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The Sonas aPc Approach

Kathleen no longer spoke with any of the other residents of the nursing home in which she had lived for six years. She was a solitary figure, spending much of her time in her room or wandering the corridors aimlessly.

She showed some of the common signs of dementia: memory loss, confusion, disorientation and lack of recognition of familiar people. Staff found it increasingly difficult to carry out routine daily tasks with her and were frustrated by their inability to communicate effectively with her.

One of the staff nurses, who held a Sonas group every Friday morning, suggested she be introduced to Sonas. Kathleen didn't participate in the session at first but neither did she give any indication that she was unhappy to be there and so she continued to be a member of the group. One day she murmured - "a host of golden daffodils". It was a poem learnt in her schooldays and the first time that staff had heard her speak.

Over time, Kathleen participated more in the sessions and the residents and staff came to know her. They learnt that she liked Frank Sinatra so they bought her a CD of his music. She had loved baking, so they involved her in the weekly kitchen activities. Finding the person behind the disability was the key to enhancing her care and her life in the unit.

Kathleen's story captures the essence of Sonas. The aim is to activate each person's potential for communication (aPc), whatever that potential might be. For some there can be real breakthroughs in communication, for others small, but no less significant, indications of wellbeing.

Sonas was devised in 1990 by Sr Mary Threadgold, a Speech and Language Therapist and Sister of Charity, specifically for older people who had difficulties with communication, especially those with dementia. It is based on stimulation of the senses, structure and repetition. Not a recreational group activity like bingo, nor a therapy such as art or music therapy, Sonas is a therapeutic activity that is completely focused on communication.

Group and individual sessions have been recorded on CD to enable those carrying out the sessions to focus completely on the participants. The group sessions involve stimulation of all five senses, music, singalongs, gentle movement, memory-focused exercises and a time for personal contributions. A trained leader and helper carry out the session with about eight participants. Repetition builds familiarity and security for the participants. The focus on abilities rather than disabilities and the creation of a failure-free environment create an environment in which people are free to express themselves without judgement. The individual session is based only on music and touch.

Sr Mary set up Sonas aPc to train staff in nursing homes and hospitals to carry out the sessions with their clients. Care assistants, nurses, occupational therapists, speech and language therapists and other healthcare staff attended the workshops and implemented the programme in their workplaces, whether day or residential centres. The Sonas group session was recently adapted for use on an individual basis (it was called SIMS - the Sonas Individual Multi-sensory Session) and family carers also began to be trained in its use.

A completely separate programme, entitled Anam, was developed in 2000 for older people with intellectual disabilities as they also experience varying levels of communication impairment. It contained the same essential features of Sonas but was tailored to their specific needs.

Evidence of the benefits grew and was confirmed by research studies. For the participants, the sessions brought relaxation, enjoyment and decreased levels of depression. There were improvements in their self esteem and demeanour, memory and initiative.

Staff also experienced significant benefits. The sessions enabled them to get to know the residents better and to share an enjoyable, relaxing experience with them. Practitioners recounted incidents where residents who were previously withdrawn began to open up and chat to the group, sharing memories and joining in the singalongs. But mostly they told of the laughter and joy, the energy and engagement and the evidence of communication.

To date, more than 5,500 people in Ireland and the UK have been trained to use our programmes. A study published in 2006 by the National Council on Ageing and Older People that examined quality of life in 526 public, private and voluntary long-stay facilities in Ireland found that Sonas was available in 43% of those facilities who participated in the survey. The availability was highest in public homes/hospitals (76%), followed by voluntary homes/hospitals (41%) and private nursing homes (36%).

The Context

There are an estimated 38,000 people with dementia in Ireland and that figure is expected to double within the next twenty years. The majority are living in their homes, with up to 40% in residential care. There are a further 25,000 people with intellectual disabilities, of whom 10% are over the age of 55.

One of the biggest challenges for Sonas aPc in 2008 is to reach family carers. To this end, we are working with active retirement groups and other organisations involved in home help and respite.

