Column June 2005, Sari Hedman (Finland);Cherishing Senses at Riistavuori Elderly Services Center

Written by Sari Hedman
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Cherishing Senses at Riistavuori Elderly Services Centre

 

 

Sari Hedman, Master of Arts, Senior Activity Coordinator, City of Helsinki, Finland, Riistavuori Elderly Services Centre

 

Translation Mikko Savolainen

 

 

 

Background

I worked as a community artist at Riistavuori Elderly Services Centre in the IIK!  Art to Institutional Homes Project of the Helsinki Year of Culture 2000 Project. The Cultural City of the Aged Project was a joint effort by eight Helsinkian institutions of elderly services with six chosen artists of various fields who each was assigned at least one home institution to work in. The project's objectives were, by way of art, to visualize the voice, line or gesture of the institutionalized old individual, and to increase togetherness in the community and pleasantness in the environment. An important aim was also to provide residents, their family and personnel with positive experiences and pleasure.

 

 

 

In Helsinki old people in long-term care living in institutions are in poor shape. Basic treatment, washing up and eating set the pace of the routines. Traditional hobbies, handicrafts and recreational activities seldom reach a dementing resident. Yet the handicrafts instructor persistently visited the wards busying himself unrelentingly beside the resident dozing or in deep sleep. The staff was more than happy to wheel a sometimes reluctant resident to the activity group so that they could take a break. The dementing person's character of participation and doing changes. To him or her participation can mean e.g. following everyday routines and doing means arranging endless piles of paper or folding linen. It made me wonder what else everyday life of experiences could be? The senses are cherished and experiences are produced by small, significant, good moments. And what brightens you up are surprises and exceptions in everyday routines.

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"Our interartistic team is rumbling down through the dementia ward in the Night of the Arts. From Teatteri Pieni Suomi we have rented a two-person cow outfit that with its teats and long eyelashes is a very impressive and genuine sight. Our musicians with their blond braids fluttering are beginning to call the cattle home. Old people are excited! Astonishment, delight and surprise is mixed with laughter. The laughter keeps on going, and no one is paying any attention to the fact that the cow has sort of thin legs and 40-denier surgical tights..."

 

Snoezelen -  Sense Experiences

The first time I acquainted myself with snoezelen was at Killinmäki Mental Disability Institution in Kirkkonummi. Afterwards we visited a small dementia care home in Kaarina near Turku, which has for a few years used snoezelen as part of daily treatment. Excursion to St. Bernadus Elderly Care Institution and van Hartenberg in Holland spring 2001 was instructive and inspiring. Encouraged by the visits I collected sensory suitcases which I used as tools and discussion openers and wing lenders in the dementia ward. The cases contained materials of sensory stimulation; various fabrics, wool, bristle, pile, cotton, scents, visual elements and some smooth-sounding, primitive instruments like the rainstick and the ocean drum.

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"I sit down beside an old lady in the dementia ward. To raise conversation during this rendezvous I have packed the suitcase with fabulous fabrics: rustling silk, velvet and lace. Lady's crooked hands are tenderly fumbling and folding the fabrics. We start the conversation carefully. Piece by piece the story begins to take shape. After looking for words she starts telling: " I remember when I was a bride. Yes, I had such a long dark dress, all the way down. Sleeves were long and they had buttons right here, see. The waist was very beautiful, had lace on it. I also had a huge hat with a large brim and rosettes too! "And the bridegroom? He must have been handsome." "What bridegroom?" "You must have had a groom, getting married and everything." "I have never had a groom. And never ever have I been married either."

 

 

 

Elements and Possibilities

In connection with the renovation of Riistavuori Elderly Services Centre a multisensory room was built in 2001. The time was also right for changes in content. The elderly services manager offered me a vast, high space, the old boiler room, for a multisensory room. As an interior designer of that space I found it important that the room would be esthetical, reduced in a Finnish way, modifiable and multipurpose. The space was to offer a relaxing experience and on the other hand such an environment that would differ from ordinary ward atmosphere and stir the senses. To soften the acoustics and atmosphere, all of the space was demarcated with white curtains. On the downstairs gable wall a projector screen wall was stretched for showing pictures.

