HPR 452
Chapter 11
LEISURE AND RECREATION IN LONG
TERM CARE

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 wellbring 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’ selfesteem, 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 decisionmaking 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, workrelated and purposeful activities, movement,
nature and the outdoors, relaxation and reflection,
spirituality, personal growth, new experiences
