Innovations in activities for the elderly : proceedings of the 1984 National Association of Activity Professionals Convention 9781315826295, 1315826291, 086656389X

Table of contents :
Content: Keynote address / Edith M. Sherman --
Interdisciplinary teamwork / Sister Patricia Murphy --
Into aging --
a simulation game / Joanne Williams --
Networking : how to use what you've got to get more of what you want / Jacqueline M. Bean --
The difference an idea makes : the art of brainstorming / Kimberly Chaffin --
Residents in the giving role / Joan Betzold --
Making connections between the school system and the nursing home / Ruth Perschbacher --
Intergenerational mixing / Karen D. Schelinder --
The day room program at Westmoreland Manor Nursing Home, Waukesha, Wisconsin / Jacqueline Brunner --
Reality therapy in the convalescent home / Sally Vogt --
Programming for optimum health and wellness / Mary S. Simper --
Innovative "resident volunteer" programming / Dennis Goodwin --
The good samaritan program : patients as volunteers / Jan Seville --
Veteranship for nursing home residents : integrating residents into volunteer services / Lyndon S. Drew --
The activity coordinator as environmental press / Edward F. Ansello --
Organizing a men's club / Marian Bentel, Audrey Lasher --
Art therapy with the institutionalized older adult / Madeline M. Rugh.

Citation preview

Innovations in Activties for the Elderly Edited by

Jane D. Cook

Innovations in Activities for the Elderly Proceedings o f the 1984 National Association o f Activity Professionals Convention

About the Editor

Jane D. Cook is an activity consultant and editor of Scrapbook Pages, a bi-monthly large print publication written primarily for shut-in elderly. Her experience in the long term care field began in 1971 when she was employed as an activity coordinator in a SNF/ ICF facility in Falls Church, Virginia. After more than seven years in that position, she joined the staff of American Health Care As­ sociation, Washington, D .C., where she was staff representative for the Section of Activity Coordinators. While employed there she served as editor o f Sharing and Caring and Senior American. She wrote several booklets relating to activities and volunteer training. Mrs. Cook is a Liberal Arts graduate of Penn State University and has completed graduate level work in communications at Amer­ ican University, Washington, D.C. She has been trained as an in­ structor of the basic 36-hour course for activity coordinators and has assumed a role in teaching that course in several states. She current­ ly is on the faculty of the Leisure and Aging Management School, sponsored annually by the University o f Maryland and other groups interested in recreation for the elderly. Mrs. Cook is Chairman of Education for the National Association of Activity Professionals and a charter member of that organization.

Innovations in Activities for the Elderly Proceedings o f the 1984 National Association o f Activity Professionals Convention

Jane D. Cook Editor

| J Routledge Taylor & Francis Croup LONDON AND NEW YORK

First published 1985 by The Haworth Press, Inc. Published 2013 by Routledge 711 Third Avenue, New York, NY 10017, USA 2 Park Square, Milton Park, Abingdon, Oxon 0X14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business ISBN: 978-1-315-82629-5 (elSBN) Innovations in Activitiesfor the Elderly: Proceedings of the 1984 National Association of Ac­ tivity Professionals Convention has also been published u Activities, Adaptation & Aging, Volume 6. Number 3, Spring 1985. © 1985 by Taylor & Francis. All rights reserved. No part of this work may be repro­ duced or utilized in any form or by any means, electronic or mechanical, including photo­ copying, microfilm, and recording, or by any information storage and retrieval system with­ out permission in writing from the publisher.

Library or Congress Cataloging in PabUcation Data National Association of Activity Professionals (U.S.). Convention (2nd : 1984 : Denver, Colo.) Innovations in activities for the elderly. "Has also been published as Activities, adaptation & aging, volume 6, number 3, spring 1985”—T.p. verso. Includes bibliographies. 1. Aged—United States—Recreation—Congresses. 2. Aged—Institutional care—United States—Congresses. I. Cook, Jane. Q. Title. GVI84.N29 1984 790.1’926 84-28996 ISBN 0-86656-389-X

Innovations in Activities for the Elderly Activities, Adaptation & Aging Volume 6, Number 3

CONTENTS

FROM TH E GUEST EDITOR Jane D. Cook

1

Keynote Address

3 Edith M . Sherman

The Settings in Which You W ork Goals of This Meeting Goals of Your Association Improving Programming With New Ideas The Use of Community Resources Interdisciplinary Team work Sister Patricia Murphy Into Aging—A Simulation Game Joanne Williams Networking: How to Use What You’ve Got to Get More o f What You Want Jacqueline M. Bean The Difference an Idea Makes: The Art o f Brainstorming Kim berly Chaffin A Sample Session Session Follow-up

3 4 5 6 7 9

13

17

25 28 28

R esidents in th e G iving Role Joan Betzold Early Visits A Resident-Built Surprise S peaker’s Bureau M aking C onnections B etw een the School System and the N ursing H om e Ruth Perschbacher Intergenerational M ixing Karen D. Schelinder T he Day Room Program at W estm oreland M anor N ursing H om e, W aukesha, W isconsin Jacqueline B runner Stated O bjectives o f the Day Room Stated Role o f Floor Aides Day Room Schedule Utilization Review Board Study Effect o f the Day Room on Residents Effect o f the Day Room on N ursing H om e A dm inistration Effect of the Day Room on Fam ilies and N ursing H om e Placem ent Sum m ary REACH

31 33 33 34

37

43

47 47 48 49 49 50 52 52 53 54

R eality T herap y in the C onvalescent H om e Sally Vogt

55

Program m ing fo r O ptim um H ealth and W ellness M ary S. Sim per

61

Physical Em otional M ental Spiritual Innovative “ R esident V olu n teer” P rogram m ing Dennis Goodwin

62 63 63 63 69

The Good Samaritan Program: Patients as Volunteers Jan Seville Veteranship for Nursing Home Residents: Integrating Residents Into Volunteer Services Lyndon S. Drew Resident Volunteers RSVP of Wichita, Kansas Homebound Veteranship The Activity Coordinator as Environmental Press Edward F. Ansello

73

79 80 82 83 84 87

Activities and Life Satisfaction Conclusion

87 96

O rganizing a M en’s Club Marian Bentel Audrey Lasher

101

Reasons and Needs fo ra M en’s Club Planning for Meetings The M eetings and Their Content Values of M en’s Clubs Art Therapy With the Institutionalized Older Adult Madeline M. Rugh Portraits Conclusions

101 101 102 104 107 110 120

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E DI T O R P H Y L L I S M . F O S T E R , A ctiv itie s P ro g ra m C on su ltan t. L ittleto n , C O

E D IT O R IA L B O A R D L a V E R N E C A M E R O N , R etired M a n a g e r , E du cation & R e s id e n t C a r e S ervices, O ntario N u rsin g H o m e A s s o c i a ti o n , O n ta r io , C a n a d a J A N E D . C O O K , B A , F o r m e r Staff R e p r e s e n ta tiv e , Section o f A c tiv ity C o o r d in a to r s , A m e r ic a n H e a lth C a r e A s s o c ia tio n . W a sh in gto n , D .C . J O L E E N S. C U R L E Y , C O T A , A c ti v i t i e s C o n su lta n t, M a d i s o n , W l E L I Z A B E T H S Q U I R E D E I C H M A N , E d M , O T R , P r e s id e n t, P o te n tia ls D e v e lo p m e n t f o r Health & A g in g S e r v ic e s . In c.. Buffalo, N Y A L I C I A C L A I R G I B B O N S , P h D . R M T , D i r e c t o r o f M u s ic T h e ra p y. U n iv e rs ity o f K a n s a s , L a w r e n c e , KS F R E D G R E E N B L A T T , M T R S , D i r e c t o r o f A c tiv itie s, J e w ish H o m e A H o s p ita l f o r A g e d , Bronx, N Y L A U R A H A R V E Y , M A , In s tru c to r, S c h o o l o f R eh a b ilita tio n M e d ic in e , U n iv e r s ity o f British C o lu m b ia , V an c ou ve r, B.C. W I L L I A M A. H I N E S , M D , G e r ia tr ic ia n , K it tr e d g e , C O E V A L Y N P. H O O V E R , M A , D ir e c t o r , G len ro c k S e n i o r C en ter, G le n ro c k , WY M . J E A N K E L L E R , E d D , M T R S , R ec re a tio n C on su lta n t, R ecre a tio n T echnical A s s is ta n c e O ffice, Institute o f C o m m u n ity & A re a D e v e l o p m e n t , U n ive rsity o f G e o r g ia , A th e n s , GA O S C A R K U R R E N , P h D , P r o f e s s o r , School o f Social Work. U n iv e rs ity o f H a w a i i at M a n o a , H o n o lu lu , HI E L L E N L E D E R M A N , M S , O T R , O c c u p a tio n a l T h era pist, B righ t H o r izo n s C enter. P o m p a n o . FL L I N N E A M . M O E , C O T A , A ctiviry C o n su lta n t. E v e r g r e e n . CO M A R I A N P A L M E R , R M T , M u s ic T h era p is t C o n su lta n t to G e r ia t r ic P r o g r a m s . D u blin , OH M A D G E B. S C H W E I N S B E R G , B A , A c ti v it ie s D ir e c t o r . A c ti v it y T herapists A s so c ia tio n , Illinois A c tiv ity P ro fe s sio n a ls A s s o c i a ti o n . E v a n sto n . IL E D I T H M . S H E R M A N , P h D , R etired D i r e c t o r , Institute o f G e r o n to l o g y , U n ive rsity o f D enver, CO M A X S H I R L E Y , P h D , R e ti r e d C h a irm a n , D e p a r tm e n t o f R ec re a tio n & L eisu re E d u c a tio n , U n iversiry o f N orth ern C o lo r a d o , G r e e le y . CO M A R I L Y N S T R I F F L E R , M S , / l c f / v / 7 y C o o r d in a to r , C o lu m b in e Care C en ter, F ort C ollin s, C O J O A N M. T H Y S , R N , B S N , G e r ia tr ic R eh a b ilita tio n C lin icia n . G e r ia tr ic M e d i c a l Clinic, D enver, CO J O A N N E W I L L I A M S , R e ti r e d A c tiv ity C o n su lta n t, Author, S p e a k e r , R o se v ille , CA

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Innovations in Activities for the Elderly Proceedings o f the 1984 N ational Association o f Activity Professionals Convention

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FROM THE GUEST EDITOR

Activity p r o g r a m s in n u rs in g h o m e s a nd r e tire m e n t h o m e s a re as b ro a d in sco pe as life itself. W h a t kin ds o f ev e n ts will result in the g reatest sense o f satisfaction f o r the nursin g h o m e resident? O b ­ viously, the a n s w e r to that d ep en d s on the individual resid ent. It is a g re a t m is ta k e to think o f n u rs in g h o m e re s id e n ts as a h o m o g e n e o u s gro u p . T h e lo n g e r p e o p le liv e, the m o r e unique they b e c o m e . O b ­ viously the w id o w o f a m id -w est f a r m e r a n d the retired p r o f e s s o r o f m icro b io lo g y will gain a real sense o f satisfaction from quite varied ac tiv ities. T h e activity c o o rd in a to r is w o r k in g with the m o s t d iv e rse po pu latio n that exists. W h a t, th e n , d o e s the activity p ro fe ssio n a l w an t to learn and e x ­ perience at an annual c o n f e r e n c e devo ted to his field? It is difficult to find a su bject a re a th at has absolutely no re le v a n c e to activities. S o m e k n o w le d g e o f the w h o le a re a o f h ea lth , both physical and em o tio n a l, is vital to the a ctiv ity c o o r d i n a to r w h o will c a r r y o u t his role su cces sfu lly . S o, to o , is an u n d e rs ta n d in g o f the gratificatio n a p e rs o n re c e iv e s fro m le a r n in g new in f o rm a tio n and d e v e lo p in g new skills, fr o m help ing o th e r s a ro u n d h im , fr o m social in teraction with friend s his o w n a ge as w ell as th ose o f d if fe re n t g e n e ra t io n s , fro m a spiritual re latio n sh ip an d sen se o f an A lm ig h ty p re s e n c e . T o p u t t o g e t h e r the p r o g r a m f o r the se c o n d an n u al co n v e n tio n o f the N a tio n al A sso c ia tio n o f A ctivity P r o f e s s i o n a ls , w e tu rn e d to the activity p ro f e ssio n a ls th e m s e lv e s and a s k e d , not so m uch w hat they w a n te d to le a r n , b u t r a t h e r w h a t did they w an t to sh are w ith th e ir ©

1 98 5 by T h e H a w o r t h P r e s s , Inc. Al l r i g h t s r e s e r v e d .

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IN N O V A T IO N S IN A C T IV IT IE S FO R T H E E L D E R L Y

c o lle a g u e s . R e s p o n s e s r a n g e d fro m in f o rm a tio n a b o u t specific p r o ­ g r a m s an d ideas to the th e o r e tic a l ra tio n a le fo r those p r o g r a m s . T h e co n te n t o f this issue hints at the v ariety o f top ics th at o f f e r the activity c o o r d i n a to r c o n c re te d ir e c tio n s for p r o g r a m m i n g , th e o r e t ­ ical r e a s o n s for d e v e lo p in g and refin in g such p r o g r a m m i n g , and in ­ sp ira tio n and r e f r e s h m e n t n e c e s s a r y to re tu rn to his v e ry c re a tiv e an d d e m a n d i n g j o b . T h o s e a tte n d in g the co n v e n tio n in M ile -H ig h D e n v e r w e r e u rg ed via the c o n f e r e n c e th e m e , to “ Shift into High in the C li m b U p ­ w a r d . ” M a n y o f the p articip an ts had tr a v e le d u p w a r d to D e n v e r ’s a ltitu d e, but th ey had only to lo o k to the w e s tw a r d h o riz o n to see th at they had not yet r e a c h e d the top o f the w o rld . Insp irin g sn o w c o v e r e d p ea k s held out the po ssibility o f g r e a t e r go als and the p r o m ­ ise o f g r e a t e r a c h ie v e m e n ts . E x p e r ie n c e d c li m b e r s s h a r e d th e ir special su c c e s s e s w ith their c o lle a g u e s . “ O l d - t i m e r s ” p u lled ; “ n e w c o m e r s ” p u s h e d . T o g e th e r th ey a re re s p o n sib le fo r the u p w a r d p r o g r e s s th at c h a ra c t e r i z e s this relative ly new field. C o n v e n tio n a tte n d e e s lo o k e d “ Into A g i n g ” and fou nd so m e reas o n s w hy the po pulation they serv e d e s e r v e s their best e ffo rts . T h e y c o n s id e re d “ E n v ir o n m e n ta l P r e s s ” and k no w that the y play an e x tr e m e l y im p o rta n t p a rt in m ain tain in g th at p o p u ­ la t io n ’s m e n ta l, em o tio n a l and physical fitness. T h e y le a rn e d how o th e r s h ave c h a lle n g e d the e ld erly to c o n tin u e livin g. This v o lu m e se r v e s as a m o r e o r less p e r m a n e n t r e c o r d o f the sh a r in g that took p la c e b e tw e e n c re a tiv e d e d ic a te d p ro f e s s io n a ls e n ­ ga g e d in an o n g o in g stru g g le to retain o r in c r e a se q uality in the li fe ­ styles o f m a n y eld e rly . Ja n e D. C ook

Keynote Address Edith M . Sherm an

Thank you for asking me to address your second A nnual C o n v e n ­ tion. M y respect and admiration fo r each and every one o f you is boundless. Y o u r w ork, your devotion, your “ h o p e ” in the face o f nu m erou s odds against success—d eserve the su pp ort o f the entire co m m unity, deserve accolades o f the highest ord er, and above all deserve increased financial rem uneration! You are truly the care­ givers o f ou r society to the needy, the disabled, to those “ who s u f­ fer.”

THE S E T T IN G S IN W H IC H YOU W ORK Your task is unique because o f the setting in which you w ork—the institution. Just what does it mean to be institutionalized? A col­ league o f mine has taught a cou rse at the University o f Denver entitled “ Total Institutions.” In this course three institutions were included as being total. They are: (1) prisons, (2) hospitals, (3) uni­ versities. What are the com m on denominators o f these three institutions? W hat synonyms reflect the condition o f persons living and working in them ? Let me suggest the following list for y o ur consideration: incarcerated, controlled, routinized, isolated, dependent, deperson ­ alized, acquiescent, regulated. All o f these terms imply an enorm ous loss o f o n e ’s basic hu m an ­ ness, identity, self respect, self im age, control o f o n e ’s environment and decision making capacity. Is it any wonder that persons so insti­ tutionalized suffer severe depression, feelings o f self hatred, loss o f personal e steem —all accom panied by a n g e r and the inevitable q u e s ­ tion—why me? Society must bear its share o f guilt for its acceptance and exten ­ sion o f ugly stereotypes o f the aging and the disabled. The famous psychological theory, “ Each to each a looking glass, reflects the other that doth p a s s , ” can be readily seen in the negative ways ©

1985 by T h e H a w o r t h P r e ss , Inc. All r ig ht s re s e r v e d .

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INNOVATIONS I N ACTIVITIES FOR THE ELDERLY

A merican society perceives the elderly and disabled, and in the e n d ­ less ways in which we try to d en y, avoid, avert, cover up the p ro ­ cesses o f aging in ourselves and those we love. T h e ill and disabled elderly are often portrayed as unloved and unloving. This perception is a cultural one and reflects a value sys­ tem that can and should be changed and reevaluated. I often recall a tribute to the C hicana grandm other in San Luis, Colorado. She was 106 y e a rs old (perhaps the oldest person in our state) and the D enver Post covered her birthday celebration. Under the picture o f her deeply wrinkled face and another o f her aged hands with num erous age spots was the caption, “ The serenity of Prima S u a z a .” T h ere is no question that her beauty and serenity w ere in the eyes o f her beholders in this ethnic comm unity which has a different set o f values.

G O A L S O F THIS M E E T IN G The goals of this m eeting as they are stated in your pro gram are: 1. 2. 3. 4.

To To To To

gain knowledge share ideas im prove program m ing renew enthusiasm

Let us address these hopes and aspirations as you start your sec­ ond annual convention. My own interest in activities for the frail/institutionalized was kindled on a study tour to Scandinavia spo nso red by C o lum bia U ni­ versity in 1970. At a geriatric c are ce nte r in N orw ay I observed the first dan ce class I had ever w itnessed in such a facility. A you ng co l­ lege student (physical education or d anc e major) with his recording machine and marvelous Scandinavian folk music was conducting in a g ro u p setting a regular da n c e class for all o f the residents w ho could c o m e or be brought by aides or activity directors to the se s­ sions . Despite the fact th a t his class consisted o f p erso n s in b eds that had been m oved into the roo m , in wheelchairs, on w alkers, using canes, the session was a dance class, not physical therapy. The im portance o f the event to me was the impact such a class had upon the residents.

Edith M. Sherman

5

1. In a group setting, there was the opportunity for socialization with teacher, staff, and other residents. 2. A scheduled event gave the residents something to look fo r­ w ard to and plan for. This event w as better than reality therapy because the days fo r dance class were anticipated with plea­ sure. 3. The change in routine increased the residen ts’ awareness o f time and relationships. 4. The music, dancing and humanities had a positive impact on the attitudes o f the residents. A ristotle’s famous p hrase, “ M an (and woman) is by nature a so ­ cial a n im a l,” can no t be stressed to o m uch. H uman beings need to rem ain social anim als regardless o f their age or physical condition. The opposite o f socialization is solitary confinement. When it is used by some institutions, as is done so wisely at times, it inflicts the m ax im um d egree o f pain and suffering.

G O A L S O F YOUR A S S O C IA T IO N The prim ary goal of activity professionals in their work e n viron ­ ment could be sum m arized as the expansion o f residents’ and p a ­ tients’ physical and social life space that will contract if left to n o r­ mal circumstances. F ou r walls o f o n e ’s room dim inish the stimulation and interaction needed by all people. Intimacy with family m e m b ers, close friends, and meaningful others is often lost. Social interaction with im per­ sonal c are tak ers can be devastating. T h e elderly do not lose their sexual needs. By that I mean a broad definition that includes touching, em bracing, and stroking. Today there is a great emphasis on pet th erapy, a kind o f substitute for hu ­ man closeness o f a physical nature. One nursing ho m e resident was heard to greet his family with, “ W hy d o n ’t you greet me like the dog d o e s ? ” T w o examples o f alternative pro gram m ing to expand the life space fo r the elderly/disabled have recently com e to my attention and I would like to share them with you. O ver the Hill Gang is a group o f older skiers. The physical activi­ ty has p ro v ed to be almost a side benefit. M ost people go just to

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INNOVATIONS I N ACTIVH1ES FOR THE ELDERLY

achieve the companionship o f others with similar interests. The group has expanded fro m skiing to hiking, sw im m ing, surfing, etc. Roadrunners is a program o f field trips organized for residents and patients o f chronic care facilities by a D en ver priest. It began with 30 p ersons and one bus and has grow n to its present size, 30 buses and 900 persons. Again, socialization is the biggest attraction, with change in rou tine and new experiences next in importance. W h en asked about how the project was financed, the Father replied with hands outstretched, “ God p ro v id e s.”

