The activities challenge.

Residents - and all of long-term care - are changing. And so will the activities profession

Twenty years ago nursing home residents could remember a time when there wasn't electricity, when the horse and buggy was the mode of transportation and a man on the moon was still the "man in the moon." Now our residents fall more into the group just preceding the "baby boomers"; they're accustomed to and comfortable with the new technologies. Their memories and leisure skills are different from those of people who entered old age 20 years ago.

A simple bingo game that was offered for socialization just 10 years ago isn't quite enough now; many of our residents want to go to the nearest casino and play "high stakes" bingo. For them, going out to lunch, means spending the day at the movies and eating in a food court at the local mall. Shopping no longer needs to be done at the five-and-dime, but can also be done on the 24-hour Home Shopping Channel. Tatting - a highly intricate form of lacemaking - has now made room for residents who learned how to knit on a machine. Gentlemen living at the facility would rather watch "Monday Night Football" than get together, drink coffee and have the newspaper read to them.

Activities will become smaller; more emphasis will be placed on specific group programs that serve to educate rather than entertain. Individual activities, with two or three residents gathered in an area to learn a new craft or to learn all about Sony PlayStations, will be the norm. Residents will opt to e-mail their great-grandchildren from their rooms or to order holiday gifts via their televisions.

For those residents with a dementia-type diagnosis, small-group programs that pique their curiosity or evoke a memory could help alleviate their stress. Technology will play a big part in their leisure time, as well. Interactive "walls" (with hardware that can be manipulated, such as faucets and door locks that don't really work) and stress-reducing rooms (with bubble columns, fish tanks and aromatherapy) will serve to calm and reassure them. Craft projects, segmented into one or two easy steps, will build self-esteem. Music that interrupts the wandering process will be heard during shift changes, and residents will spend their days in an environment that is stimulating and relaxing at the same time.

Facilities with short-term rehabilitation and acute-care units will offer nontraditional activities in the early evening so that residents who are focused on going home will learn how to resume enjoyment of their hobbies in an adaptive environment. Because of the full day of rehabilitation, there will be a relatively short window of opportunity for the activities professional. Activities will be a virtual extension of occupational therapy, with patients engaged in microwave cooking or adapting to other hobbies or avocations. An evening on the Internet chatting with others will be the activity for most residents. No longer can we rely on traditional program. ming to interest and challenge our residents. Increasingly, residents in long-term care facilities are falling into two categories: the relatively high-functioning, demanding and vocal patients of short-term rehab centers, and the very ill and low-functioning residents of our Alzheimer's-oriented units. Activities will range from instruction in "country crafts," such as crocheting, soapmaking, candlemaking, weaving or woodcraft, to accommodating those for whom gluing two pieces of wood together would be an accomplishment. Programs will change on a monthly basis to better meet each individual's needs and leisure interests. More than ever, the activities professional will have to provide empowerment activities for the residents to enable them to become self-reliant. More time will be spent working on an individual or small group basis with those residents who require an especially supportive environment.

Meanwhile, activities professionals will move into different levels of care, including assisted living and - fastest growing of all - adult day care. In these settings, they will find themselves providing the more traditional types of "cooking and crafts" activities that were common among nursing home residents of 10 to 15 years ago. As the world changes, so do the residents or patients for whom activities professionals are responsible. And as long-term care changes, so does the work and the environment of the activities professional.

Kathy Hughes, ADC, COTA, is president of Activities Assistant, which provides activities-related consultation to activities professionals and facilities throughout the United States and Canada. For further information, phone [phone] or e-mail [e-mail].