A 5 hour train journey home from York is a rare piece of thinking time to digest the course I have been on today - Montessori based dementia programming, and to consider how it might impact on my day to day work.
There were 9 people on the course; a selection on Occupational Therapists, Physiotherapists ... and me! I am quite sure that those professionals, everyone of them passionate about improving the lives of people living with dementia will have their own opinion of the methods we learnt about today. There is much about it that leaves me cold not least of which is the name. Montessori is so closely associated with the education of children, and dementia 'programming' sounds very rigid and impersonal. The creator of the techniques, Cameron Camp speaks passionately about how the word Alzheimers Disease has a negative impact and that it should be renamed Alzheimers Syndrome so he understands the power of words, and yet there is no acknowledgement of the impact of using the terms 'Montessori' or 'Programming'. I am sure that if nothing else the name will stop this menthod from becoming more widely used.
What is Montessori
The Montessori method shares some underpinning principles with other dementia approaches such as the Eden Alternative; the importance of meaningful activity that is person centred, and that a diagnosis of dementia should not be a signal to disengage, disempower or disenfranchise that individual. The practical application of Montessori seems more confusing. It is a mixture of implementing everyday living activities such as laying the dinner table and more therapeutic interventions like moving beans from one bowl to another. It is these latter activities which are more controversial. They are based on the first in / last out theory that skills we learnt first as a child are the last to go.
When it works
In my opinion it is the later stages of dementia that the therapeutic approach of Montessori comes into its own. The facilitator is encouraged to consider environment, demonstrate before expecting participation, start at a basic level before increasing difficulty, and to use minimal communication to avoid confusion. Tasks are straightforward and use everyday objects that are pleasing to the eye. All good so far. The concerns many people have with Montessori is the types of tasks suggested. They seem to rarely have purpose, they could be construed as childish and patronising.
I have tried some of these tasks, for example sock matching and putting pegs on a box, and I think this approach has a place; with an individual who is disengaging, is lost in the world around them, who finds every day activities challenging, confusing and distressing. The simplistic tasks can be really successful at providing someone with the occupation and achievement otherwise lost to them.
A word of caution
If possible try to retain some form of purpose. If you want to try shoe polishing find shoes that actually need polishing. If the task is to fold towels get freshly dried ones from the line or tumble drier. In other words, activity should be a spontaneous reaction to the environment around you rather than prescribed tasks pulled out of drawer. This is where Montessori and I part ways! Taking a pile of freshly folded napkins from the linen cupboard, shaking them out and giving them to someone to fold again undermines everything we are trying to change about dementia care..... and one day one of those people you are handing them to will catch you out and you will realise how wrong it is. I've been there.
PostScript
Something I learnt from my fellow students today was how difficult it can be to be spontaneous and instinctive about activities in some medical settings, and yet how much staff want to stimulate and enthuse their clients with dementia. Life on an acute medical ward, or even a rehabilitation unit is dictated by health & safety, budget and even space. Many of the ideas I have spring from my work in residential homes and what I hope is possible in people's own homes. The determination of staff in these roles is inspiring and I will try to consider some adaptations to my weekly blogs to inspire these lovely people too!
