telford arts & dementia programme

Telford Arts & Dementia Programme

Contents2 Programme Summary

6 Introduction

9 Community Initiatives: Introduction

11 Part 1: Key Findings

18 Part 2: Focusing on the Future

23 Part 3: The Case Studies

- 23 Diamond Drop-in

- 28 Ironbridge Gorge Museum

- 32 Chillcott Gardens

- 39 Millbrook House

- 45 Farcroft Residential Home

52 Dementia Friendly Buildings: Action Research Project

64 Bibliography

65 With Thanks

Programme Summary

IntroductionThis report is an evaluation of a programme of work undertaken as part of the Telford Arts and Dementia Programme, which was commissioned by NHS Telford & Wrekin.

The programme involved a series of workshops with artists at Farcroft Residential Home, Millbrook Day Centre, Chillcott Gardens Extra Care and the AgeUK Diamond Drop-In Centre. A programme of activities was also carried out by the staff at Ironbridge Gorge Museum. This involved service users of Parkwood and Bournville Extra Care Schemes.

In addition the programme also included work to develop a Dementia Friendly community building. Action research was carried out in partnership with Oakengates Theatre. Staff attended training sessions, an action plan was established and free theatre tickers were offered to people in return for their feedback on their experiences.

The evaluation was led by West Midlands based development agency Creative Health CIC.

Key Findings

1) Demonstrating the need for a creative programme for people living with dementia

• Through the projects, people were able to engage in new creative activities, and to learn new skills.

• The projects were valuable in terms of facilitating meaningful social interaction between people with dementia and others.

• Another common theme across the projects was the value of exploring people’s interests and identities and of representing and celebrating these in creative ways.

• Creative opportunities, interaction and maintaining a sense of identity are all closely linked to promoting health and well-being.

• A range of observations may be seen as demonstrating the need for the approach. Examples include: observations of unmet needs in participants – e.g. isolation, lack of focused activities; comments from participants relating to their own perceptions of their needs; levels of interest and engagement in the projects by participants; evidence that participants were still curious and interested in learning new things, and positive feedback from carers/families.

2) Partnerships and infrastructure• Two Task and Complete Groups were

established to ensure that projects were appropriate, well planned, successfully delivered and that the learning from the projects was captured.

• A dedicated Project Coordinator was committed to the programme for a year. This provided a bridge between the Arts Team, provider of services and people with dementia.

• The projects were valuable opportunities to develop new partnerships between artists and care home/museum staff, involving mutual learning and the sharing of expertise. The support and input of these staff was important and valuable, including the part that they played in helping to gather evidence to understand the impact of creative approaches to engaging people with dementia.

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• As well as the projects encouraging general interaction between participants, there was also evidence of mutual peer support. People with dementia are stereotypically portrayed as being wholly dependent on others. The kind of group participation that took place in these projects was an opportunity for participants who were able to, to support other people.

3) Increased use of the arts for wellbeing purposes

• A total 77 hours of workshops and creative activities were delivered in a range of art forms including storytelling, singing and song writing, visual arts and crafts (water colour and oil painting, collage, book making, clay and mosaics), photography, environmental art and design.

• 64 people with dementia participated in creative opportunities with up to 47 of their family carers also engaging in the activities supporting their loved ones and/or being offered creative ideas to explore at home.

• 29 workshops were delivered by professional artists over a 6 month period culminating in over 160 people (participants, families, invited guests) attending performances and parties to view the work produced and celebrate achievements.

• 7 couples (carer plus person with dementia), 21 care home residents and two care professionals participated in work to pilot a dementia Friendly building at Oakengates Theatre.

• A legacy of these projects remain in that 19 care managers, staff and volunteers have gained new creative skills which they continue to use with people with dementia in their care settings. In addition 16 staff at Oakengates Theatre have recieved Dementia Awareness Training. In collaboration with project partners the introductory theatre ticket and tour has become a permanent offer to people with dementia.

• It was beyond the scope of the evaluation to actually measure specific health outcomes that people experienced. However, evaluation evidence includes various observations that may suggest positive impacts in terms of well-being. These can broadly be linked to the New Economic Foundation 5 Ways to Well-being (NEF 2008):

- Connect: all the arts projects were participatory, participants worked in small groups and sometimes individually with the artist.

- Be Active: participants were actively involved in each of the projects as creators and makers.

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- Take Notice: in each of the projects the artists encouraged participants to enjoy the moment and to be aware of what is taking place in the present.

- Keep Learning: valuing existing skills and learning new ones was an important aspect of the Arts Programme

- Give: sharing experiences in a group situation enabled participants to participate in a community activity.

Lessons Learned for Practice• It takes time to engage people with

dementia in arts projects; there are a range of barriers to participation; levels of attendance and engagement can be unpredictable, and participants often require one-to-one support. These issues should be considered at the planning stage. Informal meetings (e.g. Introduction Tea Parties) can help to get to know potential participants.

• All projects benefitted from the time and commitment of care staff: along with the skills and expertise of the artist, this is seen to be critical to the success of a project. Involving care staff right from the planning stages was considered important.

• Given the significance of positive interaction in the projects, it is reasonable to conclude that the ‘process’ of arts projects involving people with dementia may be equally, or more, important than the ‘product’.

• Using photographs in a project is a valuable approach. Participants’ own photographs can be used to help recall memories and to maintain people’s

identities. Photographs of the project activities can remind people of what has happened so far; be used in the art work, and support the evaluation process.

• Memory work can trigger negative memories as well as positive ones: recognising this and responding appropriately is part of the ethical implications of undertaking this kind of work.

• During the Dementia Friendly Building pilot project a number of barriers were identified, all of which stopped people from enjoying a visit to the Theatre. These were addressed straight away by small changes and improvements to customer services. Improvements included an introductory tour of the building prior to attending a performance, allocation of a designated member of staff as a point of contact and access to a quiet room.

• Further ethical issues include understanding the need for confidentiality; gaining permissions to participate in customer feedback surveys, share outcomes of the work, and gaining informed consent, especially for people at more advanced stages of dementia.

Recommendations• Explore the potential to widen access to

arts by integrating arts opportunities into dementia care services.

• The Task and Complete Groups should continue to share and develop ideas, knowledge, and training in arts and

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dementia work. There is also the potential to widen participation in the group to include those in wider strategic roles.

• There is a need for a peer mentoring scheme for artists working in the field of dementia, as well as for basic dementia training and on-going support for artists who are new to this area of work.

• In order to help to address the one-to-one support needs of many participants, developing a network of volunteers to assist on future projects would be valuable.

• Continue to explore ways of evaluating the impact of creative interventions for those affected by dementia; involve as many people as possible in assessing impact, and encourage the use of a common framework to measure impact on well-being.

• Recognise the value of observation as an effective evaluation method in this field, but explore bench-marking and also the use of available frameworks for observation. Draw on existing models of good practice, including those utilised in Health and Social Care.

• Develop links between practitioners and researchers. Map the findings from project evaluations against academic literature addressing arts and dementia.

• Adopt specific ethical guidelines; recognise that negative impacts may also occur.

• Staff working with the general public need to participate in Dementia Awareness Training as part of their induction. Quality training will enable them to consider the barriers facing people with dementia and their carers using community buildings and develop appropriate ways to support them to access services.

• Disseminate findings as widely as possible.

• Roll out the Dementia Friendly Building action research programme to local authority leisure centres and libraries.

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Introduction

Dementia over-viewDementia presents one of the greatest challenges for modern society especially within health and social care sectors. Whether one views dementia as a challenge or opportunity is dependent upon perspective striking at the heart of society’s values, attitudes and beliefs associated with ageing and how it cares for and makes provision for some of the most vulnerable in society (Department of Health, (DH) 2001, 2009).

Clearly, the health and care system has a vital role to play in improving support for people with dementia. But alone it cannot combat the stigma attached to it. Lack of awareness among the public and poor understanding in communities has a major impact on the experience of people with dementia. (Prime Minister’s Challenge on Dementia, DoH, 2012)

People living with dementia want to remain independent for as long as possible, and they want to have choice and control over their lives through all stages of their dementia. With an early diagnosis and the right support they can achieve this. But this is not the experience of the vast majority of people living with dementia. Not only do they frequently have to battle for diagnosis and support, but everyday things we all take for granted – getting to the shops, spending time with friends and family, getting money from the

bank, going to the theatre and going on holiday – are made difficult because of the limited understanding of dementia in their communities.

People with dementia talk about stigma and social isolation. They report losing friends following their diagnosis, seeing people cross the street to avoid them, feeling lonely, and struggling to use local services. Research with the general public has shown that this is often down to the fear, misunderstanding and helplessness people feel in the face of dementia. They simply do not understand enough to support someone to live well with dementia.

The common misunderstandings about dementia – that it’s an inevitable part of ageing and that nothing can be done to improve people’s lives – prevents our communities and society from becoming more dementia-friendly and meeting the needs of people with dementia and their families. As a society, we must make sure that people with dementia, their carers and families can be active citizens with the potential to live well with dementia at every stage of the condition.

Although it is a misconception that dementia is an unavoidable disease of old age, the prevalence of dementia increases exponentially with advancing age (Alzheimer’s Society (AS), 2007). This warrants consideration since national data indicates the fastest growing age group in the United Kingdom (UK) are those aged 80 and over (National Statistics, 2010). It is estimated that there are approximately 700,000 people living with dementia and within the next 30 years, as the number of people living longer increases, this will double to 1.4 million (DH, 2009).

Designated as a new town in the mid-60’s, the resulting influx of young families in the 70’s and 80’s means that there is an even greater expected increase in older age population in Telford and Wrekin over the next 20 years than in other areas of the country. Specifically, by 2026 the number of residents aged 65+ will increase by 37% and those aged 85+ by 18%.

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The programmeThis report describes a one year pilot programme which took place in various community and care settings across Telford and Wrekin between Spring 2011 and Summer 2012. It presents a number of case studies of practical creative art initiatives together with a research-based project, investigating the development of dementia friendly buildings and communities.

NHS Telford and Wrekin commissioned Telford & Wrekin Council’s Arts Development Team to undertake this work with the aim that a year-long pilot would test out various approaches in order to measure the impact and value people placed on creativity in improving well-being and socialisation of people with dementia and their family carers. An important element to this work was evidencing a need.

Policy contextThe Telford & Wrekin programme has been delivered within a national context of political prioritisation of Dementia, (Prime Minister’s challenge on dementia, ‘Delivering major improvements in dementia care and research by 2015’, Department of Health, March 2012) and ‘Living well with dementia: A National Dementia Strategy’ (DH, 2009). This strategy sets out a number of objectives for those working across the full health economy with the aim of improving the quality of life for people living with dementia and their carers.

Evidence and approachThere is an evolving evidence-base for the role creativity can play in supporting people to live well with dementia and the influence that creative arts can have in new ways of approaching person centred care and its role within wider therapeutic treatments.

‘Stimulation-oriented treatments include art, music and pet therapies, exercise, and any other kind of recreational activities for patients. Stimulation has modest support for improving behaviour, mood, and, to a lesser extent, function. Nevertheless, as important as these effects are, the main support for the use of stimulation therapies is the improvement in the patient daily life routine they suppose’

“Practice Guideline for the Treatment of Patients with Alzheimer’s disease and Other Dementias” (PDF). American Psychiatric Association. October 2007.

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The role that the creative arts can play is also recognised in the Department of Health’s commissioned report ‘Use of antipsychotic medication for people with dementia’ (2009) when it makes reference to it’s role in its description of the characteristics of care settings providing excellent care as those which:

‘...provide purposeful activities that relate to individual preferences as well as general entertainment, …. Equally, such homes seek out and enable the provision, within the home, of therapeutic activities such as art therapy, music therapy or dramatherapy, which may enhance the social environment and the possibility for self-expression’ (Banerjee S, October 2009)

‘Creative- and art therapy provides possibilities that are mostly indicated to sharpen the capacity of the senses and the patients’ propensity to act themselves. Nonverbal therapy methods, such as painting, music, etc., are able to influence the well-being of the patients positively, within the modern healthcare system in nursing homes. The elderly and some of the dementia patients take the initiative to combine creativity and arts and to define his/her feeling for aesthetical matters. Furthermore, group therapy sessions help against isolation and lack of life perspective and hope.’ (Hannemann T, 2006 Creativity with Dementia Patients, Can Creativity and Art Stimulate Dementia Patients Positively?)

Programme outcomesThe knowledge and understanding gained through this pilot clearly supports national strategic priorities, with a strong theme arising throughout all the case studies about the contribution that this work can play in the provision of person-centred care. The programme has been successful in increasing understanding about the benefits of creativity in dementia but also wider understanding of the condition itself, which is a key priority within the National Dementia Strategy, (Department of Health, 2009) and the more recent Prime Ministers’ Challenge on Dementia.

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Community Initiatives Case Study Report

IntroductionThe Telford Arts & Dementia Programme was commissioned by NHS Telford & Wrekin, in response to a growing evidence base supporting the use of creative interventions for people affected by dementia (see for example Mental Health Foundation 2011; Cutler et al.2011). The programme has involved a series of workshops with artists at Farcroft Residential Home, Millbrook Day Centre, Chillcott Gardens Nursing Home and the AgeUK Diamond Drop-In Centre. Furthermore, a programme of activities was carried out by the staff at Ironbridge Gorge Museum. This involved service users of Parkwood and Bournville Extra Care Schemes.

A Project Coordinator Post was recruited by Telford and Wrekin Council as a freelance Project Manager and worked between August 2011 and April 2012. Representatives from the Care Homes and Programme Partners worked together to oversee the projects in a Task and Complete Group. An Artist Advisor was recruited to the Group.

The WorkshopsProjects varied in length from one off workshops and performances to an artist working with a drop-in group once a month over a 6 month period. The majority of the projects involved artists working in care settings one to two days over a 6 week period. A total 77 hours of workshops and creative activities were delivered in a range of art forms including storytelling, singing and song writing, visual arts and crafts (water colour and oil painting, collage, book making, clay and mosaics), photography, environmental art and design.

A total of 64 people with dementia participated in creative opportunities with up to 47 of their family carers also engaging in the activities supporting their loved ones and/or being offered creative ideas to explore at home. 29 workshops were delivered by professional artists

over a 6 month period culminating in over 160 people (participants, families, invited guests) attending performances and parties to view the work produced and celebrate achievements. A legacy of these projects remain in that 19 care managers, staff and volunteers have gained new creative skills which they continue to use with people with dementia in their care settings.

The EvaluationWest Midlands based development agency Creative Health CIC worked with the Programme Partners to create an evaluation framework and support workers were involved in collecting evaluation material to create the project case studies. An independent evaluator worked with Creative Health CIC in developing the evaluation and writing up the findings. The evaluation focused on a number of key questions, including:

1) How would you describe the value of creative work for people living with dementia?

