Leisure and Recreation in Long Term Care

1. HPR 452 Chapter 11 Leisure and Recreation in Long Term Care

2. Nursing Homes – the only alternative for older adults? • Home health care • Adult Day Care Centers • Assisted Living Facilities • Long Term Care defined… • “Assistance given over a sustained period of time to people who are experiencing long-term inabilities or difficulties in functioning because of a disability”

3. Chronic conditions • Arthritis • Hypertension • Diabetes • Etc ---What else? • Impair independence - dressing, eating, bathing, shopping, managing $$$, making phone calls, etc. (ADLs)

4. The same impairments impact social relationships and leisure activities • Lack of transportation • Long Term Care facilities vary (pg 198) • Health Model – Maintenance and improvement of physical and mental functioning • Social Model – promotes subjective well-being • “Hybrid Model” combines both – Increasingly prevalent

5. Legislative efforts affecting LTC • Omnibus Budget Reconciliation Act of 1987 (OBRA) – Quality Control in Assisted Living toward social or hybrid model of care • “Provide activities designed to meet the interests and the physical, mental and psychosocial well-bring of each resident” • Suggests the need for Hybrid Model

6. What role should a LTC facility take to improve residents’ functional abilities? Quality of life? How may such a role differ from one aimed at merely making residents’ lives more comfortable? Is the notion of Ulyssean Living applicable in the lives of older adults residing in LTC facilities? More specifically, can residents of LTC facilities grow and develop? Can they experience old age in a positive way?

7. Research has shown that activity opportunities and involvement increase residents’ self-esteem, happiness and self-concept (Quality of Life) Activity calendar example Table 11.2 pg 200 Promotes independence and individuality Promotes success and maximizes control and addressing residents’ needs

8. Relatively new concept Residents need less medical care than nursing homes Studio or 1 bedroom apts, private or shared bath, some have full kitchen or kitchenettes Approx 38,000 A.L. facilities w/ 975,000 residents (2003) Assisted Living Facilities

9. Congregate residential setting providing personal services, 24 hr supervision and assistance, activities and health-related services Designed to minimize the need to move Designed to accommodate individual changing needs and preferences Maximize dignity, autonomy, privacy, independence, choice and safety; encourage family and community involvement A.L. Facilities Common Characteristics

10. 69% are female 80 yrs old 81% need assistance with one or more ADL Avg # of ADLs they need assistance – 2.25 93% receive assistance w/ housework 86% receive assistance w/ daily medication 2003 data

11. Residential facilities licensed by the state Typically Health Model – sometimes Hybrid Primary purpose is to care for chronic conditions Typically semi-private rooms Meals in common dining area Institutional routine is adopted by residents – Morning wake up, meds, bathing, group activities, dinner at 5:00, bed between 7:00-9:00 1999 – 18,000 NHs with 1,879,600 residents Nursing Home Facilities

12. 67% are for-profit – 27% non-profit • 3 Levels of Care • Skilled nursing – intensive, 24 hr care, supervised by RN under direction of physician • Intermediate Care – some nursing assistance and supervision but less than 24 hr nursing care • Custodial Care – Room and Board with assistance in personal care but not necessarily health care services

13. Majority are female age 75 or older in need of assistance with 3 ADLs 16.4% between ages of 65-74 35.1% between ages 75-84 36.8% ages 85 and over Females outnumber males 62:38

14. Based on research…. No activity – 51.4% Engagement in appropriate non-social activities (ambulation, TV, eating) – 34% Appropriate social activities (conversation, receiving care or instruction) – 12.1% Less activity of all types on weekends Avg 217 minutes of activity per week Activities in Nursing homes

15. Need to target recreation activities for • Residents with low level of activity participation including those who receive high level of nursing care, depressed and severe cognitive functioning • Resident Bill of Rights – NHs are required by law to provide each resident with a copy of their rights – treated with respect, right to communicate with persons and groups of their choice, privacy – Bill of rights sample on pg 203

