Technological innovations are the key to saving the dementia care system
With dementia cases predicted to triple to 150 million by 2050, it is imperative that funding for the dementia care system is increased. The current system is woefully inadequate to support any further increase in cases, and a survey for World Alzheimer’s Month from Social-Ability has found that 82% of respondents feel that the care sector will be unable to cope with the rise in demand for dementia care services. As it is, something needs to change, and technological innovations may be the solution to saving the dementia care system. Staying independent Technology and data science play a big role in predicting and identifying risks. Artificial intelligence across the world is being created to diagnose dementia early. AI developed at the University of Exeter, for example, can predict if a person will develop dementia within two years with 92% accuracy, while researchers at the University of Cambridge are working with AI that is able to identify patterns of dementia before symptoms even occur. By diagnosing dementia early, people will be able to access treatment and care that they urgently need. With the aid of AI, people with dementia will also be able to lead a more independent life. While the care of artificial intelligence is no substitute for a person, AI sensors are being developed to monitor a person’s behaviour. Placed around the house, these sensors can pick up any unexpected changes in behaviour, such as changes in temperature or walking patterns, that may be a sign of deteriorating health. People with dementia will therefore be able to live with a degree of independence, with AI intervening only to alert carers of warning signs. Preventing loneliness Chronic loneliness is one of the most significant issues for people living with dementia. Before the pandemic, a third of people with dementia experienced loneliness, with loneliness twice as common with people in long-term care settings. The pandemic has only made people with dementia feel more isolated, with care home residents not having access to family and friends. No technology is a substitute for in-person contact, but the rise of video communication has a part in reducing feelings of loneliness. Though video communication has been present throughout the 21st century, it has only become a key part of people’s daily lives since the onset of the pandemic. Since Covid restrictions have been lifted, care home residents have been allowed more freedom. However, Covid outbreaks in care homes and family members living abroad remain obstacles in care home residents seeing their loved ones. With the use of video communication, care home residents and others with dementia who lack in-person contact will be able to see and speak to their loved ones, and allow for more frequent communication than would usually be possible in person. Happiness hour One technology that has already been rolled out in care settings across the UK is interactive light technology. The technology has been used to great success across thousands of UK care venues. Social-Ability, a leading developer of this technology, has gone a step further by pairing the tech with a host of services, providing training and support to care staff to improve care outcomes and increase usage. The Happiness Programme uses interactive light technology to host games that care home residents can participate in. Each game varies, with differing goals, from training cognitive or motor skills to encouraging players to socialise with each other. The result is a holistic improvement in health and wellbeing, with other features such as the Happy Memories Programme allowing family members to share pictures with their loved ones in care homes. The diverse applications of interactive light technology will support care workers by reducing their workload, and tackle some of the pressing issues in the care sector today, such as the overreliance on medication and the loneliness faced by residents. By being innovative, there is no limit on the applications of technology to support the growing number of people living with dementia. As our health and social care system grapples with the aftershocks of the pandemic, it is vital that diagnosis and support for people living with dementia are not left behind. Technology has the power to equip us for that challenge and we must seize that opportunity now. Author: John Ramsay, Managing Director of Social-Ability
Helping a loved one with dementia during lockdown
Recognising that people need educating about dementia care, especially during these unprecedented times, Stuart Wright, Brunelcare’s Dementia Lead, shares advice to help friends and family who may be caring for, or helping a vulnerable loved one living with dementia during lockdown. Help empower the person As people are encouraged to follow Government advice to ‘stay alert’ taken, it’s a good idea to help the person living with dementia feel in control, even if we are living in a time where ‘control’ is limited. Creating a calendar, almost like a to-do list, with all the things they do routinely, will enable them to remain independent and keep busy for longer. Plotting things on the calendar such as taking the bins out, hoovering, watering the garden, or putting the washing on etc, can give people living with dementia a sense of freedom during these difficult times. Enable a positive state of mind During this time it’s easy to feel bombarded by information telling us what we can’t do, it’s important for you, and your loved one, to adopt a positive state of mind. Stuart says: “Although it can be challenging, maintaining a positive state of mind at this time is important. Watching the news or using social media too frequently can contribute to feeling anxious, especially if a person is living with dementia or if you’re caring for someone with dementia. So try to do this in moderation and focus your energy on the things that are in your control. Try not to speculate about what the future holds and instead take time to share positive moments with your loved one, all while maintaining