The role of Tapestry HüBs in supporting people to stay, and become active

Tapestry Care UK limited

Registered Office: HOPWA House, Inskip Drive, Hornchurch, Essex, RM11 3UR

Registered Company No: 3942243

Registered Charity No: 1079969

Rebuilding Community Resilience Post Covid 19

“Remaining independent is so important to people living with dementia. Exercise sessions support people to improve their muscle strength, flexibility, and therefore their ability to perform daily activities such as cooking, cleaning, and getting dressed. It also provides an opportunity to socialise to help reduce feelings of isolation”.

The role of Tapestry HüBs in supporting people to stay, and become active

Tapestry Care UK Limited

Who are we?

Tapestry is a social business and charity working for adults, predominantly, historically older adults, and since 2007 for individuals of all ages living with disability and dementia and their Carers.

Our mission is to provide all adults with services and opportunities to enable them to live connected, healthy and fulfilled lives.

We do this by providing affordable services that offer real value for money and deliver important social outcomes for society.

We provide high quality personalised, integrated Care, Health and Wellbeing services, and services that tackle Social Isolation, all with healthy Food at their heart. Everything we do is focused on the individual and we ensure that, where care plans are necessary, they are driven by the individual.

We focus on prevention:

• By the providing activities/services working to prevent, where possible, deterioration of mobility, physical and mental health.

• By providing access to heathy affordable, food preventing malnutrition or obesity.

• By providing transport and events bringing people together to prevent loneliness and isolation

Currently over 500 people benefit from our services across Havering and Barking and Dagenham

However, there are many more individuals who could benefit from our services. Ultimately, there are a significant number of individuals who could benefit from our services across Essex as a whole and East London

Tapestry HüB’s

We deliver our mission through stand alone, replicable HüBs.

These HÜBs are financially self-sustaining social businesses.

The social businesses and the delivery model are designed to be:

1. Replicable and self-funding models that can be delivered anywhere there is a community need.

2. Established within communities to meet and compliment geographical needs, in association with the Local borough council and other local voluntary sector organisations.

3. Flexible in their service provision so as not to duplicate services or provide unnecessary competition. (If they are new to a geographical area, they will work to identify current service provision and seek to compliment those services and work with the organisations, providing those services. They will also work to grow existing service provision and/or establish new services to ensure that the greatest number of people who require the services can have access to them).

4. Flexible to utilise existing buildings and work locally to find innovative solutions to deliver services that cannot normally be delivered because of a building’s limitations.

We want to enable many more people to benefit from our services as the need is growing year on year.

The role of Tapestry HüB’s - Providing solutions

What do we want to do?

• To build on existing support services to tackle the issues facing the community, in the post Covid world, and build community resilience and resources to enable communities to recover and thrive.

• To create, with local people, the local voluntary and the public sector HüBs providing care and support wherever they are required

A HüB is a nerve centre, at the heart of the community, focusing on care and support service for older people and adults with care needs, a wellbeing centre and a place of advice and practical support. It builds on and extends the specialisms of existing voluntary sector organisations, businesses and the local infrastructure.

As a pivot of community activity and planning it will be a resource to harness the knowledge, skills and interests of local people to cultivate additional ways to support people to live their lives as they wish.

A Tapestry HüB

This is a tried and tested delivery model for Tapestry It is trusted and valued by the communities it serves

It is a new innovative model that embraces technology, puts preventative personalised care at its heart and provides unique reminiscence and sensory experiences. It focuses on preventative health care providing access to affordable high-quality food, transport and opportunities to exercise/stimulate both body and mind.

The model achieves this within the community, in partnership with the community, and encourages community integration which then, at the same time, tackles the modern scourge of loneliness and isolation that is affecting so many more people.

It has been developed in partnership with older people, and their carers, the local community, local voluntary sector organisations, the business community, The Borough council, the local NHS Foundation Trust, external consultants and advice from the UKHCA and the CQC.

A HÜB is a special place where people can eat, meet with others and enjoy experiences, with others, whatever their disability or age. It is a safe place where those living with dementia can do all this and experience reminisce and sensory experiences that can stimulate interaction and communication with those around them.

