Material Citizenship in Care Homes
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Material Citizenship in Care Homes
Dr Kellyn Lee is a Chartered Psychologist and Visiting Research Fellow at the University of Southampton, School of Health Sciences. She is the founder of WISER Health and Social Care and The Dementia Care Hub (www.dementiacarehub.co.uk)
In this blog Kellyn discusses why everyday objects are crucial for reimagining dementia care. She introduces the concept of Material Citizenship and shows some results from its application in care homes in the UK.
Material Citizenship
Material Citizenship is a concept I developed in my PhD in which I explored the decision-making process surrounding personal possessions when a person living with a dementia moves into a care home. I also explored how everyday objects, typically those used to carry out tasks, were used in care homes and who it was that used them.
What I found was that whilst it was widely believed among care home staff personal possessions are encouraged in care homes, this belief was inaccurate. Once I began listing the objects I might like and getting staff to think about the objects they might like, it became clear that many objects were not deemed necessary, or would carry too much risk. For example, I was likely to burn myself with my hair straighteners or start a fire with my hair dryer! It was only certain objects that were encouraged in care homes and even those carried caveats. The importance of every day functional objects such as a certain coffee cup, a pair of curling tongs or a handheld vacuum cleaner were overlooked for two main reasons:
- Care homes are set up to care for people, this often means care home staff doing to people rather than enabling people to live their life their way
- Care homes are complex settings that often follow risk averse practices which effectively caps what can take place within them
Material Citizenship sets out to reimagine what dementia care looks like, by focusing on the objects that maintain routines and rituals at a time of significant change. We know that personal possessions can make this life changing transition easier but until now have failed to provide care homes with a framework in which to do this safely.
Since my doctoral study Material Citizenship has been developed into a training programme and rolled out in care homes in England, Wales and Scotland. Reports have shown improved levels of wellbeing for residents and increased confidence in care home staff. Below are some examples:
Impact of Material Citizenship on residents
| Object | Scenerio | After Material Citizenship training |
| Newspapers
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A woman living in a care home wanted to deliver newspapers to other residents. She was stopped from doing this as ‘it wasn’t her job’
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She now delivers newspapers to residents each morning, stopping and having a chat whilst doing so. Staff have reported improved levels of well-being for her, and the residents enjoy her visits |
| The blue chair
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A woman recently moved into the care home. She was refusing to allow care staff into her room and relationships between her and staff were becoming difficult | The blue chair was brought in from home. She enjoys this chair as it reminds her of her husband. She now allows staff into her room and relationships are more positive |
| Bread maker | Woman refusing to get out of bed, staff concerned over mental health and physical health, such as bed sores and mobility. This also used a lot of staff resource | Staff identified the woman loved to bake bread, staff bought her a bread maker, she now bakes for the home – this gives a reason to get out of bed |
Impact of Material Citizenship on care home staff
| Prior to Material Citizenship training | After Material Citizenship training |
| Staff would often feel uneasy about positive risk-taking
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Management reported staff were now working with a “can do attitude” in the home
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| Staff often worked on the basis of assessing physical harm and overlooked psychological harm | Material Citizenship provided staff with a safety net enabling them to weigh up physical and psychological risk |
| The home had task orientated routines
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One manager said, “it has transformed how we work, residents can eat when they choose rather than meal times, and are enabled to do more when they want to” |
| Staff did not notice some of the great work they already do “I just do it”
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Staff began to notice the great work they were already doing. They began to record it in care plans and encouraged other staff who hadn’t attended the training to adopt this approach |
| Staff lacked confidence
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Staff are more confident in the way they work with other members of staff, residents, relatives and external health professionals |
| Staff were uninspired and fed-up with e-learning | Staff left feeling inspired, valued and wanted more of this type of training |
These are just a few examples of how Material Citizenship is changing the way in which we deliver dementia care in a care home setting. And whilst it may not be ‘rocket science’ as was pointed out on Twitter following coverage in the guardian, it is often the small stuff that makes the biggest difference.
For more information on Material Citizenship contact Dr Kellyn Lee on info@materialctizizenship.com