Laughter: It's Contagious. (Not-For-Profit Report).

The rumble of a cart in the hall doesn't always herald a med pass or lunch at the Hebrew Home of Greater Washington in Rockville, Maryland. Very often those rolling wheels announce to its more than 500 residents that Elfinya (affectionately known as "Elfie") has come to call. Decked out in technicolored overalls, tea bag earrings, a purple wig and oversized clown shoes, Elfie spreads infectious good humor throughout the Home.

Elfie in real life is Jacki Kwan, LCSWC, CLL (Certified Laugh Leader) and a therapeutic clown who spreads happiness through HA!HA!LOGY[R] a humor therapy program she developed that uses clowning and laughter clubs to uplift the spirits of residents and staff. "People need different things at different times to be in good humor," Kwan explains. "Sometimes it's laughter, and sometimes with people who have advanced stages of Alzheimer's or dementia, just sitting and breathing in sync with them provides what they need at that time to be in good humor."

HA!HA!LOGY is not just for residents. Kwan also makes time to play with staff. "I include them in Elfie's antics because they, too, benefit from a positive outlook. People in nursing homes require more care than in the past, and staff members' work is harder. If they are happier, that trickles down to the residents, too." Kwan has noticed that even stressed-out visitors get a boost from an encounter with Elfie because it temporarily puts their problems on the back burner.

Wanting to develop a prototype for HA!HA!LOGY, Kwan became acquainted with Leslie Gibson, a nurse with more than 10 years' experience doing humor programs. Gibson invited her to a meeting in Tampa Bay, where she met Dr. Madan Kataria, a family physician in India who created "Laughter Clubs" in 1995, and Steve Wilson and Karyn Buxman, the creators of World Laughter Tour, Inc. (WLT). Now a member of the WLT's Professional Advisory Committee, Kwan conducts workshops to train others in how to lead laughter clubs using this method of exercise, which actually borrows from yoga. Laughter therapy embraces the Eastern philosophy that all parts of the body are connected and that the body is treated as a whole. "This therapy does not cure," says Kwan, "but it can give a person that nanosecond of relief that can make a big difference."

The movie Patch Adams inspired Kwan to focus on humor in the healthcare setting. That's how Elfie was born. "I've always been a clown--in the plainclothes division," she jokes. "Therapeutic clowns have been around for a longtime. They allow spirits to connect. Although the brain and body might be compromised, a resident's spirit remains very much alive, and the connection is spiritual in nature, whether it's uproarious laughter or just sitting with someone and synchronizing my breathing with theirs."

HA!HA!LOGY is humor therapy. Kwan's definition of good humor is a positive state of mind. The spontaneous and just plain silly things that Elfie does are part of the fun. "I think prunes are a very funny food," Kwan explains, "so one time I arranged little plates of prunes (lemon essence flavor, of course) on doilies and garnished them with fancy cocktail toothpicks. In my best waiter imitation I delivered them to each nurses' station, along with a sign that read, 'Have a prune, it'll loosen you up.'" Continuing to pick on prunes, Elfie wears a "Have a prune, start a movement" button on her overalls.

To supplement her antics, HA!HA!LOGY uses a rolling humor cart called "Customer Elations," which is stocked with humorous books, tapes, magic tricks, puppets, stickers, musical flowers and other fun playthings. For instance, Kwan carries pieces of costumes with her because many of the residents like to dress up (even the men!). Ever vigilant of the need for cleanliness, Kwan makes sure that anything used on the cart is bagged in plastic and sanitized before reuse.

HA!HA!LOGY "S'moregasboards" are posted throughout the Hebrew Home for everyone--residents, staff and vistors--to enjoy. These bulletin boards pass along warmhearted stories, comics and jokes, and feature photographs of residents and staff enjoying themselves.

In laughter club sessions, Kwan tells residents that the body doesn't know the difference between thinking about doing something and actually doing it. Those with limited mobility are encouraged to visualize doing the exercises involved, and it works. One woman at the Hebrew Home has multiple sclerosis and can only move a part of one hand and her head. She is cognitively intact, but the rest of her body is powerless. By doing exercises with Kwan, she becomes distracted, and it helps her forget her pain for a while. As Kwan observes, "Laughter brings people into the present moment where there is no pain, fear or anger, only joy, hope and love."

Kwan has discovered that people with early to midstage Alzheimer's are very capable of participating in laughter clubs, although residents in the late stages of disease benefit more from a one-on-one approach. "In this situation, you must begin slowly with breathing," Kwan says. "You pace your breathing with theirs and copy their gestures. Some can't speak and they make unintelligible sounds, so I 'sing' with them. I've discovered that when I'm perfectly in rapport with them, they giggle, and I feel an indescribable joy to facilitate that response."

So enriched by the positive results she's seen and the feedback she's received, Kwan has written a soon-to-be published book, Almost Home: Embracing the Magical Connection Between Positive Humor and Spirituality, describing her spiritual journey and how she realized the importance of her gift of connecting with others through humor.

Humor therapy will receive another boost in recognition when HA!HA!LOGY in action is featured in an upcoming Discovery Health Journal segment filmed at the Hebrew Home of Greater Washington.