A more recent story was where a lively mural of a village street scene, including horse and cart and a variety of probably Victorian era images, was installed in a Butterfly Home.   I had liked it because there were children playing and a few dogs in the picture and I thought it would cheer up a very long and quite bland looking hallway.  When going to check it out, a man living in the home smiled wryly at me and said, “Do they really think we are that old?!”

People living with dementia aren’t stupid! This may seem like such an obvious statement, but it is important when considering the choice of murals that we don’t patronise or confuse people.

Many people have quite strong views on this topic, but I am comfortably ‘on the fence’ in the sense that I have seen some wonderful large murals in Butterfly care homes which have brought lots of happiness and conversation, but I’ve also seen some ill-thought-out artwork which has done the opposite and just doesn’t make sense or add any joy to people.

Location, location, location

In an interesting feature by Sue Learner in 2018 (Carehomesuk) there were some important critiques of the trend for large murals.  Anna Park, care consultant shared “I understand the idea of bringing reminiscence therapy to life with colourful, nostalgic murals, but I think the scale, design and permanence of them aren’t always dementia friendly with many commercial companies jumping on the bandwagon without an understanding of the main principles of good dementia design.”  A quick internet search reveals lots of companies who are providing what are described as ‘dementia friendly’ murals.  One of the murals shared in the 2018 article was of a huge aeroplane mural across a whole wall in the dining room of one care home.   What is striking with this example is that it had no relationship with food or mealtimes.  One of the important principles of design in the Butterfly Approach is to have images which relate to the function of the room and are therefore helpful in terms of orientation. Wendy Mitchell, the late writer and dementia activist agrees with this, “As a navigation tool to indicate the function of a room they have some purpose, but they must be contextually relevant and not add to a sense of bewilderment.” (Carehomesuk, 2018)

Local themes using local talent

Some of the best murals I have seen in care homes have involved local artists coming in to create bespoke art which involves talking to the people living and working in the home, so that what is created is relevant and relates to the interests and backgrounds of people living there. Involvement of the people whose home it is seems obvious but is often overlooked (Winton, E., & Rodgers, P. A. 2019).   In one of our Irish Butterfly homes in St Brendan’s CNU in Co. Galway, Anita Boyle, the artist has created some beautiful murals of the lake and other landmarks in the area as well as a Café façade and smaller features such as vases with roses, an old radio etc.  

St Brendan’s have also involved a group of St Brigid’s Art & Design students with their teacher Siobhan Treacy to create a mural with interactive and sensory elements including lights which go on inside a house and tactile flowers around the outside of the house.  

Credit: Siobhan Treacy, Art & Design Teacher and Transition Year Students, St Brigid’s College

Coorheen Butterfly Home St Brendan’s CNU, Loughrea, Ireland

Nature scenes are likely to promote wellbeing for most people, but it will again be important to consider what kind of nature might be relevant and interesting to individuals living in the home – forests, mountains, lakes or beach scenes.    When talking to Anita, the artist at St Brendan’s, I encouraged her to include some ‘live’ elements to her landscape, such as a dog running beside the lake, a woman pushing a pram or some children playing in a park.    These can literally bring the landscape to life and are more likely to prompt a conversation, “Did you used to walk your dog near the lake?”  “What games did you play outside as a child?” etc. 

Credit: Artist, Anita Boyle

Coorheen Butterfly Home St Brendan’s CNU, Loughrea, Ireland

Keeping it real

Murals of shopfronts are popular in some of our Butterfly Homes. Whilst these don’t really convey a sense of ‘home’, they do offer a feeling of a destination or a sense of going out for those who spend long periods inside.  It is important to offer some ‘real’ objects to engage with linked to these murals, for example some fresh fruit in a basket near a Fruit Store mural or a clothes rail with dresses, shirts, scarves etc near a fashion shop scene.   This gives a more interactive and sensory element than just the ‘flat’ picture.  (Sas, C., Davies, N., Clinch, S., Shaw, P., Mikusz, M., Steeds, M., & Nohrer, L. 2020)

Appetising food related murals in dining areas can cue everyone in to eating and help promote our appetite.  We will still need to be aware that food preferences are varied, so imagine if it was something you disliked or were allergic to greeting you on the walls of the dining room – or something that you wanted and then it wasn’t on the menu!

Truth or lies?

