CASE STUDY

PREPARING VOLUNTEERS TO ENGAGE WITH RESIDENTS WITH DEMENTIA

Background

One of the three care homes that we are working with is a residential care home that specialises in dementia. They accommodate 20 long term residents and have 4 beds for short term or respite care, specialising in dementia. They also have one 8- bed wing designated for Intermediate Care. While the other two care homes are not specialist units, the residents have significant support needs, of which dementia is often a factor.

Issue(s) we faced

Volunteers unfamiliar with a care home setting do not always realise the above. During the initial visits to all three care homes, we realised that volunteering in this setting may place the volunteer in situations that they were unfamiliar with and that they could possibly find daunting – or at least more challenging that they might have expected.

This made us consider the importance of explaining and preparing volunteers for this during the initial volunteer recruitment and selection process. We wanted to give volunteers as much information about the residents’ needs and volunteering role as possible.

As always with volunteering, selection is a two way process – we have to decide if the volunteers are suitable for the role (including taking references, DBS checks and so on) - but volunteers also have to decide whether it is the right choice for them. Unlike recruitment for a job where it’s a competitive process with a cut-off date, it’s a more like a pathway where the volunteer, the Volunteer Centre, the care home and the residents get to know each other better and explore whether they want to work together. So the initial recruitment, interview, screening, training and induction and visits/taster sessions are all part of this journey.

What we did

Recruitment

The Volunteer Centre has a high profile locally and we used our pre-existing networks and communication channels to recruit volunteers – for example the do-it.org volunteering website, our volunteering e-bulletin, CVS newsletter, local press and advice sessions at the Volunteer Centre. In relation to the local press, we had a better response with publicity linked to forthcoming volunteer training dates rather than just a general request for volunteers (it seems to prompt people to respond immediately).

We also advertised within the care homes themselves (so that families, friends and visitors were aware of the project), distributed leaflets and displayed posters in local residential areas around the care homes, wrote to parents at a school near to one of the care homes, and joined forces with a Volunteer Centre in another district which was very close to one of the care homes and which had a more active local presence.

First impressions

When volunteers attend their first volunteering interview we have open and thorough discussions about volunteering particularly for those going in to the specialist Dementia Care unit. We found that this really helped, as some volunteers would explain that they had personal experience of dementia. For example, they may have family members with dementia.

Some volunteers would disclose that they felt slightly nervous as they didn’t have experience of meeting people with dementia. This didn’t necessarily put them off wanting to volunteer there, but they felt that they may need some support.

In some cases, volunteers decided this setting would be too much for them, in which case we would help them find alternative volunteering (this avoids wasting their time and the care home’s before they get too far into the screening and training process).

Training

The training that is delivered for this volunteering role plays a key part during this period of time as well and forms an important part of the selection process on both sides. It also clarifies the nature and boundaries of the role from the very beginning, as well as exploring potential difficult situations using discussion and role play. Some volunteers have decided not to proceed any further and again, it is helpful to know this early on.

I was invited to attend training workshops, which were highly informative and really gave a sense of what the volunteering entailed. I learnt a lot about what the role was and what we could and could not do.

We have found it particularly helpful when one of the Care Home staff was able to attend the training (although it has not always been possible for them to commit the time).

Introduction to the care home

Crucial to successful engagement of new volunteers is the support provided by care home staff. Having a welcoming and supportive first impression makes a big difference.

I was given a thorough tour around the care home and was introduced to some of the residents who I turned out to see regularly. The lady who showed me around also told me a bit about each of the residents, which was very helpful as it gave me ideas about

what to talk to the residents about. The staff were very friendly, I felt welcome from the start and it was made very clear that they were very grateful for as much or as little time I could spend there.

We also ensure that a member of staff from the Volunteer Centre is present with the Volunteer for their initial visit to the Care Home. At this point we have got to know the volunteer, so it allows us to pick up whether they have any worries or concerns and to offer support or reassurance if needed.

What went well and why

Support from existing volunteers

Now that we are a year into the project, one thing that is very helpful is that existing volunteers are willing to have a new volunteer ‘shadowing’ them at first. New and experienced volunteers are also given opportunities to meet and gain peer support at training sessions and volunteer meetings. This allows the new recruits to learn and gain support from more experienced volunteers.

Taster sessions

Some volunteers have taken up the opportunity to try out (supervised, one-off) ‘taster sessions’ with residents where appropriate. This has been particularly useful where volunteers had an idea about an activity or interest they could share with residents, if we weren’t sure whether it would be suitable or interesting to them.

A group of Young Rotarians (aged 16/17) from a local school took in old photographs of the town and encouraged residents to share their knowledge and memories. The residents were stimulated by and enjoyed this very much (although it was during their GCSE year so despite some initial enthusiasm none of the young people went on to commit to longer term volunteering).

A small group of volunteers went in to offer a digital art session – however this turned out to be beyond the capacity of most of the residents (useful learning for us)

A volunteer went and did a talk on his travels to different countries, with copies of photographs for the residents to keep. This went well and he has visited all 3 care homes more than once to talk on different topics.

A volunteer organised a music quiz for residents (quote below) – again the activity was too complicated, but they did enjoy and respond to the music, so the volunteer is now offering sessions where he goes in and plays different kinds of music.

