthstone Alzheimer Care who kindly organised my entire Boston itinerary and even contacted other groups for me to visit. The Hearthstone approach aims to create a life worth living by enriching lives and offering hope. Support and care focuses on creating meaningful, positive and fulfilling experiences through the effective use of programming and environments that support independence and choice. Alongside their six facilities, Hearthstone also offers education for other organisations and initiates research into non-pharmacological interventions. They are closely linked to the I’m Still Here Foundation, which aims to develop and evaluate innovative non-pharmacological approaches for people with cognitive challenges and also creates and implements inclusive, community-based arts and culture programming.

My first morning was spent observing an Artists for Alzheimer’s (ARTZ) programme. ARTZ is one of the initiatives developed and maintained by the I’m Still Here Foundation and is made up of a collaboration of artists and cultural institutions which aim to educate and inspire individuals with memory problems, their care givers, family members and friends. The day’s programme was part of the Meet Me at the Museum initiative and involved an interactive tour around Harvard's Peabody Museum of Ethnology & Archaeology. It’s a free weekly program and each event is facilitated by trained ARTZ staff. Today’s group was split into two and facilitated by Dee Brenner, Programme Co-ordinator, and Dr Christina Smiraglia. The sessions were very engaging and aimed to have a ‘fail-free’ approach, encouraging interaction with the exhibits through questions such as “how does this make you feel?” rather than focusing on factual content. Afterwards, I headed to the Hearthstone office to participate in an awareness session for organisations thinking about bringing groups to ARTZ sessions. It was very informal and questions were encouraged, of which I had many! Content included practicalities of what happens throughout the session, understanding person centred approaches and tip sheets for accompanying care partners, who don’t get a formal training session, called “Tips for a Successful Museum Tour”.

On Wednesday I spent the entire day with Learning for Life, which is an educational programme specifically designed for individuals with dementia that uses Montessori methodology and the I’m Still Here approach. Learners select their own subjects to add to the curriculum and are supported to engage in creative activities, cultural experiences and cognitive stimulation throughout the day. The basic daily framework of the curriculum is constant but the context is continuously created, giving opportunities for novelty and new learning in a safe environment. The day started with a famous event in history that happened on the day’s date and then a photo of the day to discuss. There was then individual study options for the rest of the morning, including the life story corner (today's question is where do you go to feel inspired), reading centre (article of the day that is discussed, today's is about the life of Victor Hugo), art centre (draw a place that inspires you) and the cooking centre (today is making chocolate chip biscuits). There are clear signs for each activity and it was nice to see lots of choice, giving learners the opportunity to move between them if they finish or get bored of one.

Sean Caulfield and Dr John Zeisel

After going out with the learners for lunch, the afternoon was then spent discussing the article on Victor Hugo. Throughout the article there are questions for participants such as Guernsey was a place of inspiration for Hugo, where do you feel inspired? All questions aimed to promote engagement from the learners without the stress and frustration of focusing on specific facts that would need to be recalled. The discussion was extremely interesting and allowing leaners to choose the content of their curriculum ensures that they are always talking about topics that are both relevant and interesting to them. 

I had the pleasure of meeting  Dr John Zeisel at the Hearthstone Office, president and co-founder of Hearthstone Alzheimer Care, who took me out for dinner. One of the key points I took away from this meeting was an emphasis on transformation. Both Hearthstone and the I’m Still Here Foundation aim to transform the way that people think about dementia, not only through training but also through research. The use of creativity and artistic skills are integral to this transformation at a community level, helping to develop the mentality needed to act as a catalyst for change.

The morning of my third day was spent visiting Melody Bushmich, Early Stage Programme Coordinator for the Alzheimer’s Association, who gave me lots of information about upcoming programmes. It was interesting to see yet another organisation moving individuals from the traditional role as receiver of support towards playing a more active part in service provision. This reminded me of the Brooklyn Public Library and their transition from giving stories to teaching people to capture their own. The Alzheimer’s Association offer lots of services including care consultation programmes, legal and financial services, support groups and training. However, what really interested me were the new programmes currently in development for those with early stage dementia. The aim of one of the new programmes, an intensive course lasting 4 weeks, is to provide individuals with education, support groups and training on how to engage with other groups through volunteer opportunities. The programme aims be a launching platform from which people with dementia can become advocates for the Association and active volunteers within their own community. There is also a peer to peer element to link individuals with others that are experiencing the same thing, not for professional advice as such but more for support, understanding and friendship.

My next call of the day was Goddard House, an assisted living complex that also has a memory support facility attached to it called Olmsted Place. It was in Olmstead that I observed an excellent music therapy group session facilitated by Angela Schroedar-Dill. 

From the outset the use of names on an extremely regular basis solicited a positive reaction and ensured all residents were continuously engaged, felt welcome and included. Song choice was clearly important, with the theme for the day being hopes and dreams, and the songs were interspersed with questions like ‘what would you wish for if you threw a penny into a fountain’? After the session I met with Ginny Mazur, the Community Partnership Director, and Cindy Allard, the Programme Director. 

