All is well(ness); it's more than fitness centers.

Imagine receiving this resident letter:

"Within eight months of moving (here), my husband of 57 years died. I was devastated. A friend got me to come to the 8:15 a.m. water exercise class ... I've never stopped for 4 1/2 years since. It gave me a reason to get up and get with it. It made me feel physically good, and I passed beyond what would have been depression and sorrow ... I made new friends; I have support all around me. Thank you for the wonderful result that I experienced from this program."

These words of praise--from a resident at Freedom Village, a continuing care retirement community (CCRC)in Bradenton, Fla.--were extremely flattering and demonstrated first-hand that the physical element of the facility's wellness program really works, according to Lothar Sachse, former director of wellness and community relations at Freedom Village and current regional director of Palm Beach Gardens, Fla.-based Masterpiece Living.

But this resident's new-found social climate also helped her overcome depression, according to Sachse. This demonstrates that a wellness program must go beyond meeting only one kind of need. "Any program you have must be all-inclusive," he said.

There's a difference between having a wellness center and a wellness program, experts noted. As its name implies, a long term care wellness program should ensure a resident's well-being. But for many facilities, "wellness" only means a weight center or other place that promotes good physical health, according to Perry Edelman, director of outcomes research at Mather LifeWays Institute on Aging in Evanston, III. "There's certainly the physical element--the exercise aspect, the fitness aspect--but a really good wellness center will operate other dimensions." Edelman said.

According to The Wellness Solution, by Jan Montague, Gary Eippert, Wiley Piazza, Kim Peters and Tony Poggiali at Montague, Eippert and Associates (MEA), a Highland Heights, Ky.-based developer of wellness programs for elder care facilities, there are six different dimensions a facility should include when developing a "whole-person" wellness program: physical, emotional, social, spiritual, intellectual and vocational.

"These concepts are the hallmarks of wellness and aging successfully," the authors stated. "The whole-person wellness model recognizes this fact by requiring a four-way collaborative effort among the older adult and his or her families, community and health care providers."

Let's get physical

Long term care facilities 'operators generally agree that when it comes to wellness, the physical dimension is the one nearly all caregivers try to implement. According to Montague, this dimension promotes participation in activities for cardiovascular endurance, muscular strengthening and flexibility. Typical examples are fitness classes, nutrition and weight control, health screenings and disease prevention, and enjoyment of movement.

The Selfhelp Home, a CCRC in Chicago, takes a "use it or lose it" approach in its wellness program, according to administrator Hedy Ciocci. The facility offers various exercise classes and a weight training program focusing on increasing strength and muscle tone. It recently began a walking club and "sittercise" program to encourage exercise for residents with different mobility levels. "Most of our residents have been active all their lives and intend to stay that way," Ciocci said. "They know the importance of keeping themselves involved, interested and purposeful for an entire life."

And that life is a long one, according to Ciocci. More than half of the facility's independent living residents are age 90 to 99--an age typically found in nursing homes--and several of the skilled nursing residents top age 100. "When I first came here, I wondered if it was something in the water," Ciocci said. "These people just continue to happily go on and on."

Whereas the physical dimension handles the outer self, a wellness program that takes an emotional tact goes after inner happiness. "It reflects the degree to which individuals feel positive and enthusiastic about themselves and life," according to MEA's report. "This dimension involves the capacity to manage feelings and behaviors, accept oneself unconditionally, assess (and) develop limitations, develop autonomy and cope with stress."

Emotional wellness aspects also include the ability to problem-solve, manage success and failure, show gratitude and know, feel and realize consequences, according to MEA.

Officials at Beth Abraham Health Services in Bronx, N.Y., helped their residents handle emotional highs and lows by building a recording studio at their nursing home. Coordinated by the company's Institute for Music and Neurologic Function (IMNF) and powered by an equipment donation from recording artist Moby, the studio launched in April 2004 and now enables more than 40 residents each week to make their own music and record their own CDs, according to Concetta Tomaino, Beth Abraham's vice president of music therapy and IMNF director.

The studio offers an outlet where residents can express feelings about being sick, losing body functions or simply being hospitalized. "Many times, people can't talk about those things, because it's too depressing, upsetting or they're too frustrated," Tomaino said. "So we get them to try to write in the context of songwriting what they feel, how they feel and what images come to mind when they think about their life today. Out of that comes some really incredible music--insightful, philosophical and enlightening."

