Activities Related: July 2014

Wednesday, July 30, 2014

Aha! I Knew This Was Going To Be Fun

What makes information feel good to the brain? My husband knows that information about the brain feels good to my brain, so he gave me a subscription to Scientific American Mind. In it, Matthew Hutson describes the research conducted by Sascha Topolinski at the University of Cologne in Germany. Topolinski is a psychologist who decided to look into the same question that I started with here. He relates it to what he calls “processing fluency.”

Maybe you tried to learn a second language back in your school days. It probably did not feel good to you when you struggled to speak, read or understand ideas in a new way. You lacked fluency, that wonderful place where the language flows easily to do whatever you need it to do. For Topolinski, fluency is not just about language, but about how well the brain handles any information.

He found that the faster the brain works, the more fluently it is processing data. Two ways to increase fluency are repetition and hints of what’s ahead. Each of these tends to increase familiarity with the subject, and therefore brain speed. Fluency feels good, and he noticed that a sudden rise in fluency, that “aha” moment, feels even better.

This of course makes sense in the senior care setting. Which music do our residents tend to prefer? Which topics do they most enjoy talking about? Are your answers “oldies” and reminiscing? Maybe dementia has obscured more recent things, so these are all that are consciously accessible. But some of you have already noticed that there is more to it than that. Maybe when we provide activities which take advantage of previous exposure, we are helping our residents get that “rush” of fluency.

There is a set of booklets that includes “Finishing Lines,” by Beckie Karras. Each of these has page after page of famous sayings, famous book titles, famous song lyrics, etc., that are missing the last word or two. We get some residents together and, as a group, they try to come up with the missing words. And they usually succeed. To say that this activity is popular is an understatement. My Activity Director noticed that being able to come up with the answers really gives the residents a boost in confidence and feelings of self-worth. It’s also a half-hour or so of multiple “aha” moments.

And so, late in the afternoon, I like to play some very simple classics on the piano for my residents to listen to. They enjoy most of the music, but when I hit a Strauss waltz, they will hum along, maybe sway a little in ¾ time ... and they will glow.

Hutson, Matthew. "Orange You Glad I Didn't Say Banana?" Scientific American Mind May/June 2014: 12.

Topolinski, Sascha. "A processing fluency-account of funniness: Running gags and spoiling punchlines." Cognition and Emotion 28 (5) 2014: 811-820. www.researchgate.net, online abstract.

Wednesday, July 16, 2014

What the Dog Saw, the Resident Experienced, and We Tried To Figure Out

Malcolm Gladwell always writes interesting stuff. I like the way he thinks through topics of interest. Of course, after reading his book, “What the Dog Saw,” I have to be careful about making generalizations and assuming I know what’s going on in his mind!

Gladwell examines the ways people are always trying to figure out what other people are thinking. He gives many scenarios: the TV infomercial guys, tastes in ketchup, investment risks, the Pill, the “Dog Whisperer,” and many others. Each one is an opportunity to explore how any topic, situation, or person can be seen from more than one viewpoint. Sometimes the most obvious conclusion, the “common sense” conclusion, is actually an incorrect one. Errors of this type especially apply to generalizations, decision-making and understanding each other.

We make generalizations when we see a pattern and assume that pattern applies every time. Gladwell points out that generalizations are not reliable if there is an unstable relationship between the category and the traits you are looking at. Huh? He gives pit bulls as an example. Many people believe that pit bulls should be banned because of their reputation for attacking people. But the category (pit bulls) and the trait (viciousness) are not always associated with each other, and police records show the vicious trait expresses more in different breeds in different years. It turns out that viciousness is more a result of the owner personality and the owner/dog relationship. Our generalization was faulty.

Sometimes our generalizations are correct to begin with, but become faulty because of unseen changes over time. Maybe a resident is very independent and, because of this, always tends to be agitated during activities of daily living (ADLs) and refuses to come out for group activities. Can we assume this generalization is always true? What if this month the resident has an undetected injury, maybe a spontaneous fracture, and is in significant pain? The trait of resisting activities or help with ADLs will still be present, but for a different reason.

Activity professionals, due to the nature of our jobs, are in a unique position to notice things that other staff might not. Many times I’ve had a resident tell me about pain they were suffering. Had they told their nurse, I ask? “No,” they say with a shrug. So we continue to try to figure out the residents’ thought processes. And, bless their hearts, they try to figure out ours. What a challenge!

