This is also a great resource for staff training, and a great example of a man’s perception of ageism.   I would ask everyone that works in a nursing home to take 5 minutes out of their day to read this man’s poem.  Apparently, he hid the poem among his personal belongings in his room, and it wasn’t until after his death that nurses found it while cleaning out the room.

Crabby Old Man

What do you see nurses?.  . .  . What do you see?
What are you thinking . . . . . when you’re looking at me?
A crabby old man,. .  . . . not very wise,
Uncertain of habit . . . . . . with faraway eyes?

Who dribbles his food . . . . . .. . and makes no reply .
When you say in a loud voice . . . . . “I do wish you’d try!”
Who seems not to notice . . . the things that you do .
And forever is losing .. . . . . . . A sock or shoe?

Who, resisting or not . .  . .  . . . lets you do as you will,
With bathing and feeding. . . . The long day to fill?
Is that what you’re thinking?. . . . Is that what you see?
Then open your eyes, nurse . . . . you’re not looking at me .

I’ll tell you who I am .. . . . . As I sit here so still,
As I do at your bidding, . . . . . as I eat at your will .
I’m a small child of Ten . . . . . . with a father and mother,
Brothers and sisters . . . . . . . who love one another

A young boy of Sixteen . . . . with wings on his feet
Dreaming that soon now . . . . . . a lover he’ll meet ..
A groom soon at Twenty. . . . . my heart gives a leap
Remembering, the vows . . . . . . that I promised to keep .

At Twenty-Five, now . . . . . . I have young of my own .
Who need me to guide . . . . And a secure happy home .
A man of Thirty . . .. . . . . . . My young now grown fast,
Bound to each other . . . . . . . With ties that should last

At Forty, my young sons . . . . have grown and are gone,
But my woman’s beside me . . . . . . to see I don’t mourn .
At Fifty, once more, Babies. . . . . . . play round my knee,
Again, we know children . . . . . . . My loved one and me

Dark days are upon me . . . . . My wife is now dead .
I look at the future . . . . . . . . . . . . I shudder with dread.
For my young are all rearing . . . . . . young of their own.
And I think of the years . . . And the love that I’ve known.

I’m now an old man . .. . . . . . and nature is cruel.
‘Tis jest to make old age. . . . .  look like a fool.
The body, it crumbles . . . . . . . . . . grace and vigor, depart.
There is now a stone . . . . . . . . where I once had a heart.

But inside this old carcass . . A young guy still dwells,
And now and again . . . . . . . my battered heart swells
I remember the joys . . . . . . . . . . . I remember the pain .
And I’m loving and living . . . . . . . . . . . . . life over again .

I think of the years, all too few . . . . . . gone too fast
And accept the stark fact . . . . . . . . that nothing can last .
So open your eyes, people . . . . . . . . open and see…
Not a crabby old man .   Look closer . . . see . . . . . . . . ME!!

- Poem by “Anonymous”

- Justin Zarb, ADPC

Image by jelene (Flickr)

There are many components to being a great leader, and I don’t intend to cover all of them in this post.  However, there was one that hit me yesterday that is crucial for any position you may find yourself in life.

When people in your facility look to you, do they think you follow through what you believe in?  This can make all the world to the staff underneath you.  If they believe you really follow what you say you believe, they are more likely to get on board with your new ideas.  If they can see a discrepancy between your words and your actions, you’ll run into problems.  I’ve been slowly implementing a new approach to planning our activity calender that really involves our program’s participants. Yesterday, I was challenged by one of my staff to prove that I was willing to do what I’ve been preaching.

At the end of June I ran an activity where I asked all our members to help plan a special event calender.  In this way, they could feel empowered and have an ownership in our program.  We picked out things they would enjoy celebrating such as Amelia Earhart day and the National Korean War Veteran’s Memorial Day.  We also decided to have an ice-cream social on the anniversary of the ice-cream sundae!

Well, the day before our social, I ran another group where I asked them to help us plan the menu.  It worked out pretty well, but we had a list of items that was a little bigger than our usual snack.  Chocolate, vanilla, butter-pecan, maple-walnut ice-ream, and they wanted real Sander’s hot fudge.  At the end of the day, before she went home, one of my co-worker’s asked, “Are you really going to get all that stuff they asked for?”

