The Role of the Activity Professional in Promoting Resident-Centered Engagement for Persons with Dementia Living in Care Communities
Objectives: This study examined activity planning for residents with dementia in care communities. My principal analysis explored how activity planning relates to resident-centered care. I also studied how actual or perceived challenges of activity directors may affect their ability to plan meaningful activities, and how activity professionals view residents with dementia.Methods: Sixteen care communities in Southeastern North Carolina participated, four of each organizational type: continuing care retirement community, assisted living with memory care, assisted living, and freestanding memory care. I conducted in-depth semi-structured interviews with 16 activity professionals. I collected demographic information from each activity professional and asked each to draw a person with dementia and to describe the drawing. Before each interview, I conducted in-depth observations in the care community. I also examined each care community's website. Audio recordings from the interviews were transcribed verbatim. Axial coding connected code categories and identified common themes. Drawings and verbatim descriptions were analyzed by coding specific elements in each drawing. I analyzed the observations and compared the physical attributes of each care community, and interactions between staff-and-staff and staff-and-residents. I analyzed the websites focusing on each organization's mission statement and its emphasis on resident-centered care.Results: Most activity professionals were aware that individualized activities enhance meaning and increase quality of life. However, few used resident-centered engagement in practice. Many said that the lack of personalized activities was due to limited staff and budget. None of the activity directors mentioned using a comprehensive care plan that considers the abilities, needs, and personal histories of residents as a basis for planning activities. Observations showed that daily activities were traditional: Bingo, sing-alongs, and craft activities. Drawings of persons with dementia showed mostly active, happy individuals with normal feelings of sadness and confusion. When participants talked about their drawings, most described individuals with dementia as engaged and normal persons. Discussion: My observations did not support the activity professionals' statements that they emphasized resident-centered care. In all cases, activity professionals said that they were providing more resident-centered engagement than my observations suggested. Lack of specialized training and not knowing where to find new ideas for activities may have contributed to the inconsistency between what they described as a best practice and the actual activities. Results suggest a need for increased training for activity professionals, including training on resident-centered engagement in activity programming. In addition, activity professionals should be included in the development of each resident's comprehensive care plan. Activity goals should focus on the individual resident. It would also be useful to emphasize the importance of activities in the lives of residents with dementia. Recognizing the importance of activities requires increased knowledge and communication that activities and social engagement play a pivotal role in resident-centered engagement and improving quality of life.