May 16, 2014 | by I Advance Senior Care

Beyond Bingo: Activity director role evolves

Living in a long-term care (LTC) facility does not mean that the joys and experiences of life have ended. The 1975 film Rooster Cogburn has a memorable scene in which U.S. Marshal Cogburn, played by John Wayne, is “celebrating” by tossing biscuits into the air and shooting at them. When an alarmed Eula Goodnight (Katharine Hepburn) asks him what he’s celebrating in this unusual manner, the drunken Cogburn joyously shouts, “Bein’ alive, sister. Bein’ alive!”

Although the movie is fictional, it represents part of the reality for activity directors in LTC communities. The days of simply keeping residents occupied are over, and the focus has turned squarely on making sure that meaningful, person-centered activities contribute to a life worth living—and celebrating. As always, LTC communities and their activity directors are rolling up their sleeves and taking the challenge to heart.

LIFE ENRICHMENT

Percell Smith, vice president of resident loyalty at CHE/Trinity Senior Living Communities, says he believes strongly that there needs to be a transformative philosophy that moves away from the old paradigm of activity programs and toward life enrichment and facilitates a community life that embraces everyone within it. The Livonia, Mich.-based healthcare system includes skilled nursing, assisted living and independent living communities.

“We believe an activities program should be more than diversional,” Smith says. “It should be a vehicle for enriching the lives of all the residents within our communities. It should recognize and affirm them as a whole person.”

To successfully meet this goal, CHE/Trinity Senior Living Communities realized that it would need to incorporate more people into administering life-enrichment experiences at its communities. This realization led to an increased role for nursing assistants in activities.

“We recognized that, given the way most communities staff their activity departments, there was no way they were going to be able to cover enough ground to meet the interests of each and every resident,” Smith says. “So we made a decision that the regularly scheduled caregivers—the nursing assistants—were going to work with the activity director.”

As Smith explains, the activity director still does all the traditional tasks that he or she was doing, such as assessments and the creation of a calendar. But now the nursing assistants, who often are the individuals closest to the residents, can help arrange the community into “neighborhoods” of shared interests or even advise the activity director about specific one-on-one pursuits residents would like to enjoy.

“That’s a fundamental change we find quite exciting,” Smith says. “It has been exciting for the activity directors because now they don’t feel overwhelmed by having a small department that’s called to serve people with many interests, and it’s really enriching for the nursing assistants—who we now call care partners—because many of them learn things about the residents that transform them from a resident that they’re caring for into a person who has a life history and has intellectual interests and things they want to pursue.”

PROVIDE MEANINGFUL PURSUITS

Knowing your residents is the easiest way to meet their needs with activities, and the best way to know residents is to learn as much about them as possible when they enter your facility, says Kendra Howard, LPN, RACCT, Country Lane health coach at Evergreen Community of Johnson County, a 112-bed skilled nursing facility in Olathe, Kan.

“If you know what a resident’s profession was, what his or her hobbies were, what he or she enjoyed doing, you’re going to be able to meet that person’s needs activity-wise,” Howard says.

Although Howard believes that group activities are important because they bring people together, the most import aspect of activities is ensuring that people have a purpose. “We’ve really had good success by giving people the opportunity to do things they’re still capable of doing that gives them the sense of purpose they had their whole life,” Howard says.

She cites the example of a gentleman who had been a maintenance worker. “You could tell that when he got here, he just didn’t feel like he had a purpose,” Howard says. “He would walk around checking the handrails to make sure they were sturdy, checking chair legs, things like that. So we set him up with our maintenance department when they did their rounds in the morning. He’d be with them to make sure everything looked good and was working properly, and he’d go with the maintenance workers to storage to pick up supplies.”

An added bonus, according to Howard: The more engaged and more purposeful the residents are, the less likely they are to fall and be injured.

BLENDING FUN AND THERAPY

Terri Occhionero, ADC, activity director at Avon Oaks, an assisted living and skilled nursing facility in Avon, Ohio, agrees with Howard: The key is keeping residents involved in meaningful activities that they did at home and still enjoy doing now.

One activity that Occhionero is eager to share with others is Avon Oaks’ choir.

“Our music therapist discovered that one thing many people had done in the past was to have been part of a choir,” she says. “So we put together a choir, and it has been very popular. At any given time, we have between 20 and 30 residents participating.”