16. Increase residents’ control (at least “perceived” control) • Allow them to plan, organize, and conduct activities as much as possible • “Responsibility-induced group” study – plants and movies (personal responsibility and choice) • Those in the study group were found to be happier, more active, spent more time visiting with other residents and visiting with others from outside the institution, talking with staff, less passive, higher movie attendance Nursing Home Program strategies

17. One group • received verbal message that they were responsible for making their own decisions and for their own lives • Also told birds were having a hard time surviving and each resident was responsible for attending to the bird feeder placed on their window • 2nd group • Told staff were responsible for them and not given opportunity to care for bird feeder Another personal responsibility and control study

18. 3rd Group • No verbal message and no bird feeder • Findings = residents given responsibility experienced increased life-satisfaction, an increase in self-reported control, increased happiness and increased activity levels • Choices related to mealtime, personal care, room decoration, and encouragement of self-initiative by staff are also related to life satisfaction

19. Used w/ older adults w/ cognitive impairments or some form of dementia • Based on the assumptions • All behavior in older adults w/dementia happens for a reason • They adapt to their illness with whatever abilities remain • When short term memory is gone they resort to distant past • When language is impaired they use repetitive vocalizations and motions to communicate • These are survival techniques Validation Therapy

20. Val Therapy accepts the behavior and does not impose staff’s reality on resident Marked by respect for the older person’s feelings in whatever time and place is real to them Explores meaning and motivation for observed behavior 5 – 10 individuals in structured setting designed to stimulate energy, social interaction and social roles

21. Music, talk, movement, food Example on pg 206 Studies do not prove effectiveness but Val Therapy is increasingly widespread and accepted as effective

22. Long-Term Care Environment includes • Social Environment – characteristics, numbers, and roles of residents, family members and care staff • Organizational Culture – Norms and policies that influence the roles and behaviors of residents, family members, and care staff • Physical Environment • Recreation professionals often asked to create “social environment” Environmental design

23. Typically a physical space that has private bedrooms for 8-12 residents, living room, kitchen and access to a courtyard Cozy, welcoming, relevant and meaningful furniture, photos, mementos Reflect presence of human life, friendships, personal achievements, family events, community associations, extensions of ones identity Household model

24. Pgs207-209 • Unit Autonomy • Safety/Security • Cleanliness/Maintenance • Stimulation - (lighting,Visual/Tactile, Noise) • Socialization • Personalization/Homelikeness • Orienting/Cueing More aspects of environmental design

25. Treatment Protocols: A Focus on Dementia Care • Dementia is not a disease, it is a syndrome, a group of symptoms • Encompasses 70 different diseases or causes • 1 out of 10 Americans over 65 have some type of dementia • Half of all NH residents have Alz D or related disorder Program Models:

26. Buettner and Fitzsimmons (2003) stated that the role of the recreation professional is to provide therapeutic programs that will affect the “bio-psycho-social well-being of the client”

27. “Creation of a human habitat where people thrive, grow, and flourish, rather than wither, decay, and die” Home-Like ---animals, cats, dogs, birds co-exist Plants Children Intent to reduce of medication and increase residents’ contact with outside world 10 principles – pg 210 Eden alternative – Dr wm Thomas

28. Vs. Social Model - Family Members rather than Guests (Hospitality Model) Develop meaningful relationships among residents, family members and staff Enduring relationships, caring relationships, shared domestic space – “Family Making” (Fig. 11.4 pg 213) i.e. Staff member sitting on patio drinking tea with 2 residents discussing garden, homes, Family Model

29. Organizational Culture promotes staff, residents and family members to have a voice in decision-making and increase sense-of-belonging. Physical Space that promotes ownership and use of shared domestic space and development of caring and enduring relationships Meaningful activities – “self-motivated activities that give a sense of joy and purpose and are free of stress”

30. Diversional activities (bingo, arts and crafts, current events) offer opportunities for superficial, temporary, and short-lived pleasures Meaningful activities – socialization, family and community involvement, intimacy and touch, work-related and purposeful activities, movement, nature and the outdoors, relaxation and reflection, spirituality, personal growth, new experiences