Importantly for the delivery of this project

It has a dementia and disability friendly gym. The gym provides personalised exercise sessions that enable all individuals, whether old and frail or living with a disability or dementia, to benefit from the health benefits of exercise and reduce falls. It has a dementia friendly, sensory community garden/outside space accessible to all enabling exercise to take place outdoors as well as inside.

It provides affordable dining opportunities enabling everyone to access good food which is an important building block in ensuring good physical and mental health and prevent health deterioration.

Our HüBs are accessible to all because of our fully escorted transport service.

Why is this plan necessary?

Older people and adults, with complex needs such as dementia in our communities, had become viewed as liability and challenge, in short costly. Access to care and support had become difficult to comprehend and what is offered more disengaged from people’s concerns that they have for themselves and their families. This is particularly true for those in the most marginalised communities.

The Covid 19 pandemic has highlighted the vulnerabilities of this forgotten part of our community and created a series of new challenges that need addressing. If we wish for our communities to be a place where all can thrive and live healthy fulfilled lives, we must work differently to meet these new challenges that will, if we do not address them, have a negative impact on the health and wellbeing of the whole community.

To enable people to thrive they need good food, companionship, and opportunities to exercise both body and mind. At present this is not possible for many in our community, as they face barriers to accessing places where they can exercise safely and comfortably.

Exercise has many known benefits for both physical and mental health, including reducing the risk of cardiovascular disease and diabetes, strengthening the bones and muscles, and reducing stress.

It also appears that regular physical activity benefits the brain. Studies show that people who are physically active are less likely to experience a decline in their mental function and have a lowered risk of developing Alzheimer's disease.

Physical activity is one of the known modifiable risk factors for dementia. Plus, regular exercise helps combat other Alzheimer's disease risk factors, such as depression and obesity.

Exercising several times a week for 30 to 60 minutes may:

• Keep thinking, reasoning and learning skills sharp for healthy individuals

• Improve memory, reasoning, judgment and thinking skills (cognitive function) for people with mild Alzheimer's disease or mild cognitive impairment

• Delay the start of Alzheimer's for people at risk of developing the disease or slow the progress of the diseas

• Increase the size of the part of the brain that's associated with memory formation (hippocampus)

Physical activity seems to help your brain not only by keeping the blood flowing but also by increasing chemicals that protect the brain. Physical activity also tends to counter some of the natural reduction in brain connections that occurs with aging.

Physical activity is also important to health and wellbeing. People with dementia are less physically active than their cognitively healthy counterparts. Reasons for this are multifaceted, and are thought to be social, psychological, and physiological. People with dementia often use services such as home care, day care centres and nursing home, and according to the stage of disease they are less or more dependent on other people to take part in activities. To develop appropriate services, their individual needs and preferences regarding physical activity must be recognized. Telenius, E.W., Tangen, G.G., Eriksen, S. et al. Fun and a meaningful routine: the experience of physical activity in people with dementia. BMC Geriatr 22, 500 (2022). https://doi.org/10.1186/s12877-02203

“Regular physical exercise can be beneficial for many health conditions, and research is looking to see whether it has a direct effect on reducing the risk of dementia. Being active needn’t mean running marathons; finding an activity you enjoy and are more likely to stick with is more beneficial While it’s still unclear what type of exercise is best, and at what stage of life, keeping active throughout life is important. Taking part in physical exercise is also a good opportunity to stay socially active, which can also have a positive impact on brain health” Dr Laura Phipps from Alzheimer’s Research

Common Barriers to Participation by People with Dementia and disabilities

Nearly everyone faces hardships and difficulties at one time or another. But for people with dementia/disabilities, barriers can be more frequent and have greater impact.

The World Health Organization (WHO) describes barriers as being more than just physical obstacles.

The WHO definines barriers as follows:

“Factors in a person’s environment that, through their absence or presence, limit functioning and create disability. These include aspects such as:

• a physical environment that is not accessible,

• lack of relevant assistive technology (assistive, adaptive, and rehabilitative devices),

• negative attitudes of people towards disability,

• services, systems and policies that are either nonexistent or that hinder the involvement of all people with a health condition in all areas of life.” 1

Often there are multiple barriers that can make it extremely difficult or even impossible for people with disabilities to function. Here are the seven most common barriers. Often, more than one barrier occurs at a time.

