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1
Winston Churchill Memorial Trust Travel Fellowship Report (Elaine Cartmill)
Reminiscence Methods and
Intergenerational Practice in Care facilities in New Zealand
2
INDEX Page 3 Introduction
Page 4 Background to Ageing
Rationale and comparison of NI and NZ
Page 5 Definitions
Page 6 NZ Society of Diversional Therapist Association
Page 7 Reminiscence Methods and Activities
Page 9 Oral History and Life Review
Page 11 Doll Therapy
Page 12 Pet Therapy
Page 13 Art Therapy
Page 14 Memory Therapy
Page 15 Creative Writing
Timeline
Page 16 Music Therapy
Page 17 Storytelling
Page 18 Geneogram
Page 19 Intergenerational Practices
Page 21 Ageing Issues and Cultural Aspects in NZ
Page 23 Age Sector and Related Organisations
‐ District Health Boards
‐ Ace Programme
‐ Eldernet
‐ New Zealand Ageing Research Institute
‐ NZ, Ministry of Social Development
Page 26 Monitoring of Reminiscence Methods
Page 27 Final Comments
Page 28 Appendix A – Care Facilities in New Zealand
‐ Te Omanga Hospice, Lower Hutt
‐ Hetherington House, Waihi
‐ Kauri Centre, Papamoa
‐ Chatham House, Hastings
‐ Freeman Court, Te Awamutu
‐ Tamahere Eventide, Hamilton
‐ New Vista, Wanganui
‐ Parata Anglican Charitable Trust, Gore
‐ Pacific Islanders Care Home, Otara
‐ Princes Court, Ashburton
Page 33 Appendix B – References
Page 34 Appendix C – Structure of ACE Programme
Page 35 Appendix D – Diversional Therapy Care Plans
Page 37 Appendix E – Poem by a Alzheimer’s Patient
3
INTRODUCTION We as a nation are living longer, growing older and having fewer children. The number of older people as a
population is increasing, in the UK by 2020 there will be two in five aged 50 and over, with the 85+ age
group increasing the fastest.1 There are reasons for this steady increase, one is that some individuals made
the correct healthy (physical, mental, environmental, social) choices in the earlier stages of their lives and
another reason is because of the ‘baby boom’ years; named so, because of the 1950’s ‐ early 1960’s when
the UK began to prosper after World War II had ended. This had a huge impact on society then and more
so now as that population growth is embarking on retirement (aged 50 to 70 years old).
This impact is global and with much discussion about an ageing population, the economic impacts are
causing the largest worry, yet planning for it has seen less of the impact. As a society we deal more with
the present day and rarely think further than a few years into the future. Key questions are what will
happen in a decade, or several decades from now? Especially when care facilities are finding difficulties for
beds, staff, funding, standards now in 2008? How do you expect to be treated in a care facility? What are
your aspirations as an older person? “The quality of life for a person in today’s society should be
paramount regardless of gender, race, health, religion, cultural background, sexual orientation and
especially regardless of their age.”
New Zealand is one of the key countries leading the world in tackling rural isolation, promoting active
ageing and advocating the rights for an ageing population. They have a similar ethos to ageing as Age
Concern Northern Ireland, ‘to empower people so they can have a better quality, fuller, inclusive and
independent life.’2 Therefore the purpose and objectives of the fellowship were to gain knowledge,
awareness and further understanding of ageing issues; to experience the age sector in another country; to
share best practice and issues; exchange experiences and ideas; to use the approach of shared learning and
cascade the information to others so they to can benefit.
The study incorporated viewpoints from age sector organisations both urban and rural, with consideration
of best practice for the integration of ageing ethnic minority groupings. Northern Ireland has seen a boom
in immigration; there are issues on integration of immigrants into sectors. The healthcare industry is one
sector where employment, language, culture, interpretation of ageing and rights are portrayed as being
extremely diverse and often can lead to misunderstandings and discrimination. Ageing and caring for the
aged should be person‐centred i.e. social inclusion is a problem for a majority of older people, regardless of
ethnicity.
Northern Ireland has seen some intergenerational work but their findings are scarce, not published or
mostly urban focused. By visiting and sharing experiences with the residential care facilities and
community projects that have incorporated reminiscence methods and/or intergenerational practices (IP);
a deeper insight into methods and practices of their delivery can be gained.
Through reading this research report, there is a hope your mind may be broadened and you agree that
reminiscence methods and intergenerational practice within caring facilities are of huge benefit to not only
the ageing society but the wider community and younger generations too. ‘The chronological process of
ageing is a poor indicator of a person’s biological, social, emotional and intellectual age.’
4
BACKGROUND TO AGEING
In 1982, the United Nations (UN) recognised ‘Ageing’ as one of the three major
challenges facing the world, highlighting the many definitions surrounding the
exact age that you are categorised as an older person. The common trend is
linked to the retirement age (65) which in some instances is lower for women
than men and is not universal. Roebuck (1979) “As far back as 1875, the Friendly
Societies Act, enacted the definition of old age as, ‘any age after 50,’ yet the
pension schemes mostly use 60 or 65 years for eligibility.” Even Shakespeare had a definition in the
manner of ‘Shakespeare’s Seven Ages’, whereby the term ‘Third Age’ represented 50 to 74 year olds and
the ‘Fourth Age’ as 75 years and over.
It is important to note and clarify that in many ethnic minority groups, there is a huge difference in life
expectancies. This is a reason why the World Health Organisation (WHO) has difficulties putting a ‘world’
definition on an ‘Older Person.’ A person who lives in Zambia is old at 30, with a life expectancy of 32.1
years; whilst in Japan a lady is old at 75, with a life expectancy of 85.1 years.3 Within minority groups such
as the Traveller community, life expectancy is at 65 years, so do we therefore assume they are categorised
as an older person at 45.4
RATIONALE & COMPARISON OF NI & NZ
Demographics:
In Northern Ireland, with a total population of 1.7 million, whereby 16.2% (280,000) are of pensionable
age (65 years for men, 60 for women); life expectancy is recorded as 80.7 years and 76.1 years for female
and male respectively.5 In comparison to New Zealand, with a total population of 4.2 million, whereby
12.5% (525,000) are 65 years and over; and life expectancy is recorded as 81.9 and 77.9 years for female
and male respectively.6
Older People and Governments:
In 1999, the NZ Ministry of Social Development (who host the ‘Office for Senior Citizens’) highlighted the
need for a strategic approach to ageing and older peoples’ issues. The term ‘Towards a Society for all
Ages’ was coined alongside a long term, “for a society where older peoples’ contributions are valued,
where older people can participate in their communities in the ways that they choose, where both young
and old view older age as positive and empowering.”7 The Positive Ageing Strategy was to improve
opportunities to participate; to utilize research and networks and combine actions into a strategic
framework. The precedence that the strategy has set should encourage other countries to implement
similar policies. The Republic of Ireland Government established a Minister with special responsibility for
and an Office for Older People early in 2008; they are currently implementing a similar strategy. Northern
Ireland is currently preparing to announce a Commissioner for Older Person’s.
Caring for Older People:
Care facilities have to ‘cater’ for a large array of people, of various ages; abilities; cultural and religious
affiliation; illnesses and needs. It is shocking to be aware that, 80% of older women say they would prefer
death, to a bad hip fracture that would result in permanent placement in a nursing home.8 With the
5
British Heart Foundation reporting that “residents can spend up to 80‐90% of their time seated or lying
down; where one week’s bed rest can reduce an individual’s strength by up to 20%.”9 The largest concern
in the UK amongst older people is their loss of independence, leaving their home and the loss of their
dignity. One way to combat these is by the promotion and awareness that a healthy lifestyle and the
stimulation of the mind can be a huge benefit; this is where reminiscence methods can play a vital role.
From the University of Auckland, Rod McLeod who specialises in Primary Care highlighted, “that
awareness of ageing, end‐of‐life and the acceptance are huge issues that New Zealand has discovered
through research, it is even more evidenced within rural communities. In China 60% of older people live
in the countryside with 90% dependent on family support; with 80% of rural older people in India living in
poverty.10 From such statistics we can see that older people often rely on family to provide care in their
later years, and this is particularly evident within the Māori culture. The 10 care facilities that I chose
randomly to visit in New Zealand all implemented various management styles, care practices and
programmes. Yet each one had a person‐centred approach, participated in training, portrayed positivity
and enjoyment of their role “caring is about respect, listening, patience and compassion ‐ its common
sense!”11 In NZ, there are a variety of care facilities with retirement villages the largest single specialist
provider for older peoples’ housing, with approximately 21,000 residents in 303 villages. The remainder is
for short (respite) or long‐term care (incorporating end‐of‐life care) with 540 facilities and 32,000
approximate residents.12
DEFINITIONS To assist with the understanding of terminology used in the report, and for a clearer perception, specific
definitions have been highlighted. A more in‐depth interpretation will be in the main report.