a social distance.” Go outside if you can If your loved one is able to go outside for gentle exercise, then encourage this, but only if it’s safe to do so. If they are able, encourage walking or sitting in the garden, getting out and about in nature has a calming effect and is really good for our wellbeing. Gardens are a great place to do gentle stretches or relax and gardening can be therapeutic, plus it can be a lovely pastime to enjoy together. Get creative inside If getting out is difficult, or you are shielding, do remember it’s ok to stay indoors and there’s still plenty you can do with your loved one. Stuart says: “Creating photo albums is a great indoor activity and will trigger happy memories for not just your loved one, but you as well. Another suggestion is hand massages – gentle hand massages with scented oils and creams can stimulate the senses and have a calming effect for your loved one. Another, the BBC’s reminiscence archive is a wonderful resource for people living with Dementia. Designed to trigger memories, simply select a theme or a decade of interest, the archive will then show images, videos or play audio around the subject. And finally, Singing for the Brain is now online, which means people who regularly take part don’t have to miss out and for people who are yet to try it, now could be just the time!” Technology friend or foe? Stuart says: “At this time we have seen that technology can be our friend, allowing people with capacity to maintain a connection, whether this is talking to a loved one via a video call, sending and receiving text messages or daily phone calls. However, there is a thin line between technology being our friend and our foe during these uncertain times. Technology and lack of understanding and/or capacity could cause more distress and concern than it does good. Someone living with dementia, for example, could find it extremely difficult to understand why their loved one isn’t visiting, or why their loved one is on a small screen in front of them. The majority of older people struggle to grasp new technology as it is, let alone living with dementia. Do consider if tech will cause more harm than good before implementing it.” Helpful resources If you need additional support at this time, here are some useful contacts. Dementia UK helpline: 0800 888 6678 (Free advice and support for carers between 9am and 9pm, provided by Admiral Nurses). Alzheimers Society support advice line: 0333 1503 456 Dementia Navigators, signposting to local services adapted service 01179045151 Stuart Wright has worked in the health and social care industry for more than 30 years, starting his journey working with people with learning disabilities and behavioural issues before specialising in dementia care. Stuart is currently implementing and developing a human rights framework and standard for people living with dementia.
Dementia and Incontinence
Dementia is an umbrella term for a host of memory loss symptoms. As dementia becomes more prevalent with age, many sufferers are also dealing with incontinence. Why Do People With Dementia Develop Incontinence? There are a number of reasons why someone with dementia might develop incontinence. • Not recognising the bathroom – People with dementia can struggle to recognise common household objects. While they can visually ‘see’ the toilet in front of them, they might not be able to identify what it is, and what it is used for. • Getting lost and wandering – People suffering with dementia tend to get lost very easily. The pathways responsible for spatial awareness can become muddled, and ‘wandering’ aimlessly becomes common. While this might begin out in the world, it can progress to confusion and getting lost within one’s own home. • Communication issues – Dementia can cause communication to break down. A person with advanced dementia might not be able to alert their carer that they need to use the toilet before it is too late. • Mobility loss – Dementia is often accompanied by reduced mobility and other physical disabilities. Even if a person is conscious that they need to use the toilet, their physical condition might prevent them from doing so. This often results in an inability to get to the bathroom in time to prevent an accident. Incontinence Pads and Pull – Up PantsIncontinence Pads or pull up pants can give a person suffering with incontinence a sense of normality, whilst at the same time, maintaining their dignity. A wide range of Incontinence products are available from HARTMANN Direct, which provide containment for both urinary and faecal incontinence to help reduce the embarrassment that incontinence can cause. One of the best things you can do to keep life as normal as possible for someone with dementia. HARTMANN customer Adrienne recounts her experiences with husband Jeff. “Jeff’s problem was not remembering quickly enough that he needs to go to the toilet during the day and having frequent accidents during the night. We tried to manage it ourselves, to begin with by looking out for signs he needed the toilet and setting the alarm… but he was frequently soiling the bed.” She found respite and relief with HARTMANN MoliCare® pull-up pants. Adrienne continued, “the MoliCare® pull-up pants are much better for Jeff as they look like normal underwear, so he doesn’t get upset wearing them. He can pull them up and down like normal pants, which helps him maintain his dignity.” “We want him to keep his independence for as long as possible and minimise what is already a confusing world for him.” Adrienne is just one of thousands of customers around the UK who have benefitted from using MoliCare® pads and pull up pants for themselves and their loved ones. Dementia or not, no one deserves to have incontinence affect their quality of life. Reference list 1. https://www.alzheimers.org.uk/get-support/daily-living/toilet-problems-continence 2. https://www.scie.org.uk/dementia/living-with-dementia/difficult-situations/using-the-toilet.asp 3. https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/alzheimers/art-20046222
How can we take action against dementia using technology?
