These are the words no one ever wants to hear about their loved one, but my Mum’s GP warned us that Mum had given up on life and was ready to die.

There was no denying that Mum was really poorly, living at home with vascular dementia aged 95,  she had suffered 3 falls, several urinary and chest infections and had no appetite or interest in eating or drinking resulting in dramatic weight loss and dehydration. She would not pick up a knife or fork to eat and if you tried to assist her with a meal she would turn away from you.

However, my Mum was an incredibly strong, and stubborn, lady and we weren’t prepared to just accept what the care professionals said, so we set to work to do whatever we could to help her recover.

With my, then, 26 years experience from working in the care sector, and having some knowledge of nutrition and hydration for our elders,  I decided to take charge of Mum’s mealtimes and began to observe her mealtime behaviours to see what I could do to improve her dining experience and ultimately her nutrition levels.

I learned that getting people with dementia to eat can be challenging, and that complex interaction with the mealtime environment, plus many eating difficulties can prevent their nutritional intake.

Following research, I found an online mealtime assessment tool and started to observe Mum’s mealtime behaviours, to identify, find solutions and create a care plan to help overcome her mealtime eating difficulties with the goal of bringing enjoyment for her at mealtimes, giving her back her mealtime independence, preventing malnutrition and improving her quality of life.

The assessment tool provided me with a list of suggested interventions of which I chose several to trial with Mum including:

• Decluttering the mealtime environment to reduce confusion levels.
• Reducing noise levels resulting in a calmer setting which improved her nutrition
• Introducing adapted crockery and cutlery to help her regain eating independence
• Eating with her to make mealtimes more social occasions

Mum’s transformation was miraculous! Within weeks, Mum was back to eating completely independently, enjoying her meals and gaining weight.

The care professionals couldn’t believe her transformation and her end-of-life care nurse, Sally, stopped her visits saying ‘you don’t need my help anymore!’

Having seen Mum’s transformation, I wanted to share my learnings with others, who were caring for people with dementia, to enable them to also experience more positive and dignified mealtimes and improved nutrition.

And so Mum provided me with the inspiration to write my guide, as a free resource, with one aim – to help people with dementia achieve the most dignified, independent and delicious dining experience possible.

I had walked a mile in the shoes of those who care for people with dementia. I had faced their challenges, and I had been able to overcome them and I wanted to share the strategies which had worked for us.

I wanted to empower care managers and their teams and family members caring for people living with dementia to understand they CAN make a big difference in the way they support their people to lead to improved engagement and enjoyment at mealtimes.

I wanted them to really think about how their dining experience made their residents feel by putting themselves in their shoes.

Would their dining experience pass the ‘Mum’ test – would it be good enough for their loved ones? And if not why should it be good enough for anyone else?

My guide is designed for busy care managers and anyone who ‘s role involves supporting nutritional health. It is packed with best practice guidance and combines solutions to mealtime challenges, tips to improve the dementia mealtime experience and ideas of product solutions that are enabling for people with dementia.

My guide launched in 2017 and was requested and distributed to many different care professionals and types of organisations, more than I could have imagined: OT’s, care home managers, local authorities, care trainers, CQC inspectors, SALT teams, dieticians, care quality consultants, care catering specialists, end of life nurses and home care companies to name just some of the people who have had copies and have fed back what a valuable resource it has been.

Following feedback from a senior dietician within the BDA, who highly rated it and helped me to improve it, I updated it in 2018 and very much see it as an evolving resource as I learn more, and more research is done.

In 2018, I delivered ‘The Dementia Mealtime Challenge’, an interactive workshop I created based on my guide, at the National Association of Care Catering annual training and development forum. Several people who were present, have since come back to say ‘thank you we have implemented all the suggestions from your workshop!’

This is now available as a workshop for teams in care homes who are serious about looking at ways to improve their mealtime experience.

2019 saw me start my first consultancy project after an outstanding care provider approached me to work with them on a project to further improve their already excellent mealtime experience. This led to me developing a range of services to offer care homes including:

• Mealtime observational audits
• Enabling independence at mealtimes assessments for individuals
• Creating enabling dining environment audits for people living with dementia
• Mealtime equipment audit
• Partnership working with care teams on improvement plans and implementation.
• Retained support to measure continuous improvement.

I am passionate about helping people and sharing my knowledge,  and with my own experience and care sector background would love to work with more care homes to help them too.