2) How has the project demonstrated a need for this approach to working with people living with dementia?

3) What do people consider to be the measures of success for this work?

4) What connections have people made and how have people worked together?

5) How has it improved people’s well-being?(both people with dementia and their carers)

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The framework for these case studies was developed based upon the critical questions outlined above. In addressing the questions, a range of evaluation evidence was reviewed and analysed. The evidence included the perspectives of all those involved in projects including the artists, participants, care staff, an activity coordinator, and members of the project Task and Complete group. It was generated by a wide range of evaluation methods including reflective journals; face-to-face and telephone interviews; detailed observation; participant feedback, and a participatory evaluation session with the Task and Complete group. By reviewing all of the evidence, across the case studies, we will address two further questions that

were included in the original evaluation framework:

1) What would an effective infrastructure for this sort of work look like and how will it be developed, and who else will be involved?

2) What should constitute good practice in assessing how creativity impacts well-being?

This report presents the case studies and is in three parts. Part 1 is a summary of the key findings from the five case study projects. Part 2 focuses on the implications for future development of this work. Part 3 is the analysis of individual case studies. The entire report is structured around the critical questions identified above.

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Part 1: Key Findings

The evidence presented here summarises the main evaluation findings across all five of the Telford Arts and Dementia Programme Community Initiatives. It also includes evaluation evidence from the Task and Complete Group Final Meeting, and from the Artist Advisor. Two in-depth telephone interviews: one with the Project Coordinator, and one with the Manager of Telford and Wrekin Council’s (TWC) Creative Development Team, providedfurther evaluation data. The evidence is mapped against the critical questions that informed the evaluation.


This programme of work was the first time that the TWC Creative Development Team had worked in a dementia context. It was also the first time that creative projects led by professional artists had been undertaken in some of the project’s care settings. Through the projects, people were able to engage in new creative activities, and to learn new skills. There was positive feedback from participants and their families about the value of these opportunities.

“It offers meaningful activity in terms of being able to be active. The argument was already won in care homes about the value of the work, but there was a lack of capacity to deliver at the level that an artist would...The project bought them capacity to have quality time with the residents.”

Project Coordinator

By supporting this work, staff gained new ideas that could be further developed in the future.

There were a number of factors that facilitated people’s engagement with creative opportunities. These included:

• The role of the artist in planning activities

• High degree of flexibility – participants were able to engage at a level that they felt comfortable with.

• Variety of opportunities.

• Building people’s confidence in their creativity

In analysing the evaluation findings, three key themes emerged that further contribute to our understanding of the value of creative work for people living with dementia. The themes are: interaction; maintaining a sense of identity, and health and well-being. We will briefly examine each of these in turn:

InteractionThe projects have been valuable in terms of facilitating meaningful social interaction between people with dementia and others.

Communication could be verbal or non-verbal. The projects provided a wide variety of ‘prompts’ that helped to focus conversations. Often, successful prompts would be discovered in one-to-one sessions with a participant, demonstrating the value of a personalised approach.

On occasions, it was noted that the workshop and creative activities stimulated lengthier and more meaningful conversations than would generally be seen in daily exchanges in the Care settings.

The artists played a key role in initiating and facilitating these conversations, andthey were supported by care staff and sometimes by participants’ family members as well.

“The process of working with people with dementia through the arts can offer, at its simplest level, and even if there is no artistic product, contact, in the sense that the artist gives individuals time and attention of a

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sort that they don’t receive from any other source. This was demonstrated in all of the four projects I observed, through people telling their stories, making books, taking part in a garden makeover, or visiting a heritage site, in all of which they engaged with an artist.”

Artist Advisor

The Project Coordinator also identified the particular issues facing drop-in groups, where creative activities are often based on demonstration rather than participation. She argued that an artist-led group activity could play a valuable role in building stronger relationships within the group.

Creativity has a role to play in building a group dynamic...Artists can fulfil a need by holding the group together and building relationships. It helped to break down the barriers

Project Coordinator

Maintaining a Sense of Identity

Another common theme across the projects was the value of exploring people’s interests and identities and of representing and celebrating these in creative ways. This was helpful in enabling care home staff to get to know the residents from new perspectives. The projects could thus be seen to support people in maintaining a sense of self-identity by telling their own stories, and by creating artwork based on those stories that could be kept and shared with others.

“Each person is given an individual voice, in that what they work on and produce is either an expression of themselves – a book or a story – or an individual artistic contribution to a shared product – garden ornaments or a group poem.”

Artist Advisor

The approach supported a focus on the things that the person with dementia still knew and understood, rather than on the losses. Again, the role of the artist is critical here, as they have no prior knowledge of the participants and so they may be more able than others to focus on the person rather than the condition.

“The relationship with the artist is different to that which the person with dementia experiences elsewhere. The artist generally has no knowledge of the person at an earlier stage in their life, so, unlike relatives or friends, she does not mourn the person they are remembered as being. The artist does not have a clinical care role, like care staff, so has a capacity to see the person rather than the condition.Artist Advisor

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As the Artist Advisor also points out, there can be wider impacts from such outcomes, in that they may challenge the general, public view of people with dementia ‘attesting to continuing personhood and enduring capabilities that are often perceived to disappear as soon as dementia is diagnosed.’ She goes on to argue that the arts have a crucial contribution to make if they can alter perceptions of people with dementia as having a poor quality of life with little to contribute.

Health and Well-BeingCreative opportunities, interaction and maintaining a sense of identity are all closely linked to promoting health and well-being (see for example Mental Health Foundation 2011). This is clearly important when considering the value of creative work for people living with dementia. Another issue that was identified was the way in which artists may have the skills and experience to support people with dementia to achieve more from a creative perspective than others may have thought possible. To support someone to reach their potential and indeed to experience personal growth has clear implications for health and well-being.

Arts projects may also contribute to supporting better relationships, which are widely recognised as a critical element of well-being. The Artist Advisor argues that as well as having a positive impact on relationships with relatives, arts projects may also support the development of

stronger relationships with care staff, in that giving people with dementia more of a voice may also give them ‘more opportunity to express preferences and needs’. Other issues are examined in more detail in Question 5, which looks specifically at how projects have improved people’s well-being and relates this to the New Economic Foundations ‘5 Ways to Well-being’ framework (NEF, 2008).


In assessing the need for this approach to working with people living with dementia, it is important to firstly note that there are wider issues which are beyond the scope of this evaluation to consider in depth. These include:

• Growing political concern about the implications of increasing levels of dementia in an ageing population.

• Recognition of the need for a more ‘person centred’ approach to dementia care.

• Important issues around quality of life for people in care homes.

• The need to explore alternatives to medication for managing behavioural and psychological symptoms of dementia.

• Maslow’s hierarchy of needs: opportunities for creative engagement with a group can be linked to social needs, esteem, and self-actualisation.

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Various observations from the projects can also be interpreted as demonstrating a need for a different approach to working with people with dementia, often linked to the wider issues identified above. Such observations included:

• Observations of unmet needs in participants – e.g. isolation, lack of focused activities.

• Comments from participants relating to their own perceptions of their needs.

• Levels of interest and engagement in the projects by participants. People were often engaged in creative activities for much longer than was anticipated, and also interacted with each other more than was often expected.

• Evidence that participants were still curious and interested in learning new things.

• The ways in which people were able to interact in a way that drew upon their interests, experiences and identities.

• Commitment of care staff and their willingness to learn new ideas and continue with the work.

• Positive feedback from carers/families.

“The arts can offer a model of good practice in terms of person centred care.”

Project Coordinator


A number of measures of success were identified in the various projects. They included:

• Staff/family feedback on how engaged the participants were.

• Level of engagement sustained; for example, a group being engaged in the same activity for an entire morning session.

• Increased interaction between service users.

• Participants becoming more engaged as the project progressed.

• Evidence that participants enjoyed the project and had fun.

• Increased confidence in participants.

• Evidence that knowledge, understanding and good practice around this area of practice have been shared and utilised.

• The extent to which participants have completed their own art work that has meaning and value for them.


The evidence relating to this question could be grouped into a number of themes. These are the role of the artist; the role of the Task and Complete Group; the involvement of staff; group participation, and mutual support between participants. We will consider each in turn:

The Role of the Artist• Communication between participants

and the artists was one of the central elements of all projects. The interpersonal skills of the artist were therefore critical.

• One-to-one sessions between an artist and a participant took place in some projects and were particularly valuable in reminiscence work.

• The artist also provided practical assistance to participants in their creative work.

• Flexibility and a confidence building approach to the work were also important elements in relation to the role of the artist in connecting with participants.

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The Role of the Task and Complete Group

The Task and Complete Group was focused on ensuring that projects were appropriate, successfully delivered and that the learning from the projects was captured. The Project Coordinator felt that they were ‘a really good group of people to have together’, and that participation had been developed through the links in the task group. In particular, it was recognised as being helpful in the commissioning process, as the care settings were able to make more informed decisions. The group also provided opportunities for learning, passing on best practice, networking and support.

“I think that the fact that we went along the Task and Finish Group route helped, because people weren’t just passively attending a meeting about dementia, they were coming as part of a solutions group, and were asked to do particular bits of work. I think that’s worked well and that it will be a legacy of the project that people will want to still come and take part in that.”

Creative Development Team Manager (TWC)

The Creative Development Team Manager went on to also emphasise the value of having a dedicated Project Coordinator who was committed to the programme for a year. He highlighted that the Project Coordinator’s growing knowledge and experience in this area of practice was beneficial to everyone involved in the project, providing a bridge between the Arts Team, providers of services and people with dementia. Involvement of Staff• The projects were valuable opportunities

to develop new partnerships between artists and care home/museum staff, involving mutual learning and the sharing of expertise.

• These staff played an important role in giving practical assistance and in engaging participants in conversation.

• They worked to engage people in the projects, and to overcome barriers to participation.

• They sometimes completed extra work with participants between artists’ visits.

• One artist noted that care staff, like himself, were involved in a ‘practitioner as researcher’ role, as they gathered evidence to understand the impact of creative approaches to engaging people with dementia.

Group participationEvidence in relation to group participation focuses on the ways in which participants have interacted. A common theme in the

projects was the ways in which they had encouraged positive interaction between participants. This included sharing jokes, laughter, conversations and stories.

Mutual support between participantsAs well as interacting with each other, there was evidence of mutual peer support between participants. Examples of this included people ‘actively watching one another’ as they worked together around a table and people listening to each other’s stories and applauding. Participants were able to use skills that they already had, and were encouraged to share them with participants and carers, as an instructor. One service user was particularly supportive of others in the project, and offered praise and encouragement. People with dementia are stereotypically portrayed as being wholly dependent on others. The kind of group participation that took place in these projects was an opportunity for participants who were able to, to support other people.

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5) How has it improved people’s well-being?

It was beyond the scope of the evaluation to actually measure specific health outcomes that people experienced. Within the individual case studies, various observations were made about comments and behaviour that were perceived to indicate positive impacts in terms of well-being. In order to try to find some common links between these outcomes, we have, where possible, made connections to the New Economic

Foundation 5 Ways to Well-being (five simple actions, which scientific evidence suggests can improve well-being in everyday life). In summarising the key findings, we have further developed these links.

The 5 Ways to Well-being are: CONNECT; BE ACTIVE; TAKE NOTICE; KEEP LEARNING and GIVE

Connect All the arts projects were participatory, participants worked in small groups and sometimes individually with the artist:

• Staff observed shared laughter and evidence of positive emotions at the sessions.

• There was evaluation evidence relating to people’s levels of engagement and enjoyment of the sessions, sometimes based on observations and sometimes on direct comments from participants.

• There was some evidence of some participants being unusually positive and communicative after the sessions, and looking forward to the next sessions.

Be ActiveParticipants were actively involved in each of the projects as creators and makers including:

• The length of time that participants concentrated on arts activities often exceeded expectations.

• Using heavy materials or tools.

• Participants were also physically active in some projects for example walking at Ironbridge Gorge.

“Creative work is the opportunity of taking people out of their situation and doing something else for a period of time; something that is positive and has the ability to create optimism.”Project Coordinator

Take NoticeIn each of the projects the artists encouraged participants to enjoy the moment and to be aware of what is taking place in the present. For example:

• Responses to pictures, objects and other stimulus materials.

• Creating handmade ‘memory books’ which described the thoughts, memories and experiences of participants.

• Enjoying the natural environment in the garden project.

Keep LearningValuing existing skills and learning new ones was an important aspect of the Arts Programme For example:

• New skills e.g. carving and making books.

• History and information at Ironbridge Gorge.

• There were individual examples of participants who were observed to improve in their engagement with the project or in the way in which they communicated as the project progressed.

“Sometimes people are really uncomfortable and hesitant at first. It can be a scary step to go with it, but at the end there’s pleasure and surprise.”Project Coordinator

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GiveSharing experiences in a group situation enabled participants to participate in a community activity. This included:

• Examples of participants supporting each other.

• The sharing of memories – e.g. at a celebration event.

• The sharing of stories was a key element of the projects, and as has been noted, this has benefits in terms of maintaining a sense of identity.

Based on these initial indications, there is clear potential for the 5 Ways to Well-Being model to be further used in the evaluation of future work. We will now turn our attention to Part 2 of the report, which examines the implications of these case study projects for future work.

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Part 2: Focusing on the future

In this part of the report, we begin by identifying some of the lessons learnt for practice, based on the review of documentation from the five case studies. We then address the final two critical questions:

What would an effective infrastructure for this sort of work look like and how will it be developed, and who else will be involved?

What should constitute good practice in assessing how creativity impacts well-being?

1) Lessons Learned for Practice• It takes time to engage people with

dementia in arts projects. They may find it difficult to understand what the activity is all about, and they may forget between sessions what they had done previously. Projects therefore may progress more slowly than anticipated, and this should be considered at the planning stage.

• Informal meetings (e.g. an Introduction Tea Party) at the beginning of the project can help to address barriers to participation and to get to know potential participants.

• Participants often require one-to-one support. There needs to be flexibility in the delivery of the project and a willingness to adapt activities to suit the needs and interests of individual participants. Providing the artist with information about participants prior to the project can help to support this personalised approach.

• All projects benefitted from the time and commitment of care staff: along with the skills and expertise of the artist, this is seen to be critical to the success of a project. Involving care staff right from the planning stages was considered important.

“Giving care settings the opportunity to select their project from a shortlist was important in encouraging them to feel ownership and to give them a stake in ensuring it turned out as well as possible. Assessing the projects was valuable training for the staff and raised awareness of the range that the arts encompass. Given the length of the project, training and preparation for this was necessarily short. The selection process might be

more effective if the care setting staff had more preparation, particularly in terms of identifying the needs of their specific setting and clients, and acquiring a broad understanding of the range the arts can offer, for example that the focus of activity can be much more than reminiscence.”

