At our recent Activities Strong Virtual Winter Gathering, Liza Behrens, PhD, RN, an assistant professor at Penn State University, examined “surplus safety” in eldercare, in which the goal is to reduce risks at all costs. 

“This is a byproduct of regulations and institutional practice designed to eliminate all risks, including the risk of positive and meaningful experiences that make life worth living,” Behrens said. 

To protect residents’ rights to enjoy a person-directed quality of life, Behrens asserted the need for a “just” culture of safety — one that identifies and addresses behaviors that create the potential for adverse events, calls for appropriate accountability that supports disciplinary actions against individuals or organizations who engage in reckless behavior, and avoids punishing individuals for adverse events over which they have no control. 

“We need a just culture where we can do our best to honor residents and their right to make choices,” she noted, adding, “Each of us can help this change. We can’t eliminate all risk in the name of patient safety, but we can’t allow surplus safety to continue.” 

It is important to talk about the dignity of risk-taking. “No matter what we do, we impact residents’ dignity,” Behrens said. “Dignity of risk in eldercare refers to empowering an individual’s ability to make choices and remain autonomous in decision-making, which may give rise to risk taking that subsequently enhances personal growth and quality of life.”

“If we can help people engage in risk-taking, we can improve their quality of life and wellbeing,” Behrens continued.

“If we want to create meaningful moments for our residents, we need to work backwards and start with individual preferences,” said Betsy Kemeny, PhD, CTRS, FDRT, associate professor at Slippery Rock University and president of the National Academy of Recreational Therapy. 

“Part of this involves moving away from pre-designed programs and fitting the residents into it and evolving to a live calendar that incorporates individual preferences,” with an emphasis on smaller groups with common needs such as affiliate groups or clubs that provide continuity and purpose.

Kemeny added: “We want to get away from preplanned calendars and really think out of the box. To do that, we need to go beyond Section F of the MDS [Preferences for Customary Routine and Activities].” 

In other words, we need to know our residents holistically and beyond just their medical and daily care needs.

A truly person-centered model of care that improves wellbeing must be built on a deep understanding of who the person is and what their current needs and preferences are. This is key to enabling dignity of risk and empowering residents with the ability to make choices and remain as autonomous as possible. 

When we truly get to know residents in a holistic way, we can gain an understanding of how they view risk and what risks they are willing to take to enjoy the quality of life they have defined for themselves. 

As Kemeny said, “We need to be aware of risks but not limit residents from living their own lives and do things like using typical tools like bread knives or scissors.” She added, “Don’t limit access to outcomes because of your own biases related to a resident’s age and ability to engage and risk taking.”

When we have residents’ life stories and get to know them holistically, it is easier to set expectations around the dignity of risk taking. We can all start today by being champions advocating for a stand operating procedure for decision-making related to health and safety risks for residents, especially for those who are living with dementia. 

Learn more about surplus safety, dignity of risk, and getting to know residents by watching the webinar here.

Charles de Vilmorin is the CEO and co-founder of Linked Senior, creators of the Life Story product.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

The answer is, of course, everything. Assuring the delivery of purposeful, meaningful and engaging activities is vital to person-directed living, and activity professionals are essential to this aim. 

Among the many people who bring life to long-term care, activity professionals are the ones who foster environments that honor unique daily rhythms and routines of elders, and celebrate their purpose. 

The Center for Innovation (CFI) has made it a priority to promote the advancement of person-directed living for elders. As such, we recognize that activity professionals deserve the resources, training and tools to support their important role.

CFI and its two organizations, The Green House Project and Pioneer Network, are known for ensuring the advancement of person-directed, relationship-rich living among all aging services settings. In Green House homes and other settings committed to non-institutional models of care, contextualizing and normalizing activities as part of everyday life is key to operations. 

Elders deserve rich and purposeful lives no matter where they reside. However, putting this into action is challenging in a world of competing demands, clinical complexities and stretched workforce. Sadly, much of the natural daily rhythms are disrupted inside of traditional long-term and post-acute care settings, due to risk-averse rules and procedures. 

