And Out Comes Happiness

There are some old songs from the time of the revolutionary war.  The victorious colonists took “Yankee Doodle” as their theme song, but when Cornwallis’ army was marched out of Yorktown in defeat, the fifes played “The World Turn’d Upside Down.”   This is how it goes:

If buttercups buzzed after the bee,

If boats were on land, churches on sea,

If ponies rode men and the grass ate the cows,

Then cats should be chased into holes by the mouse … (Luther 39-40)

You get the idea.  The underfunded, undertrained, outnumbered Americans had managed (with a great deal of help from France) to beat one of the best armies in the world.  It was devastating.

How many of you are feeling the same way about the COVID-19 quarantine situation?  Almost everything we were doing on purpose as activity professionals has become taboo or turned “upside down.”  Group socialization is good for the residents – no, it is dangerous.  Human touch is good for them – no, it is dangerous.  Getting out of their room is good for them – no, it is dangerous.  Singing together is good for them – no, it’s dangerous.  Visitors are good for them – no, they’re dangerous.  Assisting someone so they can be successful with a craft is good – no, you’re standing too close.  Loners are more susceptible to depression, etc. – no, they’re safer from the virus.  It seemed as though I could feel the gears in my brain screeching to a slow stop.

I could not get a picture in my brain of what the future of activities would be like.  What I could imagine looked pretty grim.  We started trying different things on the units, but it was not the same quality of life for my residents that I had been striving for these past years.  If we couldn’t provide quality of life, then what was the purpose of providing care?  Visions of the “bubble boy” came to mind.  Would it be possible for my residents to ever find happiness again, given the issues with the pandemic?

I obviously needed some outside input.  The Bible actually has a lot to say about happiness.  Useful stuff.  Some 2,700 related passages (Alcorn 19)!  I also began cruising the online TED talks.  Each TED talk is officially 18 minutes of presentation by an expert on a topic that expert is passionate about.  One of the first things I found was a 2004 talk about happiness entitled, The Surprising Science of Happiness, by Dan Gilbert.  He was describing the results of large-scale cognitive science experiments on how the brain functions.  2004 was before COVID-19.  It was even before the economic crash of 2008.  Would there be anything useful in it?

Gilbert states that the pre-frontal cortex of our brains has the ability to simulate experiences for us before we have them.  We call that imagination.  However well that works, he says the problem is that we are not so good at predicting how those simulations would affect us if they came true.  That is called the “impact bias” (TED, 2004).  He offers the example of imagining winning the lottery or else becoming a paraplegic and estimating which one would make you happier.  Well, duh, you say.  But the actual data from people who have experienced one or the other shows that neither set of individuals is particularly happier one year later.  Your prediction was, predictably, biased by lack of understanding of how your brain works.

So, what happened?  How could these two radically different scenarios result in a similar outcome?  Gilbert again explains that our brains have the tendency to change how we view our situation in a way that lets us feel better about it.  He says that we “synthesize” happiness with what he calls our “psychological immune system” (TED, 2004).  Whoa! Did he say something about an immune system?  Well, that certainly is timely.  And immunity to permanent devastation related to a bad situation sounds pretty useful.  How you look at something really does make a difference.  Actually, Gilbert says that except in certain types of cases, most outcomes even out after about 3 months!  The average natural happiness from what looks like a happy situation will tend to equal the average synthetic happiness from what used to look like a bad situation.

As a matter of fact, I think I have observed this very process at work in our building.  Two and a half months ago, the residents were not happy to be losing access to family visits, communal dining and group activities.  They became more upset as time went on.  Then I began noticing that there was more acceptance.  A new normal was setting in.  In fact, staff seems to be having more trouble adapting than the residents themselves.  A co-worker wondered if I was struggling because of the loss of control over my part of the activity program.  Well, yes, but hadn’t the residents also lost even more control over their own lives?  Gilbert might have an answer for this, too.  He describes other experiments that prove we synthesize happiness the best when we have no choices (TED, 2004).  Apparently, choices produce second-guessing which tends to rob us of happiness.  Staff is doing the second-guessing while the residents are busy adapting. 

