Leisure Activity Assessment in Residential Care: Improving Occupational Outcomes for Residents
Dorrestein, Marlies, New Zealand Journal of Occupational Therapy
New Zealand government policies such as the Positive Ageing Strategy require residential care facilities to increase leisure activity options for people in residential care. To do this effectively activities staff need a specifically designed format to help shape resident based leisure activity plans. This article proposes the introduction of a leisure activities assessment and provides guidelines to enable activities staff to gather information that is relevant, reliable and consistent. A resident centred approach to theory focuses on staff learning.
Older people, occupational outcomes, assessment, leisure activities, residential care
The primary purpose of this article is to propose a leisure activity assessment process designed to increase occupational outcomes for residents in residential care facilities. The article is based on the author's clinical experience as a consultant to New Zealand service providers. This experience provides a backdrop for this article. The service areas referred to include rest home, private hospital, stage 2 and 3 specialised dementia unit, and psycho-geriatric unit facilities and levels of care, predominantly with older people.
The article aims to highlight the critical importance of targeted and specific data gathering by activities staff in assessing residents' observable abilities, skills and interests in relation to individually meaningful activities. In addition a rationale will be presented for the use of carefully chosen language which will help activities staff to gather relevant, reliable and consistent data. A sample activities assessment form is included (Table 2) along with guidelines (Table 3).
The Canadian Model of Occupational Performance (CMOP) (Townsend et al., 1997) has been used to construct a format. This model is applied to the organisational process to support occupational therapy intervention and to facilitate improved occupational outcomes for both activities staff and residents.
The literature demonstrates that meaningful occupation enhances quality of life for older people (Green & Cooper, 2000; Jackson, 1996; O'Sullivan, 2004; Wenborn, 2005; Yerxa, 1998). Yet research from England and Australia provides evidence that older people in residential care facilities have limited opportunity to engage in meaningful activities. For instance, Mozley's (2001) research found "51% of resident-observations were of residents who were inactive" (p. 16) while French (2002) described "occupational disfranchisement" in an Australian nursing home. She claimed it was "not a safe place for residents and occupational needs of both residents and staff were being dangerously challenged" (p. 36), despite the home being regarded as "occupationally enriched" (p. 28). Wenborn (2005) portrayed the level of activity within care homes as remaining "unacceptably high" (p. 337) and Perrin's (1997) study described a "picture of marked occupational poverty" in residential care for people with dementia. This is consistent with Hancock, cited in Wenborn (2005), who found that daytime activities were an unmet need for 76% of residents with dementia in care homes. In addition, Hancock et al (2006, p. 47) described "unmet needs for stimulating daytime activities or company." A possible explanation for these claims can be found in the paper by Hocking and O'Sullivan (2005), asserting that "many of the activities that make up people's daily routines and give life meaning are not available in institutional environments". Hocking and O'Sullivan identified several barriers to health and well being for people in residential care i.e. staff 's expectation of resident passivity and frailty, economic factors (funding and wages), and limited staff training.
The New Zealand context of residential care. settings
The New Zealand Positive Aging Strategy published by the Ministry of Social Policy (2001) documents the government's commitment to "provide a framework that guides the development of services that contribute to positive ageing" (p. …