Providers are increasingly recognizing the importance of providing a greater array of activities at long term care residences. Playing Lawrence Welk music and holding daily bingo games are becoming a thing of the past as today’s long term care residents become more connected to popular culture, some even bringing their own iPads when they move in.
America is known for its emphasis on individuality, and that doesn’t change just because people grow older. An activity that enthralls one resident may bore another to tears. When a facility can offer a wider range of activities, residents’ quality of life improves, they become more social, loneliness and depression are lifted, physical health is improved, and the number of medications they require is reduced, studies show.
Array Of Activities Good For Business
That’s compelling enough to consider broadening the variety of activities, but listen to this: Doing so can even improve the bottom line by appealing to more potential residents—even private-pay residents, according to John Overton, president and chief executive officer (CEO) of Pines of Sarasota
, Fla., who has had a lengthy career in long term care.
The active environment of Pines is one reason that the facilities are always at near-maximum capacity, “8 percentage points over the area-wide average,” says Overton. The Pines’ Alzheimer’s residence even has a waiting list, “primarily because of our exceptional programming,” he says.
Since he’s left the for-profit long term care world and taken on a not-for-profit, Overton doesn’t see a big difference between the two kinds of organizations.
“Even though we’re a not-for-profit organization, we still have to run this as a business,” he says, “because if we have a strong mission but no money—we have no mission.
“Furthermore, the folks from our community who donate their hard-earned money want to make sure we’re responsible stewards and that we’ll be around well into the future. They want to know what we’re doing to make sure we’ll be here 30, 40 years from now.”
Road To Success
That philosophy may be why Overton has turned around an organization that was losing money when he was hired as CEO in 2001. Now, Pines of Sarasota is firmly in the black.
“I had two primary goals,” he says. “One: We wanted to become the center for excellence in care so that if you wanted to work in long term care we would conduct ourselves in such a way that you would want to work here.
“Two: If you need the kind of care we provide, we wanted to provide an environment that ensured you’d want to come here. Even though we’ve got a very large Medicaid population, we still have a large number of residents who can go any place in Sarasota that they choose, places with more bells and whistles than we have. Many come here because of the longevity of staff
and the active environment. Those are the factors that we believe are very critical to making it a positive business result.” Doing creative activities that others aren’t doing is just good business, he says.
Overton believes that an active, vibrant community full of meaningful activities builds business. Far from being a financial drain, “I see it as a way of being able to help people understand that what you’re doing is different from the norm,” he says.
Not only that, but the wide array of activities helps significantly to overcome the fact that Pines of Sarasota—established 65 years ago—is an older campus without the “glitz and glamour” of newly built facilities, he says. “As a result, even though it’s an older campus—a combination of old and newer buildings—the reality” is that the high demand for placement at the Pines “is because of our programming.”
Pines Of Sarasota’s Activities Program
The number of activities available at Pines requires much more work than one activity director can perform. In fact, Pines puts such emphasis on activities
that Kimberly O’Toole, Pines activities director, has 11 full- and part-time staff members dedicated solely to activities.
“I’m a working manager, constantly on the floor, running groups,” says O’Toole, who is a certified recreational therapist. Often three or more activities are going on at the same time, “but it’s necessary,” she says.
Getting the community involved in the lives of long term care facility residents can result in free or low-cost activities and may help encourage local businesses or individuals to sponsor a program or provide necessary equipment or materials to make those activities happen.
“Seeking out collaborations that can serve as a ‘win-win’ for both parties is the key to success,” Overton says.
For example, Van Wezel Performing Arts Hall, which puts on plays and features other performers such as musicians and magicians, provides free tickets for residents via a grant four times a year.
Players Theatre, a community theater, also gives residents free passes to performances. Pines has worked with a number of other venues to get residents free tickets, such as the local aquarium, Mote Marine Laboratory and Aquarium, which studies manatees and features not only manatees but also dolphins, turtles, and a host of sea creatures that residents can see up close.
And volunteers and staff together donate tickets for residents to the Marie Selby Botanical Gardens, which features winding paths that lead visitors through rainforests, mangroves, and gardens of exotic plants from around the world, to name just a few of the specialized gardens, dotted throughout with benches and pagodas where residents can rest.
Several refurbished buildings, including a gorgeous mansion, provide opportunities to stop for a cup of tea and a snack.
Inspiring Laughter, Positive Feelings
Programs designed to elicit laughter in health care settings have been studied and indicate that the physical and emotional outcomes are more positive when laughter is a part of daily life.
Pines has contracted with a local circus that achieved not-for-profit status by using laughter to help people of all ages, as well as long term care residents.
Circus Sarasota, however, is a real circus and performs several times a year. The money raised from the shows goes to help its not-for-profit mission.
Circus Sarasota’s program is called Laughter Unlimited. Part of the program involves clowns and musicians from the circus visiting residents as many as five times a week, cutting up and cracking jokes, as well as involving residents in conversations about their lives, both past and present.
