An Elder Care Conversation About Senior Activities Done Right

During my research on assisted living communities and elder care, I met a woman whom I consider to be the model activities director. Her name is Terri Glimcher and she is the Life Enrichment Coordinator for Emeritus Senior Living. In addition to her duties at Oak Park Assisted Living in Clermont, Florida, she also serves as a trainer for many other local communities. If her techniques were universally adopted, this chapter would be completely unnecessary.

I’ve spoken to Terri several times during the course of my research, as she is a true expert in her field. She gets it!

To reword our discussion would not serve her great work justice, so I’ve included the entire transcript of our discussion.

RYAN: Thanks for spending the time with me, Terri. The work you’ve done at Emeritus has been amazing.
TERRI: Thanks for the kind words.
RYAN: Let’s go ahead and get started. What is your role at the company?
TERRI: I am the Life Enrichment Coordinator for Summerville at Oak Park Assisted Living, an Emeritus Senior Living property in Clermont Florida. I am also on the marketing team here at Oak Park.
RYAN: Sounds like a lot of hats! Being a marketing guy from a previous life I know what you’re going through. I’d like to focus on the activities portion of your responsibilities. Would that be okay?
TERRI: Sure.

RYAN: What is the role of “activities” in an assisted living environment?
TERRI: Great question! Activities play a very important role in assisted living. It is very important to keep the mind and body challenged and stimulated throughout the day. More importantly, however, is the socialization that comes with activities. It is very important for your loved one to feel connected in their new residence. Activities will help to do this. Activities also help the resident continue to enjoy many things they used to do. This consistency helps with the overall transition to assisted living.

RYAN: That makes a lot of sense. I know it was tough for my mom to transition to assisted living, because she was so active before.
TERRI: What did she do?
RYAN: She was involved in women’s club, some charities and card parties with her lady friends. She missed all that when she got into assisted living, as she remembered what is was like before her stroke.
TERRI: That sounds tough.

RYAN: It was. Anyway, let me ask you another question. What do most assisted living communities do wrong with regard to activities?
TERRI: I only know from many that I have observed that they do not meet the needs of ALL residents. They focus on the mainstream population and often have activities that people with special needs such as physical, visual or hearing cannot participate in. In my community, we make sure that adaptive equipment is in place so that all residents can participate in any activity.
RYAN: That great to hear…
TERRI: I also firmly believe that the residents should have choices in their schedule, which is why a resident council should be in place. This is their home and activities should be available at all times for residents to participate in as a group or individually. That piece lacks in many communities. Another important factor is that the assisted living community should be connected to the local community. Many times residents feel isolated because their whole world revolves around the community. The community is very open to seniors and it is a great way to keep them connected.

RYAN: Your approach sounds really unique. What have you planned that is unique?
TERRI: I really believe that most of my activities are unique in that age never plays a role in what I plan. We are always involved in a community service project of some kind. My knitting class made baby hats for the neonatal unit at our local hospital. We donated 150 hats. They were also involved in the Give a Kid a Backpack Program here. The residents hand-craft a beautiful teddy bear to go in each backpack received by the children. We have made soldier caps that were sent to Iraq, we raised money for breast cancer awareness and many more. Seniors enjoy giving back. They feel a part of a bigger picture.

RYAN: That’s really amazing. This is the kind of thing that probably makes a big difference to the residents. It seems like having a purpose is often missing for many of the assisted living residents I’ve met.
TERRI: Absolutely. In talking with the residents, I learned that not working and not having responsibilities was the hardest part for them. In hearing that, I came up with a list of jobs within our building and held a huge job fair for the residents. Each resident who wanted a job came down dressed up, filled out an application for the position, and was interviewed by me. This gave them a chance to tell me about their former careers and what it was like to work when they were growing up. It was wonderful. They all got the jobs they applied for — floral committee, taking statistics, welcome committee, sending get well cards, watering plants etc. I can tell you that for three years, every one of them has taken their job very seriously. We are a family here, and it takes a family to make it work. They receive $100.00 a week funny money and shop at our General Store.

TERRI: I also started the Bridging the Generations program with all the local high schools. This is ongoing for three years now. The high school kids come to Oak Park and are paired up with the residents. They do projects together, cook together, etc. We celebrate holidays with the students. I bring the residents into the high school so that students learn about the aging process. The students play their instruments for the residents and work on their science fair projects with them. The residents are truly mentors for these students. We have been recognized by the Orlando Sentinel many times for outstanding programs here. One of our greatest activities was “Biker Day” at Oak Park. A local merchant brought their Harley’s to Oak Park. Each resident dressed up in leathers with headbands and posed for pictures on the bikes. We sent pictures to the families saying “And you thought your loved one was at home knitting!” We got a huge response of laughter from all involved. It was a blast!

