Activities do far more than help residents pass the time. When done right, they play a key role in improving resident satisfaction and quality of life, and giving assisted living operators a competitive edge.
“Residents want a variety of activities, including those that are not childish, require thinking, are gender-specific, produce something useful, relate to their previous work, allow for socializing with visitors and participating in community events, and are physically active,” said Kathleen Weissberg, MS, OTR/L, education director for Select Rehabilitation.
More than ever, communities are finding innovative ways to fulfill that need. What was once largely limited to bingo, bridge and basic arts and crafts has since blossomed into therapeutic activities that are rich in complexity, scope and content, and highly individualized, noted Pam Hayle, director of quality improvement at Augustana Health Care Center of Minneapolis. “Activity professionals have been examining their work in very different and exciting ways.” They're asking tough questions about activity practice — such as why seniors are often steered toward childish or herd-like activities, and how facilities can better engage and interact with residents — and then translating that into systematic change, she said.
Providing a healthy mix of activities for all skill levels and cultural preferences takes interdisciplinary teamwork, and a willingness to think outside the traditional activities toolbox, experts noted. It also hinges on management and activity professionals' understanding of value-based outcomes and the importance of designing activities that are well-planned, engaging and tailored to adults' ever-evolving interests.
“Management has to see the value and support recreation as much more than keeping folks occupied so staff can just get their job done,” said Jenni Seaman, an account manager for It's Never 2 Late.
Assess for success
Experts say meaningful, resident-centric programming begins with solid assessments. Upon admission at Levindale Hebrew Geriatric Center and Hospital in Baltimore, residents are assessed on their likes, for example, past occupations and hobbies, and other interests. From there, ongoing assessments and targeted activities help paint a more detailed picture of resident needs and preferences, explained Amanda Bojan, a certified therapeutic recreation specialist at Levindale.
“We have reminiscent programs where we can find out more about our residents and then brainstorm on how to incorporate their interests into meaningful activities,” she said. “We also communicate well with all staff on the unit. Some of these people know the residents better than we do and can offer great insight into what we can do to meet their needs — such as a resident's desire to spend more time outside or work in the garden.”
Of course, thorough assessments also help determine functional ability. “It's unfair to offer a resident an activity in which he or she is unable to fully participate,” stressed Weissberg.
A therapist's skilled intervention should involve evaluating functional areas that impact activity performance and providing treatment to address performance barriers. Many occupational therapists complete an occupational profile with clients where backgrounds, interests and hobbies are uncovered — and that information is then used to choose functional- and performance-based activities for treatment that will help resolve observed deficits, she continued.
“This information can easily be shared with the activities department so they, too, can develop meaningful and fun activities,” Weissberg says.
Physical, cognitive needs
Resident activities must meet both the physical and cognitive needs of all participants, noted another rehabilitation expert. Many activities, such as bingo, crafts and current events-based offerings, are geared toward higher functioning residents, resulting in a portion of the activity group sitting, unengaged, Judy Freyermuth, clinical performance specialist for RehabCare, noted.
“Many residents who are unable to engage in higher level tasks are left without stimulation, sleeping, wandering or perhaps sitting in the hall. In order to provide activities that meet the cognitive needs of all residents, therapy must work closely with the activities department,” she said.
Therapy can assist the activities department in adapting programming for various levels of performance and can train activities personnel to assist or facilitate resident performance. Activities should be adapted for residents with hearing or visual impairments, physical or cognitive limitations, use of only one hand, a language barrier, terminal illness, pain, room-bound, varying sleep patterns, diverse ethnic or cultural backgrounds, or behaviors such as wandering or agitation, Weissberg said.
Dementia residents, especially, require thoughtful activities planning. As Cheryl Stollman, director of resident engagement at Silverado The Huntington Memory Care Community in Alhambra, CA, explained, activities that require sequential steps to complete may not be conducive for someone with dementia.
