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The Importance of Leveled Programming in Long-Term Care. An in-service presentation for non-activities staff. Presented by: Aurora Crew & Amanda Gilkey. What is Therapeutic Recreation?.

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the importance of leveled programming in long term care

The Importance of Leveled Programming in Long-Term Care

An in-service presentation for non-activities staff

Presented by: Aurora Crew & Amanda Gilkey

what is therapeutic recreation
What is Therapeutic Recreation?

Therapeutic Recreation is a treatment service offered to clients to assist with restoring and fostering a person’s continued level of functioning and independence in life, activities, and hobbies that they enjoy.

*Promotes health and wellness

*Encourages socialization

*Reduces or eliminate the limitations and restrictions due to an illness or a disabling condition


Recreational therapists work with clients to restore motor, social and cognitive functioning, build confidence, develop coping skills, and integrate skills learned in treatment settings into community settings. Intervention areas vary widely and are based upon client interests.

Examples of intervention modalities include:

*Creative arts (crafts, music, dance, drama)

*Fitness programs/Sports

*Social Opportunties

*Spiritual interventions (church, prayer, bible study, etc.)

*Reminisce and discussion groups

why are activities important
Why Are Activities Important?

Allows residents to learn new skills

Allows residents to build on skills that they’ve practiced throughout their lives

Make new friends and interact socially

Improves Happiness

Improves quality of life

Think about your life, and some of the things you do for fun. How would your life change if you were no longer able to do any of those things due to illness or location?

Now, think of a resident that you work with frequently. What activities do they go to? Why do they attend those activities? How do they benefit from them?

why are activities important1
Why are Activities important?
  • Activities offer therapeutic and meaningful values concerning a variety of aspects in resident’s lives
  • Participating in activities offer residents the opportunity to thrive utilizing important life skills in the following categories:
    • Physical * Spiritual
    • Cognitive * Emotional
    • Social * Creative

Physical – Involves activities that promote exercise, health and well being, and encourage physical activity.

Cognitive – Activities that require residents to use their minds creatively or functionally and can include table games, reminiscing, discussion groups, or even educational programs.

Emotional– Offer residents the opportunity to recognize their emotions and to share these emotions with others, if desired. Some examples include meditation, guided imagery or discussions, and sensory stimulation.

Spiritual – Allow residents to express themselves on a spiritual or religious level, whether it be in a religious service, or a personal visit from a local church.

Social – Offer residents a chance to be around other people and talk in a social setting.

Creative – Allow residents to express themselves through a variety of creative modalities, such as art, music, cooking, or poetry.

what types of activities do we offer
What Types of Activities do we Offer?
  • Unscheduled activities take place on an everyday basis in our facility. They are not on the calendar. They are the little things that you may do with residents without even realizing that it counts as an activity.
  • Can you think of any examples of this?
    • Example: chatting in the common area for a few minutes, popping a movie or sing-along tape in, helping a resident complete the puzzle in today’s newspaper, dancing with a resident to music on the radio as you help them get up in the morning.
  • These activities have no specific location or time. They are completely spontaneous!
1 1 vs group activities
1:1 vs. Group Activities

Often times, it is more appropriate for a resident to receive 1:1 activities rather then group activities. This can occur when groups do not appear to be therapeutic for a resident, or if a resident is too disruptive in a group setting. 1:1 activities can be offered by anyone from the activity staff along with nurses, companions, housekeepers, etc.

Examples of one-on-one activities for individuals requiring this attention can include talking or reminiscing, working with a lap basket, taking a walk, looking at a photo album, listening to/playing music, reading a story, etc.


*Not all residents enjoy attending group programming

  • *Think of a resident that you know who doesn’t regularly attend group programs. Can you think of something that they do that would be considered leisure?
    • Examples: reading, watching movies, looking at old pictures, talking to family or staff members, etc.
  • *It’s okay for residents to not attend group programming as long as we are able to provide them with independent leisure materials (music, movies, books, magazines, cards, etc.), and as long as we remember to keep inviting them to programs that they may enjoy.
group facilitation quality vs quantity
Group Facilitation: Quality vs. Quantity

Many times in our lives we judge things depending on quantity. More is better. Well, in activities, it often is the case that more is not better.