RYAN: (Laughs) That sounds incredible. You really owe yourself a pat on the back for such great work! Can you please send me a picture of Biker Day? That sounds awesome!
TERRI: Sure, no problem.
RYAN: So, in your opinion, how have the residents benefited from those unique activities?
TERRI: The residents feel a part of the community. They truly see that they make a difference. They are loved and respected by so many people in this community. The merchants come here to do activities with them. The local florist does flower arranging, Home Depot does workshops with them, Ritters Frozen Custard makes sundaes here, and we have a merchant that sets up a fruit stand in our lobby with fresh fruits and veggies that the residents can choose at no charge. They feel very connected. It’s not just being part of their residence, but still maintaining a sense of community. That is important factor in maintaining good emotional health.

RYAN: Very cool. How do you mix physical and cognitive activities?
TERRI: I do a lot of physical and cognitive activities. I run a cooking class. We have measuring, kneading, peeling, cutting, those are all good ways to combined both physical and cognitive. We bowl and golf both in the community and out. The residents keep the score. We play twister with word games. Scavenger hunts, walking club, following a map to the destination. Most of the activities have both components as a part of it.
RYAN: I really appreciate your spending so much time with me. I am learning so much. I have a couple more questions if that is okay?
TERRI: Sure, happy to spend the time with someone who’s so passionate about it.

RYAN: Thanks! Ok, so what would you recommend from an activities perspective to readers evaluating assisted living communities?
TERRI: I think it’s very important to ask a lot of questions. You want to make sure that there are activities going on all day that include, physical activities, crafts that include a product that the residents can take to their rooms, outings, and cognitive activities. You want your loved one to be able to make choices in his or her schedule. A big component is to find out how they will help your family member connect when they first come in to the community. “What can you do to help my mom or dad connect if they do not want to come out of their room?” You should also make sure that there are outings outside of the community and that there is community involvement consistently. If people are sitting in the lobby with no activity, chances are that is the way it will be when your loved one lives there. Look for resident participation – talk to the residents. They are the best indicators of what truly goes on in the assisted living community. They will tell you if they are active or not. Stimulation is very important. If you don’t use all your faculties, you begin to lose them. Make sure each and every part of your loved one is being challenged daily.

RYAN: Last question. Do you have any other advice for the readers?
TERRI: Take the time to look around at different communities. Talk to residents; request a report from the Department on Aging for the state survey of the community. You can request it from the community as well. They have to show it to you. That is the law. This will give you the information on any violations the community has had. It covers resident care as well as dietary issues. This is an important piece of information to have. There are agencies that are able to help with the cost of assisted living. If you are a spouse of a veteran or a veteran yourself, there are ways to receive help. Look in to all options before making your decision. Remember, this is your family member’s home. It should not have a community feel but the feel of being home.

Terri’s activities plan is not the norm, although I wish it were. However, it should serve as an example of the kinds of things available to your loved one.

Unfortunately, many assisted living communities follow our typical day example rather than the fine example Terri has described. Do not be lazy about finding a community with good activities. It is a major social and emotional outlet for your loved one.

Photo credit: visual.dichotomy

Senior Care and The Importance of Staying Physically and Mentally Active

Before Mom got sick, she was an active lady. By active, I don’t mean she walked every morning. Rather, she was involved in almost every woman’s club in town, dedicated time to fundraising and countless local charities and took a deep level of interest in her family’s lives.

I vividly recall the first community I visited. As the admissions director walked me through the amenities during the tour, I drifted thinking about whether my mom would be bored there. I asked the admissions director what their most unique activity was. She responded: “armchair exercises.”

She proudly told me about the activity and suggested that I stay 30 minutes for the start of the next session. I was intrigued, so I stayed.

Slowly a few residents arrived, most of them with the help of a community caregiver and a wheelchair. Once seated in a semi-circle, the activities coordinator began walking the residents through a number of arm and leg motions.

The concept was solid. The problem: the activities director either didn’t notice or didn’t care that the residents weren’t participating. Many residents had a scowl on the face, evidence of the fact that they did not want to be there. Others went through the motions as best they could.

I remember thinking to myself when I left the community: armchair exercise is not an activity!

The point of my story is not to be sarcastic, but rather to illustrate something important. Activities represent an important part of your loved one’s day. They should be engaging both physically and mentally.

