In a previous blog, I reviewed the book, Don’t Retire/Rewire, by Jeri Sedlar and Rick Miners. Their descriptions of “drivers” aka personal motivators still resonates with me. They identify eighty-five drivers (Appendix C) and then narrow it down to 30 main ones on p. 61. Drivers are tied to the concept of what makes an activity meaningful. Activities that match our personal drivers will be more satisfying than activities that merely keep us busy. “Drivers are the key to satisfaction,” the authors state (56).
However, as this book describes, most of us are stinking bad at identifying our own drivers, much less figuring out how to fulfill them. Indeed, the authors have to put their clients through a multilayered regimen of self-analysis in order to elicit a list of personal drivers and their applications. These clients are typically alert, oriented, successful in life, and self-motivated. And they’re reaching out and paying a lot for this service. Why? Because without expert coaches, they can’t tell you what their drivers are or how to satisfy them.
No wonder we in LTC have trouble providing person-centered activity programs for actual persons. The MDS questionnaire and the average activity history form hardly measure up to the process that Sedlar and Miners use to help their clients assess themselves. Like their clients, many of our residents don’t really know what they want, so how can they tell us? We don’t have the data, or the tools to get the data, up front.
I am intrigued by residents who choose to isolate themselves. It seems like there are many factors that lead to that lifestyle, not just one pattern. For some it has more to do with physical limitations: vision, hearing, mobility, dexterity. For others, there may be more of an emotional/cognitive cause. I once had a resident who chose to sit and stare at the wall of her room because she felt she couldn’t hear well enough to participate in group activities. (Thankfully, she learned to go outside on the enclosed patio and enjoy the fresh air.) But I’ve been adjusting my thinking about these folks since reading this book. According to Sedlar and Miners, there are still drivers at work here, drivers that could help each person achieve greater quality of life. Ironically, some of the drivers are actually driving the self-isolating behavior. For instance, residents who insist on isolating are expressing power over their circumstances. Having a sense of “power” is a driver. We all know what powerlessness feels like. There are residents who realize they don’t understand what’s going on around them. Some of them want to sit in their recliner with the curtain drawn. They’ve figured it out – that’s how to have a sense of structure in their environment. Leaving that behind might make them feel too vulnerable. Being able to solve problems and needing a sense of structure are both drivers. Person-centered/directed care should lead to more drivers being identified and satisfied. I want to use my understanding of drivers to help reach more residents.
From 1:1 interviews, Sedlar and Miners found that ”the happy people had either intuitively known what their drivers were and fulfilled them with new activities after they retired, or they discovered how to satisfy them through trial and error” (60). But, of course, not everyone intuitively makes the best choices and not everyone is willing to try again when they fail. Many of their clients would say that they “flunked” retirement (3) because they initially chose activities that did not satisfy and left them feeling frustrated. A common example the authors cite is of clients who planned to spend all their time “having fun” when they retired: playing golf, relaxing, etc. It didn’t take them long to realize they were bored and wondered why retirement was not as enjoyable as they’d hoped. Our residents might have already experienced this type of failure before they came to us. Some of them still haven’t figured out how to choose or ask for activities that provide fulfillment. It is a short step from there to make the assumption that no activity can satisfy. Might as well stay in the room.
People intuitively compare the past and present, and the comparisons can be pretty depressing. You could even call it a survival response, to avoid putting yourself into a situation that might generate thoughts like comparisons. To residents struggling just to survive in a facility when their health, competence and autonomy are compromised, the added threat of depressing comparisons is just that – a threat. You can’t exactly recreate a past activity, done by a healthy and independent individual, for a sick and/or dependent person. Putt-putt in the activity room will never be the same as the foursome on the golf course. For some, it would be a pleasant tie-in to a past hobby. For others, it would be a depressing reminder of lost strength. I am always recruiting for our resident choir. Some of the holdouts are the ones who used to have the best voices. “I can’t sing anymore,” they’ll say. I’m thinking that drivers like the identity, prestige, and recognition as a good singer are lacking, and with them the motivation to risk joining the choir.
So, self-isolating, or refusing activities linked to past pursuits, might both be related to attempts to fulfill drivers like the need for authority, identity, power, structure, problem-solving, and self-esteem. That would be why they are so hard to counter. We talk of sensory or cognitive stimulation, but it sounds like we need to provide enough stimulation to satisfy drivers as well. I know CMS wants assessments and care plans done quickly, but figuring out drivers will take more time. It will take multiple small successes of trial and error. It will also take a trust relationship. We’re talking about risk-taking and a change in mindset. And most of us don’t like either one.
©Donna Stuart, ADC October 22, 2019
Sedlar, Jeri and Rick Miners. Don't Retire Rewire! 3rd Ed. New York: Alpha Books Penguin Random House LLC, 2018.
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