Caregivers Corner � November/December 2003
Moving from a Model of �Activities�
to a Model of �Community Life�

Many images come to mind when the public thinks about activities in a nursing home environment. Many of these images center around bingo and bible study. The medical model of nursing home care dictates that activities take place whenever there is free time in the schedule of a home, namely between meals and the medication pass. Today, due to the transition toward a social model this thinking is changing for the better. Fortunately for those who may currently have a family member in a nursing home, the model of activities is broadening considerably to accommodate a variety of interests, backgrounds and preferences.

�Therapeutic recreation� has been the industry catch phrase for activities since the �70s. Any activity offered or undertaken in a nursing home had to fit into a category before it was considered legitimate. Some of these categories include spiritual, social, mental and physical. Executive Director of the Pioneer Network, Rose Marie Fagan, often questions this practice, by illustrating that those things that we do in our own homes do not fall into simple therapeutic categories. �We don�t sit down with our loved ones over the breakfast table and say, �alright, let�s have a conversation because we need some speech therapy,� and then take a walk to the mailbox because we need some physical therapy, and then bake a pie and call it occupational therapy.�

Our industry�s need to define and categorize everything as a �therapy� or an �activity� has created sterile and lonely environments for our elders. The movement to change this is known as �Community Life.� Today, in many homes that are undertaking a culture change transformation, the traditional model of activities is being broken down in favor of community life, which embraces spontaneous living, relationships and elder empowerment.

Consider the monthly activities calendar. In a medical model home, usually a visitor could read the calendar for the day and it would say �Bible Study�10 am� and �Bingo�2 pm.� What is available for the elders and their families at times other than 10 am and 2 pm? In many cases, not much is available during times that are focused on other institutional tasks.

In a home that has embraced the community life model the monthly calendar may not even exist. Ask yourself if you post everything that you are going to be doing for the month on a wall in your home. Many elders cannot take in a full month at a time. Instead, many homes have adopted a weekly calendar, with activities that are printed on cards that are interchangeable and in many cases posted by the elders themselves. Other homes still use the old calendar, but have posted information around it that includes where one might find a deck of cards, some knitting supplies, novels, board games, etc.

All too often in medical model nursing homes the items that are on the calendar only represent large group activities. However, as nursing homes are beginning to decentralize and bring the operating style to the neighborhoods, so the activities program must also change. In some homes, there is a different calendar on each neighborhood, as the community has embraced doing things in smaller, more intimate and flexible groups. It is rare that we are involved twice daily in huge group activities when we live outside the nursing home. Doing things in large groups has historically been the only way to provide activities to the largest group of residents at one time.

In many instances in the old activities model, the activities director will focus the majority of their time on groups of the highest functioning residents. The perception is that it is easier to transport them, care for them, interact with them and meet their needs. Unfortunately, in today�s nursing home, the majority of the elders may be severely compromised, and many may not function well in a group. So, while that director takes the same 12 residents to bingo, bible study and weekly out trips, the rest of the individuals� needs are not met.

Part of what is changing that old way is the community life model�s emphasis on individualism and spontaneous activities. Great effort is being made in transformed homes to find out what these individuals did before they were admitted, and those things are being made available to them, regardless of their physical or cognitive ability. Today the activities director�s position more resembles a dean of college life�wherein a wide variety of activities are presented and made available based on the interests of the community.

Another necessary change has been to involve all staff in community life. For a home to have truly embraced culture change, they must widen the overlap of one position to another. The expectation is that everyone takes time to provide spontaneous activities and build relationships. In order for community life to truly succeed, it cannot be the sole responsibility of the �activities director,� or, what we are now calling the �community life coordinator.�

This initiative is far from mainstream, but ongoing national educational offerings are making community life more of a reality. Just think about those things that we enjoy in our own homes, and ask yourself if you would have to give up that weekly novel, that Saturday afternoon bowling league, or the adult ed classes you�ve been taking in bird watching. Until we can say that we will not have to give up those things that keep us so engaged in life itself, our work in transforming activities to community life is not finished.