Activities & Recreation 101

1. Activities & Recreation 101 An in-service presentation for non-activities staff Written by: Aurora Crew, CTRS

2. Activity Basics: Why are Activities important? • When residents move to a long-term are community, they are moving there because something in their life stops allowing them to take care of themselves independently. • Certain aspects of long-term care can be appealing to residents: • Food and dining experiences • Housekeep Services • Maintenance • Décor and grounds keeping • On-site medical services • Activities • Residents are encouraged to become involved in most of their interests in the comfort of their new, supportive home environment.

3. Activity Basics: Why are Activities important? • Activities are proven to have therapeutic value in a number of different aspects of resident’s lives, including: • Physical • Cognitive • Social • Spiritual • Emotional • Creative

4. Activity Basics: Why are Activities important? • Activities also allow for residents to learn new skills, or build on skills that they’ve practiced throughout their lives. • They are encouraged to make new friends and interact socially. • In general, you can say that activities make most residents happier and improve quality of life.

5. Activity Basic: Who benefits from activities? • Everyone benefits from some sort of recreation or activity. • 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?

6. Activity Basics: Who benefits from activities? • 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.

7. Activity Basics: What types of activities do we offer? • Physical – any activity that has to do with the body. This includes exercise classes, sport games, or health classes • Cognitive – these groups challenge residents to think in different ways. Many times these groups can be games, discussion groups, or even educational programs. • Emotional – these programs give residents the chance to recognize their emotions and potentially share with others. This can include meditation, guided imagery, sensory stimulation, or discussion groups. • Spiritual – These groups are places where residents can express their spirituality. Depending on the resident, this may be through a religious service, or may go hand-in-hand with one of the emotional groups. • Social – These groups allow residents an opportunity to socialize with one another. • Creative – these activities are any group where a resident can express themselves. This can be through art, music, cooking, or writing, but can really be anything that makes the resident feel creative.

8. Activity Basics: What types of activities do we offer? • Activity: You will receive an activity calendar and some markers. Use the markers to highlight the different types of activities on the calendar: • Physical – Yellow • Cognitive – Pink • Emotional – Orange • Spiritual – Green • Social – Blue • Creative - Purple

9. Activity Basics: What types of activities do we offer? • Activity Follow-up: • See the variation in programming offered? This is so that there is “something for everyone”. • Did you have any trouble trying to lump some activities into one category? This is probably because some activities have more than one category. They may be cognitive and physical, spiritual and emotional, creative and emotional, cognitive and social, etc.

10. Activity Basics: What types of activities do we offer? • We also offer programs that are considered empowerment programs, where residents are encouraged to voice opinions and make decisions. • Sometimes empowerment programs can include making decisions or forming opinions about the world, the facility, or even themselves. • What are some empowerment programs that you see on the calendar?

11. Activity Basics: 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!

12. Group Facilitation: The Whole Community Approach • What is meant by the whole community approach? • Everyone should take responsibility for helping residents enjoy activity programming. • This could mean: • Assisting in the planning of an event or activity • Attending an outing or special event • Helping to set up for an activity • Suggesting a resident for an activity you know they’ll enjoy • Implementing the IEA approach

13. Group Facilitation: The Whole Community Approach • What is IEA? – Invite, Encourage, and Assist! • Inviting residents involves visiting with them, talking to them about activities they may enjoy, and inviting them to attend. Invite Encourage Assist

14. Group Facilitation: The Whole Community Approach • Encouraging residents involves persistence. If you think that a resident will be interested in an activity or has enjoyed an activity before, but he or she says “no” the first time you ask, gently try again. Remind the resident how much he or she enjoys the activity, or ask about some aspect of the activity that relates to the resident’s background or interests.

15. Group Facilitation: The Whole Community Approach • Tips for a successful IEA exchange: • Act like the activity is the most fun activity on the calendar. • Know the activity • Have a reason why they should attend • Get on their level (kneel or bend down). • Use compliments • Use humor • Let them know they are needed • DO NOT bring a resident to an activity without asking them • DO NOT bring a resident to an activity if they turn down your invitation

16. IEA Activity • Take a look at your activity calendar. • Choose 3 activities from the calendar and circle them. • Now write down three reasons why residents may want to attend those activities. • Share your answers with the group! • This type of thinking will help you get in the mind set for inviting residents to future activities within the facility.

17. Group Facilitation: Choose an Activity • There may be times when you are asked to help plan an activity, or even to lead an activity yourself. So now that you know how to get residents to your activity, you need to figure out which activity to do! • Sometimes activities will already be on the schedule. In that case, the activity director will give you any materials and instructions you need to facilitate the program. • Other times, it may be up to you! • Think about what the residents enjoy. • Think about what you enjoy – it helps if you are comfortable with the chosen activity and know what you’re doing. • The activity director is here to help you adapt any hobbies that you have to better serve the resident population.