Sundowning ‐ it typically occurs during the late afternoon, evening, and night hence the name. It has not
been widely researched but is estimated to occur in 45% of persons diagnosed with Alzheimer’s disease.
A person experiencing sundowning may become abnormally demanding, suspicious, upset, disoriented,
hallucinate and often co‐occurs with wandering.13
Secure Unit ‐ this is where a care facility is monitored by professional staff, assistive technology is used
and/or security mechanisms are put in place within the facility. This often is to assist the role of caring
and to reduce stress on staff (especially if the facility is large and extending) with caring; reassurance and
safety for older people living within the facility.
Dementia ‐ is defined as “a syndrome caused by disease of the brain, which may be the result of a number
of different illnesses; which is the progressive failure of most cerebral functions. There is no cure; it is
destructive and as devastating as other terminally ill diseases.”14 People with dementia suffer social,
material and personal losses, in addition the loss of identity, personhood and self‐esteem, becoming
depressed and with severe neurological impairment they may also develop physical illness. There is a
strong stigma, negative perception and stereotype attached to the disease, largely because it affects a
proportion of society who is over 65 years of age. Contrary there is an increasing global awareness of the
number and the impact of dementia on people under 65 years. Alzheimer’s NZ states that “Alzheimer’s
disease affecting one person has an impact on twelve other people in the community and consequently
has been called a ‘silent epidemic.”15
6
NEW ZEALAND SOCIETY OF DIVERSIONAL THERAPIST ASSOCIATION
New Zealand has identified that care facilities are a ‘place to age’ and that meaningful
activities, communication, inclusion, interaction and participation are fundamental to
an older person’s quality of life. The New Zealand Diversional Therapist Association
(NZSDT) began in the 1980’s; being pro‐active and core to providing meaningful
activities including reminiscence to residents and community.
Diversional Therapy is “a professional practice that involves the organisation, design, co‐ordination and
implementation of client centred leisure based activity programmes. The aim of which is to improve the
quality of life through ongoing support and development of clients psychological, emotional, spiritual,
social and physical needs and well being.”16
Speaking with Judy Cooper (chair of NZSDT) and Marcia Rickman (former president of NZSDT and Manager
of the Kauri Centre), they have been instrumental to a team who have set standards and qualifications for
individuals in the healthcare industry. Judy highlighted activities they involve and the key points with
regard to diversional therapy:
• Provide meaning and purpose through participation and activity to self‐identity;
• Encourage communication, expression, socialisation and to reminiscence;
• Promote individuality, freedom of choice and opinion;
• Maintain skills such as the use of hands and visual;.
• Creative meaningful activities;
• Promotion of residents/clients to work within their own capabilities;
• Implement strategies that assist with memory, orientation and depression;
• Implement strategies that assist independence and self‐worth i.e. with personal care such as washing
and dressing;
• Implement strategies that assist with daily living and engaging with family life.
Judy commented on the need for more research on ageing and intellectual disabilities in the area of
mental health, and jointly agreed with Marcia that ‘ageing in place’ and receiving professional care is
paramount.
7
REMINISCENCE METHODS & ACTIVITIES
Reminiscence is a therapeutic intervention; “the act or process of
recalling the past’ and ‘items from the past that stimulate
conversation and memories.”17 A reminiscence method is the
theory and mechanics of reminiscence, whilst reminiscence
activities are the transmittance of the theory to practice. The
methods should stimulate the mind; encourage and maintain
communication; be participative, inclusive and sociable; it should
reduce the feeling of isolation and depression; yet promote self‐worth, self‐identity and self‐confidence.
Above all reminiscence should be enjoyable, respecting the individual’s life and experiences. “Older
people are at particular advantage, especially those who are in care facilities as the methods can assist
with their integration into an unfamiliar often misinterpreted environment.” 18
University of Ulster, Emeritus Professor, Faith Gibson who has published and investigated many avenues
within reminiscence, highlights that “Reminiscence has people as equals it is the memories which makes
them different. It is a very important way of knowing who we are, it has been suggested that knowing and
understanding our roots and life history are the basis for our sense of identity and personal confidence.”19
Reminiscence involves ‘triggers’ which can be used either individually or simultaneously, and incorporates
the use of the five senses (sight, smell, sound, touch and taste). “In NZ over 75% of over 75 year olds have
at least one disability, the triggers therefore can integrate all abilities and capabilities into the
reminiscence sessions.”20 It involves a trained/well informed person facilitating a session, to encourage
and engage conversation or acts that reflect on areas of interest in an individual’s life. Everyone’s
memories have different depths and therefore the recalling of such memories can take various periods of
time. Reminiscence can be delivered one‐to‐one or within a small group, but not everyone enjoys
reminiscence; as some have experienced horrific events and this may have personally impacted deeply.
“Caution is needed when working with individual’s past and memories. People refashion the past to
please the user.” (Thelen 1989) Therefore sensitivity is needed. Resources such as tapes of music,
instruments, recordings, books, photographs, documents, poetry, drama etc can be used to stimulate
debate and discussion amongst and with participants.
In New Zealand, they use the term Diversional Therapist, for a person who facilitates the delivery of these
programmes, with the majority paid with no reliance on the professional care staff to assist on delivery. In
Northern Ireland, such personnel are most likely to be externally funded; or there is the reliance on the
professional carers to proportion their time to include programme delivery; or alternatively the heavy
reliance on volunteers. The term in NI for such personnel is variations on Activity Co‐ordinator.
The New Zealand Association of Gerontology (NZAG) is a voluntary, social and medical working group who
have an extensive experience, knowledge and interest in ageing; longevity, geriatric medicine etc.
Membership includes public, health professionals, care facility staff, academics and researchers interested
in gerontology and representatives from age, age‐related and organisations. There are several aims of the
association, fundamentally they advise, encourage training and aid policy, research and practices, within
interested organisations and Government.
8
Verna Scholfield is the National President of NZAG, and an Adjunct Senior Fellow with the School of Social
Work and Human Services, at the University of Canterbury; a board member of Alzheimer’s NZ and
advisory board member of NZ Institute for Research on Ageing. Verna divides work and time between the
two cities of Christchurch and Wellington. With a background in psycho‐geriatric medicine, and a social
worker for older people, Verna has published many papers on ageing, dementia care and elder abuse.
On meeting Verna, she discussed how she has successfully organised reminiscence sessions for those
diagnosed with early Alzheimer’s disease and dementia; “the consensus is to keep sessions short, but
regular and therefore setting a routine.”21 It has been recognised that routine does reduce disorientation
and confusion; this obviously assists care staff in preparation for activities; to dispel any concerns
participants may have regarding the session, encourage new participants and to encourage dialogue
between carer and participant throughout the week with participants e.g. ‘did you enjoy your activity this
morning?’; ‘are you looking forward to the next session?’
There was agreement that reminiscence methods can be low in cost and still maintain a quality of
interaction, “despite the low costs involved in reminiscence, it is useful, rewarding, participative and
beneficial; the high costs of implementing reminiscence methods is the staff time and training required.”22
Reminiscence must be taken seriously, so the planning and monitoring of activities are seen as more than
a spontaneous activity, providing care workers an incentive to participating. Each of the care facilities I
visited used a variety of reminiscence but there was a generic use of:
1. Reading newspapers;
2. Discussing specific issues;
3. Listening to the radio;
4. Communal crosswords.
The following are examples of reminiscence methods and activities I experienced in New Zealand.
9
ORAL HISTORY AND LIFE REVIEW “These are recollections from another person’s lifetime rather than that of the informant.” (Hutching
1993) Oral history is the recording of people's memories, feelings, point of view in oral form; it is a living
and shared history of everyone's unique life experience. It preserves everyone’s past for the future. They
can be recorded via written notes, audio visual equipment and/or the use of a Dictaphone.
Visiting the Stout Research Centre, Victoria University of Wellington aided my understanding of the
depth and phenomenal use of oral history. Brad Patterson, Irish‐Scottish Studies Programme Director has
completed research, published findings and lectured on the Ulster‐Irish‐Scottish connection to New
Zealand, some of which have taken him to the University of Ulster, Northern Ireland. Some of the
research can trace the volume of immigrants that came, the areas they moved to and the rationale behind
their issues; the obstacles they faced with regard to discrimination, isolation, employment and housing.
This research was collated from oral history accounts and memoirs, including those from Ulster‐born
former New Zealand prime ministers such as John Ballance and Ferguson Massey. Not forgetting Tom
Bracken, whose poetic penmanship is evident in the official New Zealand national anthem.
Helen Frizzell is an oral historian from Dunedin, who has facilitated and promoted the use of oral history.
Often found tutoring on the need for oral history, its relevance today, and training volunteers and
professionals in its working. Helen is connected to the work of the NZ Oral History Society which actively
participates in the delivery of history projects which can incorporate the NZ Government Departments.
