At a focus group with a group of dementia consumers today, Bingo was mentioned as an activity used in aged and dementia care. The room was full of people who themselves may one day be facing aged or dementia care, myself included. Although it wasn’t the topic we were there to discuss, I decided to ask everyone on the room if they currently played Bingo. Not one hand went up, but a couple of comments quickly came back; yes, but it is good for them to socialise, or I’m sure they must enjoy it. How interesting that not one person in the room actually plays Bingo currently, but might one day be coerced (forced) into doing it. I feel concerned someone will force me to play Bingo one day, and if I don’t want to, then I’ll be labelled as difficult, or refusing to co-operate, or refusing to interact with others, or some other nasty, ill-informed and negative label, simply demeaning the fact I don’t want to play Bingo. And if I do appear to want to play Bingo at the time this happens, will it simply because I really hate being left alone in my room, or maybe even that I am scared of the consequences if I don’t comply. Bingo will never be a meaningful, engaging activity for me, and if someone ever coerces me into playing it, and I appear to be enjoying it, it will only be because the alternative is worse.
Activities need to be physical, creative (for each individual), functional, spiritual, and above all, intellectual. They also need to enhance the quality of life for each person, encourage personal expression, to bring some fun into the persons day, and promote intellectual stimulation. I don’t mean academic, I mean intellectual. Activities that are not patronising, that match the persons previous intellect and likes, not those of the wider group. They also need to be age appropriate, and allow a person to feel empowered and in control of something, not just participating in some meaningless (to them) activity they feel obliged to join in with. A person who loves to write poetry may not be interested in painting or singing, and vice versa. Sitting quietly all day listening to music might be a treasured thing to do for one person, and a boring existence for another. Wanting to sit quietly all day though, does not mean the person is not engaging. If I ever enter residential aged care, I fear the label of difficult will be pinned to me on the very first day. Welcome to Bingo… I think not!
Over the last 12 years or so, I’ve been in over 40 long-term care facilities around the midwestern U.S. In each and every one of them, Bingo is an important part of the residents’ lives. And more than once I’ve accompanied one of my patients to the game, incorporating it into my therapy. (And it is possible to work on quite a few cognitive goals during the course of a Bingo game — attention to task, visual scanning, following complex directions, and so on.)
But I’ve also seen residents struggle as they begin to have a hard time following the game. A gifted activities leader will adapt the game to allow these folks to continue to participate — reduce the number of Bingo cards they use, substitute cards with larger numbers, assign an assistant to sit next to the person and provide cues as needed, and so on.
That said, I agree that some facilities tend to rely on the same old tried and true activities for their residents, without seeming to have concern over what they really are interested in. Sometimes I chalk that up to a lack of training on the part of the staff. And it is a challenge to come up with a wide variety of activities, on a daily basis. I’m currently a bit dismayed at the lack of meaningful activities, in my current workplace, for the lower level residents.
What’s the answer? I honestly don’t know. Education is important, though. Providing training for our facility staff on subjects such as dementia staging, and gearing our care toward what the person CAN do rather than what they CAN’T, and all of the many facets of person-centered care, is another. But I do think we’re starting to learn from our mistakes. And posts like this go a long way toward helping.
Well done for trying so hard to provide meaningful activities and care; people like you are few and far between as far as I see, as you have said in your own workplace. Education, and somehow finding a way to INSPIRE others to want to care is probably the way, but sometimes it the ‘stick’ approach is needed? Keep on being a gifted therapist.
Kate – you said
“Activities need to be physical, creative (for each individual), functional, spiritual, and above all, intellectual. ”
Nobody in an aged care facility with dementia can do anything that is intellectual. Not that I know of. When I had next to no memory, and I couldn’t drink anything hot because I’d forget I was drinking a hot drink (and I’d burn my mouth otherwise) I couldn’t do much because I couldn’t remember to do anything much. Quite literally. So I’d sit and just watch TV all day.
Unless there’s another disease that gets you before the Alzheimers Kate, you’ll have to get used to the idea that this is the future for you.
Not unless you go down the path like what I intend to do
I don’t intend to let myself ever get that bad, should my dementia recurr. I intend to make sure that I take something so that I will die before I end up living in any condition that I don’t want to live in – like that of moderate or advanced dementia. I have terrible medical symptoms that will be harder to cope with if I also have moderate dementia…… things like 24/7 unsatiable hunger. I won’t be able to distract myself which is the only coping mechanism that I have at the moment.
To this end I hope that you’ve done an advanced care directive ….. it might be useful. Or maybe not.
I didn’t mean ‘intellectual’ in that sense… will have to spend some time thinking about how to write what I mean! And yes, my Advanced Directives etc have all been done some time ago. Take care
I find that many of the individuals I work with who are in the latter stages, and even the end stages, of dementia often have a great deal to teach me. It’s always amazing to me how much of the person remains inside, waiting for someone to show it how to get out.
At my mother’s assisted living residence the folks play Bingo. Mom was a reluctant participant because she grew up in a faith community which frowned on gambling. And Bingo was considered gambling. She still is unsure whether she should be playing or not, even though there is no money involved.
I have not yet been to a nursing home yet (and I’ve been to a lot in SA) where Bingo is not one of the main activities, and feel this is just one lazy cop out on activities co-ordinators!
Totally agree with your comments Kate. Diversional therapy programs should be tailored to the individual and not the other way around if they are to have any meaningful beneficial effect on the individual’s quality of life.
As part of our home care business we do what we call ‘escort shifts’ (not to be confused with ‘escorts’ – I don’t joke, we have come across this problem before – very embarrassing) where we get a carer together with the individual and do activities that they want to do.
For example, one elderly gentleman we had really enjoyed reading the newspaper and playing chess but his eyesight wasn’t good enough for the paper and the facility he was staying at didn’t have the staff numbers to sit and give him a regular game of chess.
We had a carer going out for 3 hours once or twice a week to sit down and do what he wanted. Which was typically to have the paper read to him and then have a game or two of chess. Can’t even begin to tell you positive impact it had on his attitude and quality of life. Despite the poor eyesight that chess board was set and ready everyday the carer arrived.
Whilst having private services like the above provided isn’t always an option for everyone it really does reinforce the positive benefits that can come from a very small investment of time into making sure the activities are tailored to the individual. The activities don’t have to be one on one like the above example either but they do need to be relevant to the individuals undertaking them.
P.S. Ironically I really enjoy bingo.
Thanks, and your Ps has given me a rather good giggle!! Your service sounds wonderful too btw.