The Impact of Implementing a Namaste Care Intervention in UK Care Homes for People Living with Advanced Dementia, Staff and Families
2. Materials and Methods
2.1. Study Design
- What was the experience of Namaste Care for care home residents with advanced dementia?
- Did Namaste Care have an impact on resident quality of life and agitation for those that attended sessions on a regular basis?
- Did Namaste Care have an impact on sedating, anti-psychotic and analgesic medication levels for those that attended sessions on a regular basis?
- Were there any other benefits or negative impacts of Namaste Care noticed for those residents that attended sessions on a regular basis?
- What was the impact of the experience for care home staff delivering Namaste Care?
- Did Namaste Care have an impact on staff stress or job satisfaction?
- What was the impact for family members of their relatives with advanced dementia taking part in Namaste Care on a regular basis?
- What were the benefits or negative impacts of implementing Namaste Care to the care home as a whole?
2.2. The Intervention
- NCI-UK sessions should be provided at least once a day, every day of the week.
- Sessions should be approximately 2 h in length.
- Sessions should bring participants together in a group, rather than one-to-one sessions in people’s rooms.
- Sessions should target people living with advanced dementia.
- Attendance/facilitation should be based on the usual staff-resident ratio in the home or unit. (e.g., 7 residents to 1 staff member).
- Staff delivering the NCI-UK session should be drawn from the care team (rather than activity staff or volunteers).
- Living with advanced dementia (as determined by the care home) and experiencing one or more of the following: sensory or communication impairment, frequent falls, limited mobility, challenging behaviour.
- Not experiencing acute physical or mental health challenges at the time of recruitment.
2.4. Measures and Enquiry
2.4.3. Family Members
2.4.4. Care Home Overall
2.5. Data Analysis
2.6. Ethical Permissions
3.1. Participating Care Homes
3.2. How Successful Was the Implementation of NCI-UK in This Study?
3.3. What Impact Did NCI-UK Have on Residents Living with Dementia?
3.3.1. Quality of Life
3.3.3. NCI-UK Impact on Individuals during Sessions
3.3.5. Qualitative Data
- Physical wellbeing
We’ve found that a lot of the residents who have come (to Namaste Care) have been taken off food and fluid (monitoring) because of the drinks that we have, the biscuits, chocolates and whatever we have... So (Resident) his intake, he has 400 mL of milkshake, he’ll have a banana, an orange, a couple of biscuits and that every day has made such an impact on him… Another (who used to be known to hide food rather than eating it) she has a banana every day, she doesn’t hide it she eats it all, a little fudge bar, a whole milky way. I’ve never seen her eat a whole biscuit and she actually had a whole one yesterday!Namaste/Activity Co-ordinator—Clover House
And she’s getting a lot of rest to her feet because you know with her…she’s walking 100,000 steps a day, really. So she is (resting in Namaste Care) and her feet are slightly better as a result. But even slightly better has got to be good!Namaste Care Worker—Elm Gardens
(Resident) with very poor mobility in her hands …to the point where she wasn’t even stretching them out…So she was getting hand massages almost daily and it was helping her. She was not as bad as she was, she was using cutlery again.Activity Co-ordinator—Azalea Court
- Mental wellbeing
A resident who constantly repeats the phrase ‘please help me, Lord’ is able to relax and fall asleep in Namaste. She entirely stops the repetition of the phrase…she seems so much less agitated in the sessions… Another resident who pulls her hair out and is constantly agitated during the day…completely relaxes during the session and does not pull her hair out at all.Staff Reflective Diary—Elm Gardens
One lady who hardly speaks or shows any emotion normally, with hand massage and one-on-one time she is clearly very happy in a chilled environment and to see her smile is a joy!Namaste Care Worker—Foxglove Place
- Responsiveness and Connection
She stroked the student’s hand and tapped. She continued to hum, tapping both her feet and her eyes opened widely whilst smiling…She (beckoned) the student to give her the other hand and she danced, holding them both whilst sat down. She sang the words to the song and continued to tap her feetObservation, Resident Y—Azalea Court