I was thrilled to speak in the Dementia Theatre at the Care and Dementia show, and to launch our new video celebrating dining in care made in collaboration with Ian Donaghy; ‘Made with Love’.

by Jo Bonser

Download your own copy of my Dignified Dining Solution Guide using this link: https://hcsuk.co.uk/dignified-dining

You can visit Jo’s website here: www.hcsuk.co.uk.

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I was inspired to pull together this list of resources when attending a WhoseShoes event in Kent and heard about Kent Libraries’ wonderful list of reminiscence boxes and associated training.

A number of councils and other organisations offer a variety of dementia-appropriate books, games, activities and reminiscence or rummage boxes via libraries and other locations, for the use of care homes and individuals.

The list below just scratches the surface; if you are aware of services that we have not included please send details to feedback@carechartsuk.co.uk.

Most importantly, encourage them to list their services online! The internet is a vital source of information for people living with dementia and their families as well as care homes and organisations / individuals offering activities and events for people with dementia. If Google can’t find it, it’s going to be more difficult for people to get to hear about it.

Other sources of information

The International Federation of Library Associations and Institutions (IFLA), the international body representing the interests of library and information services and their users, have published guidelines giving practical recommendations on how to provide mental stimulate with books and other library materials. The publication also includes suggestions for library staff on how to tailor such services to the target population.

Other sources where these services may be listed are: Alzheimers Society…  Dementia Action Alliance…  Dementia Challengers…  Dementia Web

National Organisations

The Reader Organisation is a charitable organisation which runs Reader Groups in Care Homes and other locations.

Listening books is a charity providing an online and postal audiobook library service and also offers organisations their own mini library of 200 audiobooks to lend out to patients or residents or to play in communal activity areas.

Books on prescription is led by the Reading Agency  who worked with dementia healthcare experts, people with dementia and carer groups to select a list of 25 titles that provide support and advice for people with dementia and their carers. The titles can be recommended by health professionals and are available for anyone to borrow free-of-charge from their public library.

Regional organisations

Bolton offers free bulk loans of books for care and nursing homes on application to any library.

Bury has an impressive list of dementia-related titles.

Exeter Library, one of Devon’s Libraries, stocks a wide range of books offering advice and information on dementia.

Glasgow Museums has a wide range of themed kits available. They cover topics such as childhood and tenement life. Kits contain original objects, photographs and other material

Kent Libraries not only ensure they have a good stock of appropriate books, but also make available Reminiscence Boxes to care homes and people living with dementia, and provide training for staff on how best to use them as well. Contact openaccess@kent.gov.uk or call 03000412413

Leeds Care & Repair offer a free service for family members and carers to borrow fun games and activities

North East Lincolnshire Library has a dementia specific section

Liverpool Museums As part of the House of Memories programme you can borrow a ‘memory suitcase’ which contains objects, memorabilia and photographs. The suitcase contains a range of objects relating to the past including Liverpool Overhead Railway posters / Music and fashion memorabilia / Picture books and games / Ford Anglia model car  Pre-decimal coins and pound notes. The memory suitcase is a free loan service which is available from Museum of Liverpool for up to two weeks at a time. Also available: dementia awareness training to give you the skills to run a reminiscence session.

March Museum (Cambs) has loan boxes, a resource which use original, and a few reproduction, artefacts as a stimulus for learning in schools, care homes and almost any social club or discussion group.

Newcastle Library has a dementia specific section

Norfolk libraries are marking Dementia Awareness Week with free workshops and new dementia book collections and have a collection of Reminiscence Kits and Packs

Nottingham are piloting reminiscence packs or ‘Memory Lane kits’ to support people with dementia and their loved ones.

Poole Borough offer a special library card which enables people with dementia to borrow books for up to six weeks, instead of the usual three, and they stock a  complete set of Picture to Share books. People with dementia can borrow audio books, music CDs  and DVDs free of charge (2 per visit) and take advantage of the free Home Library Service for people unable to visit the library themselves, and for carers.

Somerset Library has a dementia specific section.

Wiltshire run library memory groups in Mere, Pewsey, Purton and Warminster libraries every week. The sessions are free of charge and refreshments are provided. The groups offer an enjoyable, relaxing opportunity to meet others and stimulate positive memories. In addition, Wiltshire Council is launching a new collection of dementia books, available in libraries. The aim of the collection is to provide a range of information about dementia and how to support people to live well. The books will be available in Chippenham, Devizes, Trowbridge and Salisbury libraries, and will be available to users of other libraries through the normal loan process. For more information people should contact their local library.

Please supply further resources to be added to this list or updates to feedback@carechartsuk.co.uk.

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