Gladwell, Malcolm. What the Dog Saw. New York: Little, Brown and Company Hachette Book Group, 2009.

*This article first appeared on the Metrolina Activity Professionals Association Facebook page on 6/27/2014.

Now Where Did THAT Come From?

A friend who was born in Vietnam described the differences in the way the elderly are treated in Asian cultures and ours. A retired person could return to their former place of business and be treated with honor, as a source of wisdom. In the USA, you used to get the proverbial “gold watch” and then be shown the door. Now, you don’t even get the watch, and in our current economy, the highest paid (and most skilled) workers are dumped on the curb even before retirement age.

So, it was with interest that I picked up “The Wonder of Aging”, by Michael Gurian. He points out the differences in what you see if you change your viewpoint to make it start at age 50, knowing that you might have 40 more years of productive life. Whoa!

He paints a picture of what aging could be if we looked at it in the right way. We could aspire to grow and develop during our senior years, becoming the examples and mentors for the younger generations. He calls this experiencing the freedom of “becoming an elder”. Instead of letting ourselves be disenfranchised by our culture, we would assert our wisdom and influence to make a better future. Far from being useless or outdated, elders would be valued.

Gurian describes three main stages of growing older: The Age of Transformation, from approximately 50 to 65 years of age; The Age of Distinction, from approximately 65 to the late 70s; and The Age of Completion, from approximately 80 and upward. Just like childhood, adolescence, early adulthood, etc., each stage after age 50 has different goals, things that need to be worked through regarding relationships, sex, work, personal growth and spirituality.

Up to this point, I think this book should be required reading for activity professionals, hey, for anybody expecting to reach “a certain age.” But then, when he gets to end of life issues, he suddenly does an about face about the value of human life after 50. He promotes assisted euthanasia in cases of certain diseases or dementia. “Service Deaths” he calls them. He trots out the example of a friend who as a teenager many years ago was horrified at seeing his grandmother with Alzheimer’s disease confused, restrained in a wheelchair in a nursing home, and asking for ice cream. We’ve come a ways since then. Restraints are out. Dignity and memory care are in. And since when is asking for ice cream a capital offense??

Gurian, Michael. The Wonder of Aging. New York: Atria Books, 2013.

*This article first appeared on the Metrolina Activity Professionals Association Facebook page on 5/14/2014.

How Does Your Garden Grow?

My husband brought a book home from the library for me this spring. An Amish Garden, by Laura Anne Lapp, turned out to be an unhurried walk through the yearlong journal of an Amish woman and her domain. Although I usually go for meatier reading, this book immediately drew me in with its lush photography and soothing prose. And at a time in my life when I looked out the window and saw only mud, weeds and leafless branches, it still nudged me outside to enjoy the new beginnings in my own back yard. I would actually recommend this book for use in the senior care setting. The photos are many and the narrative is excellent for short read-alouds with reminiscing about gardening, canning fruits and vegetables, seed catalogues, raising children, and family life. Put it on your department’s wish list!

Let me say my preconceptions were way off base. I had assumed an Amish garden was only a thing of duty, but Lapp describes her gardening almost playfully as an adventure. She compares her gardening style to that of her friends and family. And they’re each distinctly different. Long rows or raised beds, different crops and planting times. She picks and chooses which things to do her own way and which of theirs to emulate, relishing the freedom to make her own plans.

She makes mistakes. The radishes she sowed in the fall, to till under as green manure, sprout in the spring instead, overrunning everything. They now have to be pulled up or plowed under without damaging the plants she wants to succeed.

She even changes her mind. Describing the pros and cons of planting peas, when the rest of her family doesn’t enjoy them, she still plants some. Later, when trying to till under the radishes, she has a fit of impatience and tills under the peas as well. At first she feels bad about it, but instead of feeling guilty, she makes peace with her decision and plants something else in that spot. There are no guarantees. Lapp discusses the failures and successes, the crops that thrived and those that didn’t produce. This sets her happily to thinking ahead as to what she might try out the next year, and what she might change.

Lapp draws us gently through the seasons, celebrating life as she goes. From planning to planting to weeding to canning the harvest, each season of the garden, even when it involves lots of work, is a source of satisfaction to this author. Again, this is great fodder for reminiscing.

