News

Most people do not have to be told that there is a close connection between an active life and a lengthy and enjoyable one. But whereas we might dodge the need to exercise our brain and body, care managers must not. It is their responsibility, emphasised by the National Care Standards Commission and investigated by their inspectors, to ensure that activities for older people are no longer given low priority.

There are many opportunities for residents to escape from torpor and few excuses for failing to help them. As the National Association for Providers of Activities for Older People (Napa) puts it: "A life of inactivity is tantamount to a sentence of death."

People in the UK are living longer. Research recently published by Age Concern and the Department of Health shows how quickly the population has aged. In 1900, the life expectancy for women was 65, now it's 80. Fifty years ago a British man reaching the age of 65 could expect to live for another three years, now the expectation is 14 years.¹ By 2010 the retirement age may be 60 or less (pensions crisis notwithstanding), which will provide an extra 25 years for women and 20 years for men. There is going to be plenty of time to be active - in or out of a care home.

The medical evidence for activity is supported by social surveys. The initial findings of the Economic and Social Research Council growing older programme emphasise, says Professor Beaumont of the Royal Hospital for Neuro-Disability, that "there are major factors in survival, such as a person's general health and cognitive powers, but mental alertness and physical well-being are vital factors too." People who retire early and live at home initially fare better. But when they need domiciliary care or move into a care home, the availability of regular mental and physical exercise falters. The four major demands - food, comfort, security and medication - become the prime factors in care. Activity sinks to fifth place or lower in the hierarchy of priorities.

Medical pressure for active retirement is matched by government enthusiasm. After all, the government's policy is to encourage people to stay in their own homes for as long as possible, so avoiding NHS and local authority costs for residential or hospital care. The charities, too, promote good health through activities. Age Concern, for example, has a programme called Ageing Well UK and an ActivAge Unit with health mentors specially trained to give information and arrange for volunteers to help with local needs.

Care homes (with some notable exceptions) have not been in the vanguard of change. They concentrate on the four main demands already mentioned. But things are changing. NCSC inspectors are helping to alter perceptions, demanding to see evidence of policies and programmes, and asking how many activities are organised, and how often.

The NCSC says that inspectors will ask if there is an activities organiser. At Morton Grange in Derbyshire the owner, June Rye, is the activities organiser. That's an indication of the priority placed on keeping clients active. Gladys, when 77, said she had always wanted to fly in Concorde. Staff set up a "wishing fund" and eventually Gladys took to the skies. The wishing fund, bolstered by profits from bring-and-buy days, cake sales and donations, now pays for visits to shows, Chatsworth House, and in-house entertainments. Angela Naylor, the manager at Allington Court, a specialist Bupa nursing home near St Albans, said: "One of our most successful initiatives was to set up a 'sensory room' as well as an activities room. Aromatherapy is very, very popular."

Training staff to draw up policies and plan programmes for residents' activities has often been neglected too. But this is changing. Veronica Read at City & Guilds predicts that the new registered care managers award at NVQ level 4 will attract "overwhelming demand from the 70,000 managers, deputy managers and supervisors in adult care homes."


The qualification includes the planning and implementation of activity programmes as part of a care service and so training organisations have geared themselves to offer this as part of their service. Peter Lambourne, general manager of Heathercroft Training Services (HTS) in Eastbourne, says that they are adding to their training materials and revising assessors' duties to ensure that activities are integrated into their resources and processes.

HTS might be training the professionals, but there is also lots of room for volunteer helpers. As Margaret Butterworth of Napa says: "There's the need - and plenty of opportunities - for the 'outside' to become more involved in the care of elders who are 'inside'."

Specialist groups such as Age Concern, Napa and Age Exchange provide low-priced courses offering theory and practical tools to assist organisers.

There are no national guidelines on activities: the NCSC says that this would miss the point - that each care home must plan its programme to match the needs and the wishes of its own residents and their families. No "national curriculum" for activities, then. The philosophy is one of self-help, but NCSC inspectors are looking closely at care homes to see if there are initiatives for activities that indicate thought, planning and action. 

Alan Jamieson is an employment, recruitment and training consultant.

References

¹ Office of National Statistics, Population Trends, 109, September 2002,

Background information

Napa publishes a newsletter and brochures including Why Are Activities Important? and A Guide for New Activity Organisers. Napa, Suite 211, 24-28 Hatton Wall, London EC1N 8JH. Tele/fax: 020 7831 3320. Age Concern Training has programmes such as Through Other Eyes, a sensory simulation workshop. Telephone 01543 503660 or fax 01543 504640 for details. Age Exchange specialises in reminiscences: telephone 020 8318 9105 or fax 020 8318 0060.

Key activities 

Some or most of these should be on a care home's programme. 

• Physical activity - walking, dancing, yoga, tai chi, aerobics, gardening. 
• Music - both playing instruments and appreciation. 
• Crafts - knitting, flower arranging, painting, drawing, cooking, aromatherapy, massage, creative writing. 
• Visits - individually with families and in groups to shops, houses, gardens, garden centres, exhibitions, theatres, library,and museums. 
• Religion and spiritual life - going to religious services, counselling. 
• Family and friends - reminiscences, talks, discussion. 
• Games - chess, draughts, other board games, scrabble, puzzles, quizzes. 
• Media - radio, television, newspapers and magazines, using the computer.