Artist Advisor

• Activities sometimes need to be short and manageable, as concentration can be an issue for participants. That said, there was often surprise at the levels of sustained concentration observed in the projects.

• Activities also need to be flexible enough to accommodate varying levels of attendance and engagement week to week. Along with one-to-one support needs, this may have implications in terms of staffing.

• Given the significance of positive interaction in the projects, it is reasonable to conclude that the ‘process’ of arts projects involving people with dementia may be equally, or more, important than the ‘product’.

• Using photographs in a project is a valuable approach. Participants’ own photographs can be used to help recall memories and to maintain people’s identities. Photographs of the project activities can remind people of what has happened so far; be used in the art work, and support the evaluation process.

• Memory work can trigger negative memories as well as positive ones: recognising this and responding appropriately is part of the ethical implications of undertaking this kind of work.

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• Further ethical issues include understanding the need for confidentiality; gaining permissions to share outcomes of the work, and gaining informed consent, especially for people at more advanced stages of dementia.

Having thus suggested some of the issues for practitioners that emerged from the project evaluations, we now turn our attention to the more strategic questions raised by the evaluation.

2) What would an effective infrastructure for this sort of work look like and how will it be developed, and who else will be involved?

Various suggestions were made in the project evaluations to suggest strategies for developing an effective infrastructure to support the on-going development of arts and dementia work.

Widening Access to Arts by integrating arts opportunities into dementia care packages

In the AgeUK Diamond Drop-In sessions evaluation, an argument was made that there should be more arts interventions included in dementia care services. Specific activities could be used to aid the patient therapy programme (the example given being clay work to build hand strength). This could make arts participation a more established part of dementia care rather than an ‘optional extra’, and could also produce more substantial evidence of benefit. A further suggestion was made by the Project Coordinator, who argued that ‘the newly formed (set up over last 6 months) activity coordinators group could be a really interesting way of sharing good practice to more settings.’

At the final evaluation session for the Task and Complete Group, it was also noted that in order to widen access there was a need to bring social workers and other social care and health professionals on board. It would also mean ‘selling’ the benefits of arts participation to the family and carers of people with dementia. Good relationships with commissioners and with the managers of commissioners were further identified by Creative Development Team Manager as being critical to the future development of the work.

“One of the professors who heads up the clinical side of dementia services asked for a meeting with us and he clearly said that he would be quite happy to be referenced as the clinical lead to the project in the future, if that helped draw in the health sector...I think that at this moment in time also [the programme of work] places the Arts and Culture

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Team in a good position with the NHS Commissioners at a point where Local Authorities are beginning to take on some of the joint well-being agendas with the Health Service. ”

Creative Development Team Manager(TWC)

Strategic Leadership through Task Groups

The Artist Advisor discussed the potential for conflicts between funders, artists, and care homes, over such things as the aims of projects and who the artist is accountable to. In this case, however, she viewed the role of the Task and Complete Group as being important in avoiding any serious conflicts, suggesting that

“It would probably be valuable for it to continue as a steering group if the programme continues and expands in order for the various parties involved...to acquire a well rounded view of what the programme aims to achieve, hopefully leading to as many interested parties as possible achieving their aims.”

Artist Advisor

She suggests a number of important issues that a future task group/steering group overseeing an arts and dementia programme needs to identify, including:

• Examining the reasons why some care facilities are unable to take up offers of projects, or respond in a limited way.

• How participants can be enthused.

• What the value is in running projects with fewer participants than planned for.

• To what extent it is beneficial for people with dementia to be challenged (e.g. leaving their own environment), or whether it is more effective for them to remain in their comfort zone.

Whilst Project Coordinator also noted the valuable role of the Task Group, she did also highlight that it had functioned at a ‘coal face’ level, and suggested that there was also a need for someone at a more senior level to attend so that they could observe and understand the impact of the projects first-hand. The lead commissioner was absent (due to ill-health) during the delivery of the projects which resulted in the Task Group losing her expertise and capacity to link the projects to wider agendas. This suggests a potential to further expand input into the Task and Complete Group in the future. The Creative Development Team Manager also supported this view, and felt that widening participation in the Task and Complete Group would provide valuable training opportunities. Staff and TrainingThere were some suggestions about how to involve more artists and activity coordinators in undertaking arts work with people with dementia. For example, at the Chillcott Gardens project, the artist suggested that there should in future be an activities coordinator who was trained in active listening technique and story collection. Artists could be involved in training such staff.

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Artists came to the residencies with varying levels of experience in working with people with dementia, and indeed one had none at all. It has been suggested that it was important to encourage artists who are new to the work, to avoid relying only on the ‘tried and trusted’.

“Telford & Wrekin as an authority has an advantage over individual care facilities employing artists commercially in that its arts team would be in a position (subject to budget) to provide training and support for artists in various ways, for example through initial training, allowing shadowing of established artists in the field of dementia (not necessarily in the same art form as the person shadowing), mentoring and support groups.”

Artist Advisor

Working with people with dementia can be an emotionally challenging experience.

“Though all community arts activity has its own challenges, working with people with dementia has specific issues which some practitioners might find difficult – the proximity of death, which sometimes happens suddenly; deterioration of the person’s capabilities during the project; reactions of care staff and relatives to the person; responses and relationships between the person with dementia and the artist varying according to the person’s mood and circumstances....”

Artist Advisor

In response to these challenges, it may be important for artists to have a mentor to support them, as well as specialist training. The mentor would be someone who understood the work and was sympathetic, but was not involved in the specific care setting. Such a mentoring scheme could potentially be established as part of the strategic development of arts and dementia practice. The Creative Development Team Manager supported the view that peer mentoring for artists would be valuable for future work, and stressed the need for basic dementia training and on-going support for artists who are new to this area of work.

The Artist Advisor also identified that artists may need training in working with care staff and support staff. Furthermore, in order to help to address the one-to-one support needs of many participants, developing a network of volunteers to assist on future projects would be valuable.

3) What should constitute good practice in assessing how creativity impacts well-being?It is no simple task to measure the effectiveness of the arts in working with people with dementia. For example, participants may not have the language or the memory to describe their feelings at the beginning of a session and make a comparison at the end. There are further challenges in terms of gaining informed consent for people to take part in the evaluation, and in particular the issues over engaging with people with more advanced dementia can be problematic.

There is a danger of evaluation methods becoming intrusive if they are found to be confusing or difficult by participants. Thus, it was often necessary to observe how participants appeared to feel, which involved making an interpretation. Moreover, people with dementia have differing needs and interests, and so the possible beneficial outcomes will also be diverse. However, in the light of the evidence that emerged from the case studies, a number of suggestions can be made about what should constitute good practice in assessing how creativity impacts well-being. These include:

• Artists and care staff take on the ‘Practitioner as Researcher’ role to contribute to our understanding of the impact of these approaches on individuals and on the overall care of people with dementia.

• Involving as many people as possible in assessing impact – people with dementia themselves, artists, care staff, volunteers, family members.

• Exploring ways to measure individual impact by carrying out informal observations IN ADVANCE of someone starting a creativity programme. This would enable ‘changes’ to be more effectively captured once the person

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begins the creative interaction. Carers could be asked to assist with the benchmarking comparison.

• Drawing on existing models of good practice, including those utilised in Health and Social Care.

• Developing links between practitioners and researchers. Map the findings from this and other project evaluations against academic literature addressing arts and dementia.

• Adopting specific ethical guidelines; recognising that negative impacts may also occur.

• Recognising the value of observations by artists – recording verbatim comments; indicators of self esteem; moods and interactions; persistence and focus. Also, noting physical responses e.g. eye contact and smiles.

“I think that on this particular project [the most valuable evidence] was the very specific examples of somebody noting particular behaviour and noting how that behaviour had changed. It was the individual capturing of the difference that it had made to that person, either in that moment or after it...it’s tracking a particular person’s journey and how monumental it can be.”

Creative Development Team Manager (TWC)

• Comparing these observations with everyday behaviour; creating some way of capturing the ‘buzz’ of an arts project compared to a typical day.

“Narrative evidence, rather than quantitative, is probably more effective in recording the diverse and possibly unexpected positive outcomes or working with the arts with people with dementia, for example through photographing and keeping a journal of the process of the project, particularly where there is a chance to record the views of the people with dementia themselves.”

Artist Advisor

• Attempting to involve participants in evaluation at the end of a session or a project may be inappropriate, as they may not remember what they have been doing.

• Building a group of artists who are experienced in working with people who are affected by dementia, and providing support for artists and care staff to develop and continually improve their reflective practice.

• Having a flexible approach to delivering and evaluating the project; being willing to make changes based on observations and reflections.

• Seeking a common framework for

analysis – e.g. linking indicators to the Five Ways to Well-being, or the New Economics Foundation ‘Measuring Well-Being’ tool (NEF 2012), in order to achieve comparability across projects.

• Disseminating findings as widely as possible.

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Part 3: The case Studies

AgeUK Diamond Drop-In The Project began with a two-hour Taster Workshop at the Horizon Cafe, Lightmoor in September 2011, and involved people with dementia and their carers. The main sessions took place at AgeUK Dimond drop-In from December 2011 and were led by an artist storyteller.


Creative OpportunitiesThe support worker noted the ‘good variety of activities within the session.’ There were opportunities for singing, that were seen as valuable by one of the carers as it had sparked a new interest in the person that they cared for:

“This session – the music based sessions, with high music based content has been tremendous and it’s been a revelation...in terms of singing, she’s developed an interest and an ability not noticed before, she actually can anticipate, and some of the songs she’s heard here she’s never heard before but she’s picked them up intuitively, quickly, and that’s a new skill. And so much of our time is mourning things disappearing isn’t it? To find something new...that’s priceless.”

There was also a comment about the use of photographs, which had been used as the basis for story telling activities. It was described as ‘brilliant’ by one of the carers, who also remarked upon how it engaged all the senses. At the initial taster

workshop, a collage activity was used, with the theme of a favourite landscape or garden. This was reported by the artist as having worked very well ‘in terms of facilitating discussions around people’s interests and memories of places visited.’

Creative opportunities in a group context were seen as being all the more valuable because it was generally found to be much more difficult to engage people in such activities on an individual basis at home: the following comment was one of a number that appeared to indicate a general consensus amongst carers about the difficulties of individual participation:

“I think it’s because it’s the group, there’s not so much individual pressure. It’s not ‘can you remember this, what do you make sense of this? Everyone is free to throw things in”.

This highlights the importance of group activities in offering creative opportunities to people who may not otherwise experience them.

The two significant elements in relation to the value of this project for people living with dementia were interaction and maintaining a sense of identity.

InteractionThe interaction at the sessions was identified as a critical element, and there were a number of different perspectives on this. It was not just about conversations between the artist and the people with dementia, it was also seen as important for carers to benefit from such interaction. The artist commented in her Journal:

“Couples are chatting together imaginatively about the provocations for the stories. They are enjoying the group singing and remembering some of the movements which accompany the songs.”

There was individual interaction with group members and the use of names, and the support worker commented that there had been ‘many smiles and engaged faces during the session.’ Storytelling activities also encouraged interaction.

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Maintaining a Sense of IdentityIt is particularly significant to note that the conversations enabled a focus on, and celebration of ‘what was still there’: the things that the person with dementia still knew and understood. This is a crucial point when considering the value of this work.


Key aspects here are enjoyment of participants, the value of interaction and the role of the artist. At the mid-project review, participants were asked three questions:

• Have you had fun today?

• What else would you like to do?

• Did you enjoy working together?

All responses were positive, and several responses to what else people wanted to do suggested an interest in further similar activities, including in one case ‘anything with singing and music’.

In terms of interaction, the needs of carers are again significant here. When carers were interviewed for the mid-project review, they left their loved ones in a separate room with the artist, and the interviewer noted how much they valued being able to step out of their role for a time and to talk freely. One of the recorded comments from carers was:

“It’s useful to be able to get on your own, you don’t want to say things in front of your loved ones and upset them.”

Furthermore, notes from the facilitators de-brief post session suggested that splitting up carers and the people that they care for had also had benefits for those with dementia, by putting them ‘in the driving seat’ and also enabling them to express themselves independently of their carer: for example, one participant told a volunteer how he loved his partner. This suggests the potential value of projects like this for providing some support for carers, in addition to the benefits for those with dementia.

3) What do people consider to be the measures of success for this work

• Members remaining fully engaged and not distracted; the support worker felt that the time and length of the session was critical in this.

• The support worker identified that the most important aspect of the work as being ‘fun for person with dementia and their carer, and an opportunity for the carer to unwind in a non-threatening way.

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• Art work itself – ‘understanding the careful selection of materials which the artist used which created a clear aesthetic to the finished work’.


A number of aspects of the development and delivery of the workshops were identified as being valuable in terms of fostering connections and interaction. These can be grouped into themes:

Role of the Artist There were a number of critical aspects to the planning and delivery of the workshop by the artist which affected the connections that people made and how they worked together. These included:

• Effective session planning – e.g. setting up session in plenty of time to welcome group members as they arrived.

• Inter-personal skills of artist; establishing a rapport with the group. A carer saw the artist as a skilled ‘performer’:

“It’s the way she stimulates and encourages, contacts people; she’s clearly a performer, which is a different form of artistry, to be a performer to have to engage with your audience and get that response going – and she does establish rapport very, very well.”

Conversations with participants were continued after the session had ended, and this was seen as ‘‘an important part of the session’ by the support worker. It is also worth noting that the artist’sknowledge about dementia was

also seen as being important; one of the carers noted that the artist had researched dementia and therefore had a better understanding of the issues.

Involvement of OthersThe effective involvement of support workers and carers was also important to this project. Carers, for example, were given roles in supporting the activities e.g. by acting as scribes. It was suggested that staff and support workers had gained confidence in the approach, and had become ‘increasingly more relaxed’ in working together on it.

5) How has it improved people’s wellbeing?

Enjoyment and opportunities for interaction are clearly recognised as being beneficial to wellbeing. In addition, some of the activities were specifically designed to promote physical health. The artist commented:

“One man spoke to me a couple of times. He has been mute up till now and

the carers remarked on this.”

In terms of wellbeing, one participant in particular seemed to enjoy the project increasingly as he got to know the artist. As his carer commented:

“...since the artist has been coming, he’s a lot happier coming because I was having job getting him into the car to come here, but when I say Sally’s going to be there he just seems to remember Sally.”