So, yes, both faith and science tell us that our residents can find happiness in a quarantined world.  Some of us would say it’s a gift that God ‘hard-wired’ in.

©Donna Stuart, ADC   May 31, 2020

Alcorn, Randy. Happiness. Carol Stream, Illinois: Tyndale House Publishers, Inc., 2015.

Gilbert, Dan. (2004, February).  The Surprising Science of Happiness.  [Video File].  Retrieved from https://www.ted.com/talks/dan_gilbert_the_surprising_science_of_happiness

Luther, Frank. Americans and Their Songs. New York: Harper & Brothers Publishers, 1942.

Driven From Distraction

Part I

What kinds of problems do older people face?  Principle #1 of the Eden Alternative states that,  

“the three plagues of loneliness, helplessness, and boredom account for the bulk of suffering among our Elders.”

Do we think this only applies to the residents we see in the long-term care setting?  Jeri Sedlar and Rick Miners are thought leaders on retirement issues.  You might have seen them on The Today Show.  In their book, Don’t Retire Rewire! they discuss their 25 years-worth of experience interviewing and coaching people through the retirement process.  Their conclusion?  Loneliness, helplessness, and boredom are not just problems in the nursing home setting.

According to Sedlar and Miners, people face the potential of boredom at all different stages of life, but especially at retirement.  That can be due to poor planning and misconceptions about themselves and their own needs.  

“Boredom was one of the biggest complaints we heard in our research, and not just from Type A personalities or hard-charging executives” (24).

They also talk about people unexpectedly missing the camaraderie of the office and the sense of accomplishment they enjoyed at work. 

“In our experience working with clients, people underestimate the things they like about their work” (25).

Many of the clients they mention are in their 50s and early 60s.  The way I figure it, all my residents are in retirement.  It is just the location of their retirement that makes us look at it differently.  Most of us will live long enough to face retirement.  And everybody, it seems, needs to plan ahead to prevent boredom, loneliness and helplessness from taking over their lives.  Wake-up call, anyone?

The authors discuss the different opportunities people have to find meaning when transitioning away from their mid-life careers.  In today’s economy, many choose to continue some kind of work, even if it is not for pay.  Among all the options for post-retirement lifestyles,

                “… retirees repeatedly returned to the theme of wanting meaningful work.  There is no universal definition of meaningful, as each of us defines it in our own way.  They wanted to be engaged in activity that was meaningful, not just activity for activity’s sake” (24).

Again, the folks at the Eden Alternative agree, stating in Principle #6 that,

“Meaningless activity corrodes the human spirit. The opportunity to do things that we find meaningful is essential to human health.”

CMS takes a stab at defining “meaningful” with its Guidelines and Intent for §483.24(c)(1):

“Activities are meaningful when they reflect a person’s interests and lifestyle, are enjoyable to the person, help the person to feel useful, and provide a sense of belonging.”

“To create opportunities for each resident to have a meaningful life by supporting his/her domains of wellness (security, autonomy, growth, connectedness, identity, joy and meaning).”

I have seen descriptions of some of the assessment tools available to recreation therapists.  These instruments claim reliability in measuring things that pertain to meaningfulness, things like attitude, interest, satisfaction and motivation for leisure activities.  I am curious about how they do that.

Sedlar and Miners tie what is “meaningful” to the satisfaction of what they call “drivers” or “personal motivators” (55).    Drivers represent the “psychic rewards” we get from any activity, whether working a job or socializing with friends.  It’s what we get out of a job besides money (59-60).

“You fulfill your drivers (which are internal) when you take part in activities (which are external)” (67).