It seems like such a trivial question, but in this moment I had the opportunity to put my money where my mouth was.  If I didn’t let her know that I fully intended on letting the members plan the menu, she would walk away knowing that all my talk about incorporating the members to help run the program wasn’t very genuine.

So I told her, “Of course, why wouldn’t I get what they wanted after I asked them to tell me?”  I wanted to hit home the point that I was treating them like real people and letting them have a hand in their own program.

“Oh,” she said.

I wanted to go a little further with her and find out what prompted her initial question, so I asked what her opinion of the matter was.

“Well, I didn’t know if you were going to get all the stuff they wanted, it seems like it could be a lot.”

“Yea, I see what you’re saying, I’m definitely planning on sticking to their menu, though its a little much.  However, I did already tell them that Maple-Walnut ice-cream is just about impossible to find!”

We held the ice-cream social today, and everything went well.  They were really excited about the real Sander’s hot fudge!  And the staff had no problems helping carry our vision out.  I recently read a quote somewhere, that said managers see that programs are carried out, but leaders see that the right thing is being done.  And that is what I tried to communicate to my staff, that by asking the members to help plan, I would be doing wrong by doing it our way behind their backs.

- Justin Zarb, ADPC

Image by Hamed Saber (flickr)

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We also have a few ladies who really enjoy making crafts, no matter how big or small.  We’ve found that one of the crafting activities that seems to work well for a variety of independence levels is crunching up little squares of colored tissue paper and pasting them to an object or a drawing.

To get an activity like this ready all you really need are some sheets of colored tissue paper and scissors, or actually, I prefer using one of those long blades with a grid base (I forget what to call it) so you can cut up one inch squares quicker.  We put these flat squares of tissue paper into small cups, like old margarine containers, and put them around the table for our members to choose from.  They can then scrunch the paper into whatever shape they’d like and then dip it in some glue to paste it to their shape.  Also, for those who have trouble with individually dipping each piece, you can spread glue onto the shape first and then scrunch the paper up and drop them on.

To take the activity one step further for your more independent crowd, ask them to help prepare the activity.  They can help cut, sort, or even help scrunch some shapes up for those who cannot due to arthritis or paralysis.  They can also give you input as to what colors to choose and can help supervise and assist less independent residents.

After our group made their patriotic stars, we hung them up on our bookshelf to decorate the room.  They really enjoy being able to look up and see their contribution to the program, I think it adds to their self-esteem quite a bit.  Today we sent them home with them as they left so they could enjoy it for the 4th of July holiday.

One lady in particular was very concerned about not forgetting her craft this afternoon.  She asked us to take it down from the bookshelf so she could keep her eye on it.  Memory is a fascinating thing, this lady remembers her short-term memory is poor, so she tries to compensate for it!

As you may imagine, once we pull one craft down, other members wanted to hold onto theirs as well, and before you knew it we only had three stars hanging and a bunch of them on the table!  People began to be picked up and the lady who started the whole episode went to the restroom before she expected her son to arrive.

When she came back, her star was missing!  She was so worried to not forget it and now we couldn’t find it!  We feared someone took it home accidentally, but I was pretty certain that couldn’t be the case.  I asked her to check her pockets but she said they were empty.  She wore a big, baggy jacket, one that was probably three or four sizes to large for her short frame.

We looked around and tried to see if she thought if one of the stars hanging was hers, but she could tell it wasn’t; she knew her own handiwork.  My heart ached for her, of all the things she would forget during the day, she couldn’t forget about not taking this craft home.

I asked her again to check her pocket, because I was sure it had to be somewhere on her, but they were empty.  Luckily, something caught my eye on the bottom of her jacket and I asked her to hold still for a minute.   I leaned over and saw a piece of gold string around a button on the bottom of her jacket.  I pulled it, and the star appeared out from under her jacket, thankfully!

The mind is a mysterious thing, she knew she didn’t want to forget it, yet couldn’t remember she tied it to her coat.

