Saturday, July 6, 2019

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


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.


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