• Attitudinal • Communication • Physical • Policy • Programmatic • Social • Transportation

“Visiting a gym, sports centre or favourite leisure facility to take part in physical activity can be daunting for people with dementia, loved ones and friends – but with support and adjustments from sport and physical activity providers, they will remain active. Jonathan Graff-Radford, M.D.

The plan - Improving access and take up of exercise for individuals from marginalised and vulnerable groups living with dementia and disability.

This plan seeks to address these challenges and remove barriers. To deliver effectively and achieve the most impact for the individual, support must be provided using a person-centered approach.

Person-centered care

Person-centered care is a world-wide care approach of choice to develop high quality dementia care. In person-centred care the person’s preferences and life history are central in the development and implementation of care and services.

People with dementia are often capable of communicating their views and preferences about what is important to them and it is ethically and morally important for service providers and informal carers to request and consider those views.

Action plan

Tapestry will

• Provide opportunities and environments for people living with dementia/disability to take part in physical activity and sports.

• Work with voluntary sector organisations working with BAME, LBGTQ+ and other marginalised groups to identify need and provide personalised solutions to people who are the least likely to have access to this kind of support.

• Provide opportunities for at risk groups to take part in activity to prevent mental and physical health deterioration.

• Provide opportunities through exercise and sport to reduce social isolation and the damage to health caused by loneliness

• Join forces with other voluntary sector organisations to call on the sport and physical activity sector to commit to becoming dementia friendly and reduce the barriers that prevent many people affected by dementia from taking part in sport and physical activity.

The campaign will be launched during National Walking Month in May 2023

The HüB’s will bring together Local Voluntary Sector Organisations (VSO’s) and Tapestry, working with local people and the local public, private and voluntary sectors, to create a more comprehensible and relevant approach to exercising and accessing opportunities to exercise The approach will contribute to building a more cohesive community of people and businesses to provide care and support for those that face daily challenges due to a disability and/or living with dementia and those that are lonely or isolated, or at risk of being lonely or isolated due their age, disability, mental health issues, sexuality, or culture

By working with local people, we can gather and review management information that will inform community and business decisions. The HüB can then provide people with the knowledge that they need to make their own decisions and support them as they wish. By adding a variety of neighbourhood support and care the HÜB can, not only address the immediate challenges but, most importantly, create early intervention activities that will prevent or delay the deterioration of the health and wellbeing of the community and reduce the prevalence of illness and loneliness in the community in the future.

The HÜBs will be partly driven by the views and concerns of local people and it is important that while guiding the debates that we are not seen as imposing their own fixed solutions. So being exact about the services developed at this stage has to be carefully managed however, we are confident that the priority areas are likely to be:

• Loneliness/social isolation

• Dementia

• Nutrition and reducing obesity

• Exercise and mobility

• Carers support

• Bereavement

• Mental health- post Covid 19

• Volunteering

Tapestry’s plan to increase physical activity – ‘What we want to do’

What does 'physical activity' mean?

Physical activity or exercise in general is considered to be aerobic exercise performed for a sustained period of time, perhaps 20–30 minutes. However, physical exercise does not just mean playing a sport or running. It can also mean a daily activity such as brisk walking, cleaning or gardening. One study found that the risk of Alzheimer's disease can be reduced by daily physical tasks such as cooking and washing up.

We will focus on:

1. Prevention.

Of all the lifestyle changes that have been studied, taking regular physical exercise appears to be one of the best things that you can do to reduce your risk of getting dementia. Several studies looking at the effect of aerobic exercise (exercise that increases your heart rate) in middle-aged or older adults have reported improvements in thinking and memory, and reduced rates of dementia.

Prospective studies follow the health and behaviour of a group of people over time. Several prospective studies have looked at middle-aged people and the effects of physical exercise on their thinking and memory in later life. Combining the results of 11 studies shows that regular exercise can significantly reduce the risk of developing dementia by about 30 per cent. For Alzheimer's disease specifically, the risk was reduced by 45 per cent.