IM P R O V I N G P R O G R A M M IN G WITH N E W ID E AS Activity program s need to be beyond the arts/crafts/female-type activities that were prevalent in the early days o f the activity c o o r­ dinator. T o o often the humanities are neglected. T h ere is a wealth o f m aterial to be tapp ed in art, literature, history, music, go v ernm ent, law. M any a lively discussion can c e n te r around aspects o f our c u l­ ture, such as food, drink, entertainment, holidays, theater, the media, philosophy and values, travel. T he National Council on the Aging (N C O A ) series entitled “ Self Discovery T h ro u g h the H u m an ities” offers a wide variety o f r e ­ source material for developing such p ro g r a m s based on literature and art. Som e examples o f topics available include: “ A Family A l­ b u m , ” a look at the family in literature; “ W ords and M u s ic ,” an in­ troduction to A m erican musical c om edy; “ The Heritage o f th e F u ­ t u r e , ” current events and their im portance to future generations; “ W ork in A m erican H is to ry .” These prog ram s make use o f p o si­ tive rem iniscence and life review techniques, o f photographic re ­ view as well as personal and historical calendars. C reative writing in the form o f poetry o r papers and newsletters written by residents themselves expand the life experiences o f those we serve. C ontests for such creative endeavors can offer motivation for those who are reluctant to try. Short courses taught by universities are finding their way into senior housing developm ents, nursing ho m es, and senior centers. Residents them selves choose the courses. In one such experiment now funded by the Colorado D epartm ent of H igher Education, di­ plo m as are given for w ork completed. The G reat Books series offered by the University o f Chicago is another source o f program ideas.

Edith M. Sherman

7

O pen Enrollment in Colleges and Universities gives opportunity for life long learning. The dissertation o f a doctoral student at the University o f D enver recently contained com m ents on the impact o f such enrollm ent. T h e English instructor w rote, “ T h e Senior Citizen in my class on A m erican literature, which as you know these days is nothing but ‘sex and s i n , ’ took to it like a duck to w a te r .” Intergenerational projects, service/learning experiences o f all types, help to destroy the artificial age-graded separation o f the g en ­ erations. T he 1982 Oscar-winning d o cum en tary film “ Close H a r­ m o n y ” illustrates the m arvelous use o f music to bring children to ­ gether with people o f their g ran d p aren ts’ generation. Residents o f nursing homes n eed to be incorporated into any and all o f the local events that may be o f interest to them. In 1983 15 o r 20 residents from the Glen Valley Nursing H o m e in G lenwood Springs, C olorado, traveled 40 miles to attend a rehearsal o f the fam ous Aspen O rchestra in A spen, C olorado. The event re p re ­ sented the cooperative efforts o f m anage rs, staff, local service o r ­ ganizations, a nd the Music Associates o f Aspen to make a treat available to institutionalized people. Involvement in local events is one way o f overcom ing the dissociation which happens to so many patients and creating a future worth looking forward to. TH E USE O F C O M M U N I T Y R E S O U R C E S The provision o f a well-rounded and challenging activity program cannot be the responsibility o f one or two staff persons working alone. C om m unity resources are available and are essential to the p rogram . (1) The Family. W here m em bers o f families exist and reside close to residents, they contribute an estimated 80 percent o f the ser­ vices to older family m em b ers. H ow ev er, a goodly num ber o f nurs­ ing hom e residents, especially w omen, are end-products o f the d e ­ pression years which left many females unmarried and childless. W here family m em b ers are available, they can be extremely help­ ful to institutions and staff. As prim ary caregivers, h ow ever, they can become m artyrs, ov erw o rked and abused. M any middle-aged w om en , daughters and daughters-in-law, are today working in the jo b-m ark e t and are sandwiched in betw een the teen-aged ge n e ra ­ tions and the g rand paren t generations. They themselves may al­ ready be o ld e r an d unable to c are for the old-old, frail, at-risk ge n ­ eration.

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INNOVATIONS IN A C T IV IT IE S FOR THE ELDERLY

(2) V olunteers. A great source o f pro gram m in g help if properly m anaged, volunteers need a D irector o f V o lunteer Services if they are to be united into an organized, dependable, re w a rd e d cadre o f help that rep resents all ages. I personally believe that through a “ Youth C o r p s ” all young people should spend a y ear o r tw o in so­ cial and comm unity service pro g ram s. In that way they would b e ­ com e b etter acquainted with many segm en ts o f our population which are so readily overlooked or ignored. Look to volunteer groups such as R S V P , Senior A ides, Senior C om panions, F o ste r G randp aren ts, T e a c h e rs ’ A ides, Paralegal W ork e rs, C hurch G ro u p s, A uxiliaries, Candy-stripers, etc. A w ord o f warning is needed here. D o n ’t confuse volunteer ser­ vices, supplementary and auxiliary, with m ajor prog ram s that must be sustained b y society and which result fro m life-long contributory taxes by almost every m e m b er o f o ur society. I am referring to So­ cial Security, Supplemental Security Income, M ed icare, M edicaid, Aid to the Partially/Totally D isabled, Aid to the Blind, and the m eans tested programs for the poor and needy. (3) Advocacy and A ction-Oriented P ro gram s. People who are old or ill or disabled need to have some feelings o f control o f their own lives. It is im portant for them to participate in political activity, to vote, to discuss curren t issues, to hear fro m their leaders, to join organizations that represent th eir interests. In a recent N ew York Times article I read the following precepts for healthy aging: 1. Stay socially involved. 2. Remain mentally active. 3. Have a flexible personality. It is im portant to avoid atrophy. Let the parts w ear out rather than rust out fro m disuse. In closing, let me tell you about an elderly w om an w h o kept a positive attitude. She was o v erheard discussing retirement plans and options with her husband, saying, “ If one o f us dies, I ’m going to F lo r id a .”

Interdisciplinary Teamwork Sister Patricia M urphy

W ho am o n g us have not been sw ept up into the fever and excite­ ment o f the qualifiers and p erform ances o f the O lympics. Even from an arm chair perspective, it is clear that each and every event is born in many layers o f teamwork from a network o f human support p e r ­ fo rm an ce—an inter and multidisciplinary approach. We long term care w orkers have ou r own Olympics on a daily basis and ou r success is dependent on ou r team w ork and ou r disci­ plinary relations. All o u r p rog ram m in g and c a re is intended to d ove­ tail tow ard the meeting o f ou r res id en t’s special needs. M any o f the “ quality o f life” needs are psycho-social and each departm ent holds within its mandate the responsibility to m eet these psycho-social needs th ro ug h their specific service. We, whose departments r e ­ volve specifically around psycho-social needs, must be continually aware o f the need to extend opportunities to all departments, to co n ­ tribute to the design, implementation and evaluation o f specific p ro ­ g ram s that m eet psycho-social needs. I would like to share the story o f an activity professional whose relief c o u ld n ’t seem to m eet expectations. She felt she was the only one in the facility who really understood the needs o f the residents and she co u ld n ’t figure out why she found herself planning and ex e­ cuting prog ram s all by herself. She co u ld n ’t understand why resi­ dents w e r e n ’t dressed and p rep ared for program s; why she was the sole transporter o f residents; why the cook forgot the birthday cake; why hard w ork craft items were thrown out by housekeeping; why the activity coo rd in ato rs’ room was dirty from other p rogram s; why medication nurses disturbed her program s by calling out names or saying loudly “ sw allow, sw allo w ” ; why residents were taken out o f the middle o f p rog ram s for their baths; why the van went h om e with Sister Pa tricia M u r p h y is c u rr e n tl y s erv in g h e r s e c o n d term as P r e si d e n t o f the Na tional A s so cia tio n o f Act ivity P ro fe s s io n a ls . She is the C o r p o r a t e D i r e c t o r o f Activities and Social Se rv ice s for B e ve r ly E nt e rp ris e s, P a s a d e n a , CA . “ Si ster P a t ” e a r n e d her M A de gr e e in C o m m u n i c a t i o n Art s from Lo y ol a Un iv e rs ity o f Los Ange le s; is a pu bl ish ed a u th o r , a le c ­ t u re r and has been a T V host. ©

1985 by T h e H a w o r t h P r e s s , Inc. All r ig h t s r e s e r v e d .

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the administrator the week o f the outing; why staff co u ld n ’t seem to be cajoled to c o m e to pro gram s unless they had food involved; why residents w ere uneasy with each other but w arm and friendly to her; w hy residents resisted volunteers an d kept telling h er they really p referred her services; why volunteers were only interested as long as she worked with them. This activity professional had a difficult time doing the pro gram she felt was so im portant because she ended up being all alone and this happened because she d id n ’t make good use o f the rest o f the team . Sometim es we feel activity professionals seem quite alone in meeting these psycho-social needs as though other departm ents are too busy or perhaps d o n ’t even care about what happens in their d e­ partments. We can go a long way tow ard changing this by seeing to it that we act as part o f a team which offers many ways for all d e ­ partm ents to meet resid ent’s psycho-social needs. This attitude will contribute to w ard m aking the provisions o f p ro g ram m in g an a d m in ­ istrative priority, an all staff responsibility, an interdisciplinary prem ise, and a pro gram and service plan that functions seven days a week. We might take a look at just who is the team we are part of. A mental check indicates administration, nursing, social services, housekeeping, m aintenance, and clerical. H o w e v e r, there are other vital com ponents to a team approach and they are consultants, resi­ dents, family, com m unity services, com m unity religious sector, comm unity college, hospital discharge planners, senior art and e d u ­ cation specialists, recreation and parks d epartm ent and so forth. The Social Services and Activities D epartm ent does provide one o f the best vehicles for all m em bers o f the team to meet their need to participate in formal psycho-social p ro gram m in g. A nd, we do come prepared with m o re training slanted to design systems to meet psycho-social needs but we will n ev er accom plish the scope, variety and leadership in our program m ing by ourselves. W hat is the process o f team w ork? First, there needs to be a p e r­ sonal and s t a f f perception o f your place on the team . Second, you need to utilize y ou r cu rren t prog ram s to educate, influence and c o ­ operate with the rest o f the team m em bers. T h ese areas are: a. care plan meetings b. d ep artm en t head meetings c. in-services (let’s specifically show why the prog ra m s we uti­ lize in o u r departm ents are useful in meeting resid en t’s needs)

Sister Patricia Murphy

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d. resident council e. family council f. comm unity forums You already have within your own departm ent many areas in which to collaborate in team planning: a. C alendar planning that involves the whole staff, the Resident Council. All o f our cale ndars should be reviewed by these components b efore they take formal and final shape so it needs to be done monthly as well as in an overall way on a yearly basis. b. Program evaluation—W e should d o at least a quarterly p ro ­ gram evaluation with the rest o f the team so that they can get input to what they feel has been successful from their point of view. c. M ajor event rev iew —A fter each m ajor event (e .g ., National N ursing H o m e W eek) the staff and m em bers o f the team should be asked for their evaluation o f the event, what could be changed and what could be added. d. Program participation by the rest o f the team especially in the early a.m . and weekend pro gram m in g. If we make it possible for oth er m em bers o f the interdisciplinary team to participate in a failsafe way in leadership positions we will give them the satisfaction of knowing just how important these prog ram s arc to our residents. e. Program posting—Each nursing station, each d epartm ent head station should be a calendar in easy view. Special programs should be posted in these areas when specific team participa­ tion is required. f. Utilizing the staff to train volunteers will help the staff un d er­ stand this part o f o ur team and take some responsiblity for their successes. g. The model set o f te am w o rk am ong the social rehabilitation staff and volunteers, both resident, family and comm unity will give the rest o f the staff an idea o f the benefits o f interdisciplin­ ary collaboration. M o s t o f us hav e experienced the pay -off o f interdisciplinary team w ork usually after a big event that comes o f f successfully. We listen to the o th e r staff talking excitedly about how one o r the other

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IN N O V A TIO N S IN A C TIV ITIE S FOR T H E E LD E R LY

residents did things they n ev er ex p ecte d w ere possible. W e ’ve seen these sam e residents p e rf o rm th at way b e fo r e and w e could be fe el­ ing ra th e r sm u g that the e x p erien ce taught so m ething special to “ t h e m . ” But this should be a daily o c c u rr e n c e , not an e x ceptio n and our own indefatigable efforts at being effective team m e m b e rs and co nsistent. In tegrating the rest o f the team into o u r p ro g r a m will help this e x p e rie n c e to m ultiply. T h e p a y - o f f c o m e s w hen: —T h e w hole staff rec og niz es that an activity is m o r e successful w h en they actively participate. —W h e n nursin g begs for an activity p ro g r a m o f their o w n. — W h en d ie tary w ants to be in c h a rg e o f th e m o nthly birthday p r o g r a m m in g . — W h e n m ainten an ce involves y o u r m e n residents in a m e n ’s p r o ­ g ra m . — W hen h ou se kee pin g insists on giving a class in “ p ers o n a liz ­ ing ” a r e s id e n t’s ro o m . — W hen the A d m in istrato r ru ns the new residen t/fam ily tea. — W hen clerical gives a p r o g r a m on nursing h o m e personal m o nies use. — W hen th e g a rd e n e r m a k e s su r e so m e residents a r e involved. — W hen C o m m u n ity S ervice asks for y o u r ex pertise in m eeting p sycho-social needs and prom ises an e x ch ang e o f re s o u rc e s. — W hen the city R ecreatio n an d P a rk s D e p a rtm e n t asks w hen y o u ’d like to use their van. — W h en the su rv e y o rs a s k if y o u w o u ld m in d their taking yo u r multi and interdisciplinary plan to o th e r facilities. — W hen fam ilies tell o th er prospective clients that y o u r facility has all kinds o f staff doing all kinds o f interesting p ro g r a m s . — W h en schools ask y o u r residents to teach “ a g i n g ” edu cation . — W hen universities ch oo se o u r facility a m o n g m a n y for field w o rk b ecau se you train activity professio nals for the long term future as well as today. Both within the facility and outside the facility, there is g reat need for a b e tter u n de rstan din g o f the capabilities o f o u r “ d is a b le d ” residents and w hat they can con trib ute to the well being o f those who serve them and the c o m m un ity fr o m which they c a m e . W e have the o pp ortunity to extend the n etw o rk o f the residen t, the s ta ff and the facility when we ed u c ate, learn f r o m , utilize and prom ote a multiinterdisciplinary a p p ro a c h in long te r m c a re services.

Into A gin g—A Simulation Game Joanne W illiam s

While aging is something that all o f us do from the m o m e n t we are born until we die, it still is largely a taboo topic in the United States. Sex, with all its ramifications, is a topic that is quite all right for discussion by the old and young in almost any context. Death, too, is an acceptable topic in workshops on death and dying, in re­ ligious sectors and in special courses in health sciences. But aging is rarely acceptable as a topic; it is still largely avoided. The consequences o f this avoidance is that less is known about the norm al aspects o f the process o f aging, and less enlightened policies and health planning for the aged are produced. “ Into A g in g ” is a vehicle w hereby our societal avoidance o f is­ sues confronting those people o v e r 65 years o f age is immediately challenged. In our largely age-graded society, it is fairly easy to avoid interchange with those not in a particular age group. This game creates a familiarity and aw areness o f issues and problems o f aging. “ Into A g in g ” is a very well researched simulation gam e. Its authors painstakingly consulted the literature for data, statistics, theories and o ther types o f materials to aid them in the formulation o f the game. The likelihood o f certain events in the gam e is carefully tied to the probability o f the same events in the real world. W hen you play “ Into A g in g ,” you will find that you em erge a much changed individual. It will no longer be possible for you to ig­ nore your own aging process or to avoid the aged around you with­ out at least a twinge o f guilt. “ Into A g in g ” is a powerful instru­ ment. It serves not to teach content in the field o f gerontology per se but to sensitize the player to areas o f interest and concern which pre viously had not been within their focal aw areness. The gam e is a microcosm ic experience intended to dram atize cerJo a nn e W ill iam s, a u t h o r , l ec tu re r , a n d c on s u lti n g e d i t o r with Po tentials D e v e l o p m e n t t o r H e a l th a n d A g in g S e r v ic e s , h a s s e rv e d as an a c tiv ity c o o rd i n a to r in both a skilled n u r s i n g f a ­ cility a n d in a re t i re m e n t r es i d e n ce . Sh e is a m e m b e r o f th e B oa rd o f T r u s te e s o f N A A P. ©

198 5 by T h e H a w o r t h P r e s s , I n c. All rights r es e r v e d.

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tain attitudes and beliefs underlying society’s w ay o f dealing with the elderly. M any aspects o f life w e re introduced into the subject matter for scrutinization. W h a t follows is a brie f overview o f some o f the m ore com m on situations o f the elderly as well as how they be­ come problems and affect stereotyping. Because o f the dynamic social structure in w hich humans exist, the individual is continually influencing a n d bein g influenced by the environm ent. This interaction begins at conception and progresses to death. D uring the process o f g ro w ing , we m onitor the way we are received by the environm ent and adjust our behavior to achieve the response we expect to be appropriate. The myth that old people are static and unchanging is thus disproved. The elderly pick up cues about what is expected from them in the way o f behavior, and may conform to stereotypes instead o f to their own expression o f self. So to a g reat extent, the way we see the elderly may well be a reflection o f ou r own attitudes about them. The perceptual faculties such as sight, sm ell, taste, hearing and touch are all subject to im pairm ent due to natural changes. These perceptual changes become more important when the individual in­ teracts with others. H u m an s rely heavily on v erbal com m unication. O n e ’s perceptual fram ew ork or beliefs about ag ing leads him to in­ terpret difficulties an d changes as being d ue to “ senility” rather than normal deficits in the senses that in some cases can be co r­ rected . Each player in the g am e receives a set o f instructions and is given a few m inutes to read this before play com m en ces. This provides the rules to be followed and goal to be achieved. T h e g am e is designed to allow participants to experience problems which many old people face in our society today. When the g am e is o v e r, players discuss their experiences and feelings. As part o f the g am e, they assume the identities they see themselves as having when old, thereby investing personal values into the game. Players share their identities and p ro cee d to three tables, set up to represent three modes o f living: independent, se m i­ dependent, and dependent. E ach table has a stack o f Life-Event cards. The deck is stacked with odds against the players, forcing th em into a dependent life style. T he exercise which must be do n e to obtain an incom e is difficult, signifying the financial p ro b lem s old people have. T he end result is that players experience the loss o f m any valued objects, including their identity, and becom ing in creas­ ingly dep en d en t, isolated, and pow erless.

Joanne Williams

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A debriefing period after the game is essential because, although “ Into A g in g ” is a game, it is not necessarily fun. It is a learning tool. Players are encouraged to discuss their experiences and how these problems can be dealt with positively. Hopefully, the player will develop and practice skills in recognizing myths and stereotypes and creating change. The following are personal im pressions and observations from having presented this w orkshop several times in California. The gam e is negatively oriented so chances o f winning are slim. Strong, honest, life-loving players have found them selves altering behavior­ al patterns in ord e r to survive with dignity. Occasionally a player will cheat o r lie or steal or hide in o rd e r to retain his m eager posessions or identity. As negative circum stances begin to catapult, even the most enthusiastic, optimistic player may choose suicide because the future appears hopeless. In debriefing, feelings h av e come o u t strong, voices have become loud and competitive as anger was expressed over the attitudes about aging. Resentm ent over the losses has been a major issue, p articu­ larly when the player considered him /herself still capable o f d e ­ cision-m aking and limited control. Having expressed feelings, players are allowed to “ re w rite ” game event cards in a m o re positive, winning m an ner. They discuss how ch ang es can be m ad e in their facilities, with their clients, in their ow n families, to alter perceptions o f aging and gain insight. Questionnaires following the game reveal negative patterns players have becom e trapped in. N ew aw areness as a result o f playing “ Into A g in g ” has sent participants away dedicated to changing their own perception and that o f society within their reach.

Page Intentionally Left Blank

Networking: How to U se What Y o u ’ve Got to Get More of What You Want Jacqueline M. Bean

N etw orking: that's an “ in ” term for the decade, and for good reasons. It’s the key to taking all the problems you encounter in your professional walk and plugging them into the people you know, so the doors will open for y o u —doors to solutions. W hen you hear the w ord “ n e tw o rk in g ,” what do you think? D oes that w ord hold any special meaning for you? If you think of contacts and how to develop them , you have a good idea of netw ork­ ing. If you picture support systems for information, advice and en­ couragem ent, y o u ’re on the right track. A fter reading the opening to Mary Scott W e lc h ’s book. Networking, one woman stated. “ It’s like a page full o f little dots, with lines drawn every which w a y , co n ­ necting those d o t s .” Each person has his o w n private interpretation o f the definition o f the w ord. Each one has his ow n dynamic way o f applying that d e fin ­ ition. And everyone has his ow n personal reasons for using the net­ w orking concept. The important point is that netw orking is a p ro ­ cess that helps people achieve their own goals. In trying to achieve my ow n personal and professional goals. I first began realizing the pow er behind the network concept. It began with a project and a com m itm ent to work with the elderly in c on va ­ lescent settings. As with any project with high goals, my project brought me my share o f pre-completion anxieties. In the midst o f a project, do you ever get the feeling o f being overw helm ed ? In working with the elderly, I did. I began seeing m yself in the place o f my residents. Ja c q u e l in e M . Be an is a lec tu rer a n d edi to r o f G e r i-A a iv e L x tiu u ig e . with e x p e r i e n c e as an activity c o o r d i n a to r in long t e r m c a re . He r va rie d b a c k g r o u n d incl ude s e x p e r i e n c e in d r a m a , r ad i o, m u sic t h e r a p y , and pub lic rel ati on s. ©

1985 by T h e H a w o r t h Pr e ss . Inc. All right s res e rv e d.