Risk isn’t something eldercare organizations are comfortable with. As a result, residents — particularly individuals with Alzheimer’s disease or other dementias — often are discouraged or even prevented from doing things they enjoy and living their lives the way they want. Positive risk-taking improves autonomy, social interactions, and elements of both physical and mental health. 

We believe there is a way to balance dignified risk-taking and safety for older adults — and activity professionals are essential to this.

While challenges are real, opportunities for engagement are ample. For example, CFI prioritizes and advances the normalization of pets as part of the fabric of everyday life in all eldercare settings. Dogs, cats and other animals bring joy to many of us throughout our lives, and they should not be prohibited simply because we have moved into a nursing home or assisted living community. 

Intergenerational relationships enrich our lives as well. Enjoying the laughter of children and the cooing of babies shouldn’t suddenly stop because someone has been placed in a new home that, ostensibly, is designed to help them live their lives to the fullest.

An important component to shifting away from risk aversion and into an environment where dignity of risk is recognized is education and training opportunities that are not one-and-done efforts. One underlying theme throughout the Green House model is knowing the elder, and that this is valued above what they have lost or what diagnoses they may have. 

By engaging in deep knowing of the residents, the Green House model empowers all staff, activity professionals in particular, to focus on meaningful engagement. Taking proactive roles in addressing loneliness, boredom and helplessness is the norm in such settings.

There is no quick fix to overcome the barriers to ensuring person-directed living for all elders. But if we continue to prioritize education and training, as well as empowerment opportunities, we can make progress. And when we empower and enable activity professionals to lead the way in meaningful and purposeful programming, we can give all our elders the lives they want as well as the care they need. 

Toward this end, Linked Senior is excited to have the CFI team present our next Activities Strong Virtual Winter Gathering on Dec. 5, from 12 p.m. to 4:00 p.m. ET as they address the importance of activities and its relationship to person-directed living. More details and registration can be found here.

Susan Ryan is the CEO of the Center for Innovation.

Charles de Vilmorin is the CEO and co-founder of Linked Senior.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

“When I first entered the world of dementia in 2013, I quickly realized that ‘what is to be is up to me’ so with the support of friends and community, my diagnosis has not been an ending but a new beginning,” shares Nelson, a co-founder of dangle & dot who has published three books of poetry since being diagnosed. “My life is full of ah-ha moments filled with sprinkles of fun, some laughter and joy amongst serious day-to-day learning about myself and dementia. I urge everyone to join us in taking it to the streets so that everyone affected by dementia can live better, longer and with purpose.”

Nancy is one of 55 million people living with dementia worldwide, a figure the World Health Organization expects to triple by 2025 — and this doesn’t include family, friends and others impacted. And yet, Alzheimer’s disease and other dementias continue to be dominated by a stigma- and shame-filled “tragedy narrative” that has led to this very human condition being surrounded by an isolating “cone of silence.”

As we have learned from those who helped bring AIDS, autism, disability, cancer and into the public space, if this is to change, we need to win the hearts and minds of people across the world so that together we can shatter the silence. That’s why we brought “Taking It to the Streets” into every possible community, including long-term care communities, where a number of our members and supporters live and/or work. 

We did this with creativity and through the arts, play and more because, as the work of our members and so many others powerfully demonstrate, this is how we restore humanity to people impacted by dementia and ensure that diagnosis is a starting point for joy, connection, growth, and new possibilities.

Reimagining Dementia is an international group of people living with dementia, carers/care partners, family and community members, dementia activists and allies, health professionals, advocates, artists, academics, policymakers, and others, who share a vision of care that promotes inclusion, relationships, creativity, joy, and the possibility of growth for everyone. Founded in 2020, the Coalition has over 815 members in 33 countries.

With “Taking It to the Streets,” the Coalition asked members, partner organizations and anyone who wanted to help transform the “tragedy narrative” of dementia to host public-facing events, activities and conversations that present a creative alternative to the fear, stigma and hopelessness surrounding dementia, and then had them share their celebrations and stories on social media using hashtags #reimaginingdementia, #takingittothestreets, #shatteringthesilence.