In the UK, someone develops dementia every three minutes, and the Alzheimer’s Society estimates that the number of people living alone with the condition will double to 240,000 in the next 20 years. Gavin Bashar, UK Managing Director of market-leading provider of Connected Care and Health solutions Tunstall Healthcare, explains how technology such as telecare can help people with dementia and those who care for them in a way that promotes independence as well as managing risks. “With 225,000 people developing dementia each year it has never been as important to introduce measures into people’s lives to protect their dignity and support their independence, as well as reducing interventions which are currently costing the UK economy £26.3bn a year. “Technology is crucial in enabling the delivery of care, which means people living with dementia can enjoy more independence for an extended period of time. It can also help to relieve the pressure on carers, improving their quality of life and enabling them to care for longer. As our social care and health systems continue to experience limited budgets and rising demand, it’s becoming increasingly important that providers employ solutions which enable care to be delivered in a more effective and person-centred way.” A range of solutions “Telecare systems can be tailored to the needs of the individual, helping to manage events such as falls, medication management and people leaving their care environment and being unable to find their way back. They can be configured to ensure help is automatically provided in the event of an emergency, 24 hours day, from a carer, response service or the emergency services as appropriate. They can also enable carers to carry out daily activities, or have uninterrupted sleep as they know they will be alerted in the event of an incident. The earlier technology is introduced, the easier it is to understand the eventual outcomes and how support can be given, enabling greater patient-centred care.” Telecare in practice “Tunstall is working with organisations across the UK to help support people with a wide range of needs using technology as part of services. The Hertfordshire Telecare Service supports almost 4,000 people in Hertfordshire to live more independently, many of whom have dementia.” Norman* has vascular dementia, and lives alone, although his daughter lives nearby. Technology is helping him to remain safe and at home, and provide reassurance to his daughter. Unobtrusive telecare sensors in his home will automatically raise an alarm at the 24 hour monitoring centre if they detect floods, fires or carbon monoxide in Norman’s home, and property exit sensors have also been fitted which will notify the centre if an external door is opened. A specially trained operator at the centre can then talk to Norman through the speaker on the Lifeline unit to assess the situation, and make sure Norman is okay. If the operator is unable to get a response, they can contact Norman’s daughter, or the British Red Cross Responder Service so they can check on him. Norman’s daughter has also given her father a GPS tracker device, which enables her to locate him should he leave home and be unable to find his way back. Together with the Telecare Service, this has already helped Norman to be found quickly and returned to his home, avoiding him being at risk. It also means that Norman is able to remain in his own home, rather than being admitted to residential care for his own safety. “This in turn relieves pressures on care homes and their employees, as telecare enables more people like Norman to live at home.” Integration is key “Although technology is a fantastic resource when it comes to reducing the pressures on care homes and the needs of residents, it should never be used to completely replace human interaction and care. Technological solutions should always be connected to the wider cycles of care within housing, health and social care to reap as many benefits as possible. Dementia sufferers often express feelings of loneliness, so giving them the opportunity to feel safe whilst also encouraging carers to interact with them regularly and family members or friends to visit, will make a huge difference to their life.” Telecare and the digital switchover “No matter the technology that is being used, it is important to remember that a digital transition has been announced which represents a huge opportunity to make services faster, more efficient and more insightful. Care home providers worried about the digital switchover and how this may affect their staff and residents, should always seek advice.” For more information, please visit https://www.tunstall.co.uk/dementia/.
