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.