One project in particular was regarding the Ministry for Arts, Culture and Heritage Department ‘Prisoners
of War’. “The rationale behind the project was recognition and accountability, it happened yet there are
few recorded accounts of the 8,300 New Zealanders imprisoned by the Japanese, Germans and Italians
during the Second World War.”23 Helen reported that, “many POWs stories will have been lost forever,
but the project allowed those who participated the opportunity to be heard, put their story across and
provide society of the 21st century an insight in times that the world will never see again.” Hamilton Library is located in the north island and the town has a strong Celtic connection, it has used the
oral history method to collate community accounts on the heritage of the town. It displays the
information to connect generations, to build community pride, and contribute to the local archives.
Rotorua Museum is located near the centre of New Zealand’s
North Island; the main attraction to the museum is the history
surrounding an 1886 volcanic eruption at Mt Tarawera which
devastated the town, and people today can relive that day
through the victims of the tragedy recording their accounts. On
my visit I spoke with the Manager about another exhibition, the
Māori Battalion C video history project. This was exhibition
began largely through a thesis by Taina Tangaere McGregor, who
used the collation of spouse interviews and written accounts of
that period.
The Parata Anglican in Gore and Princes Court in Ashburton are two care facilities that are proactive in
the use of oral histories, both facilities are serviced by local residents as they are very rural, therefore
10
there is a greater volume of male residents than other facilities may have. They introduced oral history as
a method to open and maintain communication between the staff and residents, to assist with getting to
know each other better. Shirley Turnbull, Nurse Manager at Parata recognised that, “getting to know
residents through their eulogy is obviously too late! Recognising that communication is fundamental in a
caring environment, a new approach had to be sought. The oral histories have made a phenomenal
difference.” The process used within these facilities is co‐ordinated by the Diversional Therapist, who
recruits volunteers and they are trained to facilitate oral history sessions. The sessions are held regularly
at the care facility and residents have the option to participate. The oral histories can be as long, and as
informative as the participant wishes, with the volunteer taking particular care to record key points and
often encouraging more detail or depth where necessary whilst being aware of sensitivity. Categories
range from Childhood; School; Home life; Employment; Marriage; Children; Friends; Hardships; Travel etc.
Another facility during profound work in this area is the Te Omanga Hospice in Lower Hutt, Wellington,
who cares for end‐of life patients and their families. They use the method of ‘life review’ (often used as
an alternative to reminiscence therapy), “the goal is to put memories in some sort of context and helping
the family and indeed prepare the person ‐ to come to terms with the life had.”24 The life review instils
dignity, often seen as leaving a legacy for the remaining family; this is particularly poignant if there has
been a relationship breakdown within families. Unlike the other care facilities I visited, Te Omanga is not
predominately working with older people, more often than not the patients are under 60 years of age.
The method is normally co‐ordinated by a professional therapist (but not always the case), and can involve
trained volunteers to assist in its implementation. Life review is usually delivered on a one‐to‐one basis,
ranging from weeks to months of collating of information, with the topics covered at the person’s
discretion i.e. the depth and variety of memories is determined by them. A life review doesn’t need to be
chronological; often memories can ‘jump’ from days to decades apart, even repetitive at times.
The method is held in high esteem within the Māori culture, as cited in the Pacific Islanders facility in
Otara, outside Auckland. It is seen as a resource that can bring peace and acceptance to both the resident
and the whanau (family); a practice that can pass on traditions, teachings and family history.
All the facilities encourage photographs to be incorporated into the history/review, which provides not
only a visual and a talking point but it can assist (by ‘sparking’ a memory) residents with cognitive
impairments, it also aids relatives to connect the story to a picture. The history/review is written in the
individual’s own language ‐ dialect or accent. There are two reasons for the importance of this; firstly
personality lies within a dialect/accent, secondly, the identity of a person lies within the sayings and their
account of happenings.
11
DOLL THERAPY Doll Therapy is a method used mostly with advanced dementia residents;
often spoken negatively of; yet viewing it in practice is enthralling. There is
a distinct difference in the way a person who has moved beyond the early
stages of dementia thinks. “At the stages of advanced dementia, the
person may now have lost much of their memory, their logic, rational
thoughts as well as their social inhibitions. The beliefs and values they
used to uphold are no longer important to them. They live in the moment ‐
and that is all that matters!25
The resident’s family are invited to discuss, prior to the introduction of the doll to the resident, but
fundamentally it is the resident’s reaction, wishes and involvement which is supreme. Pragmatic people
will use the method where they see that it will work, closely monitoring the implementation and delivery.
It is dynamic and evident in the Tamahere Eventide Care facility, outside Hamilton; which has a twenty
resident dementia unit, a team of specialist trained professional carer’s, several full time nurses and two
full time diversional therapists to assist with the doll therapy amongst other reminiscence methods.
Basically the doll, is given to the dementia resident, who normally take the instinctive role of being its’
carer. The professional carers are well informed of the therapy ‐ the benefits, the pitfalls, and the best
practice; and will always refer to the doll, as a ‘doll’, and not a baby. It is often seen as a controversial
method due to the perception of infantilising i.e. a loss of individual dignity. Doll therapy however can
offer many benefits, for example through the doll it can open channels of communication, assist in the
easing of agitated residents, assist in the overall well‐being of the person with dementia.
People with dementia have some universal emotional needs that are often not fulfilled.
The five most significant universal emotional needs are:26
• To feel needed and useful;
• To have opportunity to care;
• To have self‐esteem boosted;
• To love and be loved;
• To express emotions freely.
The staff at Tamahere Eventide Care facility all portrayed a positive attitude towards doll therapy, they
highlighted that such an outlook largely comes from the training they have received, their individual
understanding and acceptance, and the support of management and families. The biggest outcome for
this particular care facility is they can take the dementia residents, (who are often viewed as ‘difficult to
reach’) and socially integrate with the other 70+ residents within the facility.
12
PET THERAPY
This reminiscence method is becoming more and more popular, as it can display immediate reaction and
directly impact on an individuals’ physical, emotional, social and mental wellbeing. UK research has
supported such a theory, “for some older people, loneliness may be alleviated by pets. Older people
confirm that having pets helps to promote good mental health and well‐being in later life. Pets provide
companionship and reassurance, something to love, a reason to get out of the house and do some
physical activity, and opportunities to initiate social contact with other pet owners. ‘I think everyone
needs someone or something to love and cuddle and feel responsible for. I am never at home alone
because I have my dog.’ (Mrs K, retired nurse, aged 75).
“Relationships that are secure and supportive are important for good mental health and well‐being. They
may be with other people, such as family and friends, or with pets. Spiritual faith and belief can also
provide crucial support.” 27
The method is evident in Freemans Court, Te Awamutu; Parata Anglican Care, Ashburton and Tamahere
Eventide.
• Physically ‐ the pet needs walked, individuals feel comforted and relaxed by the physical contact;
there is an improvement in overall health due to mobility; balance and motor skills will improve;
• Emotionally ‐ the pet needs cared for, in some cases returning affection; the natural nurturance is
fulfilled and the feeling of being responsible;
• Socially ‐ the individual is mobile therefore interacting with others, with the aid of the pet starting
dialogue; interaction with care workers, motivation and the willingness to be more involved is met;
• Mentally ‐ the social isolation, loneliness, depression is reduced; being replaced with self‐worth and
esteem.
Keeping the visit or introduction to the pet routinely and regular is sufficient enough, with the pet being
either shared amongst residents or individually; at times a rota is introduced. The pets can range from
household animals such as dogs, cats, rabbits, goldfish etc to birds, pond fish, farmyard animals etc. It is
emphasised that staff record any progress and any incidents to allow for measurable effectiveness. There
are key points to consider when introducing the method which adds value to the effectiveness:
1) Matching individuals to the ‘pet’; to their background and the environment they come i.e. a retired
farmer will integrate better with a dog or farmyard animal than a hamster or budgie.
2) If bringing the ‘pet’ into the care facility, it must be suited to the environment; dogs such as the
Doberman are not very appropriate to the facility or to being handled by a number of people, whilst a
more temperate or small house dog e.g. a Labrador.
3) The pet would needs to be comfortable with the attention, the physical contact it would receive and
the noise.
4) Care workers need to be aware and understand individuals’ experiences; many may be good but some
may be hold bad memories.
5) It is a necessity to be aware of individuals’ allergies and/or conditions; if a resident is asthmatic, you
would not match them with a long‐haired fluffy cat!
“Reaching people with the right care and treatment is the best way of recovering a meaningful and
fulfilling life.”28
13
ART THERAPY
Art therapy can be a means of communication, when verbal and cognitive
functions fail, in participation it is just as effective individually as it is within
a group environment. It draws on emotions, feelings, and thoughts;
incorporating paintings, pottery, collage, crafts, needlework, knitwear, jams, chutneys and woodwork etc.