This emphasises the importance of a sense of continuity in the workshops:

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“If it’s somebody they know (they soon forget people) but if it’s somebody that’s coming again they remember they enjoyed it before; they can’t quite remember everything about it but they remember they enjoyed it...Stability is the one thing they need, anything new and they’re not into it at all.”

Whilst carers seemed to agree that the content of the sessions was often gone by the time that the participants returned home, there was a suggestion that this sense of enjoyment had on-going benefits in terms of wellbeing:

“So it is not so much the carry over of techniques and things like that, but it’s the carry over of wellbeing, of optimism.”

This suggests that the sense of elevated mood was seen here as the critical issue in relation to wellbeing.

Critical Aspects and Lessons Learned

In this project, we can learn a lot from the involvement of carers, as the nature of the drop-in activity meant that carers were closely involved in the activities. There were a number of learning points in this regard:

Clarity about RolesIn this case, the main focus was on the people with dementia themselves; as the artist commented: ‘whilst the sessions look as though they’re for everyone, it’s the person with dementia whose words, ideas and gestures are recorded and used for the final end product’. It is important to be clear and explicit about roles in the project.

It was suggested that the process of each session may be more important for the person with dementia, whereas the product may be more important for the carers.

Seeking Guidance from CarersIn the mid-project interview with carers, as well as a lot of positive feedback, there were some issues identified that had been seen as problematic. For example, there was a suggestion that the artist’s perceived ‘performance’ approach was a little too loud and noisy, which could make it very difficult to communicate. It was

suggested that there was something of a continuum for artists to consider between being a ‘performer’ and being a ‘therapist’.

In addition, there was a further suggestion that in seeking to make a connection with participants, artists could inadvertently reinforce behaviours that were seen as problematic to carers:

“...there’s a confusion, easy to make, between spotting something as an enthusiasm or interest, like whistling or drumming, and trying to make contact through it so you end up doing it as well. Actually, that is a residual repetitive behaviour that probably goes on 24 hours a day for somebody and drives them mad. It’s the last thing you want to reinforce and I know this has happened...”

Whilst it was recognised that this was more of a problem for the carers than for those with dementia, it was suggested that if carers were consulted about what they saw as the key issues when the project commenced then the artist would be better informed.

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At a Glance – Key Points•�� evitaerC� �opportunities�can�generate�a�new�interest:�this�is�highly�

significant for people whose condition is inherently associated with loss rather than personal development.

•� ehT� �comment�‘replacing�the�pressure�to�remember�with�encouragement�to�imagine’�(made�by the artist� � �in �her �project journal)�arguably highlights the potential of storytelling with people with dementia, in that it challenges the focus that often exists on reminiscence activities.

•� ehT� �enjoyment�of�the�activities�can�promote�a�sense�of�wellbeing�in�that even though the details of the activity are forgotten, there is a positive�anticipation�of�the�next�session.�This�was�also�associated�with�the role of the artist.

•� ehT� �skills�of�the�artist,�in�terms�of�interpersonal�skills;�the�design�of�the�project�and�the�art�form;�and�also,�their�knowledge�and�understanding�of dementia, are of paramount importance.

•� sA� �well�as�the�benefits�for�those�with�dementia,�the�value�of�creative�work is also significant in terms of the needs of carers, for whom the interaction

27

Ironbridge Gorge Museum

This project involved residents of Parkwood and Bournville Extra Care Home. Two members of museum staff went to Parkwood with a collection of interesting objects to discuss, and then a series of visits to Blists Hill was organised during which participants could take digital photographs of anything there that interested them. The photos could then form the basis of discussions.


Creative OpportunitiesOn the visits to the museum, objects were handled and used as prompts for discussion. In addition, participants were encouraged to take photographs. The female participants were particularly keen to use the cameras, and learned new skills in doing so. In addition, notes were taken by a member of staff during one of the visits to the museum by participants, and then those notes were used as the basis for poetry writing.

InteractionEvidence from the evaluation suggests that one of the successes of the project was the level of interaction between participants, staff and demonstrators at the museum. This included at the outset a visit to Parkwood by museum staff, who met residents in the coffee bar area and led an activity involving the discussion of various artefacts that they had brought from the museum. This appears to have been an effective approach:

“Some were easily identifiable where others were not. There was considerable lively discussion about the use of some of the objects and everyone participated. They were quite interested when we admitted we did not actually know what some of the things were and lots of amusing ideas were brought forward. It led to members of the group telling us about their experiences relating to work that had a connection to some of the objects...the objects were an excellent way to get the discussion underway.”

Similarly, when participants actually visited the museum, it was noted in the evaluation that ‘there was a considerable amount of conversation between the staff and group’. Even though the weather was very cold, participants spent an hour on one visit going into the various exhibits and talking to the costumed demonstrators. The engagement of participants was such that ‘on the second visit many were keen to recount what they had previously been told by other members of staff.’ In the case of this project, it would appear that opportunities for focused discussions were valued more by participants than more ‘hands on’ activities. As noted in the evaluation of the second visit to the museum:

“They all enjoyed looking at their photos from their first visit. No one seems to want to ‘do’ anything other than look and talk amongst themselves or with the staff on site. They do not seem particularly keen to have a go at any activities.”

It was these conversations that were recorded in note form and used as the basis for poems by artist advisor.

Maintaining a Sense of IdentityThrough the focused discussions highlighted above, participants were able to draw upon their own interests and experiences. For example, one participant was particularly interested in the bike shop, as he used to work in one, and another asked to visit Coalport as he collected china plates. This shows how people were able to engage in a way which maintained their self-identity. In addition, it also sparked their curiosity:

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“Almost everyone contributed to the discussions about their own working life and how it resembled in some way what they had seen. Everyone became increasingly comfortable with the site and asked lots of questions.”

Such positive engagement points to evidence for the need for approaches like the one taken in this project to working with people living with dementia.


The way in which people were able to interact in a way that drew upon their interests, experiences, and identities, demonstrates the need for this approach to working with people living with dementia. Even if for some people the ‘process’ takes precedence over the ‘product’, the impact of providing these prompts for focused discussions seems to have been significant. The fact that participants displayed curiosity and asked questions also highlights that this was a learning experience as opposed to just drawing on past memories. This emphasises again the potential of this approach to encourage personal development in people who may generally be experiencing losses. The evaluation noted that there was a possibility of doing workshops at the museum in the future, suggesting that the value of the work was recognised.


A review of the available evidence suggests that meaningful interaction and the enjoyment of participants are two measures of success for this work. In addition, given the involvement of museum staff who were lacking prior experience of working with people with dementia, then a further measure of success would seem to be the extent to which projects spread knowledge, understanding and good practice around this area of practice.


We have already considered some of the ways in which the project encouraged interaction between participants, staff and demonstrators at the museum. By visiting the care home at the commencement of the project, staff were able to encourage people to come to the museum and they spent time explaining the site and reassuring potential participants about access issues.

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One of the valuable elements of this project was the way in which it involved staff of the museum in planning activities. The project evaluation highlighted that the planning stage had been very effective, and that the partnership between the care setting and the museum had generally been a very positive one:

“All parties were very positive from the outset and were clear about their objectives. Support from the Arts & Dementia Team helped in the initial stages to clarify what we were trying to achieve.”

The evaluation also included the fact that museum staff ‘clearly stated their lack of experience in delivering to dementia groups’, so this was an opportunity for new partnerships and to encourage increased awareness and understanding of the issues for people with dementia. For museum staff this was a positive thing: according to the project evaluation they ‘thoroughly enjoyed the experience’.


Again, evidence in this respect centres on positive interaction and enjoyment.

6) Critical Aspects and Lessons Learned

• It is important that those involved in developing activities for people with dementia receive appropriate training; the staff at Ironbridge Gorge specifically requested relevant training if the work was to continue long term.

• There were a number of practical problems in relation to this project. These included problems with transport for participants; lack of attendance, partly due to communication issues; and difficulties due to wintry weather conditions, such as icy paths and roads, particularly as the museum is an outdoor site. The evaluation identified that having indoor activities for when the weather was poor would at least address one of these issues.

• The evaluation also noted that there needed to be more understanding of the barriers to participation, as it was seen as ‘disappointing’ that larger numbers of participants from the care homes did not participate for various reasons.

• Encouraging participants to follow their own interests made it necessary for the museum to provide almost 1:1 staffing. This sometimes meant that activities were cancelled due to staff shortages. The evaluation suggested that organising activities as a group would be ‘more practical and sustainable’, and that more staff/volunteers could be involved to avoid cancelling activities.

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At a Glance – Key Points��•��The�visit�of�museum�staff�to�the�care�home�to�run�a�workshop�at�the�

start of the project was a positive way of overcoming some of the barriers to participation.

•��For�some�participants,�the�opportunities�for�focused�conversations�that�enable them to draw upon key aspects of their self-identity may be the most important aspect of a project.

•��These�informal�conversations�can�contribute�to�people’s�personal�development�and�their�learning,�and�are�therefore�of�great�importance.�

•��Photography�can�be�an�effective�and�unobtrusive�way�to�add�creative�value�to�these�conversations,�and�can�also�be�used�as�prompts�for�further interaction.

•��Involving�the�staff�of�museums�and�other�cultural�venues�in�projects�working with people with dementia can be an opportunity to spread knowledge,�understanding�and�good�practice.�

•��It�is�important�to�provide�training�to�museum�staff�to�support�the� on-going development of this kind of work.

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Residents from Chillcott Sheltered Housing worked with a storyteller to develop a Storybox Theatre project. The Storybox Theatre is based on images representing significant memories for the participant – e.g. photographs, drawings, newspaper clippings, maps, certificates, sheet music.

Some of the participants of this project were in the more advanced stages of dementia. In the artist’s reflective journal she comments that staff had been concerned about including one of the participants as he had reached the stage in his illness where he used a lot of swearing, and his family now rarely visited him (this participant responded very postivitely to being involved and his behavior improved considerably during the project). Another female participant had lost almost all her sight and could only distinguish between light and dark.

The artist kept a reflective diary, and also recorded detailed observations about the responses of participants to the project. The care home manager and the activities coordinator also kept detailed journals. All of these data offer valuable contributions to addressing the critical questions in this evaluation.


Creative OpportunitiesWhilst initially, the artist commented that it was ‘hard to ensure that participants were enabled rather than helped’, by the third workshop, she observed that there was ‘definitely more enabling taking place this time.’ The care home manager noted that these creative opportunities were a ‘fresh approach’ that enabled learning, and the testing out of new ideas. In one of the later sessions, she also commented that seeing a particular resident smiling and concentrating on their art work stood out as the most valuable aspect of a session.

InteractionAs we will see, this project promoted interaction in various ways between participants and with the artist, carers, and the family members of participants.

The skills of the artist in developing this interaction are the key issue when considering the value of this type of creative project. The Care Home Manager described the artist’s interactive skills as ‘excellent’. In particular, she also noted that the project provided ‘quality time’ for participants through the one-to-one sessions. The final performance of the Storybox Theatres gave participants the opportunity to present their stories to family members, who were reported to be happy, very emotional and very surprised at the amount of work involved

in the project. In a letter to the care home manager, a family member of one of the participants also spoke of her enjoyment of the performance, and commented that ‘it was lovely to share the memories of all that took part, funny and sad, and to see the pleasure it gave to those telling their stories’. This demonstrates how the work has value not just to those with dementia but also to other people whose lives are affected by the condition.

Maintaining a Sense of IdentityThe focus of this project was very much about people’s identities and how these could be represented and celebrated in creative ways. One example of this was that one participant could speak Welsh and another spoke French: during the first session, the care home manager described moments when the participants spoke in those languages as two of the ‘key moments’ of the session. On the third session, the activity coordinator noted that they were finding out more about

Chillcott Gardens

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people’s pasts and about their interactive skills. The care home manager also added that they were gaining knowledge of residents’ favourite pieces of music, places, colours and so on. All such knowledge can be seen as valuable in supporting people to maintain a sense of identity and also in contributing to a more personalised approach to care.

Health and Well-BeingSee Q5.


After the first planning meeting, the artist commented on the commitment of the staff to the project, and felt that this was indicative of how much they perceived a need for this approach:

‘The staff feel that one to one sessions with participants will be the most valuable aspect of the project as they have little time to give to such work and they all feel it is very important. Commitment of the staff to the project was very clear as two have agreed to come in on their days off to do it.’

As well as amongst staff, the artist also perceived the need for this approach through her observations of residents themselves. For example, some of the participants seemed to be experiencing isolation:

‘Staff said he is isolated. Other residents muttered about his behaviour to each other.’(B)

The following week, the artist noted that this participant had enjoyed interacting with her:

‘He clearly enjoyed telling me about the ‘Anstice [Memorial Institute Club]’: ‘It was nice and quiet’’(B)

For some participants, there is a need for a focused activity. One participant, when asked if she would like to join the project, commented ‘it’d be something to do’. Another appeared to the artist to be wandering aimlessly and to need the interaction and validation that the project could offer:

‘Good days here in my memory always’ – I feel it’s important for her to have a listener to those memories.’(C)

‘(C)was wandering around the public area all afternoon. The only time she seemed settled was when she was sitting talking to me.’

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As well as these observations by the artist, there was also evidence of participants themselves reflecting on their own needs and well-being. One participant commented:

‘You’ve got to stimulate my brain’ (E) and‘That’s what I miss, writing.’

Another expressed in her own words how much she had enjoyed the interaction with the artist:

‘It’s nice to talk to someone from outside.’ (G)

The same participant also demonstrated her interest in the story telling activity, saying:

‘I’d like to be an author.’(G)

Finally, there was a comment from one participant saying simply:

‘You’re helping me’. (J)

Whilst these are simple statements, they are significant and important evidence about the need for this approach, as they come directly from the person with dementia, rather than – as is so often the case - from someone speaking on their behalf.


The artist identified a number of ‘success factors’ that she felt indicated that workshops had been successful. These included:

• Successfully connecting with participants and help them to make something they value (NOT make it for them!).

• Participants reporting their enjoyment to artist, staff and/or family members.

• Interaction between participants, including smiles, laughter and conversations.

• Staff respond positively to the project.

• Participants have been actively involved in successfully creating art work.

The care home manager also identified ‘happy memories’ as the measure of success for the residency.


There were numerous comments and quotes recorded in the artist’s mid project review about the connections that participants had made, and how they worked together. These can be grouped into themes:

Role of the ArtistOne of the key aspects of this project seems to have been the communication between participants and the artist. For example, the artist notes:

‘(A) Said she enjoyed talking to me about Kenilworth Castle’

‘(C) enjoyed telling me about her family and childhood in Ebbw Vale. “very happy days”’

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‘Tears came to (B’s) eyes talking about Old Madeley’

Reminiscing therefore provides a focus for such communication.