What about murals or wraps which are on objects which are pretending to be something which they aren’t? We encourage care homes following the Butterfly Approach to disguise their medicine or housekeeping carts with something more fun and colourful.  Some have found some creative wraps or decals to do this well including pictures of post boxes, flowers and birds and the sweetshop featured below.   It is certainly less institutional looking, but some might argue that this involves an element of deception on a medicine trolley/cart (even if some of us will remember the Mary Poppins song that ‘A spoonful of sugar helps the medicine go down … in a most delightful way’!)? 

Credit: Belmont House, Butterfly Lane, Toronto, Canada

Regrettably there seems to be little published research on this topic.   However, arguably some writers assert that we already know a lot through what has been tried and tested. (Evans, S. C., Waller, S.& Bray, J. 2022) There have been some critiques of murals which are ‘hyperreal’ also known as ‘trompe l’oeil’ which are meant to deceive the eye.  People living with dementia already often face perceptual and spatial awareness difficulties, so these could further confuse or unsettle people. (Andrews, J and Quirke, M in carehomeuk article, 2018)

Some murals I have seen are pretend pieces of furniture, for example a love seat on a wall, which is surely likely to lead to people falling trying to sit on it?

Decals of bookshelves/libraries are often used to disguise an exit door, but do we consider how frustrating and confusing it might be to reach for a book and for it to be just a picture? Others would argue in their defence that the titles and authors on the book spines would themselves provoke positive memories and discussions, and they will be helpful in distracting someone from wanting to leave.   However, it would make much more sense to have a library mural in a reading nook area with a side table, lamp and actual books chosen with some consultation as to the reading preferences of people living in the home.

There is an increasing focus in design in relation to dementia specialist elements, which might enhance our understanding of what works best for people and offers more freedom of movement, particularly in ‘secure’ environments where people understandably feel frustrated and trapped.   (Anderson DC, Kota SS, Yeh L, Budson AE. 2023)   The current thinking around disguise of exits suggests merging the colours and pattern of the walls with the elevator or door, so they become hidden, rather than making them a feature or destination, as they are in this example.

A disguised elevator and exit door

Credit: Belmont House Butterfly Lane, Toronto, Canada

In one home I remember in Bristol, UK, there was a mural of a stable door, with a very life-like photograph of a horse looking over the door.   When I looked closer, there were lots of stains of porridge near the mouth of the horse, where people had obviously been feeding him.  When I asked the home manager, she said the horse was a much-loved character in the home, so arguably this ‘deception’ had generated a great deal of pleasure.    This is not dissimilar to the use of dolls which become very real babies in the reality of some people living with dementia.

A pretend window view in a bathroom with no window is another debatable feature.  Will the view of the outside hills and the sunshine make the bathtime experience more pleasurable or will it be disorientating?  Most anecdotal evidence I have gathered is that they lessen the claustrophobic feel of the bathroom and enhance the experience, more than being a negative feature.  A large mural of a map of the world in a bathroom can also be a wonderful conversation starter about the places people enjoy visiting or would like to visit.  I personally find the predominance of seaside themes in bathrooms somewhat predictable, but I know many love them!

Long narrow hallways can easily be lifted by features which create a sense of an outside walkway or a brick wall effect wallpaper, as illustrated here in a Butterfly Home in Devon. Whilst these are ‘fake’ bricks, the effect is realistic, and the flower basket additions add character.

Credit: Old Rectory Care Home, Southern Healthcare, Exeter, UK

The writing on the wall

I particularly like murals or decals on walls which include verses of poems or songs, especially if they connect with the location, though quality and durability can be an issue with these.  In one home, the hallway which leads to the garden has the words of the song ‘English Country Garden’ as well as an array of garden related images.  In another home, the “I’m forever blowing bubbles” words are just outside the bathroom.  

Lyrics are likely to prompt people to sing as they walk down a hallway, and quotes or poetry might offer pause for reflection.  However, some of the commercial versions of these can tend to be quite sentimental, which won’t be to everyone’s taste.

Not one size fits all

Here of course lies the central problem when choosing murals in a group living situation.  It is a group of individuals who will have different things which are likely to appeal.  I would love a mural of the Star Trek Voyager crew as this has been a television series I have followed avidly since my 20s, and with which I have very positive associations.  However, for those who don’t know the series, an image of a Talaxian or a Klingon ‘alien’ character might be very alarming!