The Te Omanga Hospice demonstrates well its’ placement within the environment of palliative care and
end‐of‐life; in the context of counselling ‐ feel, heal and deal, acceptance and grieving. There are two art
therapists in residence, who strongly believe that reminiscence is an aid to grieving, pre and post end‐of‐
life. “It is beneficial for both the person (of any age) to accept end‐of‐life, prepare, feel at peace and
contentment with past and present issues i.e. putting things in order, before they pass on.” The hardest
part to art therapy within such an environment is, “that family members cannot accept the ending of their
loved ones life, this often prolongs the patients’ anxiety and discontentment, which is a reason why many
‘sleep away’ or ‘pass’ during the night, when their loved ones are not there to witness the end.”29
The method is offered to both patient and family members, with the younger generations participating
without much encouragement; often initiating and enticing others who are more sceptical to participate.
Te Omanga fondly entitles the process ‘feel, deal and heal’.
Feel ‐ to feel is to understand, empathise, accept the forthcoming loss and situation; there will be no
improvement (Te Omanga staff are aware not to give false hope). Family often remark on the
‘numbness’; which in itself is a feeling ‐ the body does not know how to react, and slows reaction to
situation down; this reaction should always be dealt with.
Deal ‐ to deal is the acceptance and understanding becoming action. It may be seeking professional
counselling, assisting the individual with arrangements and paperwork and forming the feelings to accept
the death. The shock remains, whether it is slow and drawn out or sudden.
Heal ‐ the old cliché, ‘time’ is an underestimated factor; it is dependent on the experiences of ‘feel and
heal’; the feelings involved and the type of people around at the time. Te Omanga comments that often
‘those who are feeling and dealing, are more acceptable to the stage of healing. Healing involves the
understanding, acceptance (of stages 1 and 2) and moving forward.’
Māori families in particular find the method uplifting and engage on introduction. It is personal,
expressive; sets a statement and many individuals are naturally creative and feel a sense of pride of their
accomplishments. Others feel liberated and recall their childhood, either way art therapy is a popular
reminiscence method within and out of caring facilities. With regard to cost art therapy can be as costly
or as inexpensive as your budget dictates. Freeman’s Court collates the produce from their art therapy
sessions and sells at their annual ‘gala’ day, which raises capital in the regions of $5,000NZD. This type of
activity boosts residents’ self‐worth, esteem, interest, interaction, ownership, and acceptance of the
‘place where they will age’. The community involvement, participation and intergenerational impacts are
fundamental to Freeman Courts’ objectives.
14
MEMORY THERAPY Psychologists and biologists indicate that memory is “a process of creative instruction actively revising and
creating according to the circumstances triggering it. Memory begins when something in the present
situation stimulates an occasion. Memory is living history, the remembered past that exists in the
present.” (Frisch 1990) It is important to be aware that when remembering an incident, the reaction will
be somewhat different now to when it originally happened, as obviously you would have had decades of
life experiences to neutralise or heighten your viewpoint. “Changes in personal circumstances, political
views and socio‐economic status will affect the testimony.” (Portelli 1981)
Tamahere Eventide uses the method of Memory Mats, it is inclusive, cost effective and can stimulate
conversation, and it is slow paced providing time for memories to be recalled.
The structure of the mat is a series of pictures which illustrate a topic/subject i.e. a church would typically
represent religion; although this is not always the situation, which makes this form of reminiscence
intriguing, as individuals make the image relevant to them. The mat can be revisited on numerous
occasions; it can be utilized by family carers, relatives, friends as the main skills required are to listen and
prompt dialogue. To utilize the memory mat method fully, and obtain in‐depth memory recall, training
would be beneficial as skills with recording, writing and prompting key issues would assist.
When working with patients and their families, Te
Omanga Hospice uses a method that introduces memory
boxes, (similar to the Reminiscence Network Northern
Ireland’s loan boxes). Patients at the end‐of‐life, can ‘close‐down’ channels of communication, preferring
not to discuss what was, as that would be acknowledging the end. Therefore the introduction of memory
boxes encourages and maintains meaningful communication, a discussion point for family members and
patients; it is the sharing of experience, information, knowledge, connection, understanding, happy, sad,
fun, memories.
15
CREATIVE WRITING This method can be effective individually or within a group, but does require some capability or assistance
with the recording of thoughts. It consists of various topics or prompts to initiate the thoughts i.e. the
first day I went to the beach…. The individual or group can then choose to record their experiences and
thoughts on paper through short stories, poetry etc.
This is a method that promotes participation and inclusion through a meaningful activity, whilst reducing
isolation. It is often delivered year‐round, and is extremely effective when new residents come into a care
facility. The common feeling of being the ‘new person’ is eradicated as the ‘new person’ finds people
within the facility with similar experiences to their own.
The Kauri Centre, Papamoa, Bay of Plenty uses this method to encourage self‐esteem and independence
amongst their participants. It is a process that is delivered when a new participant joins the centre, as it
can settle them into the group environment quickly. The staff collects comments and compliments i.e.
she is always smiling or he is a good listener and record these on a certificate. The certificate is then
presented to the participant.
TIMELINE The timeline is a method that Te Omanga encourages, as it forms a colourful life and assists staff to in
build a ‘picture’ and understand individuals’ reactions to particular situations. It’s depth is obviously
dependent on a patient’s age, and where the starting point on the timeline begins i.e. twenty, fifty or sixty
years ago.
Normally you begin at the birth year and then record key events in their life, preferably inserting a date or
year. This method endorses self‐identity; be inclusive and maintain communication; stimulating
memories and conversation. It leaves a ‘live’ legacy for family, and can be amended or at anytime.
16
MUSIC THERAPY This method of reminiscence is probably the easiest and least costly
of all. Music is personal, but everyone can recall a tune that they
love, hate and can identify with an occasion. All of the care facilities I
visited incorporated music into their reminiscence programmes.
In an investigation of the use of music to retrieve long‐term
memories, Smith (1986) provided six, thirty minute sessions to
twelve residents of two nursing homes in Philadelphia, USA who
were diagnosed as having Alzheimer's disease. Two sessions used musically cued reminiscence; two
sessions were spent with verbal reminiscence without music; and two sessions consisted of familiar songs.
The results and impacts of the musical activity were statistically significant. “Music has the potential to
make a major contribution towards the quality of life for older people.” (Hays & Minichiello 2005).
Similar methods are evident in Hetherington House, Waihi; Chatham House, Hastings and Pacific
Islanders, Otara. The therapy can be used through forms both physical and verbal e.g. by playing an
instrument, singing along, dancing or just listening. The sessions should be regular and held in a quiet
setting, with minimal distractions and noise.
It is most effective when a person has limited communication skills, it can calm the agitated, cheer those
who are bored, be participative and inclusive for the isolated. It is very easy to implement and deliver, in
either a group or individual environment, with the advantages far outweighing the disadvantages, but
needless to say they need to be considered.
Mobility is not an issue with this type of method, as music can be incorporated into many activities i.e.
chair based exercises which can be participated in regardless of minimum or maximum mobility. Bright
(1986) examined, by means of individually administered questionnaires, the stress level of staff working
with people suffering from advanced dementia in three institutions. She demonstrates from some of her
earlier studies that the effectiveness of using music therapy to effect positive changes in the behaviour of
disruptive dementia sufferers.
Participants react spontaneously to music which is a marked contrast to their generally apathetic state
according to care workers, “switching on music is like switching on a light, for some people.”30 It is
important to highlight that whilst this method is easily delivered, for maximum effect it should be
monitored i.e. leaving residents alone in front of a radio or taped music for a length of time will not be
effective, the method must be stimulating. Whilst the radio can be inclusive and the hearing of familiar
accents and current affairs, it is not wholly participative; the discussion after a raised point from the radio
show would be.
17
STORYTELLING
Storytelling is a therapy that should be introduced by trained
personnel, to provide more effective result. In today’s society
there is gaps within generations, with less time to build and
maintain relationships, which research indicate are crucial to
an individual’s mental health. Storytelling can help bridge the
gaps, by reconnecting with people, passing on tales and stories.
It is a method, easy to deliver in a group setting, it is very
successful and used more likely within particular cultures that
have a strong history based in storytelling i.e. the Māori, Pacific Islanders, Gaelic countries etc. This is not
always the case, as often audiences’ just needs imagination. Storytelling sparks imagination and
memories; reinforces language, listening and communications skills; boosts self‐confidence; fun and
interactive.
The purpose of the storytelling method is to:
• Make the stories positive and negative, not every story has to have morale, but to have a relevance to
the participants is appreciated;
• In the promotion of the shared‐learning and communication skills involved;
• Promote self‐worth, personal identity and the opportunity to share emotions, hopes, dreams and
desires;
• To develop understanding and appreciation of the different perspectives of a story and its impact on
emotions and identity;
• To strengthen heritage, communities, societies in a communal way to remember and to perhaps
increase respect and tolerance amongst them.