Another fan of the campaign is Wally Cox, who was diagnosed with dementia at age 62 and actively advocates for others living with the condition. According to Cox, who began painting following his diagnosis, “With a condition like dementia, knowledge about the disease process is not enough. Both the care partner and the person with the condition need connection and community to sustain them. Reimagining Dementia offers just such a thriving, inclusive and safe community. I’ve learned that at some point, you must step off the merry-go-round of dementia and its focus on all that you can’t do anymore. The Coalition helps you rediscover your ‘Can do!’ There’s so much life left and it’s precious, and that’s we all have to be part of taking it to the streets!”

Linked Senior supports the work of Reimagining Dementia and its efforts to ensure inclusion of individuals living with dementia. The adage of “nothing about us without us,” is more appropriate than ever within this context. We should always remember that our society needs to focus on the person and their care partner, and not simply the diagnosis. A diagnosis never removes the person.

For more information — and to access campaign materials — visit the campaign website here or contact the Coalition at reimaginingdementia@gmail.com. 

Mary Fridley is on the faculty at the East Side Institute in NYC, co-creator and leader of The Joy of Dementia (You Gotta Be Kidding!) and leads Reimaging Dementia: A Creative Coalition for Justice. Mary practiced social therapy for 12 years and uses the social therapeutic approach as an experienced teacher and workshop leader. 

Charles de Vilmorin is the CEO and co-founder of Linked Senior.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

In the case of memory care, this translates into creating what we call “resident-driven” communities. In such a model, residents retain control of their day-to-day existence. For example, residents choose where they would like to go for outings, how to greet new residents and integrate them into their community, what they would like for entertainment, what social causes to support, what rituals to perform when a resident passes away, what activities they prefer and on what schedule, etc. Residents help prepare meals, clean up after meals, take care of their environments, lead activities for other residents, and care for each other.

This is done through adopting a rehabilitation model of care, rather than a medical model. In a rehabilitation model, the capabilities of the person are emphasized rather than deficits. It is assumed that persons with dementia are normal individuals with some cognitive disabilities. As a result, they are not considered to be “mentally ill patients” who must be “treated” through medical intervention for their “disease.” 

Instead, the role of care partners becomes one of fostering as much independence as possible, through creating physical and social environments to enable persons to circumvent their deficits as well as to regain capacities lost due to exposure to toxic social environments (which produce excess deficit.) The capacity of persons with dementia to learn, and the techniques which enable new learning to take place in these persons, is a distinguishing feature of this model.

The Montessori Inspired Lifestyle requires a shift in the fundamental assumptions about the role of care partners and the roles residents will have within their communities. Owners, executives, managers, line staff, families and residents themselves must undergo a change in perspective. Rather than a hospital or hotel model, the Montessori Inspired Lifestyle approach is based on a model of a home. 

What do persons with dementia want? The key word in that sentence is “persons.” Most persons with dementia want what persons without dementia want – to live in a home surrounded by their things, to have a reason to get out of bed and to look forward to the day, to know their neighbors and to be called by name by them, to be part of a community that is connected to the outside world, and to have meaningful roles that enable them to feel fulfilled and to be of service to others.

It is easy to create dependence, and to do so out of love. This is seen in a parent that does everything for their child. However, this does not necessarily provide a good life for the child or the parent. The same is true for all persons. No one wants to live in a hospital. People generally do not live in a hotel. You stay in a hotel until it is time to go home.

 The memory care resident staying in a beautiful building who stands at the door of the residence and says “I want to go home” is expressing the same feeling that we get when we reach the end of a vacation. The best intervention for this situation is to make the place where that resident is living feel like a home. 

In a Montessori Inspired Lifestyle® community, staff members are invited to take our Montessori Pledge. The first line of the pledge states “I will work to create a place where I would want to live.” We believe that this must become the industry standard for memory care neighborhoods. This is our mission.

