A two year consultancy project exploring ways to transform the culture of dementia care in the UK. Applying a model based on understanding and compassion in order to deliver better care to patients and their families.
BACKGROUND
The story of All of Us begins with the work of Dr David Sheard (now a Professor of Emotional Intelligence in Care).
David began his career as a social worker in the 1980’s, working for the NHS in an elderly care ward in a hospital. He experienced how staff were being taught to manage with the growing challenge of patients with dementia and saw the impact these methods were having on people. His view was that the approach being deployed to manage the “behaviours” of people with the illness were in fact exacerbating problems rather than reducing them and there seemed to be little opportunity to deliver the more emotional aspects of care that he considered to be so vital – to all patients, but particularly those who were living with dementia.
So David set out on a journey to discover a less drug dependent and much more emotionally tuned and sensitive approach to caring for people, that could not only address some of the trickier expressions of feelings known at that time as “behaviours” that were being exhibited by people, but in fact give those experiencing the illness real quality of life: a life worth living.
He spent the next decade developing and testing various approaches, ultimately leading to the creation of “The Butterfly Model”: an operational platform designed to provide tools and give training to staff in care homes who were wanting to adopt his methods.
By 2017, David had gained international recognition for his approach and the model was being run in more than 50 homes around the world and growing fast.
THE CREATION OF ALL OF US
After successfully running his model in numerous care homes across the globe, David’s ambition was to take things to the next stage – to not only be able to influence the operational model within care homes, but to be able to design and run the care homes themselves. His feeling was that by collaborating with others to create a bigger platform for his work and expanding from operations into design, he could help lead a movement towards the much deeper systematic change towards dementia care that he felt was needed.
And so in 2017, with the backing of a private equity firm and a partnership with an existing property developer, David set out to build a new residential care company that could challenge every aspect of conventional thinking around how best to look after people, and what became known as “All of Us” was born.
DEVELOPING THE PLATFORM
We were invited to participate in the creation of this new company: working together with David and the development team to create the brand strategy, positioning, name, identity, proposition, product offer and communications strategy for the business. A core part of our remit required us to capture and distill the hallmarks of the existing Butterfly model in order to combine these elements with the vision of what would be possible if we were also designing the physical product in which the model was housed. This could then inform the brief for the architects for the kind of buildings we would need to design.
COMFORTABLE WITH INTIMACY
Connecting via touch is a key aspect of all human wellbeing but this need becomes particularly heightened during the latter stages of dementia. Just sitting next to someone and holding their hand is so simple, but it can be one of the most powerful things to do for someone, especially if friends and family aren’t able to be there. In a Butterfly home this aspect of care is considered a core human need and staff are trained so they feel comfortable doing this, as well as being afforded the necessary time in their day to day.
Two people sat under a tree holding hands is a common picture found in a Butterfly home
You can have bacon and eggs at midnight if you like, if you're in a Butterfly Home
INHERENTLY FLEXIBLE
One of the things that changes during dementia is the perception of what is the ‘right’ or ‘normal’ thing to do, at the ‘right’ time. Food is incredibly important in the daily routine, but ‘what’ that routine around food is, isn’t necessarily what we would consider to be ‘normal’ when looking after patients with dementia. In the most part, traditional care homes follow the structure of regularised meal times of breakfast, lunch & dinner, and all residents, be they undergoing treatment, recovering from a stroke, or living with dementia, are expected to conform to these routines. This can be hard on the dementia patients who are being asked to adhere to a structure they may no longer recognise. They might not feel hungry at “lunch” time, they might fancy bacon and eggs at midnight. In a Butterfly home this simple act of a 24 hour kitchen and pretty much offering residents anything at anytime, releases a lot of the tension and creates something closer to the level of control you have when you live at home – being able to eat what you want, when. you want it.
CULTURAL EQUALITY
Feeling a sense of equality in the relationship between the ‘patient’ and the ‘carer’ is key aspect of what is so different about the Butterfly Model. A simple gesture of a resident being encouraged to make a cup of tea for a fellow resident, or one of the carers, can culturally be transformative. It promotes a sense of balance in the relationship, allows the patient to feel their value, creates a feeling of being at home – in the way one would put the kettle on if a friend was coming over. What seem like small and simple things can in fact make a huge difference to people’s lives and are part of what adds up to creating a very different feeling, culture and atmosphere in a Butterfly home.
Butterfly homes are happy to disrupt the normal structure of a 'patient' vs. 'carer' relationship, to create something more equal
In Butterfly homes residents are encouraged to get involved in the cooking
FOCUS ON WHAT’S POSSIBLE
One of the most difficult things for people to comprehend when they are in a care home is why they can’t do what they used to be able to do at home. In many cases the person has been managing on their own at home for quite some time prior to coming to a care home, and although they may have a hit a point where that is no longer viable, to go overnight from doing everything for yourself to not doing anything for yourself is difficult and can make the transition much harder really than it needs to be. In Butterfly homes a great deal of time is spent on understanding what that person ‘can’ still do. If for example, they can do all aspects of cooking their own meal but perhaps just need some help with chopping vegetables, or moving things on and off a stove, then the home and team who are caring for them will try to work on that basis, doing the part they are unable to do rather than the whole thing and encouraging them to maintain as much of their existing capabilities as possible.
PRODUCT BRIEF: CULTURE-LED DESIGN
The Butterfly Model at its heart is about making life feel as normal as possible for people. Training staff to be as natural as possible, making the environment feel as homely as possible: i.e. not ‘a home’, just ‘home’.
This idea of making people feel ‘at home’ is talked about in all care homes, but how many are really delivering on that in any kind of meaningful way? Having some pictures of your relatives in your room, or being able to bring in your favourite armchair…sure, those things matter, but are they enough? Do people feel like they can be themselves? Do they feel free to follow their instincts, do what they want to do? Do they feel genuinely ‘at home’ in their environment and like they can do whatever they want to do? Are they given the autonomy, the feelings of power, the sense of your own identity, that comes from being in your own home?
This became a core aspect of the brief for the design of the first development – looking at how architecture could go beyond just delivering a high quality physical environment that reflected all the needs of the different people at different stages of the illnesses progression, to design in a way that reflected the social and cultural dimensions of the model that we knew were most critical in creating a good experience for people.
In addition to helping develop the architects brief and all aspects of the brand, we were also responsible for helping to develop the thought leadership strategy that could form the basis of delivering David’s ultimate goal of wider systemic and cultural change across the sector.
TEAM
We were members of a large team of creatives, strategists, architects and designers who worked together on this project with the founder of the model David and other members of the property development company. The brand development aspect of the project was created together with Mark Smith.