Involvement of staffAs has been noted, care staff were very committed to this project. They provided encouragement and support to participants to help them to get started with their boxes and worked one-to-one with them to support them to complete their project. A volunteer was also involved with the sessions and reportedly enjoyed the work.

Group participationFurther observations and comments were recorded that demonstrates how people engaged with the group activities:

‘(C)participated with songs and comments’

‘I think we’ve all enjoyed ourselves, nice to have a bit of company’(C)

The artist commented that on the first week that she visited, (J’s) son was there and was keen that she should be included. The second week, (J) herself commented:

‘I like this, it’s company, keeps you in touch with what’s going on.’

This suggests that group participation may be viewed as a valuable aspect of the work.

Mutual support between participantsIn the third week, the artist noted her surprise at the pleasure that group members took in listening to their own and each other’s stories. They also responded to each other supportively:

‘(A) smiled and applauded other people’s stories when I read them out. She agreed she had enjoyed the group session’

‘(E) spontaneously applauded at the end of every story, thus leading the others to participate in the applause too.’

Staff also noted that people’s engagement in the story telling sessions was ‘excellent’, with lots of emotions as well.

This again highlights the ways in which the project encouraged positive social interaction.


The project was felt by the artist and by the Care Home manager to have had a positive impact on people’s well-being. At the end of the project, the artist commented that:

‘I think the Story Box Theatres work well on various different levels and that the process, combining talk with a focussed listener and simple craft tasks was a very positive way of improving participants’ well-being.’

The artist also reported a number of comments from participants and other observations that she felt provided

evidence with regard to improved well-being. Several themes emerged from these observations:

Positive Reflection on the Session(s)In some cases, participants forgot why they were attending a session, and were unable to remember having done so in the days afterwards. However, several participants expressed how much they had enjoyed the sessions with the artist and in some cases the social interaction as well. Their comments suggested a sense of positive impact on their own well-being, for example saying that it had been ‘good for them’ or ‘relaxing’. (C), for example, said in the first week that she had enjoyed the session, and by week 3, her comment was:

‘It’s good for us, the company and especially you (the artist). We’ve been most interested in you.’

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(E) commented in the second week that ‘it’s lovely, having the pictures’; she told care home staff that she ‘couldn’t wait’ until next week. The following week she commented that she had felt relaxed in the group and had enjoyed it. All of these comments point to the positive impact of the project on people’s sense of well-being.

Progress between SessionsThere were also some observations from the artist suggesting some kind of improvement in the engagement of a participant as the project progressed. In the first week, ‘B’ was described by staff as isolated, and the artist observed other residents muttering about his behaviour. In the second week, the artist noted that he ‘was much calmer than last time’, and that he had told her a lot about the pictures that they looked at. He started

work on a story box, with care home staff noting ‘this is a first’. By the third session, the artist observed that he was ‘much more smiley and communicative than previously.’

The artist also noticed a difference in (J): in the third week she noted that this participant ‘spoke with much greater volume, animation and clarity then in previous sessions and told me a lot about the Palais dances’.

Such evidence suggests that the impact of the project was felt increasingly as it progressed.

Positive Reflection on Past experiencesThe activity coordinator identified the ‘aid to memory’ as being one of the benefits that she saw participants gaining by the second week of the project. (A) reflected that: ‘We had some lovely times. I never regretted anything. I wouldn’t have missed it for the world. It was a good life.’ In the third week, she again expressed her enjoyment of the reminiscence activities: ‘It’s nice to remember things that seem far away. Thank you very much.’

(S) seemed to enjoy recalling her mother. In week 2 she commented: ‘yes, lovely chat. I wish my mother had been alive’, and in the third week the artist noted that (S) seemed to enjoy telling her about the grocery shop that her mother had kept.

Telling the stories was an emotional experience for some; notes from the session include the fact that (G’s) eyes filled with tears at the reference to her father, and that (B) got involved in hearing his story and responded with smiles and tears. The following week, following discussions with (B) and (G), the artist reported that she was pleased that they both seemed ‘really moved by their stories’, which suggests that the emotional experiences had had a positive impact. This impact was not limited to participants:

‘My affection for the project has been overwhelming...to create images and stories, treasured memories. It has provided access to emotions and self-expression, giving my residents dignity back in their lives. Seven individuals, seven individual stories, what an experience.’

Care Home Manager

6) Critical Aspects and Lessons Learned• Particularly at the beginning of

the project it could be difficult for participants to remember or understand what the project was about.

• When working with a group facing such significant health issues, there is a need for excellent communication between care home staff and the artist. This was problematic in the case of the

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participant who had lost almost all her sight, as the artist was unaware of this until half way through the first session.

• This project also highlighted the need for some form of supervisory support for artists undertaking this kind of emotionally challenging work.

• Throughout the project documentation, there were a number of references to the importance of the participants creating the Story Boxes themselves, and that artist and staff should be facilitating, not doing it for them. Included in this was a comment by care home staff that the art work ‘should be individual to the person’, and that ‘you can’t be a perfectionist with a person with dementia’.

• Activities may need to be kept short, as dementia often affects people’s concentration. Tasks also need to be simple and manageable.

• It was noted by staff that the memories that were recalled were ‘not all pleasant’. Whilst in this case this does not appear to have caused significant problems, there are clearly ethical considerations in terms of addressing any potential distress.

• It may be useful to sometimes critically review the focus that often exists on drawing upon people’s memories and past lives in arts projects. In particular, if relatives are being relied upon to provide background information then this may undermine the aim of giving participants themselves a voice in the process.

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At a Glance – Key Points• The project not only provided more information about residents’ lives,

but also about the extent of their interactive skills.

• One of the most significant demonstrations of the need for this approach to working with people living with dementia was seen to be the interest and commitment of care staff, some of whom gave up days off to support the project.

• Observations of residents also supported the need for focused activity with opportunities for positive interaction.

• Perceived measures of success for the work focused upon: enjoyment of participants and the extent to which they have actively created something that they value; interaction between participants; happy memories and a positive response from staff.

• Positive connections were made between the artist, care staff and participants. There were several examples of mutual support between participants.

• Some participants engaged more positively as the project progressed, contributing further evidence to support the value of the work.

• The process of the project was found to be very valuable, and it was more important that the art work was meaningful to participants than that it was ‘perfect’.

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Millbrook Day CentreThis project explored the outside space of the care home, with the aim of elevating the mood of participants and reminiscing. The creative outcome was permanent sculptures made from mosaics on pieces of oak. The project was led by an environmental artist.


Creative OpportunitiesThis project offered a high degree of flexibility for participants, which enabled them to engage at a level that they felt comfortable with. This was noted by the Day Centre Manager:

‘The artist is happy for service users to come in and out of the workshops at their own leisure, and take part in whatever they take an interest in.’

She also noted how the artist made everyone feel that they could be creative and identified the benefits that she saw people gaining as being satisfaction with the work that they had created. At the end of the project the artist commented that there had been an ‘improvement in participation’ as a result of the flexible approach. In interviews, one participant reported learning ‘new skills like carving and mosaic work’ and another said that she had ‘liked making the flowers’. An outdoor exhibition of work was produced at the end of the project. People had tried new arts activities and care staff had gained new ideas and were interested in doing more in the future.

InteractionThe artist felt that the project had ‘provided a new opportunity for service users to interact’, and the Day Centre Manager confirmed that socialising and the enjoyment of working with others was one of the key benefits to participants of the project. One example of this interaction was at the second workshop when, included in the artist’s ‘list of important moments’ was ‘a table full of conversations whilst looking at gardening books’. Sometimes the Day Centre Manager noted

that participants who had engaged in lengthy conversations did not normally do so, suggesting the positive impact of the activities.

Conversations would also develop as people took part in ‘hands-on’ creative activities: the Day Centre Manager identified a key moment from the first workshop as being ‘everybody engaging in conversation when sat around the tables, working with the clay.’

It can also be a way of engaging with participants’ families; the artist commented that ‘it was great when one service-user’s wife came along to a session, providing stimulus.’

As in other projects, interaction is closely linked to creative opportunities, and both are closely linked to maintaining a sense of identity.

Maintaining a Sense of IdentityComments made by the Day Centre Manager suggest that one of the most valuable aspects about the sessions was the memories that came out that staff had not heard before: ‘We have heard new stories from our service users that we probably wouldn’t have heard’. This promotes a better understanding of people’s personal histories and identities.

Health and Well-BeingThe outside focus of this project was clearly one aspect of promoting positive health and well-being. For example, the

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first session with participants involved taking a walk to the local orchard, gathering materials from the outside space, observing what is going on, and taking photos to use in the project.

One of the strengths of creative approaches with small groups is that they offer the potential to be adapted for people according to their health issues and related limitations. A good example of this was in the fifth session, when one participant, who had previously been unable to fully participate due to poor eyesight and motor skills, was provided with a large canvas, big brushes and a roller as an experiment to try to enhance his participation. The artist reported that this had an ‘amazing result’, and that he ‘observed his confidence grow over the time of the session, and the pride he had in reflecting on it.’


The success of the project in terms of engaging people in new activities and introducing care staff to new ideas and ways of working suggests that this is a valuable approach to take:

“The final piece was a big achievement for all service users, engaging in art work, clay work, mosaic work and things we hadn’t done before but will do in the future as staff have gained more ideas and knowledge to carry it on.”

Also, importantly, the Day Centre Manager commented that a few participants had also asked if the artist was coming back to do some more work, and noted that there were positive comments from families who attended the celebration day. All such comments are indicative of the way in which the project was valued by everyone involved, which in turn demonstrates that such approaches are needed by people living with dementia.


The artist identified the following success factors:

• Staff/family feedback on how engaged the participants were.

• High level of engagement; for example, a group being engaged in the same activity for an entire morning session.

• Interactions of service users with each other.

• Participants becoming more engaged as the project progresses.

• Increased confidence in participants.

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Role of the ArtistThe artist felt that he ‘had a great relationship with both staff and service-users’, and asserts that this is ‘essential to successful work’. This was confirmed by the Day Centre Manager, who stated that their experience of working with the artist was:

“Very good. He was very patient with staff and service users; very encouraging and a friendly nature. He enjoyed getting to know everybody and made us all feel we could be creative.”

This shows the crucial role of the artist in facilitating people’s participation both practically and also in terms of helping people to interact and to overcome barriers to participation.

Involvement of StaffCare home staff helped out the participants if it was needed, but they also engaged them in conversation. Also, in the third session the artist noted that carers took the materials to individuals who were outside the craft room in order to ensure opportunities for engagement. He further commented that ‘staff were brilliant. They took the project and owned it. Things were done in between my visits which was fantastic’. In the fourth session, all staff and service users were engaging in conversations about what colours to use in the final product.

In addition, the artist noted that staff were, like him, involved in a research capacity in this project:

“Both artist and staff are taking on the ‘Practitioner as Researcher’ role, investigating what’s going on in the projects and the motivations, ideas, memories and feelings of the participants.”

This level of commitment to understanding the impact of creative approaches in working with people with dementia is essential in terms of providing credible evidence and contributing to a sustainable infrastructure for the on-going development of this area of practice.

Group participationIn the Care Settings Journal, there were numerous comments illustrating the ways in which participants worked together. For example, in the third session it was noted that they had worked together ‘very well, laughing and joking, and sharing stories together about their past.’

At the mid-residency review, there was a striking example how the activities had led to more meaningful interaction between participants than was usual:

“(A) did drawing today which reminded him of his time in Germany after the war. He started reflecting and talking about this period of his life. (J) listened and asked questions to (A) about this time and Germany, and through a discussion together they came to some conclusions

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about how German people would feel about the British Army after the war and lack of trust on both sides. This conversation was incredibly eloquent compared to the usual exchanges between members of the group.”

This emphasises the importance of the ‘process’ of the project, which may be seen as just as important as any completed art works.

Mutual support between participantsOne of the positive aspects of the project was that participants were able to support each other in a way that seemed to have been unusual: the Day Centre Manager noted that ‘it was surprising to see our service users encouraging each other’. A later comment further illustrates this point:

“One service user has been very supportive of the others and was always encouraging them when self-confidence was low. One lady saying ‘this isn’t very good, I’m not good at this,’ and he replied ‘it’s good, you’ve done a good job’. He is always helping others, reminding them what we are doing and what the task is, and encouraging them to do more.”

People with dementia are stereotypically portrayed as being dependent on others, whereas this demonstrates how the project provided an opportunity for participants who were able to, to support other people.


The artist noted that positive impact on well being could be identified through:

• Observations and comparison with everyday behaviour.

• Noting persistence and focus.

• Observing indicators of self-esteem.

• Observing moods and interactions.

There were a number of themes that could be identified in analysing the impact of the project on people’s wellbeing:

Positive Reflection on the Session(s)In the first two sessions, staff noted how the participants felt at the start and end of the sessions. The comments indicated

that with a couple of exceptions, people arrived feeling happy. Their comments at the end of the workshops were universally positive, and included ‘happy’, ‘inspired’, ‘creative’, and ‘exhilarated’.

Staff also observed shared laughter in the sessions. The activities were designed to engage with the senses, and participants responded to this. For example, at the second session, there were flowers and pot pourri in the middle of the table, and participants commented on the ‘lovely smells’ and that ‘those flowers are lovely’.

At the mid-residency review (which involved the artist, the Day Centre Manager, and the Co-ordinator), it was noted that concentration levels at all the sessions had been ‘really fantastic’, with some participants staying with the art activity for the whole afternoon.

Progress between sessionsPhotographs were useful in reminding people what they had done at previous sessions. By the fourth session, staff noted that a few participants had asked between sessions whether the artist was coming again.

The artist noted on several occasions that a particular participant had been more engaged one week than they had previously been.

Positive Reflection on Past ExperiencesAt the very first session, staff observed a participant telling a story about when he used to go fishing. At the next session, included in the ‘list of important moments’ in the staff journal were the following observations of the reminiscence activities:

“The memories that came from looking at objects, such as shells, pebbles, leaves, and twigs. Then creating pictures that resembled people’s gardens and summer holidays.”

The sharing of stories generally was a significant part of this project, and as has been noted, this has positive implications in terms of maintaining a sense of identity. It was noted that this project did not bring up painful, distressing or traumatic memories for participants. This was seen

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as ‘lucky’ at the mid-residency review. However, it could be argued that the design of the project, by focusing on generally positive aspects of life, such as gardens and holidays, was likely to trigger positive memories.


• Particularly at the beginning of the project it could be difficult for participants to remember or understand what the project was about. Some were reluctant to get involved and a small number preferred to watch. This demonstrates that even with a flexible approach to developing participation, it can still be challenging to engage everyone in activities. The Day Centre Manager also noted in the second session that an important moment was ‘realising that not everybody want to be creative’ and that ‘people need time to think whether or not they want to get involved in things’.