Shop S&S Worldwide for great prices on craft supplies, PE Equipment & more

During our mornings, we hold our Sit and Be Fit exercise activity around 11am, just before lunch.  As we began, I noticed a very small puddle underneath Dr. Singer’s wheelchair.  I wasn’t quite sure how it got there, was it from him, or did someone spill a little water?  I decided to go over and whisper in his ear that I could escort him to the restroom if he needed to use it.  He quietly obliged and nodded his head towards the door, not wanting to make a big scene.

I walk him through the door and about twenty feet to the nearest restroom.  He can walk short distances, so I locked his chair and helped him stand up.  I then held the restroom door open and told him I’d wait outside.  He’s always very jovial, and started to sing to himself as he walked inside.  As the door closed, I turned around and couldn’t believe what I saw in the hall.

All the way from the activity room down to where I was standing I saw a trail of tiny puddles.  I knew I had about five minutes before Dr. Singer would be finished in the restroom, so I tried to bend toward the ground to see if it was indeed what I suspected it was.  It was a pretty clear liquid, but I was almost certain it was urine.  Oh boy, I thought, I’m going to have to help him change his outfit when he’s finished!

I patiently waited by the restroom door for him to walk out, trying to plan in my head the best way to ask him to change.  As he opened the door, I immediately tried inspecting the front of his pants.  I couldn’t believe it, they were as dry as the desert!  I asked him, “Do your clothes feel wet, at all?”  He said, “Nooo, everything’s fine!”  I checked the back of his pants, and down to his shoes, but everything was dry.

I decided to wheel him back to the activity room, over the trail of tiny puddles.  What was going on?  As he seemed fine, I quickly got a mop to sanitize the floor and tried to figure it all out.  There were puddles everywhere, more than I noticed before!  How could he have gotten the floor all wet and be completely dry?

And then I remembered.  Dr. Singer was a very well-dressed man.  He probably spent more on his wardrobe than I could afford for mine.  Now, there aren’t very many breakthroughs in men’s business clothes, but I vaguely remembered a commercial where a man poured a cup of coffee into his kahkis and then from his khakis back into his cup.  When the coffee returned, the pants were dry.  They were treated with some sort of chemical that resisted liquids.

And there I had my answer.  Dr. Singer didn’t have magical mystery pants, they were just the latest and greatest.  Nice pants.

-Justin Zarb ADPC

Image by Robert S. Donovan

When you’re trying to make sure an activity is age appropriate, its a great idea to look to the real world to see what grown adults are actually used to doing.  Ask yourself what materials they are used to working with.  For what purpose do they carry out this activity?

In truth, adult beading is almost an oxymoron.  However, when you look around, jewelry making is something that some grown women have turned into a hobby.  Today, there are kits that let you piece together earrings, necklaces, and bracelets that many adults purchase for their own enjoyment.  One of my co-workers made everyone earrings for Christmas this past year!  Here are some tips to make this simple activity more comfortable and rewarding for our residents and members:

Buy Nice Looking Beads

Okay, I know we can get 1,000 cheap, plastic, multi-colored beads for $5, but is that really what you want to hand to your clients?  We found some professional looking beads at our local craft store (Michael’s) and organized them into like-colored containers.  That way someone could very easily make a piece of jewelry where all of the pieces actually matched!

Look for Charms!

This goes along with the first tip, but many women really enjoy showing off their charm piece on their jewelry.  It could be a heart, a musical note, one woman we work with has pink dice on her earrings for good luck.  A single charm makes the entire piece of jewelry much more sophisticated.

Quality Over Quantity

If your budget is tight, consider down-sizing your craft.  Instead of a three-foot long necklace, try making bracelets.  If you’re really strapped for cash, earrings require even fewer pieces.  You may also consider a broche.  Remember, would you go for a long piece of cheap jewelry for your own wardrobe, or pay the same for a really nice looking smaller piece?

Ask for Help

Well, sort of…ask your residents to help you with the project.  Some residents may not feel like wearing jewelry, but they’d be glad to help you organize the beads into like colors.  Others may get a kick out of making jewelry for one another.  Try asking, “Do you know Ms. So-and-so down the hall?  She could really use a bracelet.  Would you like to help us and make a bracelet for her?”  This is an approach that can really empower a resident and make their day.

Recycle these as an activity!

