At Apple House care homes we strive to support residents to lead a healthy lifestyle and to be as independent as possible. We provide access to a programme promoting healthy living and wellbeing, with home cooked fresh food, regular exercise, and creative activities. This article outlines why it is important to give people with autism the opportunity to take part in creative activities and regular exercise.

Challenges for people with Autism

For people with autism, you may notice that they can have challenges in interacting in social situations as it can be overwhelming at times with direct verbal communication. We may not get a direct response or eye contact and we can wonder if we have been understood. So it may also be a struggle to build a relationship with them through words alone.

At times people with autism can have rigid mindsets as this may be their way of making sense of the world around them. So, therefore, change can be difficult as they feel reassured by a routine that gives them a sense of control. They may not always understand that a change in routine may be something beyond their carer’s or parents’ control. Such as the illness of a friend or a change in who supports them due to outside factors.  They may need help in regulating their emotions in response to these situations.

Sensory experiences

Jackie Edwards (2017) describes how people with autism may have difficulty making connections between their tactile, vestibular and proprioceptive sensory systems where they may be overactive or not active enough with how they interact with their environment.  For example, they may have a hypersensitivity to loud noise or bright light, may also be de-sensitised to tactile experiences. So, therefore, they would benefit from a sensory diet to improve sensory integration.

She advocates giving people with autism access to different sensory experiences to help improve concentration and attention. This in turn may help them to be able to regulate awareness of their surroundings more effectively as well as to help them relax and not feel overwhelmed, leading to increased socialisation and interaction, promoting less rigid thinking, creativity, and motor skills.

Benefits of exercise

At Summerwood we recognise the importance of exercise by helping our residents access their community, take part in physical exercises such as the gym and swimming, and helping with gardening, tending the vegetable patch etc.

According to Healy S, et al. (2018) research shows that for people with autism exercise can have a number of benefits:

• Reducing stereotypical behaviours or self-stimulating behaviours
• Improving social skills with sports that promote teamwork
• Helps to reduce weight gain or obesity
• Can increase a person’s attention as repetitive behaviours can decrease
• Exercise can reduce anxiety and improve the ability to regulate emotions, build resilience to anxiety-triggering situations
• Exercise can improve motor skills and coordination for people with autism

Benefits of creative activities

The creative arts is another important activity and we support individuals to participate in regular arts and music classes in the community and within Summerwood, their home.

Art can give a person a sense of control as they learn to adapt to the task in their own way. Drawing and painting can also help to improve and maintain fine motor skills. Creative arts can be an effective way to engage with the person in a non-pressurised way. Tactile art forms such as paint and clay also provide a sensory experience to fulfill the needs of the person to be able to balance their sensory experiences more effectively. Music can elicit interactive emotional responses and melodic rhythms can help them engage.

Arts and wellbeing

People with disabilities can be more vulnerable to mental health issues so we are aware that it is important to provide a way for people to communicate their emotions appropriately. Behaviours on the surface may arise due to an inability to verbally communicate how they feel. Behaviours thus can have a function so this highlights the importance of non-verbal communication and communication aids to help people communicate their needs.

For further assistance, creative arts therapy with a trained art therapist can be a way for a person to be able to express and/or regulate their emotions when words are difficult. It can also help to improve cognition and emotional regulation where the aim is to use the art materials or creative activity to access emotional wellbeing and to help a person learn to regulate their emotions and understand themselves within a safe and facilitating environment.

— By Andrew Wright, Support Worker, Summerwood Care Home, Hants (Previously Rated ‘Outstanding’ by CQC).

References and further reading

Draycot, C. (2013) Educating Autism – Art and Creativity to Engage an Autistic Child in the Classroom. The Art of Autism: Connecting through the Arts. https://the-art-of-autism.com/educating-autism-art-and-creativity-to-engage-an-autistic-child-in-the-classroom/

Edwards, J. (2017) The benefits of multi-sensory environments. Autism Journey Blog.

Healy S (2018) The effect of physical activity interventions on youth with autism spectrum disorder: A meta-analysis. Review article. Autism Research. 11(2) · April 2018.