• The artist noted in the third session that ‘staff have taken on board the principle of valuing the process equally to that of the end product’. This emphasises the need to avoid seeking perfection and to ensure ownership of the art work by participants. Ultimately, the artist felt that ‘the process was far more beneficial and interesting than the production of the final outdoor works.’

• In this project, detailed observation was found to be the most effective approach to evaluation; asking participants how they felt at the start and the end of a session using word cards was not felt to be at all effective.

• Following the final exhibition of work, the artist noted that some participants had responded better than others, and that a longer period of time was needed to develop a bespoke approach for chair-bound service users.

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At a Glance – Key Points�•��A�flexible�approach�and�excellent�interpersonal�skills�on�the�part�of�the�

artist were considered central to developing participation in a person-centred, inclusive way.

•��Arts�projects�can�be�a�valuable�way�of�exploring�the�life�course�experiences�of�participants,�which�promotes�a�better�understanding�of�people’s personal histories and identities.

•��Involving�a�professional�artist�in�running�activities�in�a�care�home�can�introduce new ideas to carers.

•��In�this�project,�levels�of�engagement,�levels�of�interaction,�positive�feedback from staff and families, and benefits to the participant (e.g. increased confidence) were seen as the main success factors.

•��Support�from�care�staff�is�also�a�critical�factor�in�ensuring�not�only�the�success of the project but also in effectively evaluating the activities in order to contribute to the on-going development of this area of work.

•��This�project�contributed�to�more�meaningful�interaction�and�mutual�support�between�participants.�To�be�able�to�act�in�a�supportive�role�challenges stereotypical portrayals of people with dementia as entirely dependent on others.

•��Some�of�the�ways�in�which�this�project�could�be�seen�to�improve�well-being included: reported positive feelings; shared laughter in the sessions; high levels of concentration by participants; responses to multi-sensory aspects of the project; an increase in interest/levels of engagement by some participants as the project progressed, and positive�reflection�on�past�experiences.��

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Farcroft Residential Home

This project was led by a visual artist. It involved initiating conversations around the artist’s collection of photographs, fabrics, trinkets and bookmaking and printing artefacts. These conversations led to a series of illustrations created with participants, which then contributed to a collage of printed materials and photographs. These were bound together into handmade ‘memory books’ which described the thoughts, memories and experiences of participants.


Creative OpportunitiesThis was the first creative project that had been undertaken at Farcroft, and the Manager identified previous barriers as being financial; staffing issues and time,

as well as simply ‘not knowing where to start’. Initially, staff were unsure of the project and whether they would get the time or the participant engagement for it to be successful. The key to success was the involvement of an artist, which was felt to be valuable in terms of: ‘just to have an experience of someone to focus an activity, as time is limited due to care duties.’

By the Mid-Residency Review, the most valuable aspects of the sessions were identified as the ‘sharing of expertise’ and the ‘sustainability of the idea’. And at the end of the project, staff were committed to continuing the work:

“The artist has shown us a skill which as staff we can re-use with all residents within our home. We are planning to continue to fill the books that we have started and to do themed books with residents on the dementia unit – i.e. old cookery recipes, postcards /holidays etc.”

In addition to the value that staff placed on the creative opportunities, there was also positive feedback from participants and some family members indicating the ways in which these creative opportunities had been valued. For example, the Key Carer recorded the conversation that she had with the daughter of one of the participants at the end of the project:

“After the session I spoke to (R’s) daughter who was delighted with the book. She said it was a lovely keepsake for not only her Mum but for her and the family too. She said that to think her Mum had done this book, chosen the pictures and layout was just really special”.

The daughter of another participant also commented about how well her mother had engaged with the project, and added how much she had enjoyed it and was happy that she was involved. This highlights again that creative opportunities for people with dementia are valued not only by participants themselves but often also by those who care for them.

InteractionThere is evidence throughout this case study of the ways in which the activities helped to trigger interaction between everyone involved. For the artist, the ‘best moments’ of the project ‘were the ‘smile’ moments, where participants would be sitting quietly, but would suddenly smile or launch into conversation about a particular photograph or object.’

The extent of the interaction between participants was identified as a ‘surprise’ in the Care Setting evaluation of the third session, as it was noted that there was ‘usually not a great deal of interaction’.

The project was also an opportunity to involve families more. The Mid-Residency review identified that there was a ‘buzz’ from the project ‘even from families’. There was support from three people’s family members. One came to every session and two others attended celebratory events.

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At the end of the project, the artist commented that the memory books had ‘really stimulated conversation between staff and participants, and encouraged interaction between participants as they showed each other photos and objects etc’. The Care Settings Journal also recorded that ‘pulling all the stories, pictures, and materials together was excellent – a big high’. This demonstrates again that interaction is in fact an integral element of the creative opportunities that this kind of project offers.

Maintaining a Sense of IdentityParticipants brought in their own photographs, which enabled them to share some of their memories and experiences with others. This was important, given that participants disliked the artist’s resource of old photographs because they were not personal and so the people in them were not recognisable.

There was sometimes seen to be a ‘trigger’ that engaged a participant in conversations or activities by enabling them to make a connection to their own experiences. The artist described one such response from a participant in the second session:

“I didn’t know very much about a new participant, so spent some time looking at pictures with her. She didn’t react to many of the pictures, until I showed her a picture of a cat when she smiled and laughed, and told me about her black and white one.”

Sometimes, the insights into participants’ interests and experiences were new to the staff. An example of this was recorded by one of the carers after the firth session, in which the artist had engaged with participants on a one-to-one basis:

“After the one-to-one session, (R) came over to me and started chatting about Ireland where she grew up, her religion, and about her being able to play the accordion, which I didn’t know! I felt that the one-to-one session had got her talking and she wanted to share her memories with me.”

This is clearly very valuable in terms of the staff being able to better engage with service users though knowing them better as individuals. At the final celebration event, carers and family discussed the books individually with each person and looked through them. Afterwards, participants could keep the books and look at them whenever they wanted to.

One of the final questions in the Care Settings Journal relates to how staff might convince other carers to encourage people with dementia to get

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involved in future arts projects. The reply was as follows:

“To come and see the books and see the reactions of the residents when they look at their books. Their faces come alive, smiles, the stories they can tell you, as everything on that page means something to them”.

This powerfully expresses the value of creative work for people living with dementia.

Health and Well-BeingSee Q5


We have already highlighted that the approach can be seen as a valuable one in terms of providing creative opportunities, encouraging interaction, and supporting people to maintain a sense of self-identity. A further indication of the need for the approach is the way in which it can be seen to offer new ideas to improve the lives of people with dementia. Staff felt that the project was ‘really valuable for ideas’. In addition, not only was it successful in terms of bringing people together, but there was also clearly some surprise at the level of engagement demonstrated by participants; it was noted that the ‘length of engagement has been amazing – hours for some!’

It is important to compare the time that people spent taking part in the project to what they would otherwise have been doing. In the third session, the artist commented that:

“Usually everyone is listening to music or dozing. It’s been good to get everyone sitting around the table, interacting and working together.”

This illustrates the need for such interaction for people’s social well-being and to stimulate their minds.

The artist commented that participants wanted ‘new things to explore every week’. An example of a participant’s curiosity was recorded as an observation by the artist in the first week of the project, when she noted that: ‘I was really interested to see (M) exploring one of the boxes as if it was a discovery basket’. Another participant spent ‘hours’ looking at an old book of Wellington after one of the sessions. This suggests that for this group, their curiosity and interest in learning was still active, thus demonstrating a need for an approach that stimulates and satisfies such interest.

The fact that staff not only considered the project to be ‘truly excellent’ and successful with residents, families and staff, but had also learnt from the artist and planned to continue with similar activities, can be seen as powerful indication of the value of the approach.

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• Greater levels of interaction between participants


Role of the ArtistIn the Care Settings Journal, there were comments about the good inter-personal skills of the artist and the ways in which she had encouraged people’s involvement at the initial Tea Party event:

“Very friendly, good listener. She showed residents her books, rather than talk – pointed out pictures/textures/colours...Ruth spoke to each resident in turn at their own pace and level”.

There were also comments about how the artist had supported people’s involvement in the project, for example by collecting items and pictures for individual residents.

In the fourth week, the artist worked one to one with participants in their own space – she went to them. Through positive conversations with them, she gained key information to include in their books. The Care Settings Journal records that residents ‘bloomed’ in the one-to-one sessions.

Involvement of staffCare staff were actively involved in supporting the artist and the project. The artist found that they were helpful in addressing questions. In the fifth session, the artist showed staff the methods of making books, the equipment that she uses, and the methods of collecting objects to include. Therefore, carers could continue to help in practical ways, such as helping participants to stick things into their books, doing internet research, and printing things out. This passing on of skills from the artist to care staff thus gave them the skills that they needed to further develop the work.

Group participationFrom the start of the project, at the Tea Party event, there were observations related to increased levels of interaction

between people who were sitting together and chatting. When the activities began, most people were initially happy to watch what was going on, as opposed to taking part. This emphasises again that it takes time and patience to develop projects, especially when people may struggle at first to understand what is involved in the activity or why it is happening. As the project progressed, participants began to show each other pictures and items that they had chosen. Increasingly, there were conversations and evidence of people working together.

Mutual support between participantsParticipants worked together ‘round the table’, and it was noted that they had been ‘actively watching one another’. Staff commented to the artist that it was ‘nice for the ladies to work together rather than be in isolation’. These comments highlight the informal mutual learning that can be such a feature of community arts projects.


Positive Reflection on the Session(s)At the mid-residency review it was noted that there was a ‘buzz’ about the sessions and ‘positivity from all’. There were several references to the atmosphere being ‘alive’. Observations reveal ‘sudden smile moments after hours of conversation’, along with a recognition that ‘you can’t rush it’.

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There were some positive comments from participants expressing their enjoyment of individual sessions. The artist also observed positive responses from some of the participants. For example, in session 3, this observation was recorded by the artist:

“(M) was overjoyed when I went to find her in the dayroom. She said how much she liked doing her book and loved looking through the photos and telling me about them.”

More generally, the artist’s comments at the end of the project include observations suggesting that other participants also experienced positive emotional benefits:

“I feel that this project was valuable to participants. It was wonderful to see moments where participants smiled at pictures, or discussed pictures and memories.”

In common with other projects, there was a multi-sensory aspect to this one, which was also experienced positively:

“I provided more tins of items to explore. (I) was particularly interested in these, spending time exploring each one and enjoying the textures.”

As noted earlier, these positive and interactive experiences are in contrast to what participants would otherwise have been doing, and supports the value of the project in terms of people’s social well-being. It is particularly worth noting a comment in the Care Settings Journal in the evaluation of the fourth session, which indicated that residents were ‘very chatty’ after they had had the one to one sessions with the artist. Further evaluation notes indicate that one resident in particular was in a noticeably more positive mood than usual:

“She thanked the staff which prior to this had not before. She was very polite and her temperament was good. At the tea table she was chatting with (P) which is not usually the case with these two residents”.

This suggests that the project may have enhanced the mood of some participants, in a way that extended beyond the immediate activities. This in turn suggests some level of positive impact of the project on well-being.

Progress between SessionsWhilst sometimes participants had difficulties in remembering the activities that they had taken part in, this was not always the case. In week 3, the artist commented that:

“It was interesting to see that ‘I’ could remember some of the things/objects/boxes from last week. She enjoyed looking at new things. She remembered doing another art project and said ‘this is wonderful doing this”.

In the fourth week, a participant engaged in session ‘for a long period of time’ after not having engaged in previous sessions. This provides some indication of increasing interest in the project as it progressed.

Positive Reflection on Past experiencesReminiscence was a feature of this project, and there were observations of smiles and conversations based on these recollections throughout the project. Observations by the Key Carer demonstrate the level of positive impact that could sometimes be seen from participants being able to share their memories:

“While Ruth was doing a one-to-one with ‘M’, I went over and ‘M’ took my hand and said ‘this is excellent’ and ‘I am really enjoying it’. She showed us a picture and said she remembered all the people. She said she was in the RAF and she was the driver! She then went on to tell us all sorts of memories!”

It is particularly worth noting the apparent pride that participants seem to have displayed at the celebration event. Observations made by the artist included:

“The ladies were pleased with their books and showed them to visitors and discussed them”.

One participant in particular seemed to have gained a lot from sharing her stories with others:

“I was really pleased when I gave (R) her book. She was delighted with it, looking through all the pictures and telling everyone about them.”

49

Another participant was more reluctant to discuss her book with others, but the Key Carer noted that she kept picking it up and looking at it throughout and after the event. It is reasonable to conclude that participants would not only benefit in terms of well-being through engaging with positive memories, but also that there would be benefits in terms of self-esteem and maintaining a sense of self-identity though being able to share those stories with others.


• Providing the artist with ‘pen pictures’ of participants prior to the project starting enabled her to resource appropriate materials for the individuals.

• The ‘Introduction Tea Party’ at the outset of the project was a good way for the artist to meet everyone and to talk about the project.

• Staffing can be an issue, especially given that participants all required some one-to-one support. There was sometimes only one carer involved with the project and they were ‘on shift’, and so had other demands on their time. Additional staff were needed at the Care Home to support the project.

• The pace of the project cannot be rushed, which is challenging as an artist working to deadlines. This emphasises the need to value the process as much as, if not more than, the final product(s). The support of staff is essential in achieving project objectives.

• Sometimes people’s engagement can be unpredictable as it can vary from one week to the next.

• Evaluation needs to be done during the session, not left until the end, as residents will sometimes have forgotten by then what they have been doing.

• Evaluation tools can be problematic to use with people who have dementia: it was found that they were often confused about both the questions that they were asked and the activities that they were being asked about. Detailed observations were found to be a more effective approach.

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At a Glance – Key Points• There is added value in the artist introducing ideas that are

sustainable: i.e. staff can continue to develop the work beyond the life of the project.

• This project increased interaction between participants themselves and between participants and staff. It was also a valuable way to involve families.

• Participants were engaged in project activities for unexpectedly long periods of time

• People’s engagement demonstrated curiosity and interest in learning, challenging stereotypical perceptions of people with dementia.

• One-to-one sessions between the artist and the participants were found to be particularly effective in establishing meaningful conversations that revealed greater knowledge about participants’ lives.

• As well as plenty of evidence relating to participants’ enjoyment of the sessions, and of sharing their stories, it also appeared that the mood of some participants was elevated after the session as well.