Drivers are fairly subjective and the authors encourage their clients to personalize them.  CMS was actually naming drivers in §483.15(f)(1): enjoyment, making a difference (usefulness), and belonging.   The Eden Alternative talks of Domains of Well-Being, which were used as part of the CMS Intent statement and parallel many of the drivers listed by Sedlar and Miners.  For me, my main driver is probably accomplishments – I thrive on the part of the activity job that lets me design and carry out a variety of activities that actually succeed.  The duds, not so much.

I know I’ve found, by experimenting with my activity program, that you can work the drivers without necessarily re-creating past activities for people.  New or substantially tweaked activities might work just as well or better than activities directly based on past interests because there is not as much negative baggage associated with the lack of independence in performing them.  That is, if you’ve never done something before, there is no “past life/independent you” experience to compare it to.

But it’s not just the novelty of your residents experiencing a new activity that gives it value.  A new activity needs to resonate with the residents’ drivers.  For instance, when my residents collaborated on painting wood pallet murals, it was a new activity for all of them.  Most had never attempted to paint a picture since leaving school, much less a large mural.   What drivers did that activity hit?  I was going to list them, but it turned out there were potentially over 32!  Not every participant had all or even most of these drivers, but there was a good chance of some connection with a few of them.  Another program that has worked for me is tying my resident choir into the local county Senior Games.  None of the resident choir members had sung competitively before.  Many had sung in a church choir, but most hadn’t performed in front of any other type of audience except church.  It was a big stretch for them and for our facility in pulling it off.  But the reading on the “meaningfulness meter” shot off the scale.   It was good.  Residents are still periodically wearing the gold medals they won last year, and will tell you how proud they are of them.  So we did it again this year.  And now the residents are talking about next year.  I tallied up 24 “drivers” that might be involved:  accomplishments, action, belonging, fulfillment, competition, creativity, experiences, fulfillment, outside/community opportunity, goals, identity, intellectual stimulation, lifelong learning, making a difference, passion, people, prestige, problem-solving, recognition, self-esteem, skills & talents, social, structure, value, and visibility.  Yeah.

I’m going to try to do another blog post on this topic in the near future.  I want to focus on the implications of drivers relating to individual care-planning and the residents who choose to isolate.

© Donna Stuart, ADC     July 5, 2019

https://www.edenalt.org

CMS Requirements of Participation for Long-Term Care Facilities §483.24(c)(1) (as provided by https://www.nccap.org/assets/docs/F-TAG%20679%20ACTIVITIES.pdf – because after several hours of searching, I sure couldn’t find it in a recognizable form on the CMS website, bless their hearts)

Sedlar, Jeri and Rick Miners. Don't Retire Rewire! 3rd Ed. New York: Alpha Books Penguin Random House LLC, 2018.

Undoing the MDS Project

“While you are in this facility, how important is it to you to …?”

“Very important.  Somewhat important.  Not very important.  Not important at all.  Important but can’t do or have no choice.”

I’d like to turn that question around …

“As an activity professional, how important is it to you to use up to date interview techniques that directly generate meaningful information about your residents?”

1. Very important (If I’m going to be held accountable for the numbers generated by the MDS, I want them to reflect reality.)
2. Somewhat important (I’m kind of tired of residents telling me things that are the opposite of what their activity choices will be.)
3. Not very important (Don’t know, don’t care.)
4. Not important at all (I truly don’t mind wasting a lot of time to satisfy the folks at the Center for Medicare/Medicaid Services.)
5. Important but can’t do or have no choice (The system is crippled, but nobody cares what I, a lowly AP, have to say about it.)

Back in the 1950s, a fledgling psychologist named Daniel Kahneman was given the job of evaluating the new soldiers in the Israeli army.  They had been using interviews, but the results were pretty meaningless.  They didn’t help predict how the soldiers would perform.  Sound familiar?  So, he designed a new type of interview.  Michael Lewis describes the situation in his book, The Undoing Project.

“He [Kahneman] told them to pose very specific questions, designed to determine not how a person thought of himself but how the person had actually behaved” (80).