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A heated waterbed often belongs to the basic sensory room equipment. That is the case here, too. Old people relax on its swinging lap. A rocking chair is for most Finns a familiar and safe seat. Pillows, blankets and hides lure to touch. You can listen to your favourite music in the room. Here the sound world equally includes silence, babble of water, song of birds or murmur of winds. Primitive instruments are good at producing images. The sound of the rainstick can also be felt as movement of seeds inside the trunk. The ocean drum on our lap we make a journey in a hammock from the waves onto the roaring seashore accompanied by the murmuring fountain.

 

Ribbons of optical fibre glow as the room's door curtain. A lady hugged the glowing ribbons with solemnity. They were the hair of her daughter. Six tall bubble tubes bring extra light into the room. Colourful movement of water pacifies; it is nice to watch the bubbles running. The starry sky designed of optical fibres twinkles full of feeling on the ceiling. A cone of light glowing with the colours of the rainbow reflects the shimmer of the northern lights on the ceiling. Pictures can be projected on the big screen wall or on the ceiling if you like. We have photographed both summer and winter views, flowers, berries and fruit, but also views of cities and people and attached sound to them. 

 

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Bubbles of Soap and Tango

At first the use of the sensory room was to some extent restricted by the personnel's suspicious attitude and the lack of resources. When using the sensory room and testing its effectiveness, students and trainees of the field have been a big help. Student trainees often have more time and an open mind for learning new things. In the autumn of 2002 we offered a social studies student a place of training. She was excited about snoezelen, obtained information and very soon found out what it was all about. A lady, who had just moved in the psycho geriatric ward of the centre, was very restless and tormented. She had Alzheimer's disease, was confused and suffered from memory disorders. She had gone through long periods of treatment because of her mental health problems. She was under heavy medication and walked in a compulsive way round the ward repeating her own name.

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I suggested to the student that she would do her exercise on development by studying the possibilities of snoezelen and the sensory room in the lady's treatment. It was important to be able to write down experiences on use of space and make the nurses record potential changes in the old individual's behavior under the process. This was very challenging, because the student had hardly any experience on elderly care. We also discussed the possibility of failure.

The training period lasted two months. We drew up the plan so that during the first week she would gather information on possibilities of snoezelen in dementia care, familiarize herself with the use of the sensory room and become acquainted with the new occupant. "My relationship with "Hillary" grew stronger.  I read to her weekly from a book we borrowed from the library, and we went out for walks together. One Sunday I attended a service with her in Uspenski Cathedral, for she had told she was an orthodox and interested in religion..." (an extract from the training report).

 

 

 

The first visit to the sensory room was arranged, when the time seemed right for it. The student knew that the lady's favourite colour was green and that her favourite music would be found in the recordings of Olavi Virta, a popular Finnish tango singer. Based on this knowledge the setting for the introductory visit was staged. The bubble tubes were bubbling green and in the stereos sang Olavi Virta. "Before leaving the ward I told "Hillary" where we were going... She fetched a couple of chocolate bars from the bedside table drawer, took me by the hand and said let's go. At the destination, she walked downstairs without any hesitation and all but fell on the water bed. She asked me to open one of the chocolate bars and relaxed. This restless human being who at the ward could not stay put for a single moment... We spent there an hour, and she would have wanted to stay longer still..." (an extract from the training report).

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At the ward, an evening nurse was encouraged to write down changes in the lady's behaviour in the days of the sensory room visit. "... Other sensory room visits were as successful. "Hillary" was inspired enough to tell about her childhood, a nut factory where she had worked, and about her youth when she went to an open-air dance to see Olavi Virta. We blew soap bubbles together and laughed, too. And what an expression on the face that usually was almost ghostly and lacking all facial gestures! Once I forgot the Olavi Virta record at the ward and we were forced to listen to birdsong. "Hillary" was restless and wanted out of the room." The student had clearly discovered the elements that were pleasant and relaxing as far as the lady was concerned. It was significant that the elements stayed the same as long as it seemed to please her. The lady used to listen to the tango singer in her own room at the ward, too.

 

 

 

The student and the lady visited the sensory room ten times on a regular basis. ..."Hillary" was according to nurses very calm after the visits and could sit peacefully for a couple of hours after returning to the ward. No more compulsive walking. The calming effect could be detected either immediately or in a few hours. However, this special kind of calming down did not always take place. Yet the overall effect must be regarded as positive and the visits worthwhile." (an extract from the training report).