Rudy, L.J (2017) How Does Art Therapy Help People With Autism? Very Well Health. https://www.verywellhealth.com/art-therapy-for-autism-260054

The Apple House Ltd Approach:

The world of management and strategic planning can be full of jargon-based terms and phrases, which can take the core meaning away from readers who want to see the direction and aims a company wants to work towards.

While it is crucial that our company has a clear strategic plan from directorship level, the methods which enable this plan to work through an operational route are key to achieving the common goal. This planning stage will assist the company forward through an ever-increasing demanding economy and climate.

For our Company, the aim is to protect the homes of the people we support and the jobs of the people whom we employ throughout our services.

An infographic is used to give an overview of our Operational Goal Planning.

–Romaine Lawson, Director of Operations, Apple House.

“Apple House Ltd believes that its employees represent its greatest asset.  By providing opportunities, facilities and financial support for training, the service aims to ensure that all of its employees are in possession of the knowledge, skills and experience necessary to perform their jobs to the highest standard.  To this end, the service is committed to functioning as a learning organisation, providing all of its employees with the opportunity for training and re-training in accordance with their own needs and that of our homes.

Without a skilled, committed and well-trained staff team, the service cannot possibly succeed in its aim to provide high-quality care.

Training should not only motivate staff, but also encourage their co-operation, imagination and personal development.  Without being stimulated by new learning, staff can become bored, take shortcuts, lapse into bad habits or feel undervalued.

A planned programme for the training and development of staff is essential to ensure good practice and the provision of a quality service for service users.  This is why we have 25 core training courses available to our staff with more being available if there is an individual speciality being undertaken.

If you would like to be part of our team and enjoy this environment of learning and fulfilment, please get in touch through our careers or contacts pages.  We’d love to hear from you.”

––Romaine Lawson, Director of Operations

• Care home policies on oral health and providing people with support to access dental services
• Oral health assessment and mouth care plans
• Daily mouth care
• Care staff knowledge and skills

CQC, during their discussions at the Regulation of Dental Services Programme Board and with other stakeholders across adult social care and primary care, highlighted that awareness and take-up of the NICE guidelines were still low.

CQCs review included dental inspectors attending 100 routine planned inspections of care homes alongside inspectors from their adult social care team. They spoke with managers and senior staff members as well as people who use services, and their relatives, to find out about their experiences of care.
Smiling Matters is a report of what was found in those homes, conclusions and recommendations for action.

In Apple House care homes, we have used the report to raise awareness of the importance of clear guidance within our own homes to ensure that access to regular dental check ups, care plan guidance and daily mouth care is and continues to be an important part of a person’s person-centred support. We have found that staff training is crucial and this goes hand in hand with the understanding of creative support plans which reduce barriers to people receiving oral healthcare. An area of action will be to include how people find this experience within our annual service user survey to gain the views of the people we support. An area of excellence was found to be specialised training received by members of staff which has been rolled out to the teams. The report has been discussed and communicated throughout the organisation at senior, team and service user meetings.
One of the recommendations from the CQC report is:
That NHS England and local commissioners:

• Work with the care home sector to avoid lengthy waiting times for appointments and treatment and provide emergency appointment times. 

• Work with GP practices and other primary care contractors, such as community pharmacists, to establish local arrangements to signpost people to dental provision. 

• Provide adequate capacity to provide routine and emergency treatment to people in care homes. This should be linked to a clear, measurable outcome around avoidance of GP appointments and A&E attendances resulting from dental crises.

You can read the full CQC report ‘Smiling Matters: Oral health care in care homes’ here.

Romaine Lawson, Director of Operations, Apple House care home group.

[Click HERE for quick link to PDF]

Our priority has always been your safety and wellbeing. Closing our doors to visitors has been one ofthe most difficult decisions we have had to make and we understand the impact that this has on youand the people you care about. We do not know how long the coronavirus will affect all of our lives butwanted to share with you what we are doing to keep you safe and well.

