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INNOVATION

A toolkit for encouraging activities in care homes

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It is important that residents in care homes are engaged in meaningful activities; the Living Well Through Activity in Care Homes toolkit aims to help staff do this

Abstract

Activity is vital for the physical and psychological wellbeing of care home residents. It should be an integral part of their daily routine but can be viewed as an additional burden for busy staff. Activity is defined as everything we “do”, and even older people who are frail can still be active. Nurses need to consider how activity can be incorporated into residents’ daily lives; the Living Well Through Activity in Care Homes toolkit, produced by the College of Occupational Therapists, aims to help staff provide meaningful activities for residents.

Citation: Bishop K (2014) A toolkit for encouraging activities in care homes. Nursing Times; 110, 29, 22-23.

Author: Karin Bishop is interim head of professional practice, College of Occupational Therapists, London.

Introduction

There is a common perception that moving into a care home involves a loss of independence and autonomy. However, while communal living may involve some compromise, it does not mean older people have to give up the things they enjoy that are central to their identity. When people are left to sit for most of the day with little movement or stimulation a number of detrimental physical and psychological changes occur including:

  • Muscle weakness;
  • Decrease in gastrointestinal movement;
  • Urinary tract infections;
  • Increased risk of chest infections (Department of Health, 2011).

Psychologically people may become:

  • Irritable;
  • Less alert and less able to concentrate;
  • Confused;
  • Disorientated;
  • Low in mood (DH, 2011).

Meaningful activity has huge benefits for residents and staff and should be as integral to daily care home life as providing essential care like bathing and dressing. Everyone working in health and social care has a responsibility to support this and nurses in residential care are in an ideal position to drive this change.

The toolkit

The College of Occupational Therapists has developed the Living Well Through Activity in Care Homes, a free online toolkit, which shows that meaningful activity can be achieved in care homes. It contains ideas on how staff can support activities, even when they have a limited amount of time (Box 1). It also tackles additional challenges such as:

  • Choice versus risk;
  • How to motivate people;
  • Integrating activity into care planning.

Box 1. Engaging residents in everyday activities

“I am so busy… I don’t have any time to support activity. What can I do?”

  • Ask residents questions – What do you want to do? Who is in that photo with you?
  • Ask yourself questions – Is there anything I can do to help this resident be more active, for example, tune a radio station, help to phone a relative?
  • Ask residents to help – Get them involved with sorting the post, watering the plants, drawing the curtains in the living room. Rather than thinking “What do I need to do next?” try “How can I do this activity with a resident?”
  • Get prepared and plan ahead – Have a selection of portable activities that can help people to make the most of the opportunities when they come along

The section for care home owners and managers contains materials to help them identify the existing activity culture and suggests measures for reviewing progress.

The DH (2014) defines wellbeing as: “feeling good and functioning well and [something that] comprises an individual’s experience of their life”. The toolkit highlights how wellbeing can be captured, including those times when people have difficulties communicating how they feel.

Nurses are also advised to read the quality standard published by the National Institute for Health and Care Excellence (2013), which references our toolkit. This calls on care homes to ensure that opportunities for activity are available and staff are trained to offer spontaneous and planned opportunities for residents to participate in meaningful activity. Drawing on existing guidance, it contains measurable statements and comprehensive recommendations for care homes to follow.

What nurses can do

The skill of the nurse lies in understanding the importance of activity and finding ways to encourage choice and engagement. Nurses can ensure they are familiar with the key points of each resident’s biography, interests and preferences. This will help them to understand whether it is appropriate to encourage individual residents to participate in particular activities. Discussing ideas with friends and relatives may be a good place to start.

It is important not to shoehorn residents into an activity or event, but to see them as individuals with their own preferences. Nurses can begin by fostering a culture of spontaneity when talking to residents, and making the most of occasions when they can interact with them on a one-to-one basis. Actions that will instantly make interactions more human and personal include taking the time to:

  • Share a snippet of daily news;
  • Comment on an object in their room;
  • Make a joke or tell a story about what happened to them that day.

Piloting the toolkit

The toolkit was piloted in six sites; in one of these a resident summed up this approach: “It is not what nurses do but how they do it.” He cited being given his morning medication as an example: some nurses would greet him and hand him his tablets; others would chat to him, ask him how he slept and whether everything that he needed was within reach.

The first example demonstrates a task being completed but the second indicates a one-to-one moment that could provoke further activity, such as reading the paper or listening to the radio. From the nurse’s point of view, the second interaction is no more demanding, but the resident’s experience is more positive.

Working with colleagues

Promoting and incorporating activity into everyday work can seem like yet another pressure on staff, but discussing ideas as a team will give a feeling of shared ownership. Staff should be encouraged to review progress together in staff meetings, taking time to consider what works, what does not and why this is the case. This provides an opportunity for good practice to be benchmarked.

Nurses can start by reflecting on what the care home already does successfully and how activity can be built into the normal daily routine. As an example, they can encourage residents to get involved in the day-to-day running of the home; Box 1 outlines some tasks that can facilitate this. Tips for motivating staff are outlined in Box 2.

Box 2. Tips for motivating staff

  • Find out their interests and strengths. If someone enjoys singing, encourage them to sing with the residents – not just informally but to lead a singalong
  • Agree one new initiative at a time – a small step that can be easily achieved
  • Give staff the chance to have one-to-one moments with residents without having a task to do. During a quieter period, rota one or two staff members to spend half an hour with residents to talk, watch television or look at magazines and newspapers with them
  • Help staff understand the resident’s perspective. Ask them to spend half an hour in the lounge or have lunch with residents. What did it feel like? Ask for ideas on improving residents’ experience
  • Encourage staff to share ideas, make suggestions and take a lead with these
  • Recognise staff members’ efforts

Environment

As well as behavioural changes, staff can make simple but effective adjustments to the immediate environment that can facilitate activity and contribute to a general feeling of wellbeing. These include:

  • Talking to residents and observing how they spend time in their rooms. What activities do they routinely do and is the room set up to enable these? For example, do they sit in their easy chair to read - is there adequate lighting for this and a table where they can rest their book? Is it better to turn the chair to look out of the window so they can watch activity outside? Could you put up a bird table outside to encourage wildlife? From the bed, can they reach the radio, television remote control or their telephone?
  • Making sure rooms are suitably lit;
  • Ensuring the communal rooms have a range of chairs at different heights and widths, and people are sitting in the right chair for their height and body shape;
  • Thinking about the purpose of the room. Iis it set out for the benefit of staff completing tasks or is it set up for the residents? What changes can be made to enhance the experienceof residents? How would you like to room to be if it was your home?
  • Identifying any spaces that are not really used and working out what to do with these. Could you leave objects out or create an area of interest for people to explore, for example, a writing table with paper and pens or picture books on side tables?

Conclusion

Care homes need not be places where residents are inactive or cease to engage in the activities they enjoy or that reflect key aspects of their personality. Small actions can make a big difference to each resident’s experience in the home. Nurses should get to know residents and actively look for ways to encourage them to engage with staff, each other and their surroundings to improve both their physical and mental wellbeing.

Key points

  • Older people in care homes should still be able to do the things they enjoy most
  • Engaging care home residents in meaningful activities can improve their physical and mental wellbeing
  • Residents who are frail can still undertake meaningful activities
  • Activities can be as simple as engaging a resident in conversation or watching television with them
  • Staff should see activities as a part of residents’ daily routine and not an additional burden
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