Creating a Happy Christmas for Someone Living with Dementia
Spending time with loved ones over Christmas is what the festive season is all about, and for those living with dementia it’s just as important. There are, however, considerations to make when spending the Christmas season together, in order to make it an enjoyable and relaxing experience for all. Dementia wellbeing brand, Active Minds, have put together their top tips for creating an enjoyable day for someone living with dementia. Food & DrinkEating and drinking is considered a big part of Christmas traditions, and the Christmas meal itself can be fantastic for evoking memories and encouraging conversation. If the person living with dementia is able, involve them in the cooking process or perhaps talk about recipes from the past. The smell and taste of the food can be a highly sensory and engaging experience for all, which has numerous wellbeing benefits.It is important to remember when serving a Christmas dinner, that appetite may change as someone progresses along the dementia journey, so try not to overwhelm them with too much food. Alcohol consumption should also be considered and taken only in moderation; whilst it can be enjoyable to consume with others, dementia is linked to memory loss and the person living with dementia may consume more than they are aware of, which may lead to confusion. Quiet SpacesChristmas can be overwhelming, with a variety of noises, visitors and increases in decorations, so setting up a quiet space for the person with dementia to spend some time can be beneficial for relaxation. You can also have the opportunity to spend some time with the individual away from the chaos of Christmas day. VisitorsToo many visitors all at once may be confusing and overwhelming for someone living with dementia. Try and stagger visits throughout the day or introduce the person with dementia to each person in smaller groups rather than all at once. For those with later stage dementia, it may also be beneficial to show photographs of each visitor before they arrive and talk about that person to create familiarity. Time TogetherChristmas day activities can be a lot of fun, whether you’re taking part in a family tradition board game or perhaps having a sing along. These can all be fantastic for someone living with dementia also. Small considerations may have to be made, for example playing a dementia friendly board game, using dice cards instead of rolling dice or perhaps playing music or watching films from the person with dementia’s childhood; these dementia games can help evoke memories and spark conversations, as well as being relaxing social activities for spending some time together. Care HomeFor those living with dementia who may be spending Christmas in a care home, it’s important to bring festivities to them. Whether this is visiting with various family members, joining them for a Christmas meal or opening gifts together. Christmas is a fantastic time to reminisce so why not take photographs of Christmases of the past and sit with your loved one and talk about each one.
Helping Care Teams Engage
Happy Days Dementia Workshop & Nostalgic Design are constantly designing and creating nostalgic environments, engagement and reminiscence materials to help care teams, volunteers and families engage with elderly and people living with dementia. Creating a nostalgic environment in your care home or hospital ward can really bring residents, patients, care teams and families together, says Gillian Hesketh, MD of Happy Days Dementia Workshop. ‘A complete room isn’t always necessary. Nostalgic or more modern interesting wall art in corridors can help people engage. Interactive displays and trolleys, themed reminiscence baskets with memorabilia can bring about stories to share, encourage activity and enrich a sense of well-being for everyone.’ Choose from 1950s & 1960s Displays – Post Office Corner – Table Top Market – Mini Tool Shed – Train Carriage – Laundry Day – Nurturing – Seaside – Ladies Salon – Garden Room – Reminiscence Room and more … We enjoy working to your budget, not ours. Email: gillian@dementiaworkshop.co.uk – Shop online: www.dementiaworkshop.co.uk
Make Living With Dementia Easier
LEADING ELDERLY CARE EXPERT SHARES TIPS THAT CAN MAKE LIVING WITH DEMENTIA EASIER Philippa Fieldhouse from Richmond Villages suggests small home adaptions that can make life easier for people living with dementia “With one person in the UK expected to be diagnosed with Dementia every three minutes by 2051, learning how to care for people with this disease and staying at the forefront of best practice is key,” says Philippa Fieldhouse, Managing Director of Bupa owned retirement accommodation, Richmond Villages. Philippa, who runs retirement villages across the country says we must develop our understanding of the needs of those living with the disease to best care and support this increasing segment of society. Philippa is particularly interested in taking cues from her Dutch counterparts who she believes are paving the way in this sector. Philippa explains a dementia diagnosis for both the patient and loved ones can be incredibly daunting and emotionally draining: “From my experience it’s the unpredictable nature of the illness that adds such stress for families. When a parent or partner discovers they or their family member has the disease they have so many questions… “Will we have to adapt our home? How quickly will the disease take hold? Will they be safe in