Those thinking about choosing murals might therefore need to default to more generic and ‘safer’ topics which are likely to appeal to the majority.  This is why murals related to the sea, to gardens and to children and animals are the most common themes.  If you are trying to make it feel more like a real home, some might argue that photographs and paintings in frames are much more ‘home like’ and more ‘adult’ than murals.   However, they do not cover as big a space or have as immediate an impact as more large-scale murals.

Context is everything

So, what can we conclude in relation to what is positive or problematic in relation to the increasing use of murals in care homes?  It seems that context is everything, and so often the very best murals have been chosen and created in consultation with people living and working in a home, as in the St Brendan’s example above.  Thought being given to images which help people in terms of orientation to the function of the room or the direction of the hallway to help with wayfinding are surely a good addition.  Ultimately the ‘proof is in the pudding’ as you will see the reactions people have to murals and whether people stop and smile when they look at the images and talk about the things they see with enjoyment.  You might need to be prepared to admit you have made a mistake if the reactions aren’t positive and particularly if they cause any distress, so it’s obviously better and more cost-effective to do your homework in advance if you can!

At Meaningful Care Matters, we would argue that it takes much more than changing walls to create real culture change to reduce the sense of an institution. However, it can certainly have a transformative impact on the look and feel of an environment for those living and working there, with the ultimate goal of deepening the feeling of being at home and having things which bring joy, happy memories and conversations to the day.

Please do let us know your experience and share your images and stories with us via admin@meaningfulcarematters.com 

References:

Carehomes UK, 2018 – Dementia writer Wendy Mitchell warns care homes nostalgic murrals are ‘confusing and disturbing’  by Sue Learner https://www.carehome.co.uk/news/article.cfm/id/1601526/dementia-writer-wendy-mitchell-care-homes-murals

Winton, E., & Rodgers, P. A. (2019). Designed with me: empowering people living with dementia. The Design Journal, 22(sup1), 359-369.

Sas, C., Davies, N., Clinch, S., Shaw, P., Mikusz, M., Steeds, M., & Nohrer, L. (2020, April). Supporting stimulation needs in dementia care through wall-sized displays. In Proceedings of the 2020 chi conference on human factors in computing systems (pp. 1-16).

Evans, S. C., Waller, S. & Bray, J. (2022). Designing inclusive environments for people living with dementia: how much do we really know?. Working with Older People, 26(2), 89-96.

Andrews, J and Quirke, 2018 online https://www.carehome.co.uk/news/article.cfm/id/1601526/dementia-writer-wendy-mitchell-care-homes-murals

Anderson DC, Kota SS, Yeh L, Budson AE. Built Environment Design Interventions at the Exits of Secured Dementia Care Units: A Review of the Empirical Literature. HERD: Health Environments Research & Design Journal. 2023;16(1):251-269. doi:10.1177/19375867221125930

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Working an allotment has always been a favoured British pastime. We have an allotment. Well, I say we – my husband does all the hard work.

Gardeners love their outside world and tending a garden or an allotment can the main occupation of many retired people. We have broad beans chitting on a window sill right now. Later will come potatoes, runner beans and all sorts of other vegetables and fruit. There will soon be trays of seeds in the greenhouse and on any available sunny ledge.

Having an allotment has become a popular hobby for many people during the pandemic. The former reliance on normal routines became unpredictable with work, schools, clubs, shops, and holidays all stopping and starting with unpredictable regularity.  Many people reverted to activities favoured by parents and grandparents, gardening, baking and crafts. 

As a rule, if there is earth, sun, and rain something will grow. With a bit of planning and application we can even control what grows.

Gardening is an activity that can benefit everyone. Our grandchildren love going up to the allotment with their grandad to see what’s growing. Few pastimes can surpass the picking and eating strawberries on a sunny day. Harvesting route vegetables is like a miracle to young children. It is amazing that by turning over the earth it is possible to collect potatoes for dinner!

The generation of people living in care homes now are very familiar with growing fresh produce in their gardens and on their allotments. It’s an activity that can absorb the whole year from browsing through seed catalogues to potting, planting, and harvesting. Even preparing the ground is a very therapeutic activity; there is something very satisfying about spending time digging over a patch of earth.