Of course, I like to relate things to activities. Activity professionals must never enjoy planning the programs. We must never pick and choose which activities to use. We never make mistakes. We never change our minds. And our programs are always guaranteed success – no duds. Right. You know why you chose this profession!

Lapp, Laura Anne. An Amish Garden. Intercourse, PA: Good Books, 2013.

*This article first appeared in the Metrolina Activity Professionals Association Facebook page on 5/1/2014.

“No, no, no, no, no.”

What does full-contact karate have to do with senior care and activities? I was reading the book Smile at Strangers: and Other Lessons in the Art of Living Fearlessly, by Susan Schorn, a while back. In it, she chronicles her embrace of karate training, and how it improved her life.

Schorn credits her karate instructor (sensei) with teaching her the fine art of being able to say, “No,” when she chose to. Her sensei made them practice saying, “No, no, no, no, no,” to another student’s relentless badgering. A lot of us are really softies. We hate to say no. Apparently this is especially true of those of us in the “helping” professions. But what do you say when a family member insists that their resident attend every scheduled activity every day? And the resident is tired, sick, cognitively impaired, and telling you they don’t want to do that? And you know that if you do manage to push that resident to every activity, other residents will not be able to participate in some things because of it?

Surprisingly, in the process of learning to say, “No,” Schorn found that she also learned to be able to say, “Yes,” when she chose to. Sometimes it was in the form of the ritual response the karate students said when the sensei gave them instructions. “Osu,” meant “yes” in the sense of agreeing to do something hard or challenging … or even impossible. Our jobs can be hard or challenging … or even impossible at times. Nobody makes us do it. We choose.

Schorn’s karate school was run on a shoestring. That meant that when the wiring went bad or the plumbing broke, the adult students learned how to step up to the plate and fix things, or at least work around them. Sometimes not having everything perfect can bring out the best in you. This is a comforting thought since things are so rarely perfect!

Schorn’s sensei also taught them that it was okay to make mistakes, in fact, mistakes were expected. We all tend to be risk averse, but learning any skill requires trying something new, something we may not succeed at. Oh, yes, the group activity that falls flat. The chemistry just wasn’t there, and we felt really stupid as we finished up, collected the supplies and put things away. Then we went out and started the next activity.

Okay, so beating the tar out of your fellow students, and of course, having the tar beat out of you is somehow a good thing? That, my friends, is life. It can beat the tar out of you. Wouldn’t it be fun to be able to give it back, kick for kick?

Schorn, Susan. Smile At Strangers. Boston: Houghton Mifflin Harcourt, 2013.

This article first appeared on the Metrolina Activity Professionals Association Facebook page on 4/7/2014.

The Self-sufficient Farm and the Activity Program

Suzanne McMinn had the dream of moving to a farm, back to her roots in the hills of West Virginia. She wanted to try her hand at being self-sufficient and living off the land and wrote about her adventures in the book, “Chickens in the Road.” Do you think she had an adventure? Yeah-yuh! A lot of the adventure involved discovering (too late) that things done piecemeal tend to involve more work than they need to, and that she couldn’t do it all.

McMinn built a farmhouse on the side of a hill and found that doing some of the chores was downright inconvenient just because of where things were located. She began collecting animals, chickens, then goats, sheep, dogs, cats, donkeys, pigs, and cows. They were all good farm animals, but her farm was too small and poorly set up to maintain them efficiently. The goats were cute but didn’t produce milk like she’d expected. The ram terrorized her. The cow produced milk, but kept getting out of her pen. Water had to be carried by the bucket. Gates wouldn’t open. The road was almost unusable in winter. In short, McMinn was killing herself trying to keep it all going and not getting the returns she hoped for.

How about our activity programs? Do we have the big picture of what each part is for and whether it is actually doing it or not? Is a lot of our energy going toward relatively few residents? Have we figured out how to use our EHR (computer software) to help evaluate our activities and identify residents in need? Are our materials organized in a way that promotes their use? Is our budget going toward one area, while there are real needs in another? In short, are we killing ourselves trying to do everything in front of us, things that might not even be the best choices to begin with?

It’s about balance. There are all sorts of activities that we can add to our programs. McMinn kept adding animals, whether or not she had a good plan for how they fit in. Eventually, she learned to ask some hard questions about what she was trying to accomplish and which animals would help her do it. What kind of goats? How many cows? She learned to weigh their merits, identifying the ones that fit her needs, culling the ones that didn’t. In the end, she felt happier and more empowered. Time is limited and planning takes more of that time. But having a plan is worth it.