I was asked if I would do a quiz for the residents. It wasn’t until I actually arrived and started to set up my music system, that I realised I would not be able to do a picture quiz and the music quiz which would normally involve writing the answers. [The care home manager] suggested that I play the music only and ask them the questions, and rely on verbal answering.

I have never had much contact with elderly people, none at all really, apart from my parents and in-laws, and they weren’t at the same level as the residents here.

So I started, played the first tune and moved on. By the fourth tune three or four

people had come in with answers and others were making piano style motions on their tables. From that point it seemed quite a few were really enjoying it. You can tell.

Towards the end of the evening, by this time it was 7.15pm, long past the original half an hour, one lady was dancing around the tables with the help of the staff.

7.30pm and I said ‘that’s it for the evening’, and there was an audible ‘oh no’. All in all, I was really pleased with the evening. I really got a buzz from seeing their reaction.

Be realistic about the commitment

Over the months we have gathered feedback from the volunteers. One of the items that stands out is that volunteers feel they cope best with this role if they set a time limit of how long they want to spend. For some, they have found that an hour and a half is just right.

Interacting with the residents can sometimes be quite challenging because of their dementia, and they still ask me things I have answered a hundred times before, but a little bit of patience goes a long way! Despite their forgetfulness, the residents are still very wise and have definitely taught me a thing or two. I have found the whole experience extremely rewarding and I am so glad that I got involved because I have met some truly admirable people. I would strongly encourage anyone with a bit of spare time to get involved, because I have really enjoyed myself so far.

What could have gone better and why

In retrospect, it would have been useful to have spent more time preparing care homes in a practical way for the arrival of volunteers and for their role as day-to-day volunteer supervisors. This impacts particularly on front line staff (the care home managers/owners were on board and so we assumed that other staff would be). They need to understand why volunteers are there, feel positive about their arrival and be prepared for the impact on their time. Most of them were new to this kind of role and so there were some misunderstandings early on.

For example, concerns that volunteers were there to watch them; or not understanding the boundaries of the role and so asking volunteers to stay longer than agreed or help with personal care. We were very focussed on the recruitment and preparation of volunteers – less so on the preparation of those working with them.

As the relationship has developed we have realised how important it is to have input and feedback from the care home staff from their perspective, as this kind of setting is new to us. They helped us to understand the importance of considering factors such as:

Does the volunteer have a basic understanding of dementia? An understanding about different styles of communicating, for example, non-verbal,

physical communication. Getting past preconceptions of how humans communicate Is the volunteer aware that they may have conversations that don’t appear to make

sense in the traditional way? For example past and present events may be mixed up. Is the volunteer aware that they may have the same conversation several times

over? Need to reassure the volunteers that they will have ongoing support and someone to

talk to about their volunteering experience as this can be a challenging yet incredibly rewarding role.

In response to this a Volunteer Centre staff member has been trained to run Alzheimer’s Society Dementia Friends information sessions, offered to all care home volunteers. They give a basic understanding of and empathy with the experience of dementia and what they can do to help. These have gone really well, with all those attending becoming an Alzheimer’s society ‘Dementia Friend’. Volunteers in the dementia unit can also access further (staff) training through the county council (which manages the care home).

We also began with the assumption that we would be matching up individual volunteers and residents in a similar way to a befriending scheme. However, given the setting and the high support needs of residents, we realised that this needed to be a much more organic process, where volunteers begin by helping with or chatting to a variety of residents, and allowing 1:1 relationships to develop over time. This also allows for fluctuations in an individual resident’s mood, energy levels or health or accommodate their need for quite short interactions sometimes rather than the pressure of a volunteer expecting to spend a fixed amount of time with one individual. We have found that befriending relationships do develop naturally after a while, with a volunteer regularly spending time with the same few residents with whom they find a rapport.

Outcomes and impact

The Dementia Friends sessions have been very positively received by volunteers as preparing them for how to relate to and communicate with people with dementia:

I just wanted to say thank you for an insight into the above. The analogy between the bookcase and memory loss was very simplistic but something that people can relate to. I told my husband this and will try and explain it to my friends when I meet them. Many of whom have had someone in their family with dementia.

Trying to understand from a person who has dementia's point of view obviously is not easy. I think more and more people will be interested as it has been highlighted in the media and more and more families will have someone who has the disease. My father had Parkinson's and dementia and was in [residential care] for a while with about 20 other people and I can now understand their actions better as some of them were doing various things and I now realise through the lady you mentioned who was tapping out Morse code messages, that they were doing something that related to their past. It was enlightening and for me to see other volunteers was great.

There have also been positive outcomes for volunteers and residents. While the recruitment/screening/induction process may seem surprisingly drawn out, it does mean that those who complete the journey are properly prepared, minimising drop- out rates. Not all potential volunteers who register with the project do end up as active volunteers – but those who complete the process have generally made a long term commitment and stayed with the project as volunteers. This minimises care home staff time invested in the process and also minimises disruption to residents from volunteer turnover.

Although I did feel nervous at first, after a few visits I really started to enjoy myself.

Over summer I spent at least a couple of hours there every week, which usually involved just sitting and talking with the residents, going for walks in the gardens, making the odd cup of tea and sometimes playing cards and board games.

I feel like I really got to know the residents – especially a couple of my favourites – and found it extremely heart-warming when some started to remember my name and look really happy to see me. It is so rewarding thinking that you probably made that person’s day simply by sitting and chatting with them for a few minutes, especially to those who don’t get many visitors.