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Dementia Friendly Buildings Action Research Project Introduction

Dementia Friendly Buildings is one strand of a broader Arts and Dementia Programme initiated by the Creative and Cultural Development Team of Telford and Wrekin Council. The pilot stage of the project involved providing the staff of Telford’s Oakengates Theatre with two Dementia Awareness Training sessions, aimed at overcoming barriers to people with dementia and their carers attending the theatre. This was followed by a recruitment campaign to identify a small sample group of people to get involved

in a Visitor Survey involving people giving feedback of their experience of the theatre in exchange for free theatre tickets. Oakengates Theatre was selected within the pilot project with the aim that the learning and outcomes could be rolled out into other community buildings and contexts in the future.

A Task Group was established to plan and develop the work. The group comprised of members from the independent care sector; the voluntary sector; Telford and Wrekin Council, and an independent artist advisor. The role of the Task Group includes:

• Research into dementia friendly buildings.

• Evidencing the need for the use of creativity.

• Supporting new relationships, facilitating further conversations, and potentially building future partnerships.

An Artist Advisor was appointed as Artist Advisor to the Task Group. She observed the training sessions, and some of the visitor surveys, and based on her observations produced a series of creative responses.

Creative Health CIC worked with the Programme Partners to create an evaluation framework. The Project Coordinator collected evaluation material. An independent evaluator worked with Creative Health CIC in developing the evaluation and writing up the findings.

During the pilot project a number of reservations and concerns that stopped people from enjoying their theatre visit were identified. The issues were addressed straight away by small changes and improvements to customer services. These included an introductory tour of the building prior to attending a performance, allocation of a designated member of staff as a point of contact and access to a quiet room. Whilst these changes were relatively easy to implement they had a significant impact on the project’s taking on board people with dementia and their carers feedback and to effect change.

This report discusses the activities and impacts of the pilot stage of the Dementia Friendly Buildings project in detail, and is structured around the three identified outcomes which also formed the basis of the evaluation framework:

1) Establishing the need for a creative programme for people living with dementia

2) Partnerships and Infrastructure


Evaluation data includes notes from the training session, 14 completed visitor surveys, and documentation from Task Group meetings. We will now address each of the three identified outcomes in turn:

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1) Establishing the need for a creative programme for people living with dementia

At the Dementia Awareness Training Session, a number of issues and concerns were identified that pointed to the need for better planning for the participation of people with dementia. These included concerns relating to managing the behaviour of the person with dementia, on occasions when they might become agitated, disturb others, become overwhelmed or disorientated, and shout or wander. Issues that were identified for the theatre to consider included seating plans, and managing staffing, communication and expectations. Lighting in the theatre and access to bathroom facilities were also identified as issues to consider.

Feedback from participants involved in the pilot project (discussed in detail later in this report), also reveals some of the barriers that they experience, and highlights that many avoid going out to the theatre under normal circumstances due to these issues.

2) Partnerships and Infrastructure

The training that was provided was designed to support the development of an infrastructure providing better provision for people affected by dementia. Theatre staff who took part in Dementia Awareness Training identified a number of ways in which they would apply what they had learned in the context of their work. Key themes included:

• Understanding dementia “Better understanding of all signs and symptoms.” “Understanding the needs of that person. Be friendly towards them so they feel at ease.”

• Respecting the individual “Understand person centred values more, how people with dementia may be feeling, what their needs are, how you can alter simple ways to communicate.”

• Offering time, empathy and patience “Greater understanding of what life is like for someone with dementia and how to respond to them appropriately and with sensitivity.”

• Improving communication (e.g. making eye contact and positive body language). “Non verbal communication is very important.” “I will now be more aware of dementia and will attempt to talk to the person with dementia directly, not just through the carer.”

Dementia Awareness staff training, Oakengates Theatre

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As highlighted previously, the idea of the pilot project was that changes would be implemented as a result of the Dementia Awareness Training, and that these would then be ‘tested’ by people affected by dementia and their carers. The feedback that was gained from these participants forms the basis of the next section of the report, and is related to the third identified outcome.


In this section of the report, we focus on the findings of the fourteen interviews that took place with participants who received free theatre tickets in exchange for giving their feedback. Participants included:

• 7 couples (carer plus person with dementia).

• Manager of Residential Home (who had accompanied 15 residents, many with dementia, to an afternoon theatre performance).

• 4 care home residents (three female, one male).

• Activity Coordinator of care home (who had accompanied 2 residents with dementia to the theatre).

We will begin by focusing on people’s prior participation in attending the theatre. We will then move on to consider various aspects of their experiences of attending the theatre as part of this pilot project, including access, support, the facilities available, the performance itself,

and the overall experience. Finally, we will focus on their future plans for participation.

3.1 Prior Participation

In the project documentation there was evidence that some of the participants were not regular theatre goers:

• Couple 2 attended theatre having met with the Coordinator at AgeUK Diamond Drop In very anxious and concerned whether this would work but after reassurance that theatre staff would be on hand to offer additional support agreed to participate.’

• Couple 3 are not previous attenders of the theatre but took up the offer of a pre-theatre tour of building and cup of coffee with FoH staff. This gave them confidence to book tickets and attend a comedy night.’

• Activity Coordinator took up invitation and accompanied 2 residents to the theatre for the first time.’

Some participants used to participate in theatre visits and other social activities more regularly, but had now stopped doing so due to the barriers that they experienced:

“Couple 1 returning to attend evening ballet performance a big risk as they hadn’t been out in the evening for a considerable time.”

“They stopped coming to performances once D got ill as he developed challenging behaviour and can use bad language.” (Interview 3)

Didn‛t use community room option

Reception was fine

This has made a big difference

to our livesGreat

production

Arrivedearly

Concerned about parking

Building laid out well

We were treated as

VIP‛s

Have incentive to come back

Bar difficult when busy

A very good experience

Introduced to staff

Change signs on toilets

Seats were good


Introduced to staff

Will only goin daytime

LoveMusicals

Did notlike Theatresurroundings

Nothing we like on

programme

No prior concerns

Excellent performance

Used tovisit theatres

He was so happy

Theatre anddancing

previously

Somethingto look

forward to Staff verynice wellinformed

Greatseating

Biggest achievement since illness

began

Great production

Will return to see

musicals

Performancetimes perfect

Concernedabout upsetting

others

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Going to the theatre was seen by some as an activity that they could still potentially engage in, even if they had rarely done so before, because of the fact that it was based on being an audience member rather than an active participant. With the exception of some generalised anxiety from some participants, people generally seemed confident about attending the theatre, even though it was a new experience for some. The concerns of D’s carer in Interview 3 (see above) were resolved by a prior phone call to the Front of House Manager, as they were allocated seats at the end of a row, near to one of the exits and a specific member of staff to look after then during their visit. This demonstrates the value of good communication prior to the visit.

People’s journey to the theatre was generally problem-free. Some carers drove; some were driven by family members, and a mini-bus took a group of residents from a nursing home. On just one occasion, there were issues due to a Jubilee Street Party being held, which resulted in limited parking, and difficulties in manoeuvring a wheelchair from the car park, but this was recognised as unusual.

3.2 Attending the Theatre3.2.1 The Venue: Access and Support

Participants similarly reported few difficulties in accessing the theatre itself. The slope to the theatre could be a challenge for those pushing wheelchairs, but once inside, the first impression of the building was almost universally positive:

“Immediate response was surprise at how well set out the building is, very impressed with facilities.”(Interview 5)

There was also positive feedback about the welcome that was received by staff at the theatre, and about the practical support that was received:

“Manager came and spoke to us when we arrived, explained that we could take drinks into the auditorium, and reassured us that the ushers were aware of the situation and on hand to help and to take us to the quiet room if required.” (Interview 3)

In several cases, staff had checked that the participants were all right during intervals. However, the experiences of the Care Home Manager were rather less positive, perhaps reflecting also the greater challenges of supporting a larger group of people to attend the theatre:

“The Reception/Box Office area was quite busy when we arrived. Some residents are more mobile (walk quicker) but we had to wait for the whole party to be together before we were allowed into the theatre and our seats. Keeping residents waiting in a busy area made people quite agitated. We had to bring one person home half way through as they were too agitated and couldn’t settle down.”

The Care Home Manager felt that allowing people to go through and take their seats would have helped the situation, as would further assistance in actually getting people to their seats.

3.2.2 The Venue: Seating

Seating was found to be satisfactory in the majority of cases. One of the main concerns for a number of participants was that they needed to be at the end of a row and near to an exit, in case they needed to leave their seat for whatever reason.

“Seating position was great, good view and we could get out easily which is important as D needs to go to the toilet frequently.” (Interview 3)

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“Yes, as long as we’re on the end of the row nearest the exit. It’s not good to be in the middle and have people pushing past.” (Interview 6)

Again, however, the experiences of the Care Home Manager were less positive, and at the same time confirmed the importance of the issues identified above, along with the need for greater communication and planning when involving larger groups of people in theatre visits:

“We had the first seven seats in the front row and seven behind them in the second row. As we were seated at the end of the row, people kept wanting to get to their seats in the middle of the row and kept disrupting residents (who didn’t understand why they were being asked to stand up). [The Care Home] made the mistake of not asking for seats in disabled- spaces, so had to transfer (i.e. lift) people from wheelchairs into theatre seats.” (Interview 9)

One interviewee commented that the theatre was rather cold for people in wheelchairs, who might have more difficulty keeping warm, and in two interviews there were comments about low lighting:

“We were taken straight to our seats. We had to be careful as there was low lighting all through, so had to be careful not to fall...” (Interview 11)

“Yes, we could see the stage and could hear all the singers. We would have liked a bit more light (it was too dark for D).” (Interview 13)

This identifies some issues that could seem to be addressed relatively easily by Oakengates Theatre.

3.2.3 The Venue: Refreshments

Of those participants who accessed refreshments, any difficulties tended to be linked to the challenges of physical access in terms of moving around the theatre, and to the numbers of people queuing. This was particularly stressful for the Care Home Manager:

“The interval was a nightmare. Residents thought it was the end of the performance so wanted to go home. Some people wanted to go to the toilets, others wanted

to stay in their seats...One resident had a panic attack, so a glass of water was brought into the auditorium which was then tipped over the floor...” (Interview 9)

Clearly, not all of those issues were linked to the arrangements for refreshments, but a potentially useful suggestion made by the Care Home Manager, as well as other participants, was of the possibility of theatre staff bringing refreshments into the auditorium for people:

“During the interval, staff should come around with ice-cream and drinks (squash etc) to sell in the auditorium itself as there were so many people and crowds in the bar area, most people in our group didn’t want to move from their seat.”

Again, this might be a relatively easy change to make, depending on staffing levels.

3.2.4 The Venue: Rest Rooms

The rest room facilities were felt by some participants to be dementia friendly:

“With M they were not a problem. I don’t think it’s a problem generally for everyone as the toilets are directly off the Bar/Exits from the theatre so it’s clear (sightlines) and people with dementia are less likely to get lost.” (Interview 1)

“Great, the open plan bar area is good (clear visibility)...I didn’t have to actually go with D to the toilet but could keep an eye out from across the room once out of the auditorium.” (Interview 3)

However, another participant commented that the signs were confusing for the person that they cared for:

“B used the facilities at the interval and had to queue up but it wasn’t too stressful. She did walk towards the male toilet – it would help if the signs could be changed or words added to doors as currently the signs for male and female are very similar and B was confused.” (Interview 4)

Most other participants had not used the facilities, though in at least one case this may have been partly due to anxiety, linked to the challenges of moving around the venue:

“I didn’t use them. The only trouble is if you wanted to go during the performance, you had to push past other people sitting and I worried about tripping over.” (Interview 13)

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The repeated references to such issues arguably point to a need for greater consideration of the needs of people with limited mobility when designing spaces such as theatre auditoriums.

3.2.5 The Venue: Quiet Room

The theatre has a Community Meeting Room which was made available as a quiet room for people with dementia and their carers if it was needed. Most interviewees had either chosen not to use

it, or were unaware of it. In just one case it was used and was found to be a very valuable facility:

“The Front of House Manager offered this facility and we did use it at the interval. The FoH Manager took drinks into the Quiet Room and waited to show us where to go.” (Interview 7)

This was found to be especially valuable for the carer, who was also disabled and could not cope with lots of noise, ‘so the quiet room really met her needs. Would absolutely recommend this facility.”

The Care Home Manager also indicated that she would have found it a useful facility had she been aware of it:

“If only! I was not made aware of or shown this facility. It would have been really useful for the resident having the panic attack.” (Interview 9)

Similarly, in Interview 6, the carer had not been shown the room, but felt that it was something that she would make use of in

the future. In the past, her partner had felt ill and she had considered taking him out to the car park, and she felt that the room would be particularly useful in such circumstances.

This demonstrates the central importance of communication in ensuring that everyone is aware of the facilities that are available.

3.3 The Performances

Feedback about performances was almost universally positive, which supports the overall rationale for increasing people’s arts participation through this project. Some accounts about the impact of the performance on the person with dementia were powerful and moving, for example that of the carer in Interview 3:

“D kept holding my hand at the beginning as he gets nervous, but once the music started, he let go and by the end we were standing up and waving our arms to the music...My son was sitting in the middle of us and throughout the performance D kept turning to us and saying ‘it’s lovely isn’t it?’ It brought a tear to both me and my son. It was a picture to see his face.”

There are also some insights into some of the potential impacts in terms of well-being:

“Absolutely superb, haven’t laughed so much in months. Hilarious, didn’t want it to end.” (Interview 7)

The same participant referred to feeling ‘elated’ after the performance.

Despite some of the challenges that the Care Home Manager had experienced in terms of the practicalities of taking a larger group to the theatre, there was still very positive feedback about the actual performance, and the way that it had effectively engaged the participants:

“Really good. Catered exactly for the residents – they were singing along, really enjoying it.” (Interview 9)

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The Activity Coordinator who had taken two residents to the theatre was similarly positive about the performance that they had seen and the impact on residents:

“Brilliant, fantastic. J (resident) loved it, clapped his hands all the way through it. Female singers were fantastic, the Compere was brilliant. A real nice show, fantastic afternoon. Going back in time was really good, a trip down Memory Lane.” (Interview 12)

The only negative comment related to a film screening, in which the adverts at the beginning were found to be

‘too long and loud’, and the ‘computer graphics very disorientating’. In addition, the lack of an interval was found to be a problem: the person with dementia got bored and agitated, and needed to leave with her carer half way through.

3.4 The Overall Experience

Again, feedback about people’s overall experience was overwhelmingly positive, and highlights some of the potential benefits of developing arts participation amongst people affected by dementia and their carers.

The evidence suggests that even when participants were unable to stay for the entire performance, they could still find it a positive experience, as in the case of the carer who took part in Interview 2, who had accompanied their partner to see Swan Lake:

“M was absolutely engrossed, clapping...we will definitely attend more ballet in the future. M enjoyed it and with prompting she has (subsequently) talked about it. We left after the first half. I don’t think it was a disaster, it just didn’t quite come off (in terms of attending the whole performance).”

