SD24 - Recreational Activities in Adult Care Residences and Nursing Homes

Executive Summary:
Senate Joint Resolution 344 requested the Department for the Aging to study the availability of therapeutic recreational activities in adult facilities as well as the methods used to encourage residents to participate in activities which can improve their health and well-being, provide increased social interaction, and generally improve their quality of life. A copy of SJR 344 can be found in Appendix A of this report. In consultation with the bill's patron, the Honorable Yvonne Miller of Norfolk, and with representatives from the Virginia Association of Activity Professionals and the Virginia Recreation and Park Society, it was decided that the focus of this report would be on general recreational activities available in adult care residences (ACRs) and nursing homes and not on the more specialized therapeutic interventions that a Certified Therapeutic Recreation Specialist would prescribe and administer. Not all facilities have a Certified Therapeutic Recreation Specialist on staff.

In order to address the issues presented in SJR 344, the department developed an informal questionnaire which it sent to roughly 700 of Virginia's ACRs and nursing homes in order to gather some very basic information about the provision of recreational activities.

In looking at the broad range of responsibilities, activities, and skills which are common to the vast majority of Virginia's activity professionals, it was decided that a generic definition of recreation activities would be developed for use in the questionnaire. This generic definition includes both specific interventions prescribed for specific residents as well as more general recreational and social activities aimed at improving residents' well-being. The definition of recreation used in the questionnaire as well as in this study report is:

"Recreational activities, programs, and services which enhance the overall quality of life for institutionalized persons by improving their physical functioning and cognitive abilities. These can include crafts, solitary games, group activities, field trips, educational classes, informative presentations, and mental and physical activities. These activities, programs, and services provide an opportunity for independent choices, enjoyment, self-expression, mental alertness, and socialization."

More than two hundred and thirty (230) usable questionnaires were returned to the department by Virginia's ACRs and nursing homes, a return rate in excess of 35%. This return rate is considered to be very good in survey research circles. It demonstrates the commitment and interest which Virginia's ACRs and nursing homes have in providing recreational and socialization activities for their residents.


The questionnaires revealed that ACRs and nursing homes offer some type of recreational or social activity each day. The larger facilities offer several activities each day as well as evening activities. Most facilities also organize special activities on holidays. The questionnaires also reveal that these facilities provide a staggering array and range of recreational activities. All facilities, whether large or small, indicated that some residents are unwilling or reluctant to participate in activities for any number of personal reasons. Many facilities reported that they used their Residents' Council to plan activities and events that would appeal to the majority of residents. Some facilities offered door prizes or other "rewards" for participating in recreational or social activities. All facilities acknowledged that providing refreshments during recreational activities was one way to encourage participation. Most facilities, however, reported that personal. one-to-one encouragement is the key to getting residents to participate in the various activities or special events that facilities plan. Finally, many facilities reported that they tried to involve the residents' families in many of their activities or special events. Family member involvement generally assures that residents will be more willing to participate in activities and provides a structured arena for families to interact with their older relative as well as the other residents in the facility.

The questionnaires indicated that most facilities would like to have additional funds to devote to recreational and social activities for their residents. Many facilities indicated that federal reimbursement policies for intermediate and skilled care, for example, don't take into account the physical and emotional benefits that recreational activities bring to a resident's treatment and overall well-being and, therefore, don't provide specific reimbursement for these services. Even several facilities that relied on private-pay residents for the bulk of their revenues indicated that recreation services still had to compete with all the other services and programs for a share of the facility operating budget. More dollars invested in recreational activities would allow facilities to purchase wheel-chair accessible vans to transport more residents to special events in the community. More dollars would also enable facilities to hire more trained and/or certified staff with specialized knowledge of recreation and the needs of older institutionalized persons.


There are a number of strategies that facilities can use to enhance their recreational and social programming. The following three recommendations are offered concerning recreation in ACRs and nursing homes:

• Facilities are encouraged to become familiar with the benefits that recreational and social activities and programs bring to the lives of institutionalized adults. All staff need to understand the role of activities and their positive impact on overall resident well-being. Certification by a national or state professional association is one way to assure the quality of recreational programs. Facilities are encouraged to consider working with the Virginia Association of Activity Professionals, the Virginia Recreation and Park Society, the National Association of Activity Professionals, or the National Council on Therapeutic Recreation Certification in order to have their staff receive specialized training and certification.

• Families can, and should, play an important role in the residents' therapeutic goals and emotional well-being. Whenever possible, facilities should encourage families to participate in recreational activities and special programs with their older relatives. This involvement will allow the family to feel that they are contributing to the care of their relative and can help ease the guilt and deflect the anger that some family members feel when a relative has been institutionalized.

• Volunteers can augment activity staff in any facility. Facilities are encouraged to work with the Virginia Office of Volunteerism, their local Area Agency on Aging, and other community agencies and civic associations to recruit volunteers who can assist during recreational and social programs.