But it can be difficult to persuade people outside. Becoming inactive is an easy habit to develop especially during winter. Congratulations to those care teams who manage successfully to encourage people outside.

• Adding purpose to going outside is key; going to look at the snowdrops and daffodils coming up, to decide where to put the potatoes and carrots, help dig over a patch of earth.  
• Making it easy to take one or two steps outside of the door is also important.
• Enthusiasm from the care team is essential.
• Leaving a door open, or ajar on a particularly cold day, can help tempt someone outside.
• Making it possible for the people already outside to be seen by those inside
• A coat hanger by the door with some coats to slip on quickly,
• Some boots by the door
• A table just outside the door with a few pots with some soil, maybe a trowel, an old rag to wipe fingers
• Some mugs of hot tea outside can be a great reward.

If it’s cold outside, we can soon warm up afterwards. If it’s raining, we can soon dry off when we come back inside.

Bringing the outside in, with plants and pictures is valuable. But helping people get outside to breath the fresh air brings so many benefits.

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The selection of colours in dementia is not arbitrary; it is grounded in the understanding of how a brain processes visual stimuli.  Warm tones such as yellows and oranges are often employed to create a sense of warmth and familiarity, evoking feelings of comfort and security.  These colours can often be especially beneficial in communal spaces, helping to foster a welcoming atmosphere and encouraging social interactions among people living in care homes.

Cool colours, such as blues and greens, are known for their calming effects.  In areas where a serene ambience is desired, like bedrooms or quiet spaces, these colours can contribute to a peaceful environment.  Calm and soothing surroundings can alleviate agitation and anxiety, common challenges faced by individuals living with dementia.

Contrast plays a crucial role in colour selection for dementia care.  Bold colour contrasts can aid in distinguishing objects and spaces, facilitating navigation and reducing confusion.  For example, contrasting between walls and furniture can enhance visual perception, making it easier for individuals to identify and interact with surroundings.

Personalization is key when integrating colours into dementia care.  Considering the individual’s preferences and background can inform colour choices that resonate with their personal history.  Colours associated with positive memories, such as a favourite colour associated with a Sports team or reminiscent of nature, can evoke positive emotions and contribute to a sense of well-being.

Visual cues are powerful aids for individuals with dementia, helping them navigate their surroundings and maintain a level of independence.  The strategic use of colours can assist in clear visual cues, aiding individuals in recognizing doors, bathrooms, and other essential elements of their environment.  This, in turn, promotes a sense of autonomy and reduces feelings of disorientation.

In addition to physical spaces, colour can be integrated into daily activities for therapeutic purposes.  For instance, using colourful tableware and dining accessories can stimulate appetite and make mealtimes more engaging.  Incorporating a variety of colours in activities and decorations can enhance sensory experiences, providing individuals with opportunities for creative expression and cognitive stimulation.

However, it is crucial to approach colour implementation with sensitivity to individual preferences and cultural backgrounds.  What may be soothing for one person may not be for another.  Regular assessments and adjustments based on individual responses ensure that the chosen colours align with the person’s evolving needs and preferences.

The thoughtful and intentional use of colours in dementia care can have a profound impact on the well-being of individuals living with cognitive challenges.  From creating visually stimulating environments to evoking positive memories, the therapeutic palette extends beyond aesthetics, becoming a dynamic tool for enhancing the quality of life for those navigating the complex journey of dementia.

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I’ll be home for Christmas
You can plan on me
Please have snow and mistletoe
And presents by the tree

Christmas eve will find me
Where the love light gleams
I’ll be home for Christmas
If only in my dreams

Tannin, 1943

There are many songs at Christmas which describe a longing to be home. However, home creates a wide range of different emotions and for some, home is not necessarily where your heart is. Yes, Christmas is a magical time of year, but if you had a magical pair of ruby red slippers, to take you home, what and where would home be for you. What does home mean for you?

Is there really “no place like home “? 

“If I ever go looking for my heart’s desire again, I won’t look any further than my own backyard; because if it isn’t there, I never really lost it to begin with!” (Dorothy from the Wizard of Oz (Flemming, 1939). Home is a funny word. With hundreds of meanings, different places, and different people. It can be difficult to decide and define what and where home is. Home, in my opinion, is a feeling, not a place or a person, but an emotion rooted deep inside us. Home is where safety is felt not just physically but emotionally, and love is always flowing. It doesn’t have to be four walls and a roof, yet it could be… It’s somewhere that you can watch flowers grow and listen to the rain fall, but it’s also understanding this can be a metaphor for us as well. Yes, Home can be a place, but most of all home is within each and every one of us. 

