Therapeutic Recreation In The Long Term Care Setting

Recreation Therapy is often under rated and overlooked in Nursing care in spite of the quality of life it can impart.

The old stereotype of nursing homes as cold warehouses and quiet "sanctuaries" where the elderly go to wait for pills, the next meal, and the end of life, is thankfully changing. In its place resides a "kinder, gentler" facility known best now as a "Long Term Care Facility". People are being offered various options, such as independent living on the grounds of a large campus which includes medical services and nursing care if and when needed, rehabilitation services from trained physical therapists and occupational therapies to enhance independence, and a greater variety of customer service driven options.

One of the newer bonuses of Long Term Care living is the Therapeutic Recreation Specialist, also known as "recreation therapist" or "Activities professional". He or she is responsible for providing a wide spectrum of leisure activities, almost like the cruise director of an ocean liner. Whenever anyone who has encountered a nursing facility employing such recreation programming thinks of these services, surely one word comes to mind: BINGO. This is, admittedly, a very popular activity with many persons, but is by far the least of what a therapeutic recreation professional (Hereafter referred to as "T.R."), deals with.

Take the hypothetical case of Mrs. Smith. All of her life she has volunteered for her church by crocheting afghans for the annual Christmas bazaar. It is early October, the time she would usually have begun to crochet. She has had a stroke, can no longer hold a needle, and is increasingly depressed over her loss of ability to do an activity that used to give her life meaning. A T.R. professional might give her a skein of yarn to ball, look over afghan patterns together and compare the features of each, or sort the granny squares crocheted by other residents into color schemes for later piecing together. This could be a one to one activity between T.R. and the resident, or be an impetus for forming a yarn balling social in the lounge where many residents reminisce about how they used to make hats and scarves for their children, etc. Mr. Jones is another such case. All of his life, he went to the racetrack every Friday and bet on the horses. He has done it so long that he now knows the horses personally, which of his past favorites sired including which horse. He may no longer be able to get out regularly to place these bets, but he regains a great sense of identity and dignity by being handed a racing sheet and spending time with a T.R. person who takes the time to ask "Just how does one make a bet", or "If I put a $2.00 bet down on this horse and she wins, how much will I win".

In the case of programming for specialty units, such as structured care for those suffering from strokes, Alzheimer's Disease, or other such dementia, the expertise of T.R. becomes even more key. By finding active exercises for the residents which target specific areas of interest or occupation, we have found that people may actually be able to slow the losses of mental functioning by re-associating old skills with parts of the brain not yet affected by the disease process. Take the case of "Mrs. Brown", who suffers with speech difficulties. Since singing and speaking can come from different parts of the brain, she may still remember all of the old songs she used to sing and be perfectly able to communicate her emotions with these in ways that her faltering speech cannot. T.R. can come in and lead a group sing a long, and if it seems that Mrs. Brown has specific favorite songs, those can be used to communicate emotions. If she is in a good mood, she may be encouraged to sing a happy song. If she is missing someone, she may be able to communicate this through the singing of an old Blues tune. T.R. may even encourage Mrs. Brown to sing her sentences instead of speaking them, encouraging her to write her own songs to speak.

Weekly trivia contests with token prizes are another seemingly "trivial" way in which T.R. can keep self esteem alive and engender self confidence. Questions about the past, such as events from the residents' lives or customs no longer popular can bring back a flood of memories, and winners can walk away feeling like they really DO still have things in which they can succeed.

In our lives, our leisure activities are just as much a part of our identity as any other pursuit, such as occupation or family affiliation. Therapeutic Recreation can enhance the lives of the aging by enabling persons to keep as active as possible and encourage them to continue to use whatever they still retain rather than focusing on losses. It is truly an under-rated part of the Long Term Care Facility's offerings.

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