You are a character in a YouTube video, dressed in some nautical uniform and aiming to toss a life preserver to someone floating in the sea. You quickly realize that the target is moving and that a thick fog is swirling around the two of you obscuring your vision and messing with your aim even more. What can you do?
In the current environment of activities/life enrichment, I know everything is all about person-centered care or person-directed care. Let’s just say I’m skeptical about how those terms are understood and used. If you’ve read my other articles, where I’ve reviewed books about the topic of Cognitive Science, you might know why.
Doesn’t setting Person-Centered/Directed Care as a goal assume that it’s possible? Yes, I know you have anecdotal evidence of some incredible response you got from some residents when you hit that sweet spot of interest and motivation and ability and other unknown factors that happened to help. What about the rest of the residents? It is so easy to find yourself trying to convince someone to participate in an activity that all your interviewing tells you they should really want to do. Oh, those happy bang-your-head-against-the-wall moments!
Let me ask some questions. First, do you have access to the “real” people you’re dealing with? That’s a trick question, of course, because there is no such thing. Research shows that we change and keep on changing, minute by minute as well as year by year, and that process doesn’t stop just because you’re 93 years old. Second, can you find out what people “really” want or think is “important” by asking them? Research shows that people don’t reliably know what they want and that their answers are basically meaningless as relates to future activity choices. Third, are you able to mitigate the effects of group dynamics, aka conformity or peer pressure? Our residents are group members, whether or not we or they recognize it, and the group has a big effect on what they will or won’t do. Fourth, are you able to control for outside forces, like pandemics, which can actually change how our residents perceive reality? Fifth, how many of our residents have the desire or ability to direct their own care, much less that of others? I’m picturing a carload of people trying to decide which restaurant to go to for dinner. The residents I’m thinking of who had ideas, usually had ideas that were not feasible – crafts none of their cohort could do, outings no one could manage.
I have had folks who used to sing, but won’t sing now. I have had folks tell me it’s important to be with groups of people but who stay in their rooms now. I have had folks tell the resident council that they want to watch movies in the activity room, but then don’t come. I have folks who have dropped out of group activities because someone who sits at the dining room table with them pooh-poohs the whole idea. I have had wonderful large-group participation where a few natural leaders among the residents made it their job to promote group participation.
In the professional setting, our local activity professional association can’t seem to convince our members that they have enough time to participate in workshops or networking events. These are people who paid the membership fee to an organization that has typically run several workshops a year. This buy-in would seem to indicate that they “want” workshops, feel workshops are “important,” and value being with the group. Right.
In Willful Blindness, by Margaret Heffernan, she discusses the case of the vice chairman of the CIA National Intelligence Council back in the ‘80s. He had predicted the collapse of the Soviet economy, but didn’t have the data to prove it; that is, until he set up a special office to watch for unusual things, data that wasn’t normally collected.
“One of the benefits of a sense of history is that it can alert us to trends, and sensitize us to weak signals; … When is the information you’re getting denied by the evidence you are not getting?” (237)
I used to teach microscope skills in my biology class and one of the skills that was hard to teach was that sometimes you’ve moved in too close. Sometimes you need to zoom out and look at the bigger picture. If I were teaching an activity certification class, I would tell my students to back off a little and make sure they were really familiar with the culture, age, social groupings and cognitive patterns their residents were and are affected by. I would tell them to make the assumption, if possible (I know there are plenty of exceptions), that the generalized trends of those groups might still apply to the residents’ activity choices. I would encourage them to be willing to push to create the environment where those trends are used to generate activities that can more predictably apply in general. And I would tell them to throw stuff at the wall and see what sticks.
© Donna Stuart, ADC 12/3/2022
Heffernan, M. (2011). Willful Blindness. New York: Walker Publishing Company, Inc.
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