Daily routines using everyday objects to help improve quality of life for people living with dementia

Dr Kellyn Lee is a Chartered Psychologist and Research Fellow in Ageing and Dementia.  She is also Co-Director of the Alzheimer’s Society funded Doctoral Training Centre – Dementia Care and Founder of WISER Health and Social Care Ltd, a social enterprise that exists to improve the lives of people living with dementia.

What is Material Citizenship?

Material Citizenship is a new approach to dementia care that recently received national press coverage.  

It is a training programme designed for care home staff to support them to engage in practices that enable people with dementia to live the lives they want to live, their way, by focusing on functional objects (such as a pair of curling tongs or certain coffee cup).  

The definition of Material Citizenship is the right to be included in decision-making relating to personal possessions and the right to have opportunities to use functional objects to perform everyday tasks. 

When talking about functional objects, these are defined as any inanimate item which a person can use to carry out a task, not necessarily to completion or to any perceived standard, which maintains and supports their identity.

The Material Citizenship programme was developed from my Alzheimer’s Society-funded PhD research. This research found that people with dementia were:

• not included in decision-making about their possessions
• lacked control and choice over personal possessions (existing and new)
• had no opportunities to return home to collect belongings

In addition, care staff sometimes viewed certain objects as a risk. Although safety is a top priority, this can lead to some important objects being excluded from a person's daily life after moving into a care home. There was also a lack of guidance in policy and practice documents as to which objects should be incorporated into a persons routine.

Why are objects important?

Imagine you woke this morning and the clothes you planned to wear have disappeared.

There are clothes in your wardrobe but some of them are not yours. You have no access to a kettle or coffee maker, a hairdryer or shaver. The things you use every day are gone. 

How much of a disruption is this? And how would this effect you?

Objects are not simply material things, they support us to maintain routines and rituals developed over a lifetime.

But their importance is often overlooked when moving into a care home. There is a sense of 'you won’t need that in here, we do that for you, we have a hairdresser on site'.

However, the lack of personal possessions to carry out everyday tasks aligned to identity can result in disempowerment, confusion and negative psychological effects.  In turn, this can present itself in a way others view as a symptom of dementia, rather than a reasonable reaction.

Judy's story

Judy - a person who lives in a care home - would say she didn’t recognise herself when looking in the mirror. Care staff believed this was a sign of her dementia progressing. However, Judy felt this way because her hair was grey. Prior to moving into the care home, she dyed her hair blonde. Also, her hair was straight when prior to moving into the care home, she would use her curling tongs to curl her hair. 

By focusing on objects and understanding their importance to identity and agency, Material Citizenship goes beyond just looking at the person’s medical needs.

It encourages staff and relatives to explore how that person lived their everyday life before they went into a care home, and the objects they used to do this.  Acquiring this knowledge and using objects to support people with dementia can ensure we enable people with dementia to live the life they want to live, their way.

Material Citizenship training programme

During the COVID-19 pandemic, Material Citizenship was developed as a person-facilitated online training programme.  

It is delivered over two three-and-a-half hour sessions, four weeks apart. The programme takes an action learning approach with a variety of activities and discussion to get staff fully engaged.

Staff reported enjoying the training, feeling inspired to do more.  One member of staff reported she already used objects in this way but didn’t understand it’s important. Now, she feels more confident in her work.

The outcomes of the training to date amongst care home staff have been amazing. Staff feel valued and they say that Material Citizenship gives them a safety net to support residents do the things they want to do.

For example, one member of staff said: 

One of our residents really wanted to polish her own room with a particular polish. Initially this was seen as unnecessary: the cleaning staff were there to clean. But now we’ve got her the polish she wanted. She polishes her room and it makes it smell like home.

Staff gave many examples of how in just four weeks, they had implemented what they had learned within the training sessions. They also reported the changes as having a positive psychological effect on people living with dementia in care homes.

Material Citizenship has now been commercialised to ensure all care homes can access this new approach to dementia care.  

If you would like any more information, please email Dr Kellyn Lee at [email protected] or watch YouTube videos from Dr Kellyn Lee, which are available for public use.