‘Creative Carers’ – A Creative Arts Project for Family Carers/Former Family Carers

Description

There is a wealth of evidence around the connection between creative expression and health, and from this emerged the name for the project entitled ‘Creative Carers’ – A Creative Arts Project for Family Carers/Former Family Carers.

The ‘Creative Carers Project’ had never been developed or delivered in Ireland before and was uniquely designed by the HSE Carers Department and FORUM Connemara CLG.

The Creative Carers Project involved the development and delivery of 11 Creative Carers courses, over a 6 to 8 week period, with one course session per week, consisting of two hours duration, from September to November 2022. There was an average of 6 to 12 participants per course, and the 11 courses were delivered in 8 separate Connemara locations, i.e. Clifden, Letterfrack, Recess, Cashel, Oughterard, Corr Na Móna, Rosmuc, and Carna. These locations were in part selected due to the evidence of rural peripherality in these areas. The practical creative art-making sessions followed a person-centred philosophy, with participants being able to choose from among a range of arts and crafts at the outset, including, Acrylic Painting, Woodturning, Felting, Oil Painting, Stained Glass Painting, and Photography. A total of 83 family carers/former family carers completed the 11 courses.

All 11 course groups combined for an Exhibition Event on the 25th of November 2022 in Clifden, Co. Galway, during which the participants artistic creations were exhibited, and carers could also view the art and craft work of their contemporaries.

An Evaluation Report of the Creative Carers Project was completed in early December 2022 in compliance with Government funding, and the project was very positively evaluated in all areas.

Aim of Initiative

Objectives of the Creative Carers Project
There were three Objectives for the Creative Carers Project, in line with the objectives of the Creativity in Older Age Scheme by Government, as follows:

1. Support positive ageing:
This project will be an opportunity for family carers including bereaved/former family carers to acquire a new creative skill and enhance their wellbeing.
There is some recognition that leisure activities offer a buffer against stress, and have health-protective effects, especially among less socially advantaged people (Iwasaki, 2006). Leisure activities potentially reduce caregiver burden (Losada et al., 2010). Some caregivers view leisure as a temporary escape from caring, which helps to preserve health and emotional functioning, thereby enhancing coping (Gahagan et al., 2007).
There is increasing recognition that engagement in creative art-making may offer a source of health and subjective well-being, with suggestions that this is a topic that requires more research (Camic, 2008; Clift et al., 2009; Mowlah et al., 2014; Murray and Gray, 2008). Furthermore, museums, art galleries and other cultural resources are now being regarded as promoting public health (Camic and Chatterjee, 2013).
A number of literature reviews have summarised evidence about the benefits of visual art-making for health and well-being, in medical contexts (Stuckey and Nobel, 2010), for people with mental health problems and older people (Hacking et al., 2006; Heenan, 2006; Leckey, 2011; Spandler et al., 2007). Recurring themes are that engagement in art- making reduces stress, facilitates contact with more positive emotions, increases self-worth and promotes feelings of social connectedness. The review by Perruzza and Kinsella (2010) adds that creative arts interventions commonly enhance perceived control and sense of purpose, and may transform the illness experience.

2. Mitigate the negative impact of social isolation and social distancing:
The weekly programme sessions will act as a respite break for family carers and will have the dual benefit of being a social outlet and a form of peer support for family carers who will have universal experiences of caring. The carers will also be facilitated by the Group Coordinator, FORUM Connemara CLG to join any of the two local Carer Support Groups affiliated to FORUM Connemara CLG. The confining and socially isolating impact of full-time caring is very evident. According to a 2016 Institute of Public Health Study in Ireland, carers were cited as being one of five groups particularly at risk of loneliness. In Ireland, a Report from the Loneliness Taskforce (Swanick, 2018) states that loneliness must be considered a priority public health risk and there is extensive international research which links experiencing loneliness to significant psychological and physiological difficulties. This report also cited family carers as an at-risk group. Loneliness can be worse for people than well known risk factors such as obesity (Christina et al, 2012). The magnitude of health risk associated with social isolation is seen as comparable with that of cigarette smoking (Kharicha et al, 2007). Smoking can decrease life span by up to 10 years (Jha et al, 2013). Evidence highlights that older people experiencing high levels of loneliness are almost twice as likely to die within six years compared to those who are not lonely (Ye Lou et al, 2012). Loneliness increases the risk of death by 26%, lack of social connections increases the risk of death by 29% (Holt-Lunstad, 2015). Loneliness can increase the risk of heart disease and impede recovery rates from stroke (CARDI, 2012). Loneliness has been linked to a wide variety of mental and physical health outcomes, such as depression, nursing home admission, and mortality (Barrett et al, 2011).