Suddenly, they were generating more meaningful data, data that had predictive value.

In the 60s and onward, Amos Tversky joined Kahneman to study how people make decisions.  Again, Lewis describes their findings:

“When people make decisions, they are also making judgements about similarity, between some object in the real world and what they ideally want” (114).

Residents in long-term care are asked to make decisions about which activities to participate in.  At that point, they are making judgements about the activities offered compared to what they ideally might want.  But judgements about similarity, Lewis continues, are related to the features we choose to compare, like how noticeable they are, the context we see them in, and how our brains classify them.  For instance, a resident who likes music might chose to skip a group music event because “it’s for old people who have lost their minds.”  He knows that other seniors, ones with memory/health issues are likely to be there.  However, if his room is close enough to the event, he might hear the music and excitement, change his mind, and show up.  Or not.  Decision-making is highly subjective and can change at any moment.

Tversky and Kahneman also realized that people make decisions based on the potential loss or gain they associate with the decision.  But to use potential loss vs. potential gain you have to start at some “reference point” of how you value where you are right now.  The problem is that the reference point can also vary.  It is basically a “state of mind” (275).  I don’t know about you, but my state of mind changes all the time.  I have good days and bad days, good moments and bad moments.  I remember skipping a good friend’s wedding back in the days when I was single.  It was only at the last minute that the prospect of sitting through a lively Polish wedding reception with no date suddenly sounded like a more of a downer than I wished to risk.

In the 1980s, I was in graduate school studying sociolinguistics.  We were trying to find out which language people would tend to use, and for what reasons, in societies that were multilingual.  Some languages enjoy higher prestige.  Some languages provide more credibility on the street. “Do not base your data on self-reported language preferences,” my professors told me.  Instead, we read about ingenious work-arounds that linguists use to ferret out when, where and why people choose to use one language instead of another.  I have interviewed people who claimed to always use a certain higher status language.  Only when pressed did they admit to using a lower status language for some situations.  Self-reported language use is more about self-image, than fact.  I suspect that the self-reported importance of religious participation also often falls into this category.  It’s a normative, a “what should be”, rather than what is.

Even major league baseball and basketball have learned to upgrade the metrics they study.  These teams compete during games, but they also compete to sign the best players.  Lewis documented how the 2002 Oakland Athletics baseball team competed successfully against teams with much more money to hire new talent.  They found that the normal statistics that scouts had been using failed to predict future performance.  The Oakland A’s knew what to look for and could get those players more cheaply because the big teams were overlooking them.  I wonder what metrics we could come up with that would more accurately predict future activity participation. And what if what is important to US, and what WE prefer, is more relevant to their participation than any data we could get from the residents themselves?

Do our residents maximize their utility?  Short answer – no.  “Maximizing utility” means that people will reliably attempt to get the most value for their expenditure, the most bang for their buck.  In the case of activity programming, it could mean the most happiness for the expenditure of time and energy.  Kahneman saw that economists lagged behind the psychologists because the economists

“…assumed that you could simply measure what people wanted from what they chose.  But what if what you want changes with the context in which the options are offered to you?” (278)

Just because someone used to enjoy doing something independently doesn’t guarantee they will want to do it with our “facilitation,” or in the nursing home environment at all.  Ever.

Lewis summarizes Kahneman’s conclusion about maximizing utility.

“…people’s anticipation of happiness differed from the happiness they experienced, and … both differed from the happiness they remembered.

… If happiness was so malleable, it made a mockery of economic models that were premised on the idea that people maximized their utility.  What, exactly, was to be maximized?” (351).

In 2001, Kahneman, the psychologist, won the Nobel Prize in …economics!

Scientists, psychologists, linguists, statisticians, sports analysts, and economists, have found that people in general are systematically irrational in their thinking processes and choices.  We don’t really know why we do what we do.  Making irrational choices is not an aberration.  It is normal.

