There are abundant opportunities to engage our residents in meaningful activity around the home. I have merely listed a few examples here, but that list is by no means exhaustive. If you are already doing some of these things, that’s great. Hopefully you will have another few ideas to add to your repertoire. If not, have a look at the suggestions below and get cracking!

Polishing and dusting
Scattering dusters around the home is a great way to encourage spontaneous engagement. It is especially good for those residents living with dementia who are always on the go. Placing dusters or cloths in strategic places such as handrails, tables or bookshelves can provide a visual prompt to start “the cleaning”. You will be amazed how often your residents will pick them up and begin dusting. Alternatively, those less agile residents can be handed ornaments and bric-a-brac to dust. Or simply ask or simply ask for their opinion on how best to set them out on display.

Meal preparation
When you think about it, all the normal cues that signify that we are about to eat are often missing in care homes. The sights, sounds and smells of cooking happen in a distant kitchen far removed from them. Can you imagine what it must feel like to have a meal placed in front of you without warning or to be informed out of the blue that it is time to eat? Everyone can be involved in preparing for a meal in some way. From setting the table, to preparing a few veg as we discussed in “Making sense of Meaningful activity”. Even if they are only choosing the colour of the tablecloth they are still involved and engaged. We might even find appetites improving weight loss becoming a little less in evidence.

Making a cup of tea
Tea drinking is a national custom and plays an important social role in our lives, especially for our older generations. Yet we provide tea, coffee and other hot drinks in much the same way as we provide meals. That is without the familiar cues of preparing a cuppa. Drinks appear on the trolley and everyone is served at exactly the same time. There is no involvement with residents and few opportunities to have extra hot drinks on demand. I can think of no reason why residents cannot be involved in the process of tea making. The obvious health and safety issues can be overcome with care, attention, and a bit of imagination. My reward for finding a way to set this up in our home came when one of our ladies’ comment, “My God! It’s years since I heard a kettle boil!”
Washing the dishes
Doing the dishes after eating or having a cup of tea is as familiar as brushing your teeth before bed. So get your resident’s involved. If you have a satellite kitchen or designated washing area, that’s all well and good. You are quids in. But any old sink or even a basin does the job just as well. It doesn’t matter that most dishes have to go to the dishwasher to meet the required hygiene regulations. It is the participation in normal daily routines that matter. This can make a huge difference to restoring a sense of involvement and normality. You could also try asking for help to wash the medicines cups. Many of our residents are thrilled to feel that they have “helped the nurses”. Remember, everyone needs to be needed.

Laundry
Washing day was a familiar and essential ritual in family life. You only have to watch shows like “The Steamie” to see the truth of this. One home I know of had a corner of the home set up with a large mural of a scene from this show with an old mangle, washing tub and scrubbing board. A great way to stimulate memory and conversation. While this may not be a realistic option in your own home, enabling residents to fold up towels, sheets and dishcloths or hanging out a few pieces of washing is an excellent means for to keeping them involved in this familiar chore. Slipping into this accustomed role promotes familiarity and even confidence. It helps them to somehow find themselves again. The effects can be quite startling.
Shoe Polishing
Nicely polished shoes played an important role in how you present yourself to the world for many of our residents. It was an integral part of creating a sense of self and self-esteem. Yet little attention is paid to this when they enter the care home setting. This is an easy activity to set up. All you need is a few old newspapers, aprons and rolled up sleeves. Taking part in this familiar task can stimulate a sense of purpose and enable them to achieve pride in what they have produced at the end of it. Residents who are unable to actively participate can still be involved through watching the process. It can be quite entertaining to see the “Gaffer” emerging with their opinions and criticisms of how it should be done.
A bit of DIY
OK this is not everyone’s cup of tea, but for those residents who are interested, being involved in helping with the day to day repairs around the home can be very satisfying and absorbing. Again, it gives the opportunity to support a sense of purpose and belonging. This involvement can range from simply passing a screwdriver to painting fences. Asking for and opinion on how a job should be tackled can bring similar results. So assign a resident to the maintenance person for an hour or so once or twice a week. Set up little jobs which are easy to complete. Give then the opportunity to do a bit of weeding or planting in the garden. Then stand back and watch the effect it has.
Community visits
Most homes have members of the community to come in for a visit from time to time. Usually, this is with the intention of them doing something for the resident, such as carol singing or holding a church service. Try reversing this so that your resident can serve a function for the community. One idea we tried was taking some of our residents to the local school which some of them had attended in years gone by. They were fascinated to revisit this old haunt and meet some of the children. When those children heard that they had attended the school, they were eager to find out what life was like in “the olden days” at their school. Soon, these ladies were holding court with a captive audience, and telling stories of their childhood. It was a heart-warming scene and the children really engaged with it. Especially the tales which involved their naughty escapades.
Friday night in
Everyone enjoys a chippie meal or a takeaway in front of the telly at the end of a busy week. I have lost count of the stories families have told me about their “chippie teas” together. In the care home setting, you can provide any of the available options. Since most establishments deliver these days, all you need is a list of menus, a phone and then you are off. From chippies to Chinese, everyone can choose exactly what they want to eat. Some will want it on their knee in front of the telly while other might want to have it in their room or at the dining table. To make it an even more sociable event, families and staff can eat with them too.

Staff recruitment.
It’s only right that our residents have a say in who cares for them. We can involve them in setting questions for the interview chatting to candidates, or even showing them round the home. Some residents have been known to take part in the interview process too. For the less able bodied residents we can simply ask them what they think are the important qualities that a caring person should possess. Alternatively, we can watch how candidates interact with residents over a cup of tea and get their opinion on what they thought of them.

