VW Bro Chris Caine gives a talk to Florence Nightingale Lodge
VW Bro Caine commenced by thanking the Worshipful Master for providing the opportunity to provide a relatively short, but comprehensive presentation on the important, topical and at times emotive subject, ‘Understanding Dementia’.
He went on to suggest that during the next twenty minutes he would provide a detailed explanation of dementia and its two most common forms: Alzheimer’s disease and vascular dementia, he would then move onto explain, from a personal perspective, how the RMBI Care Co., one of the four central Masonic charities within the scope of the MCF and based in Freemasons’ Hall, is providing for high quality care of RMBI resident’s living with Dementia.
In so doing, he would explain the importance of colours, fabrics, pictures and photographs as well as providing examples of signs, a memory box and a detailed explanation of how to address those living with dementia, the use of precise narrative and the care needed when considering the use of mirrors.
VW Bro Caine explained that dementia is a word used to describe a group of symptoms including memory loss, confusion, mood changes, and difficulty with day-to-day tasks. The most common form of dementia is Alzheimer’s disease which affects around 62 per cent of those living with dementia. With Alzheimer’s disease, two abnormal proteins build up in the brain forming plaques or tangles usually first seen in the part of the brain responsible for making new memories. The second most common form of dementia is vascular dementia which affects around 20 per cent of those living with dementia. Vascular dementia reduces the blood flow to the brain often damaging those parts of the brain important to attention, memory and language.
VW Bro Caine suggested that all of the above could sound terribly frightening, but assured all present that from the perspective of the RMBI the prospect of living with dementia needn’t be frightening as by the careful use of fixtures, fittings, furnishings, colours and other specifics, life can be quite comfortable. All 16 RMBI homes throughout England and Wales are registered for dementia care with 12 having specialist Dementia Support Units.
He explained exactly the purpose of a Dementia Support Unit; RMBI residents who live in a Dementia Support Unit are so confused by their dementia that were they not to be protected in a keypad controlled environment, they could well wander off and do damage to themselves and others because they wouldn’t remember where they live, indeed some don’t even remember who they are.
In that relatively short time – only 50 years – the average age of new admissions to RMBI homes is now approaching 90. With two out of three people within that age group having some form of memory loss leading to dementia, it’s essential that RMBI reflects the need of Craft. As previously advised, he suggested that the careful use of colours, signs and pictures can greatly assist normal life and a fine example is the Davies Wing at Shannon Court, Hindhead in Surrey. VW Bro Caine explained that in 20 years’ time he would be 90 and if he’d developed a dementia, could move into an RMBI home and would quite like it to be Shannon Court where he might live on the Davies Wing.
On the Davies Wing there is a one colour carpet with the warp all in one direction. If the carpet were to be joined and the warp to be at right angles to that which is normal then the dementia resident may well perceive that to be a step and be confused. VW Bro Caine suggested that he knew of another care home provider that had a beautiful new floral display carpet in their main lounge. Sadly, those living with dementia were attempting to pick the flowers from on the carpet and none of those with dementia would go near the beautiful lily pond in the centre of the room.
Now on the Davies Wing in 20 years’ time there will be hand rails down the corridor to assist with ambulance, because many residents are frail when 90. Many residents are already very frail when they move to an RMBI home. The hand rail would be extended over a utility door such as a laundry or a sluice room, to ensure that it wouldn’t be confused with a resident’s room. VW Bro Caine suggested that he would provide examples of what had been done in relation to recognising particular rooms and that he would show an example of the sign for a bathroom suite. In pre-refurbished RMBI homes a bathroom may have been a sapele coloured door with B1 or B2 on it which means nothing at all to somebody living with dementia, but the sign he displayed, clearly showing the narrative ‘bathroom’ and a coloured picture of a bath full of water is much easier to understand. He asked all present to note the particular shade of blue behind the black narrative, which is cyan and it’s one of a small group of primary colours – magenta, cyan and yellow – which following extensive research at Sheffield University has been proven to be most easily recognised by those living with dementia, even with acute dementia.
In RMBI homes there is often a large dining room with smaller dining rooms for use by fewer residents. Previous to refurbishment the dining room might say D1 or D2, which would mean nothing to somebody living with dementia, but the sign he displayed quite clearly showed a plate of food, a knife and fork and the clear narrative ‘dining room’ which would ensure that there would be no misunderstanding that that is indeed the dining room.
