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Supporting health and social care providers in Devon

Coronavirus occupational therapy advice to help keep people busy!

This leaflet provides easy tips for carers to help prevent boredom and maintain routines when having to self-isolate because of the virus.

Changes to daily routine, staff who don’t know the person, and reduced ability to engage in a range of activities outside of home will create anxiety and potentially distressed behaviour.

This leaflet will help you think about how to fill the day meaningfully and ensure there is minimal disruption to the predictability and structure of the day.

Meaningful activities & resources:
• Look on the internet and buy resources. Here is a shopping list to get you thinking! (see the leaflet called Ideas of activities to do in the home and garden)
craft
– sensory play items
– garden games (throwing & aiming; targets; therapy balls)
– indoor games (throwing & aiming; targets; therapy balls)
• bLook in your cupboards – what can you find! Dust off the old games!
• Risk assess each activity for each person
• Make a grab sheet of ‘things I like to do / interest me’ for each person
Living Well in Care Homes resource for a selection of leaflets with ideas of activities and how to engage people

Changes to staff team & the environment
• Staff changing will increase a person’s anxiety as the order of how they are being supported will change. Make sure you have clear care plans detailing the exact order someone likes to do things in their day and the step by step order that the person does specific tasks eg;
– document the flow of someone’s day eg; wake up, clean teeth, have breakfast
– document the step by step task analyses eg; the order someone gets washed; 1) wash face; 2) wash arms; 3) wash legs
– make a grab sheet for staff to follow
• Create quiet spaces where people can be supported to calm if the home is too busy

Changes to daily structure & routines
If the person needs to be quarantined because of the virus make sure you fill the voids in the day for when the person would normally be out. Think about what activity swaps you can do. Look at the leaflet called ‘ideas of activities to do in the home and garden’.

For further information, ask to speak to an Occupational Therapist within your local IATT team.

Before starting an activity…
•  Have a good balance of activity ideas to hand which you know are meaningful to the person, and which you have the resources to do.  A staff meeting is a good place to share activity ideas, and speaking to family members for ideas is important.  You may want to then pool these ideas together in a resource file.  Think about activities under broad categories of personal care tasks, domestic tasks and indoor/outdoor leisure activities.
•  Plan the service user’s day with them, giving simple choices of activity.
•  Break up the day into small sections of time to make it easier for the service user to understand and for carers to plan, e.g. from breakfast to morning coffee, morning coffee to lunchtime.
•  Help orientate people by using a wall chart to display the day and date, put up photos of the staff who are on duty that day.
•  Provide a sense of anticipation and control by making sure the person knows what they’re about to do next.  Use sequencing strips if  needed.

Ways to interact…
•  Staff need to be consistent in their approach to service users. The whole team needs to be in agreement with how they interpret and respond to service users’ needs.  Otherwise the service users’ needs may remain unmet, which can lead to frustration, confusion and behaviours which are hard to manage
•  Communicate appropriately.  Use simple sentences backed up with gestures/signing. Give only one short instruction at a time, allowing time to process information.  Consider alternative communication techniques like objects of reference, signing, etc.
•  Create opportunities to use an intensive interaction approach.  This is a good way to engage with non-verbal service users, and can be used throughout any activity.  Opportunities abound!  e.g.: looking at a photo album together; moving a wind chime to draw their attention to the sound; watching their favourite scene from a DVD and re-playing the part that they seem to enjoy most, drawing their attention to a nice smelling fruit in the supermarket, etc.  Or just joining the person in whatever they find meaningful; this could be simply rocking, flicking etc
•  Give the service user encouragement and support throughout.  This provides a sense of achievement and self-worth.  Remember that the process of actively engaging in an activity is more important than the end result, so it’s not important if the final outcome isn’t successful

During an activity…
•  Provide support and assistance throughout the activity according to the person’s level of need.  You may need to use verbal prompting, commentary, hand over hand assistance, gestures, demonstration etc
•  Break activities down into small achievable steps so the service user can participate in one or more steps.  For example during a bath, encourage the service user to hold the flannel while you put the soap on it
•  Focus on a sensory angle during activities by building in a focus on the sensations being experienced.  Draw the person’s attention to what they are experiencing.  For example during a painting session, offer them the opportunity to feel the bristles of the brush, to smell the paint, crinkle the paper etc
•  Acknowledge that the planned activity may not always be successful.  Everybody’s moods and preferences for activities can change hour by hour, so if the service user looks disinterested in what you are offering, try an alternative activity or two.  However if they clearly decline further alternatives, allow quiet time or time alone if appropriate for the person, or offer some form of relaxation session
•  Remember even fleeting moments of engagement are important. They provide a good base for rapport and further interactions.  For some service users, being able to just sit next to someone is a real achievement.  Sharing space with another person, giving even brief eye contact or engaging for a few seconds are all indicators of interactions and should be celebrated

After an activity…
•  Celebrate the outcome, even if it’s not perfect!  Frame or display art projects on the wall, or gather a group together (other housemates) drawing attention to the achievement
•  Capture highlights of someone’s day by considering the use of a video camera or digital camera.  Play the footage back to them onto a TV, computer or portable DVD player at the end of the day or week as a record of what they’ve achieved.  Involve them in the process of editing clips/adding music/simple captions etc.  This could become a routine, before bedtime, to mark the end of the day on a positive note.  A disposable camera and scrapbook can achieve the same result, but not so quickly
•  Monitor and record activities and what work well and not so well to share with the whole staff team.


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