Being physically active can prevent and help treat many of the most common chronic medical conditions associated with old age. Physical activity is one of the most important steps older adults can take to maintain physical and mental health and quality of life. Yet today, more than 60% of older adults are inactive – and this number is probably much higher for residents of assisted living communities. Many are sedentary, physically unfit, and experience disability from chronic medical conditions as they age.

Community administration and staff members hear many reasons from residents as to why they are not active:

  • It’sboring.
  • It doesn’t feel good.
  • It makes my arthritic joints hurt.
  • It takes too much time.

However, they need physical activity more today than they care to admit. In fact, without physical exercise they will continue to suffer the loss of strength and stamina.

Walking groups and physical activity programs can help residents become and remain active.

Strength training is recommended for all adults, but it is a vital link to health for older adults. The reason is that strength training prevents sarcopenia, the muscle deterioration that comes with aging, and also helps maintain bone mass. “Stronger people have better health outcomes,” noted Dr. David Buchner, Chief of CDC’s Physical Activity and Health Branch and renowned Gerontologist. However, some elderly people avoid physical activity and become sedentary out of fear of falling and fracturing a bone. Dr. Buchner added that emerging data indicate that physical activity can prevent falls by improving strength, balance, and endurance.

Keeping Young at Heart aerobic activity, which is cardiorespiratory or cardiovascular endurance activity, is also important. It keeps the heart strong, lowers blood pressure, and relieves anxiety and depression. Even when the activities in a program such as this one are too strenuous, older adults can obtain significant health benefits with moderate physical activity, such as walking or gardening.

“We need to make physical activity part of the daily routine for older adults,” said Dr. Buchner. To that end, you should search for a community that has an active, diverse fitness program. Or, should the community you select have less-than-desirable physical activity programs, become instrumental in developing them.

What about Mental Fitness?

A large-scale study of women aged 65 and older found that cognitive decline was least common in those who were most physically active, while a large-scale study of men aged 71 and older found that those who walked less than a quarter of a mile a day were nearly twice as likely to develop dementia as those who walked more than two miles a day.

Basically then, aerobic exercise appears to improve higher cognitive functions (planning, organization and working memory) in the elderly. Another way physical training may help cognitive function in the elderly is by increasing their confidence in their abilities.

A small 14-day study found that those following a memory improvement plan that included memory training, a healthy diet, physical exercise, and stress reduction, showed a better performance on a cognitive measure controlled by this brain region, and participants reported that they felt their memory had improved.

The memory training involved doing brainteasers, crossword puzzles and memory exercises. Diet involved eating 5 small meals daily (to prevent fluctuations in blood glucose levels) that were rich in omega-3 fats, low-glycemic index carbohydrates (e.g., whole grains) and anti-oxidants. Physical exercise involved brisk walking and stretching, and stress reduction involved stretching and relaxation exercises.

Photo credit: brad montgomery

3 At-A-Glance Guides for Assisted Living

There are many details involved in choosing an assisted living facility that will work for your loved one. The process involves navigating the terminology and verbiage of health insurance policies and also figuring out what a day-in-the-life would be like at a facility.

Here are three at-a-glance guides to help illustrate what long term care insurance is, clarify key insurance terms and show what a typical day at an assisted living facility should look like.

1. Long Term Care Insurance

You may hear a lot about long term care insurance, but how do you know if it is the right choice for your family? Below we’ll outline the target market indicators for long term care insurance, to help give you a better sense if these types of policies would be a good fit for you.

Who needs long term care insurance?

  • People who have assets they want to protect
  • People who want to maintain their financial independence.
  • People who are concerned about having a choice in the quality of care they will receive in the future.
  • The average age of people who buy long- term care insurance is about 65.
  • Married people with assets of above $100,000 (not including a house).
  • Single people with assets above $ 50,000. Otherwise a client would probably deplete their assets before the insurance kicks in, making them eligible for Medicaid.
  • Since women live longer then men,they have a greater chance of ending up in a nursing home. According to a 1997 study by the Health Insurance Association of America, half of all women who live to age 65 will need a nursing home at least once during their life, compared to about one- third of men.