18. Group Facilitation: Quality versus 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.

19. Group Facilitation: Quality versus Quantity • Scenario: Mary has severe dementia and believes that she is 22 years old. She calls out often for her parents and her husband who she married at the age of 20, but who is now deceased. Mary believes that the year is 1928, and that she is just a visitor in this beautiful home. One day, Mary is invited to the Current Events group which contains most of the higher functioning residents in the building. In the group, the leader reads selected news articles and the residents, most of whom already have an understanding of the issues, comment on them. It is a discussion group. How do you think Mary will react in the group? How will the other residents react toward her?

20. Group Facilitation: Quality versus Quantity • Discussion: Mary will probably be even more confused in this group. She is unaware of the current political world, and being in this group may make her feel more confused, anxious, or even stupid. As a result of her confusion and anxiety, Mary may start to call out or make inappropriate comments. Now the integrity of the group has been compromised for everyone involved.

21. Group Facilitation: Quality versus Quantity • Closed Groups- Sometimes a group will be considered a “closed group”. While we try to be as inclusive as possible, there are some times when a group is working toward a goal together, and it’s not fair to have outsiders or beginners start once the others have already started. In these cases, the group will be in a cycle when there will be a designated time for new residents to join in, but the rest of the time will follow a list of residents for attendance.

22. Group Facilitation: Quality versus 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.

23. Group Facilitation: Time • Most activities have a set time of 30, 45 or 60 minutes. However, there are many things to take into consideration when deciding on how much time you should allot. • Is there enough time to complete the activity? Residents may feel rushed or anxious if there is not enough time. • Will the activity be over in time for important resident events like meals? • Will the residents get bored if the activity goes on too long? • Some residents may have a hard time focusing for long periods of time if they have certain diagnoses. • Residents with dementia have a hard time focusing on activities that are longer than 15-20 minutes.

24. Group Facilitation: Space • When choosing where to have your activity, there are a few things to consider: • Is the room big enough to fit everyone in the group? • Is the room too big? • Is the room bright enough? • How is the volume of the area where you are having your activities (echoes, outside noise such as office activities, televisions, etc.) • Does the activity need to be in a private setting (Spiritual programming, resident council meeting, discussions)? Or is it okay to be held in a more public or open setting?

25. The Group Program Design Tool (GPDT) • The Group Program Design Tool is a tool used in Recreational Therapy to ensure that there are an appropriate number of groups for all of the different residents that we have in our building. In order to ensure this, we give the residents a “Level Rating”.

26. GPDT • Level 3 Residents: • Considered “high functioning” on a cognitive level. • Seek out intellectual experiences. • Seek out friendships and social interactions. • Capable of planning their day independently with minimal to no reminders to attend/complete day-to-day activities or ADLs. • Have a longer attention span, and can attend groups of about an hour or more. • Have good long-term and short-term memory recall. • Are socially appropriate in group settings. • An ideal group setting for this person would be a higher functioning group (discussion group, group that promotes creativity, etc) that would last between 45 minutes and an hour, and a group size of 10 to 15 people.

27. GPDT • Level 2 Residents: • Need encouragement or reminders to attend activities or complete ADLs. • Need prompting and cueing within groups. • May need assistance with completing social interactions. • May show some behaviors that make them inappropriate at times within a group setting. • May have good long-term memory recall, but short-term memory is compromised. • Have a shorter attention span. • Need more 1:1 assistance within groups. • An ideal group setting for this person would be a group that will challenge the resident intellectually, but will not be so challenging as to embarrass the resident or make them anxious. Group size should be between 5 and 10 residents, and groups should last 30-45 minutes.

28. GPDT • Level 1 Residents: • Need maximum reminders, prompts and cueing to attend activities, and complete tasks within activities, and also with ADLs. • Needs assistance with completing social interactions, but may not be able to complete them at all. • Show behaviors that make them inappropriate for group programming. • Have difficulty recalling short-term and long-term memories. • Have extremely short attention span. • Usually always needs 1:1 attention in and out of group setting. • An ideal group setting for this person would be a 1:1 or very small group setting with a lot of sensory stimulation rather then discussion. Group size should be between 2 and 4 residents or 1:1, and length of the program should be 10-25 minutes.

29. GPDT • Not all resident will fit cleanly into one of these categories. They usually will be have aspects of two categories, but we have to categorize residents based on the category that they mostly fit in. Knowing about the GPDT should help you to understand more about why certain residents are appropriate or not appropriate for some of the different groups offered here.