3.4. What Impact Does NCI-UK Have on Staff Working in Care Homes?
3.4.1. A Sense of Purpose in Resident Care
It was wonderful and the staff I think have really bought into it in a big way, not just (manager)... They all just seem to be so enthusiastic!Relative—Gardenia Lodge
My staff are definitely starting to ‘walk taller’. There is a new buzz about the place…Staff are beginning to take more pride and ownership in the quality of care they are delivering.Director—Elm Gardens
3.4.2. Improvements in Staff Wellbeing
Caring is a very stressful job…it sometimes gets you down and you’re tired, you’re exhausted…but I think being able to do the Namaste sessions…it gives you a bit of a break, gives you that one to one time and in those sessions you do calm down as well. You feel a bit of stress relief and I think that’s amazing.Namaste Care Worker—Elm Gardens
It’s a wonderful, wonderful thing…It’s the ability to engage with another person on a much deeper level than every day…to reach them in ways that you can’t normally reach them. I think it’s a privilege to do it. …It’s for the betterment of everyone, because we’re reaching them and we’re making a difference but they’re also making a difference to us.Namaste Care Worker—Elm Gardens
It’s had a big impact on me. Because to see them enjoying it, that to me, to see somebody… I’ve got tears in my eyes now haven’t I? It makes me feel as if I’m doing a good job and at the end of the day that’s what we try to do every day isn’t it?Namaste/Activity Co-ordinator—Clover House
It’s very emotional, because you’re with that person and they’re going through…they’re dealing with dementia, they’re at the end of their life. It’s hard to describe, but I mean, there are a couple of times where I’ve sat in (Namaste room) and can’t help but cry. You know, it’s a, I don’t know…it’s a happy emotion. Because you’re doing good and you’re helping them get through.Namaste Care Worker—Elm Gardens
3.4.3. Developing Positive Relationships
I’m finding that, as I’m doing (Namaste Care) the bond has grown much stronger. For example (resident) he sees me in the corridor, he’ll come up and give me a hug, which he didn’t used to before… the other day he got really upset. He was crying in the lounge and he came over to me and just threw his arms around me. He just wanted that closeness, a hug. That’s all come from Namaste.Namaste/Activity Co-ordinator—Clover House
3.5. What Impact Does NCI-UK Have on Families Visiting Care Homes?
3.5.1. Seeing the Difference
For me, I have noticed some things with my mother because before Namaste I used to massage her hands etc… and she was usually quite placid then, but now, she kind of tries to respond … and just now I went to see her and she was kind of, you know, exploring my finger. You know those are very small little things, but those things didn’t happen before Namaste.Relative—Clover House
3.5.2. Improving Relationships
I will be honest, doing the whole training myself has encouraged me to do more things with him in that way. So when it snowed, I took snow into him., in a bowl and put his hands in it…I planted a window box for him and we put lavender in so I can rub the lavender and give him that smell…It was a real eye opener for me, because as a relative of somebody with dementia you get nothing…It’s given him more quality of life through what the home have done but also making me think differently. It was a real light bulb moment for me.Relative—Elm Gardens
3.5.3. Being Involved and Utilised
Those relatives who do come for sessions and are very much involved in Namaste, they want to stay with their relative while they’re in the room and they want them to have Namaste and they say how important it is that they have Namaste.Activities Co-ordinator—Foxglove Place
People who were quite negative maybe 20 months ago, when (organisation took over the home) there was a negative attitude. But those very ones were the ones that were very, very positive at the last meeting and actually said ‘we don’t need negative people in the room’. A lot of that is down to the Namaste programme and what they’ve seen…in terms of engagement… It’s a palpable, tangible difference.Director—Elm Gardens
