It’s 2:00 p.m. at Forest Hills, a nursing care center in Washington, D.C., and the place is buzzing. A group of gentlemen consults with an engineer on a robot that curiously looks like Rosie from “The Jetsons.” Two women sit at a table, staring intently on their smartphones, as they conduct separate Facetime chats with their loved ones. In another room, several seniors are being interviewed by sixth graders at The Maret School on what it was like for them as students. Nowhere in sight is there a Bingo game, and no sounds from a blaring television set are heard.

This scene is a familiar sight across most nursing centers in the country. Long term and post-acute care facilities have come a long way from the regimented schedules and group classes of yesteryear. In fact, many are doing away with the schedule, opting for plans focused more on the individual resident’s needs and wants. Several seniors have adopted the technologies that have become mainstream—with even more to follow suit as the first set of baby boomers enters the centers. Those who are in charge of facilitating the events that take place—activities directors—find themselves in a field that is rapidly evolving.
“The activities director’s role is in transition,” says Judah Ronch, PhD, dean and professor of the Erickson School at the University of Maryland Baltimore County in Baltimore, who has authored books on culture change and person-centered care in elder care. “There has been an expansion of activities, where it is much more than activities but rather engagement throughout the day. We need to change from activities with a capital ‘A’ to activities with a small ‘a’ because everything that is done is an activity.”

Homes, Not Institutions

This change in dynamics can be partially explained by a movement in the mid 1980s that heralded sweeping changes across the nursing center front. This movement seeks to change how nursing centers are viewed—not as health care institutions but as person-centered homes offering long term care services. Ever since the Institute of Medicine published its 1986 report, “Improving the Quality of Care in Nursing Homes,” emphasis has been placed on the home part of the description rather than the nursing aspect of nursing centers.
The report ushered in the Nursing Home Reform Act, which requires each nursing center resident to be provided with “services sufficient to attain and maintain his or her highest practicable physical, mental, and psychosocial well-being.”

Person-centered care honors the importance of keeping the person at the center of the caregiving and decision-making process. Residents in each household are able to decide many of their activities, such as whether they’d like to sleep in, celebrate birthdays, and in what group activities they will participate. Staff of these households practice active listening and observing so they can adapt to each resident’s changing needs regardless of cognitive abilities.

Killing The Schedule

Listening to their residents has caused some activities directors to jettison a hallmark of their job: the monthly activities calendar.

Referred to in some circles as “killing the schedule,” this movement involves letting the residents choose what they would like to do with their day and following suit.

“It is definitely mulled about,” says Debbie Hommel, president of the National Certification Council for Activity Professionals (NCCAP), a credentialing body that sets standards and criteria for the field. “Yet, we need to find a balance for that. For larger communities, those who have 120 beds, there is a need to develop a calendar. For smaller communities, however, it’s doable.”

Echoes NCCAP Treasurer Dawn Worsley: “The way the government regulatory agencies write the F-tags, there is a movement away from the traditional calendar toward individual care. It’s an interesting struggle, as many marketing directors use that calendar as a marketing tool.”

The Fairfax, a nursing center in Fort Belvoir, Va., still uses a calendar but it’s tailored based on residents’ interests.

“Our residents dictate the schedule with their preferences and lifestyle wishes,” says The Fairfax’s Activities and Volunteer Coordinator Morning Carson. “We custom-tailor our programs based on the resident’s past and present cognitive capabilities.”

Involving The Building

Not only are the residents involved in The Fairfax’s programming, so are staff from other departments typically not geared for activities, such as business and maintenance.
“We learn about our team members as well as connect with our residents,” says Carson. “Our maintenance director tinkers with motorcycles. He did a bike workshop in which he brought in several bikes. The gentlemen residents really enjoyed it.”

The Chelsea at Brookfield, Belvidere, N.J., is slowly phasing out its calendar, says Activities Director Cindi Halkola. “We’ll be posting weekly calendars with times omitted for each activity,” she says. “Gone will be the large monthly calendar for the memory care unit.”

Halkola recalls when she used to have an activity scheduled at 1:00 p.m., right after lunch. The residents were unmotivated during these sessions, as they were still digesting their meals. She then adjusted her schedule to play music instead at 1:00 p.m. to match her residents’ natural flow. She adds that her staff don’t simply tell residents that activities are happening, but specifically name the activity like they would in their own homes—they never force them to unwillingly participate.