“The old adage that laughter is the best medicine is clearly in evidence each time we are visited by the Circus Sarasota clowns,” says Overton. “Not only do they make a difference in the lives of other residents, but help to refresh and add laughter to our staff as well.”
“Studies have shown an increase in cognitive abilities and a reduction, in some cases, in the need for medication” merely from increasing episodes of laughter, says Wendy Leslie, chief development officer for Circus Sarasota.
“Outcomes impact several groups of individuals, including patients, families, staff, and visitors, as well as enhancing the overall atmosphere,” she says.
Frequent Intergenerational Activities
A major component of Pines’ ability to offer opportunities for residents to interact with children arose from an attempt to meet a completely different need. Pines’ children’s program involves not only a day care center for the children of both staff and the larger community, but a preschool as well.
“It was originally started to stabilize our staff turnover, and achievement of that goal has been dramatic,” says Overton. A published study by a gerontology professor at a local university found that the program had positive impacts on both staff and residents. The day care center, as a business, barely breaks even financially, “yet it is a critical business unit at Pines,” says Overton. A number of key staff would not have been able to stay with Pines without it, and the benefit to the seniors is “monumental,” he says.
“Children interact with our seniors pretty regularly,” says O’Toole. “They call our residents ‘Grandma’ and ‘Grandpa.’” Pines has many special programs to bring the generations together. “We have a luncheon on Friday afternoons, the children come and sing songs for the residents. Most residents interact with children about twice a week, and some assisted living residents volunteer at the day care center.”
When O’Toole says “intergenerational,” she isn’t kidding. All age groups are integrated into activities at the campus. Pines’ 200 volunteers include retirees and students from local colleges—some of them there to learn as part of their curriculum and others just to help any way they can. High school students from the Sarasota Military Academy come by, too, some of them every day to play Wii and other games with the residents or to perform tasks that don’t require specialized training, such as passing out resident mail.
Students from an after-school program run by Circus Sarasota, who are learning skills such as juggling, also visit Pines, both to entertain the residents and to spend time just talking with them, says Leslie.
Pines uses music to engage residents in a number of ways.
One is a drumming and rhythm group, or drum circle. Residents can select their own percussion instrument—anything from djembes (an African drum that rests on the ground and is held between the knees) to, for those who have limitations that restrict their drumming abilities, hand-held shakers filled with beads, other percussion instruments, or just pots and sticks to bang with.
Music Activities Critical
Circus Sarasota also contributes to the music program, playing songs and encouraging residents to dance. “There are physical prompts and steps to each song,” says Leslie. “It also stimulates memory—I remember being surprised to hear the second verse of ‘Whoops, There Goes Another Rubber Tree Plant’ belted out by a lovely older woman who had lost her sight, but hadn’t lost her smile when she sang.”
“It’s amazing how it’s all noisy and clattery in the beginning, but by the end of the second ‘song’ they’re all alert and making eye contact” and able to find a rhythm that fits with the dominant beat, she says.
“It’s just magical; it makes me smile for days. And I love that this program can be adapted to everybody’s abilities and skills.”
Pines also has a program called Music and Memories every Friday. It’s part of the Laughter Unlimited program. Two clowns and a pianist from Circus Sarasota come to the facility—one of the clowns also plays a banjo—and they sing, make jokes, and do tricks.
Another component of the music therapy program is having the day care and preschool children come over, as they frequently do, and perform songs for the residents.
Fridays brings another musical event during which a music therapist brings a keyboard and residents play Name That Tune while O’Toole and her staff dance around holding residents’ hands and do line dancing and generally “make fools of ourselves,” she says, laughing.
Twice a week, a professional cellist comes to Pines and plays beautiful and moving classical music for interested residents.
And music is also used to reduce the anxiety of residents with dementia when it’s time for a shower by piping their favorite music into the bathroom.
Activities that involve music may be the most important. “There is no question that music has the most powerful impact, as it takes you back to memories,” says JoAnn Westbrook, director of Pines’ Education Institute.
Pines has a certified art therapist as well as three volunteers who offer several art classes a month, during which residents paint or work with textile art, such as needlepoint.
Even residents with dementia can take part. Say the goal is to paint a sunset: The therapist will take the resident’s hand and help her daub paint on the left side of the canvas and then guide the resident’s hand to streak it across the canvas, “and together they produce amazing art,” says O’Toole.
The Power Of Art
Westbrook is particularly interested in the positive effects, both physical and emotional, of the arts on health.
For 25 years, she was a classical ballet dancer, choreographer, and founder of a professional ballet company and school.
Then her mother got cancer, and that experience prompted her to make a radical career change. She got a degree in gerontology and became a licensed administrator of both nursing homes and assisted living facilities and an Alzheimer’s care trainer.
“I know how powerful the arts are, and I continue to bring the arts into health care whenever possible,” she says. “Arts and health integration involve the application of visual arts, theatre, music, dance, environmental design, laughter, and the literary arts to support health and wellness.”