There was a clear emphasis on staff engagement and the promotion of continuous learning for all. Cindy explained that each staff member was very unique, with different passions and skills that they were encouraged to share. One staff designed jewellery, another played the flute and another was interested in technology. Ginny and Cindy aimed to encourage staff to use their interests and skills to provide the residents (and other staff members!) with new learning opportunities.

Day Programme at Hearthstone

On my last day with Hearthstone I visited one of their own sites in Woburn to meet with Stephanie Faulkner, Program Director. A huge amount of thought had gone in to the individual programming on offer, with so many activities and experiences available that it was impossible for someone to do everything! There were multiple programmes every hour, in stark contrast to the one activity in the morning and one in the afternoon schedule that you often see in other care facilities. It was a truly excellent example of how much really can be offered with the right attitude and training. The use of parallel programming, where individuals have choices that are tailored to their varying abilities, also ensured that all residents participating in experiences were being set up to succeed. The notion of ‘failure-free’ programming is essential when trying to avoid feelings of frustration that can occur when given challenging tasks that may lead to failure. Wording is also extremely important, with the different levels being called discovery, vitality and serenity. 

Resident companions, or care workers as they are known elsewhere, also do programming and there is a real emphasis on having a team approach, all working towards the common aim of giving residents excellent care, support and a life worth living. What I also found interesting was seeing improvisation skills acknowledged as a key component in the successful facilitation of resident experiences, a theme that has been touched on in other visits throughout my travels. Stephanie’s background in drama helps her continue the flow of conversation with residents in a natural, carefree way. Threading is the term used to describe the method of connecting conversation and topics together, a key component in good improvisation. 

My time with Hearthstone has been extremely inspirational and has helped highlight the difference between good person-centred care and great person-centred care.

Two Tribes...?

Two Tribes? by John Dennis 

NHS and Local Authority Social Care Provision

An interesting article appeared on the BBC website last week.  It reported that the Baker Commission (Set up by The Kings Fund to look at Health and Social Care provision), had recommended the NHS and Local Authority Social Care Provision should be merged.

http://www.bbc.co.uk/news/health-29047190

This is not really remarkable!  This is after all Labour Party policy and the present Government, whilst making no such commitment has established a direction of travel which brings services from both the NHS and Local Authorities into ever closer alignment.

What is remarkable is how slowly this process is moving despite a sense of crisis in Social Care resources and provision. Labour’s commitment does not extend to any detail about how the merger would work and the Coalition seems to prefer small steps rather than any bold resolution.

Could the answer be an unresolved turf war? How would the Department of Health respond if Local Authorities were given the role and resources to deliver all Social Care? How would Council Leaders respond if the NHS were given the role of providing all Social Care?

When “Frankie Goes to Hollywood” recorded the song “Two Tribes” in 1983, they asked “what happens when two tribes go to war?”  In this case the answer seems to be “virtual stalemate!’

New York, New York - WCMT

Jenny travels to the Big Apple

I have finally finished my first week in the USA and it feels like it has gone on forever! In a good way, I’d like to add. I had a four day working week and then had a few days break from visits, to take in some of the New York sights. I was getting a little worn out so I think that it came at the perfect time in my trip! But first let’s talk about my visits before discussing play. When I arrived in New York I got a bus from the airport to my accommodation in Brooklyn (I used airbnb, so I was staying with locals) which seemed to take the better part of forever. When they asked how I had travelled from the airport, my hosts were horrified to learn of my mode of transport and questioned how I had survived with all limbs and bags accounted for - “I don’t want to tell you not to get the bus… But don’t get the bus”. So I spent the rest of the week cycling around Brooklyn, which admittedly was a much more pleasant way of seeing the area.

 My first port of call was Gary Glazner, Founder of the Alzheimer’s Poetry Project (APP). On the day I spent with him, I observed a poetry session and was amazed by the reactions the ‘call and response’ method evoked. Gary, as the group leader, recited lines from well-known poems which the group then echoed back to him. In the second half of the session this was then used as inspiration to create their own poem as a group, although any topic can be picked. Once the poem was finished it was then recited by the group as a final product. All the participants clearly felt comfortable in the environment, giving them a space in which they could safely express emotions and feelings, with everyone’s point being valid no matter how many times they repeated it. Conversation and songs naturally flowed if participants felt they wanted to say something, with impromptu songs and comments springing from nowhere and being draw into the mix. After having agreed that the theme of the song was ‘making money, honey’, my favourite response to Gary’s question “so what could we do make some money?” was from a particularly mischievous lady who replied “sell our bodies”! The morning was filled with laughter and jokes, making the whole experience enjoyable to both participate in and observe.