Fast forward to 2018, and CMS still has us ask our residents to self-report on their activity preferences in the absence of any observable behaviors.  That is the MDS 3.0.  Then we are expected to relate that to the activity decisions the residents will actually make.  That is the activity care plan.  Then we are held accountable for any pattern of discrepancies between the MDS 3.0 and the residents’ actual behavior.  That generates a CAA and potentially a flag.

I know it’s possible to make lemonade out of a lemon and use the MDS interview to also generate a certain amount of activity history.  But that doesn’t make up for the amount of time and energy that CMS wants us to waste on the quest for that precious #1 – 5 that we have to try to coax from the residents.  There are better ways to get an activity history.  There are better ways to develop care plans.  And there are better ways to help activity professionals and residents develop good activity programs.  My activity director gave me a chuckle and a quote for this paper when she wrote to me that, “I am blessed to have you on our ALF actively engaging those folks into things THEY never knew THEY wanted!”

What am I saying?  Activity professionals are made to use methodology that is as much as 60 years out of date.  We are held to bad science that academics who study human behavior have spent whole careers discrediting.  There is a big difference in why our residents do things as opposed to why they think they do them.  Study after study has shown that nobody is a rational decision-maker.  So, who at CMS still thinks that you generate meaningful numbers by asking our residents “how important” something is?  And how long are we going to go along with it?

©Donna Stuart, ADC        January 21, 2018, 2019

Lewis, Michael. The Undoing Project. New York: W. W. Norton & Company, Inc., 2017.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/Archive-Draft-of-the-MDS-30-Nursing-Home-Comprehensive-NC-Version-1140.pdf

Who Did You Say?

Anybody need a little help second-guessing themselves today?  I think I have the book for you!

When I write my blog, I typically summarize what an author has said and relate it to senior care and the activity profession.  In this case, I had some difficulty in summarizing the book “A Stitch Of Time,” by Lauren Marks.  Her wording is so precise and meaningful that “summarizing” ends up muddying the prose rather than simplifying it.  What makes this remarkable is that the author is the survivor of a stroke which left her aphasic.

Aphasia isn’t rare.  Somewhere around a third of stroke victims will experience aphasia, an impairment of language involving speech and/or comprehension of speech, and possibly reading or writing.  From the Greek a “not”+ phanai “speak.”  Other sources of brain trauma or disease can also lead to aphasia.

We might think of language as simply a tool for communication with other people, but it is much more.  We also use it to communicate with ourselves.  Marks talks about the uses for external language and internal language, that inner voice that you use to ask yourself questions or sort and label thoughts.  She explains, 

“Language is wrapped up with our current and remembered sense of identity.  We assign certain words to an experience, and some of them become part of our telling and retelling of the event – the script of our lives” (vii).

And,

“We use words to describe ourselves to others, but also to describe ourselves to             ourselves.  This makes language and memory often inextricably intertwined” …           “Memory is a constant act of creation” (viii).

Marks considers herself to be fortunate.  She pretty much lost the ability to read or write, and her speech was profoundly affected.  But because her inner voice was also muted, she was unable to register how bad her speech sounded.  And she was blithely unaware of how devastating her situation would have appeared to her PhD student, pre-stroke self.

“With my internal monologue on mute, I was mainly spared from understanding my condition early on.  Unable to ask myself:  What is wrong with me?  I could not, and did not, list the many things that were.  I was no longer the narrator of my own life” (20).

While still in the hospital, she had picked up a book and realized that she couldn’t read any more.  There was a momentary disappointment, she says, but without the words to think about it, the disappointment quickly passed.  She also tells of the moment she first picked up a magazine.  The graphics were too visually stimulating, “shouting” at her, and she put it down quickly (6).

With one side of her brain damaged by the stroke, Marks experienced her environment in new ways.  The functioning side of her brain was much more vigilant and sensory oriented.  Without the distraction of language, it hyper-focused on her surroundings.  She felt an “interconnectedness” with the world around her (20).