3.6. What Impact Does NCI-UK Have on the Care Homes as a Whole?
3.6.1. The Home’s Reputation
What’s also been lovely is when we’ve had open days and done show arounds, people have been very impressed because they’ve walked past a session…peering through and saying what’s going on in there? It’s been a bit of a selling point for our home…we’ve (even) had community psychiatric nurses come up and go in a session.Manager—Azalea Court
Good feedback from CQC–says that the home feels ‘well-loved’. Honestly, I feel like (Namaste Care) is one of the most effective things that I’ve done in the last 20 years… I have relatives come up to me and say ‘what do you think about that?’Director—Elm Gardens
3.6.2. The Home’s Journey of Improvement
(Elm Gardens) I think is a really lovely example…because of the place that they’ve come from and where they’ve gone to. They have a lot of residents with advanced dementia who were, I think, probably a kind of classic example of receiving good personal care but not necessarily the emotional and psychological care. And that’s the bit they’ve done brilliantly, and they’re really proud of themselves. (Namaste Care)’s become part of their identity.Dementia Practice Coach–Interview
4.1. The Intervention
4.2. The Care Home
Conflicts of Interest
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|The Namaste Care Space||A beginning and an end||Participants are welcomed individually into a relaxed, calm space at the start of a session. Towards the end of a session participants are activated through change to music, aroma and lighting.|
|The overall ambience||The space is prepared in advance and attention paid to creating a calm, warm, welcoming and safe atmosphere.|
|Natural light and the ability to alter light levels||Strong light levels are avoided, and it should be possible to adjust light levels. Additional atmospheric lighting may be used.|
|Specific and calming aroma||Natural aromas are used rather than artificial ones.|
|Background sounds or music||Gentle and relaxing sounds or music are used to create an atmosphere rather than providing entertainment.|
|Background visual stimuli on a screen||Gentle and relaxing images are used to create an atmosphere rather than providing entertainment.|
|Basic activities||Physical comfort||Comfortable seating is provided. Pain assessments are undertaken with individual participants prior to sessions. Levels of comfort are monitored throughout.|
|Expressive touch||Closeness is communicated using touch, through activities such as hand massage, foot massage, hand and face washing, foot washing, and hair brushing.|
|Food treats||Opportunities are created so participants can experience favourite tastes, sensations and textures.|
|Drink/hydration||Opportunities are created so participants can experience favourite drinks and ice lollies.|
|Tactile stimulation||Opportunities to experience different touch sensations are offered, including soft blankets and fabrics.|
|Nature||Opportunities are created so participants can engage with and experience nature such as plants.|
|Individualised activities||Involvement of the family||Families and visitors are actively welcomed to join the Namaste Care Intervention UK sessions.|
|Personalised music||Playlists that are significant to individual participants are incorporated into sessions where appropriate.|
|Significant items||Connection and interaction is enhanced by using objects that are significant to individual participants.|
|Use of dolls||If participants enjoy interacting with or holding dolls then this is incorporated.|
|Use of animals||If participants enjoy interacting with or holding animals (live or toys) then this is incorporated.|
If in-house or visiting animals are available, these can be included in Namaste Care Intervention UK sessions. Robotic simulations can be used if already available.
|Snoezelen/multi-sensory equipment||If sensory equipment/Snoezelen environments are already available, they can be used in Namaste Care Intervention UK sessions.|
|Care Home Name||Total Number of Residents||% Residents Funded by Local Authority||% Residents Living with Dementia||Care Home Registration||Size of Owner||Type of Owning Organisation|
|Azalea Court||69||64%||46%||With nursing||Large||For profit|