2. Key Health Insurance Terms

Insurance is a major factor in today’s eldercare system. I advise you to contact an insurance advisor who specializes in working with older adults and their families. Here are some basic terms you’ll need to be familiar with:

  • Medicare: A federally-funded health program administered by the Department of Health and Human Services. It is available to all Americans over the age of 65. It is made up of two parts.
  • Part A: This is available to everyone, and covers inpatient care and some aspects of in-home care.
  • Part B: This is optional and requires a monthly premium. It covers many outpatient services.
    Both Part A and B include deductibles and co- payments, and exclude certain services. You may choose to purchase Medigap insurance to cover the “gaps” in coverage by Medicare.
  • Medicaid: This is also known as Medical Assistance, and covers health care services for low-income Americans. Funded by federal, state and local governments; this program requires that applicants meet stringent income and asset requirements. While it covers some inpatient services in hospitals or certified institutions, it rarely covers in-home care.
  • Secondary Insurance: Purchased privately, these policies do not cover long-term health care costs, and rarely cover long-term in-home care. This insurance is designed to supplement Medicare.
  • Long-Term Care Insurance: Such a policy covers both in-home and residential services (including nursing homes) over an extended period of time. Often prohibitively expensive.

3.  A Typical Assisted Living Schedule

When you begin to tour assisted living communities, pay attention to the daily schedule of activities, as physical and mental stimulation will help keep your loved one happy and well.

Planned correctly, activities will become the cherished part of your loved one’s day. To set our frame of reference, let’s look at a typical assisted living day from the perspective of the resident:

  • 6:45 – 7:30am: Have breakfast and receive assistance for a shower from the aide that I’m already comfortable with
  • 7:30 – 9:00am: Make my way down to breakfast. An aide will assisted me to the dining room if necessary, and the medication technician will provide my medications for the day.
  • 9:30 – 10:30am: Morning exercises in the activity room include some stretches, leg lifts and rubber band exercises.
  • 10:30 – 11:30am: Choice of a scenic drive or reading a book by the fireplace. If I take the scenic drive, the van will be wheelchair-accessible.
  • 11:30 – 1:00pm: Lunch and return to my apartment to rest for a while.
  • 2:30 – 4:30pm: Different things happen on different days. During a week, I’ll usually see education presentation, musical performances or craft demonstrations. Nothing is required if I am tired.
  • 4:30 – 6:00pm: Dinner.
  • 6:00 – Bedtime: Evenings can bring visits from family and friends, outings in the community van, or quiet time at home.

Photo Credit: Jan Krömer

5 Holiday Gifts That Make Senior Living Easier

senior gift ideasTransitioning your mom or dad into an assisted living or retirement community is never easy. You have the best intentions at heart, but sometimes they may not see it that way, and it could take a little convincing for an easier adjustment. With the holidays right around the corner, here are the top 5 gifts you can get your parent that will help them enjoy senior living that much more.
Talking alarm clock

No matter how old you are, getting out of bed can be hassle, but it’s much easier when you have someone hassling you. If your parents are struggling with their vision, there’s no need for them to strain their eyes with this talking alarm clock from Senior Superstore. It features a voice time and temperature reader and allows you to choose whether you want the time/temperature announced when you touch the clock, if you want an hourly announcement throughout the day or if you want it on a 16-hour schedule (7 am to 10 pm).

 

Amazon Kindle

The Amazon Kindle can be a senior’s new best friend. These compact and easy-to-read devices are extremely portable and are perfect to help keep ensure your parents’ minds stay sharp. They can hold up to 3,500 books with a simple download, so as long as they have internet access, you won’t have to worry about a trip to Barnes & Noble each time they need a new read.   The Kindle is easy on the eyes; you can read it in the bright sunlight, and it doesn’t stress your eyes out like a computer screen does.

 

Lighted reading glasses

To further prevent parents from over-straining their eyes while reading, lighted reading glasses from LightSpecs are a great investment. These lightweight reading glasses feature small lights that focus light in the direction you are looking. The replaceable batteries are also equipped to last up to 50 hours.

 

Golf cart

Maintaining mobility is critical for assisted living or senior care, and golf carts are an excellent way to do that. If the community is in a subdivision like area with interconnected roads, shops and restaurants, golf carts are a great solution if they’re too far to walk. Road Rat Motors has a great selection of golf carts that are street legal, and they can double to be used for the golf course, too. These are also all electric, so with a simple charge, they’re ready to go, and you won’t need to make a trip to the gas station. While some of the prices may be a little out of reach, you could chip in as a whole family, and it’ll sure to be something they won’t forget.

 

Bath towel warmer

There’s nothing better than a warm towel fresh out of the dryer, and with a bath towel warmer, they can have that feeling every time. This is ideal warming your bones immediately after a nice warm bath or steam shower, especially in areas up north prone to colder temperatures.  The towel rack is also within arm’s reach of the bathtub or shower, so there’s no excess maneuvering that could result in slips or falls.

 

What are some other great ideas you have for gifts to make senior living a little easier?

