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
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.
