Anon ‘Mr B’

Mr B was referred to Perton Manor after a failed placement. He had been very isolated for a considerable time: refusing to wear any clothing and unable to socialise with peers and staff because of his behaviours that challenge care, highly resistant to personal care interventions and intolerant of any form of touch or others in his environment.

After being admitted to Perton Manor, where he is supported by staff who have been trained in Capulet Care’s own model of care, ‘Metavasi Care’, Mr B was very quickly able to freely access the grounds; sit in social groups with his peers; was accepting of support from our highly training Metavasi Care Champions and began to demonstrate consideration of others – this, his wife informed us, is the real Mr B.

Mr B’s wife tells us that she now has her life back again; she is trusting of the care he now receives and enjoys quality visiting time with him.

At review, both his psychiatrist and CPN were overcome with emotion as they observed Mr B wearing his Bermuda shorts, T shirt and sun hat, covered in suncream applied by staff, sitting amongst staff and peers whilst eating an extra-large ice cream.

Mr B lives a better life in a Capulet Care Specialist Nursing Home.

Anon ‘Mr R’

Mr R was admitted to us presenting with complex behavioural and psychological symptoms of dementia: agitation; aggression; anxiety; distress; wandering across day and night. Whilst in a psychiatric unit, his behaviours were managed by use of level 3 observation (1:1 support); physical restraint, clinical holds and chemical restraint – anti-psychotic medication (Use of Force Act, 2018), with multiple very serious physical attacks upon staff reported. Mr R had remained, walking around the psychiatric unit for extended periods, both day and night, and had not been outside since admittance. Prior to being detained under the Mental Health Act 2005, his wife reported that he was used to being outside every day and enjoyed walking.

Mr R. was admitted to one of Capulet Care Specialist Nursing Homes with a 24-hour level 3 observation package of care. Initially, Mr R. presented with extreme anxiety when staff initiated therapeutic touch or entered his personal space, and with extremely aggressive behaviour prior to personal supported care interventions. Our internal specialist team were utilised to risk assess and evaluate, then form agreed approaches to trial. Using highly skilled staff and multi-professional approaches, different methods of support were utilised, intending to increase Mr R’s feeling of being in control of what was happening to him, and to enable him to express himself, in his time, in his way. Over time, Mr R. became accepting of supportive touch and appeared to understand, agree, and participate in what was being communicated to him i.e., personal care, increasingly accepting of staff actively supporting.

The practice: Level 3 (1:1) staff built trusting and formative relationships with Mr R. enabling him to feel he has control over what is happening to him, using choice to maximise this. Skilled staff used built relationships to communicate in a person-centred way, including our own ‘Afi therapy’ (touch therapy), so that Mr R. was informed and participated in the process of personal care, in his own way and in his own time. Mr R. falls under management of a Multi Disciplinary Team who meet 6-weekly to discuss behaviours, employ therapeutic interventions, and have safely reduced his antipsychotic medication.

The outcome:  Mr R. continues to present with wandering behaviours across day and night, with slight improved night-time sleep. Skilled staff have used his wandering behaviour to occupy him; to enable long walks in grounds and visits to local community. Whilst Mr R. continues to require 1:1 support across 24 hours, with 2:1 support as risk assessed, trained therapeutic approaches and support have resulted in greatly reduced need for chemical and physical restraint. Mr R. has increased in weight; he participates in activities, enjoys time outside with his wife and expresses himself in a person-centred way. (Equality Act, 2010; Health and Social Care Act 2008 Regulation 13; Human Rights Act 1998; The Mental Capacity Act, 2005; Nice Guidelines NG10, 2015)