Reducing the Risk from COVID-19

• We closed our doors to all visitors at the start of the pandemic, as the situation escalated quickly across the nation. Any visitors, such as visiting health professionals, only enter the care home if it is necessary and if they have followed strict infection control procedures. This includeswearing the correct personal protective equipment (PPE) and of course, making sure that goodhand hygiene is always followed.
• You will have seen the news about concerns relating to masks,  gloves and aprons. We want toassure you that we are following the correct procedures to make sure we protect you and our staff teams. We are keeping up to date with all the guidance and are making sure that our staff knowhow to use the correct equipment.
• Any staff with symptoms, or staff who have been in contact with anyone with COVID-19,  arenot coming to work and are following the government’s guidance on self-isolation.
• We are monitoring all of the people we support for symptoms or behaviour that is considered different to their usual presentation. We understand that not everyone will have the samesymptoms of a persistent/new cough and temperature or loss of smell and taste, and our staffunderstand the need to look for other symptoms and act immediately.

Responsibilities of Apple House Ltd

• We are responsible for ensuring that we support people within our care to meet with family and friends if they wish and that staff have the ability to facilitate this. This support includeshaving written policies and procedures so that all of our team understand what they need to do.
• We will identify other ways to connect with friends and family when face-to-face visits arenot possible. We will use technology such as video conference or telephone calls tocompensate for limited visits.
• We will ensure that we are open and transparent and we will keep family members informed about their own relative’s COVID-19 status (suspected or confirmed) where their relative hasprovided consent or a best interest decision has been made.
• Where the service user has an appointed power of attorney, relevant person’s representativeor another formal role, they will be informed of any changes in health including COVID-19.
• We will provide timely and regular updates to the people we support and their nominatedindividuals on the impact of COVID-19 at our homes and on visiting.

Visits can happen and we are working with you to make these possible in a number of ways including:

• Window visits: This will need safe ground floor window access for both residents and theirvisitors and the relevant social distancing and PPE measures will need to be observed.

• Garden visits: Relevant PPE measures and social distancing will apply. Independent access to the garden will be needed to avoid visitors moving through the care setting to the garden.

• Drive-through visits: These are facilitated visits in the car parks of homes. Again, anyrelevant PPE measures and social distancing will apply.

• Picnics and meetings in local parks/forest, beach or family member’s garden with adherance to social distancing, the use of PPE and the latest government guidance relating to numbers of people in one gathering and households who can mix.

• Designated areas within a care setting where settings allow for this: depending on the service it may be possible to enable visits to one of the cabins within the grounds reserved forthis purpose. These cabins facilitate good ventilation, social distancing, ease of access by the people we support, and limits visitor journeys through the residential areas.

• Family home visits: Where a robust risk assessment and best interest decisions have been reached, visits away from the care home to family members can take place taking into account up to date government guidance.

• We want everyone to be involved in supporting this policy and assisting with ideas of creative visiting and we welcome feedback and input.

The evolving nature of this COVID-19 pandemic means that government guidance can be changed at short notice. For the latest government guidance please refer to the gov.uk website.

— Romaine Lawson, Director of Operations.

Everyone had a great time in a socially distanced manner!” — John Caslake, Registered Manager, Summerwood.

We have made trench boxes, discussing about how these boxes were sent out at Christmas time for the soldiers at the front. We also made a tea party of favourate foods eaten in the 1940’s including Anzac biscuits which we put in the trench boxes. Great fun had by all!” — Sharron Eyears, Registered Manager, Redcroft.

Nature Garden Creation, Third and Fourth Sessions:

“Sessions 4 and 5 saw a continuation of the process of creating a footpath through the garden to ensure everyone has access. It was heavy work, but the end results were noticeable and made the efforts worthwhile. One highlight was digging round the fallen tree and in doing so starting the process of turning this once magnificent tree into a marvellous seat.

The team also noticed that, like many pop bands before, they now have their own fan club, although instead of screaming fans the team have a devoted following of local Robins who take great delight in investigating the team’s hard work for food.

Session Six:

Session 6 was relatively short in the garden due to the unpredictable English weather (RAIN !!). However, we did manage to clear all the loose foliage from the area where there are bird bath stands. We also removed a lot of dead branches from around the large tree at the back of the garden (you could say we spent our time getting rid of a lot of deadwood) which we intend to make the centre piece of our future bird neighbourhood.

Although rain halted play in the garden, we diverted our efforts into researching actions/steps we could undertake to attract more wildlife.

