The Whiddon Group, NSW
Henpower trial in residential care
The Whiddon Group, NSW
Residential - Regional, Remote / very remote, Less than 30 + beds / 30 - 79 + beds
Health and wellbeing, Communication and engagement, Social participation
About the program
Henpower is an evidence-based creative ageing program created by Equal Arts in the UK. Its original aims were to give older men living in the community increased purpose through delivering henkeeping activities into aged care homes. We sought permission to use the Henpower brand name and adapt the program to our Australian context.
Henpower was trialled in our aged care residential services as a sustainable program that benefits residents through combatting social isolation and loneliness and underpinning relationship-centred care. In keeping with its UK creator’s aims, we enabled the residents, their families, volunteers and staff to co-design Henpower in their services to suit their needs and interests. This resulted in three very different adaptations of the Henpower program, all providing considerable benefits to residents and the care home environment.
Apart from its flexibility, there are several elements that we identified as distinguishing Henpower – external community involvement, resident and staff co-design, creative activities, strengthening of internal community and resident/staff relationships and belonging to an international Henpower community.
Keen to understand the benefits, we measured the program’s effect on engaged residents. There were challenges in getting the trialling services and the organisation as a whole to recognise the difference between Henpower and standard hen-keeping but good internal communication of the benefits to residents and national media interest has meant that acceptance is now very high and Henpower is being implemented as a standard program across all services.
What we did
Following a visit to Equal Arts in the UK in June 2014 and subsequent negotiations, we obtained permission to trial the Henpower program for the first time in Australia. Equal Arts had at this stage not developed resources for the program, but were able to describe to us how it functioned in UK care homes and the guiding principles of the program.
We created resource materials including marketing materials for services to advertise the program both in the homes and in the community to attract and interest as many volunteers, residents and their families and staff as possible.
We designed a trial with three waves and evaluation stages – Baseline (pre trial), three months and six months and decided on our approach. This was a mixed methods approach using the Qol-AD Scale (Quality of Life – Alzheimer’s) at all three waves, the Cornell Depression Scale at Baseline and six months months and qualitative interviews with residents, staff and where possible families and volunteers at three months. To reduce the burden on our staff, we asked them to evaluate engaged residents only and to include residents with and without dementia, ideally representative of the resident profile in their service. A filming and interviewing tour was built in at the three month stage.
An important part of the internal communication strategy and materials was to stress the added value elements of Henpower and difference to standard hen-keeping. This was needed to garner acceptance of the trial at all levels of the organisation, and overcome perceptions that “country folk won’t find the idea of chook keeping at all special or interesting”.
The main elements of Henpower were therefore communicated as co-design, community connection, creative ageing activities and belonging to an international Henpower facebook community.
Services were invited to take part in the trial at our Managers’ conference in March 2015. Four services in rural and remote areas volunteered and the first henhouses went up in May/June 2015. Monthly teleconferences were held to trouble shoot problems and tease out stories to help gauge resident engagement and to post on our own and the Henpower facebook page. Chook care plans were shared, along with methods for discouraging snakes and vermin and how to overcome staff resistance.
Three different Henpower models emerged that responded to the different resident and service needs. One service pursued a strong pet model, where a group of eight residents (all with moderate to advanced dementia) bonded with their own chooks, named them and sat for many hours a day in a group stroking and cuddling them.
Another adopted more of a farm model, where all the residents in the small home participated in chook keeping chores and a third located the chook house in the courtyard of the dementia secure unit, which houses 10 residents. This was more of a mixed model where the male residents in the Dementia Unit became very engaged in chook keeping activities and some of the female residents enjoyed regular cuddling and stroking of the chooks.
Why we did it
As part of our wellbeing approach to care, we have developed a new focus on supporting relationship-centred care and programs and approaches that enable our residents to have more purpose, give back and engage in meaningful activity. Two areas of particular interest have emerged from this new model of care – combatting social isolation and loneliness and its links to ill health (Holt Lunstad 2010) and creative activities and their benefits to older people (Cohen 2006: Creativity and Ageing study).
Feedback from residents and their families, as well as a knowledge of The Eden Alternative and benefits of animal therapy (Berget and Braastad 2011) has also underlined a collective desire to have more access to pets and animals in our homes.
In addition, we are continuously looking for activities that engage our male clients, as the predominance of female residents has resulted in activities and programs with more female appeal.
Henpower seemed an intriguing and innovative program: For example, Equal Arts described how the hens come inside the care home, and the calming and transformative effect that daily interaction has on both residents and staff. It appeared to meet a number of different resident and wellbeing care needs in the form of a relatively cost effective, easy to run program that could be co designed by residents and staff, have appeal to male residents and might be particularly suited to our regional, rural and remote services.
