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The residential home that's reinventing dementia care
With its imitiation Fifties sitting room and a lifesize mock-up of a shopping street from yesteryear, Abbeyfield House is an ingenious care home that keeps its residents mentally engaged
“Have you noticed there are no mirrors?” asks Alastair Mulvie, at the end of an afternoon spent among dementia sufferers and their carers. As a so-called trained observer, I’m ashamed to admit that the absence of mirrors had not struck me. I’d been, too, busy poking around the imitation Fifties’-style sitting room, fitted out with wing chairs, a wireless, an early television and a bakelite telephone, where residents could slip comfortably back to that part of their lives they best remembered. How inspired. Even the botanical wallpaper was right.
I’d admired the mock K2 red telephone box in the hall, the post office counter and the bow-fronted “shop” stocked with products familiar to the elderly in their active days – Spel washing powder, Borwick Baking Powder, Cremo Oats. Abbeyfield is a house of reminiscences and diversions. There’s too much going on to notice anything missing.
Music is soothingly audible all over the house, illustrated books left open on tables. A radio is babbling softly on the landings and a caged bird trilling somewhere upstairs gives the place an unexpected feeling of lightness. Two or three people are nodding over the pages of their “lifestory” books, a compilation of photos and words to remind them – and their carers – who and what they were. The pictures provoke a stream of reminiscences and a ready topic of conversation. This much is easy to appreciate.
But mirrors, or lack of them? Slowly it begins to dawn on me. How terrifying to wake up finding you have aged 50 years, not to recognise the hands on the bedclothes as your hands. Passing a mirror in the corridor and seeing a stranger reflected there is unnecessarily upsetting. Mulvie explains: “In their minds, some people have reverted to being 20 or 25. It can be alarming not to recognise their present selves. We try to take away that anxiety.”
In an enlightened place like Abbeyfield House, at New Malden in Surrey, the feared stereotype of the dull, tidy, institutional care home where lines of frail, subdued people are ranged blankly in front of a television has nowhere to take root. Stimulation is the watchword, together with thoughtfulness for individual needs and individual pasts. It’s significant that among the 36 elderly residents, all of whom are in a moderate or advanced stage of dementia and need specialist care, only three are currently on antipsychotic medication – and then at the lowest possible dose.
“Many homes have residents who are drug dependent, and that may be because they lack stimulation,” says Mulvie, head of fundraising for the Abbeyfield Society. “We find that giving people interests and helping them to engage with their surroundings helps to keep them off drugs by minimising the anxiety that so often goes with dementia. As time rolls back for them and recent memories tend to disappear, we try to help them recapture a level of remembrance.”
We are in a bright ground-floor sitting room, five of us, and Mulvie is talking quietly out of deference to the people who live here. “We are in their home. We are not necessarily invited.” One of care home’s slogans is: “You’re not our guest, we’re yours.”
Abbeyfield is a Hertfordshire-based charity with 500 homes across the country. Eighty-two per cent are dedicated to Supported Living (the elderly live independently but with a house manager), two per cent provide Independent Living with Care (such as help with dressing) and the remaining 16 per cent are Care Homes like the New Malden house, with expertise in dementia, a terminal illness often misunderstood as a natural part of the ageing process.
Michael Perrett’s 81-year-old wife, Sheila, has been at Abbeyfield House for more than two years. He spends three or four hours with her every day, helping her with meals because she won’t eat without him. Some months ago when he developed a chest complaint and could not travel, staff brought Sheila to visit him at home in Kingston where they have lived all their married life. On their 60th wedding anniversary, they invited the couple’s neighbours and relatives to a surprise party. “They know me. They welcome me. They check up on me. From the cleaning lady to the house manager, everyone is fantastic. I feel they look after me as well as my wife.”
He recalls the day it all started. They were out shopping in Bentalls and Sheila told him to wait in the courtyard while she chose him a birthday present. “I waited and waited. Three-quarters of an hour went by. I went through all the departments looking for her. Then I rang home. Sheila was there. She had travelled by bus. She had no explanation for it.”
Through accelerating dementia, he nursed her for three years, changing bedclothes in the middle of the night, constantly on alert, frightened for her safety. They were both prisoners of her condition. “I had to lock all the doors and take away the keys. Eventually I collapsed from the strain and ended up in hospital. I was just worn out.”
