I came across a recreation assessment form in which a resident wrote: “Please don’t throw balloons at me!” Nothing else. No favorite hobbies, no where I grew up, what I like to be called, or favorite foods. Why would a resident have requested that? It raises a critical concern around respect and dignity in programming.
A recent review of programming in care homes found no compelling evidence that existing interventions are reducing loneliness (Victor, 2012). Recreation staff work hard and are given the important role of addressing the social and emotional well-being of residents in their care. Loneliness however, continues to be an epidemic and simply placing residents together in an activity neither reduces loneliness nor promotes a sense of belonging (McLaren, Gomez, Bailey, & Horst, 2007). Furthermore according to Katz (2000), non-stop activity programming can in some ways mask emptiness of meaning.
Balloon Throwing Programs in Long-Term Care
A study examining quality of life indicators in long-term care, included integrated the opinions of residents and their families. One of the top three indicators was being treated with respect (Robichaud, Durand, Bédard, & Ouellet, 2007). Balloon throwing is an example of a recreational and physical activity common in care homes. So why would a resident write “Please don’t throw balloons at me”? Even though no follow-up notes were made on the assessment form, it is significant because if one elder had that concern, there are likely more that share it.
I believe it is not because there isn’t a place for balloon throwing as part of an exercise program or as something fun to do with visiting children. It is the intention with which the program is carried out. However, activities can supersede meaning and become regular token programs. It is almost impossible for someone (especially those with advanced cognitive impairment) not to react, when a balloon is thrown at them.
Although it can be argued there are physical and social benefits for residents to participate in balloon throwing, I believe we should question the impact it has on resident’s dignity. Merely reacting to a balloon neither results in improved quality of life or addresses social or emotional needs.
Non-Stop Activity Programming: Why We are Keeping Residents “Busy”
The issue of dignity and respect is complicated by the drive for non-stop activity programming. Activity calendars are often filled with a multitude of social events and entertainment. There is a reason for this. Katz (2000) stated it seems to be unprofessional to even ask the question, but why do we schedule non-stop activities in long-term care homes? We do this in assisted living and retirement homes and even adult day centers as well. Even though this is not something people do in their own day-to-day lives.
There is a demand from our society (therefore from home administrators and others), that we keep elders busy. When family come to visit they want to see their loved one occupied. This demand furthers the notion that simply being at an activity equals better quality of life. So recreation staff are compelled to demonstrate that there are seven full days of activities scheduled and that all those in their care attend as many of them as possible. All of this can drive meaningless activity programming and documentation of an artificial quality of life as evidenced by attendance statistics.
A Shift in Focus and Four Questions to Ask
I believe we need to rethink recreation for seniors. To shift our focus from what we can do for them and to them, to how we can help them help one another.
Gruenewald (2012) talks about this issue using a concept called Generativity. Generativity is something which involves contributing to the well-being of others and provides feelings of being useful and needed (Gruenewald, Liao, & Seeman, 2012). Not contributing or helping others results in increases of impairment of activity of daily living (ADL’s) or even death. Whereas the health benefits of helping others are tremendous (Vaillant, 2007). Mutual support groups are an excellent format for engaging residents with one another on a meaningful basis.
Here are four questions we can ask as we set about planning programs and completing tasks in our work day. But not just the recreation staff—all staff including care staff, maintenance, administration, kitchen and housekeeping and the volunteers. These questions were initially proposed by Dr. Bill Thomas and are revised:
1. Can a resident do this on their own if I ask them?
2. Can a resident do this if I give them a little help?
3. Can a resident help me while I do this?
4. Can a resident go with me while I do this?
Let us help them, help one another – their health depends on it.
Kristine Theurer, PhD
Founder, Java Group Programs
References
Gruenewald, T. L., Liao, D. H., & Seeman, T. E. (2012). Contributing to others, contributing to oneself: Perceptions of Generativity and health in later life. The Journals of Gerontology: Psychological Sciences, 67(6), 660-665. doi: 10.1093/geronb/gbs034
Katz, S. (2000). Busy bodies: Activity, aging, and the management of everyday life. Journal of Aging Studies, 14(2).
McLaren, S., Gomez, R., Bailey, M., & Horst, R. K. V. D. (2007). The association of depression and sense of belonging with suicidal ideation among older adults: Applicability of resiliency models. Suicide and Life-Threatening Behavior, 37(1), 89-102.
Robichaud, L., Durand, P. J., Bédard, R., & Ouellet, J.-P. (2007). Quality of life indicators in long term care: Opinions of elderly residents and their families The Canadian Journal of Occupational Therapy, 73(4), 245-251. doi: 10.2182/cjot.06.003
Vaillant, G. E. (2007). Generativity: A form of unconditional love. In S. G. Post (Ed.), Altruism and health (pp. 219-229). New York, NY: Oxford University Press.
Victor, C. R. (2012). Loneliness in care homes: A neglected area of research? Aging Health, 8(6), 637-649. doi: 10.2217/ahe.12.65