3. Develop and establish new forms of creative engagement for older people that accommodate prevailing public health guidance in the community:
For carers who wish to progress further with their newly acquired talent/interest, they will be assisted by the Group Coordinator, FORUM Connemara CLG and linked with Age & Opportunity and the Bealtaine Festival at Galway County Council. The Group Coordinator, FORUM Connemara CLG will also offer family carers the opportunity to be referred to the Carers Department, HSE, Galway for a review of their general needs/unmet needs as a family carer. Family Carers, as appropriate, may also be linked to the two Carer Support Groups in NW Connemara affiliated to FORUM Connemara CLG and South Connemara, where they can avail of continued peer-support, respite breaks, information sessions and other training opportunities, facilitated by the Group Coordinator, FORUM Connemara CLG.
Shanley (2006) suggested that brief experiences of leisure could provide a creative form of respite for carers enjoyed while their loved ones with dementia were being well cared for by others. However, the forms of leisure that were envisaged consisted of ‘pampering’ and passive entertainment, rather than activities that invited active engagement, challenge or development of new skills which this Creative Carers Project will address.
Roberts et al. (2011) found that carers of people with mental health problems tended to interpret the artwork on display in an art gallery through the lens of their caregiving experiences (e.g. viewing the art as metaphorically expressing loss and grief). Therefore their art-work was a form of cathartic self-expression.
Roberts et al. (2011) also described the creative arts programme experience as offering carers a bridge into new occupations and some of the carers expressed a desire to continue with their newfound creative leisure occupation, which is a potential longer term outcome of this Creative Carers project. The creative arts group offered camaraderie and participants highlighted that making art together was more pleasurable than problem-focused carer support groups. Previous studies have noted that some participants use arts interventions as ‘stepping stones’ to new roles and occupations (Heenan, 2006).

Expected Outcomes of the Creative Carers Project
It was the goal of the course developers to achieve the following potential outcomes for the participating family carers/former family carers:
1. Increased carer wellbeing,
2. Reduction in caregiver burden and stress,
3. Offers a respite break from caring,
4. Offers an opportunity for cathartic self-expression,
5. Increase in self-worth,
6. Promotes feelings of social connectedness,
7. Reduction in social isolation,
8. Increase in carers own level of participation in creativity as well as attendance at local cultural activities/events,
9. Offers carers a bridge or ‘stepping stones’ into new roles and occupations, which is a potential longer term outcome of this project.

It was anticipated that the project would thus play a pivotal role in bringing family carers and former family carers in NW and South Connemara together, creating opportunities for carers/former carers to fully participate in the creative and cultural life of their communities.

The project would enable different forms of creative expression by family carers in various arts and crafts, with an opportunity to also learn an art and craft indigenous to the local Connemara area. Such activities are enjoyable, and therefore something that carers are more likely to continue participating in within their own homes. This is very important among older carers in particular, as we wanted older carers to remain active and engaged in their community, so the course developers felt that offering a range of activities was an effective way of achieving this, particularly among the genders who may have differing interests.

There are a myriad of physical, mental and emotional benefits for family carers who participate in the arts. The Creative Carers Project it was anticipated would provide a sense of purpose and social participation and would help to create a sense of community and peer-support amongst family carers when they find commonality among each other.

The course developers also believed that the project would provide a sense of purpose and accomplishment for family carers, while also building self-esteem and confidence, and would also help to reduce anxiety, stress and depression associated with the demanding and often full-time nature of their caring roles. It was also anticipated that the project had the potential to improve physical capability and cognition. More importantly, creative expression could be made available to everyone in some form, regardless of age, disability and frailty, as overseen by the Course Developers.

This project set out to embrace the six values in the Government’s Cultural and Creativity Strategy: Collaboration, Inclusivity, Empowerment, Participation, Community and Communication. In essence, this project involved engaging from the outset with local artists/ facilitators to promote culture-led development within the NW and South Connemara community. Older family carers often find themselves excluded from certain creative activities, due in part to the 24/7 demands of their caring role, their rural environment and the ‘invisibility’ of informal caring, but through these dedicated facilitated sessions, positivity and wellness within the lives of rural older family carers/former carers could be enhanced.