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I am really worried about something. You see, I am a “ baby b o o m ” baby. T hat m ade things ever so exciting while we “ baby b o o m e r s ” were in high school and college, but the pressure is b e ­ ginning to set in. While we went through o ur tw enties and thirties, we began to realize w hat it m ean t to have ju st a little bit too m any o f us, and not enough o f ev ery on e else. The squeeze was on for hou s­ ing and som e commodities. The population is getting top-heavy. While the median age in this country used to be young enough to m ake this a teen-oriented so ­ ciety, it is now edging to w a rd forty. Our society is maturing. You can see it in the ads that cater to those over thirty and over forty. Products made especially for “ hair over f o r ty ,” Levis cut just a lit­ tle bit wider than when we w ere teens. We baby boom ers will have plenty o f company as we go through the “ crisis y e a r s ” o f middle age. Fine; we can be sociable. But what happens when the median age slips closer to 50? I realize there will always be younger folks to pull the cumulative dem ographic ag­ ing effect back dow n, but what happens w hen the baby boom ers reach 60 . . . 70 . . . 80? Those who reside in nursing homes at this time are just a small percentage o f the general population. And yet we struggle to keep up that steady quantity and quality o f pro gram s fo r o u r curren t resi­ dents. Will our innovations, plans and funding keep up an adequate pace so that the demand will be met when the baby boom ers hit c o n ­ valescent age? R em em b er w hen the baby boom ers hit school age? T here was a sudden aw akening to the need for quality education: build schools, train better teachers, pay teachers better salaries. By the time so ­ ciety was finally p repared to m eet the onslaught, the baby boo m ers w ere slipping into their caps and gowns for the graduation c e r e ­ mony . By then there were all those m o de rn facilities, m an ne d by e x ­ cellently trained teachers w h o faced nearly empty classroom s. Sorry, M om and Dad, your tax dollars did the trick, but too late! What will happen in the year 2020? Baby boomers will turn seventy. Will A m erican society wait until the crisis time to panic over potential gross lack o f care for their elderly? O ur program s may w ork now, given to d ay ’s ratios and dem ographic spreads. But what about quality care in the future? W e have to start building to­ w ards that p rog ram now. Everyone is familiar with the people/time squeezes an activity c o ­ ordinator experiences at times. That is like an experience 1 had a

Jacqueline M. Bean

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few years ago. I got this terrific idea for a new project at my facility. I decided to devise a system o f hand signals that aphasaic stroke vic­ tims could use in ord er to com m unicate basic needs. I began te ac h­ ing signs, modified from Standard A merican Sign Language. I taught the aides. I taught the entire nursing staff. T ogether, we were planning to work patiently and regularly with five to ten selected residents. And then cam e crafts. And bingo. And music. And visiting time. And meetings. And p aperw ork. And the project lost the persistent effort it needed to stay alive. I dropped it. And I regretted it. Later I learned how I could have handled the situation in a differ­ ent m anner. Instead o f depending solely on paid staff, already over­ burdened with daily routine, I could have devised a new kind o f plan. This was a plan I discovered through research for our state’s professional council. One day I was reading some information on taxes and the IRS and organizations. I ran across a phrase familiar to many o f you: tax e x ­ em pt non-profit corporation. I had known about those types o f groups for years. But this day, I let m y m ind wander. I started think­ ing, “ W h at if . . . " What if I still could do my sign language project? W hat if I could find funding for my idea and put it into a pilot project, with additional paid personnel? What if all this could be done under the sponsorship o f my state organization? What if my state organization becam e a tax exempt non-profit corporation? I began researching everything I could find on non-profit a g e n ­ cies . . . foundations . . . writing grants . . . fund raising. This turned up an enorm ous am ount o f data that boiled down to one fact. My idea, while fantastic, was going to need a lot o f groundw ork. In o rd er to be prepared for the project, my main concern needed to be network building. In o rd er to make a project workable, you must first consider some things. Developing a project is like making a sandwich. Both have five basic elements. In making a sandwich, you grab a piece of bread, slap some mayo on it, follow that by some meat, then another slice o f bread and mayo. Project-building involves investigation, identification o f needs, netw ork building, information gathering and dissemination, and developm ent o f resources. Five elements: and, like the sandw ich, it is what is in the middle that counts. It's the

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m eat that gives you muscle. It’s the well-planned netw ork that will insure y o u r p roject’s success. Five steps: investigation, identification, netw orking, prom otion and developing resources. The beginning and ending are easy. You already know what to do to invent creative projects. It’s the middle step—n etw orking—that d e m a n d s extra attention. So, how to build a netw ork? How do you meet people? How do you plug them into your project? Consider the idea o f influence. E veryone has a sphere o f influence. You need to let yours work for you. Visualize the im pact o f your sphere o f influence. F o r a m o ­ m en t, in your m in d ’s eye, picture yo u rself at the edge o f a country pond, poised and ready to toss a pebble into the water. As the splash subsides, little ripples form w here the pebble ente re d the water. T hose ripples gradually exp and , stretching out to reach to the very shores o f that pond. T hose ripples are like your sphere o f influence. N o w , how do you m ake that sphere o f influence w ork fo r you? Take another imaginary trip back to that country pond, only this time bring along a friend. You stand at one end o f the pond, and your friend walks to the other end. T ogether you pick up pebbles, and simultaneously toss th em into the water. A s they hit the p o n d ’s surface, watch those ripples. Starting sm all, each p e b b le ’s im p res­ sion on the w ate r gradually radiates outw ard. At one point, the rip­ ples from your pebble and those o f your fr ie n d ’s intersect. At that point, you have illustrated a working netw ork system. Y our spheres o f influence intersect. The question arises: How fa r can your netw ork reach? T h e o re t­ ically, this could stretch on forever. To get a definite idea o f your personal sphere o f influence at this point, try an exercise. T ake a piece o f blank binder paper and a pen. W e are going to organize your acquaintances through a technique called patterning. F irst, in the center o f the p age , write the word “ m e . ” D raw a small circle around this word. T he n, think o f the various roles you play in your daily routine. You may be a volunteer, or a m other, or a supervisor. You may claim all o f these titles and m ore. F o r each descriptive title o f the aspects o f your life, draw a line radiating out from the center w o rd , like spokes on a wheel. Label each line with a title. T he n, subdivide by listing descriptive tasks you fulfill. F or in­ stance, under the title volunteer, you may have three branches la­ beled political cam p aig n, den m o ther and Red Cross. For the final step, begin filling in names o f those you w ork with in each o f those descriptive capacities. You then have a diagram o f not only the

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areas in which you exercise your sphere of influence, but the people you influence regularly, as well. This influence is im portant a s a key elem ent o f networking. Spheres o f influence are forever expanding. People are interfaced in a dynamic w ay as a method o f goal accom plishment. In netw orking, there a re four basic possibilities o f operation. I m a y meet you, and we develop an acquaintance based on professional ties. In the course o f my w o rk, I may meet M rs. X, w hom I re fe r to you because she may need your assistance. O r you may refer me to a M r. Y, who has the perfect idea for a project I ’m tackling. Finally, you and I are careful to re-establish mutual ties on a regular basis. In each of these four instances o f netw orking, the contacts are m ade to help or give help to professionals, not only in activities, but in all fields and occupations. This becomes especially important w hen a project you are working on suddenly needs advice from an accountant or support from a politician. If you have developed and enlarged your sphere o f influence, offering your own expertise w here possible, it is like m o n ey in a savings account. W h at you do will come back to you through the netw orking endeavor. Building a netw ork is a task to be taken serio usly . No matter how great your m e m o ry , keep everything on paper when it comes to re­ m em bering who your contacts are and why they are important. It is a good idea to develop a card file system in duplicate—filing each entry by nam e, alphabetically, and by a code system listing special­ izations, such as law, the media, o r business. On each card , be sure to include ro om for the p e rs o n ’s nam e, address, phone num ber, c o m m en ts on areas o f personal interest and professional affiliations. On the bottom o f the card , o r on the back, leave a good portion of space for record keeping on each meeting or contact, promises m ad e and any other information to refresh your m em o ry on the last mutual contact. While netw orking is o ften used on a personal basis, the concept o f netw orking can also be applied on a group basis. This becomes clear when you consider that each organization you are affiliated with is m a d e up o f individual m em bers. T h e se individuals all have their ow n spheres o f influence. W hy let your m em bers be selfish? Give th em the opportunity to share the wealth o f their individual net­ works. Print up a questionnaire to help y ou r m em be rs share infor­ m ation on their netw orks. This may prove valuable to you at a later time. N etw orking skills a re people-meeting skills. Sometim es people

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hesitate to expand their netw orks because they are apprehensive when it com es to making new acquaintances, especially those who will be asked to do a favor. And yet this skill is vital to professional self-im provem ent. I f you feel like you need some moral support b efo re em barking on a netw ork-expanding project, try the following exercises with som e friends o r a group like y ou r regional activity co o rd in ato rs’ organization. To practice verbally putting your best foot forw ard (not in your mouth): have grou p sit in a circle. Round-robin, have each person take a turn at repeating and c om pleting this statement: “ I feel I am a successful Activity C oo rdin ator because . . . ” One by o ne, the participants will feel a growing confidence in their o w n unique skills. To practice giving a verbal, concise description o f your p ro fes­ sion to new acquaintances, try this round-robin ex ercise using a m oderator. The challenge is, in 25 words or less, to answer a “ stranger from outer s p a c e ” (the m oderator) who has just asked you, “ W h at do you d o ? ” D o n ’t take any stock phrases for granted, for the “ a lie n ” m o d e r a to r’s task is to constantly interject com m ents like “ L T C ? W h a t ’s that?” R em em b er, your m od erato r is from outer space. O nce you provide him or her (or it?) with a satisfying and concise description o f your profession, you can be sure you will be amply p rep ared to take on the world and other humans like y o u r­ self. To develop listening, divide into pairs. One person in each pair will begin telling the partner a b o u t a significant o c c u rre n c e or p ro j­ ect that gave that person satisfaction. The listening partn er is al­ lowed only a few minutes to hear the story before all partners have to split up and find new partners. At this point, the old listeners b e ­ com e the new speakers, telling ab ou t the story just told by the form er partner. At the end o f the session, have a few people share the stories o f most interest with the group as a whole. N ote how well the listener rem em b ered details, and which story lines helped a listener rem em b er the best. A rm ed with records o f your sphere o f influence, current contacts, and with a goo d deal o f confidence-building u nd er your belt, you are ready to becom e an avid netw orker. The last point is really a q u es­ tion. W hy are you, personally, interested in netw orking? W hat reason was there for you to develop the technique? In the beginning o f this article, it was pointed out that n etw o rk building is part o f a process, the muscle of planning a successful project, no matter what

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the topic at h a n d . B u t w h a t a b o u t y o u , p ers o n a lly ? W h a t is y o u r c u r ­ ren t p ro je c t? Sit d o w n fo r a m in u te and e v alu a te y o u r c u r r e n t p ro fe ssio n a l g o a ls . W h a t is y o u r c u r r e n t p ro je c t? L ist y o u r o b je c tiv e s . D e c id e w h at ty pe o f p e o p le y ou n e e d to m e e t. R e v ie w y o u r e v a lu a tio n o f y o u r presen t n e tw o rk to d e te rm in e the n e tw o rk y ou will n eed to o b ­ tain y o u r g o a l. Set a sch ed ule to h elp yo u m e e t all the new pe o p le y ou will n eed to c o n ta c t f o r y o u r p ro je c t. A nd co n stan tly re -e v a lu a te y o u r p lan s an d g o a ls . P a c e y o u r s e l f for s u c c e s s. R e m e m b e r — no o n e likes to say “ n o ” ; e v e ry o n e likes to give a d ­ vice. K e e p o th e r s in te re s te d in w h a t y ou a re d o in g . R e m e m b e r w hy y o u a re n e tw o r k i n g . Y o u w a n t to r e c e iv e input from s u c c e s sfu l p e o ­ ple in th e ir fields. Y o u w a n t to p r o v i d e fellow p ro f e s s io n a ls with a m u tu a l s u p p o r t sy s te m . Y o u w a n t to a d v a n c e y o u r c a u se (and y o u r c a r e e r ) . Y o u c o n tin u a lly w a n t to m e e t ro le m o d e ls as a m e a n s o f edu cation al o u tr e a c h . A n d y ou a re building y o u r n e tw o rk as a m e a n s o f d e v e lo p in g y o u r c u r r e n t p ro je c t. Y o u a re using w h at you h a v e ( y o u r in flu ence) to get w h a t yo u w an t. Y o u a re utilizing y o u r n e tw o rk to a c h ie v e y o u r p ro f e s s io n a l g oa ls.

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The Difference an Idea Makes: The Art o f Brainstorming K im berly Chaffin

On a scale o f “ 1 ” to “ 1 0 ,” w here would you rate the importance in y o u r position o f new ideas and the ability to solve problems? 1 2 3 4 5 6 7 8 9

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I f most o f you said “ 10,” my next question would be w here would you rate yo u rself in possessing the ability to stimulate new ideas and solve problems? 1 2 3 4 5 6 7 8 9

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Every person in this room possesses a vast resource o f creative ideas, talents, and im pressions o f the world. M uch o f this remains untapped because the skills and confidence are lacking to bring them to the surface. Today in this session you will learn the art and im portance o f brainstorm ing. “ B rain s to rm ” as defined by The A m erican Heritage D ictionary is a sudden, clever, w him sical, or foolish idea. To e x ­ p a n d that, brainstorm ing is an orderly strategy in w hich problems can be w orked out. Mastering the skills o f brainstorming guarantees you the chance to develop new ideas, solve complex prob lem s, and add whole new dim ensions to your jo b . Brainstorm ing is a method o f creative thinking. The basic ingre­ dient in any form o f brainstorming is O s b o r n ’s four rules. 1. Criticism is ruled out. 2. Free-wheeling is w elcomed. The wilder the idea the better. 3. Quantity is wanted. K i m b e r l y C ha f fin is activity c o o r d i n a t o r at F l a n n e r y ' s N u r s in g H o m e , P o r ts m o u th , O hi o. She a ls o s e rv e s as c o o r d i n a to r o f a lo ca l A l z h e i m e r ’s S u p p o r t G r o u p . She ho ld s a BS d e g re e in C o n s u m e r Se rv ice s from M ia m i (O h i o ) U n i v e rs i ty . In 1983 M s . C h a f fi n wa s listed a m o n g the O ut sta nd in g Y o u n g W o m e n o f the Y e a r. R e fe re n c e s from B r a in sto r m in g by C h a r l e s C l a r k , D o u b l e d a y & C o m p a n y . 1958. ©

1985 b y T h e H a w o r t h P r e ss , Inc. All right s r es e r ve d.

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4. C om bin atio n and im p ro v e m e n t are sought. Participants should suggest how ideas might be combined into better ideas. T o begin any brainstorm ing session one must first choose the problem to be attacked. There are two basic types o f questions. The first, a steam-shovel question is very broad and general. For e x a m ­ ple: how can I en han ce the public im age o f the nursing hom e? The problem with this type of question is that it is so broad that stim u ­ lating w orkab le ideas from it would be difficult. E nhance the public im age for w ho m ? W hat would be the targ et audience? A spade question digs into the p ro ble m . W o rk to establish a q u e s­ tion that is w o rd e d in the shortest possible fashion but is limited. A question is limited by asking for w ho, w hen, w here, and by w hom . F o r example: how can the activity d epartm ent enhance c o m m u n ica­ tion betw een relatives and residents? C ould this question be even m ore limited? (during holidays?) It is im portant that each m e m b e r in th e brainstorming session should know the four basic rules. T h e re should be one leader o f the session and one person to write the ideas down. T h e re are certain phrases which should be ruled out by everyone participating. They are “ killer phrases. ” W e ’ve never done that before. It w o n ’t work. W e h a v e n ’t the time. W e h a v e n ’t the m an po w er. I t’s not in the budget. W e ’ve tried that before. W e ’re not ready for it yet. All right in th eo ry , but can you put it into practice? T oo academic. What will the custom ers think? Somebody w ould have suggested it before if it w ere any good. T oo m odern. T o o old-fashioned. L e t’s discuss it at som e other time. You d o n ’t understand the pro blem . W e ’re too small for that. W e ’re too big for that. We have too many projects now. It’s been the same for twenty years, so it must be good.

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W hat bubble head thought that up? I just know it w o n ’t work. L e t’s form a comm ittee. L e t’s think it over for awhile. T h a t’s n ot our problem . D o n ’t m o v e to o fast. W h y something new now? L e t’s wait and see. H ere we go again. I d o n ’t see the connection. Nuts! Sounds good, but I d o n ’t think it will work. It’s not in the plan. No regulations covering it. W e ’ve never used that approach before. I t ’ll m ean m ore work. I t ’s not ou r responsibility. I t ’s too early. I t ’s too late. It will offend. It w o n ’t pan out. O ur peo ple w o n ’t accept it. Something j u s t as negative as the “ killer p h ra s e ” is the person who is apologetic about his own idea. Do you see yourself in any o f these “ self killer p h ra s e s? ” This may not be applicable but . . . This may not w ork, but . . . It is n ’t clear if we need this, but . . . I d o n ’t know if we have the m o ney , but . . . It m ay be a dead end, but . . . Would it hurt if we did? Do you suppose it would be possible? It m ay take a long time, but . . . You probably have ideas about this too, but . . This may not be the right tim e, but . . . This idea seem s useless, but . . . I ’m not too familiar with this, but . . . This m ay be too expensive, but . . . Y o u ’ll probably laugh but . . .

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I h a v e n ’t th ou gh t this o ne th ro u g h , bu t . . . It m ay not be im p ortant, but . . . Joe d o e s n ’t ag ree with m e bu t . . . I realize this d o e s n ’t solve the p ro b le m , b u t . . 3 I f I ’m out o f line, co rr e c t m e . . . D o n ’t be afraid to hitch hike o n so m e o n e e l s e ’s ideas. T h e r e should be no hesitation to sp eak out. Ideas sho uld be p u nch y and qu ick. Ideas should not be sold, d e fe n d e d , o r attacked . T h e y are m erely to ssed o n the table an d jo tte d dow n. Y ou are not tryin g to evalua te th e m ; simply rush on to the next o ne.

A S A M P LE SE SSIO N Now we will test y o u r b ra in sto r m in g skills. B re a k up into g ro u p s o f ten. E lect o ne p erso n to take notes and o n e p e rs o n to act as c h a i r ­ m a n to help identify the p ro b le m . Y o u have 10 m in u te s to c o m e up with th e m ost id eas w hich solve this p ro b le m . H o w ca n activity d i­ re cto rs im p ro v e c o m m u n ic a tio n b etw een relatives a n d residents? You m ay r e w o r d the q uestio n o r m a k e it m o r e specific if you w ish.

SE SSIO N F O LLO W -U P 1. W hich g ro u p c a m e u p with the m o st ideas? 2. W h a t p ro b lem s did you e n c o u n te r while y ou w e re b r a i n s to r m ­ ing? 3. W a s it d ifficult no t to j u d g e an idea? T h e s to rm is ov er. Y o u r list is full o f id eas a n d w h e re do y o u go from there? Ideas c a n ’t be h o a rd e d . T h ey are only c o n sid e re d v alu­ able w h en they are tu r n e d into s o m e th in g (action, p ro d u cts, s e r ­ vices, beliefs). T o m ak e sure y ou have collected ev ery possible idea, give e v e r y ­ on e 24 ho u rs to ad d o th e r ideas to the list. T h e n let the list rest for a couple o f day s b e f o r e sorting the id eas into th ree ca te g orie s. 1. H o t ideas that can b e tried alm ost im m ed iately 2. T h o se w hich need lo ng rang e planning 3. T h o s e w hich are ob viously unusable

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Remain as open minded as possible. The 10 most workable ideas are the ones to be saved. Selling y o ur ideas to your facility is the next crucial step. Most people spend 95% o f their energy thinking up new ideas and only 5% thinking about what to do with them . O ne ought to spend a third o f the time putting his ideas to work. How does y ou r administrator usually react to new ideas? D oes he inhibit you by his attitudes? To sell som eone else you should: 1. Appeal to their motives. How will your idea enhance their jo b ? 2. P rov id e assurances, show them th e re is a need for it, a dem and for it. T hat it w o n ’t increase their workload! 3. Have the idea well thought out and prepared. 4. If they begin to see advanta ges, let them add to the idea and feel that it is their ow n. Individual brainstorm ing incorporates the same techniques as listed above but includes these steps: 1. Establish a good spade question. 2. Write down all the ideas that com e to your head. Brainstorm ing alone lacks the stimulation o f other people, but it is possible to get ideas from many places. Reading magazines, w alk ­ ing the floors o f the facility, spending hours in a library, looking at the problem in a new way. Y ou can b ra in sto rm anyw here. Now try your hand at som e solo brainstorming. T he question: How can I celebrate my next birthday? R em em be r, there a r e no limits to m o n e y , time or distance. Write down all the possible answers to this question that com e to your head. P roblem s seem ingly insoluble, irritating, frustrating, a g g ra ­ vating, frightening are the birthplace o f new ideas. Duncan Hines was a printing salesman who had a hard time finding places to eat while he was traveling his territory. He sent out C hristm as cards to friends recom mending good places to eat. It becam e his career. W hat pro b le m s exist in your facility which m igh t be solved by a few new ideas? T hink o f an ideal w orkplace to you. T hat should produce many potential ideas. The facility I work in is an old m a n ­ sion. It has w inding staircases, a b asem en t dining ro o m and no a c ­ tivity ro om . T h e se given situations leave me plenty o f opportunities to develop ideas for adapting the activity prog ram .