Home is a place blessed, where you and the people who you recognise as family can be secure, have all you need, and share your sadness and happiness. Where you can help each other and find a place where we are free to be ’me’. It does not matter how big or small home is as it is not always bricks and mortar (Habitat for Humanity International, 2022).

It is not about blood relatives who are family as sometimes they are not the relationships that allow us to feel safe and be who we want to be.  Home is about you.  Home is where you can be yourself and no one judges you for doing so.  Home is being surrounded with people who matter. We are home when we feel contentment, happiness, and love.

In a care home in Toronto recently, a woman who was feeling quite distressed, saw a little pair of shiny red children’s shoes on a table, which had been brought in by one of the MCM team as a prop to illustrate the power of objects.  Her face lit up and she clasped the shoes close to her heart saying “Sophia, Sophia” repeatedly.  The shoes had clearly transported her to someone precious to her.  She kept smiling and rocking the shoes as if they were the child who had worn them. 

The true magic of the ruby red slippers is they transport us home, just as they took Dorothy back to a place of happiness (Aunty Em’s house) they too can transport us to a place where we can ‘BE’. This is the magic of Christmas.

Don’t presume that people living with a dementia, disability, mental health problems are thinking of home as the traditional stereotype which is often portrayed this Christmas.  To be truly emotion centred, understand what makes home meaningful for people and create a way for the people we care for to truly experience ’home’ this Christmas. 

There’s only one way to end this blog.  Close your eyes imagine a pair of ruby red slippers click your heels three times and say, ‘there’s no place like home’, ‘there’s no place like home’, ‘there’s no place like home’.

Bibliography

Flemming, V. (Director). (1939). The Wizard of Oz [Motion Picture].

Habitat for Humanity International. (2022). What does home mean to you. Atlanta, Georgia, United States of America.

Tannin, K. &. (1943). I’ll be home for Chirstmas [Recorded by B. Crosby]. Hollywood, Calafornia, United States of America.

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Growing up and living in Australia for most of my life, I took for granted ready access to sunlight and the outdoors throughout the year. One of the biggest challenges I have discovered living in the UK is the weather. If you stayed inside every time, it rained you wouldn’t leave the house for months!

Recently we had the opportunity to have a short family break at a lovely cottage in Cornwall. We even had the chance to take our dog with us for the first time. We all had such a lovely time. The beautiful countryside and outdoors made such a huge difference. Yes, it was still cold, days were short, and the nights were still long. It was such a pleasure to be able to spend time all together in the outdoors and fresh air.

There are so many benefits to the outdoors, some of which include:

• Boosting your energy, mood, and immune system
• Increased opportunities for exercise such as walking
• Your vision can benefit too when you have a break from screen time.
• Sunlight boosts your Vitamin D, and may also help with pain

Sometimes we forget that so many people living in care homes can’t readily access the outdoors and enjoy its immense benefits. Whether this is due to lack of an outdoor space or access to the outdoors (e.g. an inner city location) physical limitations or difficulties finding an accessible outdoor space.  If physically helping someone in your care to access the outdoors isn’t possible, maybe you can help to bring the outdoors inside to them using the five senses – sight, sound, taste, touch and smell. Let’s help everyone to enjoy and remember the benefits of the outdoors.

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It is not unusual for people living in care homes to say ‘No’ when offered an opportunity to go outside.  For similar reasons, the familiar chair and warmth of the inside might be hard to leave, and the fear of the unknown will mean that person is anxious about going out.  Another common reason for older adults to be nervous is that there might not be a bathroom or toilet nearby if needed urgently.   It is important for Recreation/Activity teams and care workers to understand this anxiety, so that they can provide reassurance that bathrooms are close by.

When providing incentives to just go into the garden, there are a range of simple ideas which can encourage people.  Martha, aged 88, was asked if she could fill the bird bath with water on a regular basis and however cold the weather, she went out every day with a watering can to do this important job.   George, who is a keen gardener enjoys sweeping leaves and helping prune the flowers, when invited by the care home gardener.    Another care home put up a basketball net on a wall in one of their garden areas and lots of the people living and working in the home became quite competitive about scoring goals in this.   This had the triple benefit of fresh air and lots of good physical stretches and laughter thrown in!   

