In the world of intellectual and developmental disabilities (ID/DD), the role of activities in the life of a client is quite different than what is seen in skilled nursing and assisted living communities where more structure is needed to meet life enrichment goals, says Renee Naylor, vice president of ID/DD services at Westcare Management.

While facility-based care is increasingly focused on making individuals “kings” or “queens” of their choices to the greatest extent possible, this is already the case in the ID/DD setting, which is all about residents creating their options to the extent feasible.

“What drives it all is based on the individual. They choose the activity and decide what they want to so. If they want to see a movie, say, on Thursday, then we make it happen,” she says.

There are some activities that encompass the entire population of residents, or as Naylor calls them “agency-wide” events like family barbeques or Bingo nights, but for the most part, the individual interests of the community resident rule.

Operating in Alaska, Idaho, and Oregon, the different Westcare agencies serve adults from 18 on up, with one recent client living to the age of 86 in one of the homes, she says.

While individual interests are paramount, it is staff working with a client that plays a major role in actually planning activities, be it an excursion to the mall or if a resident is more interested in gaming, then ensuring the Xbox is in place.
Naylor says for those clients unable to express their interests, staff pick up on the nonverbal cues that indicate what activities make someone happy and then incorporate that knowledge into the activities that are planned, she says.

Different Times, New Ideas

Of the many changes that have occurred over the years in ID/DD homes for adults is the shift in activity planning. Where once there were lots of group activities and heavily managed calendars made well in advance, there are now more one-on-one events, Naylor says. Along with this more freewheeling and individualized approach has come more integration in the general community.

“We used to just really do the activities among ourselves, but now we are driving toward integration,” she says.

Examples of this way of thinking include ID/DD clients entering into relationships with retired seniors as volunteers for the Meals on Wheels program, or taking part in church-based activities. 

“In general, all of this activity is becoming more and more normalized,” Naylor says. “We still run into some from other generations where they want to put our folks away and never be heard from again, but that is not the rule. Overall, we are as a nation moving toward greater integration and having great success going into the community.”

Individualized Focus

In living out the requests of the client, the ID/DD staff are either participating with the resident in their activities, like playing basketball at the YMCA, or observing as monitors in some fashion, she says. “We have one client who really likes to take adult education classes, so that client goes with staff,” Naylor says.

And, as part of integration into the outside world, there are those clients who like to socialize in ways anyone else would, say for instance going out and having a beer. 

“Usually this comes with some written instructions and after we verify with the doctors that it is okay with any medications. We limit this to two or three drinks, and they cannot be intoxicated and come back to the house; there are guidelines in place,” she says.

The good intentions of this integrated, person-centered mindset make staff working with the residents that much more important and put the onus on the provider to ensure they are hiring the right people.

“We have several questions in the interview about how creative they [potential staff members] are and their thoughts on being able to really go out in the community and have a lot of fun and not sit home all the time, like going shopping or whatever they are interested in,” Naylor explains. “If they are reluctant, then it usually does not work.”

Another thing that does not happen as much is for the residents to all go out together in large groups or do so-called time-wasting activities. She says any activities really need to have meaning and purpose for the lives of clients, beyond the normal fun events everyone may enjoy like getting their nails done or seeing a film.

“We need to drive activity around that idea, meaning, and purpose. We have a resident who loves cats and had a cat. So, we drive her to the shelter to help groom the pets, and her employment is to shred paper that is then used as bedding for the cats,” Naylor says.

It all goes together with one of Westcare’s major philosophies, which is to provide residents a meaningful life, she says.