McMinn, Suzanne. Chickens in the Road. New York: Harper One, 2013.

This article first appeared on the Metrolina Activity Professionals Association Facebook page on 3/8/2014.

Are Nursing Homes Like Third World Countries? (Part 2)

Continuing my thoughts connecting Jessica Alexander’s book, Chasing Chaos, and the humanitarian aid industry to the long-term care industry …

Ms. Alexander points out one of those tricky little problems that humanitarian aid runs into, namely the fact that what they provide is not necessarily what the recipients want or feel they need. Sometimes the recipients would rather you gave them money to buy what they need instead of handing them a bundle of supplies. Maybe it bugs them when we build schools and expect their daughters to attend or latrines for their refugee camps and expect them to use the smelly things instead of going out to the bush like they’d prefer. Do the outsiders with the money and education always know best? Do the aid recipients have any rights?

Of course, in long-term care, we do prescribe to what is called the patient’s or resident’s “rights.” And one of those rights is the right to refuse, whether it is something as critical as medical care or as “ephemeral” as activities. It would be nice for us providers if the residents always made wise choices. It would be nice if I always made wise choices! It would be nice if we always knew what the wise choice was – drug benefit vs. side-effect, wheelchair vs. fall risk, “healthy” food vs. comfort food, activity participation vs. … wait a minute! … What could be good about not participating in activities?

I remember a resident I once worked with who was very limited in what she did, usually spending her time in bed or in her wheelchair without moving much or speaking. Well, we still took her to group activities that we thought she might get something out of. This time, however, she moved around a little and seemed to be trying to speak, so I leaned in closer to listen. “Get me the h*** out of here!” she whispered. Her daughter and I were thrilled, because in saying ‘No’, the mom had shown that she was still here, no matter how passive she usually appeared.

On the other hand, is the tendency to only trot out the same easy-going residents for every group activity. If someone says, “No,” then you don’t keep nagging them. Maybe they say they’ve worked all their lives and now they just want to chill out. Maybe they say they just want to be entertained, and avoid anything physically active or productive. Maybe they just won’t let themselves be dragged away from all the drama near the nurses’ station where they park their wheelchairs for 12 hours a day. Unfortunately, social scientists know that asking a person their opinion or activity preference has very little correlation to what they actually do or not. We all know about the residents who say that participating in religious activities is “very important” to them, but who would never agree to come to a church service. Where is the tipping point when there is interest but not yet the corresponding action?

For my nurses’ station gang, I learned to take the games, crafts, sports, food socials, and music to them. Near the nurses’ station, they participated gladly. In this case, as the saying goes, it was, “location, location, location.” For some of the men who were interested in being productive, but didn’t want to do “girly” crafts, we got out the wood-working tools and built “useful” stuff. In this case, it was the content of the activity. Sometimes I’ve known residents who would not go to a group activity by themselves, but would go if I made a point of inviting them with their roommate or a friend and making sure they got to sit together. In this case, it was the relationship that mattered.

So, while the residents’ right to refuse any activity is a good thing, we don’t give up too soon when they say, “No.” In the real world, there is negotiation, and don’t we want our facilities to be more like that world?

Alexander, Jessica. Chasing Chaos: My Decade In And Out of Humanitarian Aid. New York: Broadway Books, 2013.

Let me know what you think.

*This article first appeared on the Metrolina Activity Professionals Association Facebook page on 2/192014.

Are Nursing Homes Like Third World Countries? (Part 1)

I was reading Chasing Chaos: My Decade In And Out of Humanitarian Aid, by Jessica Alexander, the other day. She lived and worked in some of the places you hear about on the news: Rwanda, Darfur, Sri Lanka, Sierra Leone, Haiti, New York City… (Yes, New York City is its own country – just ask anyone from western New York). In her book, Ms. Alexander was sorting out her feelings about her humanitarian aid career compared to what she knew from the statistics and actually observed in the field. Sometimes they don’t all jive. Sometimes the big picture gets lost in the day-to-day, and sometimes it is the other way around.