Cameron J. Camp, PhD, is the Director of Research & Development at the Center for Applied Research in Dementia. With over three decades of dedication to the applied and translational research of gerontology, dementia intervention, and cognitive intervention, he has earned international renown for his work to improve the quality of life for persons with dementia and memory disorders.

Charles de Vilmorin is the CEO and co-founder of Linked Senior.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

In fact, in 2023, total engagement and contacts seem poised to continue improving. Even if you have already successfully implemented a person-centered environment for your community, you can benefit from the data we are releasing in our 2023 Resident Engagement Benchmarks report. 

The first part of this report lays out the current state of resident engagement and the importance of measuring data about engagement so that we can manage it. For instance, data in the report indicates that in 2022, residents received, on average, 26 minutes of engagement per day. In the first half of 2023, however, there is a 23% increase to 32 minutes of engagement per day. Although still not at the recommended goal of 35 minutes per day per resident, it does show a 23% increase which is a promising trend.

The next part of this groundbreaking report indicates that there has been a 43% increase in the average number of engagement contacts per resident per day from January to May of 2023. The average from our 2022 data showed just 0.65 contacts, compared to 0.93 in 2023, a 43% increase. This means that despite staffing challenges, our communities are finding ways to work in an interdisciplinary way that is, in turn, increasing meaningful engagement opportunities for residents. 

Finally, our report shows that there has been a 100% increase in decline ratio for 2023. The average ratio was 15% in 2022, and in 2023, that average was 30%. This is an important piece of data. It means that coming out of the pandemic, residents now have an ever-increasing number of activities to choose from which gives them the opportunity to decline engagement more frequently based on their needs and preferences. During the height of the pandemic, our data showed that the average decline ratio was quite low, as residents said yes to any opportunity for engagement when such activities were limited due to safety precautions and lockdowns. 

Other findings of the report highlight the challenges resident engagement still faces, including a lack of support from other departments, a lack of communication and support from their managing supervisors and insufficient access to and use of tools and technology.

While our data shows encouraging trends, there remains a lot of work to be done to improve meaningful resident engagement for older adults in our communities. An important step in the right direction would include understanding the demographics of our activity and life enrichment professionals. Linked Senior surveyed our #ActivitiesStrong audience and found out more about the characteristics of those who lead our activity departments. Two particularly interesting aspects are that 91% of our audience is female, and 42% have more than 15 years of experience in their role as activity professionals.

When we better understand the characteristics of activity and life enrichment professionals, we will be better able to support them in providing meaningful engagement to residents. We also need to fund the activity and life enrichment department because its success has a direct impact on the health and well-being of our residents which in turn impacts occupancy, family satisfaction and the organization’s bottom line. 

Charles de Vilmorin is the CEO and co-founder of Linked Senior.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

Today, the activity director job description starts like this:

“The Activity Director plans, implements and evaluates activities for residents. Designs programs to encourage socialization, provide entertainment, relaxation and fulfillment, and improve daily living skills to ensure the highest level of wellbeing for all residents.”

Most activity and life enrichment professionals do not have the tools and resources they need to achieve the objectives of the job outlined above. They often face staffing ratios of 1:90 with little budget, few tools or supportive technologies and often no clear line of communication with their executive director or other department heads.

This disconnect between what is promised to the resident and the expectations set for the activities department and what is actually implemented leads to staff burnout, poor resident satisfaction and quality of life and lower occupancy.

With this in mind, it isn’t hard to see why artificial intelligence could become a great accelerator in activities and life enrichment by enabling staff augmentation, streamlining decision making and creating technology enhancement improvements that allow staff to use the social prescription model. 

There are four pillars of activity and life enrichment programming that will be positively disrupted by artificial intelligence in the following ways: 

1. Assessment

When conducting the intake process for residents in senior living, the quality of the data input into the system is essential for team members to know how to best engage with every older adult. Artificial intelligence can improve this process by helping communities to better gather, understand and classify information about any resident.