Although less research has been done with healthy older people, there is some evidence to show older people can also reduce their risk of dementia with regular exercise. In a study of 716 people with an average age of 82 years, people who were in the bottom 10 per cent in terms of amount of daily physical activity were more than twice as likely to develop Alzheimer's disease as those in the top 10 per cent..

We will establish activities that,

• Enable active ‘at risk ‘people to take part in physical activity that might prevent the onset of dementia

• Enable people diagnosed with dementia to take part in physical activity that might slow down the progression of dementia

2.

Physical activity

for people with early onset dementia. - (See appendix 1 WHO categorisation)

Being physically active for at least 2.5 hours per week could delay decline in mental capacity in a rare form of Alzheimer’s disease that starts years earlier, according to recently published research led by Washington University School of Medicine in St. Louis, MO The study also concluded that

“Therefore, a physically active lifestyle is achievable and may play an important role in delaying the development and progression of ADAD. Individuals at genetic risk for dementia should therefore be counselled to pursue a physically active lifestyle.”

People living with early onset dementia are younger and more active and physically capable, therefore their exercise needs to reflect this.

We will develop personalised programmes that include activity in the community as well as in the gym and exercise spaces in the HüBs

3. Physical activity for people with early moderate dementia.

People living with moderate dementia are likely to be predominantly older and may have difficulty communicating, be demonstrating behavioral changes and may need help with personal care

Activity will be predominantly inside the HüB environment and its dementia friendly spaces such as the garden and the pub pod.

4. Physical activity for people with high needs dementia.

This group is often unable to take part in group activities or supervised exercise because of challenging behaviours.

Our Hornchurch HüB provides high needs support and as part of this personalised 1-1 supervised activities will be undertaken.

5. Loneliness and isolation

Research by the Alzheimer’s association highlights that social isolation was the only risk factor for loneliness consistent for both carers and people with dementia.

Risk factors for loneliness in carers were caregiving stress and relationship quality and in people with dementia living alone, depression and life satisfaction/quality of life.

The social care institute for excellence highlights that a person with dementia is much more likely to become withdrawn because they feel isolated or bored. Many people with dementia spend much of their time alone or, even if they are with others, there may not be much conversation between them.

Physical activity sessions will encourage group interaction through music and dance and games and will involve the carers of those living with dementia. People will also be encouraged to eat together after sessions in the HüB restaurant.

6. Access to good food

Although there are no conclusive findings on whether individual supplements or so-called 'super-foods' can improve cognitive function or reduce the risk of developing dementia.

It is well known that he nutritional quality of our diet has an impact on our physical and mental wellbeing.

For many people with dementia, the changes that are experienced as dementia progresses can have an impact on the whole mealtime experience. These changes can result in weight loss, dehydration or even weight gain. Malnutrition and dehydration can contribute to the risk of developing delirium.

People with dementia can experience difficulties with chewing and swallowing as the dementia progresses. These problems can affect how well a person with dementia eats.

Food is key to a healthy life and therefore all activities and sessions will include access to a healthy affordable freshly made meal in the HüB restaurant and Cafe

7. Environment

A recent survey, highlighted in the report, Raising the Bar, from Future Fit Training, highlighted the following key points.

• 86% of fitness employees think that current training does not equip gym professionals to work with disabled people

• Personal trainers (PTs) not being equipped to work with disabled people,

• Ftness professionals not recognising disabilities

• Employers being unsure of how many of their gym members have a disability

• Following a diagnosis, many people living with dementia stop doing the activities they love.

We will establish an friendly supportive environment where people feel comfortable to continue being active with the confidence that staff are on hand to support them when needed.

We will ensure that

• All attendees receive personalised plans with goals they have chosen themselves.

• Friendly signage is in place to allow simpler navigation around buildings.

• All staff have dementia awareness training and are “Dementia friends” Dementia Friends is an initiative run by the Alzheimer’s Society and is designed to inform people about dementia and empower them to ‘turn their understanding into action’.

• Our instructors will undergo training to enable them to deliver sensitive advice and guidance to people living with dementia

• The exercise classes are specifically designed with the needs of the individuals attending the sessions

• The equipment used is the best we can afford and utilises new technologies whenever possible.

We will also provide dementia awareness training opportunities for those working in the fitness and leisure industries