South London’s Nightingale House shares space with on-site nursery Apples and Honey. Charlotte Goddard finds out how high-quality intergenerational practice benefits both residents and children

It’s unusual for a care home to feature a tree house, sandpit and mud kitchen, but the gardens of Outstanding-rated Nightingale House cater to children as well as older people. One of two homes run by charity Nightingale Hammerson, Nightingale House has shared its grounds with social enterprise nursery Apples and Honey Nightingale since 2017. A fifth of the nursery places are subsidised and reserved for care home staff, with a positive effect on recruitment and retention.

On the day that Caring Times visited, Apples and Honey co-founder Judith Ish-Horowicz was setting up the sunny lounge area for a baby and toddler group, attended by local parents and children as well as children from the on- site nursery and residents of the home, known as ‘grandfriends’. The home’s residents are Jewish, and the nursery is centred on the values and traditions of Judaism while accepting children of all faiths or none.

Toddlers pulled out toys from a bag and handed them to their grandfriends, while everybody sang the relevant song – Teddy Bears’ Picnic for a bear, Baa Baa Black Sheep for a fluffy lamb. Fay Garcia, 95, was one of the residents at the session. “It seems incongruous to have tiny tots in with old people like me, but they amaze me how bright they are and how quickly they learn,” she said. “Not having any children of my own, it is a new experience for me.”

Garcia, who has lived at Nightingale House for eight years, has kept in touch with families she met through the nursery. During the pandemic, activities took place over Zoom, in the garden or with children behind glass screens. “During lockdown we had a session called We Can Still Bee Together; we made bee hives and candles,” she said.

While many care homes welcome one-off visits from schools and nurseries, intergenerational practice is embedded within the daily life of Nightingale House. Careful planning and delivery is essential to ensure both parties benefit, with activities including music, pottery, cooking, exercise classes, cultural activities and gardening. Children pay visits to grandfriends who can’t attend activities, and play in the gardens and communal areas. Of course, residents are not obliged to interact with the children; intergenerational activities are just part of the home’s wider programme, which includes a book club, French conversation and tea dancing.

“Intergenerational work is much more complex than people think, if you are ensuring it is purposeful and that one group is not simply acting as a tool for the benefit of the other group,” explained Ish-Horowicz. “It must be
valuable, appropriate and relevant to the people participating, and aim to build relationships.”

A 2019 study of Nightingale’s intergenerational programme found residents benefited from improved mental health and decreased social isolation. When children joined residents’ exercise classes, improvements were seen in the older people’s core strength. “People regained their motivation when children joined for the last 20 minutes – they thought to themselves ‘we’re not going to be beaten by the little ones!’” related Ish-Horowicz.

Registered manager Clemence Muchingaguyo, who has worked for Nightingale since 2011, has noticed changes in the residents since the nursery opened. “When the children are around residents who are nonverbal, or get distressed a lot, are either quiet, or smiling and enjoying what is happening,” he said. “Other residents are able to interact with and teach the children, which they find valuable.”

The intergenerational team works closely with the home’s therapists to develop activities which will best support the needs of residents and children. Nightingale House has one of the largest in-house therapy departments in the UK, including physiotherapists, occupational therapists, a moving and handling advisor, and dietitian.

In 2021 Nightingale House and Apples and Honey set up an education and training centre, Apples and Honey Training. The centre has developed a set of quality standards, as well as the UK’s first Level 3 accredited intergenerational qualifications. The qualifications, accredited by awards body Cache, can be taken by care workers or early years practitioners.

Among the first cohort of 12 students is Nightingale House’s own Marilia Pavlou, who joined the organisation as intergenerational officer earlier this year. “I think there is a need to insinuate these intergenerational experiences into care homes. The kids get to see what getting older means and the mental health of the people in the care home improves,” said Pavlou.

Nightingale House, which dates back to 1906, comprises six separate households, each with its own communal and dining areas. Two ‘general residential’ households are for older people who require minimal support, and a third is for people with mild to moderate dementia. Three more households provide specialist nursing care, two for people living with advanced dementia and one for those with physical issues such as cancer, heart disease or kidney failure. An on-site GP is available throughout the week.

The home’s concert hall hosts musical and theatrical events, and a massive activities room is well stocked with arts and crafts resources, including a pottery kiln. A terrace café looks out on the tranquil gardens complete with fish pond, aviary and bee hives. Evidence of the children’s and residents’ creativity is everywhere, including pottery fish and birds and a honeycomb sculpture. Those living with dementia have their own secure garden, which includes nostalgic objects such as a bus stop and even an old-fashioned car.
The home currently supports 110 residents, although it’s registered to care for 215. Occupancy has been affected by the pandemic and by the opening of Nightingale Hammerson’s North London home in 2021, with some residents moving to be closer to their families. Half of the residents are self-funding and the remaining costs are covered by local authorities, family support or through fundraising.

In the afternoon of Caring Times’ visit, residents and children came together again for the weekly Havdalah ceremony, to mark the symbolic end of Shabbat, the day of rest. The multi- sensory ceremony saw children pouring grape juice into silver cups, passing round fragrant spices, lighting and extinguishing a multi-wicked candle and sharing news with their grandfriends, developing their language skills.

Building on the knowledge and expertise gained at Nightingale House, the intergeneration programme will be extended to new home Hammerson House. Nightingale Hammerson hopes that its trailblazing approach will soon become common across the sector.

“Our aim is that every care setting will employ someone with responsibility for intergenerational practice,” concluded Ish-Horowicz.