Who worked with us
We worked with Equal Arts, who gave us the principles of the Henpower program, allowed us to use the Henpower branding and provided us with some interim photographic assets for our marketing materials in advance of developing our own.
They eventually provided more resources with logistical tips for setting up Henpower and a suggested program of creative activities. We found that there was some adaptation needed to the Australian climate and wildlife and amended their tips in this area accordingly. In addition they welcomed us to their Henpower facebook community where our residents and staff could compare notes with Henpower care homes in the UK.
The program is essentially a co-design program with residents, their families and engaged staff members. The steering committees set up at every service essentially decided how the program was going to be designed in their service, for example where to locate the hen house, whether the chooks were to come inside or not, responsibilities around chook keeping tasks. Our local chicken whisperers, expert volunteers that our services connected with in the community have provided invaluable help and support to the steering committees. They have for example provided guidance around the best breeds for handling, and pet like activities, education to the residents and staff around how to handle and general chook care.
An independent researcher analysed and reported findings.
What we learned
"The chickens make me happy and forget all my problems. It’s the best part of the day " Resident
Quantitative Data The Qol-AD scale provided quantitative data for the trial at all three stages. While some of the data was incomplete, mean scores showed an increase in quality of life scores, both from residents and caregivers. We have found however that the Qol-AD scale on its own is not a sensitive measure of change in a trial situation and that it is important to look to other indicators and qualitative feedback for a fuller picture. In addition numbers of residents being evaluated through this trial were small, n = 26.
Cornell Depression Scale
There was a low response rate for completed Cornell depression scales with only 8 (31% of) residents across all locations having data for both baseline and at 6 months. However of these, 88% (7/8) clients recorded a significant decrease in their depressive symptomology (mean scores decreased from 13.75 to 9.42).
Themes and case studies were developed from comments from the QoL data and interviews at three months. The three main themes were empowerment, connection and health:
At a high level a key element to this program is empowerment of the individual, whatever their cognitive state. Depending on the program model, this comes from either the added purpose that residents gain from caring for the chooks, regular routines and getting outside or from new social routines and interaction. Henpower is reported as “normalising” life in the care home and providing opportunities for responsibility, ranging from day to day chores such as feeding and collecting eggs to one resident with advanced dementia enjoying opening and closing the coop to check on the chooks each day. The residents who co-designed a pet model in their care home take on the responsibility of caring for a particular hen e.g. ‘My Molly’ ‘Priscilla’. Creative activities such as the making of hen tapestries and collages, story telling posters and sculptures are also felt to add to a more welcoming environment. Henpower also helps new residents settle and transition into life in the care home, one resident with dementia, for example, who made daily requests to travel home, stopped making these requests as soon as she became enthusiastically involved in the collecting of eggs every morning.
A sense of connection and increased social interaction is observed at many levels: resident to resident, resident to staff and resident to family, care home to community, helping reduce social isolation and loneliness. Henpower provides good opportunities for conversation starters and connection even for those who tend to be on the periphery and self-isolate. The social interaction isn’t always verbal but is sometimes the regularity of sitting together in the afternoon, sharing experiences such as stroking a chook and laughing at Pam’s invisible rooster sound.
The chooks help build internal community, increase laughter and enjoyment in the home and are often seen as a valuable substitute for residents with no or limited family interaction. Many residents acknowledge what a different experience Henpower is to what they remember of chooks on the farm. The chooks are also a draw card for local school children, and one care manager has ambitions to run arts and crafts sessions with the residents, local home care clients and school children.
Opportunities for improving health are also observed with increased activity and time spent outside for many residents. Also improvements in mental health were measured through reduced depressive symptoms and residents describing the calming and distracting effect of stroking their hen. Staff also observe that residents with severe dementia experience more opportunity for positive emotional response and reduced agitation. One care home manager commented that the repeated petting and stroking may even be a mindfulness type activity.
We learnt about the importance of the co-design phase: One home where the program was introduced hurriedly and without resident or staff involvement or communication quickly encountered problems. Staff became resentful of what they saw as increased “mess to clear up” and poor location of the chicken coop caused issues for residents and staff alike.
The Henpower program has become part of the daily fabric of the trial homes, has proven benefits for residents and the care home community and is cost effective to run.
Our internal communications and increased media exposure overcame internal resistance and Henpower has now been accepted as a standard program that we are in the process of rolling out.
More information on this program:
Karn Nelson, firstname.lastname@example.org, or phone (02) 9827 6626