LEISURE AND RECREATION IN LONG TERM CARE

HPR 452Chapter 11

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”

Chronic conditions Arthritis Hypertension Diabetes Etc ---What else?

Impair independence - dressing, eating, bathing, shopping, managing $$$, making phone calls, etc. (ADLs)

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

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

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?

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

ASSISTED LIVING FACILITIES 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)

A.L. FACILITIES COMMON CHARACTERISTICS

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

2003 DATA 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

NURSING HOME FACILITIES 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

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

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

ACTIVITIES IN NURSING HOMES 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

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

NURSING HOME PROGRAM STRATEGIES 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

ANOTHER PERSONAL RESPONSIBILITY AND CONTROL STUDY

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

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

VALIDATION THERAPY 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

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

Music, talk, movement, food Example on pg 206 Studies do not prove effectiveness but

Val Therapy is increasingly widespread and accepted as effective

ENVIRONMENTAL DESIGN 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”

HOUSEHOLD MODEL 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

MORE ASPECTS OF ENVIRONMENTAL DESIGN

Pgs207-209 Unit Autonomy Safety/Security Cleanliness/Maintenance Stimulation - (lighting,Visual/Tactile, Noise) Socialization Personalization/Homelikeness Orienting/Cueing

PROGRAM MODELS: 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

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”

EDEN ALTERNATIVE – DR WM THOMAS “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

FAMILY MODEL 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,

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”

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