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Safe Experiences

 

 

 

The studies on domesticity in elderly care institutions have shown that the way old people feel about domesticity is quite different from the view of the personnel. For the old the institution is not like the own home, but domesticity for them is rather like security and intimacy and not like the home-like environment the staff tries to create. The restless lady calmed down visibly in the sensory room where the environment with its elements was soothing and where she felt safe and close to someone. The rendesvouz was a success. We cannot argue that it was the sensory room, shimmer of the green light, starry sky and tango alone that alleviated her anxiety. The lady enjoyed different, soothing elements around her, and above all, the fact that there was somebody with her listening to her, on her terms.

 

 

 

 

 

 

In the sensory room, according to our experience, interaction, attitude to life and mood of the visitor and the escort alike have an essential impact on the atmosphere and reactions. The Riistavuori multisensory room is not used only by dementia patients. The residents, nurses and the family members use it, too. The visits to the sensory room are always arranged in accordance with the client's wishes. Some want to talk, others relax dozing under the starry sky. I have noticed that for some old people oriented in time and space it is difficult to let the senses take over. To allow oneself a pleasure is a skill as well.

 

 

 

 

 

As a rule, the atmosphere and moments in the sensory room have been good and relaxing. For some the colourful lights and starry sky have been a really great event. Many relax in the waterbed's warmth and in its tender movement so well that they fall immediately asleep, although they usually have sleeping difficulties. Some have, after their afternoon naps, imagined to have drifted into everlasting sleep and arrived in paradise. A deeply demented resident communicates to me that he has relaxed, when he dozes off after having observed the colourful lights for a while. The sensory room visit lasts about an hour at a time in accordance with the client's preference. Only few have wanted to turn back at the door at once.

 

 

 

On discussing multisensory environments too much emphasis, in my view, has been put to the built-up (staged) space. Now we have a newly built space for the elderly to relax in. The next step will be to infiltrate more and more sensory activation and cherishing into the everyday treatment routines of the ward. Nature is important to the Finns, and our short summer with its nightless nights is always as wonderful. We grow scented herbs in our balconies and plant potatoes in the soil of our flower pots. We open the windows for the summer breeze and fragrance to enter. Each ward has also a sauna - the Finnish multisensory paradise.

 

 

 

The Museum of Senses Project has expanded the sensory scheme of Riistavuori elderly services centre outside the facilities. We have been participating for a year now in the Attainability Project with the Ateneum Art Museum, which aims at discovering ways towards multisensory experience of works of art. An old individual can experience the atmosphere of a painting through e.g. the world of sounds or scent samples attached to the work. In connection with some works of art, a set of articles from the painting is on display.

 

 

 

On the Touch

 

 

 

We Finns are often regarded as reserved and withdrawn people, whose culture does not naturally encourage hugging and kissing on the cheek. I too am a typical Finn myself, evasive of close contacts, protective of my own large territory. However, the sense of feeling is our primary sense. It is also a means to communicate. We have discussed bodily interaction and communication. In a care situation every rendezvous and touch should be esthetic and safe.

 

 

 

In Riistavuori we have discovered that hand massage with mildly odorous essential oil gives an experience of luxury and pleasure. Hand massage requires no extra resources, neither big space nor equipment. The tender touch relaxes. Carefully we release locks and soften stiff muscles. We feel the crooked hands, tense wrists, bumpy joints, veiny fingers, soft hands, small hands, big hands, plump hands and bony hands. We wonder at lines of life, scars and wrinkles.

 

 

 

The old people are enjoying themselves. How good can a touch feel and how good it feels to touch! High spirits make you talk. Interaction is natural. You are allowed to be close. Allowed to touch. Due to leisurely movements the spastic hand seems to relax a little and open in the midst of conversation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First Steps

 

 

 

In Finland snoezelen has been approved as a form of care in mental disability institutions, although in the early 90's opposition was still strong. Introduction of snoezelen into elderly care is taking place step by step. The users are delighted, and scattered documents of encouraging results have been drawn up in Finland, too. However, applying snoezelen as treatment varies both in quality and in the principles and methods. The unevenness of quality complicates the clinical assessment of snoezelen and inconveniences its development as a complementary form of treatment in dementia care.

 

 

 

Snoezelen is part of the ideology of client-centered care and pro-rehabilitative activities. For us snoezelen is interaction, communication between two individuals. It has given us a new perspective on elderly care and promoted the positive dialogue between the care giver, environment and client.

 

 

 

 

 

 

 

 


 

Thanks to Sari Hedman!

For the website of Riistavuori Elderly Services Centre: Click on Logo below!

 

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