Activities in our facilities fall into three categories, supportive, maintenance, and empowerment. Supportive activities require staff or volunteer support for the member or resident to participate in. Maintenance activities help a resident maintain their physical and cognitive abilities as well as their sense of socializing, spirituality, and emotional health. Empowerment activities help the resident re-develop a sense of purpose in their own life. Often, these involve self-expression, personal responsibility, and/or self-respect.

When working with the dementia population, most of our activities fall into the supportive and maintenance categories.  It is for good reason, that particular population has an inevitable decline in most cases, and we’re trying to prolong, or plateau, their lives with therapeutic recreation.  Sadly, the person with dementia loses out on empowerment opportunities in our facilities because we’ve been so focused on helping them maintain what abilities they still have.  We must never forget, that the person with dementia is still a person who is conscious of themself, and therefore needs opportunities of empowerment that help maintain their sense of dignity and self-respect.

This brings us to the activity I led this morning with our dementia group.  One of our staff is on leave to be with one of her family members with a serious illness.  I wanted to give our members an opportunity to help (because they’re going to notice our staff is gone!) and I thought that making “Get Well Soon” cards would be a nice way to get them involved.  Right away, this activity is empowering all of our members by giving them the opportunity for self-expression and the responsibility to help cheer someone up.

I got together some various colors of construction paper.  Usually, our staff gets all the materials together ahead of time.  This time, however, I wanted to try involving our clients even more (I was inspired by some of our discussions in the MEPAP 2nd. Ed. course!).  It was an hour before our group activity was scheduled to begin, and some of our members were drinking coffee together at a table.  I asked them if they could fold the construction paper to help me get ready for the craft.  I was quite pleased because one lady who really doesn’t enjoy card or dice games was very eager to help in this manner.  One of our male members also brought forth an idea.  He asked if he could cut the paper into different shapes so we could have different sizes and shaped cards.  Wow, I did not expect this!  He was a tool guy throughout his life, so we quickly brought out some tools for this task, a ruler, pencil, and scissors (yes, real adult scissors!).

As the group was working on the paper, I brought out a stack of donated cards that we have in storage.  Some of them were for birthday occasions, some were holiday cards, and others were for any occasion.  I asked the group to cut out pictures they thought were appropriate from these cards to be glued onto the construction paper.  Also, I told them we were helping the environment because we were recycling old greeting cards.  If you’re looking for places to get used greeting cards try asking a local church or elementry school to hold a ‘card drive.’  This works especially well around and after the winter holidays when everybody has a zillion greeting cards they don’t know what to do with anymore!

So, our group was buzzing with activity, and the best part was that the “real” activity hadn’t even begun yet!  Instead of our staff spending one to two hours working to get this together, we extended the opportunity to our clients and we both benefitted!  They have something worthwhile and rewarding to work on, and our staff will get burned out less.

We spent about 45 minutes prepping the activity, and I gave them a 15 minute break to wash up or use the restroom before our Card Shoppe would begin.  Also, this gave our other members who planned to arrive at the scheduled time a chance to show up and chat without being distracted or feeling like they were left out.  One of our volunteers was about to clear the rulers, pencils, and glue from our male client’s seat, but I said, “Oh no!  He’s a tool guy, let’s let him keep his tools!”

The activity began, and this male member wanted to keep helping out.  He passed out construction paper around the room and asked what color each person preferred.  I could tell he was glowing inside.  To us, this may seem like a trivial task, but to him, the opportunity to be a leader in passing out the paper was the highlight of his day.

After a half an hour of working on the cards (we also brought out stickers and shapes they could glue on) I asked everyone to make sure they signed their names.  We then held an art show and everyone had a chance to display their work to the group, with applause in between.

I cannot overstate how many times we’ve held a card shoppe activity, and missed out on this great opportunity to empower our folks.  And in reality, its not us who were missing out, but those who we are responsible to care after.

- Justin Zarb, ADPC

Image by: Richard Moross (Flickr)

I like to think that planning activities is not simply a task or job, but that it is an art. It is a craft that one can hone. Just like any other craft, it is not easily mastered overnight or by working in the field for a long period of time. In fact, I still consider myself to be at the beginning of my journey to hone my craft of being an activity professional.

