Re-thinking arts as intervention: the creative role of performance in dementia care

To mark the publication of her new book – Performance and Dementia – Dr Nicky Hatton, lecturer in drama at York St John University, reflects on her experiences as an arts practitioner in dementia care homes.


As a theatre practitioner and researcher who works in health settings, most of my practice in the last few years has been in care homes, including working with people who are living with dementia. My new book, Performance and Dementia, looks at how performance can change the way we think about dementia care and some of the environments in which caregiving takes place. This blog post reflects on how the research came about. 

Art in Care Homes

Over the past decade, the scale and variety of arts practices taking place in care homes in the UK has increased significantly. Much of this work takes place in communal spaces which are used for a range of purposes. It is not uncommon, for example, for artists and residents to be working together in a room where other residents are sleeping or watching television. Care homes are often hot and noisy, and the sound of television, call bells, and doors opening and closing can make it difficult to hear each other. Residents are often seated in heavy armchairs that are hard to move, meaning that the simple act of gathering in a circle can be difficult to do. At first glance it can be difficult to see care homes as places where creative activity can thrive.

As a theatre practitioner, I’ve always been interested in the way that the sensory properties of a space can shape a creative process. A few years ago, I found myself working in a noisy care home dining room with a small group of residents, some of whom were living with dementia. I wanted to make the room into a more homely space and had ideas about transforming it using lighting, sound and projection. However, being in the space threw up a lot of practical questions. How would I minimise the disruption that these workshops created? How would we address the challenges of the space; the noise from the adjoining kitchen, the heavy tables that couldn’t be moved easily?

In order to understand how it could work, I started to volunteer at the care home. I had lunch with residents, attended a cocktail party and joined the weekly quiz team. Each time I visited, I got to know the residents and learnt about the relationships they had with different spaces in the home. I found out, for example, that some residents, who were living with dementia, preferred to hang out in the reception area so that they could watch people come and go. Another resident liked to watch Columbo at 4pm in the lounge when he was unlikely to be disturbed. The more time I spent there, the more I became intrigued by the care home as a unique community, with its own routines and customs. I realised that my interest had shifted from the impact of performance on the care home to a creative interest in the home itself.

Art with the Care Community

This is the focus of my book, Performance and Dementia, which explores how artists can engage with the different types of relationships that exist in a care community. It’s based on a period of collaborative performance practice that I embarked on with residents over an 18-month period. A key part of this practice involved working with the sensory properties of the home, particularly  sound as a primary medium. Together with the residents we explored the sounds of the dining room, listening, recording, and manipulating them into a soundscape. We worked with noisy objects and created sound poems, built from the resident’s responses to what they could hear. Through vocal work, we explored the sensation of sound in our bodies and how the collective sound of our voices filled up the space. This culminated in an audio installation of bodies and objects, played to an audience of staff and residents at the home.

In another phase of the practice, residents gathered for a weekly film and music club, watching movie clips and listening to music over tea and cake. The clips and the song we listened to were often associated with a particular period in their lives. For example, being young mothers in London in the 1960s listening to The Beatles, or growing up Punjab listening to classical Indian music. What was particularly interesting was the chance that these gatherings gave residents to express their personal tastes – an opportunity that is sometimes restricted after moving to a care home. Mutual appreciation of films or musicians often led to social interactions between resident, whereas differences sometimes led to disagreements. Pop music was particularly significant in highlighting people’s tastes, and how factors such as ethnicity, age, and socioeconomic background can affect the way that residents participate in an arts project.

Living in a care home should not be a barrier to accessing the arts and the growth in practice over the past decade has highlighted the possibilities of care homes as places where important art is created. Arts practices in care homes can also support social justice by highlighting how a care home is a diverse population of people who are all ageing differently. By approaching care homes as unique communities, and allowing the practice to develop gradually around it, artists have an opportunity to work in a way which is responsive, and for residents to have greater voice in an environment where opportunities to express themselves are often limited.