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.
Pines of SarasotaThe 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.”
 Pines of Sarasota
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 of SarasotaPines 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.

Visual Arts

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