I’m sure that every activity director, in every facility, comes across the same problem. Namely, that activities are becoming too routine and mundane for the participants in the facility.  Of course, this is just one extra idea to spice things up, but I hope that by sharing my thought process behind this activity, I can help inspire others to innovate on their own.

Initially, our program was lacking variety in our table games. We can only play UNO and Yahtzee so many times before the staff and even those with short-term memory loss grow bored of it. In looking for a new activity, I wanted to start by investigating what sort of games our members used to enjoy. This way, I hoped to find an activity that would be readily relatable and feel comfortable for the members when we began playing. It turns out, somebody mentioned that their family played BUNCO with their neighbors and that it was a riot whenever they got together. At this point I was slightly petrified, I had never even heard of BUNCO.

So, we investigated and bought a small box of BUNCO at the store. I opened the top and found three white dice, three blue dice, and three red dice accompanied by a silver bell and some rules and score sheets. Naturally, I started looking at the rule book. It turns out, BUNCO is quite a complex and fast-paced game. Without going into the entire game, it involves multiple tables throughout the room all rolling three dice trying to hit a Bunco, which you do by rolling three of a kind. It sounded quite chaotic, and the scoring was complex. First you were all rolling for one’s, and once someone hit enough points you were to run and hit the bell, then everyone was supposed to get up and change tables and start rolling for two’s. I didn’t have to read much to know that this game was going to need some serious rules adaptations for our dementia population!

First off, I knew that we’d have to have one game, at one table, with one score sheet. So, running around trying to play musical chairs between rounds was off limits. Secondly, I needed to simplify the rules so I could explain the game in a sentence or two. I decided that instead of rolling for one’s in perpetuity until someone scored enough points, we would go around the table once for each number. The first time around we would all try for one’s. The second time around we would try for two’s, and so forth up until six. Third, I knew that the bell that came with the game was going to be worth its weight in gold, I mean, who doesn’t like ringing a bell? So whenever we sit down to play, I ask one of our members to be in charge of ringing the bell. When someone rolls and scores, the bell-ringer’s job is to hit the bell. I’ve found this to be empowering for some of our members with dementia, as well as entertaining for the rest of the crowd.

How do you score? The original BUNCO rules were complicated and differentiated high Buncos and low Buncos and all sorts of quirky things to keep track of. So I simplified the rules. During the first round, when you roll the three dice you gain one point for every one that you roll. In the second round, you score for rolling a two. Also, if you roll a three-of-a-kind you gain five points, which is called a Bunco. Additionally, if the three-of-a-kind is the same number as the round (i.e. you roll three four’s in the fourth round) you rolled what I call a Super Bunco and gain ten points. Sometimes, I refer to it as a Holy Bunco just for fun.

Now on your turn, you continue to roll as long as you are scoring points. So, if on your first roll you get a one, you score one point and roll again. If you roll a Bunco you score five more points and roll again. On your third roll, if you score no points, your turn for this round is over and you gain a total of six points. It is possible that on your first roll you do not score, if this happens your turn is over.

The explanation on paper seems more complicated than seeing the game in action. I was very happy to see that this adaptation of the game was still relatable for those who played the game earlier in their lives, but was simple enough for those who had never seen it before. The bell-ringer turned out to be a great idea, and it got our members more involved in leading the game as well.

Anytime you introduce a new game you should be prepared to tweak it as you see how its being received by the participants. At first, I tried using the score sheets that were included with the game, but after trying it out a few times I decided to make my own. I made a simple sheet up with eight columns and a bunch of rows. The first column was for each player’s name. The next six columns were numbered one through six so that you could keep track of each person’s score for each round. The last column was to total up the scores at the end of the game.

We’ve been playing this new version of BUNCO for quite a while now, and to be honest, many of our members ask for us to bring it out to play! The game is easy enough to be played by pretty much all of our members with dementia (all it really requires is rolling dice). Also, I keep evaluating our activities to see how we can improve them and I’m coming to the opinion that we don’t even need to keep score for the game to be fun. One day I wanted to experiment and I asked one of our members to start the game and let the members direct each other through the steps of the game. The dice went around the circle and they started rolling for two’s during the second round. What could be better than this?