Residents with different conditions see their most improved outcomes with different arts, O’Toole adds. “For example, Parkinson’s patients respond very well to dance. It helps them focus and reduces their tremors while they are dancing,” she says.
“We also know ballroom dancing is very powerful for those who have dementia,” she says.
“At Pines, we find that it is the combination of environmental changes and combinations of all the arts” that make the biggest difference for residents.
A professional horticultural therapist helps Pines residents plant and care for a garden in which plants are designed to be especially attractive to butterflies, says O’Toole.
The garden is as popular among the children from the day care center as it is for the residents, making it an ideal place for the two to interact.
Winding paths through the garden offer beautiful walks, while a gazebo provides seating for those needing a little rest, and a pagoda with vines twining up along the structure offer an opportunity to garden in the shade.
Even exercise is a fun activity at Pines.
Every morning O’Toole and the activities staff or the restorative staff hold a Positive Moves exercise class to warm everyone up for the day. In addition, a trainer comes twice a week with a chair exercise program called Magic Moves with Robin, and on Saturdays, a yoga instructor offers a class onsite.
Every year, some residents compete in Senior Olympics, collaborating with other area nursing homes. Olympics participants train for the events, such as shooting baskets in preparation for the basketball event. Winners receive awards.
Guys May Have Different Ideas Of Fun
The Men’s Club, which has about 10 members, is made up of two main components, says O’Toole. The first is simply conversation. One of the clowns comes twice a month to talk with the men. “They stop clowning around,” says O’Toole, “and they know the residents—their careers, what town they’re from, their families.” The clown will talk with the resident, getting him to reminisce, laugh, and joke when that’s appropriate or put a sympathetic arm around his shoulder if that’s needed.
The second part is run by a male staff member. Twice a month, the Men’s Club will gather for various activities geared toward what they find fun. For example, they love to play card games, including blackjack, or watch YouTube videos of sports bloopers. They watch football games and root for their teams, cheering when they score a touchdown, hooting when the opposing team fumbles.
During football season, the staff member who runs the club makes sure he checks the scores of the games of each of the club members’ favorite teams each week so that, if they weren’t able to make the gathering, he can fill them in.
The group also plans outings of the men’s choosing, anything from just a guys’ day out to going to a baseball game.
Every week, all residents can choose to go on an outing into the community. Sometimes the outing is to one of the local theaters, aquarium, or botanical gardens. At least once a month, residents go out for a lunch in the community or take a shopping trip to wherever residents feel the urge to shop.
Sometimes the outing is a Mystery Ride, which is a relaxing drive along, for example, the Gulf of Mexico so that residents of all functional abilities can take in the area’s beautiful environment. It’s called the Mystery Ride because the residents never know what scenic area they’ll be touring. Often, they’ll stop for an ice cream or hamburgers paid for by Pines.
Expand Activities Without Breaking The Budget
Overton and his staff have found ways to make offering such a wide array of activities financially reasonable. The budget for all of the activities combined represents just 1.3 percent of the Pines’ total budget.
Key to that is the enormous number of volunteers—about 200, according to O’Toole—that have been recruited and are managed by a full-time volunteer coordinator, with input from the activities director. “Having a volunteer coordinator makes very strong financial sense, whether you’re for-profit or not-for-profit,” Overton says.
The organization also does a lot of fundraising. One of its more creative ideas is holding what staff dub the Wit and Wisdom luncheon. Members of the community are invited to a lunch at which a panel of local VIPs who have had illustrious careers share their stories and convey some of the lessons they learned along the way.
Pines has been fortunate in the speakers it’s been able to convince to entertain the crowds that attend the Wit and Wisdom luncheons. “We’ve had a former president of ABC television, a pro golfer who was the first person from Great Britain to win the Masters, a man who did a lot of the narration for National Geographic productions,” Overton says.
An annual event, it’s proven to be highly popular. “We sell out one of the largest restaurants in town,” says Overton. “Over 350 people attended this year, and we netted $150,000 in donations, a portion of which goes to support activities. And it’s another way to get our name out to the public,” he adds.
The Pines campus also includes two thrift stores, created primarily to “give our residents an on-campus place to shop,” says Overton. Over time, though, revenue from the thrift stores has helped to offset the cuts in Medicaid reimbursement rates and now contributes significantly to the organization’s bottom line, he says.
Community collaboration, volunteers, and local philanthropy supporting such things as a wide array of activities will be critical in coming years to enable long term care organizations to provide a high quality of life for residents.
“The community support over the years has sustained this campus,” says Overton. “Increased regulation and decreased reimbursement will increasingly place additional strains on operators, regardless of their for-profit or not-for-profit status. As a result of this, we believe that communities supporting their long term care communities through active volunteer involvement and financial support will be extremely critical in the years ahead.
“By continuing to do innovative things, we will continue to prove our relevance daily.”
Kathleen Lourde is a freelance writer based in Dacoma, Okla.