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T h e r e a r e all so r ts o f w ays to force y o u r s e l f into w o rk ing on those new ideas. A n sw e r the fo llow ing question: W h a t w ould you gain if you could think o f m o r e ideas? N o w is the tim e to co n ceiv e ideas, and now is the right tim e to do so m ething ab o u t th e m . F irst, b ra in sto rm w ay s to m a k e y o u r job m o r e re w ard in g and ch alleng ing . T h e n start putting th e m in action.

Residents in the Giving Role Joan B etzold

Intergenerational activities have long been recognized as being of great benefit to all involved. The elderly have an opportunity to share their life experiences and be close to the freshness, fun and e n ­ thusiasm o f youth. On the o th e r hand, you ng sters learn to a p ­ preciate, respect and understand, as well as benefit from the aging process. With this in mind, as Activity D irector at M an or C are Rossville (M aryland) I began my search for intergenerational o p ­ portunities for the residents. I presented my ideas to the R esiden t’s Council. The vast majority o f the residents were extremely excited about them . M any o f their grandchildren and great-grandchildren are not allowed to visit due to what is conceived by family m em bers as an “ unh ealthy ” en vi­ ronm ent. After many inquiries, I finally located a local Tiny T ot C e nter in White M arsh , M aryland. T he school was o w ned and operated by the Baltim ore D epartm ent o f Parks and Recreation, with volunteer help by m others. After much convincing, the Tiny T o t coordinator gave me perm ission to attend the registration meeting and plead my case. I took four Resident Council m e m bers to the meeting, intro­ duced myself, and gave them the floor. By the time they finished their individual appeals to the parents, everyone in the room was in tears. They gave the residents a standing ovation and we were in! The program was designed to get the tots into the facility, have some type o f mutually interesting experience and the opportunity for sharing and interaction. T he second W ednesday o f every month at lunch time was chosen. Tots arrived with parents and teacher and “ p ickn icked ” on sheets on the dining room floor with the residents. T h e Dietary D epartm ent provided tot-like meals, i.e ., peanut butter J o a n Betzold is Qu al ity A s s u r a n c e M a n a g e r for Act ivi tie s, M a n o r H e a lth c a re C o r p o r a ­ tion. B ef o re accepting that position she was activity c o or d in a to r f o r the M a n o r C a r e facility in Ros sv ill e, M a r y l a n d . She r ece iv ed h e r BS d e g r e e in T h e r a p e u t ic R e c r e a t io n from the Un iv e rs ity o f M ary la n d and is cu rre ntl y co mp le tin g w or k f o r her M a s t e r ' s D e g r e e in R e h a ­ bilitative C o u n s e l in g . ©

1985 by T h e H a w o r t h P r e s s , Inc. All right s r es e r ve d.

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and jelly sandw iches, hot dogs, cheese sandw iches, sloppy jo e s , etc. After lunch, entertainm ent was provided for all to enjoy. E n tertainm ent was tricky! Getting something that interested a population that ranged in age from 2 to 102 was a definite challenge. W e experim ented. Local resou rces w ere delighted to co m e in without charge. S o m e pro gram s w e re successful and s o m e w e r e n ’t. Some extremely successful ideas include: — A merican Indian d a n c e rs ’ dem onstration and explanation o f traditional dances — Baltimore C ounty C anine Division P o lic em en ’s demonstration o f attack by police dogs — Puppet show s — C low n/m agician show — Baltimore Z oo slide show and touching display — Judo/K arate demonstration — Baltimore C ounty Fire D epartm ent fire safety p ro g ra m . (Tots w ere allowed to try on coats, boots, etc.) — A m erican Flag history dem onstration by the A m erican Legion — Santa (a resident) visit with distribution o f gifts — Pet Store (told how to take care o f and let tots touch com m on pets, i.e ., gerbils, guinea pigs, rabbits, cats) — Doll show provided by the local doll hospital — Kite show (local kite club brought slides and helped tots make their own kites) — Baltim ore Orioles player A1 Bum bry talked and signed a u to ­ graphs. T he team mascot, the Oriole Bird, accompanied him. — Balloon release — M r. Do Bee from the TV show , R o m p er Room — Balloon sculpture — Baltimore Colts player Jim m y M o o re talked and signed a uto­ graphs — National Nutrition W eek p ro gram in M a rc h , featuring local food p ro d u c e r s ’ mascots. Baron Von Esskay did a magic show; G reen Spring Dairy Cow and Dairy Princess gave out cow e rasers, coloring books, pencils, chocolate milk; Twinkie the Kid gave out Twinkies. — Beekeeper showed an observation hive and offered tastes o f different flavors o f honey. — Pinata filled with candy

Joan Betzold

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E A R L Y VISITS Initially staff, residents, parents, and tots were apprehensive. Tots cried and would not eat nor leave their parents. I decided I would try the exchange for a certain period o f time and if the situa­ tion d id n ’t im prove, I w ould chalk it up for a good try. Im provem ent was dramatic! After tw o m onths, tots were sitting on resid ents’ laps, giving out kisses. T hey even visited betw een luncheons. The program continued to grow and flourish with both tots and residents taking m ore and m o re interest in each other. Soon resi­ dents w ere paying for the to ts’ meals out o f the R esident’s Council T reasury and preparing the meals themselves. By the end o f the first year, the Council decided to present the Tot School with ch ild ren ’s exercise records to thank them for com ing and to show how much they loved them! I surm ised the p ro g ra m was a success!

A R E S I D E N T - B U IL T S U R P R IS E As a formality, we again attended the next registration meeting that su m m er and the program had a firm foundation. During the sum m er, the Council discussed a big surprise project to give to the tots the following spring—som ething special. M any ideas were p ro ­ posed. Finally the Council decided to construct a playhouse for the school. The instructor o f o u r Basic W oo dw o rkin g for the Senior Adult course, offered through Essex Comm unity College, was consulted on the project. Estimated cost was $400. T hat was all the in fo rm a­ tion the residents needed. T hey got busy with raffles, bake sales, balloon releases and other m o ney -m aking projects. T h e plans were found, lum ber and supplies purchased, an d the work began under the in structor’s supervision. W o odw orking class w o rk e d on the house tw ice a w eek starting in O ctober. As the pieces grew in size and n um ber, an area in the nursing h o m e ’s main dining room was sectioned o f f with sheets from ceiling to floor. The secret steadily grew . T h e Council w as v ery co ncerned about the authenticity, safety and durability o f the house. The price o f the house increased as we added real shingles, indoor-outdoor carpet, plexi-glass workable windows, etc. T hese raised the price to about $525.

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T h e final touch w as a hand-stenciled sign o v e r the door: Built and D onated by the Residents of M an or Care Rossville M ay 14, 1980 T h e day o f the unveiling arrived. Baltim ore County Public L i­ brary heard about the secret an d decided to film it for their “ G e n e r­ ation” Series about elderly in the Baltim ore area. T he cam e ra s and crew w ere set up, lunch was ready, and the presentation planned. The entire nursing facility was ecstatic. The Council m em bers m o v ed into their positions. A fter a few short speeches, the sheets w ere raised. I rem e m b er the air as being still and every on e just taking a m o m e n t to enjoy the accom plishment and the outstanding w orkm anship, love and pride that was evident to all. T h at m om ent passed, as all 50 tots dashed for the house and played and scream ed for o v e r an hour, to the delight o f the resi­ dents. L ater, as the hou se was being loaded for transport to the tot center, a little boy cried and scream ed , “ You c a n ’t take my h o u se !” The M an o r C are Rossville Tot House is perm anently part o f the T ot C enter, the movie is perm anently on file in Baltim ore County Public L ibrary, and the tot program is perm anently part o f M anor Care Rossville. It was a huge undertaking. M any times I doubted both my sanity for initiating it and ou r ability to complete it. The project pulled all the residents, volunteers, staff and families to­ gether. It is a treasured m em o ry o f the residents, and we show “ G en eration s” every once in awhile to refresh that m em ory .

S P E A K E R ’S B U R E A U A nother intergenerational activity that was extremely successful at M ano r C are Rossville was the R esiden t’s S p e a k e r’s Bureau. As the Activity D irector, I have oriented and “ h ir e d ” many teen ­ age volunteers. It has been fascinating over the years to watch the relationships develop betw een the elderly nursing hom e residents and the teen volunteers. M o re than any other age group, teenagers have dem on strated an intense interest in and involvement with the elderly. It continually am azes m e every time I see a teenager adopt, in a completely accepting m an ne r, a very confused resident w ho d is­ plays b iz a r re behavior.

Joan Betzold

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These volunteers provide an in-facility outlet for the elderly to share their life experiences. I have long felt that even though a large num ber o f teenagers interact with the nursing hom e residents, there is virtually a limitless num ber o f teenagers that are never given that opportunity. The schools h arb or the largest amount o f this age group. With this in mind, I literally set up a crusade to get a program g o ­ ing in the area schools. I initially contacted teachers that I was well acquainted with through the w ork study p rog ram . The teachers passived my inquiries with, “ Y es, it sounds like a good idea. W e ’ll work on i t . ” T hat was the last I heard about it. Finally, after w orking with them for another y ear, I began to ex­ ert pressure. T h e underlying message com m unicated was that we try my idea o r they would lose their job site at the nursing center. As a result, M ano r C are Rossville founded its S p e a k e r’s Bureau in the fall o f 1980. The first speaking engagem ent was in a work study class at C hes­ apeake Senior High; the topic, “ H o m e R emedies and Supersti­ tio n s .” The residents w ere so excited to go. T hree ladies volun­ teered to speak at the first session. T he teachers were patient but dubious about the success. The tenth grade students were spell­ bound. T h ey listened very intently, stayed aw a ke and asked q u e s­ tions galore! M r. C arroll, the teacher, let the students stay after the bell rang to continue the discussion but finally made them go to their next class. As a result o f the first encounter, the word spread like wild fire through the school and school district. The Student Council ap­ pointed a student coordinator to accept inquiries o f times available and topics and to coordinate them with residents. I coordinated the transportation. T h e program spread to six Baltim ore County Ju n io r and Senior High Schools. The response was amazing! Students begged to have the S p e ak er’s Bureau visit their classes. Students stopped residents in the halls on the way to class—kissed, hugged and really made them feel special. Several appointments w ere made every week. Som e engagem ents lasted fo r several class periods. Topics included W orld W ar I, W orld W a r II, G row ing Old, W om en in the W orking W orld, Im m i­ gration, W h a t is a Fulfilling Life?, M otherhood, Death and Dying, Nazi G erm a n y , as well as m an y others. As a result o f the S p e a k e r’s B ureau, a resident fro m the nursing

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INNO VATIO NS IN A C TIV ITIE S FOR THE E LD E R LY

cen te r was invited to spend the day at C h e sa p e a k e Senior H igh . She w en t fr o m class to class and w as treated like one o f the students, even g iven a bus ride h o m e. A fter several y ears , the B altim ore C o u n ty Public L ib rary w as con v in c e d the p ro g r a m w as go ing to s u r ­ vive and visisted one o f the S p e a k e r ’s B u reau sessions. T h e y film ed a n o th e r o f their “ G e n e r a ti o n s ” series, which is available to all B altim ore C o u n ty P u b lic li b ra ry patro ns. Interaction b e tw ee n the schools and the nursing cen te r has c o n ­ tinued to g ro w and flourish ev en today. T h e bottom line is that interg en era tion al activities a re terrific. Be patient a n d do a lot o f public relations with y o u r staff, fam ilies, tots and residents to g et it going. But d o n ’t stop there. U se it as a starting point for so m e thing ev e n b ig g e r.

Making Connections Between the School System and the Nursing Home R u th P e r s c h b a c h e r

Activity prog ram s in the long-term c a re setting serve a diverse population o f elderly. T he abilities, interests, and needs o f this gro up vary widely. T hey frequently have dissimilar religious and social backgrounds. In ord er to meet this challenge, activity p ro ­ g ram s must combine resources with co m m unity settings. In tergen­ erational p ro gram s which utilize the educational system are e x a m ­ ples o f this reso urce sharing. T h ere are many potential advantages to using the public and pri­ vate school system as resources fo r intergenerational prog ram s. The school environm ent is relatively stable with regard to personnel, lo­ cation, and scheduling. O perating the pro gram with the same teacher and students over a period o f time will provide consistency. T he activities can be structured to meet objectives o f the school as well as the nursing home. Additional grade levels within the school are resources fo r possible expansion. As the benefits to the students becom e evident, their parents are likely to prom ote the pro gram . T he school board and parent-teacher organizations may also become a support netw ork for continuation and further development. Most school systems will become involved in intergenerational program s fo r either the educational benefits or for service-oriented goals. Before contacting the school, the activity professional should understand the implications o f intergenerational prog ram s to both education and service. In education-oriented p ro g ra m s, the nursing hom e residents can utilize their know ledge and experience to teach oral history (Perschbacher, 1984), foreign languages (L aufer and Ruth P e r s c h b a c h e r is c u rr e n tl y e m p l o y e d at Hillhaven Rehab ili tat ion and C o n v a l e s c e n t C e n t e r, A s he vi lle , N o r th C a r o li n a . She e a rn e d b a c h e l o r ’s d e g r e e s in mu sic e du c at io n and m u sic t h e r a p y from Phillips U ni v e rs i ty , Enid, O k l a h o m a . Pr ior to a c c e p t in g her pres en t p o s i ­ tion she w o r k e d as activity di re c to r in n ur sin g h o m e s in O k l a h o m a and Ka ns as . ©

1985 by T h e H a w o rt h Pr ess , Inc. All right s r es e r v e d.

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INNOVATIONS IN ACTIVITIES FOR THE ELDERLY

L aufer, 1982, p. 548), o r special skills. In service-oriented p r o ­ gram s the residents can function as “ adopted g ran d p a re n ts” (Greenblatt, 1982, p. 21) by participating with the students in activi­ ties which prom ote on-going relationships. Nursing homes becom e involved in intergenerational program s because these pro gram s offer g reat potential for helping m eet th e ra ­ peutic goals. Capitalizing fully upon this opportunity is m o re likely if specific goals are defined at the outset. These goals can then direct the structure o f the p rog ram . If the purpose is to highlight the abili­ ties o f oriented residents and encourage rem iniscence, the ed uca­ tion-oriented program s are quite appropriate. The residents will regain a feeling o f usefulness as they pass th eir knowledge and/or talents on to others. This process o f life review will reflect a c c o m ­ plishm ents rather than failure. R eminiscence can also be utilized as a therapeutic tool in service-oriented p ro gram s. As relationships d e ­ velop, the students will rem ind the residents o f their own childhood experiences. These on-going relationships will become strongly a f ­ fectionate and almost totally positive for both generations. The resi­ de n ts will have an increased feeling o f self-worth as they becom e engaged in m eaningful relationships. Finding the appropriate teacher is o f great im portance in setting up an intergenerational prog ram . The compatibility o f the teacher and the activity professional will have a major im pact on the success o f the p ro gram . A teacher who recognizes the abilities o f old er p e o ­ ple and feels com fortable in the nursing h o m e setting will set a posi­ tive exam ple to the students. If the te ac h er views the prog ram as beneficial, this will be com m unicated to the school. T h e te a c h e r’s role as liaison to the school is vital in prom oting the long-term c o n ­ tinuation o f the prog ram . In the initial stage, the activity professional may need to meet with the principal o r school board as well as the teacher. Data about a variety o f successful intergenerational program s that have resulted from the cooperative efforts o f school systems and nursing homes should be m ad e available to them . A proposal with specific sugges­ tions abo ut the frequency o f m eetings, nu m b er o f students and resi­ den ts to be involved and types o f activities should be presented. T h e sch o o l’s involvement may not initially fulfill all the nursing h o m e ’s expectations. H o w ev er, as the p rog ram develops and its benefits b e­ com e tangible, the sch oo l’s involvement is likely to increase. O nce the joint proposal has been form ed, the activity professional and the teac h e r can plan specific activities. T h e objectives o f both

R uth Perschbacher

39

settings will provide ideas for each session. The oral history class can include discussion topics that center on specific time periods like the D epression or subjects such as early 1900 clothing styles. Trips to m u seu m s, old-fashioned picnics, or churning butter can provide actual experiences o f history. In service-oriented p rog ra m s, relationships betw een the students and residents will develop as they participate in activities such as d e­ signing posters for a health fair, making valentines, or preparing a music p erfo rm an ce. An orientation about the aging process and the nursing home e n ­ vironm ent will help p repare students for the pro gram . This p re sen­ tation should include a b rie f explanation o f reasons for nursing hom e placem ent and co m m en ts regarding rehabilitation, hearing and visual deficits, w heelchairs, canes, restraints, potential resident deaths, incontinency and disorientation. Describing the p r o g r a m ’s purpose will help clearly establish the stud ents’ roles. Students can then be en cou rag ed to ask questions and share their experiences with the elderly and /or nursing homes. Selection and preparation o f the residents must b e carefully m a n ­ aged. First, the activity professional must choose which residents are most appropriate fo r the pro gram . The goals o f the program will dictate the criteria for selecting the residents. A p ro g ra m which will require intellectual abilities and grou p participation is suitable to oriented residents who function well in groups. A p ro g ram which p ro m o tes on-going relationships is appropriate for a long-term resi­ d ent who consistently attends activities and is able to engage in meaningful com m unication. O ther group dynamics can also play a role in selection. For ex am ple, if a husband and wife have a te nd en­ cy to argue in a group setting, one spouse could be placed in the intergenerational program while the o th e r participates in so m e other special activity. Interviews o f the selected residents can help d e te r­ mine their interest in the p rog ram . The residents should be notified o f any expectations such as consistent attendance or the sharing o f inform ation. If pictures will be taken o f the residents or their q uo ta­ tions published, a waiver o f confidentiality may be obtained. O ther p reparatory steps include d eterm ining the location o f m eet­ ings and staff education. In most long-term care settings, resid ents’ decreased mobility level will necessitate that the activities take place in the nursing home. A room which is well lighted and can be shut o f f from distractions will be im portant to the success o f the activi­ ties. A “ D o Not D istu rb ” sign may be needed to limit interruptions.

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INNOVATIONS IN ACTIVITIES FOR THE ELDERLY

Staff education about the structure and benefits o f the prog ram will pro m o te their understanding and enjoym ent. Furnishing staff m em b ers with a schedule and list o f residents involved will help them provide baths and medical treatm ents without interrupting the p ro gram . As the prog ra m develops, its progress can be shared through m em os an d/o r newsletters. Intergenerational p rogram s developed with varied grade levels help to satisfy diverse resident and student needs. Having several p rog ram s operating with different objectives can increase the nu m ­ ber o f residents involved. Residents can be assigned to the program which best meets their individual needs and interests. Both small groups and one-to-one sessions can be utilized. An oriented resident who speaks a foreign language can provide one-to-one lessons for a high school student. Third grade students can learn about the ad v e r­ sity, effort and courage o f the elderly as they help residents involved in a strok e rehabilitation pro g ram . T h e students will give the resi­ d e n ts unqualified and enthusiastic support to recover. O ther aspects o f intergenerational pro gram s which m a y b e antici­ pated are transportation difficulties, resident deaths, and discontinu­ ation of the p ro g ram during certain periods o f time. In many situa­ tions, transportation difficulties can be resolved by cooperating with a school that is within walking distance or by utilizing nursing home or school volunteers. Preparation fo r resident deaths can be handled during the initial orientation. At that time, students can ask ques­ tions and express concerns. W hen a participating resident dies, p ro m p t com m unication to the teacher and students will allow them to share feelings and w o rk tow ard acceptance. F or optim um results, the p ro gram should be scheduled to follow the entire school year. H o w ev er, so m e schools may need to schedule the p ro g ram only during a certain sem ester acco rd ing to the curriculum . A b reak in the p ro g ram may also occur during the s u m m e r months. A fter the p ro g ram has be c o m e well established, these gaps may be shortened by enlisting the help o f the students’ parents. Once the parents become acquainted with the p r o g r a m ’s benefits, they are likely to advocate its continuation. Intergenerational p ro gram s w h ich utilize th e school system have great potential for addressing the diverse needs o f nursing home residents. T he activity p r o g r a m ’s resources are expanded by tapping into this rich comm unity resource. The skills o f the teacher and the enthusiasm o f the students will act as catalysts in promoting resi­ d e n ts ’ involvement. This involvement will allow therapeutic goals to be realized.