VW Bro Caine explained that he had spoken to Professor Clive Ballard concerning life expectancy following diagnosis of dementia, particularly Alzheimer’s disease and that he also spoke of the importance of the careful use of signs and memory boxes.
He went on to suggest that were he to be living on the Davies Wing and was making his way down the one coloured carpet, holding onto the hand rail over the sluice room door he would come to his front door. At the moment he lived at 15 Roseacre Close in Emerson Park near Hornchurch and has a white front door with number 15 on it. If he were to remember that when he moved into the Davies Wing in Shannon Court he would have a white front door with the number 15 on it to assist him, and to further assist, and many of residents’ have these, he would have a memory box outside, at eye level.
VW Bro Caine suggested that he would show an example of a memory box in a moment and he hoped when doing so that all viewing might consider what they might have in their memory box. It should contain intrinsically personal items to help one remember that one is approaching one’s own room and that when walking along the Davies Wing he would come to his white front door and, at eye level, would be the memory box displayed, a twelve by twelve glassless casement frame with intrinsically personal items belonging to Chris Caine.
He explained in detail, the number plate was purchased by him in 1995 from the DVLA and had never belonged to anyone else before Chris Caine. Significantly, again, the colour yellow with black numeral and letters on there. Above that was a photograph of a couple of his cars and being privileged to be a Liveryman of the Worshipful Company of Makers of Playing Cards in the City of London, there was a depiction of the two jokers from the Livery emblem. In the top corner was a picture of his late wife, Joy, who sadly died 25 years ago. He hoped that he would never ever forget her and the picture showed Chris and Joy at their first Ladies’ night when he was President. Next to that was the double-headed eagle of the compliment slip of the St John Group of the Rose Croix Chapters in London where he’d been privileged to be Group Recorder to the Inspector General, Very Illustrious Brother Graham Redman.
VW Bro Caine explained that these were intrinsically personal items to Chris Caine, which would assist him when he walked along the Davies Wing corridor and came to his white front door his memory box would be at his eye level so there could be no confusion that that was his room. He explained that once having entered his room there may well be the end of a wardrobe or a white board with other intrinsically personal photographs displayed, possibly of his son and daughter, his favourite nephew with their respective wives and husbands, maybe even children with their boyfriends or girlfriends, and if they did come to visit him he hoped there would have a label with their name on because at that stage, when he’d be 90, he might not remember who they are or the names of their boyfriends or girlfriends.
VW Bro Caine suggested that he should explain about age perception in many forms of dementia. Although a person may be in their 80s or 90s they usually believed themselves to be in their mid-20s, say 26. He went on to say that some years ago he was faced with a very embarrassing situation when he was being shown through the newly refurbished wing at Devonshire Court in Oadby in Leicester. There the manager took him into one of the small lounges, which had been refurbished, and there was an elderly lady in her late 80s or 90s watching television. There was a 1940s style mantelpiece with a ticking clock, and she was very happy in her lounge. As he approached her she looked up at him and said “are you my dad?”
VW Bro Caine explained that he was embarrassed and didn’t know what to say or how to respond to her, but now having been trained, as have all staff in RMBI homes, not just nurses and care assistants, but laundry ladies, the cleaners, the gardeners and handymen. Indeed many head office staff including the Chief Executive, himself, James Newman the Past President, and other Trustees have been trained. He now knew how he should have answered that lady, so as to not cause her any offense or further confusion or fear. Importantly he should kneel down at her eye level showing no condescension and should hold her hand.
Now, by that very carefully contrived statement, importantly, he hadn’t told her a lie because there will always be moments of lucidity with dementia, and it’s important not to lose the trust of somebody living with dementia; he hadn’t been condescending because he knelt to be at her level and he had risen and left.
VW Bro Caine explained that it may have only been a few moments to make that statement, but that the lady’s attention span could be as short as a couple of minutes and were he to have gone back to the lounge, five or ten minutes later, she might have asked again “are you my dad?” He advised that he had been in a situation with someone with dementia in his car on a car journey and within an hour, she had asked thirty times “where are we going?” and that every time he answered the question it was important that he did so with a freshness as if it were the first time he’d heard the question.