 

About the Author: Kelsey Bohannan is a freelance writer who writes for the marketing agency 352 Media Group and has a passion for helping seniors.

Photo: rustybrick

People to Meet on Your First Community Tour

Meeting new people has never been a problem for me. But when I arrived in the parking lot of the first community, I found myself very nervous. I spent many hours on the Internet looking for the right questions to ask, the right people to meet, what safety metrics to ask about, etc. I met with the admissions director, took a tour and was back in my car 60 minutes later. I saw the entire community and even met a few of the staff members. I still had no idea of why that community was better or worse than any of the several I was planning to visit.

While I summarized our plan in the last blog, it makes sense to add more detail regarding the people you need to meet during each of your initial community visits. Your first community visit will be overwhelming. Assisted living is just like any other business. In the world of assisted living, beds are products and the goal of the admissions department is to sell that product.

Unless you arrive prepared, you’ll leave with nothing but a sense of completion and a shiny new brochure. What you won’t leave with is any useful information that will help you either eliminate that community from contention or move it on to the next round of consideration.

Try visiting during the week so you can get a feel for the full staff level. When you visit your short-list a second time, you can validate the weekend team.

Who You Need To Meet

When you set up your appointment, make it clear to the admissions representative that you’d like to meet with several members of the staff. I’ve listed below the ones I believe are crucial to meet on your first visit.

Admissions director: The admissions director will likely be your primary contact at the community. At many communities, this person is also responsible for sales and marketing. As such, you should expect an upbeat conversation with little or no negativity. The admission director’s primary role is to fill the beds (product) in the community, but they more than likely care a great deal for the people they place in the community. That being said, expect to get the pros, but not a complete picture of the cons during your discussion. I do recommend that you leverage this person’s knowledge of the staff to learn more about their backgrounds.

Activities director: The job of the activities director is to provide entertaining and stimulating activities for the residents. The demeanor and attitude of this person is tremendously important. Their patience, creativity and tenderness can make a world of difference in residents’ daily lives. Find a grumpy one, and your loved one could be looking at days of old movies and bus rides. The following chapter discusses the right way to implement an activities program.

Registered nurse: Assisted living communities are not required by law in all states to have a registered nurse (RN) on staff during some portion of the day. The RN will likely be the one to follow up with your doctor if your loved one is not feeling well, and they’ll also be the one to call an ambulance. Spend some time with the RN to clearly understand his/her hours. Get a feel for their philosophy. At all costs, avoid those who have that “tough it out” attitude.

Medication manager: The medication manager (also called a “med-tech”) is responsible for getting all medications to your family member on schedule. In assisted living, residents are usually not allowed to keep medications in their rooms – over-the-counter or prescription. Spend some time with the medication manager to understand their experience and communication skills. Make sure the night shift med-techs have the same training and language skills as the day shift.

Physical therapist: Depending on your family member’s ambulatory skills, the physical therapist may, or may not be, of value. Aside from my mom herself, the physical therapist had the most impact on her recovery and ongoing mobility.

Most communities have a therapy room, and you should visit it. If you time your visit in the morning or early afternoon, you’ll likely get to see the therapist with one of the residents. Speak to the therapist to get a feel for the experience they have working with seniors. If you family member has a specific condition, make sure they have successfully worked with that condition. In the case of my mom, it was important the therapist have experience helping stroke victims learn to walk.

Head chef: The head chef is responsible for planning the menu and managing the chefs who cook it. Look at the menu and ask how they plan for sodium, cholesterol and sugar-restricted diets. It always struck me as odd that with many older people suffering from heart disease and diabetes that chefs would serve food that I wouldn’t eat myself.

Executive director: The executive director has ultimate authority over all aspects of the community. They are also the one responsible for passing on and maintaining records for state health inspections. The executive director should have a deep and profound connection to helping the residents. You’ll run across executive directors that are all business. While it’s obviously important to take a business approach to the community, make sure this demeanor doesn’t come at the expense of the patience and compassion required to make the residents happy.

Don’t Forget the Residents

The biggest barometer of a community is the residents themselves. Pay close attention to the way residents interact with each other and with other residents. If you notice a group of residents in front of the TV with no real engagement in the show, ask questions. This could be a sign of a disengaged activities director.

It is also perfectly reasonable for you to speak to the residents. As I mentioned, you’re unlikely to get honest answers about the quality of the community. In fact my mom has told me on several occasions that residents feel pressure (perceived or not) to not speak negatively about the community. So, take their words to heart, but with that proverbial “grain of salt.”

Photo credit: Sahaja Meditation