All Is Well—and Getting Better

It is now becoming commonly accepted: We age successfully by incorporating wellness concepts and beliefs into all aspects of our lives. Simply defined, wellness is the integration of an individual’s multiple dimensions into positive and meaningful activities. This approach to health-a comprehensive wellness model-requires a lifestyle perspective that includes self-responsibility for emotional, intellectual, physical, social, spiritual, and vocational health; an optimistic outlook; and a can-do attitude. Wellness is about adopting a whole-person health philosophy throughout your entire life.

“After about a year we wanted to see if we were ‘walking the talk’ in wellness and did a campuswide survey of residents. Overall our Wellness Report Card gave us an 86, or a high B, average, which we thought was pretty good for starters. Residents and staff said we needed to do more education about wellness, particularly in the long-term care and rehab center. Some wanted more intellectually stimulating programs. Many appreciated the greater opportunity for socialization, but some said this was limited somewhat by the physical environment.

“Food was an item of major importance, and we’ve since developed a direct dining program where food is served hot in the individual units by people who have been trained as hospitality-type wait staff. Part of this reflects that the care and rehab building is more than 30 years old and we’ve simply outgrown some aspects of the building.

“We don’t call this a nursing center anymore; it is a care and rehab center. We don’t want to be seen as a nursing home because people would have the image that it’s a place where they would come to die. We want to provide our residents with whatever they find brings meaning to their lives, recognizing that this is not ‘the end’ but rather a continuing journey.”

Some general advances that have occurred in recent years:

• Vision and Mission Statements are being rewritten to reflect a wellness focus.
• Communities are establishing a wellness culture in all departments and living areas (independent, assisted living, post-acute, and long-term healthcare).
• Wellness-based attitudes, expectations, and language are being communicated to residents and staff daily.
• Staff titles and job descriptions are being rewritten to demonstrate the community’s commitment to its wellness-based mission.
• Wellness environments are being created for both individual and group participation.
• Communities are creating wellness identities to remain competitive and progressive.

Innovation continues in programming:

• Resident-led wellness committees are guiding programming.
• Programs are being planned, on a yearly basis, to achieve an outcome or goal that relates to a wellness mission, as opposed to planning activities to fill time.
• Through effective outcome measurements, communities are recognizing that wellness is relevant to each individual, regardless of the person’s functional or mental status.
• Program names and descriptions reflect an individualized strength-based approach that emphasizes proactive and positive behaviors.
• Wellness staff are using behavior change techniques to motivate residents toward maintaining or improving their personal wellness. Information on behavior change (contemplation, preparation, action, maintenance, and relapse) can be found in the groundbreaking work of James Prochaska.^1-3

• Communities are conducting strategic planning sessions aimed at effective wellness center development.
• Those communities that are opening their wellness centers to the general public are using census tract feasibility studies to determine the appropriate membership potential and space allocation for their facilities.
• Wellness Center environments are reflecting holistic concepts with features offering feelings of openness, such as curved walls, plants, natural sunlight, artwork, open-social areas, and full-spectrum lighting.
• Space is being allotted now for meditation fountains, integrative therapy areas (e.g., spaces for massage, acupuncture, aromatherapy, etc.), multipurpose rooms with higher ceilings for modified individual and team sports, spa/salon areas, and gardens.
• Wellness-based fitness areas are increasing in size and complexity to accommodate not only strength-training and cardiovascular equipment, but comfortable seating, a wellness library, computer kiosks, stretching areas, and functional training stations.
• Universal design principles are being incorporated into all areas of future wellness centers and fitness rooms to accommodate users as they age. Examples include equipment and facilities designed to be handicapped-accessible. In general, wellness centers are becoming better adapted to the target populations they serve.

Closer attention is being paid to employing qualified, appropriate personnel for these centers:

• Colleges and universities are increasingly offering courses and certifications in senior wellness and fitness.
• Communities are staffing their wellness programs and centers with appropriately degreed and certified wellness professionals.
• Wellness staff are assessing resident wellness and fitness using national standards. Roberta Rikli and C. Jessie Jones created the Senior Fitness Test, the national standard for fitness testing in older adults. The American College of Sports Medicine also has useful standards.

Senior care in general is trending toward broader, deeper approaches to wellness:

• Larger communities and multisite organizations are creating vice-president and regional wellness executive positions, establishing quality control measures, and maintaining corporate wellness standards throughout their organizations.
• Industries such as therapy providers, dining services, and architects are offering specific wellness-oriented services and programs.
• In the future, there will be more opportunities available to people who physically cannot visit a wellness center to have access to wellness resources in their own homes-possibly via closed-circuit TV or the Internet, for example.

“Twin Lakes is located on 56 acres in beautiful Montgomery, Ohio. Three distinct campus neighborhoods offer something for everyone-from villa homes and apartments to assisted living and nursing care. Embracing a wellness philosophy, Twin Lakes encourages all residents to ‘be the best they can be’ by stimulating all six dimensions of wellness. Holding true within the wellness philosophy, associate name badges say ‘Wellness Specialist’ and give the area in which each specializes. We believe that our associates are very well versed in the six dimensions of wellness.

“The Connection is located centrally, directly across from the clinic and physical/occupational therapy areas, and down the hall from assisted living and nursing care. Long-term care residents have direct access, including wheelchair access, to the center. The two-level facility is just under 11,000 square feet. To the left of the welcome area is a spacious juice bar, with many opportunities for social interaction. Men’s and women’s locker rooms lead directly into the aquatic area, with towel service provided. A family changing room is located outside the aquatic area for anyone who may need assistance from his or her spouse.

“The second floor houses the Individual Fitness Room with performance trainers, treadmills, NuStep, and Keiser strength-training equipment, allowing stretching, standing, or sitting using pneumatic equipment; Integrative Therapy Rooms with massage therapy and reflexology; and the Movement and Education Room for various classes. Our facility is open for membership to interested individuals throughout the community who are age 50 and above.”

References
1.Prochaska JO, Norcross JC, DiClemente CC. Changing for Good. New York: William Morrow and Company, Inc., 1994.
2.DiClemente CC, Velieer W, Rossi J, Prochaska JO. A criterion measurement model for health behavior change. Addictive Behaviors 1996;21(5):555-583.
3.Prochaska JO, DiClemente CC, Norcross, JC. In search of how people change. American Psychologist 1992;47:1102-1114.