As he had explained earlier, some dementia affects part of the brain which creates new memories and she wouldn’t remember that she’s just asked the question. He suggested that it may well be that those to whom he was speaking had had dealings with people with dementia and been asked “when am I going home?” and that instead of saying, “you are at home mum, you now live here,” one should say “can we talk about that when we’ve been out for a walk?” Or “can we chat about that when we’ve had a cup of tea?” Although prevaricating, the response would not cause any aggression.
VW Bro Caine suggested that he thought it important to understand about the use of mirrors with certain forms of dementia. At the RMBI home at Stisted Hall in Essex, the Dementia Support Unit is on the ground and first floor and many residents have their own bedrooms and assisted bathroom on the first floor. They gain access to the first floor via a lift, so the carer would assist the resident into the lift and travel to the first floor. While they are in the lift they wouldn’t see a mirror because reflected to them would be an old person who is staring at them when they perceive themselves to be in their mid-20s and that could cause fear.
Assistance can also be provided in one’s home environment with the careful use of photographs and precise narrative can be of assistance. VW Bro Caine explained that he had given a presentation to a Lodge at Chingford in Essex some time ago and after the meeting and before the festive board the junior warden had come to him and said: “my mum has been living with Alzheimer’s for some time now. She visits us regularly, she used to be fine, but more recently she has become more frustrated, and aggressive and much to the embarrassment to my two young children she has become incontinent where in the same place she sits on the sofa, but her frustration has manifested itself by her wetting the sofa.”
After he had heard a lot more about mum’s home environment and her background VW Bro Caine suggested that the next time he visited mum he should take copies of pictures of the Ford Consul with members of the family, the family home and garden as it was in the 50s and place the copy pictures in frames. Some weeks later when he saw the Brother again, he suggested that he had heeded his advice and when mum visited she sat in the same place on the sofa, but within her home environment, her very close environment, she had familiar pictures which made her very happy, and importantly, she was no longer incontinent or frustrated.
In all forms of dementia early assessment is essential as with the use of non-anti-psychotic drugs, in some cases, short-term memory loss can be reversed and the person living with dementia can continue to live with their dementia on a plateau and then have a slow deterioration rather than declining steadily and slipping away. Normally, an assessment can be arranged through one’s own GP, but if that’s difficult it’s important to remember that the very successful Freemasonry Cares helpline can channel the call to where it needs to be, possibly to one of the extended Advice and Support Team (AST) from the Central Charities who could visit at home and give guidance and advice.
VW Bro Caine said that he was pleased to advise of future RMBI plans. Not only will training be extended to families and the wider Masonic groups in relation to dementia, but the RMBI is looking into day care throughout the wider Masonic community. When summing up, VW Bro Caine suggested that in the relatively short time he hoped that a true meaning of dementia had been gained, especially the two most common forms, Alzheimer’s disease and vascular dementia, and by the examples shown he hoped that an understanding had been gained of how to deal with somebody living with dementia and how even in their own home or one’s own home a balanced environment could be achieved with the careful use of photographs.
VW Bro Caine completed his presentation by thanking the Worshipful Master and Brethren for their polite attention.
< return to News Index
VW Bro Caine commenced by thanking the Worshipful Master for providing the opportunity to provide a relatively short, but comprehensive presentation on the important, topical and at times emotive subject, ‘Understanding Dementia’.
He went on to suggest that during the next twenty minutes he would provide a detailed explanation of dementia and its two most common forms: Alzheimer’s disease and vascular dementia, he would then move onto explain, from a personal perspective, how the RMBI Care Co., one of the four central Masonic charities within the scope of the MCF and based in Freemasons’ Hall, is providing for high quality care of RMBI resident’s living with Dementia.
In so doing, he would explain the importance of colours, fabrics, pictures and photographs as well as providing examples of signs, a memory box and a detailed explanation of how to address those living with dementia, the use of precise narrative and the care needed when considering the use of mirrors.