2. Production

Artificial intelligence that is used in tools like ChatGPT can be a game changer in terms of staff efficiency because it makes it so easy to create, gather and modify data. It could allow any team member to engage any resident at any time, which fosters a true interdisciplinary approach. 

Consider at least two levels at which this technology could be used:

Level one: Engagement for one resident

Jeff was born in 1951, and he likes hockey and French music. Artificial intelligence can produce unlimited programs for meaningfully engaging Jeff that include text, images, songs and videos. These programs can then be deployed by any team member.

Level two: Engagement for the community

Using data from all of the residents in the community, artificial intelligence can improve programming by understanding the social clusters of residents (those who are all French or those who are piano lovers…) and then suggest programs to engage these groups. 

It can also suggest programs that take into account physical/cognitive abilities, such as residents who are hard of hearing, have different cognitive abilities or even those with changing preferences.

3. Delivery

Once an activity program is produced for a resident, there are then two obstacles that staff may face in having an impact on residents: dissemination and attention. 

Artificial intelligence-powered technology can empower any team member to communicate and deliver the right program at the right time for the right resident, which supports dissemination.

The bottleneck is then about how to capture the attention of the residents. This is overcome with the support of this new technology because it can suggest programming that fits the cognitive and physical needs of each resident as well as match activities to their unique preferences. 

4. Feedback

Activity and life enrichment professionals need feedback from residents on how they can improve programming. Artificial intelligence can streamline this process by making it easier for residents to offer their thoughts on how activities can be improved to best meet their needs. 

Any Certified Therapeutic Recreation Specialist (CTRS) or educated Activity Professional certified through the National Certification Council for Activity Professionals (NCCAP) will recognize the evidence-based process called Assess, Plan, Implement and Evaluate (APIE) detailed above. 

Solutions like artificial intelligence that can optimize this process will improve team efficiencies, resident satisfaction and quality of life as well as the provider’s occupancy.

Learn more about the future of resident engagement at Linked Senior’s annual #ActivitiesStrong Virtual Summit happening on Tuesday, June 27th.

Charles de Vilmorin is the CEO and co-founder of Linked Senior.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

Are you meaningfully engaging every resident in your community?  Too often the answer is I don’t know. 

Most long-term care and senior living providers believe their activities program addresses the needs and preferences of each of their residents every day, but they have no data or systems to back that up. Likely there are more than a handful of residents in communities who are hidden from us, just waiting to be meaningfully engaged. That must be our priority.

The evidence based assess, plan, implement and evaluate (APIE) model shows the important steps of engagement: assessing the needs of the resident, planning engagement based on those needs, implementing the plan in real-time and then evaluating their successes based on the changing needs and preferences of the resident. This can all be done more easily with the help of technology.

It’s time to consider a simple resident engagement framework with technology support! 

There are three key resident engagement questions that providers need to be asking themselves:

• Are we engaging everyone? 
• Starting with choice and preferences? 
• Enabling wellbeing and outcomes?

To answer these questions, providers need to give staff members the right tools so they can focus on meaningfully engaging residents. According to a Linked Senior survey in August 2022, when asked if they have enough tools and staff to engage all their residents with purpose, 34% of the 299 activity professional respondents said no. 

Another obstacle is that a lot of the APIE work that an activity professional does is still paper based. Paper-based documentation can prevent our teams from having the time, data, and insights they need to get to know residents and engage them in a meaningful way. A Linked Senior survey of activity professionals at the end of 2022 found that of the 161 respondents, 20% were not tracking activities attendance and 35% were tracking using only paper. 

But by tracking attendance and engagement electronically, in real-time, life enrichment professionals can see how much time is being spent on one-on-one engagement compared to group engagement, how often residents are being engaged and residents’ satisfaction with their engagement. Staff can also more easily collect information about their residents, especially those who may have been hidden, and put it to use, so they can spend more time engaging with them rather than organizing, planning, and documenting. 

