Motivation and communication How can I motivate people to take part in activities? What are the obstacles? Helpful tips ‘You surely can’t expect me to do that at my age?’ Negative stereotypes of old age stops a person thinking and feeling they can have a go. Use humour, kindness and verbal encouragement. Consider asking another resident or relative to support and encourage them. ‘Residents no longer want to do things for themselves.’ Routines and ways of working can mean residents have limited day-to-day choices or opportunities to do things for themselves. Find out what is meaningful to them. Give residents back a sense of control over their lives and offer choices. People are sometimes more motivated if they are doing something for others. Activities are generic and carried out for the sake of it – without taking into account each resident’s interests, needs and barriers. Use activities that relate to each resident’s individuality. Up to 40% of people in care homes are depressed (Royal College of Psychiatrists and British Geriatric Society 2018[1]). Don’t judge, and be patient. Be kind – when someone is depressed they can be very hard on themselves. Give them the chance to talk. Music and creative activities can be comforting and an emotional outlet Befriending, pets or contact with children are great ways for residents to connect. ‘I’m not interested in flower arranging.’ Some people don’t want to join in and prefer to keep to themselves. Respect differences. Don’t just run group activities and expect everyone to join in. Find out what is meaningful to them. Make people feel valued and included. For example, are you supporting everyone regardless of culture, religion or sexuality. It is important to ask each person and their families about their sexuality, culture, beliefs and practice and incorporate them in daily life. In many homes men are a minority group. ‘I’m happy to stay where I am.’ If people are scared about risks, they can limit what they feel they can and cannot do. Find out why somebody doesn’t want to move. Is it because they are frightened of falling or are in pain? If yes, get specialist advice. See Balancing risk and choice. Always give positive feedback and encouragement. Reduce pain and anxiety, through diversion. ‘Whenever I ask Ann if she would like to do an activity she always says “no”.’ You can feel that you can never get some people involved in anything. Try different ways of communicating, for example: Rational approach – discuss the benefits of joining in. Enthusiastic, positive approach – this can work for some but for others it can be a real ‘turn-off’. Used in the right place it can be a useful ‘kick-start’. Caring/nurturing – a more gentle, caring and nurturing approach can help with confidence. Giving responsibility – allow people to make a choice for themselves from a selection of activities. ‘Ted used to like gardening but he can’t do it anymore.’ You may do a life history but find the person is no longer able to physically enjoy previous hobbies and interests. Think outside the box. What element of the activity did they most enjoy? What was it about that activity that motivated them to do it? Can these elements be met in other ways? For example, some people may enjoy gardening because they like being outdoors and for others it is the reward of growing something. ‘George’s family feel he has come into the home for a rest and to be looked after.’ Sometimes the anxieties and expectations of family can restrict what a resident thinks they can and cannot do. Take time to find out what the person wants. Make them feel valued and included. Give them a sense of control and choice. ‘I asked everyone in the lounge if they would like to help me make some Christmas decorations but they all said no.’ Is the activity you have chosen the right one? Encourage curiosity – people are inquisitive. Start an activity and let people come to you. Consent/assent It is important that you respect every resident’s free will and choice. So if someone refuses to participate in an activity or an outing, they should never be made to do it. However, always think about whether the person has anxieties or concerns that might be stopping them from getting involved (for example, they may be worried about being able to access a toilet when out and too embarrassed to mention it). Sometimes you might need to use a different way to approach the situation, like those listed above. References Royal College of Psychiatrists, British Geriatrics Society (2018) Collaborative approaches to treatment: depression among older people living in care homes. London: RCPsych, BGS. CommunicationCommunication is the way that we express our thoughts, feelings, hopes, fears and aspirations. It’s the way that we show others who we are as an individual. So not being listened to can make us feel stressed, frustrated and undervalued. To communicate effectively, we use different skills and strategies: Non-verbal Listening Verbal Written. Ten tips for effective communication Always believe that communication is possible. Show respect in your tone of voice and the language you use. Try to focus on the non-verbal signs as well as verbal. Avoid making assumptions: check things out with the person. Let your face be seen. Face the person squarely at eye level and make eye contact. Speak clearly. Avoid using jargon or complicated explanations. Be a good listener. Give the resident your full attention and resist the temptation to finish their sentences or talk at them. Be calm, unhurried and patient. Don’t be afraid to try or say ‘I don’t understand’. Check hearing aids and glasses are in good working order. (Care Services Improvement Programme 2007)[1] Communicating with people who have special needs Tips for communicating with people who have impaired hearing Face the person and get their attention. Ask if they need to lip read or have a ‘better side’ for hearing. Speak clearly and keep your head still so they can watch your mouth. Use plain language and do not waffle or use jargon. Check that they fully understand any instructions. Use visual cues and write things down if necessary. (Action on Hearing Loss 2018)[2] Tips for communicating with people who have impaired vision Get the person’s attention and introduce yourself. Do not touch the person until they are aware you are there. Use verbal responses, avoid nods and head shakes, and tell them if you are making actions they can’t see. Tell the person when you are moving away from them or leaving the room. Make sure the room is evenly lit, without sources of glare, bright light and reflection. Allow the person time to adjust their eyesight and vision to changes in distance and lighting. Use large-print books, signs and instructions with clear contrast and definition. In a group conversation, always make it clear who you are and who you are speaking to. Provide information in audio, large print or braille. (Royal National Institute of Blind People 2016) Tips for communicating with people who have dementia Say who you are and use the person‘s preferred name. To get the person’s full attention position yourself where they can see you and make eye contact. Be positive, encourage them with smiles and head nods, and use humour. Introduce one question, instruction or idea at a time. Use short, simple sentences. Allow pauses to give the person time to process what has been said. Try to avoid questions which have ‘why’ in them. The reasoning involved in giving an answer may be too difficult. Consider what might be the best time of day to talk – avoid times when they may be tired, such as after lunch or a tiring activity. If the person forgets what they have just said, repeat it back or gently remind them of the subject they were talking about. (Alzheimer’s Society 2019)[4] Tips for communicating with people in the later stages of dementia Respond to the emotion behind the words; the feelings are real even if the words are inappropriate. Use objects, pictures, symbols and gestures as well as spoken communication. Use colour rather than black and white images. Make associations, using songs, rhymes, words or pictures. Use rhyme, repetition and rhythm. Use interesting objects and pictures to talk about. Tips for helping with word-finding difficulties: Offer a choice of words: for example ‘Do you mean chair or shoe?’ Provide the first sound of the word: for example ‘p’ for ‘pen’. Use word association: for example ‘tooth … brush; hair …. brush’. Use a lead-in phrase: for example ‘you eat with a knife and _____’. References Care Services Improvement Partnership (2007) Older people’s mental health programme. Action on Hearing Loss (2018) Tips for communicating clearly. London: Action on Hearing Loss. Alzheimer’s Society (2019) Tips: communicating with someone with dementia. London: Alzheimer’s Society. Communicating and connecting with relatives and close friends Know who regularly visits each resident. Be open and invite opportunities for visitors to talk in a private space about their relative and their life in the home. Remember relatives are making that transition too. They may be feeling guilty if they are no longer the main carer and need opportunities to talk. Remember relatives and close friends would like to hear about the life of the home and how their relative or friend is coping. Whenever possible discuss with the resident how they would like this to be done. The resident may not remember what they have been doing this week and cannot share this with their visitors. Relatives and friends can help contribute to their friend’s/relative’s life history. Relatives and friends may be able to help shape the resident’s preferred daily routine. Visitors may have their own communication difficulties.
