ABOUT THIS MODULE Included here you will find 10 pages of a 75 page educational module which is intended for use by nursing homes who wish to promote more social, nontraditional models of long-term care. The intent of the PEAKED project is to assist organizations in implementing progressive, innovative approaches to care that should make a significant difference in the quality of care and the quality of life for those living and working in long-term care environments. To receive the module in its entirety, please send an email to gerontology@ksu.edu with the following required information: # Name of Individual and title # Name of Organization/Facility # Complete mailing address including zip code # Telephone number # Email address A CD (or email attachment when possible) will be sent with the module along with forms to complete which will enable our project to track the number of people and hours spent reviewing/implementing these ideas. CD's will be sent free of charge to any nursing home in Kansas, and will be sent to those outside Kansas for a fee of $24.00 to cover costs of materials, postage and handling. For further information on the PEAK-ED project please email gerontology@ksu.edu. Pioneering Change Activities Education Module Promote Excellent Alternatives in Kansas Nursing Homes Table of Contents Activities Course Objectives . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .3 Pretest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Meaningful Activity . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .6 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Transforming Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Daily Pleasures Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Getting to Know You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Learning Circle Activity. . . . . . . . . . . . . . . . . . . . . . . . . .9 Think Outside the Box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Connect the Dots Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Same Old, Same Old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Calendar Analysis Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Mastering Something New . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 I’d Rather Be Fishing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Why Are Activities So Important?. . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Activity Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Adult Development Stage Theory . . .. . . . . . . . . . . . . . . . . . . . . . .17 Motivations for Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Types of Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Physical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Social . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Intellectual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Spiritual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Creative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 Ideas by Type Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 The Role of the Activity Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Regulations and Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 Keeping Their Favorites Going . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .33 SOC Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Encouraging New Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Setting Up Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Evaluation Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Don’t Get Stung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .38 Other Ideas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Animal Residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Considering Pets Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 Friendly Visitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Animal Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 Green and Growing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 Horticulture Therapy in Nursing Homes by Candice Shoemaker . . . . . . . . . . . . . . .46 Horticulture Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 Put ‘Em Together . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 Going High Tech . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .55 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56 Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57 Post-test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Pretest and Post-test Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62 Clip Art Credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65 Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66 Appendix A: Daily Pleasures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Appendix B: Getting To Know You . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 Appendix C: Connect the Dots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Appendix D: Pet Policies and Procedures . . . . . . . . . . . . . . . . . . . . . . . . 72 Course Objectives: 1. To instill an understanding of the importance of meaningful activity on quality of life. 2. To reinforce the importance of relationships and explain their necessity in meaningful activity. 3. To demonstrate the effects of individualized activity on residents and staff roles. 4. To develop an understanding of how the home’s culture impacts resident individuality and choice. 5. To highlight the importance of individualizing care plans and having all staff utilizing the plans for an activity program. Meaningful Activity Happiness is a state of activity. -Aristotle Introduction Activities are among the most important components of resident care, but in the medical model of nursing homes they may be treated as merely a way to keep people busy between clinical care interactions. Staff can be so wrapped up in providing the best clinical care that they fail to provide the best care for the whole person. In the past, with the focus being primarily on clinical care, the choice for activities was deciding to attend Bingo or not to attend Bingo. Now activity choices include trips to Las Vegas, airplane rides, and honeymoons! Viva Las Vegas A resident wanted to go to Las Vegas for her 103rd birthday. Staff at Anthony Community Care Center in Anthony, Kansas worked with the resident and her family to set up the trip. The home used some proceeds from the annual carnival and other fundraisers to send her. The staff