As you examine your current resident engagement strategy, try using this framework to help set up your teams for succeed as you improve your approach:

1. A program is better than no program/engagement
2. Programming based on each resident’s preference is ideal
3. Therapeutic engagement is best

This framework is simple, but the order of the steps matters a lot! Many times, activity professionals will focus on step 2 and 3 without first making sure to locate and meaningfully engage hidden residents in their community who are at the most risk for loneliness, boredom and helplessness. 

Learn more about how to create and implement your own framework here.

Charles de Vilmorin is the CEO and co-founder of Linked Senior.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

These eight words should help anchor and inspire the long-term care and senior living industry’s collective work to change, renew and elevate the ways in which we serve this unique segment of our customer base. Dementia care communities often borrow operational practices from their counterparts in assisted living or even independent living.  In areas of resident care plans, food operations and resident activities — to name a few — most of our industry’s memory care communities are just assisted living plus (AL+).

Resident activities in assisted living and independent living largely follow social models and are typically represented by the activity calendar. Even programs and philosophies around dimensions of wellness (ex: physical, social, emotional, etc.) are still simply line-item variations within an overall framework of a calendar.

Consider what a calendar does for most people. It is a means to organize, plan and make decisions about your day, week and month ahead.  What are some of the most common symptoms for a person living with dementia (PLWD)? They typically lose the ability to organize, plan, and make decisions. A foundational belief about person-centered care is to assist the person in their own decision-making — not to make decisions for them. The traditional activity calendar, then, serves as a direct contrast to person-centered care without proper and intentional modifications. 

Bella Groves’ approach to resident programs and activities is foundationally about experimentation and learning how to infuse person-centered or person-directed support where care and activities are a blended priority. Whereas many dementia care communities prioritize care plans and relegate activities to “things to do” outside of care tasks, our team is given a different framework.  

Instead of prescribing what specific activities will happen at different times on different days, our team is taught about dementia — not activities.  We help team members to understand how dementia affects a person’s experience of a day and how we might be able to assist them in having a more successful one.  For example, following a roadmap for the circadian rhythm (the natural and internal patterns of physical, mental and cognitive/behavioral changes that occur along the sleep-wake cycle) may be more informative to a care partner than simply planning activities.

Understanding that most people’s naturally occurring moments of highest alertness happen around mid-morning, care partners can be given tools and supplies to assist the PLWD to take advantage of this peak of alertness.  Within this window of time, the care partner can assess what cognitively stimulating activity feels appropriate for (or directed by) the person they’re supporting.  

For example, one resident may wish to have a phone call with his daughter at this time, which gives him a feeling of a successful social interaction with someone he loves.  Another resident at this same time may wish to work on puzzles that she enjoys but may have greater difficulty with later in the afternoon.  Though these are very simple examples, consider how faithfully they meet the definition and spirit of person-centered care.

Resident engagement has been viewed as ‘nice to have’ and ‘fun’ but not an important part of a resident’s overall well-being. Furthermore, the traditional view of activity is to “do a program for,” while the person-centered approach is to think of resident engagement as collaboration with the PLWD so they can find purpose. 

When residents are engaged in a meaningful and person-directed way beyond the traditional activity calendar, it will decrease their loneliness, keep them independent longer, and improve their well-being. This, in turn, offers providers the opportunity to experience improved clinical and financial outcomes.

Dementia is not a normal part of aging. Our actions, whether related to resident activities or family consultations, should not feel like a normal or routine framework we utilize in independent or assisted living. If we move away from the calendar being the center of activities, we may potentially move towards a better frame of reference — the person. Learn more about this topic by watching this recording from Linked Senior’s #ActivitiesStrong initiative Executive Edition webinar series.

James Lee has served in the senior and aging services profession for 15 years. In 2021, he transitioned from progressive and successful work in established senior living organizations to launch three interrelated endeavors: co-founding a dementia support company, establishing a consulting firm for small businesses in senior living, and creating a leadership podcast and associated content/events. He resides in San Antonio, Texas and is a graduate of the McCombs School of Business at the University of Texas.

Charles de Vilmorin is the CEO and co-founder of Linked Senior.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

These behaviors can be disruptive in long-term care communities and affect the quality of life of the person living with dementia as well as others, such as fellow residents or team members.