“Those with dementia don't necessarily think in a particular order,” Stollman explained. “Utilizing the brain creatively with free-form expression is much more
Baking muffins is one example of how activities can be easily modified to still engage all residents, including those with dementia. Rather than having the resident read the recipe and perform most of the tasks, they could be asked to stir the batter in the bowl, reasoned Susan Leport, caregiving manager for Senior Helpers. “The best part of any activity is the companionship and sense of wellbeing the activity can bring,” she noted.
Distractions can make or break resident activities, reminded Charles de Vilmorin, CEO of Linked Senior: “Research shows that residents will leave or withdraw if distractions are too high.” The same is true of activities that don't adequately match interest or capabilities, he said.
Let residents lead
Great activities don't always have to be run by staff. In fact, some of the most popular have residents at the helm.
“Residents offer a wealth of knowledge, experience and talents that can really enhance activities within their own communities. Asking a resident to share of themselves and lead an activity can be a wonderful experience,” assured Seaman.
Fostering teamwork is an effective way to build camaraderie and drive resident participation.
“Give more responsibilities to able-minded residents to lead activities, or in the very least, assume a role in them. Do activities as a team and give team members t-shirts and appoint [a resident] team captain,” suggested Dennis Berkholz, founder of National Senior League Games.
Wii bowling tournaments and other team-based games, and clubs for those with shared interests, such as art, music or travel (with a resident chairing the group) are also catching on. Levindale, for example, has book clubs, cooking groups and horticulture groups, to name just a few, which allows residents to stay rooted in their interests.
Flowers are delivered to a different unit each week and residents gather to arrange them, according to Bojan. In the greenhouse and outdoor garden, residents plant, tend and harvest mint, tomatoes and flowers in raised beds. “They cook with the tomatoes and we're using the mint in their tea this summer.”
For memory care residents, Stollman stressed that special interest clubs — such as those geared toward cultural cooking, vintage cars or clothing — can be big hits with residents. “All these clubs need real-life props to enable an opportunity for peer engagement.”
Vista del Monte, a Front Porch retirement community in Santa Barbara, CA, has art-loving residents flocking to an art studio and loft where they create and display their work, and there's even a woodshop on campus so residents can stay vocationally connected. Offsite excursions keep cultural interests sharp and have run the gamut from museums and music festivals to wine tasting, community exploration, restaurant visits, and more. A new theory in activity programming, called enchantment, is also proving successful. As Hayle explained, this theory functions by creating a deeper intent around an activity to make it more meaningful to residents. Enchantment activities may include exercise classes with intent to walk five miles in a month, or community engagement with a social issue or humanitarian effort, she said.
One-on-one activities can be equally rewarding, especially if they involve engagement that honors a resident's past.
If a resident was a patriarch in the family who everyone historically sought for advice or assistance, a staff member can simply ask a resident if he or she would help with a productive activity, noted Leport. In fact, any engagement that enables normalcy and values residents as contributing members of society can help them maintain or recapture a sense of purpose and fulfillment, added Stollman.
“Normalcy also means simulating an experience or passion an individual once treasured. This could be anything from a one-on-one walk outside to holding an associate's child or caring for one of our community dogs,” she says.
Learning and self-exploration is another essential part of a successful activities program, experts say, as it fulfills the “intellectual” component of the six dimensions of wellness. Among other programs, Vista del Monte offers Spanish classes and educational slideshows, and a speaker series on various topics of interest.
A strong mix of activities allows residents to branch out into other recreational pursuits. Preferences and interests change and residents often withdraw because their preferences are no longer matched, according to de Vilmorin.
“One might assume that if Bill likes golf and the impressionists, that will never change and we should only adapt programs to his capabilities over time. That has been proven to be wrong,” he says.
Surveying and effectively communicating with residents is what keeps activities relevant and meaningful.
“You have to know your residents and always be finding new ways to meet their evolving needs,” reasons Peggy Buchanan, director of wellness and vitality at Vista del Monte. “That's how you keep them vital.” n