Special programs in nursing homes encompass a wide
    range of activities and services.

    Their purposes are:

    1.  To enable residents to react and interact with their

    2.  To help them fight back, to shape their destinies,
    to find new and satisfying social relationships; and

    3.  To be able to be self-directing and spontaneous.

    together. The programs should meet the needs of the
    residents as the resident defines them. In other words, the
    residents as the resident defines them. In other words, the
    programs are done with the residents, not for them.
    programs are done with the residents, not for them.

    The variety of programs available in any nursing home
    depends on the health and interests of the residents. The
    range of activities should meet the needs of all residents,
    from the disoriented to the wheelchair bound to the
    ambulatory. Possible programs to meet resident needs are
    described in this article as activities, religious services, and
    therapies. While the structure and delivery of programs
    varies from home to home, their availability is essential to
    the total nursing home community.


    A broad range of programs is directed by the activities
    coordinator. A home certified for Medicare and Medicaid
    must have someone designated as an activities coordinator.
    The planning and implementation of activities comes from
    requests by residents, families, staff, and volunteers. The
    activities are usually posted on a calendar of events that is
    available to each resident and also posted in large print
    where a wheelchair-bound resident can easily see it.
    Examples of a few such activities are:

    Monthly birthday parties to which all residents are invited.
    Families and friends may be invited to participate. Volunteers
    often help to bring residents to the party and join in the fun.

    Celebrations of various holidays, both secular and
    religious. Holidays are particularly difficult times for those
    away from their own homes, families, and friends.
    Valentine's Day, Halloween, Christmas, Hanukkah, Easter,
    and Memorial Day are a few examples.

    Musical events can be enjoyed actively or passively
    depending on the abilities of the residents. Many homes
    have sing-alongs in which the residents request their favorite
    songs and sing along with a leader. Again, the involvement
    of volunteers, families, and friends is crucial to the success
    of such a program. Sometimes concerts are given by a
    church or school group or friend of the nursing home.
    Hopefully, the public is invited to attend, for this allows the
    residents to provide a source of pleasure to their community.

    Games foster both one-to-one relationships and group
    activity. Bingo is a favorite for many, but bridge, chess, and
    other games for smaller groups usually are available.
    Volunteers and families often are the ones to stimulate
    resident interest in a game and they may be able to help
    arrange suitable opponents. Contests sometimes are run
    with work games, and tournaments are arranged for bridge
    or game players.

    Outdoor activities include gardening, cookouts, or just
    enjoying time in the sun alone or with a friend. Often the staff
    does not have the time to take the immobile residents
    outside. Family and volunteers are relied upon to make this

    Trips and tours to community events. Some homes have a
    special resident fund from the sale of arts and crafts made
    and sold by the residents to finance transportation rentals
    and ticket purchases. Friends or volunteers may donate to
    the fund or sometimes the nursing home sets aside money.
    Transportation can be a problem for those in wheelchairs,
    but the activities coordinator usually can find volunteer
    drivers who are taught to cope with the special needs of
    disabled people. Some communities have special vans that
    transport residents in wheelchairs. Trips outside the home
    offer variety and mental stimulation.

    Nursing home newsletter, especially if published by
    residents. This is an especially valuable method of
    expression and uses resident talent that otherwise may lie
    idle. Poetry, history, birthdays, and resident and staff
    personality profiles are all topics that can be included.

    Resident discussion groups. Sometimes a resident is an
    expert on a particular subject and will be the group leader.
    Other times a volunteer may offer to lead a discussion group.
    Topics may include current events, literature, and religion.
    The residents choose the topics and those interested attend.
    Exercise fun and physical fitness. Community leaders often
    volunteer to lead yoga or other exercise sessions. Even
    wheelchair-bound residents find satisfaction in
    exercising on a regular basis.

    Books. Volunteers may run a book service, taking a cart of
    books to the room of immobile residents. There may be a
    central library or small bookcases on each floor. Talking
    books for the blind may be part of the service. Families,
    friends, and volunteers can buy, bring, and hand out books.
    Many people help with reading to those unable to see well.

    Coffee or cocktail hours. Policies vary from home to home,
    but social hours provide a time of resident interaction. It is a
    particularly nice time for volunteers, family,
    and friends to join the residents.

    Arts and crafts programs separate from occupational
    therapy frequently are offered by the activities coordinator. A
    volunteer, resident, or family member may lead this program.

    Religious services. Every Medicare- and Medicaid-certified
    nursing home must, by federal regulation, provide the
    opportunity for residents to attend religious services of their
    preference. Many nursing homes welcome denominational
    groups to provide religious services in the home for those
    who wish to attend. Again, this often provides an opportunity
    for families and friends to join the resident in worship. The
    organization of such services is usually handled by the
    activities coordinator.


    Reality orientation therapy is a technique used to
    rehabilitate residents who suffer from moderate or severe
    disorientation. These people may no longer know who they
    are, where they are, or what hour, day, or year it is. The
    technique can be carried out by anyone who comes into
    contact with the resident. The nursing home offering such a
    program involves the entire staff, families, and friends in the
    process. One or two staff members in the home may be
    responsible for the program. This is a relearning process,
    individually and through short group sessions, of basic
    information such as name, place, age, and day. As these
    facts are learned more facts are added. It is the basis of
    more advanced re-motivation techniques designed to help
    the resident function better.

    Re-motivation therapy is under the direction of a trained re-
    motivation coordinator and carried out by her or someone
    she designates such as an RN, LPN, or nursing assistant. It
    is for those who are already oriented but who need to take a
    renewed interest in their surroundings by focusing their
    attention on simple, objective aspects of daily life.

    Regular meetings are important for successful re-motivation
    programs. The meeting site must promote a relaxed
    atmosphere and be devoid of other distractions. A topic of
    conversation is introduced by the leader; a short poem or a
    newspaper item is appropriate. Often, the residents are
    asked to read part of the poem or story. Next, the topic is
    developed through the use of a preplanned set of questions.
    Then the topic is related to each individual experience.
    Finally, the meeting is brought to a close and plans for the
    next meeting are made.

    Occupational therapy is a service provided by a qualified
    occupational therapist to evaluate, diagnose, and treat
    problems that interfere with everyday living skills.
    Impairments may be due to physical illness, injury,
    emotional disorders, or the aging process. Therapists and
    patients together work toward the goals of optimal levels of
    independent living, prevention of disability, and maintenance
    of health.

    Specific occupational therapy services include education and
    training to increase independence in activities of daily living
    such as dressing and eating; to improve eye-motor
    coordination, sensory integration, concentration and
    attention span, thought organization, and problem solving;
    and to correct impaired visual-spatial relationships.

    Additional services also seek to prevent muscle atrophy,
    prevent or minimize deformity, and increase pain tolerance.
    For instance, someone who has weakness in an arm due to
    a stroke may benefit from an activity such as sanding wood
    that strengthens muscles. Or the occupational therapist may
    make a splint for the hand and arm to prevent the muscles
    from stretching or contracting.

    Volunteer Services

    Volunteers provide an important link between the community
    and the nursing home resident. Many are involved in the
    activity program because they have special talents and skills
    to contribute. Many others assist residents who have
    disabilities, to participate in activities. Friendly volunteer
    visitors provide one-to-one relationships for residents.
    Regardless of their specific roles in the home, volunteers
    must be recruited, oriented, and supervised to be used
    effectively. A dedicated group of volunteers from the
    community is testimony to a concerned nursing home.

by Linda Lucas, AD

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