Stories teach understanding and can assist in the changing of attitudes and behaviour, encouraging
memories from the past. It is useful in bridging the gap between the cultures of the world e.g. Animal
Farm by George Orwell; the storyline is in parallel to issues regarding the Russian revolution. In Northern
Ireland, aside from tourism, one particular use of the storytelling method was to publish ‘Healing through
Remembering’; which incorporated individuals describing their experiences of the conflict in NI. This will
obviously aid those who wrote the book, as ‘feel, deal and heal’ but will also be a recordable account to
assist future generations on the way life was and perhaps lessons can be learnt.
Pacific Islanders Rest home highlighted that people who have emigrated from other countries can tell
their stories to help build acceptance and a sense of personal value in their new community. “Their
stories add a new and different flavour, helping to enrich the culture and develop understanding amongst
the community they have adopted.”31 Storytelling takes into consideration all the cultures that are
present. Due to the superstitions and beliefs amongst these populations, storytelling is very lively,
creative, imaginative and extremely popular. Poetry, short plays and role‐playing are common activities
that incorporate storytelling and due to the location of the facility and the individuals there is a healthy
resource of storytellers.
18
An important note is that when a story teller visits a care facility they must be fully aware and prepared
for the audience i.e. that some residents may have hearing problems; the ambience/acoustics within the
room; the may need to speak slower; and the needs of the individuals ‐ the wandering, restlessness,
personal care issues etc.
Gore District Library is a rural town in the southern east region of the South Island. Through research the
library discovered there were dwindling numbers of younger readers, to counteract the library developed
in partnership with the Southland Reading Association, an intergenerational programme which
incorporated reminiscence. It was piloted in 2007. The programme did not only boost membership and
encourage younger readers; it promoted creativity and imagination, heartened the local community, and
bridged the gap between generations; it increased individuals’ literacy, listening and communications
skills. The programme has been successfully implemented, and has been disseminated to several libraries
throughout the South Island; it incorporates 17 primary schools and numerous older people and care
facilities.
GENEOGRAM
The Te Omanga Hospice uses a geneogram, as a reminiscence method, it identifies the person, and their
family circle, beginning with the individual, and creating a ‘family tree’ like structure. They introduce it at
the initial stages of admission and find it extremely effective when communication is poor. Family
members are involved alongside the patient, and when there is an absence of family members the
individual and staff work collectively to form a picture. Staff highlighted it is successful when outlining
‘who is who’ for those who need information, counselling or involved in the caring of the patient. The
Geneogram encourages and stimulates conversation it can be used as a starting point for beginning a life
review. The chart is continual, and be started and left numerous times.
James Betty
Lily Sue Bob
Fred
David
Jack Susan
- - - - separated □ male o female // divorced
Geneogram Example, symbols vary
19
INTERGENERATIONAL PRACTICES
“Intergenerational Practice (IP) aims to bring people together in a mutually beneficial, purpose filled way
with activities that promote understanding and respect between generations and may contribute to
building more cohesive communities.”32 IP is inclusive and has effective approaches to address issues
such as building communities, promoting citizenship, regenerating neighborhoods and addressing
inequalities. Many changes in society ‐ such as increased mobility geographically have led to generations
becoming segregated from one another ‐ especially in the younger and older generations. This separation
can lead to unrealistic, negative stereotypes of whole generations and a decrease in positive exchanges
between them.
The project ‘Research Agenda on Ageing for the 21st Century: 2007 Update’ highlights that research into
intergenerational practices, is one of its critical research areas, is one of ten top priorities for countries in
Africa, Latin America and Caribbean, Asia and Pacific and finally Europe. Its importance and need for
‘solidarity’ is highlighted further in the MADRID International Plan of Action on ageing (2002).
In the 2001 New Zealand census, over 4,000 children were being fully parented by their grandparents.
This does not take into consideration their provision of full time and part time child care. The Māori
young are becoming more distant from the rituals, religious and cultural rules and often seen turning the
Māori culture; ‘the way we behave’ into ‘the way we believe’. This has lead to an increasing rigidity in
cultural practice.33 There are several overall trends in the world contributing to an ageing population, the
changing of family structures, the change of work pattern, finances, retirement and the evolving systems
in social and personal welfare.
Participants of IP often feel an increase in their self‐esteem from being able to give to and receive from
others; they can feel valued with a greater sense of being part of a community. Older people can provide
younger people with positive role models both of engaged citizenship and of active ageing. Young people
represent a link to the future for older people. IP can incorporate members of one generation supporting
another with different generations working together; or by bringing younger and older people together.
Intergenerational Practices can take many forms; the ones I visited in New Zealand were a mixture of care
facilities, schools and community initiatives. All had one common trend they involved reminiscence
methods.
Hetherington House, Waihi developed a programme which integrated the care facility and three of the
local primary schools; it was entitled ‘Reading Recovery.’ The programme involved school children
between the ages of 7 to 11, who had learning difficulties and issues with reading. They would attend
Hetherington House twice weekly and spend two hours with a resident to participate in reading, writing
and spelling. The matching of the two (the pupil and the resident) was crucial, with patience, tolerance,
encouragement, praise all being involved. The results indicated that there is an improvement with
communication across the generations, grades increased, learning was enjoyable, understood and
friendships formed. Often the pupils return after the programme as ended, as visitors. The programme is
now entering its third year.
20
New Vista, Wanganui is a facility that engages with the local school that involves storytelling, music and
drama. Residents work with the students to design, build and decorate ‘sets’ for drama productions and
concerts; passing on labour skills to the students. Regarding music the residents teach dance to the
students and converse about dance and music in their day; with the storytelling project they highlight the
environmental, lifestyle and industrial changes locally. These initiatives assist the students’ education as
well as promote citizenship between the generations. “Many happy memories are brought to life as
residents remember their own families and significant life events. When the residents are with the
children, they appear more responsive and happier.”34
Wanganui Museum, located in the North Island, is a museum managed through the local council, and is all
about local people, past and present; triumphs, failures, peace and war. At the time of visit was hosting
local exhibits of world war heroes, Māori history, animal wildlife and ‘our street’. The ‘Our street’ exhibit
is an intergenerational project, incorporating reminiscence; outlined by the manager, “younger
generations have no idea, what life was like 30 years ago never mind 50! With Wanganui being a garrison
town during the war, it was found that children and teenagers could not comprehend what it was like to
be drafted into the army by 18.”35 So the museum encouraged the local community, assisted by the
history classes within the local secondary schools to gather information, evidence and artifacts on loan to
be displayed to bring a sense of reality to the past, understanding that younger generations need visuals
for meaning and to highlight what ‘old’ Wanganui was like in from 1900’s through to the 1940’s.
The exhibition is about 25m in length, featuring some of the old businesses as shop fronts. The
dressmakers’ window displayed a mannequin wearing dressage of the early 1900’s; the blacksmiths’
illustrated the tools of the era with an addition of smell. “Younger people, parents and grandparents can
picture where things are now and what used to be there. It gets everyone involved.”36
Other IP work can involve:
• Mentoring;
• Collaboration on neighbourhood, community issues;
• Befriending schemes;
• Care facility visiting programmes;
• Voluntary support;
• Historical projects;
• Physical Activity Programmes.
Ministry of Social Development is located in New Zealand’s capital, Wellington. Marlene Levine provided
information on an intergenerational practice entitled the ‘SAGES programme’, which encourages older
people to be mentors within their community. The programme is supported by approximately 17 NGO’s
who co‐ordinate the programme, recruit, support and train volunteers, “Older people are trained as life
and home skills mentors for the families and individuals in their community. Skills in home management,
cooking, budgeting and parenting can be achieved.” Marlene summarized that, “Older people make great
mentors because of their wealth of experience, insight and approach to tasks such as practical household
skills like cooking and budgeting.” 37
21
AGEING ISSUES & CULTURAL ASPECTS IN NZ
“Māori society has been slow to absorb and identify the needs of their older
people within healthcare and long term residential care, this is largely due to
their belief that such matters as caring for their elders is largely by whanau
(family).”38 Care facilities need to accept, adapt and think positively on such
needs, especially due to the concerns that New Zealanders have on the high
volume of Pacific Islanders and Asian migration, which one day will age and
with the low number of trained care workers, the affect could be detrimental. If people are to retain their
individuality and identity, it is important to acknowledge cultural differences.