After the session had finished Gary and I had some time to talk about the training he does for groups in the aged care sector to help them connect with people living with dementia, including family caregivers, healthcare workers and artists. The focus is on engagement, using simple techniques to elicit positive responses and techniques to create new poems. The APP also has a teaching manual "Sparking Memories: The Alzheimer's Poetry Project Anthology" which has information about the techniques and the medical implications of using poetry. Training can be done face to face, but Gary also offers virtual training, consisting of hour long skype sessions each week with time in between to use learning and report back. This blended approach is crucial in ensuring that practices become ingrained in people’s behaviour, rather than an individual simply learning skills and not having any practical experience before training ends. Once again, the best case studies Gary spoke about were those that had the backing of upper management (yes I am starting to sound like a broken record – leadership and management)! After doing training sessions in one facility, he returned a few years later to find that, although all the original frontline staff members had changed, the knowledge and understanding had been passed on and poetry sessions were still taking place. The fact that management understood and valued the APP ensured that new members of staff were encouraged and supported throughout the learning process.

A day with Christopher Nadeau, Executive Director at The New York Memory Centre (NYMC), was next on my agenda. The NYMC offers many different services including adult day care that focuses on non-pharmaceutical interventions, care giver support services, computer cognitive training for those with memory problems and staff and care giver educational training. I observed a percussion session with artist in residence David Azarch and a music session with artist in residence Ismail Butera. Seeing the different styles of artists made me appreciate how individual each form is and also highlighted the variation for participants. The day care service also offers a huge range of other creative programmes such as poetry, theatre, painting, sculpting, multimedia expression, dance and yoga. There was something for everyone!

I was particularly interested in the relationship between the staff and artists in residence. Staff members took an active role in facilitation, both within sessions and between them, and I asked Christopher more about what training they have in the creative arts. He explained that they have knowledge assessed training in areas such as dementia, but the learning process for artistic initiatives was less formal, with much of their understanding being gained through shadowing artists during sessions. During the induction phase for new starters, underpinning knowledge is also developed by a training package about the philosophy of the centre. Once again, the focus is on increasing understanding of the value of artistic and creative initiatives and, from this basis, building practical knowledge through hands on learning.

My last two days were spent with Judy Kamilhor, Brooklyn Public Library’s Coordinator of Older Adult Services, who creates and maintains a huge range of services that stretch across the 58 neighbourhood branches. The department’s main services that go out into the community are ‘Books by Mail’, library books sent out through the mail for older people who are homebound, and ‘Books to Go’, that offer a kind of mobile library for groups in communal settings such as care homes. Inside the libraries themselves, the Creative Ageing initiative runs regular programmes, each one usually spanning over 8 weeks and consisting of a minimum of 16 learning hours. These programmes are facilitated by professional artists and Judy had kindly arranged for a session to coincide with my visit; ‘Room for Everyone: An Afternoon with Poems’ by Jess Greenbaum. This was a three hour poetry taster session and I was extremely impressed with the intellectual and thought provoking content, which managed to keep me fully engaged for the whole three hours even though I wasn’t even taking an active role in the session! Judy herself sat in, which is something she tries to do regularly not only to ensure quality control, but also as both personal and professional development.

I was also lucky enough to catch an ‘Exergamers’ session, an activity that is new to the programme and sees older adults using the Xbox™ bowling game. Different library locations throughout New York compete in virtual bowling competitions, helping to develop social networks not only in their own location but also with older adults throughout the whole area.  Another Creative Ageing programme that I found particularly interesting was ‘Our Streets, Our Stories’, that focussed on capturing and documenting the diverse stories from older people in the area (many of whom emigrated to the country) through in depth interviews. Training on interviewing techniques and how to use technical recording equipment was not only for staff but for people in the community – teaching older adults to capture the stories of older adults! Now that is a creative concept. What is happening here is a crucial development in the relationship that the library has with its surrounding community; a shift from sending out stories and telling people what to read to a focus on providing people with the tools to collect and create their own stories.

So how are these innovative ideas and the culture shift that comes with them cultivated? The library has a comprehensive training package ‘Everyone Serves Seniors’ that includes a series of sessions and publications. Judy is also currently updating it to cover even more ground in the arts and creativity field, with the finished product hopefully also including sessions with guest artist speakers around specific topics. The overriding aim of the training is to ensure that everyone understands how to give all older people great service. I can’t wait to see the new package and, from what I have seen, I am sure that it will lead the way in arts and creativity within the library system.

Once my working week was over, I had a few days down time with my partner Sam, who came over from England for the weekend. Most of the photos this week are from touristy things as there weren’t many opportunities in the visits for snaps, but hopefully they have brightened up your reading. Some of the main events included; 

• going up the Rockefeller building at sunset 
• a boat trip to see the Statue of Liberty
• a musical lunch on Broadway
• walks through Central Park 
• a trip to the Sea, Air and Space museum 

We definitely packed lots in to just a few days! Well that’s all for now and I’ll catch up with you next week!