Ruth Perschbacher

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REFERENCES G ree n b la tt, F. “ A d o p t-a -g ran d c h ild P r o g r a m : Im p ro v in g Attitudes o f A dolescen ts T o w a r d the A g e d , ” A ctivities, A d a p ta tio n a n d A gin g, 3: 2 1 -2 5 , 1982. L a u fe r, E . A . , and L a u fe r, W .S ., “ F r o m G eriatric R e sid e n t to L a n g u ag e P ro fesso r: A New P ro g ra m U sing the T alen ts o f the E lderly in a Skilled N u rsin g F a c il it y . ” The G eron to lo ­ gist. 22: 548-549, 1982. P e rs c h b a c h e r, R. “ A n A p plicatio n o f R em in iscen ce in an A ctiv ity S e t t i n g . ” The G eron to lo ­ gist. in press.

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Intergenerational M ixing K aren D . S ch elin d er

E a c h F rid a y a f te rn o o n re side nts o f T ufte M a n o r R e tire m e n t H o m e assem b le in the front lobby o f the h o m e and anxiously await the arrival o f second g ra d e students fr o m nearb y Kelly E lem entary School. W h a t h ap p en s o n c e the ch ildren arrive is the basis for an in ­ terge neratio nal p ro g r a m w hich is m eeting with re m a rk a b le success for the resid ents and their y o u n g visitors. In an article, Aging Each Other, H en ry M. Plaw ecki a n d Judith A . P law ecki state: “ A geism is a con ven ien t m ec ha nism that allows y o u n g e r peo ple to see o ld e r p eople as d ifferen t from th em selves. T h u s, the y o u n g e r ge neratio n subtly ceases to identify with its elders as fellow h u m a n b e in g s . ” S o m e months ago, to bring about a chan ge in this attitude, the retire m e n t h o m e s t a f f m et with the teachers fro m Kelly E lem en tary to plan how best to bring to gether the y ou ng and the old. T h e y dis cu ssed a p ro g r a m that w ould involve 48 second g rade students and 25 resid ents o f T ufte M a n o r . T h e objective was to a s ­ sist the residents and c h ild re n to form n ew relationships with o n e an oth er. An h o u r e a c h w e e k was set aside w hen the c h ild re n would walk o ver to T u fte M a n o r and spend that time in the e n v iro n m e n t w h ere old er people live. S taff w ho planned the activity h oped that the y o u n g e r peo ple w ould benefit from their contac t with o lde r res i­ d e n ts in m o r e than o ne im po rtan t way. T h e y w ould m a k e new friends an d, equally im p ortant, th ey would sp e n d time in a hom e w h ere the “ old p eople liv e ” and find it a positive, jo y fu l, exciting place to e x p e rie n c e new ideas. T h is was p la n n e d to be a con tin uin g, g ro w in g , o n-g oing relation sh ip, not a o n e - y e a r ex p erien ce . T h e vehicle for interaction is reading . E ach child plans for F riday a fterno on s at T ufte M a n o r by choosing som ething to read. T h e re s i­ d e n t m ig h t also plan so m ething to r e a d to the ch ild re n . K a r e n D . S c h e li n d e r is H o u s i n g M a n a g e r at T u f t e M a n o r . G r a n d F o r k s . N o r th D a k o t a . Sh e is a g r a d u a t e o f G o l d e n Va lle y C o l le g e a nd a p a rt - ti m e s tu d e n t at the U n i v e rs i ty o f N o r t h D a k o t a . G r a n d F o r k s She has c o m p l e t e d s p e ci a li z e d tr a i n in g in the m a n a g e m e n t o f n o n ­ profi t h o u s in g f o r the e ld e r ly . ©

1985 b y T h e H a w o r t h P r e s s , I n c . All rig h ts r e s e r v e d .

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INNOVATIONS IN ACTIVITIES FO R THE ELDERLY

Once the program was underw ay, ideas kept coming from other staff m e m b e rs, both at the school and the retirement ho m e. Students saw that the residents were b ecom ing m em bers o f an extended fa m ­ ily. Parents b egan co m in g to visit in the evening with their children, inviting the residents for m eals in th eir ho m es, and bringing flowers for special days in the res id e n ts’ lives. Barriers traditionally know n as “ generation gap” are coming dow n. Such effects o f integration o f the generations as lack o f c o m ­ munication, intolerance o f handicaps, and stereotypes o f aging are disappearing am ong the participants o f this p ro gram . A s Carol Tice has stated in h e r article, Creating Caring Commu­ nities—Linking the Generations, “ W orking side by side, old and the young serve as natural teachers to one a n o th e r .” A good exam ple of this is what the children are learning about handicaps and how peo ­ ple cope daily with deficiencies. Before the children started coming to the ho m e, they studied handicaps for one sem ester. T hey learned about blindness, w heelchairs, walkers and other aids to mobility. They learned about hearing im pairments and how to com m unicate clearly. T hey understand that many deaf people read lips. T hrough this study, they are better equipped to relate to and understand the residents. T w o girls read to a blind lady, Ingeborg. For Ingeborg, Katie and Sarah must explain the pictures on the pages. If they bring draw ings for Ingeborg, they also have to explain and describe their art work. W h e n talking to hearing im paired people, students are learning to speak louder, clearer and som etimes m o re slowly and to look dire ct­ ly at the person being spoken to. Close relationships are being built as exemplified by the word Grandperson, the stu d e n ts’ name for participants in this p rog ra m . The word Grandperson c am e fro m the second grad ers themselves. They coined it after visiting grand people at Tufte M an or. The word “ g r a n d ” has a very majestic connotation to it; w hen eight-year-olds think o f “ g r a n d , ” they think big and w onderful. Each Tufte M anor resident finds himself in a place o f honor, a special G randperson to a y ou ng er individual. In addition to reading to each other, the participants ‘tell each o th er th in g s ,” in the w ords o f one o f the students. The stories they share might include the reside nts’ tales o f their grow ing-up years; th e days w hen they to ok a ho rse and buggy to town to buy groceries enough for maybe a month at a time. The young people hear stories

Karen D. Schelinder

45

about barn dances, other forms of entertainment and how important their churches were to them. T he young people talk about co m pu ters, fast fancy cars and how m uch faster you can m ove today. With this ex perience, it would be hard for a young person to imagine all older people as “ lying in bed, waiting to d i e . ” T h ere are several offshoots from the original p rog ram idea. The participants have been involved together in woodworking projects, decorating H alloween cookies a n d sharing meals. A t C hristm as an afternoon tea was hosted by the residents o f Tufte M anor. The sec­ ond g rad e students from Kelly School w ere the special guests. Christm as goodies (all N orwegian delicacies) were served after residents and readers together presented a program that included songs sung by a combined resident/student choir and stories told by the residents. The c h ild ren ’s parents and family m em bers o f the residents w ere in the audience. Informal Friday noon dinners are scheduled each week. Four readers and two residents eat to gether at the hom e. This experience provides m ore personal interaction than the planned 45 minute r e a d ­ ing sessions. A prog ram such as the one described here involves community participation. People in the comm unity learn about needs that are being m et by interaction o f children and older adults through c o v e r­ age on television and in the local new spaper. A local television sta­ tion taped a reading session and aired it with a full explanation o f the p r o g r a m ’s benefits to both young and old. Additional coverage is planned. The local new spaper told about the program with pictures and a w a rm , personal story about two o f the residents and the chil­ dren w h o a r e involved with them. Parents are a great asset to the success o f this p r o g r a m . After the initial planning by school and retirement home staff, parents volun­ teered to walk the children to and from school. They m on ito r the halls at Tufte M a no r, helping out if a child c a n ’t find a room or sometimes needs a little extra security. It is impossible to record on paper all the rew arding experiences that happen every day betw een the people involved in this program . The hugs and kisses that are exchanged, the smiling faces and the giggling at a funny story are being shared by the old and young c o m ­ ing together on this one-to-one basis. They a re finding the meaning o f giving o f them selves; they are reaching out and touching in love.

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T h e D a y R o o m P rogram at W e s tm o r e la n d M a n o r N u r sin g H o m e , W a u k e sh a , W is c o n s in Jacqueline Brunner

The Day R oom Program at W estm oreland M anor was set up in response to a 1981 State o f W isconsin Nursing H om e Survey recom m endation to increase program m ing on the 2 North geriatric unit. The initial ob jectives o f the program w ere to assure that the e n ­ vironm ent on the unit w ould increase the m ental orientation and physical com fort o f the residents there. At the time the day room w as op en ed , the residents on the unit were clearly the most co n ­ fused, disoriented residents in the nursing hom e.

STATE D O BJE C TIVE S O F THE D A Y R O O M

The objective o f the 2 North D ay Room program is to assure that the environm ent is conducive to increasing the mental orientation and physical com fort o f the 2 North resident. N ursing aides w ill be encouraged to bring their residents to the day room after their m orning care has been com pleted. Once they have been checked in, the day room sta ff will involve them in appro­ priate activities, provide mental and physical activity and regularly scheduled ou tin gs both in the facility and in the com m unity. Residents w ho cannot be m anaged and are disruptive will be re­ m oved from the day room to the nursing station area. N ursing will then determ ine what action should fo llo w . U nder no circum stances R i v e r H i l l s W e s t in P e w a u k e e , W i s c o n s i n w a s e x t r e m e l y h e l p f u l in s h a r i n g its p r o g r a m a n d r e s o u r c e s . I n d i v i d u a l s w h o c o n t r i b u t e d m u c h t o th e s u c c e s s o f t he p r o g r a m a n d w h o m erit special reco g n itio n are: G ay le A llen -B u rk e t, T R S , C o llab o ratio n C o n su ltin g S ervices, C h i c a g o , I l l i n o i s ; J e a n N e i t z e , R N , D i r e c t o r o f N u r s i n g at W e s t m o r e l a n d M a n o r ; M a r y B a rn e r, L P N , D ay R o o m S u p e rv iso r; and S h e rry Lincoln, D ay R o o m Aide. J a c q u e l i n e B r u n n e r is a c e r t i f i e d o c c u p a t i o n a l t h e r a p y a s s i s t a n t w o r k i n g a s a n a c t i v i t y d i ­ rector for W e stm o re lan d M a n o r , W a u k e s h a , W isco n sin . ©

1985 by T h e H a w o r t h P r e s s , Inc. A ll rig h ts r e s e r v e d .

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will the well-being and safety o f residents be co m p ro m ised by a dis­ ruptive resident. Such behaviors will be monitored at the n u r s e ’s station. C H E C K IN P R O C E D U R E : 1. Resident is washed and o ral c a re completed. 2. R e sident’s hair is com bed and brushed. 3. Resident is appropriately dressed, including proper and m a tch ­ ing socks and shoes/slippers. 4. Resident is wearing glasses, hearing aid and/o r dentures if such items are appropriate. 5. Resident has been toileted within one-half hour prior to e n te r­ ing the day room. This time will be reported by aide during check-in p rocedure.

S T A T E D R O L E O F FLOOR A ID E S Daily care will not really change. Residents will be dressed a p ­ propriate ly and checked into the day room for pro gram s. Residents should be freshly diapered or toileted before checking in. Nursing assistants will be called if a resident requires a m ajor clean up, toileting if diapered o r is scheduled for regular bowel and bladder program . T he day room will accept all appropriate residents within the lim­ its o f the ro o m an d w hatever prog ram is running. S o m e residents will be considered passive participants in the program with the goal o f becoming m o re actively involved. An inappropriate resident is one who is disruptive to other residents and does not respond to p os­ itive reinforcem ent and en couragem ent. Inappropriate residents will be rem oved from the d a y room an d checked in with nursing p ers o n ­ nel fo r close m onitoring o f behaviors. T h e luncheon program will only accom m odate six residents. They will share a family style lunch with day room staff five days weekly. R eminiscing, m anners and conversation will be developed during these luncheons. Day room staff will w o rk together with general activity staff to continue the large group pro gram s already established on unit. In addition activity staff will work together to im prove the en v iro n ­ m ent and living areas for the residents who spend a m ajor part of their day in their room s and beds.

Jacqueline Brunner

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DA Y R O O M S C H E D U L E 9:0 0 to 10:30

D ay ro o m su p e rv iso r and aide will w ork on finishing touches o f m a k e - u p , hair and nail care and o v ers ee the ch eck-in process for day ro o m .

10:30 to 11:30

D ay ro o m staff and the activity aide will w o rk to g ether in large g ro u p activity.

11:30 to 12:30

D ay ro o m p erson nel will set up for luncheon g ro u p , w hich will include high er level 2 N orth residents.

L u n ch B reak for S taff 1:00 to

3:00 Room visits, sm all group p ro jects in day ro o m . Plan nin g fo r activities, dec o rate day ro om and re s id e n ts ’ roo m s.

3:00 to

4 :3 0 L a rg e g r o u p activity in day roo m .

4 :3 0 to

5:0 0 P a p e rw o rk as req uired.

U TILIZATIO N R E V IE W BOARD STU D Y T he p roject served as a Utilization R eview B oard study from June 1982 throu gh Ju n e 1983. D urin g that tim e we looked at (1) the effect o f the day ro o m on residents, (2) the effect o f the day room on n u r s ­ ing h o m e a d m in is tra tio n , an d (3) th e effect o f the d a y r o o m on fa m ­ ilies a n d nursing h o m e p lace m ent. As p art o f the proje ct a lu nch eon p ro g r a m w as set up to o ffer as m a n y residents as possible the benefits o f family style lunches four times a week. R esidents w ere en c o u ra g e d to set the table, pass food and serve the m selves if possible, to rem inisce and co n v ers e with p eers and s t a f f d uring the m ealtim e. P r o g r a m m in g specific to the needs o f these residents was d e v e l­ op ed with the help and co o p eratio n o f the Activity D irecto r. T h e day ro o m s ta ff had the com p lete c ooperation o f the g eneral activity staff to c ontinue the large group p r o g r a m s and outin gs fo rm erly available to th e re s id e n ts on a limited basis. In add itio n, activity staff an d day ro o m p erso n n e l w orked together to im prov e the living e n v iro n m e n t

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fo r the residents w h o spend a m a jo r p a r t o f th eir d a y in th e c o m p a r ­ atively isolated 2 N orth a rea. E F F E C T O F T H E DA Y R O O M O N R E S I D E N T S A ltho ug h the physical are as for p ro g r a m m in g w e re not c h a n g e d , increased e n v iro n m e n ta l stimulus w as added to the ro o m . A n indoor g ard en w as p lanted and kept up, birds in c ages w ere b ro u g h t in as pets, a d o g w as a d de d to th e unit d u rin g th e d a y , an d a stereo unit was p u rch as ed . T h e ro o m w as tr a n sfo r m e d into a bright c h e e ry e n ­ v iro n m en t by d a y r o o m staff. S taff time in activities allotted to the 2 N o rth p ro g ra m p rio r to N o v e m b e r 1981 was a p p ro x im a te ly 15 ho u rs a w eek. As o f June 1983 sta ff h ou rs a re ap p ro x im ately 70 h ours p e r w eek. P rior to N o v e m b e r 1981 the residents w ere offered five specific p ro g r a m s on the ir unit an d allotted tw o h ou rs w e e k ly for ro o m visits. In Ju n e 1983 the residents w ere o ffered 30 h o u rs o f sched uled p ro g r a m s with five h ou rs for ro o m visits w eek ly. T h e day ro o m w as staffed from 8 :3 0 to 4 :3 0 p . m . M o n d a y th ro u g h T h u rs d a y and 8:30 to 1:00 p .m . F rid ay . T h e schedule was stru c tu red to allow p r o g r a m ­ ming for activities o f daily living, individual crafts and gam es, and oth er leisure recreation al pursuits a p p ro p ria te to a geriatric p o p u la ­ tion. An LPN w as assigned to be Day R o o m S u p erv iso r a nd a n u rs­ ing assistant as D ay R o om A id e. Both positions a re full tim e. As p a r t o f th e g ro o m in g p ro g r a m e a c h m o r n in g , a pp ro xim ate ly three male residents are e n c o u ra g e d to sh ave th em selv e s. Staff teaches the self help aspect o f this g ro o m in g skill. A p p ro x im ate ly four fem ale residents a re taught nail care during this tim e. F o r m e r ­ ly, the nursing staff n ev er had the time for teaching this th erapeutic skill. It quickly b ecam e a p p a re n t that so m e residents w ere responding so well to the in creased p ro g r a m m in g that as they w ere review ed at plan o f care m eetin g s , a review and frequently a reduction o f daily m ed icatio ns w as c o n sid e re d . A ra n d o m sa m pling o f 15 residents sho w s the follow ing results using a N o v e m b e r 1981 base period with review on m ed icatio ns in Ju n e 1983: 8 residents d e c re a s e d in m ed icatio n , 1 resid en t increased in m e d icatio n , 6 resid ents ha d no change in m ed icatio n. Several residents w h o lived in the 2 N o rth unit prior to the day ro om p ro g ra m ev id e n c e seriou s ag g re s siv e ten den cies w h ich are well d o cu m en te d . T h e fo llow ing p a ra g r a p h s d escribe five residents

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who caused m ajor behavioral problems p rior to the day room pro­ gram . The observations in these examples are subjective and given by staff w orking on the unit with many years o f experience. R esident HI F orm erly yelled, punched and verbally abused anyone for any reason. Never attended activity p rog ra m s. Was very difficult during activities o f daily living. S ta f f m e m b e r states, “ He is much easier to do activities o f daily living now that he is active in the day r o o m . ” Resident #2 K nown to hit an d physically abuse other residents an d staff. Was verbally abusive to residents and staff. A program o f behavior modification was developed, and the nursing staff and day room personnel have seen a 95% im provem ent in acting out behaviors. R esident #3 W as impossible during activities o f daily living. Required 2 or even 3 aides to assist. Since day room involvement, needs only 1 aide for A D L . R esident U4 V ery loud disruptive resident, cried much o f the time. Is present­ ly m uch quieter and appropriate when in the day roo m , although o n ­ ly a passive participant. Resident #5 Noisy and disruptive before the p ro g ram and continues these same patterns at present. In addition to the above, the effect o f the day room on residents is evident during a brief walk on the unit. Residents seem m o re alert, they appear better groom ed and happier. T hey can occasionally be seen interacting with peers and staff on a regular basis. Prior to the day room, som e o f these observations could be made on isolated cases, but since the day room program began, they are normal everyday occurrences.

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E F F E C T O F THE D A Y R O O M O N N U R S IN G H O M E A D M IN I S T R A T IO N Although there was som e initial resistance to the day room p ro ­ gram , staff was counseled and en co ura ged to cooperate with the p rog ra m . O ver the one and a half y ears o f the p ro g ra m , a m arked increase in cooperation and understanding is evident betw een day room personnel and nursing personnel on the unit. T h e Nursing D ep artm ent has gradually b een reducing scheduling on the unit, but with the day room p ro g r a m , quality care for resi­ dents is continuing. In the q u arter betw een July 31 through O ctob er 22, 1981, nursing assistants w ere scheduled for an average o f 411 hours per weekday shift. In the M a rc h 10 through M ay 19, 1983 qu arter, nursing assistants w ere scheduled for an average o f 361.75 hours. This reflects a 4 8.2 5 hour weekly decrease in staffing for the unit. According to figures subm itted by the adm inistrator, the 2 N orth unit av eraged 3.5 to 4 empty beds p rio r to N o ve m b er 1981. Since the prog ram has been in full swing, the unit averages 1 to .5 em p ty beds.

E F F E C T O F THE DA Y R O O M O N F A M I U E S A N D N U R S IN G H O M E P L A C E M E N T The admissions coordinator notes that she receives placem ent r e ­ ferrals directly to the 2 N orth d a y room unit. F orm e rly she w as u n ­ successful in placing n ew admissions on the unit. T h e unit was filled by in-house transfers as a residen t’s n eeds for a m o r e restricted e n ­ vironment becam e clear. She also noted th at families are requesting the day room program for their family m e m b e r as a result o f their favorable impression o f the p ro g ram during their tour o f the facility. T he following observations and com m ents have been m ade by family m em bers regarding the day room program . Family #1 Sister o f a resident refused to have the resident in any pro g ram s, preferred to have him isolated in his room . She now has given her permission and even com es into the day room to visit briefly with staff.

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F am ily If 2 States, “ I ’m alw ay s h appy t o see M r . _______ in the day r o o m . ” Family If 3 W ife w an ts resident involved in ev ery aspect o f p ro g r a m . W as very opposed to r e s id e n t’s tra n sfe r fr o m the first floor and had diffi­ culty adju sting to re s id e n t’s nu rsing h o m e p lac e m en t. She now asks, “ w h o h as m o r e fun in th e d a y ro o m , staff o r re s id e n ts ? ” Family ft4 N iece o f resid ent w ants a u n t involved as m u c h as possible. H as voluntarily a sk ed if resident needed m o r e m o n e y to participate in day ro om outings. Family ffS H u sb a n d o f y o u n g nursing h om e resident with co m plicated p h y s­ ical and e m o tio n al p ro b lem s states, “ I ’m v ery g l a d _______ is active in the day ro o m so she d o e s n ’t have to be alone all d a y . ” T h e day ro o m staff is so significant to this resident th at the speech therapist has included their n am es on h er very limited c o m m u n ic a tio n board. Family ft 6 W ife o f long tim e resident states, “ I can no t believe the difference in the physical a p p e a ra n c e o f the residents and the u n i t , ” and is am a z e d in the increase in con versation and socialization betw een residents.