VW Bro Caine explained that dementia is a word used to describe a group of symptoms including memory loss, confusion, mood changes, and difficulty with day-to-day tasks. The most common form of dementia is Alzheimer’s disease which affects around 62 per cent of those living with dementia. With Alzheimer’s disease, two abnormal proteins build up in the brain forming plaques or tangles usually first seen in the part of the brain responsible for making new memories. The second most common form of dementia is vascular dementia which affects around 20 per cent of those living with dementia. Vascular dementia reduces the blood flow to the brain often damaging those parts of the brain important to attention, memory and language.
VW Bro Caine suggested that all of the above could sound terribly frightening, but assured all present that from the perspective of the RMBI the prospect of living with dementia needn’t be frightening as by the careful use of fixtures, fittings, furnishings, colours and other specifics, life can be quite comfortable. All 16 RMBI homes throughout England and Wales are registered for dementia care with 12 having specialist Dementia Support Units.
He explained exactly the purpose of a Dementia Support Unit; RMBI residents who live in a Dementia Support Unit are so confused by their dementia that were they not to be protected in a keypad controlled environment, they could well wander off and do damage to themselves and others because they wouldn’t remember where they live, indeed some don’t even remember who they are.
Dementia is a word used to describe a group of symptoms including memory loss, confusion, mood changes, and difficulty with day-to-day tasks
However, it’s not necessary for everyone with dementia to live in a Dementia Support Unit. VW Bro Caine explained about the RMBI home in South Wales, Porthcawl, which was built in 1973; when it was built the average age of new admissions was 64 and every perspective resident had to provide a Certificate of Ambulance, signed by their GP to prove that they could walk unaided to and from the dining room three times each day.In that relatively short time – only 50 years – the average age of new admissions to RMBI homes is now approaching 90. With two out of three people within that age group having some form of memory loss leading to dementia, it’s essential that RMBI reflects the need of Craft. As previously advised, he suggested that the careful use of colours, signs and pictures can greatly assist normal life and a fine example is the Davies Wing at Shannon Court, Hindhead in Surrey. VW Bro Caine explained that in 20 years’ time he would be 90 and if he’d developed a dementia, could move into an RMBI home and would quite like it to be Shannon Court where he might live on the Davies Wing.
On the Davies Wing there is a one colour carpet with the warp all in one direction. If the carpet were to be joined and the warp to be at right angles to that which is normal then the dementia resident may well perceive that to be a step and be confused. VW Bro Caine suggested that he knew of another care home provider that had a beautiful new floral display carpet in their main lounge. Sadly, those living with dementia were attempting to pick the flowers from on the carpet and none of those with dementia would go near the beautiful lily pond in the centre of the room.
Now on the Davies Wing in 20 years’ time there will be hand rails down the corridor to assist with ambulance, because many residents are frail when 90. Many residents are already very frail when they move to an RMBI home. The hand rail would be extended over a utility door such as a laundry or a sluice room, to ensure that it wouldn’t be confused with a resident’s room. VW Bro Caine suggested that he would provide examples of what had been done in relation to recognising particular rooms and that he would show an example of the sign for a bathroom suite. In pre-refurbished RMBI homes a bathroom may have been a sapele coloured door with B1 or B2 on it which means nothing at all to somebody living with dementia, but the sign he displayed, clearly showing the narrative ‘bathroom’ and a coloured picture of a bath full of water is much easier to understand. He asked all present to note the particular shade of blue behind the black narrative, which is cyan and it’s one of a small group of primary colours – magenta, cyan and yellow – which following extensive research at Sheffield University has been proven to be most easily recognised by those living with dementia, even with acute dementia.
In RMBI homes there is often a large dining room with smaller dining rooms for use by fewer residents. Previous to refurbishment the dining room might say D1 or D2, which would mean nothing to somebody living with dementia, but the sign he displayed quite clearly showed a plate of food, a knife and fork and the clear narrative ‘dining room’ which would ensure that there would be no misunderstanding that that is indeed the dining room.
VW Bro Caine explained that he had spoken to Professor Clive Ballard concerning life expectancy following diagnosis of dementia, particularly Alzheimer’s disease and that he also spoke of the importance of the careful use of signs and memory boxes.