Good Samaritan Society - Boise Village in Idaho still holds on to its calendar.

“Consistency is important,” especially for residents with dementia, says Activities Director Sherri Ellis. “Our residents are still looking for that calendar.”

Preparations For The Silver Tsunami

Not only is the job changing for activities directors, so are the residents.

The first wave of the Silver Tsunami, or baby boomers, is trickling into the facilities. The generation that brought the civil rights movement, computers, and the Internet is now bringing social consciousness and tech savvy into nursing centers.

“Baby boomers are turning activities upside down,” says Hommel, herself a part of this generation. “They like to do things on their own schedule, which can be hard to grapple with as the industry has been used to structured routine. We’ll need to adopt a more relaxed approach to activities.”

This more spontaneous approach may mean the ejection of old standbys.

“Bingo is a popular game with the current generation in nursing centers. So is patriotism. When the baby boomers come in, I’m not sure these two will be as popular,” says Halkola.

Adds Ellis: “Part of the culture of the older people currently in nursing centers is to visit with neighbors. Most of the women were housewives who would have coffee with neighbors when their husbands and children left for the day. Now, most baby boomers work outside the home. They relish their solitude and once in a while do a group activity.”

Given baby boomers’ strong sense of self, activities directors are doing more one-on-one programs, such as reading with them, doing personal art projects, watching videos in the residents’ own rooms, or painting their nails.

Yet Ellis cautions against doing only solitary activities. “Interaction is an important part of this stage of a resident’s life. Nothing takes the place of human contact.”

Brave New (Digital) World

Another item factoring into activities professionals’ livelihoods is technology. The aforementioned baby boomers have embraced the pixels and pings of the Internet.

“Technology will have to be included into activities,” says Hommel. “Maybe virtual games or Google Glasses so we can all go to Italy together.”

The residents and activities staff of Forest Hills of D.C. are fully embracing the Brave New World of Technology. According to Activity Director Linda Moreno, a handheld devices class is held on Fridays, and Internet “travels” (photos and lectures about certain countries and cultures) are also conducted on a weekly basis.

“It’s cost-effective,” says Moreno. “One saves on buying materials. Instead of paying $50 for a one-time book, you can use the Internet relatively for free.”

Additionally, many residents use laptops and iPads and smartphones to talk with their loved ones via Skype or Facetime. Residents have even requested a Facebook page so their family and friends can further keep in touch.

The most ambitious project at Forest Hills, however, is a robot that the residents are helping to build with engineers. Called LOVOZO, the robot, to be built in several stages, will serve various functions, from offering refreshments, to calling Bingo, to checking in on high-risk fallers and alerting the nursing staff of any trouble, and to reading editorials for residents with hip fractures or post-acute residents who want to be alone in their rooms.

“We’re giving residents the ability to help develop the robot by asking them how they see it functioning in the community,” says Moreno.

“You’re never too old to give back and be productive and show your knowledge.”

Changes In Latitude, Changes In Attitude

On top of the changing clientele and resources, work settings are also in flux.

“There is a move from the traditional nursing center to more individualized settings that are not putting seniors behind a gate,” says Hommel.

These specialized settings include nursing centers that house eight to 10 individuals. Activities directors are usually brought on as consultants or contractors, says Hommel.

Niche care communities for people of particular interests are also popping up. For instance, Hommel says in New Jersey there is a wing at a nursing center of all Korean residents. She also mentions an artist colony out in Burbank, Calif, that caters to the interests of senior sculptors, illustrators, and painters. In the Midwest, ranches have emerged for seniors to continue taking care of animals as they’ve done throughout their lives.

Because baby boomers have accumulated more wealth than any generation, there is also a rise in luxury assisted living that caters to a limited number of residents.

Lastly, intergenerational communities are sprouting up in places such as Florida and Washington in which families move into neighborhoods with their parents.

Despite all the changes in their profession—technology, baby boomers, setting—there is one constant that remains: a focus on the resident. Says Halkola, “The individual is the important thing—today or tomorrow.”