Remember, your residents’ ability to engage will vary from individual to individual. Similarly, their interests will vary. A thorough assessment of their needs and abilities will help you to help them engage in activities which are meaningful to them. How long they engage and the level of their involvement is irrelevant. Even a few seconds of simply watching an activity is worth the effort (Meaningful Activity in Practice).

Meaningful activity is a often misunderstood. But when you get right down to it, meaningful activities play a central role in all our lives.

We all have our individual likes and dislikes. Things that excite and stimulate, and things that leave us bored or uninterested.

When we look at the concept of meaningful activities  The key word here is “individual”, and that is often overlooked in communal living in care homes.Walk into any care home and you will see activity boards proudly displaying plans for the days, weeks or even months ahead. Most of these planned activities include board games, outside entertainment, bingo, one to one chats or similar.

So the question I want to ask is, “To whom are these activities meaningful?”.

Meaningful activites are not about “passing the time”

While dominoes, draughts and sing-a-longs have their place for some people, they don’t appeal to everyone. More importantly, playing games or being entertained may bring some short term enjoyment, but in themselves are unlikely to bring about a sense of fulfilment and purpose in life.

Meaningful activity, then, is not about pastimes. Neither should it be viewed as a tick box to please regulators, relatives and prospective clients. And it certainly should not be a routineschedule of pastimes that are planned only at certain times on specific days by one member of staff who has been employed for the role of activity co-ordinator.

I for one would not know if I wanted to play dominoes at 10am next Tuesday morning for example, would you?

How it should be done

Iff we are serious about bringing meaning into the lives of our residents, we need to rethink the whole process.

We need to look at what will bring that meaning for individuals, instead of looking at which activities we can slot into the day to fill the gaps or pass the time. We need to understand that everyone involved in the care of our residents is by turn, responsible for bringing meaning into their day

Meaningful activity is a far simpler thing than it might first appear and it is inextricably linked to the concept of (person-centered care). It encompasses the whole person for the whole of their day and includes all aspects of daily living.

We can bring meaning and purpose to the simplest activity through fully involving our resident. This means supporting them to make choices, listening to their opinions and respecting their decisions.

Let me give you an example of what I mean by this:

Ellen, an 82 year old lady who lives with dementia, is very disorientated to time. She has very little communication, having difficulty with both receiving and giving verbal communication. Even when she is desperately tired to the point of falling asleep, she has difficulty in understanding that night is approaching and it is time to go to bed. Supporting Ellen to go to bed became an ordeal for her.

In the past, staff would get her room organised for sleep before approaching her in an attempt to reduce her stress experience. Ellen was then assisted to her to her room, helped to get washed and changed into her night clothes and then into bed.

Throughout this process, Ellen became very distressed and tried to fight staff off, even though she was obviously very tired and in need of sleep. Once in bed, however, she relaxed and settled down to sleep.

When we reviewed her care, it was evident that Ellen’s distress was largely due to her inability to understand what was happening to her. They key point here is in the phrase “what was happening to her”.

Ellen was not involved in any way, she had no control over the situation and no opportunity to make her own choice about when she went to bed.

We changed her bed time routine. When Ellen began to feel sleepy, a member of staff would assist her to her room. Using visual cues, the staff member asked Ellen to help her close the curtains, turn down her bed and choose a nightie out of the drawer. Keeping her involved throughout each step, Ellen was assisted to get washed, changed and into bed.

The process of going to bed was a much calmer one for Ellen as a result.

Involving Ellen in the preparation for sleep gave her visual cues that she was getting ready to go to bed. It is what we all do every night in our own homes.

These cues are often absent in our care homes because we do these preparations for our residents, believing that we are being helpful. Keeping Ellen engaged through the whole process gave her a sense of control and purpose.

We were doing it with rather than for her. In other words, we were giving her meaning for the activity.

This is a very simple example but the principle remains the same no matter how complex or specific the activity is. It is about looking at the individual. Assessing their needs, abilities, personal preferences and level of cognition. By using the principle of meaningful activity, we can support our residents to make choices and have control over how they spend their day. Their level of engagement will vary greatly from one resident to another. It will also vary day to day for each resident.

Here is another example:

Maime, a lady whose life centred round feeding and caring for her very large family. This role was very important to her. It was how she identified her purpose and meaning in life.

We learned that as she became older and frailer, she was no longer able to fulfil her role, but retained the ability to peel the potatoes for tea right up to the time she was admitted into our care home.

So every afternoon, she was given two potatoes to peel to help us get the evening meal underway. This simple activity gave her immense pleasure and a sense of purpose.

During the meal she would proudly tell her fellow diners that she peeled the tatties they were eating.

However, she refused to engage in this activity on a Sunday because that had always been her day off. On Sundays, Dad took over the role to give her a break!

So when we talk about meaningful activities, we need to pay more than the obligatory lip service that can be seen in the majority of care homes. Meaningful activities should be incorporated into the whole day, for every resident, every day.

If playing dominoes or similar games is important to them, then we should make that available to them when they want it, and not limit it to specific days or times. If spending time in the solace of their own room matters to them, we should support them to have that time rather than encouraging them to engage in group activities because we are worried about them becoming isolated.

However our resident choose to spend their day, or their level of involvement in their care we need to respect their right to choose and support them to make informed choices.

By asking the question, “Is this meaningful to you?” we can’t go far wrong.