Patient Therapy

The idiosyncrasies that form our personalities can be stripped away once inside in a care home but John Burton reports that this need not be so. Overleaf, Nina Jacobs visits a project that has won an award for maintaining client individuality

Amid the rhetoric about privacy, dignity and respect, we may overlook the deep anxiety of losing one's identity in a care home. What makes us tick -- each person's identity -- is made up of thousands of apparently small events, relationships and preferences. The way we dress, our odd little habits and pleasures, the music we like and the books we read, the way we eat and sleep, how we make a cup of tea, how we wash and clean our teeth, our "funny ways" -- all the idiosyncrasies that, when put together, make up our everyday lives and make each of us unique.

Many of the underlying fears associated with moving into a care home are to do with losing identity and selfhood. While the national minimum standards set out the importance of treating everyone as an individual, there is an inescapable contradiction in the need (and there is a real need) to have "national standards" for the care of individuals. Setting standards implies a conformity that is at odds with the promise that each resident will be able to retain that unique and complex mix of "me-ness" which makes us who we are.

The true measure of a good care home will be found in to what extent these contradictory demands -- standards and individuality -- can be happily reconciled.

The manager usually sets the tone; the staff are likely to adopt it; and the residents live with the results. A manager who is happy to be different will encourage staff to be themselves and to identify with residents' individuality.

At care home Ivybank House in Bath, manager Karen Webb asked the residents what little things made a big difference to their lives and they came up with this list:

• Good relationships with care staff and the small things they do for me.

• Friendships with other residents.

• Walking in the garden.

• The daily newspaper.

• Activities, exercise, the theatre, bingo and pub lunches.

• My favourite TV programmes.

• Having a drink.

• Massage, make-up and hairdressing.

These were summed up as "the freedom to do as one pleases".

With a multi-racial staff team at Ivybank, Webb says it is essential to promote and value the different identities of staff and that in turn allows them to treat residents as individuals and really get to know them.

One of the most obvious and deliberate expressions of individuality is in the clothes we wear. Residents do notice what staff wear, except when they are wearing uniforms, when there is nothing to notice. Clothing