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May 2006

Activities and Creating a Resident-Directed Culture

Residents in Long-Term Care need to receive care and/or services to maximize their highest practicable quality of life. However, defining “quality of life” has been difficult as it is subjective for each person. It is important for the facility to conduct an individualized assessment of each resident to provide additional opportunities to help enhance a resident’s self-esteem and dignity. 

Research findings and the observations of positive resident outcomes confirm that activities are an integral component of residents’ lives. Residents have indicated that daily life and involvement should be meaningful. Activities are meaningful when they reflect a person’s interests and lifestyle, are enjoyable to the person, help the person feel useful and provide a sense of belonging. (2)

The relevance of the activities to the residents must be considered. Research indicates residents want a variety of activities, including those that are not childish, require thinking (such as word games), are gender-specific, produce something useful, relate to previous work of residents, allow for socializing with visitors, are participatory in community events and are physically active. The study found that the above concepts were relevant to both interviewable and non-interviewable residents. 

Today some culture-changed homes might not have a traditional activities calendar and instead focus on community life to include activities. Rather than having an Activities Director, some homes have a Community Life Coordinator, a Community Developer or another title for the individual directing the activities program. (4)

For more information on activities in homes changing to a resident-directed culture, the following web sites are available as resources:
www.pioneernetwork.net
www.culturechagnenow.com
www.qualitypartnersri.org
www.edenalt.com

Definitions

  • Activities refer to any endeavor other than routine ADL’s in which a resident participates that is intended to enhance her/his sense of well-being and to promote or enhance physical, cognitive and emotional health. These include, but are not limited to, activities that promote self-esteem, pleasure, comfort, education, creativity, success and independence.
  • One-to-One Programming refers to programming provided to residents who will not or cannot effectively plan their own activity pursuits, or residents needing specialized or extended programs to enhance their overall daily routine and activity pursuits.
  • Person appropriate refers to the idea that each resident has a personal identity and history that includes much more than just his or her medical illnesses or functional impairments and that activities should be relevant (as much as possible) to the specific needs, interests, culture, background, etc. of the individual for whom they are developed.
  • This term Person appropriate has been endorsed by the Alzheimer’s Association as a replacement for age-appropriate. The rationale includes the desire to consider individual preferences instead of instituting blanket policies.
  • Program of activities includes a combination of large and small groups,
    one-to-one and self-directed activities as well as a system that supports the development, implementation and evaluation of the activities provided to the residents in the facility.

These are typical aspects of the activities program.  However, this does not mean every facility needs to offer every type of activity. Rather, the facility should base its range of programming types on the interests of residents. 

(2) (4) – CMS Survey and Cert Ref:S&DC-06-09

The activity programs you put in place at your facility will need to be based on the residents’ comprehensive assessment. The information you gather from the assessment needs to be specific enough for the facility to develop a care plan to meet the residents' interests and to be able to understand what specific adaptations and assistance are needed. When assessing the resident, the staff should note what the resident would like to do and if there are any adaptations needed. You should note their lifelong interests, spirituality, goals and life
roles as well.

The information you obtain from the individual assessment is to be used to develop the activities components of the comprehensive care plan. The objectives should be measurable and focus on the residents’ desired outcomes. Remember, all relevant departments must collaborate—not just the activities department. Activities can occur at any time, not just during formal activities provided by the activities staff. The assessment should be completed by or under the supervision of a qualified professional. 

Questions you should be asking on admission:

  • What are the resident’s life long interests?
  • What does the resident prefer?
  • Are adaptations needed?

CMS Survey and Cert-Ref:S&DC-06-09

Phyllis Bouley, LPN
Clinical Project Consultant, Briggs® Corporation

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