Rather than immediately looking to pharmacological answers to these behaviors, providers can have a positive impact on residents’ wellbeing by offering personalized engagement so they can live meaningfully even in the later stages of dementia. Providers need to offer more than just medicine. There are many non-drug options that can help health and wellbeing. 

A “social prescription” is something that senior living and long-term care professionals can use to offer these non-drug solutions that are based on life history, individual preferences and current abilities. These types of “prescriptions” are affordable and can have a more positive impact on health when compared to medicine. A social prescription considers who a person really is and offers options to improve their wellbeing in a meaningful way.

It is important to point out that unwanted behaviors are common when people get to the mid and later stages of dementia. The brain structures that deteriorate and make unwanted behavior more likely are the same structures that develop during childhood and during teenage years (i.e., prefrontal areas). We often see a lack of awareness, empathy and understanding of how their behavior is affecting others. 

Keeping this in mind can help us be more patient and respond effectively. Care professionals are often very aware of how common these types of unwanted behaviors are, but it is family members who need reassurance and an understanding that these behaviors are not unexpected. 

Tracking when the behavior occurred, who is present and what might have triggered the behavior, can be an excellent first step in addressing them. Some common times that care professionals report increases in unwanted behavior are when staff shifts change, when people are in pain or when they are overstimulated. Be aware of those times and see if they are correlated with more challenging behaviors in specific individuals. 

If you find a connection, try to remove the resident from the situation that triggers them. For example, think of a memory care community where there is a small sitting area near the main entrance and a reception desk. One resident who has difficulty communicating verbally after a stroke may randomly start screaming and becoming upset. The screaming can be loud and affect other residents. The staff may document the antecedent conditions or what was happening before and when the screaming took place. They could come to realize that it happened when men that the resident did not recognize were buzzed in through the front door. Once the staff realized this, they could quickly introduce unfamiliar men to the resident (e.g., “This is Margaret’s son, he is her to visit his mom…”) if she was in the sitting area, close to the door, which would likely reduce the screaming behavior.

Redirecting attention away from the situation that is causing a resident distress is one of the most effective ways to respond in the moment. If someone is continually upset and acting out against staff or residents, we can ask the family members for some old photographs of good memories for their loved one. Photographs with several people in them that the resident can recognize can also be effective because we can ask the resident who someone is or if they recognize someone. If the names are also shared with us, we can give them a cue, for example, “Is that Aunt Charlotte or Aunt Ruth?”. The resident will usually become quite focused on the photograph and stop perseverating on what was making them upset. If the resident is living in the past, then get photos from the past. Music through headphones can also be used in situations like this.

It can be challenging to address unwanted behaviors and engage with residents experiencing them in a meaningful way but don’t give up on trying to figure out what is causing them and making adjustments to reduce the behavior, as that behavior is a sign of distress in the resident. It often takes considerable time and patience, but it can make a huge difference in the resident’s quality of life.

Rob Winningham, Ph.D., received his Ph.D. in neuroscience from Baylor University and joined the faculty at Western Oregon University in 2000, where he served as a Professor of Psychology and Gerontology. He helped create the Gerontology Department, when he was Division Chair of the Behavioral Sciences Division. He has served as the Dean of the College of Liberal Arts and Sciences and Provost and Vice President for Academic Affairs at Western Oregon University.

Charles de Vilmorin is the CEO and co-founder of Linked Senior.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

An Altarum study from July to August 2020 of 365 nursing home residents in 36 states found that they felt both lonely and isolated. Seventy-six percent felt lonelier, and 64% reported no longer leaving their rooms to socialize with other residents. 

It turns out, based on a recent study, that during that acute phase of the pandemic, many residents living with dementia were also being over-prescribed unnecessary antipsychotic drugs, and those prescriptions have not returned to pre-pandemic levels. 

The most troubling aspect of this is that long-term care providers have always had the opportunity to prescribe meaning rather than medicine for residents, pandemic or not. And yet, most residents still do not experience meaningful engagement each day in senior living communities. 