Another new sense was of serenity, a pleasant, peaceful, almost meditative state that occupied her consciousness when left to her herself.  Lacking the constant chatter of an inner voice, she could think but without noise.  She labels that meditative state “the Quiet,” and she valued it intensely (18).

“It was a placid current, a presence more than an absence.  Everything I saw or touched or heard pulsed with a marvelous sense of order” (3).

But the agenda of those around her, who cared about her, was to pull her out of the Quiet and into language use.  In other words, speech therapy, family visits, conversations, and recovery-oriented activities worked against what the author then considered high quality of life.  Marks recalls that as soon as a visit or speech therapy would end,

“… I would gently be redelivered to the happy stillness of the pervasive Quiet”(11).

As Marks progressed in recovery and her language skills, both external and internal, improved, she struggled with the actual meaning of recovery.  If language, thought, memory and identity are so closely entwined, and so malleable, who exactly IS the person recovering and what identity are they recovering TO.  She expresses frustration with family and friends who seem fixated on her returning to her pre-stroke identity, when she feels like she is in the process of establishing a new identity.

In terms of care planning for someone like Marks, we have several issues to balance:

Are we attributing thought processes or feelings of loss that are not present?  I certainly feel that being aphasic would be frustrating for me, and it is easy for me to project that emotion onto someone with the condition.  But Marks and those around her noticed that she wasn’t that disturbed about it, especially at the beginning.

Also, how do you define quality of life for someone who can’t communicate well?  Marks valued the “Quiet.”  Most of those around her were unaware of what it was or that she enjoyed it so much.  What if our agenda of promoting social interaction and stimulation are actually depriving the person of what they feel provides quality of life at the time?  But what if quality of life at the time is at odds with the goals of the person who that individual was before the stroke?  And what if quality of life at a certain stage is at odds with the goals of the person who the stroke victim will become as recovery progresses – if it progresses?  To whom do we as caregivers owe our loyalty and person-centered care planning?  Obviously, we encourage, we flex, we try different approaches … we might even manipulate.  Part of our expertise in person-centered care is in figuring out what works.  But for whom?   In this case, the author during the worst symptoms vs. the author before the stroke vs. the woman writing this book –each was the same person, but each would have had different preferences/goals.

So, now you have some more fodder for second-guessing yourself as an activity care-planner.  You’re welcome.

© Donna Stuart, ADC       February 18, 2019

Marks, Lauren. A Stitch Of Time. New York: Simon & Schuster, 2017.

That’s The Way We Like It - Or what do cell phones, Starbucks, polarized politics, and bingo have in common?

Maybe we can figure it out with some help from Mark Penn.  He is a political strategist who ran polls for presidential candidates and authored the book, “Microtrends Squared.”  During his career, he became aware of information that many other pollsters, news outlets, and marketers were not paying attention to, much less analyzing.  He is making his own news nowadays pointing out what he observes and how he interprets it.  His book offers many interesting examples of what he calls microtrends and how they might add up to something bigger in our future.

For instance, we consumers, have been given more choices.  From burgers to personalized cosmetics and, of course, Starbucks, we can have things just the way we want them.  Penn says,

“Something rather surprising happened, however, as consumers got more choice.  It turned out they found choices they intensely liked, and they stuck with them.  More choice ultimately resulted in people making fewer choices. … Once everyone had the opportunity to choose their perfect drink at Starbucks, most customers now ask for the ”regular” – the same grande mocha Frappuccino they get every single day”(8).

We know that for many seniors, the perception is that people have more choices in activities on their own at home.  But by the time a person needs long-term care (LTC), that is not really the case any longer.  Denial takes over as the person is able to do less and less.  At one facility where I worked, there was a woman who sat moaning to herself in her wheelchair by the nurse’s station.  A family member told me that, at home, his mom had basically been lying on the bed all day looking at the ceiling.  He thought maybe she might –finally- be a candidate for assisted living.  I backed out of the conversation before I said something inappropriate.  I don’t make any excuses for LTC.  We CAN provide greater quality of life for many of our residents than what they had been experiencing at home.

