Chapter 9: Activities

We all need ways to be physically and mentally active and involved in the world.  For many residents, activities are the heart of the nursing home.

The objective of good activity programming is not only to serve the best interests of the participants but also make activities a rewarding experience for both the person with Alzheimer’’s and health care professionals. If an activity is to be meaningful, it must have purpose, be voluntary, feel good to the participant and offer the person with Alzheimer’’s a reasonable chance of success

This description of good activity programming from the Alzheimer’s Association, is equally true about activities for all people living in nursing homes.

Make sure that the activities coordinator knows about your mother as soon as she enters the facility.  Most residents will need encouragement and assistance to participate in activities.  Speak with the activities staff and with the CNA who is assigned to your mother, to make sure that your mother knows about activities and is getting to the ones she should be getting to.  Having an activities program which reflects your mother’s abilities and wishes, and making sure she gets to those activities, should be part of her care plan.  

A nursing home is supposed to have activities appropriate to the needs of its residents.  Activities are supposed to be scheduled every day, including weekends.  The range of activities may include discussion groups about books or current events, “reminiscence” groups, arts & crafts (painting, drawing, working with clay or papier maché, collage, making jewelry), indoor or outdoor gardening, religious meetings, singing, playing or listening to music (often songs which were popular when the residents were younger or that they sang to their children,) using puppets, watching old movies, dancing, walking, exercise, meeting with visiting children, playing with visiting animals.  If your mother wants her morning newspaper, the staff should be able to arrange for this.

Whenever possible, activities should include going outside and doing things elsewhere in the community.  The nursing home is required to make the arrangements if your mother wants to go to religious services in her community.  It can charge her for transportation (if she must use a private car not usually available to residents for free,) and for the salary of any staff who must go with her.

Your mother may be happier and more comfortable if she feels she is still useful to others.  Ideally, she should have either some function she can still perform in the community, or some task she can perform in the nursing home.  Residents may be able to help prepare an evening snack for other residents (even help bake cookies), lead a discussion or Bible-study group; sort the mail;  or read to another resident.  

If the activities program the nursing home now has is not appropriate for your mother, speak to the activities staff about changing or adding to it.  If the response is not satisfactory, talk to the administrator.  Unless your mother’s physical and mental abilities are completely unique, if her need for appropriate activities is not being met, neither are the needs of many other residents of the facility.  Even if your mother’s situation is unique (she speaks no English, or is completely deaf,) the home is required to meet her needs.

Although most nursing home residents have some kind of dementia, it is most often those residents for whom there is the least to do.  It is not morally or legally acceptable to leave residents with dementia to wander through the nursing home with nothing to do.  Putting people with dementia in a room with the television turned to soap operas, game shows and Jerry Springer is not an acceptable “activity.”  It is not just meaningless: it can be actually harmful.  Loud noise and bright lights are confusing and frightening to people with dementia.  Because people with dementia may confuse characters on television with real people, or hear bits of dialogue which they think is being spoken by a real person in the nursing home, soap operas and programs with confrontational and threatening language on television are a particularly bad choice.  For people with dementia, television is almost always at best a hypnotic pacifier, not an activity.

The Alzheimer's Association has excellent written material and training for professional staff and families, about activities programs for people with dementia.  See here  and here.   Their description of “comfort care in action” is a sensitive and smart way of describing how the staff should be relating to and working with all people living in the nursing home, not only those with dementia.  You can read more about this at pages 8 - 9 of this booklet.  The Chicago Hearing Society can provide technical assistance in helping deaf residents.  The Lighthouse for the Blind  can provide help for residents who are blind or have seriously impaired vision.   Your local library should have recorded music and books.