Social tendencies

At four locations in Chicagoland, residents of neighboring senior living communities--and anyone else who is interested--can socialize in what some have dubbed Starbucks for seniors. The four cafe restaurants blend catchy menus, programs and ambience--including computer classes, art instruction, fitness classes, financial planning and various community resources for the age 50-plus market, according to Carla Windhorst, vice president of community initiatives for Mather LifeWays in Evanston, III.

"Everybody loves to eat--it's a very social thing to do," Windhorst said. "Most of our customers come from within a two-mile radius. As they come in to eat, you introduce them to other things. They start doing more--using services, playing the computer and exercising."

Sometimes customers help develop the programming offered, Windhorst added. "We've had people come in who know some skill they are willing to teach, such as knitting or playing the piano," she said. "We end up organizing a class for them to teach."

Each cafe serves about 3,000 people per year, with 70 to 80 percent visiting four times or more, Windhorst said. Some of the customers call it the neighborhood hangout, she said. That fits in with the mission of the well being.

Getting in the spirit

As people get older, they often find themselves thinking more about the "higher power" and what it means to them. "The spiritual dimension involves seeking meaning and purpose in human existence," according to the MEA report." It involves developing a strong sense of value and ethics, (and)includes development of an appreciation for the depth and expanse of life and natural forces that exist in the universe."

Long term care facilities try to accommodate this need in various ways. For example, it's common for a facility to have an on-campus chapel or have a local clergyman deliver a weekly service. Certain classes and programs can also help residents develop a sense of inner peace, said Vickie Firch, director of resident services at Eskaton Village in Carmichael, Calif.

Eskaton Village's efforts include St. Ignatius Day, an intergenerational spiritual awareness program in which two to three dozen junior high-age students from a local private school meet with residents once a month to sing spiritual songs, tell stories, meditate or pray, Firch said. "This is the children's way of relaying their spiritual faith into the Village and creating a social spiritual program," she said.

Spirituality also encompasses a time when residents contemplate death and dying, Firch said. That's why the facility also tries to integrate touch, massage and music into its hospice efforts. "One of the mistakes we make as a society is equating wellness with perfect health," Firch said. "We see wellness as being present in the dying resident, the terminally ill, or in the person with an inoperable condition. Because wellness isn't about good health. Wellness is a sense of well-being."

Use your intellect

Often overlooked, the intellectual dimension involves one's ability to think creatively and rationally, and "encourages individuals to expand their knowledge and skill base through a variety of resources and cultural activities," according to MEA.

Such activities can include anything that helps a person learn a new skill, stimulate creative thinking or encourage desire to explore new areas, according to Montague. But the intellectual dimension also applies to projects that help a person pay attention, recognize or recall objects, follow directions or judge, match and strategize actions, the MEA report noted.

One of Freedom Village's programs is its six-week, one-day-per-week neurobics class, where participants learn how their brains work and how attitudes and nutrition affect memory, according to Sachse. The class covers memory aids residents use to improve their cognitive skills. "We're also working on the myth that just because you're getting older does not mean you're getting more forgetful, because we all forget things at any age," Sachse said. "We just don't pay enough attention to it when we're younger other than saying, 'Oh, I think I have a senior moment coming on.'"

Computer classes are also popular, Sachse added. What started as a small lab with 12 computer stations has turned into a group meeting involving 50 to 60 residents, he said. "Once exposed to a computer--and the Internet--they realize it doesn't bite and it's not that difficult," Sachse said. "They also realize it's a great opportunity to have quicker and easier contact with family."

The vocational dimension also gets less attention during development of a wellness program, experts noted. In this case, long term caregivers typically encourage goal-setting for each resident's personal achievement and development, according to Montague.

Walter, Florence and Horace didn't quite know what they wanted to do as retirees and residents of Beth Abraham Health Services. Then it hit them that they've always wanted to be musicians. So, they became "The Rejuvenators," a name chosen to reflect their belief in regaining strength by pursuing musical goals. They're a hit, according to Tomaino.

"When you talk about wellness, people are sometimes limited in what they think they can do in their life until a door is opened," Tomaino said. "And then the opportunities appear that open up all these windows of possibilities. People just need to be introduced to them."