But they reach LTC and suddenly there is a whole activity calendar full of choices.  A bit overwhelming, yes?  The Starbucks mentality says more choices are better, but apparently human nature does not.  According to Penn, we will try some new things until we find our favorite, and then stick with that.  Which brings us to bingo.  Straightforward rules that even someone with pretty advanced dementia can still command.  Happy payoff in little dopamine bursts as you find each number.  Self-confidence among peers.  Respect from staff – yes, bingo deserves respect.  Prizes!  What’s not to like?  And the next thing you know, the commitment to bingo is locked in place.  Grande mocha Frappuccino, anyone?

What about those who never used to play bingo but now will do almost nothing else?  It certainly did not show up in their activity history or MDS.  For this, we must remember the cell phone.  Penn describes the problem created by carefully finding out what people want and then sticking with it: 

“… they will often change their perspective when they see something new.  The big consulting companies told AT&T that the cell phone would never take off.  They were told it was nothing more than a specialty item—because they were dealing with people as they were, not as they would be transformed” (343).

Many researchers have told us that our choices and preferences are affected by our environment, experiences (new as well as old), and mental/emotional state, among other things.  All this is to say that people do change.  Even seniors in LTC.

Even you and I.  So, where do you get your news?  Penn explains that

“It is a powerful and unexpected result of the world of microtrends that greater personalization created more polarization” (9).

One of the other NAAP bloggers, Krista Fischer, ADC, recently shared some ideas on how to deal with politics in the workplace.  What Penn’s book suggests to me is that the “microtrends” that affect our politics can also affect our activity calendars in obscure ways.

We are allowing a whole marketplace of internet providers like Facebook to collect data about us.  Penn describes how that data helps businesses target their marketing to us individually … to allow us the maximum of, once again, personalized choices.  Back in the day, there were only 3 network news channels to watch on TV and they were fairly similar because they were targeting a general population.  They couldn’t afford to offend whole groups of viewers.  But with all the cable channels available, and the ability to target specific groups of viewers profitably, came more polarized reporting.  Hence CNN vs. Fox.  People tend to watch one or the other with a strong preference.  If either channel does try to include thoughtfully opposing viewpoints, many of the viewers will protest in outrage.  If you get your information from the internet news or social media, it’s even worse.  The info bots will ferret out your interests and selectively feed you news stories that reinforce your opinions so that, in the process, they can get their ads in front of you.  Been Googling heartburn symptoms and following your side of the latest political debate?  Don’t worry.  They’ve got you pegged.  You, and this goes for liberals and conservatives, may have more in common with a radicalized Muslim teen in Germany than you ever realized.

Penn sums up his point,

“Perhaps the single greatest issue arising out of the data-driven society we have built is that, when it comes to news, food, work, or how we raise our children, more choice has resulted in people making fewer and fewer choices.  This is also maybe the most difficult issue to correct.  Americans find what they like and cocoon within it, in ways that distort their views of the rest of the world.  Then these choices reinforce themselves as we repeat them over and over again”(343).

I like to think that one of the challenges of my job as an activity professional is to help people re-think their activity choices.  Some folks, bless their hearts (as we say here in the south), have a gung-ho attitude and will come out for almost any activity.  What would we do without their support?  Others, bless their hearts, have cocooned themselves in ways that distort their views of the world around them.  It is difficult to change this choice, but not impossible.

Oops, now where did I leave my cell phone?  It’s time for bingo.

© Donna Stuart, ADC                   July 15, 2018

Penn, Mark. Microtrends Squared. New York: Simon & Schuster, 2018.