members that traveled with her received a little help from fundraisers and donations, but also contributed funds for the trip. When she got off the plane she shouted, “Viva, Las Vegas!” What a wonderful way to celebrate 103 years of living! Flyin’ the Friendly Skies A resident from Lyons Good Samaritan in Lyons, Kansas said he wanted to go on an airplane ride. The staff discussed it and then advertised the resident’s wish. A volunteer pilot from the community came forward, and soon he was flying high! When Lyon’s Good Samaritan residents want something the facility cannot provide they advertise the resident’s desire to the community. Volunteers step up and fulfill residents’ wishes. A Golden Honeymoon A resident at The Cedars in McPherson, Kansas was preparing to celebrate her 50th wedding anniversary. Since she and honeymoon, the staff decided to give them one as an anniversary gift. She could not ambulate and had to be transferred with a lift, so going on a trip would be very difficult. The staff made arrangements for the couple to stay in an assisted living apartment. They enjoyed a wonderful dinner by candle light. After the dinner, staff members helped her into a double bed, so she and her husband could spend the night together. While these are special activities that cannot be facilitated every day, the individuality, autonomy, and creativity can be replicated, in various ways, throughout the day for each resident. Individuality and spontaneity are needs that have typically been maintained by family members and friends. Activities are a great way for caregivers to begin fulfilling these needs and improve residents’ quality of life. A study by Kane (2001) identified eleven domains associated with quality of life. The domains include: safety, security and order, physical comfort, enjoyment, meaningful activity, relationships, functional competence, dignity, privacy, individuality, autonomy and choice, and spiritual well-being. Many of the domains identified can be directly enhanced by activity. Throughout this module many of the domains will be discussed in relation to activity programs. Kane (2004) suggested a stronger correlation between the number of people on the activity staff and resident quality of life than between the number of nursing staff and resident quality of life. This indicates that activities have a huge potential to change and enhance the lives of residents. This module, as past modules, is an opportunity for administration and leadership to share concepts with staff members through case studies, examples, activities, discussion questions and projects that can be implemented and evaluated. Transforming Activities To begin the transformation of activities, it is necessary to define meaningful activity. Meaningful activity is when “residents engage in a discretionary behavior, either active activity or passive observation that they find interesting, stimulating, worthwhile. Conversely they are not bored” (Kane, 2004). Each resident should have the opportunity to be involved in activities of interest to him or her. This involvement could be in the form of participation or enjoyment through watching others. Staff may think that residents already have such opportunities. The difference between the choice to participate in an activity versus a meaningful activity comes from an understanding of each resident and what gives him or her pleasure or fulfillment. Without a true knowledge of each person, the relationships necessary to provide meaningful activity cannot be developed. This knowledge has to include a resident’s preferences, hobbies, interests, past occupations, goals, dreams, and other personal history. There are many ways to learn about residents. An idea from Action Pact is called Daily Pleasures (personal communication with LaVrene Norton on February 25, 2006). This interview tool helps staff learn what residents enjoy having or doing on a daily basis. Norton suggests, “The key is taking the resident back to when they were living at home.” This enables residents to mention pleasures from home including those they consider impossible in a nursing home. Some of the pleasures discovered through the interview will be small, like “Having a cup of coffee in my pajamas every morning,” while others will be more complex and require more planning. After the interview is conducted, a group of staff members and residents brainstorm about how these pleasures can be attained. A copy of the directions and interview questionnaire and be found in Appendix A at the end of this module. Daily Pleasures Activity Take a moment to list the daily pleasures of the people in the staff learning group. It might be necessary to share some ideas to get the group started. Ideas might include a certain kind of perfume or a type of food. List the responses given. Once you have a list, ask if each item would be possible in the nursing home. If something listed is not currently possible, brainstorm ideas about how this pleasure could be facilitated in the home. Getting to Know You Most nursing homes use activity assessments that ask questions about hobbies, interests, how the elders like to spend their time, and their preferred schedule. Assessments such as these help develop an understanding of the elders’ preferred lifestyle. This information helps assure the day goes according to the resident’s plan and not one set by staff. In Appendix B of this module there is a sample “Getting to Know You Questionnaire” that is very comprehensive. It contains in, addition to the basics, questions like “Is there something you would like to learn?” and “What is something you never got to do that you wanted to?” Questions such as these will offer further insight about residents. No matter how staff goes about getting the information about what residents enjoy, the important thing is to do it! Most elders are not going to ask for things or make their interests known unless staff offer the opportunity. Staff need to listen and observe carefully because the information may be presented subtly. Family members or friends are a valuable source of information about residents’ past preferences and interests as a supplement or if elders cannot provide this information themselves. Another way to gauge interest is to observe the residents to see if they seem engaged with an activity or if they are sleeping, focusing their attention elsewhere, or being disruptive. The body language of a resident