Although it may seem cruel or unpleasant to not invite or include everyone in an activity, it can actually make the program more therapeutic for everyone involved.

Later, you’ll learn about the Group Program Design Tool, which will tell you more about the appropriateness of different residents for different groups.

group facilitation quality vs quantity1
Group Facilitation: Quality vs. Quantity
  • When thinking about if a resident will be appropriate for a certain activity, it is best to imagine the concept of Flow.
  • Flow is the mental state of operation in which a person in an activity is fully immersed in a feeling of energized focus, full involvement, and success in the process of the activity.
  • It is an equal balance between challenge and skill.
    • If a person has many skills in one area, and is not challenged enough, this will result in boredom.
    • If a person does not have enough skills in the area, and is therefor too challenged, this will result in anxiety.
    • Try to consider residents skills or ability to learn skills involved in certain activity to determine if the activity is appropriate for them.
which activities are appropriate for each resident
Which Activities are Appropriate for each resident?

Our residents are very diverse in many aspects of their life, including all of the categories we just discussed.

Leveled programming offers staff members the opportunity to recognize and appreciate each resident’s unique situation

Leveled programming is enforced by placing resident’s into categories to determine which activities they will benefit the most from in each of the categories previously listed.

This is determined by assessing each resident’s skill level, including their current cognitive, physical, and social conditions

leveled programming
Leveled Programming

Starting in August 2013, we will be rolling out leveled programming in Muirfield.

The purpose of this is to provide the highest quality of programs to all of our residents.

We hope to increase participation and better meet the needs of all.

Three categories showcase resident skills: level 1, 2, 3.

leveled programming1
Leveled Programming
  • There are three separate levels that resident’s are placed into:
  • Level 3 (Blue Jays): Minimum assistance with planning their day and following through with their individual leisure pursuits
  • Level 2 (Red Robins): Moderate assistance with planning their day and following through with their individual leisure pursuits
  • Level 1 (Gold Finches): Maximum assistance with planning their day and following through with their individual leisure pursuits
level 3 residents blue jays
Level 3 Residents“Blue Jays”
  • Considered “high functioning” on a cognitive level
  • Capable of sharing intellectual experiences
  • Personally seek out friendships and social interactions.
  • Have the capability to plan their day independently and to chose how they spend their time
  • Have a long attention span and can therefore, attend groups that are longer
  • Have adequate long-term and short-term memory recall
  • Are socially appropriate in group settings
level 2 residents red robins
Level 2 ResidentsRed Robins
  • Need encouragement or reminders to attend activities or complete ADLs.
  • Need prompting and cueing within groups.
  • May require assistance with completing social interactions.
  • May show some inappropriate behaviors at times, causing them to be inappropriate for group settings.
  • May have adequate long-term memory recall, but short-term memory is limited
  • Have a shorter attention span.
  • Need more 1:1 assistance within groups.
level 1 residents gold finches
Level 1 ResidentsGold Finches
  • Need maximum reminders, prompts and cueing to attend activities, and complete tasks within activities
  • Require assistance with completing social interactions, but may not be able to complete them at all
  • Display behaviors that make them inappropriate for group programming
  • Have difficulty recalling short-term and long-term memories
  • Have little to no attention span
  • Usually always needs 1:1 attention and hand-over-hand assistance in and out of group settings

Not all residents will easily fit into one of these categories

They usually will have attributes relating to two categories, but they will most likely display behaviors more appropriate for one category

It is always best to try to place the resident in a category where they will continue to thrive and receive the maximum benefits during activity programming

Understanding leveled programming should help family and staff understand why certain residents will thrive in certain levels of programming offered here at Waverly

how can you assist with leveled programming
How Can You Assist with Leveled Programming?
  • TR will keep a list of residents and their levels updated in each care base for your reference
  • Activities will be labeled for level 1, 2, or 3 on the calendar.
    • Unlabeled activities are general interest activities that anyone can attend
  • If you have any questions about who is appropriate for certain activities, please ask a member of the TR Staff.