Health:
Research has illustrated that the Māori population have a lesser degree of getting Alzheimer’s disease and
dementia, due to their lower life expectancy. Although “Māori are more acceptable to blood vessel
damage such as diabetes, high cholesterol and blood pressure ‐ this increases the likelihood of developing
vascular dementia, which occurs at a younger age than Alzheimer’s disease.”39 Māori men are most likely
to die of respiratory, circulatory or neoplasams than Māori women and non‐Māori women and men. It is
believed this is due to years of healthcare neglect on both sides (the service provider and of the Māori
clients).40
Ageing in Place:
Māori like other New Zealanders are feeling the strain of caring full time for an older person, with the
grind of daily living and working taking its toll. So the perception that Māori’s whanau (family) is the
exclusive carer is changing and care facilities’ are being readily used. A prime example is the waiting list
that exists at the Pacific Islanders Rest Home, Otara, outside Auckland. Care facilities need to action and
consider:
Religious and spiritual beliefs:
“Māori see life as a balance between (noa) relaxed with no restrictions and (tapu) which is sacred and
private. They believe that a transgression of tapu would result in suffering and illnesses, therefore an
illness such dementia would be (whakama) shameful.”41 These beliefs are within the Māori culture, but
they are parity to other indigenous groups such as Pacific Islanders, Indian and Asians, with an end result
that leads to individuals ‘hiding’ their disease, from health professionals, family and community; therefore
often seeking help when the disease is within late stages or in a time of crisis.
Customs and healing:
Some Māori have a strong belief in traditional healing, with some District Health Boards (DHB) providing
funding. The two (traditional and medical) can work together, but western society needs to incorporate
the cultural beliefs of the individual. Prayer and blessings (karakia) are very important especially at the
end‐of‐life and passing stages; family should always be involved, informed and supported where possible.
Within pacific islanders superstitions and beliefs around illness can be seen as punishment or a curse
towards the individual and/or family, so a ‘mental health’ illness would be seen as ‘breaking custom’
possibly resulting in anger.42 This results in another reason that medical assistance may not be sought.
22
Resources:
Food services such as meals‐on‐wheels do not provide the type of food someone from the Māori
community or other populations would eat. There is a small number of Māori, Cantonese and Mandarin
speaking health professionals but they are often within particular areas like the main cities; this is a huge
issue for the rural communities where 24.5%43 of Māori’s ageing population heavily remain e.g. Northland,
not in the cities as perceived. The majority of health professionals are non‐Māori.
Ageism Society see value in a person who contributes to the wealth of society, when a person retires, society see
this as retiring from their contribution to society. In NZ older woman face both sexism and ageism, even
from younger women. Ironically we all hope to love long lives so why is ageism still prevalent. Yet within
the Māori community, ageing is seen positively, “Ko te hina te tohu matauranga” ‐ Grey hair is the sign of
wisdom.44 When an older person accepts the role of leadership, the kaumātua is given by the
community; this title indicates they are the keeper of tribal lore, the arbiter of disputes, the source of
wisdom and guidance and the link with the past ‐ the personification of the tribe.
Policy
Government policy on pension age eligibility and old age has caused researchers confusion, as the pension
age is 60 years of age in New Zealand, with the Māori life expectancy is at least 10 years lower than other
New Zealanders e.g. male (66 years), other male (76 years); Māori female (71 years), other female (81
years).45 These figures create issues with regard to pension eligibility etc. In 1988, the Royal Commission
on Social Policy recorded, “the need to allow everyone to participate in society, and a genuine opportunity
to fulfil their potential and to live a fulfilling life.”
23
AGE SECTOR & RELATED ORGANISATIONS District Health Boards District Health Boards (DHBs) are responsible for providing, or funding the provision of, health and
disability services in their district. Beginning in 2001 there are 21 DHBs in New Zealand, when the New
Zealand Public Health and Disability Act 2000 came into force. The DHB objectives are:
• To promote, protect and improve the health of communities;
• To promote the integration of health services, especially primary and secondary care services;
• To promote care and support to those in need of personal health services or disability support;
• To promote participation, inclusion and independence in society of people with disabilities;
• To reduce health inequalities for Māori and other population groups.
Funding sources were categorised as DHB funded or non‐DHB funded (District Health Board) and there
was a common trend of issues regarding lack of staff, training, environmental space, ideas etc. DHBs are
expected to demonstrate a sense of social responsibility, community participation in improving health and
to uphold ethical and quality standards, commonly expected of providers of services and public sector
organisations.
The Funding Structure:
Ministry OF
Health
District Health Board
Intellectually disadvantaged and
Ethnic committee
Application accessed and substantial
funding awarded
Community Agencies
• Older people & Disadvantaged • Personal Care • Day Care facilities
Residential Facilities
• Dementia • Long Term facilities
NZ Healthcare funding distribution specific to older people
24
Ace Programme The ACE (Ageing Care Education) Programme ‘Supporting the Older Person’ was developed in line with
Home and Residential care workers. It a low cost, effective and recognisable qualification set as a
minimum requirement, when recruiting care workers. The programme has three levels, with the first
focussing on knowledge and skills that support workers use on a daily basis and therefore need to learn as
soon as possible to work effectively in their role. Research has revealed that a large portion of issues,
abuse, discrimination etc are found in care facilities due to a lack of understanding, awareness and
communication. To eradicate these, the first programme has modules on:
1. Introducing Support Work
‐ demonstrate knowledge of the role of a support worker; observe report and document changes;
apply knowledge of a consumer’s rights and responsibilities in a health or disability setting.
2. The Ageing Process
‐ demonstrate knowledge of the ageing process and its effect on individual support needs.
3. Providing Personal Care
‐ support a person to meet their personal care needs in a health or disability setting.
4. Effective Communication
‐ listen to gain information in an interactive situation; respond to loss and grief in a health, disability
and community setting.
5. Transfer People Safely
‐ demonstrate musclo‐skeletal care and handle people safely in a health or disability setting.
6. A Safe and Secure Environment
‐ maintain a safe and secure environment in a health or disability setting
7. Infection Control
‐ demonstrate knowledge of infection control requirements in a health or disability setting.
8. Nutrition and Food Safety
9. Continence Promotion and Management
The second and third programmes are entitled ACE Advanced and ACE Dementia, respectively and follow
on with a more in‐depth learning to the first programme. There is one module specifically and
compulsory ‘communicating in plain English’, this is due to the high volume of Pacific Islanders and Asian
immigrants embarking on a care worker career path; as communication in older people is paramount,
workers need to have a grasp on their needs. There are National qualifications at Level 3, (National
Certificate in Community Support (Residential); National Certificate In Community Support (Core
Competencies) and these are included in the three ACE programmes, please see appendix C on how they
integrate. These are qualifications compliment the diversional therapist qualification.
Eldernet Chief Executive Officer Eleanor Bodger and team provided me with information on care facilities in New
Zealand who were actively participating on reminiscence and intergenerational work. Eldernet was
established as a ‘one stop shop’ so older people had one place to go to receive information on a range of
topics, such as residential care facilities, to the latest news that would affect them.
25
New Zealand Ageing Research Institute Dr Sally Keeling is Director of the New Zealand Institute for Research on Ageing which is located in Victoria
University, Wellington. Due to Dr Keeling’s professional and personal commitments a physical meeting
was difficult, although her encouragement and support at the initial and final stages of the research study
were gratefully appreciated. The ageing research institute in NZ has similar aims, objectives and mission
“to foster understanding of such issues through promoting multidisciplinary research, in partnership with
other interested organisations and individuals,”46 to the CARDI in Ireland, “to advocate for and advance
the ageing research agenda by identifying, co‐ordinating, stimulating and communicating strategic
research on ageing and older people as a means to improve the lives of older people in Ireland (north and
south) especially those who are disadvantaged.”47
Dr Sally Keeling has co‐investigated and been principal researcher, publishing on a wide range of ageing
matters. More recently the ‘grandparents in rural families, young people’s perspectives’ which highlights
information collected on attitudes and involvement from young people on their grandparents. It
highlights the impact of ‘grandparenthood’, the number of children having a third and forth generational
upbringing and households, and the need and practice of intergenerational programmes. The publication
of ‘Ageing in Place’ that incorporates the need for
independence, activities and caring; the right for
choice and support etc highlights the NZ adoption of
the objectives of ‘ageing in place’ which largely
derives from the NZ Positive Ageing Strategy, “it
promotes the ability of older people to remain living
in the residences and communities of their choice
whenever possible.” In respect of reminiscence and
intergenerational activities impacting on an
individual’s wellbeing, the conceptual framework of
factors affecting wellbeing by Hine et al. 2005
illustrates that a person’s wellbeing derives from
personal and context factors but their experience and
participation in activities is a contributory to their
overall wellbeing. “Individuals whose social
environment impacts strongly on their experience are
often people with strong family, cultural and
community ties; they have better health than people
who are socially isolated.”