He went on to suggest that were he to be living on the Davies Wing and was making his way down the one coloured carpet, holding onto the hand rail over the sluice room door he would come to his front door. At the moment he lived at 15 Roseacre Close in Emerson Park near Hornchurch and has a white front door with number 15 on it. If he were to remember that when he moved into the Davies Wing in Shannon Court he would have a white front door with the number 15 on it to assist him, and to further assist, and many of residents’ have these, he would have a memory box outside, at eye level.
VW Bro Caine suggested that he would show an example of a memory box in a moment and he hoped when doing so that all viewing might consider what they might have in their memory box. It should contain intrinsically personal items to help one remember that one is approaching one’s own room and that when walking along the Davies Wing he would come to his white front door and, at eye level, would be the memory box displayed, a twelve by twelve glassless casement frame with intrinsically personal items belonging to Chris Caine.
He explained in detail, the number plate was purchased by him in 1995 from the DVLA and had never belonged to anyone else before Chris Caine. Significantly, again, the colour yellow with black numeral and letters on there. Above that was a photograph of a couple of his cars and being privileged to be a Liveryman of the Worshipful Company of Makers of Playing Cards in the City of London, there was a depiction of the two jokers from the Livery emblem. In the top corner was a picture of his late wife, Joy, who sadly died 25 years ago. He hoped that he would never ever forget her and the picture showed Chris and Joy at their first Ladies’ night when he was President. Next to that was the double-headed eagle of the compliment slip of the St John Group of the Rose Croix Chapters in London where he’d been privileged to be Group Recorder to the Inspector General, Very Illustrious Brother Graham Redman.
VW Bro Caine explained that these were intrinsically personal items to Chris Caine, which would assist him when he walked along the Davies Wing corridor and came to his white front door his memory box would be at his eye level so there could be no confusion that that was his room. He explained that once having entered his room there may well be the end of a wardrobe or a white board with other intrinsically personal photographs displayed, possibly of his son and daughter, his favourite nephew with their respective wives and husbands, maybe even children with their boyfriends or girlfriends, and if they did come to visit him he hoped there would have a label with their name on because at that stage, when he’d be 90, he might not remember who they are or the names of their boyfriends or girlfriends.
VW Bro Caine suggested that he should explain about age perception in many forms of dementia. Although a person may be in their 80s or 90s they usually believed themselves to be in their mid-20s, say 26. He went on to say that some years ago he was faced with a very embarrassing situation when he was being shown through the newly refurbished wing at Devonshire Court in Oadby in Leicester. There the manager took him into one of the small lounges, which had been refurbished, and there was an elderly lady in her late 80s or 90s watching television. There was a 1940s style mantelpiece with a ticking clock, and she was very happy in her lounge. As he approached her she looked up at him and said “are you my dad?”
VW Bro Caine explained that he was embarrassed and didn’t know what to say or how to respond to her, but now having been trained, as have all staff in RMBI homes, not just nurses and care assistants, but laundry ladies, the cleaners, the gardeners and handymen. Indeed many head office staff including the Chief Executive, himself, James Newman the Past President, and other Trustees have been trained. He now knew how he should have answered that lady, so as to not cause her any offense or further confusion or fear. Importantly he should kneel down at her eye level showing no condescension and should hold her hand.
In all forms of dementia early assessment is essential as with the use of non-anti-psychotic drugs, in some cases, short-term memory loss can be reversed and the person living with dementia can continue to live with their dementia on a plateau and then have a slow deterioration rather than declining steadily and slipping away.
He explained that tactility is terribly important with dementia and often some RMBI residents’ enjoy an appropriate cuddle from the staff. He should maintain eye contact with the lady and show a smiling face; often a smiling face will just get a blank look in response, but by showing a smiling face he would be promulgating an attitude of friendliness towards her. Then he should say a precise form of words which is “that’s very kind of you to think of me like that, but I am just visiting today.” he would then let go of her hand, rise and move off.Now, by that very carefully contrived statement, importantly, he hadn’t told her a lie because there will always be moments of lucidity with dementia, and it’s important not to lose the trust of somebody living with dementia; he hadn’t been condescending because he knelt to be at her level and he had risen and left.
VW Bro Caine explained that it may have only been a few moments to make that statement, but that the lady’s attention span could be as short as a couple of minutes and were he to have gone back to the lounge, five or ten minutes later, she might have asked again “are you my dad?” He advised that he had been in a situation with someone with dementia in his car on a car journey and within an hour, she had asked thirty times “where are we going?” and that every time he answered the question it was important that he did so with a freshness as if it were the first time he’d heard the question.
