CASE STUDY

ORGANIZING PATIENT ACTIVITY SERVICES

IN AN EXTENDED CARE FACILITY

Possible Solutions to Problems and Discussion:

1.

What are the specific activity needs of nursing home patients; and how can a well planned activity program meet these needs?

Discussion:

All human beings--young or old, at home or in nursing homes--need and use special activities to maintain morale and improve the emotional and social tone of the environment. This is particularly true in a nursing home situation where an absence of physical and social activity can contribute to the rapid deterioration of a patient's health.

The daily life of the patient in a nursing home can be more meaningful if there is an effective program of activities at his disposal. This program must not only be interesting and applicable but take into consideration the following factors:

a.

C.

d.

e.

f.

The aged and infirm are not children but have sometimes lost
interest in activities and must be encouraged to participate.

Nursing home patients can learn new skills, but activities must be geared to their pace because they are usually apprehensive about their ability to learn new things.

Many nursing home patients must be reassured, and often taught, that recreation is just as respectable and dignified as work.

With continuous stimulating leadership, a nursing home patient can be kept in the main stream of activity within the home and thus limit the tendency to withdraw and become overly concerned with his own illness and disability.

The nursing home patient must maintain an effective degree of self-respect. Nothing enhances self-respect more positively than the feeling of being useful. Participation in the planning and implementation of the activities program can often provide this kind of gratification for the patient.

Many nursing home patients are lonely, frightened, unhappy and
without substantial friendships. Staff members and other
patients are often their only source for comfortable inter-
personal relationships.

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2.

g.

h.

Some nursing home residents will be physically and/or mentally
incapable of participating in organized activities. The staff
must plan an individual activity program for these patients.

The nursing home patient can benefit from frequent involvement
with younger people. In a recreation setting the blending of
ages has been found to stimulate the patient into increased
participation.

What should be the goals of a comprehensive patient activity program?

Discussion:

Consideration and formulation of patient activity program goals should be realistic and within the reach of agency and staff capabilities and resources, and should be based on the following:

a. General health needs of the patient as a person.

Health and social needs peculiar to the nursing home patient.

C. General attitudes and concepts of extended care facilities concerning health services and standards.

d.

e.

The quality and/or availability of activity program staff for
program planning, supervision and presentation.

The attitude, knowledge, and abilities of other professional staff in the nursing home toward a program of patient activities.

With the above considerations in mind, the following goals seem appropriate for a nursing home activity program:

a.

C.

To develop an activity program that will be broad enough in appeal and content to give every patient an opportunity to participate.

To develop the abilities of each patient and provide continuous
opportunities for self-expression through participation.

To create and maintain the best atmosphere possible for activity that will initiate and sustain the voluntary participation of the patient.

d. To develop a program that adds to the total treatment services of the agency and inspires the confidence and cooperation of the staff.

e.

f.

To develop a program that in direction and content will minimize the isolation of the patient from community life.

To make the maximum use of community resources both in the nursing home and within the community.

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3

What activity areas and equipment are necessary to insure an adequate patient activities program?

Discussion:

Certain equipment and facilities are essential for an effective nursing home patient activities program. Providing and maintaining the basic items can be expensive but is often unavoidable.

Special facilities such as a ballroom for parties and dancing, an auditorium for spectator activities, or a full-scale workshop for arts and crafts activities are desirable but not an absolute necessity. A sitting room, when tastefully decorated and appropriately furnished, can serve as a library or movie theater. The dining room can often be used as a workshop, party room, or bingo parlor when not in use for meals.

More equipment and supplies might also be available than one might realize. Used arts and crafts supplies, games, hobby materials, and other items of this nature often may be obtained through effective solicitation of community resources.

A list below contains examples of both areas and equipment that will enhance the activity program value to the nursing home and its patients. Some nursing homes could have multi-purpose areas that will support more than one type of activity. For example, a single outdoor recreation area (5) if properly designed could accommodate the activities and purposes listed under both (4) and (5). The same could be true of certain indoor activity areas.

4)

5)

6)

Outdoor recreation area for sunning, reading, table games
Outdoor recreation area for sports activities; i.e., horseshoes
Outdoor grill

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4.

What qualities and qualifications are desirable in personnel employed to lead patient activity programs?

Discussion:

The nursing home staff must be warm, understanding, and responsive to the interests and needs of patients for social activities. The following personal assets are considered essential regardless of the prospective employees' training, experience, and education background:

a. Skills in interpersonal relationships

b.

C.

A basic awareness of the value of possessing some knowledge of
group dynamics

Administrative and teaching abilities

5.

e.

Extensive knowledge of recreation skills and techniques

What organizational steps can be taken to initiate a patient activity program?

Discussion:

The administrator, regardless of the type and depth of his planned activity program, should seek the active support of everyone who can possibly be involved or affected by the program. It would be wise to discuss the program with every member of the staff from the nursing director to the cook's helper. Also, not to be overlooked are the planning guidelines that an administrator may receive through discussing the potential activity program with the patients in the home. Information and suggestions from the patients regarding activities and equipment can put additional zing in the activity program and provide the difference between success and failure. There are several methods of organizing a nursing home patient activity program, but the following two are probably most common:

a.

b.

The administrator obtains the services of a person with a
reasonable amount of education and experience in activity
programming and then usually leaves the basic responsibility
for activity program organization and planning in the home
to this individual.

The administrator involves his home in what is known as "Coordinated Recreation Programming." This is the kind of activity program that allows several homes or agencies in a particular community to pool their resources and make a common effort to provide an adequate patient activity program in each home. The following two-step plan might be followed in setting up a program of this kind.

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Step I. Organization

The administrator meets with proprietors and administrators of other institutions or agencies in the general vicinity to determine if all or part of them would be interested in coordinating efforts and resources to sponsor worthwhile patient activity programs in their facilities. Consideration would include the following:

1. What is the sum total of vital resources available in the group, i.e., money, supplies, and equipment, etc.?

2.

3.

4.

What resources are available in the community?

What kind of equipment should be purchased that could be shared by all on a rotating basis?

How much money is available to hire a full-time activity leader?

This is a crucial step. It requires imagination, flexibility, and clear vision from each person involved. It is at this point that the cooperative decision is made to hire a qualified person, and to determine the extent of services he is expected to provide.

Regardless of the number of participating institutions and the number of patients, the patient activity director or consultant cannot be expected to service more than two institutions or agencies a day. He will probably work a forty-hour week, but he will plan a six-day week, in which a group of patients in each home can look forward to at least one afternoon and/or one evening of supervised activities per week as a start. He will encourage you, the administrator, to designate some individual on the agency staff to take some responsibility for activity planning in between the visits of the consultant.

The patient activity consultant will work directly with the staff and volunteers in each of the institutions he services. As he directs and guides programming and supervises the work of the volunteers, he will attempt to develop leadership qualities in likely staff and volunteers and encourage them to take more and more initiative in working directly with the patients. In each institution involved in the coordinated programming, he will see that the program is geared to the patient's physical, intellectual and cultural potential and limitations. He will keep introducing new activities, or modifications and variations of old ones, being sure that all activities that he initiates have some familiarity and offer some degree of stability to the patient within the nursing home environment.