Sessions Seven, Eight and Nine:

Sessions 7, 8 and 9 of our nature garden creation project were spent clearing a path to the area that will become the BBQ/Quiet area. The team worked very hard and uncovered many unexpected items such as the large rocks pictured in the first picture below. We also started work on clearing the foliage from the rockery as we have now also decided to overhaul the Sensory area and add to the hard work carried out several years ago.

To be continued! Please check back here soon.” — David Dellow, Redcroft.

Historically, care homes and nursing homes followed the hospital model of rigid visiting times.  This in turn meant that families may not have been considered to be intrinsic in the planning of care pathways or, in fact, in the individual’s life inside a care environment.  Today, things are changing for the better but there is always more work to be done.

Apple House care homes embrace an ethos of inclusion.  Families and loved ones have a hugely crucial role to play and, as such, are our partners and never an inconvenience.

Apple House are proud to have signed up to John’s Campaign who champion family inclusion in care settings, and to have been featured in their blog. These are just some of the ways in which we include families of the individuals entrusted to our care:

• Decision making: From the moment that we receive a referral for a placement at our homes we establish communication with the individual’s family unless they do not wish to be involved in the assessment process.  This means that we invite the family and the individual to the home for an initial look at the facilities offered and to meet our team.  An open line of dialogue is created so that families feel empowered to ask any questions and to express concerns or wishes.  Often close family members advocate on behalf of their loved one or have worries about how the individual will adapt to their new home environment.  After all, change is scary for all of us and we understand that.  Only by being fully informed can families and their loved one make a decision that is right for them.
• Partnerships: We believe that families and friends are an invaluable source of information.  No-one knows an individual as well as those closest to them.  Insights and preferences, life history, hobbies and matters that are important to the individual can sometimes be shared with us more fully by family members, especially if their loved one finds verbal communication to be a challenge or if their memory is poor.  Memories are precious and we would like to learn about the memorable moments that are important to the person – all of this makes the individual who they are today. Working in partnership with families as well as the individual in care planning produces a more holistic and comprehensive pathway.
• Approachable: Communication is key.  Three words that summarise the entire partnership between ourselves and the loved ones of the individuals we support.  It is essential that strong communication is in place to form a bridge between families and staff teams.  That bridge helps to avoid rocky roads where anxiety and disharmony could take hold.  After all, it can be stressful and emotional entrusting the care and support of someone you love into the hands of others.  By us being approachable–letting families know that we are there to support them, that they can talk to us at any time–we hope to alleviate concerns, discuss expectations and to be friendly and flexible.
• Flexible: The people who live at Apple House homes are not living in our workplace.  We are working in their home.  They are free to invite their families and friends into their home for a cuppa or to enjoy their gardens with them.  We minimise rules about visiting to, for example,  the need to sign in which is a legal requirement, and to the consideration of others living alongside the individual.  There will always be a warm, genuine welcome from staff.  We have an ‘open door’ approach to visiting, just as we all expect within our own homes outside of care.
• Homely:  We work hard to ensure that Apple House homes are exactly that – homely!  To achieve this, we choose furnishings for our public areas such as lounges that are not clinical or generic in style.  We encourage the displaying of items and pictures that have meaning to the individuals who live there.  Our gardens are created and maintained with the help of those individuals who are able and wish to, for example our chickens are cared for by residents who collect the eggs and bake with them.  There are sensory areas and places to simply sit and be.  Where we are required to display certificates of registration, fire, health and safety etc, we endeavour to do so discretely.  Individuals are encouraged and empowered to decide how they wish their bedroom to look (and we’ve certainly painted some wild and varied colours!).
• Communication: We understand that it is not always possible to visit and so we ensure that alternative means of communication are accessible.  These include Skype video calls, email and telephone calls between individuals and their loved ones.
• Participation: Invitations are extended to families to events within the homes that are varied and regular.  These include invitations to birthday celebrations, BBQs, seasonal parties, special activities such as visiting owls and birds of prey and charity fund-raiser coffee mornings.

This list is not exhaustive – there are so many diverse ways of ensuring that we are family friendly.

–– Jane Montrose, Managing Director.

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