The humanitarian aid industry usually comes into the picture after a crisis: hurricane, war, tsunami, or earthquake. The people doing the humanitarian aid have their own way of doing things which is almost never the way the locals did it themselves, be it housing, nutrition, infrastructure or health care. By definition, humanitarian aid is a disruption in the re-establishment of the local economy. If you give things away, the local vendors can’t compete. If you hire people to do things (so they can buy things from the local vendors), those jobs you created will disappear when you leave. That is if you CAN leave, because sometimes the crisis created by the departure of the aid industry can be almost as traumatic as the crisis that brought them there in the first place. There are always trade-offs.

In long term care, we have the parallel issue of sorting out our feelings, understanding and observations about what we do as activity professionals. Someone ends up in assisted living or a nursing home as a result of a crisis. It may have come on gradually, but that individual can no longer deal with life on their own. Our long-term care facilities and communities have their own ways of doing things, which no matter how “home-like” we try to make them, are still different than what the residents were used to. They go from a private home or apartment to some level of group setting. Solitary or family meals become group dining. Instead of running their own lives, there are administrators, financial officers, social workers, housekeepers, maintenance staff, and care providers who must now be dealt with. And don’t forget wheelchairs and bed alarms, schedules and strange roommates.

Now, don’t get me wrong. A lot of families spend a lot of money for the privilege of sending their offspring to experience college dormitory life – which, other than the health part, is not so different than long-term care. But a college student will eventually, we hope, emerge from the dormitory to re-engage in what we call the “normal” life. For most seniors, leaving assisted living or the nursing home without major home care assistance is the prescription for a new crisis: falls, fire, self-neglect, malnutrition. There are always trade-offs.

The activity professional is in a strategic place in both the big picture and the day-to-day. We are the ones who are charged with knowing our residents individually and figuring out how to make it possible for each of them to enjoy the highest quality of life possible under the circumstances. We plan day-to-day, but we also look at the long-term patterns. When one approach doesn’t work, we look for something else. Ideas are our currency. Some we come up with on our own, but others come from the residents themselves, the residents who are creating their own new economy.

Alexander, Jessica. Chasing Chaos: My Decade In And Out of Humanitarian Aid. New York: Broadway Books, 2013.

This article first appeared on the Metrolina Activity Professionals Association Facebook page on 2/13/2014.

Why Have A Choir?

I was reading a book called Imperfect Harmony, by Stacy Horn, the other day. She sings with the Choral Society of Grace Church in New York. Horn describes how she got into chorale singing and how much she gets out of it. She states that the group goals, discipline and regular practice add to her quality of life and allow her to experience joy in the process.

Now, I’m thinking about my nursing home activity experience. The residents sort of participated in the sing a-longs. A lot of them liked to sing, or used to like to sing. But this “sort of” business was not satisfying for them or for me as the activity leader. Volunteer groups came in and also failed to really engage the residents in sing a-longs. What was missing?

Then we started our own choir group, scheduled for 30 minutes every Thursday afternoon. I hunted down the singers, the “used to be” singers, and the “never could sing very well but still liked to try” singers. I made sure that they, their nurses, and their CNA’s knew when practice was and that I was looking for regular attendance by choir members. I still had to assist many of the targeted residents to get them there each week, but some of them did make it a point to be there on time on their own. We practiced for 30 minutes. Every week. The residents could plan on it, look forward to it, and feel competent knowing what they planned to do with one small part of their week. We practiced the same set of music for about 3 months in a row. Same songs. Every week. And I pushed them, making them work on their skills. We practiced finding the starting key, changing volume for emphasis, adding a few bits of harmonies, and even singing in rounds (they almost mutinied on that one!). We improved during those 3 months, and the choir members knew that they had improved. Then we performed. By the time we performed, we had been practicing long enough that the choir members felt confident that they were truly giving something of value back to the community.

And the feedback? Completely positive, of course. Staff, family members, volunteers and other residents let my choir members know that they had succeeded in putting on a great show. The choir members could allow themselves to feel proud of what they’d accomplished.

So, by having a regular, disciplined choir, my residents were able to experience: the choice of joining or not, feelings of competence in goal-setting and planning their own lives, learning and improved skills, confidence, and pride! This is exactly what Stacy Horn, not in a nursing home, experienced with her chorale group. Not bad for 30 minutes a week!

Horn, Stacy. Imperfect Harmony, Finding Happiness Singing with Others. Chapel Hill: Algonquin Books of Chapel Hill, 2013.

*This blog first appeared on the Metrolina Activity Professionals Association Facebook page on 1/23/2014.