their own home? How can I help them remember key milestones? Is a specialist care home the best place to be? “At Richmond we appreciate the prospect of dementia is daunting initially but we have the experience in supporting people to reduce their fears and have had success in making their journey easier for the residents and their loved ones. “For most people, dementia progresses very slowly, meaning that people live with it for many years. Doctors can try and prevent further damage and slow down the progress in patients with some forms of the disease. At Richmond Villages we aim to create an environment which is as comfortable as possible for those living with dementia. “In 2020 we will be opening our first dementia-only centre in Willaston, Cheshire. Inspired by the Dutch model at Hogeweyk, it will be a lifestyle-led community with residents living with likeminded peers in small households of six people. The theory behind the concept is that it preserves residents’ autonomy with choice; over food, drinks and leisure activities and gives residents the freedom to run their own households. “As we are all only too aware of the detrimental effects of loneliness, we encourage as much social interaction as possible at our Villages across the country. We always run a busy schedule of activities including choirs, arts and crafts and exercise sessions. “Safety and security, balanced with creating a real sense of home and visual recognition prompters, are at the heart of our care. Many of our ideas can be brought into the home to help with the early onset of dementia and help people navigate their surroundings in a world that is increasingly hard to make sense of.” Philippa’s tips: Create a memory box:It sounds very simple, but a family photo, a keepsake or a newspaper article can help bring back a memory. These memories can help to prompt conversations with loved ones. Label key places in the home: Labels and signs are useful; for example, a sign on the toilet. And as elderly people tend to look down as opposed to up, ideally place them lower. Put photographs on key cupboards: Consider putting images of cups and saucers on the cupboards and drawers to show what’s inside them. Clear cupboard doors can be very useful. Buy dementia-friendly devices: These include telephones with large buttons and clocks with LCD displays showing the day of the week, the date and the time. Make flooring safe: Plain flooring is best and it’s a good idea to get rid of rugs or mats as they are trip hazards. Lighting:Consider extra lighting in the home, ideally in the kitchen and bathroom to keep these rooms safe. Lights that come on automatically may help prevent falls if the person gets out of bed and walks about at night. Run by the National Alzheimer’s Society, National Dementia Action Week, aims to unite people, workplaces, schools and communities to take action and improve the lives of people living with dementia. Richmond Villages provide varying levels of accommodation from independent living homes and apartments through to assisted living care suites with specialist care for dementia.
Residents dreams and wishes granted in a plan to spread happiness
A specialist dementia care home in Oxfordshire has created a wellbeing plan to entertain residents and make their dreams and wishes come to reality. Rosebank Care Home has put into action the concept of a Wish List Wednesday, giving residents an opportunity to express their desires to provide more fulfilled lives. By granting residents’ wishes, Rosebank hopes to provide them with a sense of fulfilment as well as making their dreams come true. The Bampton-based care home’s latest experience took place recently, when residents wished they could go swimming for a day. As part of the Wish List Wednesday plan, two residents were taken to Lincoln Farm Park, in Standlake, to enjoy a day taking part in both water therapy and swimming sessions. Other wishes granted by Rosebank include the hatching of chicks, requested by excited residents who wished they could have little chicks around the home, and a horse and carriage ride around Bampton village, a request made by a keen horse rider who wished she could visit and see horses more often. Mandie Acock and Gemma Foster, lifestyle support coordinators at Rosebank, commented: “The Wish List Wednesday is a chance for us to provide residents with an opportunity to ask for something that makes them feel excited and happy. It’s greatly beneficial for their overall mental wellbeing as it also gives them something to look forward to.” They also said: “Our latest experience granting residents’ wishes was absolutely wonderful. We spent the day in the swimming pool and had a lovely meal afterward at the care home.” Rosebank care home owner, Jane Roberts, added: “We are delighted that we were able to give our residents such an incredible experience and we are all looking forward to residents’ next wishes. We are constantly looking for new ways to spread happiness and the Wish List Wednesday seems to be an amazing way to do so!” Rosebank Care Home provides short and long-term care for elderly ladies and gentlemen and has an Outstanding CQC Rating. Lifestyle Support Coordinators are central to daily life at the home and work closely with residents to develop a varied and interactive programme of activities and events each and every day. For more information on Rosebank Care Home, or to take a look around the home, please call 01993 850308 or visit www.rosebankcarehome.co.uk.