So, what is getting in the way here, and how can we finally move beyond this reliance on unnecessary medications, especially for those residents living with Alzheimer’s disease and related dementias? The key to implementing a social prescription model is to address these barriers:

1. The Issue: According to a 2016 Centers for Disease Control and Prevention report, long-term care residents are typically receiving only 11 minutes of engagement per day outside of assistance with activities of daily living, and assisted living residents are only receiving 20 minutes of engagement each day.

The Social Rx Fix: Prioritize resident engagement! The providers we work with know the importance of investing in staff and tools that support resident engagement. They were able to elevate their average minutes of engagement per resident per day to 26 in 2022.  

2. The Issue: Activity and life enrichment departments in long-term care communities receive pitiful budget allowances that seriously impede their ability to offer meaningful resident engagement opportunities every day. Furthermore, our survey data from 161 activities professionals in December 2022 found that 35% are using only paper to track attendance, and an alarming 20% are not tracking at all. 

The Social Rx Fix: Prioritize investment in technology that supports activity and life enrichment professionals by digitizing resident preference and engagement data! We have found that by doing this, activity professionals are twice as likely to be able to create individualized plans for each resident, 133% more likely to build community and groups, 162% more likely to know if residents are engaged in programs in real-time and 183% more likely to know if programs match their residents’ preferences.   

3. The Issue: Too often, meaningful resident engagement is considered the job of only activity and life enrichment professionals. How is this possible when there is typically one engagement staff person available for every 60 residents in the community? Our survey data from 142 activities professionals in November 2022 found that 55% reported they are not consistently getting help from other departments. 

The Social Rx Fix: Embrace an interdisciplinary care model and then commit to the 35/85 rule! Providers should prescribe at least 35 minutes of meaningful engagement per resident per day, and at least 85% of all residents should be engaged meaningfully each month. To achieve this, research recommends that communities have at least one engagement person for every 27 residents in assisted living, every 23 residents in skilled nursing and every 13 residents in memory care communities.

4. The Issue: Behavioral and psychological symptoms (BPSD) of dementia are still being addressed using harmful antipsychotic medications rather than making the non-drug solutions the first course of action, based on a resident’s life history, individual preferences and current abilities. 

The Social Rx Fix: Educate yourself and your team on evidence-based therapeutic interventions! To name a few organizations that we support through our Resident Engagement Institute: Best Friends Approach, the Center for Applied Research in Dementia, and the Validation Training Institute (VTI). Learn more about VTI by watching the session recordings from our World Congress, which took place on Tuesday, February 21^st. 

Antipsychotic stewardship programs are growing in popularity; and more communities are employing formal strategies, processes, policies and procedures to prevent the inappropriate use of these medications. One key to this is consistent, ongoing training and education for staff, including those such as housekeeping, dining and maintenance, who aren’t part of the clinical team but who may have insights into residents’ behaviors, pet peeves, favorite things, etc. Their thoughts and observations, as well as those of family members, can be an enlightening part of care planning and can help identify non-pharmacologic interventions to address behavioral expressions.

If you need further encouragement to get started on implementing the social prescription model, there are already so many promising examples in our field. For instance, during the middle of the pandemic and worst staffing crisis the industry has ever reported, Janean Kinzie, director of social wellness and enrichment at American Senior Communities, led the CARE Companions programs that dramatically reduced the use of antipsychotics by more than 2% for their 59 skilled nursing and memory care communities. At the end of 2021, their average long-stay antipsychotic rate is now at 8.9%, compared to the national average of 14.2% reported by CMS.

Resident engagement has been viewed as “nice to have,” “fun,” and a regulatory requirement but not an important part of a resident’s overall wellbeing. However, if residents are engaged in a meaningful and personal way, it will decrease their loneliness, keep them independent longer, and improve their wellbeing. This, in turn, offers providers the opportunity to experience improved clinical and financial outcomes.

Charles de Vilmorin is the CEO and co-founder of Linked Senior.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.