Who is it aimed at

Target Groups for the ‘Creative Carers’ Project included:
– Older male family carers,
– Older female family carers,
– Former family carers, no longer caring due to bereavement of care recipient, were also included in the above two target groups.

The role of the family in providing long-term care is critical in Ireland as is the case in many other countries. Census 2016 defines a carer as “Someone who provides regular, unpaid personal help for a friend or family member with a long-term illness, health problem or disability” (CSO, 2016).

A key objective of Government policy for older people, children and adults with an illness or a disability is to support them to live in dignity and independence in their own homes and communities for as long as possible. Family Carers are vital to the achievement of this objective and are considered the backbone of care provision in Ireland. A key finding of the Irish Longitudinal Study on Ageing (TILDA) showed that the majority of care was infact provided by family carers at 70%, with only 30% receiving either state-provided or private home support (TCD, 2018). Two of the four National Goals of the National Carers Strategy (DoH, 2012) that are relevant to this project are to: 1. Support carers to manage their physical, mental and emotional health and well-being; and, 2. Empower carers to participate as fully as possible in economic and social life. According to the Irish Health Survey 2019 (CSO, 2020), there are now over half a million family carers in Ireland. The survey estimates that 1 in 8 people in Ireland aged over 15 are family carers. Extrapolation to the national population estimates currently available, suggests that some 516,594 people provide regular unpaid care. Previous estimates had put this figure at 355,000. Family Carers Ireland (2020) has estimated that the financial contribution of family carers is now €20bn per year. Galway has the third highest number of family carers in Ireland (after Dublin and Cork), (CSO, 2016).

3 Steps critical to success

1. Government Funding Application & Approval:
   The Carers Department, HSE, Galway in partnership with FORUM Connemara CLG, Letterfrack, Co. Galway made an application for Government funding under the Creativity in Older Age Scheme 2022 by deadline 25/01/2022, to develop and deliver a unique ‘Creative Carers Arts & Crafts Project’ for family carers and former/bereaved family carers in North, West and South Connemara. This Government funding scheme was established to counteract the social side effects of the COVID-19 pandemic. A full funding grant of €18,720.00 was awarded by Government on 16/05/2022, and the project had to be delivered and evaluated before the 30/11/2022, in compliance with Government stipulations.The ‘Creative Carers Project’ had never been developed or delivered in Ireland before and was uniquely designed by the HSE Carers Department and FORUM Connemara CLG, and such was the interest by Government in this uniquely designed project, that we were advised via Government’s local funding administrators- Galway County Council, to double the size of the project and in so doing, a doubling of funding for the project would be awarded. Although this put immense pressure on our respective organisation’s workloads, we fervently agreed as the value of the project to more family carers was an opportunity we could not refuse.
2. Needs Assessment Conducted:
   From June to early September 2022, the Project Team conducted an extensive Needs Assessment in advance of delivery, which informed the specific course schedules and locations, and potential participants were asked their preferred programme times and dates and preferred art/craft. A Cover Letter and a Course Application Form was disseminated via the Carers Department, HSE, Galway, Forum Connemara CLG and via Connemara Care CLG to their respective members in compliance with GDPR. The course information was also disseminated to local relevant groups/organisations, and to General Practitioners and Public Health Nurses in the area, and a notice was also included in all local parish newsletters, to assist in identifying any ‘invisible’ carers/bereaved carers not known to these organisations or professionals.Meetings were held with the 7 Course Tutors who were all local accomplished Artists to discuss the findings from the Needs Assessment and to discuss the course detail across a range of arts and crafts, including, Acrylic Painting, Woodturning, Felting, Oil Painting, Stained Glass Painting, and Photography. We ensured that the course Facilitators/Artists in the Connemara Gaeltacht areas, such as Carna and Rosmuc, were fluent in Irish in compliance with the Official Languages (Amendment) Act 2021.

   A detailed costing was sought from all 7 Course Tutors. Arts and Crafts Supplies were sourced under the expert and experienced guidance of the Artists. The Needs Assessment results informed the need for 8 separate Connemara locations for course delivery, i.e. Clifden, Letterfrack, Recess, Cashel, Oughterard, Corr Na Móna, Rosmuc, and Carna, and local suitable venues were booked.

   Course Timetables for a total of 11 courses were developed and the course times and dates were informed by the Needs Assessment. A letter of course offer was posted to all successful participants in August/September. Respite need to enable carers to attend the sessions were sought through the Needs Assessment process, and a total of three full-time carers required cover and all other carers arranged cover through either their existing formal care supports or through informal cover from other family members. Transport need was also determined from the outset.