Creating invitations and destinations

It is important to consider two important things when creating an engaging garden space – invitations to sit or do things and destinationswhich are inviting and interesting.  Invitations could include some garden equipment like a broom, watering can or trowel which are accessible to people.  Seats which invite people to sit, watch and chat like benches or companion or love seats which face each other can work well.  Destinations might include an area where people can watch a bird table, or a fish pond or even a view of a car park and people coming and going.  Other day services and homes have created vegetable allotments or sheds for doing jobs like potting plants or woodwork.  Another one of our Butterfly Homes in Nottinghamshire, UK have a wooden Tea Room in the garden, with pretty tablecloths, tea pot and cups to give the experience of going on a special outing, even it its only meters away from the main care home.  

Whatever invitations or destinations you offer to people, it is the role of the care worker or recreation or activity team member to provide the right incentive to encourage someone to go out.  For one person, it might be the tea (or something stronger!) and cake, for someone else it might be the basketball net and for someone else it might be to ensure that the birds are being fed.  As always, knowledge of the individuals we support can make all the difference.

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In one of the hallways of a care home I was working with a few years ago it was decided to decorate one long hallway wall with a mural depicting scenes and characters from the film ‘A Wizard of Oz.’ Where this idea came from remained a mystery and although it was well executed, it puzzled me from my first viewing. What was it about? What relevance did it have to the people living there? Again, it was a big improvement on how it looked previously, but I felt an opportunity had been missed.

Other places I have been to have incorporated outdoor scenes to varying degrees of success. Murals of nature and farm animals certainly went down well in a care home in the far south of Ireland, but not so much in a care home in Bristol.

In the former place, people would talk about the jobs they did, their experiences as children and sometimes just the sheer beauty of it all. In the latter, people seemed to like it more than the bland hallways, but you got the impression that they wondered too what it was all about.

The rationale for trying to bring the outside, in seems simple. Often in the UK, it’s seen to be ‘difficult’ for people to get outside and enjoy nature. Surely, it’s easier and safer to bring it indoors. It’s too wet, too cold, too windy out there. Certainly, I have never seen a deliberate attempt to bring those elements of the ‘great outdoors,’ ‘indoors’ at a care home.

But pastoral themed hallways should never be used as an excuse for people not needing to go outside.

Careful thought needs to be given before bringing the Great Outdoors inside. Are pastoral scenes always desirable? In Ireland, the care home was on the edge of a village and the scenes depicted in hallways related directly to what was around. There were also objects for people to look at and hold linked to the scenes painted in the hallways.

Thinking about it now, in Ireland it was real. In Bristol, it seemed an irrelevant ideal. The countryside scenes seemed to depict a place out of reach and far away. In terms of objects, what had been put there, had often been put away.

By the way, don’t get me wrong. I really like Bristol. It has great character and beauty, so why wasn’t it depicted in this care home?

When we want to bring the outside in, it doesn’t just have to work on a sensory level but also on a cultural level too.

I was born in Liverpool. I would like to think the hallways in a care home I lived in would need to be decorated with pictures of home, not just the docks or Anfield football stadium, but the terraced street I first lived in and then the suburban close so familiar in many British cities. For us city dwellers, what would be the ‘Great Outdoor’ items to fill the hallways? A plastic football, a skateboard, bus tickets, the newspaper we got from the shop, supermarket shelves? They may not look pretty, but I think they would make sense to me.

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During our research, the attitudes, values and practices of the organisation, its people and its culture, was shown to be the biggest factor influencing engagement levels outside by residents. Those care settings practicing person-centred care, and beyond, will more naturally engage outside as and when a resident wishes throughout the year.  So, if you are asking yourself ‘why don’t we go outside more?’ we often have to look at ourselves and our own attitudes first.

Many of us, not surprisingly, may not like winter or really relish the thought of going out in the cold, rain, snow or wind. Who wouldn’t much prefer going out on a perfect summer’s day?   Our own connection, or resistance, to going outside at this time of year may have a subtle sub-conscious influence on our willingness to go out with residents too. As in so many areas of life we may need to check in on our own bias, to watch any negative language, regards going outdoors. Instead we need to consciously focus on peoples’ interests, life story and listen out for those often subtle connections and desires that present an opportunity to step outside when people reveal the wish to do so.

