What do evaluations of arts programmes in residential care tell us about embedding arts in care homes?

a young man and an older woman laughing together
Live Music Now: LIBOR concerts 2017-18

by Alan Dix, Artistic Director 509 Arts

This was originally a talk given by Alan at the Creative Arts and Dementia Conference, MAC Birmingham, on 24 September 2019. The featured image above is from Live Music Now's LIBOR concerts. LMN are conducting their own ongoing evaluation of music in care.

When I am asked to evaluate a creative programme there is generally a discussion with the client about its purpose. More often than not I am asked for a public document that can be used for advocacy with stakeholders and interested parties. This requires a degree of tact and diplomacy when identifying areas that require improvement or further development.

Today I am released from that necessity, and as a consequence the words I am about to speak represent perspectives I have developed after visiting many care homes in many parts of the country. You may view them as a mixture of moan and manifesto.

Evaluation in a care home setting is unique. There is no longitudinal view. The participants often have limited capabilities to inform and feed back. Many are near the end of life. Residents’ capacity to ‘progress‘ or ‘develop’ – a frequent measure used in evaluation – is generally not a feasible option. We work in the moment. Assessment of impact requires the perspective of others - managers, activity coordinators, care staff and the like. Attempts to measure impact objectively can result in data collection that is divorced from reality and more suited to the needs of the academic – as vital and important as it is – rather than the immediate needs of the resident.

For an evaluation to be of value it must have influence. It must be able to take staff and management on a journey of change. In the context of the care home this can be devilishly difficult.

There is a deeply ingrained institutional resistance to change in many care homes. The origins of this go back decades and have their roots in a medicalised environment that is dependent upon routine, schedule and safety. Most care homes still operate on a medical rather than a social model of care. Over many years disabled artists have very successfully campaigned for use of the social (rather than medical) model of disability, one that focuses upon the individual as a valued and effective member of society. We now need to apply this principle to the lives of older people in care.

Too often artists have to accommodate the restrictions the medical model implies. The amount of feedback I have received from artists about the limited and limiting expectations they have encountered over and over again is significant. This must be deeply disempowering and I’m sure it has a dramatic effect on a creative workforce that that has to work in environments that are unsuitable with staff who are overworked and with a management who are underprepared.

I paint a bleak picture and of course it is skewed. Not all homes are the same and not all staff are the same. But the overwhelming sense I have received is that for the vast majority of care homes arts activities are bracketed with entertainment and diversion. Something to relieve the monotony.

Artists are generous people who will mostly make the best of a difficult situation. So, they go into homes where they know it might be tough and do their very best to use the very special skills and talents they have at their disposal.

Evaluation of the work they do is not easy. It is based on observation and feedback. Case studies and a narrative assessment are the bread and butter of making a judgement of success or failure in this context. The moments of triumph are few but when they happen, they can be remarkable - demonstrating possibility and opportunity, examples of what could be happening in every care home rather than in the lucky few.

Imagine an education system where art was only taught in one school out of a hundred. Where there was no provision for drama or music unless external funding had been secured. Where teachers were never trained to understand or exercise their students’ creativity. That is the position in most care homes today.

When I evaluate arts work in care homes, I look for evidence that its impact will be long lasting – that the home has an expectation of more to come, that the work will continue. Because creativity in the care home setting should not be an option, an occasional luxury. It should be as important to the daily life of the home as eating, drinking and sleeping. Because art is compassionate and provides shape and substance to life. It enables those who feel their sense of self and their identity unravelling to be recognised as valid human beings. To sing, to listen, to move, to make, tell and to imaginatively remember is a powerful tool in this process.

The anonymous confines of the care home with its generic decor and easy on the eye furnishings are antithetical to self-expression. Would any of us wish to be living in a place where our carefully crafted amateur paintings could not be displayed, where the only room to move was the crowded corner of a living room, where the songs we were singing and the stories we were telling had to stop because it was time for lunch?

Probably not.

There are of course examples of care homes where this is not the case. Where artists are part of the fabric - the warp and weft - of care home life. Where imaginative play, creativity and access to beauty are part of the everyday. But they are few and far between. We live in a world where the cost of an artist is constantly balanced against the cost of lunch or the price of heat and light, and it is an unfair competition.

But of course, we must not give up. The evaluator has to take the long view and we know that whatever happens change over time will come. The care home residents of tomorrow will be very different from those of today. They will be children of the sixties and they will not be afraid of making themselves heard. So, listen up everyone.

Tomorrow’s care home residents will come from a diverse post-war culture. Their memories will be of the 1960s and Top of the Pops, Tomorrow’s World, the music of protest and the poetry of feminism. The artists that influenced them as young people will be more like David Bowie and less like Vera Lynn. Many will have made art, consumed culture and lived highly creative lives. They will have come from all parts of the world and been the generation that transformed the UK urban landscape as a consequence. Many will be comfortable with fluid genders and sexualities. They will have been the first users of digital technology and grown up in a world fundamentally different to that of their parents and grandparents.

It is necessary therefore that care homes respond to the challenge of the coming generations of residents in ways that are relevant, appropriate and timely. A shift is required that transforms the care home environment from one which is reminiscent of a respectable but slightly dull mid 20th century living room, to a place that is more flexible and dynamic, reflecting the mosaic of experiences that post-war generations have had.

The role of arts and culture in such a scenario will be key, enabling residents to connect to their past, the present and the world around them in ways which are appropriate and relevant. There is a growing body of skilled and capable artists who know how to use creativity within a care home setting to improve residents’ health, quality of life and wellbeing. They should be given the environment to do their job properly and it should be incumbent upon care home providers to make it possible.

Let us think about the Creative Care Home and what it could be.

The Creative Care Home is one that has an artist in residence, involved in planning and policy. It is a place where imagination and creativity are as valued as food, comfort and medication. Where the individuality and identities of residents are shaped by artists who know how to work in a community setting, who can turn the stories, experiences and testimony of the people they work with into high quality artistic adventures.

So, let’s find a way of making a truly Creative Care Home, a beacon for others to follow and a place where residents, artists and staff share and shape, create and make on a daily basis. Where the walls are vibrant and memories are kept alive; where music is made, songs are sung and laughter is heard. Where residents’ lives are validated and described in unexpected ways. A place for visitors and communities to share and explore, that is unstuffy, flexible and dedicated to the individual’s creative wellbeing as well as their physical safety.

I speak as someone who might not be that many years away from becoming a resident of a care home myself. And no matter how old or young you are today, there is a strong possibility that a care home could be the place where you spend the last part of your life. So let’s make that an exciting prospect and work towards making every care home the kind of place we would all want to live in – a place where we can thrive, celebrate and be part of this world we helped to shape and want to remain a valued part of.

© Alan Dix 2019