SUM M ARY T h e effect o f the day ro o m o n residents is ob vious to any o b ­ se rv e r. T h e residents ap p e ar to be an d are better oriented to th eir e n ­ v iro n m en t. T h e y are b usy an d h appy . T h e r e is less c ryin g o u t and acting out. T h e unit itself is attractive and stim ulating. T he residents have a w ide variety o f p r o g r a m s to cho ose fr o m and interact daily with p eers and sta ff on an app ro priate age level. In som e cases d e ­ creased m edication allow s a m o re no rm al life. A busier day e n c o u r ­ ages n orm al sleep patterns at night.

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T he effect o f the day room on nursing hom e administration for the unit is one o f pride in a jo b well done. T h ere is an opportunity to view residents as individuals with likes and dislikes. T he staff was requested to adjust to a completely new routine for the benefit of residents and has done so. Although nursing aide hours on the unit have been decreased, the day ro om is staffed using nursing hours, and the unit has worked together to establish a new distribution o f w o rk w hich benefits the residents. The effect o f the day room on families and nursing h om e place­ ments has been positive. As the re p o rt indicates, families are lavish with praise. T h e reduction o f e m p ty beds on the unit is an obvious financial a dvanta ge to the nursing home.

REACH An auxiliary p ro gram connected with the day room developed as it becam e apparent that the 2 N o rth residents needed their rest p eriod during the afternoon and that the Day R oom staff w as poorly utilized during this period. The effectiveness and enthusiasm o f the Day Room staff also created a strong desire in the general p ro g r a m to open the services o f the day ro o m to certain special residents. The residents viewed with special needs frequently are those new ­ ly admitted individuals who are having difficulty adjusting to n u rs ­ ing ho m e p lacement or those residents w hose condition is apparently changing either for the better o r w orse. As an answ er to the ab ove concerns the R E A C H program devel­ oped. The day room is opened three afternoons each w eek for specific residents fro m the other units whose status meets the above criteria. T h e day room staff provides remotivational and reality oriented p ro g ram s. T hey develop purposeful activities to keep resi­ dents interested. The s ta ff provides consistency and the grou p devel­ ops p eer support and interaction. As an adjunct to R E A C H , the day room accepts on a daily basis two severely and profoundly retarded adults from our Developmentally Disabled unit into the regular p rog ram m in g. These visitors benefit from a pleasant change o f environm ent and the tender con­ cern o f the day room personnel. Occasionally they are included ac­ tively in the p ro g ram but their passive abilities usually preclude a c­ tive participation.

Reality Therapy in the C onvalescent H om e S ally V o g t

I was a student in R eality T h e ra p y (R T ) w h e n I b e c a m e the C o o r ­ d in a to r o f A ctivities at F o u r F ou nta ins C o n v ale sc e n t C e n te r in Belleville, Illinois. Reality T h e ra p y was d ev elop ed by D r. William G lass er, M . D . , w h o has w ritten several b o o k s sh ow ing th e use o f it in sch oo ls, institutions, and with ado lesce nts, in both g ro u p s and in on e-to -on e personal coun seling . Its basis stresses that our b e h a v ­ i o r - t h i n k i n g , do ing and fe elin g —is based on o u r p erception s o f the world as w e see it. Reality T h e ra p y allow s that w e are responsible for o u r beh av iors, and it is this responsibility that can give us control o f o u r ow n lives. O u r think ing , feeling and do ing b ehav io rs control o u r actions and though we a re alw ays controlling for o u r basic needs o f food and shelter, we are also co ntro lling for four o th e r needs: belo nging, self-esteem , fun and fre ed o m . I can no t elabo rate on all parts o f R eality T h e rap y in this pa p e r. In total, it is c o n c e rn e d w ith th e relationship o f the n ew b rain to th e old brain: th e c o m p a r in g station in o u r m in d ; that o u r perceptual err o rs in o u r co m p a r in g station cause us to c h o o se b eha vio rs that may or m ay no t w o rk (such as d e p re s sin g , paining, h eadach ing ); a nd that we cho ose these b eha vio rs because they may have w o rk ed in the past o r we d o not know a better way. T he point is that by w orking to m e et the needs o f be lo n gin g, self-esteem , freed om and fun, a person can be h app y. Reality T h e ra p y also teac hes people to be in pro cess, not o u tc o m e . W e enjoy o u r p ro c es s realizing that the future is out o f o u r con tro l. W e stay in today for that is all we have. T h e basic four questions that are used in this th erapy arc: Sa lly V o g t is a n activity th era p ist a n d c o o r d i n a t o r o f activities at F o u r F o u n t a in s C o n v a ­ le s c e nt C e n t e r in Be l le v i ll e , Illino is . M s . V o g t e a r n e d h e r A A d e g r e e at M o n ti c e ll o C o l l e g e , G o d f r e y , I ll in o is , a n d h a s r e c e i v e d s p e c i a l i z e d t r a i n i n g in rea lit y t h e r a p j at the Insti tut e o f Re al ity T h e r a p y in C a l i f o r n i a . Sh e is a l s o a w r i t e r a n d h a s w o r k e d with c o m m u n i t y a d v o c a c y gro u p s fo r c hildren and y outh. 1985 b y T h e H a w o r t h P r e s s . In c. All r ig h t s r e s e r v e d .

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1. 2. 3. 4.

W hat do you want? W hat do you really want? W hat are you doing now to get what you want? Is it working?

These basic questions help us to get into ano th er p e r s o n ’s w orld, to see what he wants and also to enable the p ers o n to m a k e a value ju dg m ent by him self about w h eth er or not his behavior is working. I personally use these questions w hen visiting with residents instead o f the standard “ How are . . . ” questions referring to how they are feeling, etc. With this brief background o f Reality T h erap y , it is also im por­ tant to know that to teach RT one must incorporate it into his own life. T w o inservices were given to the nursing personnel in the F o u r F ountains C onvalescent C enter, not only to show how RT can work in our lives, but also how to apply this at w ork. Included with Reality T h erap y was a background o f Independent Living from an Independent Living Organization in St. Louis. Inde­ pendent Living techniques w ere taught there to enable a person who was disabled to live independently with dignity. The w ords “ live in­ dep end ently ” do not necessarily m e a n living a lon e, for that is im ­ possible for some. T h ese w o rd s mean to function as an individual with self-esteem and belonging. T hey refer to the organizing, plan­ ning and control o f not only the functions o f the hum an body but the use o f available resources o f the hum an mind. In the medical w o rld o f hygiene, p ap erw o rk , medications and time schedules, there is rarely time to help a resident learn to wheel his own wheelchair, to make decisions o f daily living skills and the use o f adaptive equipm ent, to discuss feelings o f depression and rebellion, to clarify his confusion with the use o f Reality Orienta­ tion. This is w here the Activity T herapy D epartm ent can step in with its program o f rehabilitation. This p ro g r a m can truly c o m p l e ­ ment the m edical role in a C onvalescent C enter. T h e following is a discussion o f how the Reality T he rap y te c h ­ niques are used at F o u r Fountains. W h en a new resident enters the facility, im mediate contact is made. A to u r o f the facility is reco m m e nd ed and includes introduc­ ing the activities p ro g ra m , explaining the dining room p ro cedu res, etc. The move fro m a hospital to a convalescent cente r often is very disorienting. An activity schedule for the w eek is given to the new resident and an initial care plan devised the first day. This is Reality

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Therap y a n d Reality Orientation w orking together. In effect I am saying, “ This is w here yo u a r e now ; this is what we hav e. N ow , what do yo u want and w hat y ou willing to do to g et what y ou w a n t!” (O f course this does not alw ays w o rk with som e residents; but it w o rk s for a surprisingly high n u m b e r o f p eo ple who respond to and know exactly w hat I am saying to th em .) T o be able to move freely around the facility a non-am bulatory person must learn the mechanics o f his wheelchair. Role modeling is a valuable tool for teaching anything. Get in a w heelchair yourself and show the person exactly what you are trying to teach o r ask ano th er resident to demonstrate. An ad ded benefit is a very good “ ey e-to -ey e” contact rather than standing over a resident “ talking do w n .” All ou r activities are taken seriously as Activity T herapy . O u r ex ­ ercises are professionally done by o u r Physical T herapy D e p a rt­ ment. T h ere are no spectators during group exercise. All who are in that room , including visitors and personnel, do exercises. Bingo games are an aid to those who are struggling to recognize nam es and numbers. W ord games provide mental stimulation. Music p ro gram s reach out to the non-com municative and the disoriented, linen fold­ ing provides self-esteem while doing a service ty pe o f w o rk. Each activity has a purpose. However, tnere is much laughter as we share in the joys o f small accomplishments. We use adaptive equipm ent as m uch as possible such as ju m b o bingo cards for those with limited sight, a portable m icrophone for those with limited hearing. Radio Information Service fo r the Blind and large index cards with pertinent w o rd s on th em for those with limited speech. O u r residents learn that what they c a n d o for them selves they should do; but w hen they cannot do something for them selves, they must learn to ask for help. Asking for help is not easy for a person that has been self-sufficient for 50 years o r m o r e . As a m atte r o f ex ­ ample I also have learned to ask for help fro m the residents in my job. One o f o ur most successful p ro gram s has been ou r innovative “ Rehab Lunch P r o g r a m . ” A bo ut a third o f our residents eat in the dining room . The rem aining tw o-thirds are for the most part disori­ ented and non-com m unicative, and completely bedridden. T h e y eat in their room s or in the day room . Twelve people are selected from the dayroom (3 to a wing) to have lunch with the Activity T herapy D epartm ent and the D irector o f N urses. W e all eat in the Activity

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R o o m . S taff d o e s not assist a n y o n e at this tim e for this is also our lunch p e rio d . T h e trays are serv ed , and we all eat and talk as we w ould in any o th e r setting. W e have dis cov ered an am a z in g lack o f problem eate rs with this lunch p ro g r a m . Only an occasional nudge o r w o rd o f e n c o u ra g e m e n t is n eed ed. O u r role-m od elin g again pays o f f while tea c h in g p eo p le the reg ain ing o f lost skills for feeding th em selves. S o m e are “ g r a d u a t e d ” into the dining ro o m ; so m e go back to the w ings with a few a dd ed skills. The p ro b lem o f offerin g choice s to p rom o te in depende nce and ju s t plain getting a person to co m e to activities is one that I have h eard over and ov er fro m o th e r Activity T h erap ists. As I said b e ­ fore, I use the basic four questions w h e n visiting a resid ent. A t y p ­ ical con versation is: “ G ood m o r n in g . W h a t are you d o in g ? ” “ N o th in g ” is the inevitable an sw er. “ W h a t d o you w a n t? ” “ I w ant to go h o m e . ” “ W h a t a re you doin g to g et th a t? ” “ Just sitting h e r e . ” “ Is it h e lp in g ? ” I ask. “ I d o n ’t k n o w ” o r “ W h a t c a n I d o ? ” “ H o w about m akin g a choice tod ay to co m e to ex erc ises o r b in g o . It m ay help you to g e t w h a t y o u w ant, a n d it is certainly b e tter than sitting h ere do ing n o th i n g .” D o in g som ethin g is alw ay s better than sitting alone d ep ressin g and painin g. W h en I ca n n o t reach a p e rs o n , I leave with the w ords, “ H ave a good day . I t ’s y o u r ch o ice , and I ’ll be back this afternoon to v is it . ” N e v e r give up and never expect unrealistic goals. As stated b e fo re , R eality T h e ra p y teaches that a person will be happy if he is w o rk in g to meet his own needs. Activity T h e ra p y can be built a ro u n d these needs o f be lon gin g, self-esteem , freed om and fun, allo w in g a resident to have a choice. T e ach in g skills to meet these needs is the p ri m a r y role o f a Reality T h erap ist. C a re plans can be w o rk ed a c co rd in g to these n eeds and a resident can ta ke an active p art in the skill-building p ro c e s s , le arn in g or relearnin g how to m e et these need s. A ctivities can be passive o r active. W e look at the active part o f activities as the most im po rtan t, giv ing each resi­ den t th e o pp o rtu n ity to use o r learn the nec essary skills for his re cov ery.

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REFERENCES G la ss e r, W illiam , M . D . G la s s e r, W illia m , M . D . G lass e r, W illia m , M . D . G la s s e r , W illiam , M . D . K arrass, C h e s te r L. and C ro w ell, 1980.

Stations o f th e Mind. N e w Y o rk: H a rp e r & R o w , 1981. The Identity Society. N ew Y ork : H a r p e r , 1975 (re v .) P o sitive A ddiction. N ew Y o rk : H a r p e r , 1976. Schools Without Failure. N ew Y o r k : H a r p e r , 1969. W illiam G la ss er. Both-win M anagem ent. N ew Y ork : L ippincott &

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Programming for Optimum Health and W ellness M ary S. Sim per

The main and long term objectives o f p rog ram m ing for the aged are: (1) to produce the optimum sense o f total wellness possible, and (2) to assist in establishing a positive purpose in life. Total wellness is the absence o f dis-ease. W h en we are diseased we feel depressed and lethargic, with certain parts o f our being stressed. These feelings are reflected in the whole body. Everything affects o u r health, all factors, physical, mental, emotional, spiritual. W hat holistic health represents is the ac­ cepta nce o f ou r entire reality: being in our bodies, owning our feelings, attitudes and beliefs, being open to relationships and change and being responsible fo r every thought, deed and co n ­ dition we are involved in. (Ryan, 1981) An aging person can be living to the optim um capacity o f w e ll­ ness even though physically handicapped, in pain, or frail. W h a t­ ever o ur position, there can be an appreciation for ourselves as hu m an beings. We can move to w a rd positive health by accepting sit­ uations an d finding new meaning to life. Emotional states o f bored om , listlessness, stress, loss o f dignity, loss o f self esteem and relinquishment o f self authority can set the stage for physical dis-ease to manifest through the lowering o f the b o d y ’s resistance. With the reversal o f these states co m es a sense o f well-being. A dd ed positiveness affects the physical being. S y m p ­ toms are reversed and further im pairments prevented. M a ry S i m p e r is c o n s ul ta n t to Bo nn ev ill e Heal th G r o u p and pl ans and assists with p r o ­ g r a m m i n g at an a du lt da y c a re c e n te r and re si de n t h o m e f o r o l d e r w o m e n in Salt La k e City , Ut a h. S h e h o l d s a BS d e g re e in h u m a n r ela tio ns from W e s t m i n s t e r C o l le g e , Salt L a k e C ity , a g r a d u a t e cert ifi cat e in g e r o n t o l o g y from the U ni ve rs i ty o f Uta h, and a P h D in g e r on to lo g y and holistic health at Union o f E x p e r im e n ti n g Colle ge s a n d U ni ve rs i ti e s , C i n c in n a t i, Oh io . ©

1985 by T h e H a w o rt h P r e ss . Inc. All r i g h t s re s e r v e d .

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Dealing with wellness and self-responsibility requires a tuning in­ to o n e se lf and dealing with the whole person. P ie ro Ferrucci (1982) says: The Italian psychiatrist, R obert Assagioli noticed several years ago that a great deal o f psychological pain, imbalance and meaninglessness are felt w hen ou r diverse inner elements exist unconnected side by side or clash with each other. But he also observed that w hen they m e r g e in successively g reater wholes, we experience a release o f energy , a sense o f well-being a n d a greater depth o f meaning in our lives. I find it beneficial to p lan p ro gram m ing around the four aspects of the whole person—the physical, mental, emotional and spiritual bodies. P ro gram m in g involving all four o f these areas stands a greater chance o f eliciting a response than attention to one or two. W hen we are lock ed into on e discipline, we are denying ourselves and ou r clients the benefits o f flexibility and creativity. For in­ stance, we ourselves may despise bingo. H o w ev er, if this is the first activity in which a person will becom e involved and during that a c ­ tivity he experiences a physical expression o f co ncern , such as a hand held o r touch on the shoulder, his participation in other activi­ ties m ay result. If petting a cat or dog, or holding a baby has the same effect, great! Perhaps just sitting quietly listening to music and holding hands will be the beginning. T he following ideas m ay be helpful in planning holistic p ro ­ gram m in g.

P H Y S IC A L 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

A suitable routine of physical exercise Discussions on nutrition Relaxation techniques Deep breathing C raft activities G ames Recreational activities Discussions on touching, sensuality, sexuality Tai Chi W alking

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EM OTIONAL 1. Learning to express oneself assertively 2. Expressing emotions in ways that com m unicate to others how one is feeling 3. Creating and cultivating close relationships and und erstand­ ing their im portance in later years 4. Discovering o n e ’s real needs and finding ways to meet them 5. Learning to m ake choices (decisions) 6. Realizing that one is the expert about oneself 7. Practicing exercises in building self esteem 8. Reminiscing with music and discussion 9. Discussing c hange, bereavem ent and death

M ENTAL 1. 2. 3. 4. 5. 6. 7.

Studying Exploring new areas o f interest Learning to appreciate music, art, sculpture W riting poetry Learning to m im e W riting a Journal Joining discussion groups on c urren t issues

SP IR IT U A L 1. M aking decisions about the meaning o f o n e ’s entire life until the last breath. This concept was suggested by V iktor Frankl fifty years ago in his L ogotherapy. 2. Replacing the fears and stresses o f aging by love—love o f self and love o f others. With this realization will com e a relaxa­ tion and letting go o f fear and anxiety and a lessening o f phy s­ ical and mental sym ptom s. 3. Relinquishing guilt 4. Gaining recognition o f the individuality o f each being and a connectedness with all things 5. Removing the blocks to o n e ’s aw areness o f l o v e ’s presence in ou r lives. 6. Practicing relaxation techniques leading to meditation

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T o incorporate all these elements into prog ram m ing involves a long-term com m itm ent. H o w ev er, I try to make each gro up setting complete in itself. I start with the affirmation th at each person is his ow n authority and can participate in each section o r not as he desires. I com m ence with a very simple exercise routine which can be done either sitting or standing. I suggest that each person be responsible fo r deciding how much to do and w hen to abstain. Tai C hi is an excellent form o f slow, graceful m ovem ent for those who are am bulatory and is also a g reat form o f mental c on centra­ tion. Certainly music helps during exercise time and just moving as one wills to the music is helpful. T he simple relaxation techniques o f d eep breathing, tensing and relaxing muscles are helpful in controlling pain and leading to m ed i­ tative visualization. Following the exercise routines lively discussion can ensue around the topics o f physical touch, sensuality and sexuality. Discussions about extended families can en co u rag e people living in supportive environments to build familial relationships with other residents. Doing very simple personal things fo r each other, such as polishing fingernails, helping with hair com bing can provide opportunities for touching and pro m ote discussions o f feelings. To many older people assertive comm unication is synonymous with aggressiveness. T hey need to understand that assertive c o m ­ munication says “ I care fo r me, and I care for you, too. I want to explain how I feel and understand how you fe e l.” Practicing situa­ tions and role-playing can be very effective. Helping people un­ derstand that everyone has a right to his/her feelings, beliefs and opinions. Developing the ability to com m unicate these without a g ­ gressiveness becom es a great stress re d u cer and helps to eliminate the feeling of being “ v ictim ized .” F orm ing positive affirmations and using them during relaxation time is a pleasant and effective way to improve o n e ’s outlook on life. Making lists o f em otions, “ g o o d ” and “ b a d , ” and expressing these feelings allows everyone to share the recognition that others experience emotions and brings about a sense o f norm ality. Discussion topics that may lead to im proved self esteem include: 1. 2. 3. 4.

Accept yourself as good. Assume responsibility for y our happiness. Assume control over y ou r life. Be sure you always have input regarding things affecting you.

Mary S. Simper

5. 6. 7. 8.

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N urture close, loving relationships. L earn that you c a n be an agent for change. Stand up for yourself. Be in h arm ony with yourself. T ru e p o w e r is not coercive nor demanding nor manipulative.

M em ories can be evoked and emotions shared through simple ac­ tivities rath e r than in a formal discussion group. E xperiences such as making ice cre am lead naturally to a sharing o f fo rm er ex p eri­ ences. W h en negative emotions a re running high am id residents and staff toward a “ difficult” person, starring that person in a combination “ This Is Y our L if e ” and “ Queen for a D a y ” can elicit e m p ath y and greater understanding. A prim ary concern o f older people is m em o ry loss. O p e n reco g ­ nition o f the fact that we forget all our lives and that the problem only takes on great im portance as we age can allay fears and bring forth hu m orous incidents. G am es stimulate m em o ry . Sharing m e m ­ ory aids and m ethods o f orderly planning for bill paying, medical needs, etc. can provide positive support. Book reviews, especially in resident hom es, can becom e shared experiences with a willing resident preparing a chapter fo r discus­ sion each time. Books that pro v e m ost successful are those that have self contained chapters. Som e that have proved successful are Megatrends by John Naisbitt, Love is Letting Go o f Fear by G erald Jampolski, and Particular Passions by Lynn Gilbert and Gaylen M oore. Journal writing can be a method o f positively evaluating a life sit­ uation. Individuals who cannot write can be assisted by tape reco rd ­ ers or friends willing to be secretaries. Discussing an d writing different forms o f poetry, learning to ap ­ preciate m usic, art, sculpture are other avenues to follow. Personal involvement is always a criterion for enjoym ent. Sing-alongs and rhythm bands are successful when the songs are familiar. One does not have to be a musician to lead this type o f entertainment. Records and cassettes provide an effective accom panim ent, and often a leader will e m e rg e fro m the group. Developing the aw areness o f lo v e ’s presence in oneself can be an exciting adventure. T h ere is a myth in A m erica that old age is not loveable, that old people are angry and frustrated. I believe that myth can be debunked. People have been taught that love o f self is pride a n d arrogance. T hey need to learn that only by loving oneself

IN N O VATIO N S IN AC TIV ITIE S FOR T H E E LD E R LY

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is one able to love o th ers. T h e sharing o f positive loving ex p erien ces can help. A “ love c i r c le ” in w hich e v e ry o n e holds hand s for a quiet m o m e n t o f reflection to finish a g ro u p session c an b e c o m e a routine closure. D u rin g this quiet time n a m es o f friends w h o are absent or sick m a y be m ention ed. V isualizing those friends, o r oneself, sur­ ro un ded by a golden light is a beneficial adjunct. This e x e rcise has been used very successfully w h en a death has o c c u rre d . A so n g for closing, with o r w ith o u t m o v e m e n ts , can be le a rn e d by e v e ry o n e . T h e follow ing, taken fr o m a reco rd in g , " O n Wings o f S on g," (F retless R e c o rd s, Philo R ecord s F e rr is b u r g , V T , 1980) is an exam ple: May M ay M ay N ow

the blessings o f G o d rest upon y o u , His p eace abide in you: His p res e n c e illum inate y o u r heart, an d fo re v e r m o re .