|Bluebell Drive (withdrew during implementation)||60||1%||43%||With nursing||Large||For profit|
|Clover House||80||1%||69%||With nursing||Large||For profit|
|Foxglove Place||24||21%||100%||Care only||Medium||Charity|
|Elm Gardens||80||81%||75%||With nursing||Small||For profit|
|Gardenia Lodge||59||53%||56%||With nursing||Small||Charity|
|Care Home||Azalea Court||Clover House||Foxglove Place||Elm Gardens||Gardenia Lodge||Totals|
|Length of implementation||24 weeks||12 weeks||18 weeks||24 weeks||18 weeks|
|Data source and type|
|Number of NCI-UK sessions run (NSQs received)||121||60||165||144||31 (i)||521|
|Resident participants (quantitative data)||7||7||14||13||7||48|
|Residents participants (observation data)||4||4||5||6||4||23|
|Session Data||% of Sessions AM||% of Sessions PM||Mean|
Length of Sessions
|Mean No. of Participants p/Session||Modal Number of Facilitators per Session (Inc. Volunteers)|
|Azalea Court||78.51||20.66||1 h 7 min||8.03||2|
|Clover House||96.67||3.33||1 h 29 min||9.15||1|
|Elm Gardens||88.89||10.42||1 h 32 min||6.36||2|
|Foxglove Place||58.79||39.39||1 h 49 min||4.75||1|
|Gardenia Lodge||0.00||100.00||1 h 59 min||3.97||1|
|Care Home||Azalea Court||Clover House||Foxglove Place||Elm Gardens||Gardenia Lodge||Total|
|Participant number at each stage of data collection||Recruited||7||7||14||13||7||48|
|Excluded as ‘low attenders’||1||1||4||3||3||12|
|Included in final data set||6||6||10||10||4||36|
|Full data returned QUALID||6||5||9||9||2||31|
|Full data returned CMAI||6||6||9||10||2||33|
|Full data returned NSQ||6||6||10||10||4||36|
(Lower Score Indicates Better Quality of Life. Minus Figure Indicates Improvement in Quality of Life)
|Baseline Range (Mean, Standard Deviation)||12 Weeks Range|
(Mean, Standard Deviation)
|Average Actual Change||Average Proportional Change|
|CMAI over All Scores|
|Baseline Range (Mean, Standard Deviation)||12 Weeks Range|
(Mean, Standard Deviation)
|Mean Actual Change||Mean Proportional Change|
|Baseline to 18 Weeks||Baseline to 24 Weeks||12 to 18 Weeks||12 to 24 Weeks||18 to 24 Weeks|
|CMAI Score||N||Significant Change?||N||Significant Change?||N||Significant Change?||N||Significant Change?||N||Significant Change?|
|Aggressive||29||Yes (p = 0.02)||15||No (p = 0.66)||28||No (p = 0.35)||16||No (p = 0.23)||16||No (p = 0.85)|
|Physically nonaggressive||29||Yes (p = 0.02)||15||No (p = 0.39)||28||No (p = 0.41)||16||No (p = 0.08)||16||No (p = 0.14)|
|Verbally agitated||28||Yes (p < 0.01)||14||No (p = 0.70)||28||Yes (p = 0.04)||15||Yes (p = 0.04)||15||Yes (p < 0.01)|
|Total||28||Yes (p < 0.01)||14||No (p = 0.40)||28||No (p = 0.85)||15||Yes (p = 0.02)||15||Yes (p = 0.04)|
|Physical Wellbeing||Emotional Wellbeing||Alertness/Awareness||Total|
|Number of residents (n = 36) who scored more than 50% of total sessions in this domain||6||30||0||16||20||0||14||22||0||22||14||0|
|Qualitative Impacts of NCI-UK Implementation|
|Improvements in physical wellbeing|
|Improvements in mental wellbeing|
|Improvements in responsiveness/connection|
|Increased sense of purpose|
|Improved staff wellbeing|
|Developing positive relationships|
|Seeing a positive difference in their family members||n/a|
|Being involved and utilised|
|Contribute to a journey of improvement||n/a|
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Latham, I.; Brooker, D.; Bray, J.; Jacobson-Wright, N.; Frost, F. The Impact of Implementing a Namaste Care Intervention in UK Care Homes for People Living with Advanced Dementia, Staff and Families. Int. J. Environ. Res. Public Health 2020, 17, 6004. https://doi.org/10.3390/ijerph17166004
Latham I, Brooker D, Bray J, Jacobson-Wright N, Frost F. The Impact of Implementing a Namaste Care Intervention in UK Care Homes for People Living with Advanced Dementia, Staff and Families. International Journal of Environmental Research and Public Health. 2020; 17(16):6004. https://doi.org/10.3390/ijerph17166004Chicago/Turabian Style
Latham, Isabelle, Dawn Brooker, Jennifer Bray, Nicola Jacobson-Wright, and Faith Frost. 2020. "The Impact of Implementing a Namaste Care Intervention in UK Care Homes for People Living with Advanced Dementia, Staff and Families" International Journal of Environmental Research and Public Health 17, no. 16: 6004. https://doi.org/10.3390/ijerph17166004