Occhionero notes that singing not only is enjoyable; it also helps residents breathe better.

In addition, each choir concert features four or five residents who are selected to perform a solo, which is tremendously popular with the soloists and their families.

“It’s not just about singing; it's about participating in something as a group and being involved in something they can share with their families,” Occhionero says.

Many LTC facilities have found that intergenerational activities are particularly enjoyed by their residents, and Avon Oaks has the benefit of being a rare nursing facility that also has a day care center on site. Occhionero realizes not every nursing home will have this arrangement, but she highly recommends finding ways to bring youngsters from the community into the LTC facility for visits. “The residents just love the kids, and we do everything together,” she says.

YOUNG AND OLD GROWING TOGETHER

One intergenerational activity—and one this is especially timely with summer just around the corner—is to set up a community garden. An excellent example of this can be found at the Lynnwood Senior Center in Lynnwood, Wash., where the intergenerational garden project won a 2013 Program of Excellence Award from the National Council on Aging’s National Institute of Senior Centers.

Participants and volunteers ranging from 4 to 90 years old constructed 30 garden boxes and filled them with just about anything that it’s possible (and legal) to grow in Washington, including flowers, squash, corn, sunflowers, tomatoes, spinach, kale, swiss chard, radishes, carrots and potatoes. The boxes were raised to be easily accessible to older individuals in scooters or wheelchairs.

Mary-Anne Grafton, MSW, recreation supervisor for senior programs, tells Long-Term Living she wanted to set up a garden for several reasons, including providing seniors in the city with an enjoyable activity and a source of fresh fruits and vegetables, and it also to allow them to share their knowledge with younger generations.

“Many older adult lose their ability to garden—either through downsizing or physical ailments such as bad knees—after a lifetime of experience,” Grafton says. “I think it does the whole community a disservice to put older adults in a corner and say, ‘Now we’ve provided for you.’ It seems like an unnecessary loss to me.”

Grafton also saw the community garden as an opportunity for high school students to perform community service projects. “It allowed us to pair up students with older adults, so the students could learn and the adults could engage with people of different ages from the community,” she says. “It’s a simple thing to do, and it brings people together and builds community. There has been no downside to this project. It has been all benefit.”

Grafton’s advice on starting your own community garden: Seek out others who are willing to get behind it.

“I couldn't get this project off the ground until I found another co-worker who was willing to help out, and then we received enormous help from community partners who engaged local businesses that were willing to support the project,” she says. “We had businesses that went out of their way to get us really good materials at discounted prices.”

The payoff, according to Grafton, was well worth the effort. “We had one elderly gentleman who had loved gardening, but he hadn’t been able to garden for more than 10 years,” she says. “He came by every day, sometimes just to put his hands in the soil and just connect with something that he loved and that he wasn’t able to get elsewhere in his living environment. That really moved me. The impacts from this kind of community effort can last for a long time and can really affect a lot of people.”

ACTIVITIES ADD MEANING

As Howard sums up: “I think offering activities is one of the most important things we do in an LTC setting. They keep people happy and make life worth living.” And although you might prefer that individuals don’t shoot biscuits á la Marshal Rooster Cogburn, in today’s person-centered care environment, the activities that it is possible to create to make your residents’ lives worth living are limited only by your imagination.

Resources abound for activity directors in LTC

Why do activities professionals do what they do? Perhaps that is summed up best by Lisa Ost-Beikmann AC-BC, ADC, CDP.

“I personally love the people,” says Ost-Beikmann, who is in charge of education outreach for the National Association of Activity Professionals (NAAP). “You meet so many different kinds of people, and these individuals raised families and did all they could, and now they need us to help them. There is tremendous satisfaction that comes from helping people who can’t help themselves anymore.”

Ost-Beikmann adds, however, that the role is filled with challenges—often multiple challenges in the same day. That’s why she suggests that activity professionals rely on each other for help. “There’s no greater resource than another individual who does the same thing you do,” she says. “They know it, they’ve lived it, and I think you really need peers who are in your same situation to be able to help you.”

To get that peer-to-peer interaction, as well as opportunities for training and continuing education, Ost-Beikmann encourages activity directors to consider becoming members of the NAAP. The organization's website includes information on becoming a board-certified activity professional or activity consultant.

In addition to NAAP, several other resources are of potential interest to activities professionals:

Ron Rajecki is a Cleveland-based freelance writer.

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