during activities gives clues about the types of activities the resident enjoys. Observing the items in a resident’s room may provide insight as well. The information received from residents, family members, or observation should be shared, so all staff members have an opportunity to get to know the resident. Staff will probably find they enjoy the conversations as much as the residents! This information should be used in care planning to develop an activity program for the individual resident. Collecting information about a resident once is not enough. People change, and the residents’ desires will need to be constantly updated to reflect their changes in preferences and ability. As relationships develop, elders may open up and share more. The care plans need to reflect changes as well as new information to allow the activity plan to continue to be life enhancing. Learning circles are a wonderful way to gather information and provide opportunities for a group to continue learning about one another. The learning circle can be a powerful tool in the home for learning about each other, making decisions for the home, and building a team. To facilitate a learning circle someone will need to be the leader. This person will state the question or problem. He or she will give his or her response and then ask for a volunteer. The persons on each side of the volunteer will determine which way the conversatio n moves depending on who would like to share next. Each person in the circle has an opportunity to speak without being interrupted by anyone. If the person does not want to share they may say “pass”. After everyone in the circle has had a chance to contribute, those who passed are given a second opportunity. After everyone who wants to has given input, the group opens up for discussion. This tool gives everyone the opportunity to share and puts everyone on the same level, so participants feel comfortable. The learning circle is a very simple concept but is invaluable in knowing residents and creating home. Learning Circle Activity Using the instructions above form a learning circle. Make sure everyone in the group understands the rules. You might want to begin the learning circle with a question to help participants become better acquainted. For example, “If you could invite one person to a dinner party who would it be and why?” The depth of this question depends on the level of comfort within the group. Now have the group answer the following question about the activity program. “What do you think the outcome will be when activities are individualized?” You may wish to add more questions depending upon the group’s discussion. Think Outside the Box One of the goals of this module consistent with all culture change principles is out of the box thinking. Persons providing meaningful activities within a nursing home environment, whether they be paid activity professionals, front-line staff, volunteers or others, have to think outside of the box! In homes with consistent staffing where relationships between caregivers and residents are strong, staff can begin to recognize the individual related to day-today living within the resident community. In this environment traditional activities like Bingo and reminiscing become less significant, and a quiet moment for Bible study and prayer or preparation of a midnight snack become more so. In a culture change environment unscripted moments, like reading a family letter or styling the resident’s hair, are recognized as activities and are therefore worthy of being recorded. Connect the Dots Activity This activity is designed to encourage staff to think outside the box. Give each person a copy of the connect the dots worksheet located in Appendix C of this module. Ask them to connect all of the dots by drawing four straight lines. Tell them they cannot lift their pencil off of the paper or retrace any of the lines, but the lines may cross. Have them turn their paper over when they have finished. Allow 3-5 minutes for drawing. Once the time is over ask if anyone has the solution. If not, show the solution located in Appendix C. Spend a few minutes discussing the activity. Write down a few of the responses to the following questions, so they can be revisited if the concept needs to be refreshed in staff’s minds. Why did most of us not think of going outside of the lines? I’d Rather Be Fishing Activities are of little value if they are not meeting the needs of the residents. Even the most exciting and creative activity loses its luster if the residents have no interest in participating. One resident might want to play golf while another may just want to spend the day at the local fishing hole or even watching old movies. Remember, what one resident finds enjoyable another might find miserable. Care must be taken to ensure that residents are not forced to participate in or disturbed by activities they do not enjoy. Case Study: Living to the Music Mary never responded to anything going on around her. She just sat looking blankly out the window of her room. Staff members always brought Mary out to the living room for group activities, but she was never engaged. She just sat there, in her own world, waiting for time to pass. No one had ever heard Mary speak. One day Mary was still in the living room when another resident’s granddaughter began to play an old hymn on the piano. Out of nowhere Mary came to life and began to sing along. She knew all of the words and never missed a beat. She even moved her body with the rhythm of the music. The activity director (AD) decided that Mary would be a wonderful candidate for music therapy. She pulled out all of the educational materials she had on the subject. One piece suggested playing music frequently around the resident to keep him or her engaged. The AD brought a radio into Mary’s room and turned it on. Mary smiled as she swayed to the music. There was one problem...Mary’s suite mate Ida had never liked music. She always thought of it as noise. Having the radio playing in the room was so distracting that she could not even concentrate on her scrapbooking. Ida was glad to see Mary coming out of her shell but hated that her quiet retreat had turned noisy. List a few options the AD has for making sure both residents are able to enjoy their leisure time and their private space. When the individual needs of two or more residents are conflicting, how could you negotiate a positive outcome for all?