Why I Blog

I like to read.
I used to read everything. 
Something changed.
In spite of, or maybe because of, the lack of orcs, robots, damsels in distress, etc., I discovered that real life is actually more exciting than the made-up stuff.
Real people doing real things and facing real consequences ... now, that's exciting.
History, science, biography, thought leaders - they're all good.
And then I discovered something else.
In each field, no matter how outwardly unrelated, I keep finding connections to the activity profession.
It's like I can't avoid seeing the connections.
Well, so what?
I believe the activity profession is at a transition point.
What many of us are doing is not sustainable.
What if we let outsiders, other professions, other times, other situations inform us?
Maybe we'll find a path to change.

No Gas? Thumb a Ride

Sometimes we need to figure out what's really going on.  “A drill company thought it was selling drills.  Their customers were actually buying holes”(25).  I pulled this quote from a mind-sharpening book Alan M. Webber put together, called “Rules of Thumb.”  Webber describes 52 truths he picked up while hobnobbing with folks like those at the Harvard Business Review and Fast Company magazines.

Webber sums it up as Rule #6:  “If You Want To See With Fresh Eyes, Reframe The Picture”(25).  Most companies, he states, “don’t see what business they’re really in.”  He draws from the classic article, “Marketing Myopia,” by Ted Levitt, who famously differentiated between marketing and selling.  Levitt taught that selling was all about exchanging your product for cash.  Marketing had to do with satisfying the actual needs of the customer through the product:

…a truly marketing-minded firm tries to create value-satisfying goods and services that consumers will want to buy.  What it offers for sale includes … how it is made available to the customer, in what form, when, under what conditions, and at what terms of trade (Levitt 143).

I’m an activity professional.  A good nursing program can help keep our residents alive.  A well-run activity program will remind our residents of the reasons they have for wanting to BE alive.  Is that something they or their families would be interested in buying?

So, how does my job in activities at a CCRC intersect with marketing?  “KTR,” they tell us in our national certification classes, “Know Thy Resident.”  We do our best to find out what makes each resident tick, what they used to like to do but can’t anymore, what they might enjoy doing now if they had the chance and didn’t talk themselves out of it, what they never really did before but might someday, at some precious moment, decide to give a try.  We know that how we stage an activity, what we call it, what time and day we put it on the calendar, where we hold it, and what incentives go with it, will make a BIG difference in participation and satisfaction levels.  We market to those with dementia as much as to those who are cognitively intact.  Just because someone has dementia doesn’t mean they don’t want a life.  So, yes, part of what makes for a well-run activity program is the marketing that we activity professionals do with the residents.

Let’s say I have a resident who won’t come out for crafts, games, exercise, music, bingo, anything.  But they are interested in joining a group of other residents for ice cream and conversation on the patio after supper, when the worst heat of the summer day is past.  What are they buying?  Ice cream?  Nope.  They tell me they are still full from supper.  People and conversation?  Just left that a few minutes ago in the dining room.  Sweat and the occasional fly?  Not so much.  The chance to feel like what they consider to be a “normal adult" again.  Absolutely.

Levitt said, “When people buy gas for their cars, they don’t really want the gasoline – they want the freedom to continue driving down the road” (145).  That is so true it makes me laugh.  I don’t want gasoline, do you?  Activity Directors (by whatever title we’re called) are not selling activities – we’re marketing freedom from “boredom, helplessness and loneliness,” as The Eden Alternative suggests in their vision statement.  Or maybe it’s freedom from meaninglessness and from anger about still being alive.  How do the residents define what they’re buying?  Some days it feels like we’re actually marketing an alternate reality where the residents are younger, more capable and controlling their own lives again.  Your activity professionals are doing successful marketing all the time to your target demographic.  If you want to increase your census numbers, maybe you should ask us how we do it.

©Donna Stuart, ADC      July 21, 2017

Levitt, Theodore. "Marketing Myopia." Best of HBR July-August 2004: 143, 145.

Webber, Alan M. Rules of Thumb. New York: Harper-Collins Publishers, 2009.

http://www.edenalt.org/about-the-eden-alternative/mission-vision-values/