As he had explained earlier, some dementia affects part of the brain which creates new memories and she wouldn’t remember that she’s just asked the question. He suggested that it may well be that those to whom he was speaking had had dealings with people with dementia and been asked “when am I going home?” and that instead of saying, “you are at home mum, you now live here,” one should say “can we talk about that when we’ve been out for a walk?” Or “can we chat about that when we’ve had a cup of tea?” Although prevaricating, the response would not cause any aggression.
VW Bro Caine suggested that he thought it important to understand about the use of mirrors with certain forms of dementia. At the RMBI home at Stisted Hall in Essex, the Dementia Support Unit is on the ground and first floor and many residents have their own bedrooms and assisted bathroom on the first floor. They gain access to the first floor via a lift, so the carer would assist the resident into the lift and travel to the first floor. While they are in the lift they wouldn’t see a mirror because reflected to them would be an old person who is staring at them when they perceive themselves to be in their mid-20s and that could cause fear.
Assistance can also be provided in one’s home environment with the careful use of photographs and precise narrative can be of assistance. VW Bro Caine explained that he had given a presentation to a Lodge at Chingford in Essex some time ago and after the meeting and before the festive board the junior warden had come to him and said: “my mum has been living with Alzheimer’s for some time now. She visits us regularly, she used to be fine, but more recently she has become more frustrated, and aggressive and much to the embarrassment to my two young children she has become incontinent where in the same place she sits on the sofa, but her frustration has manifested itself by her wetting the sofa.”
After he had heard a lot more about mum’s home environment and her background VW Bro Caine suggested that the next time he visited mum he should take copies of pictures of the Ford Consul with members of the family, the family home and garden as it was in the 50s and place the copy pictures in frames. Some weeks later when he saw the Brother again, he suggested that he had heeded his advice and when mum visited she sat in the same place on the sofa, but within her home environment, her very close environment, she had familiar pictures which made her very happy, and importantly, she was no longer incontinent or frustrated.
VW Bro Caine explained that he had spoken to Professor Clive Ballard concerning life expectancy following diagnosis of dementia, particularly Alzheimer’s disease and that he also spoke of the importance of the careful use of signs and memory boxes
VW Bro Caine explained that a close friend of his, Shane, whose mother had been living in a home in the south coast of England, living with a particularly nasty form of dementia, not yet diagnosed, but believed to involve vascular dementia and possibly dementia with Lewy bodies because of her disillusioned state and when Shane was visiting her recently he went into the lounge and said “hello mum,” and his mum said “oh, your father was in earlier.” Sadly, Shane’s dad has been dead for more than ten years, but because Shane understands how to deal with dementia he didn’t tell mum, “mum, dad has been dead ten years,” because that would have re-introduced all the unhappiness of having lost her husband and loved one from so many years. Instead, Shane simply said “Oh, I haven’t seen dad today.” He hadn’t told a lie and hadn’t caused any further confusion.In all forms of dementia early assessment is essential as with the use of non-anti-psychotic drugs, in some cases, short-term memory loss can be reversed and the person living with dementia can continue to live with their dementia on a plateau and then have a slow deterioration rather than declining steadily and slipping away. Normally, an assessment can be arranged through one’s own GP, but if that’s difficult it’s important to remember that the very successful Freemasonry Cares helpline can channel the call to where it needs to be, possibly to one of the extended Advice and Support Team (AST) from the Central Charities who could visit at home and give guidance and advice.
VW Bro Caine said that he was pleased to advise of future RMBI plans. Not only will training be extended to families and the wider Masonic groups in relation to dementia, but the RMBI is looking into day care throughout the wider Masonic community. When summing up, VW Bro Caine suggested that in the relatively short time he hoped that a true meaning of dementia had been gained, especially the two most common forms, Alzheimer’s disease and vascular dementia, and by the examples shown he hoped that an understanding had been gained of how to deal with somebody living with dementia and how even in their own home or one’s own home a balanced environment could be achieved with the careful use of photographs.
VW Bro Caine completed his presentation by thanking the Worshipful Master and Brethren for their polite attention.
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