- Justin Zarb, ADPC

Image by ty_asta (Flickr)

Although successful as an employee within the company, being promoted to its flagship brands throughout the years, DeLorean eventually left GM because of the culture he described in his book.  Mainly, there was an attitude that GM was too big to need to do improvements, that the GM way was inherently the right way, and the fruitfulness the company enjoyed would never and could never pass away.

We who work in long term care, and especially the nursing home, have been hearing about the need for culture change for almost a decade now!  Sure, nursing homes continue to generate income and jobs for those they employ, and with the baby boomers coming into retirement, we should all feel very good about our job security.  Or should we?

The percentage of the aged who come into our homes is dramatically decreasing.  Funding for Medicare and Medicaid gets tighter almost every budget year.  Those that can afford to pay their own way tend to live at other non-medical senior communities, or even just stay at home.

It is a fact, whether we want to admit it or not, that the nursing home has developed a negative stigma within our popular culture.  Watch the Simpsons, who almost weekly make a jab at our places of employment through Grandpa Simpson’s “life” at the nursing home.  If you’re really brave, why not ask a stranger at the supermarket what they think of going to a nursing home.  What do you think they’ll say?

As activity professionals, we stand in a unique place to turn back the tide against the negative stereotypes (most of which aren’t true anymore!) associated with the nursing home.  In the past, we’ve been thrown to the side more often than not because we weren’t considered as important as the nurses, or social workers, or psychologists,  or occupational therapists.   But the activities staff is just as crucial to the care of a resident as these other professionals.

The nurses may heal the wounds, but we can help heal the heart,

The social workers may organize residents’ care schedule, but we can help the resident make sense of their life.

The psychologists can help catch signs of depression and other disorders, but we can help each individual recreate the meaning in their life.

The occupational therapists can help regain the abilities needed for daily living, but we can go beyond, and help make each day meaningful to do those activities again.

You, as an activity professional are CRUCIAL!  And don’t let anyone tell you otherwise.  Now, realize that you cannot do it all on your own, you need to work as a member of a team with the nurses and other staff.  But when you help rehabilitate someone and they leave your facility, what do you think they’ll ultimately tell their friends and family about their stay?  Will it be about the efficiency of med pass?  Will it be about how their weight was measured periodically to make sure they were eating enough?  Almost certainly, no.

It will be about how meaningful their life was while they were at your facility.  And if we can send home, one by one, residents who felt fulfillment and purpose during their stay, they will tell their family.  They will tell their friends.  And one by one, we just may change the perception about where we work.

The activity is writing a letter to soldier who does not receive very much mail, to let them know how much their sacrifice is appreciated.  How do we know which soldiers don’t receive much mail?  Well, there is a program called Any Soldier where soldiers who do receive a lot of mail volunteer to help pass mail out to those who don’t hear from back home very much.

There is nothing more engaging for some of our folks that we care for than this idea.  Many of our men served in the military in their youth and many of our women had husbands or sons serve as well.  And, when you tell your residents or members you are writing to a soldier who does not receive any other mail, you can really create a meaningful, dignified activity for them.

Part of our job as activity directors is to ensure that our residents can maintain a sense that they can interact with the world outside of the facility.  Also, this is an activity where our resident, who is is usually the one being cared for, gets to reverse the role and support someone else.  While I’m sure these letters will help our soldiers overseas, writing and sending them can also improve those we care for in our facilities.

This is an activity you might do with your men’s group, or with a single resident if you think they would really enjoy it.  You can also open up a large group activity if you have a lot of people with dementia and write the letter as a group.  This way, everyone can participate without having to articulate an entire letter.  You may want to ask the group to take their picture and send it with the letter.  And, of course, please have everyone sign their own name to the letter.

You can find all the information for sending a letter at www.anysoldier.com.  One word of caution, when you address your letter, you must address it to a real soldier and put “Attn: Any Soldier” on the second line.  The USPS will not deliver a letter if the only person on the envelope is “Any Soldier.”  You may also want to put your letter in a second envelope, underneath the official one, that way when it is received it might appear more special to the troop.

- Justin Zarb, ADPC