Activities bring residents to life.

About one and a half years ago, my mom came to the Lebanon Health and Rehabilitation Center (LHRC) nursing home in Lebanon, Tennessee, from an assisted living facility, primarily for skilled wound care she could no longer manage herself. Her first impressions of the nursing home were not good--no familiar faces, a rigid schedule, food that she wasn't used to, a roommate who could only moan and keep her awake at night. She was distrustful of the nurses caring for her wound and colostomy, fearing they didn't have the necessary expertise. The local accents of the staff were hard for her to understand. "Where am I?" she would ask. "Some of the people here scare me. When am I going home?"

Today, at 92, her wound has healed, although she still needs the safety and support of the full-time care setting. She is more of her bright, curious self, interested in people, excited by a good book, and appreciative of the warmth and friendliness of the staff. She adores the wound specialist nurses, has "convinced" the staff she needs to sleep in, doesn't mention the food as much, and sometimes even likes her roommates. The staff think she is cute.

The Lunch Group

Time, familiarity, proof of expertise, and caring all played a role in her comfort. In addition, someone had an innovative idea: Let's get the mentally alert residents together for their own lunch group in their own lunchroom.

A room was opened up and decorated as "Ms. Gracie's Cafe," bright and comfortable with a big table and many chairs. Miss Kitty, the residential cat, is usually there. The women conversed with each other, got to know each other and began to be friends. During the day they sought each other out.

Regina Waller, the activities director, was the facilitator for the lunch group--and she was wild. Talking a mile a minute, telling stories that would get everyone laughing, involving them in conversations, teasing, joking, and generally carrying on, Regina brought life to the room of 8 to 10 women.

But that wasn't all Regina did. She has been activities director for 14 years and, in her words, "I have to do different things all the time because I get so bored." So Regina makes sure no one is bored.

Derby Day and Other Events

Regina implements a monthly theme and asks her lunch group for ideas. The first story I heard was about the horses. When discussing May, my mom remarked to the group that in her hometown of Louisville, May is Derby month--how about that for a theme? So it became the theme and Regina set to work.

Most of us would expect an activities coordinator to work hard to prepare a wall poster using horse pictures, show a videotape (such as Seabiscuit) about horse racing, serve Derby-inspired snacks and (untraditionally) nonalcoholic drinks, and deck out all the ladies in hats, and everyone would be happy. Instead, on "Derby Day," Regina, the staff, the administration, and the residents (wheelchairs, walkers, and all) gathered outside the nursing home while a local farmer/horseman arrived with truck and trailer, bringing two huge live horses. He paraded the horses around the grassy yard, where they performed their tricks, and he explained how he trains them. Residents were encouraged to pet the animals. They were thrilled to participate in Derby Day activities. Mom talked about this for weeks afterward. She remembered how Regina said, "Granny Fannie, we're going to put you up on that horse, and you're going to ride it around." But then she remembered then that this was her suggestion.

T[TEXT UNREADABLE IN ORIGINAL SOURCE] there was the campout. A group of kids, chaperoned by parents and activity staff, were invited to LHRC for a festival and bonfire. Games were manned by the residents. Picture the children throwing their fishing lines over a curtain into the "pond," behind which Mom and other residents in their walkers or wheelchairs attached "fish" to the lines, tugging them so the children would know that they had a bite and could reel the fish in. The children also did craft projects with the residents. The campout featured a bonfire, where everyone roasted hot dogs and made s'mores, and listened to campfire stories. At 9 p.m., the children went home and the residents went to bed (in their rooms, not tents).

[ILLUSTRATION OMITTED]

As the community prepared for the American Cancer Society's annual Relay For Life walk, Regina insisted that the residents could contribute to the event, too-not by walking, but by decorating pots, planting flowers in them, and selling them to raise money. The first step, decorating the pots, took weeks to accomplish. Everyone in the lunch group decorated at least one large pot (Mom's was a painted desert scene). Their goal was to sell 40 pots, so the pressure was on. Regina hustled daily ("We need to finish the pots; come and do just one more"). Then the residents filled the pots with live flowering plants. They completed the project, reached their goal, and donated approximately $500 to the American Cancer Society, proud of being part of the community.

These special activities were held throughout the year. In the fall, the entire men's baseball team from a local community college, dressed to play, stopped by to play a baseball game with the residents--well, baseball trivia. A correct answer was a base hit; incorrect answers were strikes and outs. Everyone laughed and had a great time.

Another day, Mom reported that the lunch group had just cooked its own meal. Regina had assembled all the ingredients for fried chicken, peach cobbler, green beans, mashed potatoes, and salad. An hour before lunch, the group went into the main kitchen and began cooking. Most of the women had not cooked for many years, but they all had cooked many, many meals during their lifetimes, meals they reminisced about as they worked together. Some ladies fried the chicken, others just tossed the salad, but everyone contributed. It was so delicious that they decided to cook breakfast that same week.

And Halloween--well, we'd need another article for that story.

So, What's Going On?

How do we think about nursing home residents? That they are old, frail, tired, weak, immobile, and mentally impaired? That they are isolated from family, past, friends, home, and spouse? That they are medicated, need help, slow, focused on themselves, and bored? That they sleep a lot and are confined to bed, room, or facility most of the time? We know they need good medical and nursing care, clean and safe facilities, nutrition that supports health, available rehabilitation and physical therapy, and assistance with activities of daily living. But that is not enough for them to really thrive. They also need stimulation, something to look forward to, friendships, attention, and a chance to feel needed and valuable, to be part of something.

When I hear my mom talk about the activities at LHRC, which go so far beyond daily bingo, a distinct philosophy emerges:

* Adapt any concept to the abilities of your residents.

* Connect with local resources and the community.

* Use humor and have fun.

* Plan bold and dramatic events.

* Use an element of mystery to create interest.

Nursing home residents' lives can be enhanced through social activities that are exciting, dramatic, fun, and participative. Activities help residents connect to each other, the staff, and the community, and help them to feel productive despite their limitations. When residents are happy, they are easier to care for, which means the staff and families benefit, as well.

Everyone wins with just a little extra effort.

Lynn Howe is retired, having worked 24 years in occupational health and health promotion. She and her husband tour the country in their motor home and enjoy spending time with friends and family, including her mother in Tennessee. To send your comments to the author and editors, e-mail [e-mail].