Similarly, in Interview 8, the carer describes how much ‘H’ had enjoyed the performance of ‘There’ll Always be an England’:

“Brilliant, really really enjoyed the whole thing. H was so involved, throwing his arms about, and enjoying himself so much. He would have got up and danced if he could (but he can’t).”

There were further examples in which participants had continued talking about the experience afterwards. ‘J’, for example, was one of the group of Care Home residents who also attended ‘There’ll Always be an England’ and talked about being able to tell her grandchildren about it (Interview 11). Another of the residents involved in the trip talked about her feelings of comfort in going in to the theatre, even though she had not been there before, and stated her intention to go again:

“Walking through the main door everything was in order and I knew where everything was. I would definitely go again. Everyone who came on [the stage] was great.” (Interview 13)

Didn‛t use community room option

Reception was fine

This has made a big difference

to our livesGreat

production

Arrivedearly

Concerned about parking

Building laid out well

We were treated as

VIP‛s

Have incentive to come back


A very good experience

Introduced to staff

Change signs on toilets

Seats were good


Introduced to staff


LoveMusicals

Did notlike Theatresurroundings

Nothing we like on

programme

No prior concerns

Excellent performance

Used tovisit theatres

He was so happy

Theatre anddancing

previously

Somethingto look

forward to Staff verynice wellinformed

Greatseating

Biggest achievement since illness

began

Great production

Will return to see

musicals

Performancetimes perfect

Concernedabout upsetting

others

58

Similarly, ‘D’ and his partner went to see the Bootleg Beatles, and it clearly had a significant impact on him, as highlighted by his partner:

“D couldn’t stop talking about it for the week after the performance; when visitors came he wanted to tell them about it. He wanted the whole family to be there with him...I was very pleased I’d tried it out and how much D enjoyed it. It made me happy to see him happy.” (Interview 3)

It is worth noting here that they used to attend the theatre regularly, but had stopped coming to performances once D became ill as his behaviour and language had become challenging. They attended the performance with their son, and it is clear to see that being able to share such positive experiences as a family, and also for D to be able to share his feelings about his new experience in conversations with others, is immensely valuable.

There were several further instances in which people had found the overall experience such a positive one that they had booked to see other performances as a result. For example, the Activity Coordinator talked about the interest that had been generated in future activities, and referred to the sense of achievement that they had all felt:

“Really enjoyed it. Lovely to take the two residents out, felt like we’d really achieved something. Coming home, they [the residents] asked when they could do this again. The other carer thought quite a few other residents would also like to go to the theatre.” (Interview 12)

Planning and booking future visits could also give people something to look forward to:

“Really good. J looks forward to each performance. We have tickets pinned to a board at home (reminds J of upcoming events to look forward to.” (Interview 6)

Such positive anticipation is clearly significant in terms of its contribution to well-being.

3.5 Future Plans

As previously indicated, there was evidence that attending a particular performance had generated interest in further visits to the theatre. In particular, there was generally a strong interest in performances involving music. This perhaps reflects the fact that cognitive impairment is less of an issue when music is involved:

“Anything to do with singing and dancing and costumes – gives H enough to watch. Plays and comedians wouldn’t be suitable for H as he won’t understand them.” (Interview 8)

Several participants also expressed a preference for performances involving ‘old time music’.

Some participants were happy to attend performances at any time of the day or evening, but around half voiced a preference for afternoon shows.

The final questions that were posed to people in interviews were: ‘Why is this important to you? How does a night out at the theatre/attending an art event contribute to well being? How important is it to you?

People’s responses to these questions further contribute to establishing a need for a creative programme for people living with dementia. A theatre visit was seen as offering relaxation and shared enjoyment for people with dementia and their carers. It was an event that they could look forward to and a break from the ordinary:

“We can’t go to clubs anymore. Mr B is not able to go out, can’t get up and dance, so to come out to the theatre and be able to sit down and enjoy a performance together – it’s relaxing. It gets us out of the house. Something to look forward to.” (Interview 7)

Similarly, in Interview 8, P commented that as H’s carer 24/7, the theatre was the only way for them to go out, as meals out were no longer possible. They rarely went anywhere at all. H ‘really enjoys music’, and so going to

59

the theatre was again a valuable opportunity for shared enjoyment. For some, there was a realisation that these opportunities were still open to them:

“The experience of going out. Now realising you (I) can do this, it does require organising but it’s worth doing.” (Interview 2)

“We always loved the theatre but when D got ill I didn’t think I could do it any more. By coming to this performance, it’s been the biggest achievement (since D’s diagnosis) and it is so important knowing we can do this in the future. [I thought] we had no where to go in the evening but now there is something to look forward to.” (Interview 3)

For others, it was music that they identified as always having been important in their lives. This was the case in Interview 6, in which P (carer) commented that ‘our house was always full of music’, and that ‘music is very important to J. It does him good’. S, one of the residents who attended the theatre as one of the group from the Care Home also commented that ‘music is really important – I keep it on [the radio] all night. I would be lost without it.’ (Interview 10). Being able to engage with musical performances in the context of a lifetime of being a music lover can therefore clearly be seen as valuable in terms of maintaining a sense of identity. It can additionally be seen as a positive strategy in terms of constructive use of time. Another participant with dementia noted that:

“I love music. Beautiful, the singing at the theatre – it stayed in my mind. Everything about it [the show] was great. Time didn’t drag.” (Interview 11)

Furthermore, the Activity Coordinator felt that encouraging people to go out more would help them to maintain their independence.

All of the evidence presented above highlights the extent to which people valued the opportunities that they had experienced, and in many cases their enthusiasm to attend future performances.

Task Group Reflect and Review WorkshopAt the final Task Group meeting on 26th April 2012, there were discussions about what had gone well with the pilot project, what barriers still exist, and how to move forward. The following key points were identified:

What went well?

• The application of staff training to the Visitor Survey research, piloting people’s experiences and making changes to meet people’s needs.

• The depth of knowledge of front-line staff demonstrated personal and professional experience through dealing with the general public. Feedback from staff after training was that it had been one of the most interesting sessions they had received.

• Participants were very forthcoming with feedback; offering theatre tours in particular had a positive impact on the success of the Visitor Survey work.

• The commitment of theatre staff to the pilot project, including the pre-show visits to familiarize people with the building, and giving people a choice about what to attend.

• The Task Group involvement.

What barriers still exist?• Overcoming people’s anxiety about

attending community events – both from Third Sector partner agencies and individual participants.

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• Lack of understanding of the relevance of Dementia Awareness Training at the recruitment stage for the staff training: theatre managers had to work to overcome this. Younger members of front of house staff who attended the session found it difficult to comprehend but were nevertheless engaged.

• The issue of disclosure when participants revealed wider issues and concerns during interviews which researchers and theatre staff were not qualified to deal with and needed to be referred to relevant health professionals. In particular, this could be an issue because once an initial needs assessment has taken place, people may not be seen by social/health care professionals, during which time their needs are continually changing.

• Developing a creative offer for people with dementia attending unassisted (i.e. don’t have carers and/or short break respite for carers). This was identified as an issue requiring ‘very careful consideration’, as most existing opportunities encourage people with dementia to attend with their carers, and each tended to gain a lot from the experience.

• The need for further evidence about how creativity is relevant to people’s needs, and for arts and dementia advocacy.

How do we move forward?

• More work to raise understanding of the relationship between art/creativity and other community initiatives and art therapies.

• Roll out the pilot to other buildings and settings in the light of evaluation findings.

• Explore further ways to incorporate dementia awareness training into staff induction, training, and support, including visits to care homes and community projects. Provide opportunities for on-going reflective practice, and also for peer support in relation to specific experiences and incidents.

• Need to agree signposting protocol so that any disclosure issues that arise during interviews, so that research staff and artists know who to contact about issues that cause concern, and could gain consent to do so. This would be a longer term policy development to be referred to a Commissioner.

• It was agreed that the introductory ticket and theatre tour should become a permanent scheme in collaboration with Task Group partners, to encourage new participants via various Dementia Cafes and drop-ins. The Task Group would then convene regular review meetings to consider the responses.

Shorter Productions

please

Seating was comfortable

The staff were great

Will attend more productions

Parkedfine

First evening out in years

Absolutelyperfect

No intervalin film


Frequent Theatre/gallery

visitors in past

Some apprehension

before visit

Parking went well parked in disability space

Everyone recognised me

from previous visit

Film advertstoo long and

too loud

61

• Long term aim is to roll this research out to other local authority leisure centres and libraries.

• Explore possibilities of developing a new theatre volunteer scheme and whether this can be linked to Age UK Telford’s new ‘befrienders’ scheme, in which new carers of people with dementia buddy up with experienced carers.

The engagement of the Task Group in this process of reflecting and reviewing is seen as particularly appropriate for a pilot project that will be used as the basis for planning future activities.

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Task and Finish Group set up.Invited expertise from agenciesonto a development group to inform process and outcomes

Theatre staff receivedementia awareness training

Large scale eventwith artists, carers and agencies Exploring the potential for Arts in terms of well being. An outcome of this was mapping and prioritising year one. Key priorities for

initial year agreed

Appointment ofArts and DementiaCoordinator

Outreach contacts told aboutspecific theatre offers andasked to promote these onbehalf of Coordinator/theatre

Coordinator visits settingsand builds relationshipswith group

or

Theatre VisitFor those that want to it we arrange aninformal visit to the venue to see cafe,toilets, auditorium and meet key staff so thatpeople are aware of the setting and supportin order to make an informed choice aboutattending a show and to discus any specificneeds Attend show with carer

or care setting staff

Post show feedbackCoordinator gathers feedbackon peoples experience andrelays this to settings and theatre to improve the service provided

Backto task

and finishgroup

Dementia Friendly Buildings: The Place Theatre Oakengates

63

The Project Team• John Cocker - Creative Development

Team Manager (Telford & Wrekin Council)

• Rebecca Owen – Project Coordinator

• Jacqui Rowe – Artist Advisor

• Sharon Walford - Artist Advisor

The Artists• Fiona Collins

(Chillcott Gardens Extra Care)

• Mark Riley (Millbrook Day Centre)

• Ruth Swallow (Farcroft Residential Home)

• Sally Tonge (AgeUK Diamond Drop In)

The Evaluation Team• Kate Gant

• Janet Hetherington

• Jackie Reynolds

With Special Thanks to:Everyone who contributed to this evaluation, including Care Home Managers and Staff; Oakengates Theatre Managers and Staff; project participants and their families.

Bibliography and Further Reading

Andersen-Warren, M. (1999) ‘Creative groupwork with elderly people – drama’, Milton Keynes.

Clarke, R. (2004) ‘Precious experiences beyond words’ ‘Journal of Dementia Care’, vol 12, no 3, pp 22–23.

Cotter, A., Fraser, F., Langford, S., Rose, L and Ruddock, V. (2001) ‘Getting everybody included’, London: Magic Me.

Craig, C. (2005) ’Focusing on the person: exploring the benefits of photography for people with dementia’ Dementia Services Development Centre, University of Stirling.

Craig, C. (2003) ‘Meaningful making: a practice guide for occupational therapy staff’: Dementia Services Development Centre, University of Stirling.

Craig, C. (2001) ‘Celebrating the person: activity pack’ Dementia Services Development Centre, University of Stirling.

Craig, C. (2001) ‘Celebrating the person: a practical approach to art activities’, Dementia Services Development Centre, University of Stirling.

Cutler, D. et al. (2011) Creative Homes: How the Arts can contribute to quality of life in residential care. London, Baring Foundation. Available from: http://www.baringfoundation.org.uk/CreativeCareHomes.pdf [Accessed 24 September 2012]

Heywood, B. (1994) ‘Caring for Maria’, Tisbury: Element Books’.’

Innes, A. and Hatfield, K. (eds) (2001) ‘Healing arts therapies and person-centred dementia care’, London: Jessica Kingsley Publishers.

Killick, J. (2008) ‘Dementia diary: poems and prose’, London: Hawker.

Killick, J.(2000) ‘Openings: dementia poems and photographs’, London: Hawker.

Killick, J. (1997) ‘You are words: dementia poems’ London: Hawker.

Killick, J and Allan, K. (1999) ‘The arts in dementia care: touching the human spirit.’’ Journal of Dementia Care’, vol 7, no 5, pp 33-37

Knocker, S. (2006) ‘’Activities in the later stages of dementia’ in the Alzheimer’s Society Book of Activities’, London: Alzheimer’s Society.

Koenig Coste, J. (2003) ‘Learning to speak Alzheimer’s’, London: Vermilion.

Langford, S. and Mayo, S. (2001)’ Sharing the experience:’ ‘how to set up and run arts projects linking young and older people’, London: Magic Me.

Mental Health Foundation (2011) An Evidence Review of the Impact of Participatory Arts on Older People. Edinburgh, Mental Health Foundation. Available from: http://www.mentalhealth.org.uk/content/assets/PDF/publications/evidence_review_participatory_arts?view=Standard [Accessed 29 September 2012]

Michaelson, J. Mahony, S. And Schifferes, J. (2012) Measuring Well-being: A guide for practitioners. London, New Economics Foundation. Available from: http://www.neweconomics.org/sites/neweconomics.org/files/Measuring_well-being_handbook_FINAL.pdf [Accessed 29 September 2012]

NAPA (2010) ‘Activity at the heart of care: a guide to developing community links’. London: NAPA.

Perrin, T. (2005) ‘The new culture of therapeutic activity with older people’ Milton Keynes.

Websites

Arts4Dementia: http://www.arts4dementia.org.uk/

New Economics Foundation (Five Ways to Wellbeing): http://www.neweconomics.org/projects/five-ways-well-being

West Midlands Arts Health and Wellbeing: http://www.westmidlandsartshealthandwellbeing. org.uk

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The Project Team• John Cocker - Creative Development

Team Manager (Telford & Wrekin Council)

• Rebecca Owen – Project Coordinator

• Jacqui Rowe – Artist Advisor

• Sharon Walford - Artist Advisor

The Artists• Fiona Collins

(Chillcott Gardens Extra Care)

• Mark Riley (Millbrook Day Centre)

• Ruth Swallow (Farcroft Residential Home)

• Sally Tonge (AgeUK Diamond Drop In)

The Evaluation Team• Kate Gant

• Janet Hetherington

• Jackie Reynolds

With Special Thanks to:Everyone who contributed to this evaluation, including Care Home Managers and Staff; Oakengates Theatre Managers and Staff; project participants and their families.

telford arts & dementia programme

Documents