From 2008 onwards, all residential facilities will be required to provide meaningful activities for older people with dementia. The Draft National Quality Standards for Residential Care Settings for Older People published in 2007 by the Health Information and Quality Authority (HIQA) lays down standards for dementia-specific units. Staff must be trained to understand the communication difficulties of these clients and care units must provide evidence of the use of techniques such as sensory stimulation.

Spirituality of the Older Person

The other major work of Sonas aPc is in the area of spirituality of the older person. Ciúnas is a selection of traditional Catholic hymns and prayers recorded on a CD, with an accompanying video. It is for all older people of the Roman Catholic faith, particularly those who, because of failing memories or difficulties with concentration, find it difficult to pray independently.

Sonas aPc has secured funding for a major project called Dóchas, the rationale of which is: "to help older people to find joy and peace through a broad range of spiritual experiences." Two programmes are being developed, one for all older people and the other for those who are caring for older people with cognitive impairment.

Training & Accreditation

All of our tutors are experienced dementia care trainers and clinicians. Sonas and Anam workshops take place on two days, set five to six weeks apart. The first day involves training in the communication process, especially non-verbal communication, and in the programmes. Attendees go back to their workplaces and carry out sessions, returning for further training and feedback.

The basic two-day workshop, with a third training day and assessments, is a FETAC Level 5 accredited module. It can be used as one of the eight modules making up any FETAC Level 5 Award, including the Healthcare Support Certificate. Since we received accreditation in 2005, there have been FETAC graduates in every assessment cycle.

Some Recent Achievements

Sonas aPc was presented with the FETAC QA Certificate in November 2007, by Sean Haughey, T.D., Minister of State for Education and Science, and Stan McHugh, CEO of FETAC.

Máire Hoctor, T.D., Minister of State with responsibility for Older People, presented the first ever Sonas award to St Monica's Nursing Home in January 2008. The award recognises the achievement of a high standard of implementation of the Sonas programme and evidence that it is part of care planning for residents.

The prestigious University of Bradford is currently developing the Sonas workshop into an elective studies module. Professor Dawn Brooker is also leading a major Sonas research project. The research sites are Peamount Hospital, Newcastle and St Vincent's Hospital, Athy. Jackie O'Toole, a Sonas lead tutor who is carrying out the project, also runs Dementia Training Ireland.

Quotes

"Sonas is a lifeline for older people with communication difficulties and an invaluable resource for those who care for them. It is also an inspiration for all who focus on the older person with a disability rather than on the disability itself" Bob Carroll, Former Director, the National Council on Ageing and Older People.

"I would like to commend Sonas aPc on its contribution to raising the standard of care in nursing homes, hospitals and day centres throughout the country. This organisation is playing a vital role in enhancing the quality of lives of thousands of older people with dementia and intellectual disabilities" Mary Harney, T.D., Minister for Health and Children.

"I notice great interest and response from residents. They smile a great deal and look forward to the sessions" Sonas practitioner from a Cork nursing home.

"Mam didn't speak for months. Then, after starting Sonas, she began to talk to us again. It was extraordinary" The son of a nursing home resident in Dublin.

Cost of Training

Attendance at the Sonas/Anam workshop costs €200, plus €50 to €100 for the materials to implement the sessions. If an organisation sends four attendees, a fifth place is given free of charge. Organisations with a large number of staff to be trained may opt to have the workshop held on their premises.

There are several possible sources of grant-aid for Sonas aPc training: The National Council for Nursing and Midwifery, FAS and Private Healthcare Skillnet (for its members).

Sonas aPc is also building links with Nursing Homes Ireland, the representative body for private and voluntary nursing homes in Ireland, of which 75% are expected to be members by the end of 2008.

Sonas aPc is a not-for-profit company and receives annual funding from the Health Service Executive.

This article has been contributed by Sinéad Grennan, chief executive of Sonas aPc.

For further information on Sonas aPc and its services, consult the website www.sonasapc.ie or contact: Sonas aPc, St Mary's, 201 Merrion Road, Dublin 4, Tel: 01 260 8138.