Residents who enjoyed an outdoor life through their work or hobbies, or owned a pet which took them outside to undertake daily tasks (dog, horse, chickens to name a few) may well have had to go out in all weather. And as many will tell you, they too may not have wanted to go out in the rain etc but having done so, they then will often recount tales of unexpectedly beautiful moments outside and a sense of glowing, even smugness, at having made the effort when they come back in.

Others may have stepped out simply for the joy of being out in the elements themselves; going for a walk or enjoying watching the birds and nature unfolding around them.  Who doesn’t enjoy a hot drink after a bracing walk on a cold or windy day? How can you plan this ‘hug in a mug’ reward for those who venture out to feel the cold and wind on their face?

The Scandinavians have a saying that ‘there is no wrong weather only wrong clothing’. Look at how prepared you are for being able to support people who may wish to go out in all weathers, what may they want to do there and who may need to support them? Do you have the right clothing and shoes to hand so you can grab the moment when they wish to go out? Just as importantly do you have suitable clothing to hand for yourselves too? 

For those living with dementia, seeing and sensing the changing seasons may help people orientate themselves within the year with key triggers such as: bare branches of trees or the sight and feel of  frost or snow on the ground and seeing the birds and animals working hard to get through this tough season, possibly with help from us with feeders and water. What activities can you do to emphasise the seasons unfolding outside the door? What seasonal tasks did people do in their gardens at home and what can they help with now?

For more information for supporting people to go outside in all weathers you may find the following resources helpful:

An inspiring and colourful A3 Infographic poster including hints and tips for engaging outside more and helping visits last longer. Ideal for noticeboards:  https://stepchange-design.co.uk/shop/a3-infographic-poster-why-dont-we-go-into-the-garden/

A Webinar recorded for NAPA exploring ‘Weather’ to go outside? This explores the role of Care Culture by using the weather to help understand what may hinder your engagement outside. (50 minutes)

There are lots of free articles exploring much more at:  www.stepchange-design.co.uk

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Firstly, it’s helpful to understand that there are two distinct types of interactive table:

Interactive Digital Tables and Interactive Projection Tables

Digital Tables

These behave very much like a giant iPad with touch sensitive screens.

They’re often mounted in a large frame so they can lay flat or be tilted for upright use.

They require a basic level of touch-screen fluency

They are usually limited to one user at a time

May include access to the internet, youtube and other websites & resources

Are best suited to 1:1 activities or when staff are facilitating a group activity

Projection Tables

These use motion sensitivity rather than touch-screens

The projections are displayed on an ordinary table of any size.

They respond to movements/gestures over the surface using infra-red technology

They are intuitive to use and can work with many people playing at once

Provide a variety of motion-led activities incl. ‘painting’ flowers, ‘popping’ bubbles & ‘catching’ fish

Often include music and sound effects

Are more accessible for people living with dementia or anyone who struggles with dexterity

12 Questions to ask when considering rental/purchase of an Interactive Projection Table:

1. Can we see one in action? (Use this opportunity to check it responds well to movement)

2. What is included in the package? What else will I need? Are there hidden costs?

3. What Effects/Games styles are included? E.g. Wipe/Paint, Splat/Pop, Water, Scatter, Ball Games

4. How many different Activities/Applications of each Effect are supplied?

5. Was the content designed for older adults or is the same version used with children?

6. Is there a good balance of sensory/calming activities and more upbeat/physical games with props?

7. Are there activities for all moods, interests and cultural backgrounds?

8. Does the system include music and sound effects? If so, is there a volume control?

9. Can it be moved easily, and used on a floor or over a bed?

10. Can it be wheeled/transported to use on different floors/sites?

11. Is the projection bright enough to be seen without closing too many blinds or curtains?

12. Can the content be personalised with photos and recordings?

If you are planning to use a mobile projection system with people living with dementia, then explore the sensory content available, particularly nature sounds, music and images. The way the system responds to movement and its intuitive use can be a powerful combination for anyone lacking a sense of control in their life.

Good luck! And remember it’s all about making connections not filling time, any interactive resource needs to be shared with warmth, humour, energy and the right balance of support.

ANNA C. PARK
Care & Training Consultant

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