30. Activities for Residents with Dementia • Considerations • Keep programs short, meaningful, and have few participants to ensure the most therapeutic outcomes and reduce behaviors associated with dementia. • Get on “their level”, meaning that you should sit, or be at eye-level with the residents during the group. • Don’t Argue. Residents displaying certain behaviors may disagree with your or argue. Avoid arguing by redirecting or restating your information in a different way. • If a resident becomes physically aggressive, remove other residents and yourself from the situation immediately. If you need to calm the resident down, calmly ask another staff person to assist. Do not go near the resident yourself, as you may be the reason why they are acting aggressively. • Be aware of the residents in your group and their different behaviors. Remember that it always helps to have a second pair of eyes, ears and hands, especially during groups that involve supplies that could be ingested or hurt the residents in some way (cooking, arts & crafts, etc). • Although it may seem boring to us to do the same thing every day, residents with Dementia benefit most from a routine, so it’s best to schedule similar activities at similar times of day.

31. Activities for Residents with Dementia • Considerations for conversing with residents with Dementia: • Speak clearly and at a volume that they can hear. Try to avoid shouting, as some residents who are not hard of hearing may find this insulting. • Always approach a resident from the front. Never approach a resident from behind, as it may confuse or scare them. • Be aware of touch and personal space. While some residents enjoy a hug or pat on the back, others do not. Do not touch a resident unless you have enough of a relationship with the resident to know their preference. Remember, “personal space” for most people is three feet. • Do not use phrases such as, “Don’t you remember?” or “I told you before”, because most likely they do not remember what you’ve said to them.

32. Activities for Residents with Dementia • Validation Therapy Vs. Reality Orientation • Validation therapy validates or recognizes what the residents are feeling, whereas reality orientation revolves around making the residents aware of their current surroundings. • Putting yourself in the place of the resident vs. bringing the resident to where you “are”. • Reality Orientation is an outdated form of therapy that is rarely used anymore when dealing with dementia. It is found to make people with dementia feel unsafe, insecure, and exhibit more behaviors. • Validation therapy is proven to make people with dementia feel safe, secure, loved, and to reduce behaviors.

33. Activities for Residents with Dementia • Validation Examples: • A resident tells you she needs to go home to her mother. • The correct response is not, “Your mother died years ago.” You would instead approach with, “Tell me about your mother. Are you close with her? You must miss her.” • A resident tells you that they are sad because they can’t remember anything. • With reality orientation, you may “blow off” the resident by saying, “It’s okay, you don’t need to remember anything here.” With validation… empathize!!! “That must be a terrible feeling. Do you want to talk about it?” • Always recognize that a person’s emotions are real and shouldn’t be trivialized.

34. Activities for Residents with Dementia • One-on-Ones vs. Group Activities: • Sometimes its appropriate for a resident to receive 1:1 activities rather then group activities. In fact, there are times when group activities are not therapeutic at all for some residents. One-on-one’s can be done by anyone from the activity staff to the nurses to the housekeepers. • Ideas for one-on-one sessions for individuals with dementia include: working with a lap basket (see below), working with life skills stations (see below), taking a walk, talking/reminiscing, looking at a photo album, listening to/playing music, and so many more.

35. Activities for Residents with Dementia • Life Skills Stations • Life Skills Stations are areas stationed around the floor or unit, where residents can go to work on things that are familiar to them, or things they have done throughout their lives. These stations can include the nursery, the office, the garden center, the vanity, the laundry room and the kitchen. • These stations are specially designed areas that give residents an opportunity to practice familiar, every day tasks, alone, with each other or with you!

36. Activities for Residents with Dementia • Lap Baskets • Lap baskets are bins or baskets filled with items that remind residents of their lives, and activities to do. They may include yarn for the avid knitter, cards & poker chips for the card shark, postcards for the world traveler, family pictures, and much more. We build and improve upon these baskets with the help of the residents loved ones. • Use the baskets to engage residents during down time, to calm them down, or have them show off to other residents like show and tell.

37. Activities for Residents with Dementia • Sensory Stimulation Kits • While it’s nice to stimulate the senses through scented lotions, soothing music, entertaining DVDs, etc., most sensory experiences should be themed. This makes the experience less random and definitely more meaningful for the residents. Themed Sensory Stimulation kits stimulate all senses: sight, sound, smell, touch, and taste. Currently we have the following kits: Cooking, At the Beach, Americana, Movie Theatre, Weddings, and In the Garden.

38. Comments? Questions?

39. About the Author Aurora Crew, CTRS, has worked with seniors for over ten years in skilled nursing, assisted living, memory care, senior centers and in their homes. She has a B.S. in Therapeutic Recreation, and currently works as the Director of Therapeutic Recreation at Waverly Heights, Ltd, a CCRC in Gladwyne, Pennsylvania. She also serves as the Pennsylvania Member at Large for the New Jersey/Eastern Pennsylvania Therapeutic Recreation Association (NJ/EPA TRA), is the committee chair for the PA TR Licensure Committee, and sits on the board for the Temple University Therapeutic Recreation Program Advisory Committee. She is currently pursuing her Masters of Science in Recreation Therapy at Temple University, and is focusing her studies on research and geriatric care. Aurora guest lectures at Temple University and at long-term living facilities in her area. You can contact her at aurora.crew@waverlyheightsltd.org.