Abbeyfield has given him peace of mind and liberated him from the isolation of dementia caring. “When I come in, Sheila has a lovely expression, holds her arms out and says: ‘I do love you.’ She still recognises me, but not her twin sister, Mary. She doesn’t remember our life together and that’s one of the most difficult things. I used to read to her but now she shuts herself off.”
Mr Perrett, 82, takes me proudly through his wife’s lifestory book – her growing up, their wedding, their many walking expeditions, her retirement presentation. She is diminished now, her head drooped forward like a flower too heavy for its stalk. He cannot believe this is the woman who walked over half of Devon, Cornwall and Somerset with him. Yet leafing through the book is not unremittingly sad because he sees it as one of the simple, intelligent things Abbeyfield has devised to create interest and identity for even its frailest residents – and it works.
“We were always best pals,” he says. “She is more at ease here, we both are, than struggling at home. After lunch, she likes to cuddle up with me on the settee. She knows me as a nice boy, and a nice man. Even though she can’t respond when I talk to her, coming in here is something I look forward to every day.”
One of the most poignant rooms in the home is a small crepuscular nursery with soft toys, dolls, an old-fashioned cot and a bentwood rocking chair. Here, women who believe they still have a child, or who miss a child, can act out consoling maternal routines, nursing themselves back to security without the need for anti-psychotic medication.
John Rivers’ wife Margaret used to take care of the household accounts, did the cooking, shopping and washing and generally spoiled him, he admits. One day, she burst into tears over columns of figures and blurted out: “I can’t do this any more. I can’t think like I used to.” Soon, she could not remember her pin number. “It just gradually got worse and worse,” he recalls. “I had to dress and feed her. One night I found her sleeping fully dressed on the kitchen floor and couldn’t lift her up. After three months, I went to pieces, I really did.”
Margaret, 79, was a watercolourist and skilled teacher and writer on embroidery. John, 86, is a graphic designer. He rejected five “awful” care homes before finding the right level of specialist care and dedication at Abbeyfield. “It has given me a life back and Margaret is as contented as she can be. She can’t talk now, but I know she enjoys my company and that she is in a wonderful place.”
This month, Abbeyfield was in a shortlist of five for a “best dementia care home in Britain” award. As a leader in the field, it funds academic research and campaigns to improve the lives of older people. Currently, it is working on a prototype for a benign form of tagging that will prevent confused old people from entering the wrong bedroom and helping themselves to other residents’ possessions – a familiar source of distress in care homes.
It already has an electronic system to warn care staff when a resident who is at risk of falling attempts to walk unsupervised. Falls are one of the commonest causes of premature death.
The house manager, Danny Torsoo, knows all the residents’ likes and dislikes, their fears and foibles as well as their personal and medical needs. Using first names and often walking arm in arm, he converses gently with them, unhurried and attentive. Their physical and mental health is constantly assessed, their families kept in the loop. A person with dementia can forget how to eat and may not even recognise food because the part of the brain governing sense and smell may be damaged. “The skill is in knowing the residents, what they need and how to provide meet those needs” he says. “Once they have been offered a place here, we look after them until they pass on.”
At the heart of the Abbeyfield Society is an army of more than 4,000 volunteers, who are as dedicated as the staff to providing warmth, friendship and dignity through the trials of old age.
To many relatives, Abbeyfield House has become family, creating ties that are stronger than those with the community outside. It is an extraordinary testament that the person left behind after the death of a partner may well decide to live at the home even though they are not suffering from dementia.
Abbeyfield relies on the generosity of donors and fundraisers to secure its future. Most of its costs go to providing salaries for specialist staff, but constant dementia-friendly improvements to buildings and environment are needed. Abbeyfield House, New Malden, has plans for an indoor garden, an all-year-round gazebo surrounded by a sensory garden and to replace each anonymous bedroom door with a door that looks like the front door to a house.
* The Telegraph’s Christmas Appeal is supporting The Abbeyfield Society, Medical Detection Dogs and The Masanga Mentor Ebola Initiative. Our charity phone-in day this year will be Sunday December 7, when you can call a member of the Telegraph staff and make a credit or debit card donation – last year we raised some £120,000 on the phone-in day alone, once Gift Aid was reclaimed. For more about these charities, and details of how to donate to The Telegraph Christmas Charity Appeal, go to telegraph.co.uk/charity