3. Project Implementation/Delivery & Project Evaluation:
   The first Course began on the 29/09/2022 and the 11th and final course concluded on the 22/11/2022. The two partnership organisations attended the first course session to welcome the group and explain the background, goals and support network. An unannounced visit was undertaken by one of the partnership organisations atleast once during the course delivery of all 11 courses.At the final course session for each course group, an Evaluation Form was given to each participant which was a self-report questionnaire and this process was facilitated by either a staff member from the HSE Carers Department or from Forum Connemara CLG.

   The Course Developers’ began planning for the Exhibition Event in October and following a booking of the hotel, invitations were developed and disseminated to all participants, Artists, Funding Organisations and partnership organisations. Return bus transportation was arranged for all carers. The Exhibition Event was held on the 25/11/2023, which included a 3-course meal, speeches by the partnership organisations, a photo call, media releases and a Presentation of Certificates was conducted at the Event also.

   An Evaluation Report of the Creative Carers Project was completed in early December 2022 in compliance with Government funding.

3 Challenges in Planning / Delivery

1. The ‘Creative Carers Project’ had never been developed or delivered in Ireland before and was uniquely designed by the HSE Carers Department and FORUM Connemara CLG, and such was the interest by Government in this uniquely designed project, that we were advised via Government’s local funding administrators- Galway County Council, to double the size of the project and in so doing, a doubling of funding for the project would be awarded. Although this put immense pressure on our respective organisation’s workloads, we fervently agreed as the value of the project to more family carers was an opportunity we could not refuse. The success of the project in recruiting 83 carers was due to FORUM Connemara CLG and the HSE Carers Department’s interconnectedness with existing, former and new carers, through the organisation’s long established and ongoing delivery of carer supports in the area.
2. Securing formal carers/ home support workers (due to a country-wide deficit in formal care staff) to provide an in-home respite service to enable family carers to attend the courses. However, having good established links with a local care company- Connemara Care CLG, this issue was mitigated and any family carers who required cover to attend were provided with same.
3. Ensuring all project courses were delivered and evaluated before the Government deadline of 30/11/2022, as it was the preference of family carers to commence the courses during the autumn and winter. However, with effective partnership working between the HSE and Forum Connemara CLG this was achieved efficiently.

3 Outcomes / Benefits

1. Project Evaluation
   A Questionnaire was developed during the project development phase to evaluate the impact and quality of the Creative Carers courses, and to evaluate if the projects expected outcomes and objectives were met. The Questionnaire was disseminated to all course participants at the final course session for each of the 11 course groups, which was facilitated by the Carers Department, Community Healthcare West, Galway and FORUM Connemara CLG. A total of 83 participants completed the 11 courses and a total of 78 participants completed a Questionnaire, giving a very good response rate of 94%.We set out through the development of this Creative Carers Project to help rebuild the social connections that were lost during the pandemic. From the evaluation of this project, we did not even fully anticipate the impact the project was going to have on family carers and on bereaved family carers wellbeing. Almost half of carers reported that their wellbeing was not where they wanted it to be before they started the creative carers courses. However, at the end of the courses, 95% of carers indicated that their overall wellbeing had improved, and 91% said that the courses had helped to reduce their feelings of stress, loneliness and/or low mood, in part due to the weekly course sessions being a respite break and a social outlet which was reported by 97% of carers. A more detailed summary of the main results of the project evaluation are outlined below.
2. Impact on wellbeing
   41% of participants reported that their wellbeing was not where they wanted it to be before they started the courses. However, at the end of the courses 95% of participants either ‘agreed’ or ‘strongly agreed’ that their overall wellbeing had improved.Impact on stress, loneliness and mood – 91% of participants said that the courses had helped to reduce their feelings of stress, loneliness and/or low mood.

   Impact on use as a respite break and social outlet – 97% of participants either ‘agreed’ or ‘strongly agreed’ that the course sessions were a respite break and a social outlet for them as a carer/former carer.

   Impact on interest in creative arts – 97% of participants either ‘agreed’ or ‘strongly agreed’ that the courses has led to them having an increased interest in the creative arts. All participants either ‘agreed’ or ‘strongly agreed’ that they have learned a new creative skill in arts and crafts having completed the courses. 95% of participants reported that they would like to undertake further training in this creative art. Over three-quarters (79%) of participants reported that they will continue to practice this creative art at home now that the courses are over.