The New Zealand, Ministry of Social Development The New Zealand, Ministry of Social Development is about
“helping to build successful individuals, and in turn building
strong, healthy families and communities.”48 With regard to
older people they “support older people to live full and secure
lives, help them maintain independence and enjoy opportunities
to use their skills and knowledge in their communities.” In 2007
they provided retirement income support to over 500,000 older
26
people. The New Zealand Carers’ Strategy and Action Plan (5‐years) was published in April 2008 by Hon
Ruth Dyson has highlighted the contribution and plight of NZ carers. “This strategy is an important first
step in acknowledging the very real difference carers make in people’s lives. Improving support for
informal carers is important for developing strong healthy families and meeting future challenges of
providing care.”49
This will be achieved when:
• Carers have choices and opportunities to participate in family life, social activities, employment and
education;
• Carers’ voices are heard in decision‐making that affects them.
In regard to the inequalities that minority populations face in New Zealand, the Ministry provides the role
of co‐ordinating the RIOC (Reducing Inequalities Officials Committee) and therein a policy which
incorporates social and economic initiatives was implemented. This defined further means:
• To achieve a minimum level of wellbeing for all people, so all may participate in our society (e.g.
tackling poverty, low levels of foundation education skills and victimisation), and
• To try to ensure a more equal distribution of the determinants of wellbeing across society, i.e. greater
equality of real opportunities, where family background, ethnicity or disability are not major
determinants of individuals’ life chances.
MONITORING OF REMINISCENCE METHODS
For reminiscence to be most effective it is vital to monitor their implementation, delivery, and the
outcomes. This allows for amending the group or individual programme. Each of the care facilities i
visited used variations of a care plan, which were monitored bi‐monthly, quarterly and six monthly,
(dependent of the individuals’ needs and condition). See appendix D for examples.
The care plans were exceptionably detailed and incorporated the physical, emotional, intellectual, psycho‐
social, cultural, sexual and spiritual preferences for individuals. The plan is completed initially with the
individual, with a family member present. Each subject is further defined with details on support needs;
goals; intervention/activities; evaluation; details of medicine; allergies; professional medical information
e.g. not to be resuscitated.
There is a second document which accounts for the individuals’ profile, which is a generic form and
requests information on, ‘preferred names; language; place and date of birth; education; occupations;
interest; religion; family and friends connections; general information i.e. community involvement; values
and beliefs; particular likes and dislikes; challenges and difficulties; personality and assistive aides i.e.
walking stick, hearing aid, sight etc.
The process is especially effective when an individual is not settling into their new environment or has
been in the facility for a long time ‐ things change!
27
FINAL COMMENTS
For me the whole experience was surreal, putting a lot of theory into practice; the positivity and
enthusiasm of care staff and professionals was absorbing. Funding is issues, as the care facility managers
‘hold the purse strings’ and with regard to reminiscence and intergenerational activities, money is
allocated dependent on their knowledge and interest of such practices.
Each of the care facilities I visited was actively positive about older people; they were person‐centered
with staff well‐informed and aware; working with various resources and funding; they participated in
and/or seen the value of reminiscence methods; those who participated in intergenerational practices
were true advocates for the work, highlighting that more findings and practice, need to be published.
They all reported on the need for communication, from Government level to the ageing individual,
stressing the need for respecting dignity, equality and choice. Indeed Age Concern New Zealand uses
some of these points as their core values:
It was highlighted that there are concerns when the Government changes, as funding will become slower
or the focus on older people will be removed. Although the general consensus was that the NZ
Government have been forward thinking, establishing an ‘Office for Senior Citizens’ in 1998, a ‘Positive
Ageing Strategy’ in 2001, with ACNZ, (60 years established) lending support. Thirty‐five local authorities
have taken the PAS on board and are proactively putting into action as their local area needs.
The New Zealand organisations and ageing facilities I met have a great ethos for ageing, Age Concern New
Zealand, “Working for the rights and wellbeing of older people, koroua and kuia for an inclusive society,
they are respected, valued, supported and empowered.”50 The each recognized that whilst there are
fundamental issues within their sector such as elder abuse, cultural difference ‐ racism, ageism, negative
stereotypical attitudes, lack of resources etc, they also recognize the importance of action.
I would like to thank the Winston Churchill Memorial Trust Travel Fellowship, for the opportunity to
represent them and to participate in the research study, the experience has been unbelievable. A special
thanks to Judith and General Major Jamie Balfour for their support and efficiency which was much
appreciated. To the individuals I met from presidents and ceo’s to care facility managers and the ‘young
at heart’, your warm welcome and friendliness will make me return to NZ but you’re sharing of
knowledge, practices, ideas and positivity will contribute greatly. Thank you.
Dignity Well-being Equity Cultural respect
To respect the dignity and uniqueness of every person as an individual and as a valuable member of society.
To ensure that older people, koroua and kuia are given the opportunities to achieve physical comfort, engage in satisfying activities and personal development, and to feel valued and supported.
To ensure that older people, koroua and kuia have an equal opportunity to achieve wellbeing by directing resources to help those disadvantaged or in greatest need.
To respect the values and social structures of Maori and people of other cultural and ethnic backgrounds, demonstrating respect by working together to gain mutual understanding.
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APPENDIX A
Care Facilities in New Zealand
Te Omanga Hospice, Lower Hutt (Wellington)
Mary Harmer, Patient & Family Support Co‐ordinator
Established in 1980, a ten bed unit for those terminally ill, as part of ‘ageing in
place’ they facilitate homecare for an additional 100 persons. Currently Te
Omanga is receiving 5 referrals on a weekly basis from an age range of 45 to 95 years of age, with a higher
capacity of males than females. Palliative care is about presence and listening. It is a person‐centred
facility, with staff conscientious of the physical and mental needs of the family. This obviously assists in
the caring of patients, by lessening anxiety, reducing stress and making for a more peaceful passing. Te
Omanga staff discuss the lessons learnt, the family/friend reaction and a way forward when a patient dies.
This can incorporate counselling or recommendations for staff or therapy for the family. Te Omanga has a
strong resource in their volunteers.
Hetherington House (Waihi, Bay of Plenty)
Margaret Clarke, Nurse Manager and Heather Watters, Diversional Therapist
A forty nine bed care facility, current resident age range, is from 65 to107. There is more male than
female residents, with 75% with some stage of dementia. Speaking with the diversional therapist,
Heather Watters ‐ diversional therapy is constant programming of ideas into activities. Ideas are often
exhausted and too repetitive, although care workers want to participate in more meaningful forms of
reminiscence. Individual needs are considered with a dedicated, positive, eager team of staff. There was
a real empathy, patience and interest in older people and ageing. The care facility incorporates the local
community by hosting ‘open days’ at the facility and as part of outings attends local events i.e. fair day,
local rugby matches etc.
Kauri Centre (Papamoa Beach, Bay of Plenty)
Marcia Rickman, Diversional Therapist Manager
The Kauri Centre meets in a community church, near Papamoa beach, 15 minutes from Tauranga in the
Bay of Plenty. Geographically the area absorbs a large number of older people who migrate there in the
retirement years. The Kauri centre work with older people who have varying mental, physical and
emotional abilities. The centre receives upwards of 80 participants a week; it receives limited funding
from the District Health Board, relying therefore on small grants, donations and more commonly,
subscriptions. Currently the centre is fundraising to move to a purpose built unit, although the
community church facilities have served the centre well for many years. The centre has a real community
feel, and relies on volunteers and part paid staff to assist in programme delivery. The programmes are
themed i.e. the 1960’s, and changed monthly. Therefore all activities have an element of the 1960’s, from
quizzes to music, from artwork to films. The programme for the day is on a thirty minute rotation; Marcia
believes this keeps everyone active and interested. Marcia highlighted her vision for the centre, one of
which was delivering computer programmes. I reported on the computer programme ‘Getting Started’
which I delivered in the border counties of Northern Ireland and Republic of Ireland; and concluded I
would forward relevant information on the programme may be helpful.
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Chatham House (Hastings)
Donna Hedley, Manager
Chaptam House is a five‐day a week house that supports people who are in
the various stages of Alzheimer’s disease. Its locale is within a 4km radius of
Chaptam house, taking in rural and urban clients. The house is designed to be
relatively small, homily and secure. Its main function is to give carers respite,
by providing activities and day care programmes for people with Alzheimer’s
disease. They work with approximately 80 people per week and an additional 100 on home care
programmes, with the local District Health Board (DHB) providing partial financial support. The facility
does rely on volunteers; not surprisingly the majority of the volunteers have experience of either caring
for or knowing someone with Alzheimer’s. Without the volunteers Chaptam house would find it difficult
to function. We concluded that more awareness and education is needed surrounding Dementia and
Alzheimer’s.
The daily programme is routinely carried out, but each afternoon there is a small variance in the session.
9.30‐10.30 Clients begin to arrive, listen to local radio, chatting over tea and scones
10.30‐11.00 Chairbased exercise
11.00‐12.00 Reading local paper, book, poetry and/or communal Crossword
12.00‐1.00 Lunch (there is a house cook, although clients can assist in the preparation of it)
1.00‐3.00 *Reminiscence Activities (collage, music, sing‐a‐long, creative writing, talk time etc)* varies
3.00‐4.00 Home time and ‘Sundowning’ (this is a period when people with Dementia have more of a
tendency to ‘wander’). Clients can walk around the gardens, do gardening, play darts,
snooker, do woodwork, watch television, have visitors etc.