E m p hasis on living now rather than dw elling on the past can be a positive exp erienc e. W h e n circu m stan ces c han ge and anger and frustration result because o f an inability to return to past places and lifestyles, it is possible with help to view the situation differently and with m o re positive feelings. Saint F ran cis de Sales said: “ Be patient with ev e ry o n e , but above all be patient with y o u r ­ self. I m e a n , d o not be dish earten ed by y o u r im p erfe ction s, but always rise up with fresh c o u ra g e . I am glad you m ak e a fresh beginning daily. T h e r e is no better m eans o f attainm ent to the spiritual life than by continually beginning again, and never thinking that we have d on e eno ug h. H ow a re we to be patient in dealing with o u r n e ig h b o r ’s faults if we are impatient in dealing with o u r o w n ? H e w ho is fretted by his ow n failings will n o t c o r r e c t th em . All profitable c o rre ctio n c o m e s from a calm and peaceful m i n d . ” So ex ercise, relaxation and d e e p b reath ing begin the sessions. Usually a sh o rt discussion on som e aspect o f e m o tio n s and dealing with them follow s. T he “ m e a t ” o f the grou p is usually the part d e a l­ ing with the m ental aspect, but flexibility is n e ed ed h ere. Planned activities should be put aside if a need to do som ething else arises. C losure is alw ays with the “ love c i r c le ” o r quiet time. F ollowing are som e o th er suggestions to help with p r o g r a m m in g .

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T o en c o u ra g e w alking, a m ileage ch art is effective. Participants select a d estination. T h e are a su rro u n d in g the h o m e (as well as the hall area which is used in inclem ent w e a th e r) is m e a s u re d , and the participants re cord on the c h a rt ho w f a r they w alk . T h e re can be a c eleb ration as each p erso n reach es his “ d e s t in a t io n .” V o lun teers to help with d ev elo pin g a w a re n e s s o f the arts can be recruited th rough A rts C o u n cils, M u s ic ia n s ’ U n io n s, colleges and universities, v o lu n te e r o rgan izatio ns. Visiting sy m p h o n ie s, ballets, m o d e r n da n c e , c h o ru s p e r f o r ­ mances can best be e x p e rie n c ed by attending dress re h e arsals rather than actual p e rf o rm a n c e s . This w ay there is less c onfusion with w he elch airs and w alk ers. Dress reh earsals often take place during the day tim e and a re e asier to attend than night rehea rsals. A ltho ug h attend ance at functions aw ay from the facility is e n c o u ra g e d , it can be very tiring to physically im p aire d p erso n s. S o m etim es th ro u g h the sam e av en u es e n tertain m en t can be b ro u g h t to the resid ence.

REFERENCES F c r r u c c i . P i e r r o . W h a t W e M a y Be. L o s A n g e l e s : J . P . T a r c h e r , I n c . , 1982. F r a n k ) , V i k t o r E. M a n ’s S e a r c h f o r M e a n i n g . N e w Y o r k : P o c k e t B o o k s , S i m o n a n d S c h u s ­ t e r , 1949. P r o g o f f , I ra . A t a J o u m a l W o r k s h o p . N e w Y o r k : D i a lo g u e H o u s e , 1975. R y a n , S a r a R e g i n ia a n d T r a v i s W. P r e s s , 1981.

W el l n es s W o r k b o o k . B e r k e l e y , C a l i f o r n i a : T e n S p e e d

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Innovative “ Resident V olunteer” Programming Dennis G oodw in

O ne area o f p ro g r a m m in g which provides a double benefit is that o f utilizing the volunteer resources o f the nursing hom e com m unity. This turns the tables on the usual concept o f “ bringing the c o m m u ­ nity into the facility” and allows the residents the opportunity o f giving back something to oth ers who have given to them . T h ere are many creative resident volunteer positions which g o far beyond the simple “ sock so rtin g ” and “ plant w a te rin g ” type of jo b . M any individuals re q u ire a position they can really “ sink their teeth in to ” in o rd e r to feel constructive and rew arded. Resident volunteer positions can include activities either in o r out o f the facility. F or exam ple, if the resident is able to leave the facil­ ity, he could serve as a “ h o s t” at a com m unity event su ch as an art show or give short tours and talks at a local m useum . It is, o f course, a sham e that the vast am ount o f knowledge and experience o f so many o f o u r nursing hom e residents often goes un ­ tapped. Presenting lectures to Historical Societies o r to the Council on Aging would help ren ew feelings o f belonging to the com m unity. One o f the best and most formalized techniques o f sharing this “ his­ torical tr e a s u re ” is called the Living H istory P ro g ra m . In this p r o ­ gram , residents utilize a team teaching approach to presenting classes to schools o r other organizations. These classes center a round particular time periods o r historical events. A nother excellent method o f including residents in comm unity functions is using their assistance in fundraisers. Ideas for these are nearly unlimited and can include such projects as raising money for a seeing eye dog, for Christm as gifts fo r needy families, etc. The residents can also contribute their own efforts and talents to the comm unity through such activities as raising plants to give to isoD e n n is G o o d w i n is an a cti vit y p r o g r a m co ns ul ta nt for the B e v e r ly E n t e rp r is e s n u r si ng h o m e s in F l o r i d a . M r. G o o d w i n h a s a BS d e g r e e in p s y c h o lo g y a n d six y e a r s e x p e r i e n c e in t h e recr ea tion field. He is the a u th o r o f t w o m a n u a l s for activity c o o rd i n a to r s . ©

1985 by T h e H a w o r t h Pr e ss , Inc. All right s r e s e r v e d .

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lated people in the to w n, repairing “ T oys for T o ts ” toy donations, o r making layettes for needy mothers. T h ere are also many organized volunteer p rogram s in the c o m ­ munity which the resident could consider joining. Examples of these would be the Retired Senior Volunteer P ro g ra m , Foster G ra n d p a r­ ents P ro g ra m , Pink Lady auxiliary in a local hospital, and others. One o f the most enjoyable ways for a group o f nursing hom e resi­ dents to volunteer is to give som e type o f perform ance. Resident rhythm bands, puppet shows, bell choirs, clown shows, theater gro ups and skit reading, and resident choruses can provide a lot of “ good w ill” and fun. These do not have to be extremely profes­ sional to bring about a w a rm , enjoyable interaction. Perform ances such as these would be very w elcome at Senior Centers, other nurs­ ing homes, or any type o f senior citizen organization. Even if the resident is not able to venture out into the comm unity, his productiveness to his neighbors by no means needs to end. N e a r­ ly anything the individual could have d one in his earlier home can be done in a nursing home. One o f the most innovative ideas is a “ Telephone R eassurance P r o g r a m ” from inside the nursing home. It is an easy matter for an Activity or Social Service Director to o b ­ tain lists o f individuals in the com m unity who are considered “ shutin s .” C h urch es, the Council on Aging, the S h e riff’s D epartm ent, and other agencies know o f such people. T h en, depending on the nu m b er o f interested residents and the time they want to invest, a schedule is set up for calling these individuals on a regular basis, ju s t as in the traditional Telephone Reassurance P rog ram . This would, o f course, not only m on ito r the isolated individual, but sup­ ply great social interaction for both participants. A t least one nursing home resident volunteer grou p sponsored a scholarship for a n u rs e ’s aide in order to pay fo r Licensed Practical Nurse training. This was given as a bonus for excellent w ork. F u n d ­ raising activities could lead to sponsoring a scout troop, adopting a needy family for Christm as, supporting children overseas, and others. A no ther m ethod o f helping the comm unity which d o e s n ’t involve leaving the facility is to sponsor and “ staff” a “ M o t h e r ’s Day O u t .” This could be weekly or m onthly, at a set time, and could supply baby sitting to staff m e m b ers, specific clubs, or to the c o m ­ munity in general. In the same vein, the residents could offer to tu ­ tor children in such areas as basic reading, writing, o r mathematics. This would assist sm all children w h o a re having some trouble keep­ ing up with their classmates.

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Residents who have som e ability at craftw ork or needlew ork could give their talents in various ways. Mittens, scarves, or knitted toys would be welcome at C h ild re n ’s H o m es. Christm as de c o ra ­ tions would be useful if sent to hospitals or similar facilities. In addi­ tion to sending the craft items them selves, residents could often sell o r raffle the items and d on ate the p roceed s to a w orthw hile cause. Sewing skills can also be used to repair torn clothes or sew on bu t­ tons for other residents right in the facility. If the resident wants to turn his volunteerism toward the other residents o f his “ m in i-c o m m u n ity ,” there are unlimited opportuni­ ties. One individualized ex am ple is called the “ Buddy S y ste m ” in which an alert resident teams up w ith a som ew hat disoriented resi­ dent in o rd e r to assist him in his daily schedule. Too often residents w ho are in th e hospital receive no c o rrespo n­ dence fro m those back in the facility. Resident Volunteers can write and send cards, not only to those in the hospital, but to residents who have been discharged o r transferred to other facilities. A letter o f thanks from a resident would also m ean a lot to a volunteer. W hen a newly admitted individual enters the nursing home, a resident “ W elco m e W a g o n ” goes a long way in easing his adjust­ ment. T w o o r three residents willing to spend a little time visiting and helping to orient the new person w ould be extremely helpful, e s­ pecially to individuals w ho seem upset about the admission. A nother twist on the babysitting idea is a “ Plant Sitting” service for houseplants o f employees and volunteers who are going on vaca­ tion and are concerned about their living things getting proper care during their absence. Residents can plan and give parties and celebrations for staff m em bers, volunteers, and family m e m b ers. They can help celebrate such important events as graduations, prom otions, and marria ges. Not only can they have parties a n d social get-togethers for staff and volunteers, but for each other. F o r ex am ple, a “ going away p a rty ” for a popular resident who is being transferred o r discharged, or “ W elcom e B ac k ” party for a resident returning from a prolonged stay in the hospital would really help support the feeling o f “ c o m ­ m u n ity ” within the facility. These ideas are just a few possibilities for the utilization o f Resi­ dent V olu nte er positions in creating and maintaining m o r e o f a feel­ ing o f rewarding, self-directed productivity in nursing h o m e envi­ ronments. In actuality, n early ev ery volunteer position which can be staffed by a comm unity volunteer can also be staffed by a resident volunteer.

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The Good Samaritan Program: Patients as V olunteers Jan Seville

T h e qu ality/qu antity issue re volu nteers is frequently b ro u g h t up w h e n A ctivities D ire cto rs m eet. D o y o u have to o m a n y o r not enough v o lun tee rs? Is there an age limit in y o u r volunteer p ro g r a m ? W h at are y o u r volu nteers a llow ed to do? S o m e tim es we, as A ctiv i­ ties D ire c to rs, m ay n o t look closely e n o u g h at w h a t r e s o u r c e s we have at hand . . . o u r o w n patients. W h a t m o r e readily available v o lu n te e r could we ask? S everal y e a rs ag o I started an in-house v o lu n tee r p r o g r a m at the facility w here I w o rk . I chose the n am e “ T h e G o o d S a m a r it a n s ” for the v o lu n teers—o u r very o w n patients. T h e p ro g ra m con trib ute s to the m en tal, em otio nal and social w ell­ bein g o f o u r patients w ith in th e institution. In v olv em en t in such a p ro g ra m can give new m ean in g to a p a tie n t’s life. W e a tte m p te d to build on existing strengths and capabilities, and establish feelings o f pride and p erso nal w o rth as a result. V o lu n te ers can receive p le a ­ su re and self-satisfaction from th e ir in v olv em en t and at the sa m e tim e e x p a n d their p e rs o n a l interests. T h e philosophy o f the G o o d S am aritan P ro g r a m reflects the g e n ­ eral p u rp o s e o f the activities p ro g r a m as a w h o le —p ro m o tin g “ m eaningful a c ti v it y .” As it is fu rth er stated in the co de o f the N ew Y o rk State H ealth D e p a rtm e n t these pu rp o sefu l activities should “ p ro m o te and maintain a sense o f usefulness to se lf and o t h e r s . ” 2 This spe cial vo lu n teer p r o g r a m m u s t also follow certain p r i n ­ ciples. T h e p ro g r a m m u s t m eet th e needs o f th e institution, relating to the objectives o f the A ctivities d ep a rtm e n t. T h e n eed s, in terests Ja n Seville is a c ti v iti e s d i r e c t o r at L e R o y V il la ge G r e e n N u r s i n g H o m e a n d R e h a b i l i t a ­ tion C e n t e r , I n c . , L e R o y , N e w Y o r k . Ms. Seville h o l d s a BS d e g r e e in “ C o m m u n i t y a n d H u m a n S e r v ic e s wi th S p e c ia l E m p h a s i s in T h e r a p e u t i c R e c r e a t i o n wit h the E l d e r l y a nd H a n d i c a p p e d " a nd is r e g i s t e r e d as a T h e r a p e u t i c R e c r e a t i o n S pe c ia lis t wi th the N a t io n a l T h e r a p e u t i c R e c r e a t i o n So c i e t y . 2N e w Y o r k S t a t e D e p a r t m e n t o f H e a l th . C o d e for Sk i ll e d N u r s i n g Fac ili ty. 73 1.6 (1 )(iv). 19 7 8, 5 7 2 3 H . ©

1985 b y T h e H a w o r t h P r e s s , In c. All rig h t s r e s e r v e d .

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and abilities o f each patient must be considered. Caution must be taken not to violate the rules and regulations o f the state code. Under the patient’s and reside nt’s rights, num ber 10 ensures that each pa­ tient/resident “ is not required to perform services for the facility that are not included for therapeutic purp oses in his plan o f c a r e . ” 3 Once a patient is accepted into the G ood Samaritan P ro g ra m , his or her involvement m u st be incorporated into the individual care plan. Each p e rs o n ’s projects or duties are presented at care confer­ ences and documented in quarterly reviews. G oals formulated through this program for “ therapeutic p u rp o s es” are also charted. Within the first 48 hours o f an admission, we, as Activities p ro ­ fessionals, begin to learn ab ou t ou r new patient—his/her limitations, abilities and interests. As this patient adjusts, w hether he or she b e ­ comes involved in activities groups or stays aloof, talents, desires, or needs relevant to the pro gram may be discovered in the indi­ vidual. That person is then approached to join the Good Samaritan P rogram . Posters recruiting G ood Samaritans, an article in the facility’s newsletter, o r an announcem ent made at Residents' Council meeting have all been effective in increasing the num ber o f volunteers. W ord o f mouth and peer influence have also contributed to increased m em bership. Like other prospective volunteers, those interested fill out appli­ cations. Written applications, I feel, serve several purposes. First, they are an official sign-up for the patients. T h e information o b ­ tained is documented feedback o f the patients’ interests and schedule preference. T hen, too, the application denotes membership for the patient. The format o f the application can vary but should include certain necessary information. Useful data include: name; room number; date signed up; time o f day preferred (m orning, afternoon, ev enin g — weekday, weekend); interests (with a checklist o f a reas in which volunteers are needed, plus a line for their suggestions). The second part o f the application is for ‘ ‘office use o n l y . ” In this latter part staff makes an initial charting o f projects in which the Good Samaritan is involved. This is convenient for a comparison of the assignment with what the volunteer initially requested. The c o n ­ cluding part for office use is used to log the dates on which the Good 3N e w York State D e p a r tm e n t o f H e a l t h . C o d e for Skilled N u rs in g Facility. 7 3 0 . 1 7 ( 1 0 ) . 1980. 5 71 2 H and Resi den ti al Heal th C a r e Fa c ili ty . 4 1 4 . 1 4 ( 1 0 ) , 1980, 4 6 1 5 H .

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Samaritan was honored for services and the type o f aw ards p r e ­ sented. A residen t’s individual qualifications are not ju dged as critically for this program as are the com m unity v o lu n teers’. A confused or agitated person can function with simple tasks, although a minimal ability to follow directions is helpful. A stroke victim may need adapted techniques o r equipm ent, but can still offer his o r her s e r­ vices. O f c o u rs e , tim e an d willingness help, ev en though the volunteer might p re f e r a certain day or time. Sincere interest sparks enth u ­ siasm and that in turn en courages responsibility and dependability. Often, because the project is governed by specific needs o r req uire­ ments, the volunteer must also be willing to take directions. Organization o f the program takes very little work o r p reparation, especially w hen co m p ared with the com m unity volunteer pro g ram . Once the needs o f the program are established, related projects are set up accordingly. As soon as response fro m an applicant is re ­ ceived, the volunteer can be assigned a specific project according to his or her needs, interests, goals and abilities. The goals o f this G ood Sam aritan In-House Volunteer Program are subdivided into tw o areas. T he first is related to the goals o f the Activities departm ent, and the second is related to the individual volunteer. Outstanding goals may include, but not be limited to, making life m o re meaningful for the individual, preserving th e indi­ v idual’s dignity, promoting the patien t’s w ell-being, and providing for the constructive use o f leisure time. T h is volunteer p ro gram should, w henever applicable, try to help each individual G o o d Samaritan m eet his/her o w n goals. Assistance can be given by assigning related projects to the individual, thus creating opportunities for goals to be reached. Goals may be short-term (or im mediate) and long-term . They in­ clude fun and personal enjoyment as well as a sense o f achievement. Other appropriate goals are an increase in self-confidence, p ro m o ­ tion o f self-worth or feelings o f usefulness, and the continuation o f work interests through w o rk substitute projects. A sense o f identity may be maintained, and attitudes toward self and o th ers enriched. Fun and personal enjoym ent can result for patients simply from being out o f their roo m s, enjoying what they are doing. P erhaps, if several are working on projects together (be it the sam e or a d iffer­ ent project), they enjoy being with others and socializing while they work.