   Quality of the courses – 100% of carers ‘strongly agreed’ that overall they were satisfied with the quality of the courses. All participants ‘strongly agreed’ that the Facilitator’s were approachable, knowledgeable and supportive. All participants stated that they would recommend the courses to another carer or former carer.

   Impact on community engagement – 56% of participants stated that they would like to join the local Carers Support Group in their area, 17% were unsure, and a further 18% were already a member.

   What was most useful about the courses?
   Carers were asked what they found most useful about the courses; and the two greatest benefits were the social outlet the courses offered, which was indicated by 65% of participants, and the opportunity to learn a new skill/art, which was stated by 62% of participants.

   To illustrate this further, some direct quotes made by the participants included:
   “The course has helped me to feel more happy in myself and to get out and meet people especially as my husband whom I cared for died during the Covid pandemic”
   “I was in a bad place when the course started and I found it really enjoyable”
   “The creative arts course has really helped to lift my mood. I was feeling very lonely and isolated. I love the arts but would never have the time or space at home”
   “After Covid in particular I felt very cut off from society. So this course got me out of the house”
   “I found the course really beneficial to my mental health and wellbeing”
   “I forgot my troubles while attending the class. It was a great help”
   “I loved the course so much I really had trouble deciding if I would miss the last course session or go on a holiday abroad”
   “This is a really good initiative, caring can be very isolating and it has been rewarding doing this course”; “I was lonely and the course helped me”
   “I am nearly 70 years and I have just started swimming lessons as I felt so perked up that I can do anything from having done the course. This course gave me courage and I had a fear of water and now I can put my head under the water”

   What was least useful about the courses?
   Carers were asked what they found least useful about the courses; 71% of participants stated N/A or Nothing, with comments primarily relating to extending the duration of the course, especially during the winter months.

   How the courses could be improved?
   When participants were asked how the courses could be improved; many carers indicated ‘Nothing’ or ‘the course was perfect’. Suggestions primarily related to increasing the duration of the courses, especially over the winter months, which was indicated by 63% of participants.

3. Progression opportunities and follow-up support after the ‘Creative Carers’ Project concluded:
   • Any carers who wished to progress further with their newly acquired talent/interest, were assisted by the Group Coordinator, FORUM Connemara CLG and were linked with Age & Opportunity and the Bealtaine Festival at Galway County Council. The two course groups in Clifden were particularly interested in this progression opportunity.
   • All family carers were given the opportunity to be referred to the Carers Department, HSE, Galway for a review of their general needs/unmet needs as a family carer. As such, all active family carers were registered with the HSE Carers Department.
   • All family carers were offered the opportunity to join either of the two Carer Support Groups in Connemara affiliated to FORUM Connemara CLG, where they could avail of continued peer-support, respite breaks, information sessions and other training opportunities, facilitated by the Group Coordinator, FORUM Connemara CLG. As such, the 44 carers who indicated that they would like to join the local Carers Support Groups subsequently joined the local support groups.
   • The course group in Cashel consisting of male family carers/former family carers only, requested the support of FORUM Connemara CLG and the HSE Carers Department in setting up a Men’s Shed in Connemara, as there was no Shed in existence in North Connemara at the time. As such, a suitable premises has since been secured in Clifden from Galway County Council, and linkages have been made with the HSE Health and Wellbeing Division and with the Men’s Shed Association of Ireland. An Information Evening was held and a Men’s Shed Committee has been established in compliance with governance procedures. All 10 male carers/bereaved carers who undertook the creative carers course have joined the Men’s Shed and three have taken up an Officer position on the Connemara Men’s Shed Committee.In the words of Mother Teresa: “Kind words are short and easy to speak, but their echoes are truly endless”- this project has demonstrated to family carers and bereaved family carers that they are not alone and that the HSE is supporting them. Particularly as we are aware from the TILDA study that the bulk of care to older people in our community is in fact provided by family carers at 70% and only 30% are receiving state-provided or private home support. The health service would indeed be adversely impacted if it were not for family carers.

   Currently, the project developers have applied for additional Government funding to support the existing course groups, Men’s Shed and Carers Support Groups to continue to develop their newly acquired art/craft, and also for new course groups to be provided in 2023. We have received a favourable response to our application and we are confident that given the proven benefit and positive impact of the Creative Carers Project that funding will again be committed by Government, and hence this innovative project will continue.