The house is informal, open‐planned with plenty of viewpoints within the house, to overlook the gardens.
This environment assists staff greatly, particularly in the ‘sundowning’ period, when many feel stressed
due to the number of clients versus care staff/volunteer ratio. Speaking with clients and staff was
insightful and really enjoyable. I was given the opportunity to facilitate a talk‐time session. I asked
questions about their past e.g. are the locals, what they did as an occupation, about their families, about
holidays and travel etc. The session revealed many laughs, and when I asked ‘why do you come to
Chatham house is it the scones, the exercise session, the crossword?’ there was all‐round agreement that
it was because of ‘the people’. ‘The friendliness and consideration that people show,’ said Betty (a lady
with advanced Alzheimer’s).
Freeman Court (Te Awamutu)
Erin Lyford, Diversional Therapist Manager
Freeman’s Court is and independent house that caters for older people, by providing individual units and
day care, within a socially inclusive and secure unit. It began in 1970 by a board of trustee’s (made of local
people), who wanted a local unit to house older people who by choice or circumstances were alone. Over
the years the unit has grew in size and residents, whereby 49 older people of various abilities can receive
security, support and care. Each resident has a single unit, which contains furniture, tv and entertainment
systems, telephone line and wash area. There was even a resident with their own computer and internet!
Freeman’s Court promotes independence, with residents taking responsibility to care for their individual
units and making it available for cleaning and laundry.
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The unit does not receive funding from the DHB, 70% of funding is from resident fees and the remaining
30% is a breakdown of bequests, donations and fundraising. The house does have policies, guidelines and
codes of conduct. It relies heavily on fundraising as this is the only allocation of finance the Diversional
Therapist receives for programme. Erin highlighted that the New Zealand Government are leading the
way on research, planning for the future and providing educational courses to that effect. The New
Zealand Diversional Therapy Association is also playing a huge role by providing guidance materials,
support and training (amongst other resources) throughout the country.
Tamahere Eventide Home, (Hamilton)
Christine Brocket, Senior Diversional Therapist and Louis Fick, Chief Executive Officer
Tamahere Eventide is contained over several acres; it caters to over 100 residents daily with various
abilities. Firstly, there are 34 self‐contained units (these are not physically connected to the main
building). Residents can either buy or rent the homes, which are specifically designed with on‐site
security and optional catered meals. When the homes become vacant, the cost is returned to the
individual’s estate; family or designated wishes. The demand for such facilities is overwhelming, and
another 50 are planned within the next 2 years. Secondly, there are 30 smaller self‐contained units
attached to the main building. These would house those who need more assistance, on low incomes and
likely to have mobility or dependency issues. These particular units received architectural design awards
in 2005 and 2006. Residents in these facilities can participate in the home activities and eat their meals in
the communal dining room (although the units do contain a kitchen).
Thirdly, there is the Cognitive Impairment (CI) unit, which houses 20 residents with their own individual
rooms. The unit is attached to the main building and is only accessible through a security system; it does
have its own ‘green space’ which assists with sundowning. Approximately 90% of residents have varying
stages of dementia and the unit is staffed with specialised carers and health professionals. Two full time
Diversional Therapists are employed within this unit alone and because of the sundowning a diversional
therapist is employed for several hours each evening.
Finally, there is the day care residents, contributing from 30 plus older people participating daily. Due to
the large volume of residents activities are often held separately from the CI unit, but this makes for more
memorable unions on special occasions, when the day care and CI unite. Activities could involve music,
physical activity, dance, arts and crafts, storytelling, day trips to local places of interests, museums etc.
Louis Fick is a former accountant originally from South Africa, and is the CEO of Tamahere Eventide. After
introductions, a discussion on an ageing population, ageing research, funding, staff and reminiscence.
Louis expressed that there are concerns for the future of ageing, emphasising there is some planning for
the future, but not at the pace or degree that it should be. Further highlighting that government has
piloted programmes and projects, with research often reflecting the desired outcome and jargon rather
than the harsh reality in understandable terminology. Louis reported that there is a lack of budget control
with the health system, with funding to caring facilities often in waves, there is either a lot to be spent in a
short time period (which often leads to futile spending) or it is scarce with complicated applications. In
relation to ageing research there is a feeling that it doesn’t affect the facility directly, indirectly it can
determine funding and requirements. Communications is vital amongst staff, especially because in recent
years a large number of Pacific Islanders are being employed within the health industry. Issues around
culture differences and language are complex, but one solution is the ACE programme which has
compulsory modules, one which is to be competed in English and another which incorporates awareness,
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dignity and respect in cultures within New Zealand. The facility welcomes new trainees and recognises
professional qualified and dedicated staff as an invaluable resource. Regarding reminiscence, Louis
commented that its effectiveness is evident with impact far outweighing the costs. Louis values the staff
input into reminiscence and their work, and this is reflected in their budget for reminiscence work.
Beryl is the ACE programme co‐ordinator who is based at Tamahere Eventide. Beryl highlighted the ACE
programme is a ‘working progress’ and it has just seen an overhaul. A reason for the continuous updating
is to make the ACE qualification a minimal requirement acceptable for staff working with older people and
the country’s changing demography of cultures within the healthcare industry. The minimum
requirement presently is the passing of 4 modules out of 9, and trainees receive resources such as
support, study papers, reading lists and assignments. In their own words they have to define the ‘rights if
an older person’ to obtain a clear understanding.
New Vista (Wanganui)
Robyn Gracie, Diversional Therapist Manager
The New Vista is a 42 beds residential and day care facility, located within a quiet neighbourhood. The
resident ratio is 90% male, 10% female; the cultural diversity is also evident amongst staff and residents,
with Māori, Asian, European (Dutch and English) and New Zealanders. The facility incorporates a lot of
active activities e.g. sports, dance, music, crafts and woodwork; there is also a number of outings per
week, which staff expressed is very popular with the residents e.g. rugby matches, museums, coastal
walks etc. The residents participate in the ‘rest home games’ which is funded through the Wanganui
District Council and Sports Wanganui, and involves the sport of bowls.
Volunteers do play a huge role in New Vista but are not dependent on, they use the ACE programme to
recruit appropriate carers and encourage staff to attend the Diversional Therapy Support Group meetings,
organised by the NZDT Association which is held locally for ideas, networking and support.
Parata Anglican Charitable Trust (Gore)
Shirley Turnbull, Manager
Parata is located in a quiet neighbourhood; it is a 25 bed facility with 4 studio units and is a non‐profit
organisation. The home rents out the studio units at a low cost, with the income going towards the
maintenance, the demand for these units is unbelievable with waiting lists holding names for several
years. There are plans to build and buy more units within the next two years. There are more female
than male residents. Shirley Turnball is the Manager on being a carer she said ‘it is about respect,
listening, patience and compassion ‐ its common sense.’ The home has a non‐uniform policy; this is in
keeping with making the Parata an informal environment, relaxed and non‐institutionalised. They are
involved in the ACE programme but are concerned about the ‘open book’ theory that is implemented as it
allows for trainees for many years to work but not be qualified.
Pacific Islanders Care Home (Auckland)
Deo Prasad, Manager
The care facility is located on the outskirts of south Auckland in the North Island, which would have an
unsavory reputation for ethnic gangs and community problems. The area is one of the Māori culture
strongholds and the care facility is well placed in the community, despite the statistics indicating that
Māori have a low enrollment in care facilities. The facility is interdenominal with an ethnic resident list
from the Pacific Islands (Fiji; Cook islands; Samoa; Tonga; Raotonga etc); NZ European and English.
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Pacific Islanders care facility encourages participation in reminiscence methods such as storytelling, oral
history and life review. They are always advocating equality within the care environment, and are
involved in a befriending scheme to encourage the younger pacific islanders to communicate and interact
with the older population. The Manager Deo would be a representative on many cultural awareness
committees and programmes.
Princes Court (Ashburton)
Chris Lill, Manager
The Princes Court facility is 40 bed units, located one hour south of Christchurch, and incorporates a short
term resident centre with a Specialist Dementia Unit. It does receive funding from the DHB, which allows
the facility to hire a Diversional Therapist. The Diversional Therapist completes a programme of 5‐7 hrs a
day, depending on the level of involvement. Storytelling was evident; highlighting any book could be
introduced to participants, as they use their imagination and talk the conversation to a ‘place’ where is
comfortable to them. Crafts and Arts were also encouraged, especially amongst the dementia residents;
music therapy was introduced recently with great results and joint events with the short term residents
are becoming popular, which is breaking down the barriers of ‘them and us’.
Elaine Cartmill, 28 October 2008
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