Garden Project for Dementia Clients
Anastasia Barnes, a senior occupational therapist at the Emerald Centre in Colchester, was the proud winner of the Cosyfeet OT Award 2018. The £1000 award helped to fund the creation of a sensory garden where dementia clients and their families spend quality time, gardening and relaxing together. Here she reports on the project. We recently celebrated the official opening of a very special garden at the Emerald Centre. Clients and their families, supported by staff, worked very hard to create the sensory garden, which was officially opened by the Mayor of Colchester. The Emerald Centre is part of the Essex Partnership University Trust. The centre houses services for people with a diagnosis of dementia. These services include initial memory assessments, consultant reviews, medication monitoring, crisis intervention assessments, home treatment, occupational therapy, psychological assessment / treatments and a 24-hour helpline. The centre also houses group therapies and activities, including cognitive stimulation therapy and a vascular wellbeing group. An individual suffering from dementia, whether the cause be from Alzheimer’s disease, vascular problems or any other brain injury, have in common a group of symptoms associated with an ongoing decline of the brain and its abilities, including thinking, memory, language, understanding and judgement. Although the most common is Alzheimer’s disease and is generally diagnosed in people over 70, there are individuals who have a diagnosis before the age of 65. This is referred to as early-onset dementia and can have a profound effect on the individual, their family and friends. It is important that whatever age a person is diagnosed with any form of dementia, they continue to feel worthwhile, useful and understood. With this in mind, when the opportunity arose, we decided to create a garden where people could enjoy being together in a creative way, using and maintaining the skills and creativity they might have, giving them a sense of purpose and pride. The Garden At the Emerald Centre there is an enclosed garden area that was little used and only maintained by Trust gardeners to prevent overgrowth. The project was started when a volunteer offered to decorate the four very large clay pots in the garden with mosaic tiles to add some colour. We decided to expand on this and invited our clients and carers to become involved in creating a sensory garden which would be a therapeutic space they could enjoy. The garden project for our client group was designed to encourage and promote the following: A sense of achievement / building confidence / self esteem To boost energy levels and help with sleep difficulties Working with others to promote social interaction / reduce isolation To create a sense of purpose /meaningful activity Exercise to promote physical health and wellbeing / help to maintain mobility and flexibility To help maintain skills / encourage memories Enjoyment / pleasure / reminiscence A place to share experiences and create new memories with their family and friends It is well documented that gardening is beneficial for mental health and wellbeing. Studies have found that the mental health benefits of gardening are extensive, reducing problems such as anxiety and depression. It can also reduce stress, help combat high blood pressure and help improve overall physical fitness. According to Ulrich (1999)* being involved in garden activities can help improve memory and assist with maintaining rational thinking and cognitive function. The activities in the garden help to arouse the five senses of sight, sound, touch, smell and taste. Garden activities can also promote a feeling of calmness and reduce problems associated with dementia such as boredom, depression, aggression, agitation and increased stress. It was a huge undertaking and hard work to begin with. We were fortunate to have the help of a group of volunteers from the university and an enthusiastic group of Girl Guides to clear the space and ready the garden for our clients to begin their project. Fliers were sent out to our clients and their families or carers informing of a start date for the group and requesting donations of old unused garden equipment or any spare plants. We applied to the Trust for funding to enable us to purchase gardening tools and entered the Cosyfeet OT Award programme. We were overjoyed to win, and the £1000 award enabled us to purchase, paint, plants, arbours and seating. The client group was divided into two, with the clients who wanted to work outside in the garden busy designing areas, painting benches, planting, weeding and generally creating the garden. The ‘inside’ group were busy creating artwork for the garden that included making bird boxes, painting pots and using household items to create various sculptures. The project has grown since the opening and we now have a very well attended group who are enthusiastic, creative and motivated to continue developing ‘their’ space. The project has proved to be an enormous success. We have observed the benefits first hand with our clients forming relationships, talking, laughing, being physically more active and best of all inviting their families and friends to enjoy the garden with them. Case Study A – Maria Hinch, aged 63 Maria was diagnosed with vascular dementia six years ago. She also has a diagnosis of depression and arthritis /spondylitis, which causes Maria chronic pain. Maria lives with her husband Norman, who is supportive, but Maria likes to remain as independent as possible and continues to cook and bake. When the garden project started, Maria joined and it quickly became apparent that Maria’s skills in art and craft would be a huge benefit to the group, as this is an area that Maria excels in. In the past, Maria has found it difficult to be in groups but now she reports she enjoys the interaction in the group. “For me it’s a source of social interaction and an outlet for my creativity. I also paint and do art and crafts at home, but I love seeing my work on display in the garden. It makes me feel proud”, says Maria. “The garden group has