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T he G ood Sam aritan P rogram can serve as a m eans to increase self-confidence and self-w orth. Both a re received w hen a resident shares a m usical, craft or cultural talent; they receive praise from p eers for a job w ell do n e. The responsibility o f raising and low ering the A m erican flag is considered a special h o nor by a legally blind resident o f o u rs, a retired policem an . A fo rm er pianist for the silent m ovies now enjoys playing for o u r p arties. A fo rm er secreta ry types our internal new sletter. A ttitudes tow ard others c a n b e enriched when people d o “ fav o rs” fo r others. Good feelings a re a tw o-w ay street. Patients learn to feel good about departm ents w ithin the institution and the departm ents gain added respect for the patients. W hen patients can assist a d e­ partm ent through a specific task (w hich is also beneficial for them ), positive attitudes are increased. Several exam ples o f these tasks are making tags for laun d ry , w rapping plasticw are in napkins for pic­ nics by dietary and m aking d o o r decorations for th e A ctivities d e ­ p artm en t. W hen a p atien t is assigned to visit o th e r patients o r to w rite letters for them , new friendships can develop. T he G ood Sam aritan P ro g ram helps to m eet all these goals and needs through its various p rojects. Listed below are many of the projects from which o u r d ep artm en t, facility and patients benefit. — deliver new spapers — raise and low er flag — read to patients — telephone assurance calls to elderly alone in com m unity — type (internal n ew sp ap er, large print songsheets) — m ake laundry tags — bring o ut/take in patio furn itu re cushions — w rap plasticw are for picnics — friendly visits w ith patients — w rite letters for patients — share m usical talent (i.e ., piano at parties) — teach craft o r p rep are craft supplies for “ k its ” — propel w heelchairs to /fro m activities — m ake place tags o r decorations — pass napkins at parties — pass bingo card s, chips, p rizes, assist others T he A ctivities s ta ff alw ays w orks to stim ulate the G ood S am ari­ tan volunteers, keeping them enthusiastic and m otivated. A sincere thank-y ou is voiced upon com pletion o f each task, no m atter how

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sm all. A w ritten thank-you note for doing an unusual o r larg e r, m ore involved project is visible and m o re lasting th an a verbal a c ­ know ledgem ent. P erio d ically , about ev ery six m o n th s, the G o o d S a­ m aritans are h o n o red form ally for th eir serv ices. Initially I chose this frequency for th ree reaso n s: (1) T he health conditions o f o u r G ood Sam aritans w ere susceptible to change which might necessitate dropping out o f the p ro g ra m . (2) W ith new adm issions to the facility, new possibilities for the p ro g ram are allo ­ cated , and (3) W ith lim ited o pportunities fo r g ratificatio n o f needs within the institution, m ore frequent form al recognition seem ed d e­ sirable. T he first reason has not proved relev an t; h o w ev er, (2) and especially (3) are quite valid. T o enhance y o u r special luncheons for y o u r G ood S am aritan s, consider these follow ing suggestions: 1. D eliv er form al invitations th e day b efo re. 2. Invite d epartm en t heads w ho a re able to attend. 3. U se china an d silv e r serv ices, especially if d ifferen t than the d ie ta ry ’s everyday kind. 4. H av e y o u r G ood S am aritans h elp p rep are p art o r all o f the m eal. 5. M usic can enhance this special occasion. 6. G ive a sm all speech to y o u r guests reg ard in g the value o f their w ork to your d ep a rtm en t and the facility. 7. P resent certificates o f ap p reciatio n , encouraging applause after each for im m ediate individual acknow ledgem ent as their nam e and duties are announced. An official handshake at this tim e binds the sincerity o f appreciation. 8. T ake their pictures with aw ard to m ount in the hall fo r public aw areness w ithin th e facility. T h ese p ictu res can la te r be th eirs for a souvenir o f the o ccasion. 9. H ave y o u r local new sp ap er co v er this e v e n t an d th u s increase the outside c o m m u n ity ’s aw aren ess. W e have found a m ultitude o f values in o u r G ood S am aritan P ro ­ gram . T he values are su bdivided into th re e m ajo r categ o ries: social, psychological and perso n al. R esulting u n d e r th e social values a re a concern for the w ell-being o f o thers and social in teractio n. C o o p e ra ­ tion is also encouraged . T he pro g ram creates a b ette r m orale b e­ tw een patients and d ep artm en ts, thus prom oting unity within the in­ stitution. T he psychological benefits include n on-m onetary rew a rd s, re ­

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ceived through prom oting a sense o f u sefulness. T he need for re c o g ­ nition is fulfilled. Both rew ard s and recognition can be v erb al, as in a thank-you, o r m aterial, as in a c ertificate, pin or a parag rap h w rit­ ten in a new sletter. P ersonal values m ay b e continued through pursu in g w ork-type in­ terests or w ork substitute p ro jects, thus giving the feeling o f p ro d u c ­ tivity. T he p ro g ram m ay contrib u te to a sense o f identity. Personal w orth is enhanced through accom plishm ents w hich prom ote dignity. Som etim es people do not ex pect help fro m the underdog. Like the original G ood Sam aritan in the G ospel o f L uke, who was not e x ­ pected to help th e p e rso n w ho w as m u g g e d , o ur patients a re not n o r­ m ally considered by non-professionals to be able to help or do any­ thing. But they a re —they c a n —and they do!! In conclusion, the G ood S am aritan In-H ouse V olunteer P rogram is an extrem ely useful and rew arding pro g ram to the p atients, as well as to the A ctivities d ep artm en t and institution as a w hole. All projects within the p ro g ra m , no m a tte r w hat type, contribute to the patien t’s constructive use o f leisure. T he p rogram is an o u tlet for creativity, sharing and carin g . Patients are encouraged to use th eir talents and abilities to their fullest. T hroug h prom oting feelings o f usefulness, self-esteem is in­ creased. Self-esteem enhances self-confidence; b oth crea te a p o si­ tive self-im age. The G ood S am aritan P rogram can be an A ctivities d e p a rtm e n t’s right hand. I return to the issue o f quality/quantity frequently brought up in referen ce to volunteer p ro g ram s. W ith o u r im m ediate resource o f p atien ts/resid en ts, we have quantity from w hich to choose and use according to o u r need. A nd with p atients/residents w ho w ant to be involved, w e have quality because they find rew ard in being useful.

Veteranship for Nursing Hom e Residents: Integrating Residents Into Volunteer Services Lyndon S. D rew

N ursing hom e residents can co n trib u te their tim e and talents to com m unity p ro jects. This paper highlights p ro g ram s w hich o ffer residents the opportunity to v o lu n teer. W e conclude with a c o m p re­ hensive description o f the H andi G ro u p sp o n so red by the U nited W ay R etired S enior V o lu n teer P ro g ram (R SV P) o f W ichita, K an ­ sas. O lder A m ericans are m aking substantial investm ents in com m un­ ity life. C om m unities have tapped their reso u rces through the A C ­ T IO N volunteer pro g ram s o f R S V P , F o ster G ra n d p aren ts, and S enior C om panions. M arjo rie Janz recently sum m arized the b e n e­ fits o f RSVP this w ay: “ T he activities o f RSV P are m eaningful to the old volunteer precisely because they address g enuine areas o f need in th e co m m u n ity ” (Janz, 1981, p. 261). C om m unities have been slow to recognize nursing hom e residents as a reso u rce. F riedm an, w riting in 1975 a b o u t v o lu n teer services in o n e h om e, o b se rv e d , “ T h o se w ho a re institutionalized h av e been neglected in the belief that they them selves are too im paired both m entally and physically to be suited fo r such in v o lv em en t” (F rie d ­ m an, 1975, p. 362). T h e p ro g ra m s describ ed below belie th e b elief th at resid en ts can n o t be involved in v o lu n te e r services. T w o im portant theoretical ju stification s for serv ice equally apply to older A m ericans reg ard less o f their resid en ce. A nthropologists have found reciprocity an im portant social norm in all ages. In a study o f residents in public housing p ro jects fo r the elderly in M ilL y n d o n S. D r e w is a ssi sta n t p r o fe s s o r a n d field p l ac e m en t s u p e rv i s o r o f the G e r o n to l o g y C e n t e r at W ic h i ta State U n i v e rs i ty , W ic h i ta , K a n s a s . With BA, M A , and P h D d e g r e e s in political science, he c o m b i n e s an in terest in public policy and g e ro n t o l o g y . ©

1985 by T h e H a w o rt h Pr ess , Inc. All rig ht s re s e r v e d .

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w aukee, Jonas and W ellin found, “ T h e g iv ers have opportu n ities to play useful and needed ro les, in retu rn for rew ard s ran g in g from socio-em otional gratification and heightened self-esteem to m aterial co m p en satio n ” (Jonas and W ellin , 1980, p. 237). A nother an th ro ­ pologist, G loria W entow ski (1981, p . 60 8 ), con clu d ed , based on a study o f recip ro city , that “ the need to co n trib u te ” w as “ essential to people o f all a g e s .” A second theoretical p ersp ectiv e is o ffered by D ouglas N elson, who argues that the idea o f veteran sh ip could liberate “ productively the en erg y , creativ ity , and experience o f the o ld ” (N elson, 1982a, p. 166; 1982b). V eteranship u n derstands old age as a m easure o f e x ­ p erience. T h e id ea, acco rd in g to N elso n , im plies that public policy should prom ote “ p ro g ram s th at utilize the life experience skills o f older p e rso n s” (N elson, 1982a, p. 161). V olunteer services reco g ­ nize the veteranship o f o ld er A m ericans. This paper proposes to d em o n strate that nursing hom e residents are veterans with skills to share and that nursing hom e residents, like other older A m erican s, find m eaning in useful lives.

RESIDEN T VOLUNTEERS R esidents at M ille r’s M erry M an o r, Inc. o f L aG ran g e, Indiana, are finding the m utual benefits o f intergenerational p rogram m ing (W arner, 1981). T he residents began in 1980 to help students with their studies at the P arkside E lem entary School in L aG range. The p ro je c t’s success enco u rag ed Clay School, a school fo r the developm entally disabled, and the local ju n io r high and nu rsery schools to request volunteers. T h e literature on intergenerational program m ing docum ents its value both to the young and to the old (P arn ell, 1980). For exam ple, the T eaching-L earnin g C om m unities project in Ann A rb o r, M ich i­ gan, is credited by th e d ire cto r o f th e A nn Bach N ursing H o m e with saving “ the lives o f som e o f o ur seniors who w ere literally giving up their sp irit” (D oyle, 1976, p. 30). T he residents benefited b e ­ cause they w ere sharing th eir lifetim e accum ulation o f skills with the children in the Ann A rb o r public schools. R esidents o f B riarfield, In c . in S ylvania, O hio are helping sev ere­ ly and profoundly retarded children who live in Sunshine C h ild re n ’s H om e (Pitzen, 1983). T he residents had volunteered within the nursing hom e by assisting with the care o f fellow residents. The

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Sunshine program gave them an opportunity to w ork outside the hom e. The staff trained the volunteers with slide presen tatio n s on m ental retardation and the Sunshine H om e. D uring a to u r o f the Sunshine H om e, s ta ff and v olu n teers discussed th e c h ild re n ’s and th e vo lu n ­ te e rs ’ needs. R ecru its w ere th en paired with ch ild ren . Since O ctober 1, 1981, 22 volunteers, a q u a rte r co n fin ed to w heelchairs, have w orked alternate T hursdays w ith the reta rd e d ch ild ren . V olunteers have found " a new purpose for liv in g ” (P itzen , 1983, p. 37). T he R etired Senior V olunteer P rogram has enlisted 300 nursing hom e residents in M o n tg o m ery C o u n ty , M ary lan d . All o f th ese vol­ unteers help o th e r residents w ithin th e hom es as did the B riarfield residents; but, 18 residents are helping in the co m m un ity , in schools, day care cen te rs, public lib raries, and o th e r non-profit agencies ( “ N ursing H om e R e sid e n ts,” 1981). A bout 125 residents help the com m unity w ithout leaving their homes. T hese residents are m aking flash cards and picture books for hospitals and schools and recording books fo r blind children. O ther activities include m ailings for the A m erican H eart A ssociation and telephone reassurance fo r people living alone in the com m unity ( “ N ursing H om e R e sid e n ts,” 1981). T he residents w ho cannot get out freely are m aking a contribution in M ontgom ery C o u n ty, M ary ­ land (N ational C itiz e n s’ Coalition for N ursing H om e R eform , 1981). Fifty residents o f nursing hom es in G ainesville, F lo rid a, have jo in ed RSV P and assum ed the role o f service p rovider ( “ R SV P B rings V o lu n te e rin g ,” 1982). A gain, these residents did not need to leave their hom es. Like the 300 residents in M ary lan d , G ainesville volunteers are helping in the care o f their fellow resid en ts. Som e volunteers are m atched with o th er residents w ho need help with e a t­ ing. Som e volunteers deliver mail within the hom e. Like the 125 residents in M aryland, G ainesville volunteers are also helping with com m unity projects. T hey have p rep ared large m ailings for co m ­ m unity organizations. T he result is a new role as a careg iv er. All o f th ese cases illustrate th e veteranship and g enerosity o f nursing h om e residents. They have skills an d ex p erien ce to share and they derive m eaning from a life o f serv ice. Som e program s be­ gin with apprehension and u n certainty. C an a nursing hom e resident help a student? Som e p rogram s find opportu n ities w ithin the hom e as well as in the com m unity. Som e o f the volunteers help o th er resi­ d ents o f th e hom e; som e help resid e n ts o f th e com m unity. T he p o ­

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tential o f residents as v o lu n teers has been dem onstrated but not re p ­ licated in m any hom es. T o facilitate replication, this p a p er now draw s on the experien ces o f a previously undocum ented RSVP p ro j­ ect.

R S V P O F WICHITA, K A N S A S R SV P o f W ichita, K ansas, recognized in 1982 th at many resi­ d en ts o f W ich ita’s nursing hom es could co ntribute to com m unity projects. G iven a ch o ice, residents m ight w elcom e the opportunity to w ork in the com m unity. In S eptem ber, 1982, A lexine L arso n , a vo lu n teer, began the Handi G roup w ith residents m eeting tw ice a m onth at Im m anuel L u th er­ an C hurch. W ithin a y e a r, the volunteer group grew to a size o f 25 to 30 residents and m oved to the new dow ntow n senior cen te r. Five hom es, C atholic C e n te r for th e A ging, C hrist V illa, H illhaven, L akew ood, and W ichita C are C e n te r participate in the p ro g ram . T he w ork projects include clerical w ork for com m unity non­ p ro fit organizations such as U nited W ay, M arch o f D im es, A m eri­ can C ancer S ociety, the W ichita area office o f the state D epartm ent o f Social and R ehabilitation S erv ices, and the Child C are A ssocia­ tion. A typical task is th e prep aratio n o f new sletters o r b ro ch u res. T he H andi G roup also assem bled 10,000 pins for United W a y ’s a n ­ nual fu ndraiser. T he key to th e success o f the g roup is the volunteer co o rd in ato r. A lexine L arson invests a w eek in the execution o f each m o n th 's w ork. T he volunteers w ork o n a F riday from 9 :0 0 a .m . to 2 :30 p .m . L arson begins the M onday before by calling each participating hom e to find out th at w e e k ’s roster o f p articipants. T h en she can call th e M etropolitan T ransit A uthority to arran g e for transp o rtatio n . T ransportation has been a continuing p ro b lem . The nursing hom es have not been willing o r able to use their ow n vans to tran s­ port residents. R SV P now spends $67 a w eek for specialized tra n s­ portation services. T h e cost o f transportation forced RSVP to cut back w ork days for th e g ro u p from tw o to one each m onth. A second day w ould now req u ire ano th er volunteer co o rd in ato r because o f the tim e co m m itm ent. T he physically and som etim es m entally im paired volunteers take a lot o f supervision. Even with tw o volunteer assistan ts, the co o rd in ato r is busy. T he coo rd in ato r m ust m ake final arran g em en ts on T h u rsd ay , the

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day before the Friday w ork day, fo r transportation and meals. At first, the meals-on-wheels program served the Handi G roup, but the meals were not much different from the meals in the nursing homes. R SVP then tried snack packs from Kentucky Fried Chicken. These meals were so popular that RSVP decided to use them in addition to the food service offered at the downtown senior center. This adds variety to the menu provided to the volunteers. Not all residents are capable o f participating in Handi Group. Each volunteer must fill out the standard volunteer registration form. The work is assigned according to the volunteers’ capabili­ ties. Some can staple; others can collate. T hey all need recognition and encouragem ent as they com plete their w ork assignments. For these volunteers, the work is a godsend. The work is meaningful and offers volunteers an opportunity to leave the nursing home en­ vironment. The volunteers find usefulness and friendship. Many volunteers meet old friends from nursing homes where they pre­ viously lived. Only one volunteer has ever complained that the ex­ perience was disagreeable. T h e group o f volunteers finds the monthly meeting a real joy. Community organizations have welcomed the participation o f the Handi Group. A staff m em ber o f RSVP, Phyllis Bauman, arranges the work on Monday or Tuesday in time to pick it up on Thursday from the agency for F riday’s w ork day. The project is returned as quickly as possible. The agencies have been a satisfied partner. RSVP budgets $50 a month for meals and $67 a month for trans­ portation. Staff tim e is necessary to arrange the w ork. Volunteer time is necessary for coordination and supervision. The activities di­ rectors must see that the residents are ready to be picked up on F ri­ days. This investment in tim e and money is minim al com pared to the opportunity given the volunteers.

H OMEBOUND Residents o f two nursing hom es, G reen M eadows Nursing C enter and Homestead Health Center, have participated in the RSVP homebound program. Residents o f Homestead Health C enter volunteered for the Handi Group for three months but switched to the homebound program from 9:15 a.m . to 12:30 p.m . on the first Tuesday of each month. Residents o f G reen Meadows N ursing Center devote each Thursday m orning to homebound projects.

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RSVP o f W ichita is enlisting m any hom ebound p erso n s, in p ri­ vate hom es as well as nursing hom es, to w ork on co m m u n ity p ro j­ ects. W ork is arran g ed by the R SV P office personnel as it is for the Handi G roup. T he differen ce is the w ork site. T he w ork is im portant to the volunteers because it is fo r som eone e ls e ’s benefit. A s one v olunteer said, “ I just like to help o th ers. I c a n ’t get out an y m o re, and this is on e w ay I can do th a t” ( ‘‘S eniors Lend H elping H a n d ,” 1983). P articipation is lim ited to the tw elve G reen M eadow s and eight H om estead residents w ho volu n teer. Still, the participation is im ­ portant. T w o w om en w ho did not do anything else at H om estead H ealth C enter volunteered fo r R SV P. O ne d e a f w om an w ho only w atched television b efo re her p articipation in RSVP began to make a few crafts after her particip atio n in R S V P . T w o people who w ere too fearful to leave their room began to p articipate in R SV P within the hom e. As a front page article in a suburban daily rep o rted , the volun­ teers have stuffed ‘‘pledge envelopes for the L ab o r Day Jerry Lewis M D T elethon, . . . m ade picture scrap books from g reetin g cards fo r H ead S tart p resc h o o le rs, sized and folded T -sh irts for the E p i­ lepsy F oundation, m ad e braided ju m p ropes from bread w rappers for the Institute o f L ogopedics, and m ade soft fabric therapy balls for Starky D evelopm ental C e n te r” for m entally reta rd e d children ( “ Seniors Lend H elping H a n d ,” 1983). These are all m eaningful projects benefitting com m unity agencies and their clients and filling w hat otherw ise m ight have been aim less days. T he nursing hom e and R SV P staff and vo lu n teers agree that the Handi G roup ex p e ­ rience is su p erio r to the h o m eb o u n d exp erien ce. T he p roblem s are coordination and tran sp o rtatio n . W here tim e and m oney are un­ available, the hom ebound alternative offers m ore residents the o p ­ portunity to v o lunteer.

VETERANSHIP T he R SV P H andi G roup and hom ebound pro g ram dem onstrate that nursing hom e residents have a contrib u tio n to m ake to the co m ­ m unity. T he concept o f veteran sh ip o ffers activity perso n n el and volunteer co o rd in ato rs, a sophisticated rationale for the d ev elo p ­ m ent o f m ore o p p o rtu n ities for service across the country. T his paper has attem pted to give the essential details o f the exist-

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ing p rogra m so that d e v e lo p e r s can replicate and e m b e llis h current e x p e r ie n c e . A so p hstica ted rationale should not o b fu scate the s i m ­ plicity o f the idea. P h y llis B a u m a n e x p la in e d it w e ll . “ W e tend to put o ld e r p e o p le on the s h e l f and sa y t h e y ’re not w o r th an yth ing. T h is g iv e s them m e a n in g fu l w o r k , really h elping s o m e o n e ” ( “ S e ­ niors L e n d H e lp in g H a n d , ” 1 9 8 3 ). T o p e o p le w h o think o f nursing h o m e s as w a r e h o u s e s for the d y in g , the idea o f v ete r a n sh ip for r e si­ d en ts w ill s e e m absurd, e v e n d a n g e r o u s . N u r sin g H o m e resid en ts n eed not fear the p oor farm s o f y es te r y e a r or the m en ta l institutions o f y este rd a y w h e n w o rk w a s a c o e r c iv e p enalty or a c o r r e c t iv e ther­ ap y . T h e e s s e n c e o f v ete ran sh ip is c h o ic e . R esid e n ts en tering a nursing h o m e to d ay n eed not le a v e their n eig h b o r s beh ind . In sid e or ou tside the h o m e , resident v o lu n te e r s can lend their n eig h b o r s a helping hand.

REFERENCES D o y le . J.R ' ‘D igging for Hum an T r e a s u r e . ” Educational Leadership, 34: 2 6 - 3 0 , 1976. Friedm an, S. “ The Resident W e lc om in g Commi ttee: Institutionalized Elderly in Volunteer Services to Their P e e r s . ” 7 he G erontologist, 15: 3 6 2 -3 6 7 , 1975. Janz. M ' R S V P and a Mean ingful Later L i f e . ” In F. J. Berghorn, D . E . Schafer & A s s o c i ­ ates. Ih e D ynam ics o f A ging, W e s t v ie w , B ould er, C o l o . , 2 6 1 -2 6 4 , 1981. Jonas. K . & W ellin, E . “ Depe nd enc y and Reciprocity: H om e Health Aid in an Elderly P o p ­ ulation In C .L . Fry (E d .). A ging in Culture and S o ciety, B r o o k ly n : J.F. Bcrgin, 1980. National C itiz e n s ’ Coalition for Nursing H o m e R efo rm , A Guide to D eveloping R etired Se­ nior Volunteer Programs Nursing H om c P rojects, Program A ssistanc e Paper # 16. W a s h ­ ington. D C.: A C T I O N , Old er A merican V olu n te er Progr ams, February, 1981. N e ls on . D “ Alternative Images o f Old A ge as the Bases for P o l i c y , ” In B .L . Neugarten (fcd.). Age o r N eed? P ublic P olicies fo r O lder P eople, Beverly Hills: Sage, 13 1-1 69, 1982a. N els on . D W “ The Meanings o f Old A g e for Public P o l i c y , ” N ational Forum , Fall, 1982b: 27-30. "N ursin g Hom e Residents Join R S V P . " A ging, January-February 1981: 35 -3 7. Parnell, K “ Y o u n g and Old Together: A Literature R e v i e w , ” C hildhood Education, Jan ­ uary: 184 188. 1980. Pit/