PART 4, By Susan Misiorski

Susan Misioriski

Susan is the National Director of PHI’s Training and Organizational Development team.

Elders interviewed regarding what matters most to their quality of life named four primary themes contributing to a meaningful living experience in the nursing home: competent staff who meet their individual care needs; freedom to make personal choices; relationships in which each person is able to both give and receive; and opportunities for meaningful activity.

In this last of a four-part series on what matters most to elders living in nursing homes, we’ll focus on engaging in meaningful activity. [Read also: PART 1 | PART 2 | PART 3]

When interviewing elders living in some New Hampshire nursing homes, consistent opportunities to engage in meaningful activity was named as one of the highest priorities to elder quality of life. Historically, residential care settings have engaged in a fairly formal, organized approach to activities. This formal approach has typically included the creation of monthly activity calendars that offer a schedule of group activities elders are invited to attend.

While elders certainly look forward to some of these group activities, alone these large group options are not enough to eliminate boredom. The Eden Alternative® –a well established approach to nursing home culture change– describes boredom as one of three plagues that accounts for the bulk of human suffering (the other two plagues are loneliness and helplessness). To combat boredom, it is very helpful to step back and look objectively at the living environment.

Here are some tips on what to observe:

• In a 24 hour day, how much time is each person spending engaged in something meaningful to them?
• During group activities, what are the elders who chose not to attend doing?
• Are elders sitting in hallways?
• Are elders asleep/slumped in their chairs?
• Are elders lined up outside the dining room waiting for meals?
• Do the activity staff bear sole responsibility for activities, or is activity a responsibility of all?
• What is the level of activity in the home in the evening after the supper meal is finished?
• What opportunities exist for activity on weekends?
• How often can elders leave the home?
• How are elders involved in designing activity options of greatest interest to them?

A Home Filled With Spontaneity

Creating a home filled with spontaneity is foundational to transforming nursing home culture. Homes that have created a high involvement process toward activity are offering us some excellent examples of what is possible with strong teamwork among elders, families, volunteers, and all staff. Perhaps most important to this teamwork is the involvement of elders themselves, as only the elder can best determine how they want to spend their time.

At Harris Hill in Concord, NH, the elders have created their own happy hour. There is a small bar area adjacent to a dining room where residents gather in the early evening to simply enjoy each other’s company along with a cocktail if they choose. There is no formal activity—the elders generate their own fun spontaneously. Sometimes they play games, they share jokes, they talk with each other, they laugh together.

In other locations, we are seeing elders who are able to participate in household happenings—setting the table, clearing dishes, folding laundry and sweeping the floor are examples of things some elders find familiar and pleasant.

A recent facebook posting by the Green House Project® offered an excellent example of how far we can “push the activity envelope” with some creativity and persistence. Residents of the Leonard Florence Center for Living in Chelsea, MA, took a vacation to Disney accompanied by staff!

I have been very encouraged by the exciting ideas emerging from homes that have made eliminating boredom a high priority. If you have a story you would like to share about how you have infused spontaneity into your home environment, please reply to this post and share your great ideas!