Aligning Leisure Practices with Culture Change

 PiDC Alliance Logo and Cartoon tree and landscape with the words "New Possibilities for Meaninful Leisure Experiences"

This page contains resources from a day long intensive presented at a number of professional conferences including the Canadian Therapeutic Recreation Association conference in May 2013, and the Pioneer Network 13th Annual Culture Change Conference in August 2013.

This day long intensive was created by:

Looking for slides from the day-long intensive? New Possibilities for Meaningful Leisure Experiences [powerpoint slides]. These slides are not AODA accessible, but all information contained within the slides, plus downloadable forms containing instructions for the Small Group Exercises are available in an AODA accessible format below.

Introducing the New Possibilities for Meaningful Leisure Resource:

About the resource:

Who is this resource for?

This day long intensive workshop is aimed at recreation and leisure professionals who are interested in connecting their practice with the principles of the growing culture change movement in long-term care.

How can I use this intensive workshop?

The exercises, and learning opportunities in this intensive can be used to:

  1. Spread the message about culture change and leisure to others in your group or organization.
  2. Re-vitalize your leisure practice and learn more about the future of leisure for persons living with dementia.

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Part 1: Setting the Stage

In this section of the Intensive - focus on creating a safe space for your group and understanding the broader objectives of the day.

Objectives:

  1. Reflect on the impact of the institutional, medical model of care on leisure policies, practices, and experiences in long-term care homes.
  2. Consider how a community, relational model of living might reshape leisure policies, practices, and experiences in long-term care homes.
  3. Learn about Authentic Partnerships and Living and Celebrating Life through Leisure.
  4. Envision new possibilities for meaningful leisure experiences.

Getting to know each other...

  1. Divide into pairs.
  2. Introduce yourself to your partner and interview each other using the following question:
  • Thinking about your personality, what type of building would you be if you were a building? What type of kitchen utensil? What type of transportation vehicle?
    3. We will invite those who wish to share what you found out.
 

Creating a safe space …

  • What do you need to feel safe to share your stories, experiences, and opinions?
  • What do you need from your facilitators?
  • What do you need from your colleagues?
  • What do you need from the space to participate in meaningful ways?
Facilitators should consider posting some of these responses as Guiding Principles in the meeting space so that participants can refer to them over the course of the workshop.
 
 

Part 2: Culture Change defined

In this part of the intensive, work with your group or organization to explore what culture change means to them, and then share the following definition.

Culture Change…

  • Is an organic on-going and evolving process.
  • Involves critically examining the language, values, assumptions, attitudes, practices, approaches, and policies embedded within an organisation.
  • Is a movement from the medical/institutional model of care to a relational/social model of living.
  • Involves the development and implementation of a comprehensive set of fundamental reforms in order “to create caring communities where both empowered front-line staff and [Elders and families] can flourish” (Rahman & Schnelle, 2008, pp.142-143)

Culture Change is NOT...

  • An end product or outcome.
  • Solely a quality improvement initiative.
  • A specific program or model of care that is implemented.
  • A one-size fits all approach.
  • A top-down mandate imposed by others.
  • Easy.

Part 3: Reflections on the medical/institutional model of care

In this part of the intensive, two small group exercises are used to describe and define the medical/institutional model of care and to learn about the consequences of this model for persons living with dementia.

Begin with the exercise below, designed to help the group demonstrate the medical, institutional model of care 'in action'.

Dramatic Performances and Large Group Discussions

Once your group has completed their skits, come together as a large group, and discuss the following questions:

  • Which of the aspects of the institutional, medical model are observed in each of the performances?
  • What are the similarities and differences between the performances?
  • What other impacts are you aware of that were not shown in the skits?

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Recreational Therapy

Meaningful engagement and well-being has not always been thought of in terms of leisure. Certified Therapeutic Recreation Therapists (CTRS) are often trained to think of 'recreation therapy' as a treatment service designed to restore, remediate and rehabilitate functional deficits. In this intensive, we sense that some approaches align better with culture change values than others. The group is encouraged to reflect on how their own practices align with culture change values today.

a treatment service designed to restore, remediate and rehabilitate a person’s level of functioning and independence in life activities, to promote health and wellness as well as reduce or eliminate the activity limitations and restrictions to participation in life situations caused by an illness or disabling condition.

(ATRA, 2009)

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Therapeutic Recreation

The Canadian Therapeutic Recreation Association (CTRA) describes Therapeutic Recreation in ways that are functionist and interventionist.  Therapeutic Recreation is defined as:

a profession which recognizes leisure, recreation and play as integral components of quality of life. Service is provided to individuals who have physical, mental, social or emotional limitations which impact their ability to engage in meaningful leisure experiences.
To this end, according to the CTRA, therapeutic recreation
is directed toward functional interventions, leisure education and participation opportunities. These processes support the goal of assisting the individual to maximize the independence in leisure, optimal health and the highest possible quality of life.

Common Implications

Approaching leisure in this way has a number of implications for recreation professionals and for those with whom we work.  The group is encouraged to consider how many of these challenges exist within their community?  How many of the following implications have you witnessed?

  • Dominance of the biomedical paradigm a undervaluing of leisure and a diversional or therapy focus (i.e., recreation as distraction, treatment or intervention) --> undermines personhood.
  • Professionalization of activities and recreation --> departmentalized approach.
  • Large group programs and too few individually meaningful opportunities.
  • Structured programs and too few spontaneous and self-initiated opportunities --> disrupts the rhythms of daily life.
  • Assessments tend to focus on measuring functional levels in order to identify deficits in need of treatment or intervention.
  • Limitations experienced are often attributed to the illness or disability with little regard for social or environmental factors.
  • Valuing independence over interdependence.
  • Little attention is given to strengths and continued abilities, and how Elders themselves think about recreation and leisure in their lives.
Complete Small Group Exercise #2, designed to demonstrate the consequences of the medical, institutional model on older adults.

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Part 4: Reflection on Culture Change Values and the social, relational models of care

Illustration of a woman meditating.

In this part of the intensive, the group is asked to reflect on culture change values and the relational, social model of living via a guided imagery exercise and two small group exercises.

 
 
Ask the group to 'sit back, relax and put yourself in the story' and begin to read the Guided Imagery resource below. Move on to Small Group Exercise #3 immediately.

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Culture Change Values

There are strong links between the images from the story, and culture change values.  Ask yourself, wouldn't we all want to live in a place like Hillside? A home that honours:

  • Choice and self-determination
  • Dignity and respect
  • Nurturing body, mind and spirit
  • Knowing and focusing on the person
  • Living life
  • Enabling, normalizing environments
  • Close interdependent relationships
  • Collaborative decision-making
  • Flexibility

Complete Small Group Exercise #4, designed to facilitate a re-imagining of the skits created in part 3 of this intensive in a way that reflects the relational/social model

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Dramatic Performances and Large Group Discussions

Once your group has completed their skits, come together as a large group, and discuss the following questions:

  • Which aspects of the relational, social model are observed in each of the performances?
  • What are the similarities and differences between the performances?
  • How might individual experiences change if the relational, social model was a reality?
  • What might limit or impede the implementation of a relational/social model into practice?

Part 5: Alternative Meanings of Leisure in Long-Term Care (LTC)

In this part of the intensive, the group is asked to share personal meanings of leisure and reflect on meanings of leisure from the literature.

Ask the group to begin by completing short paired interviews.

Paired Interviews on Leisure

  • Find a partner you have not worked with before.
  • Together explore what leisure means to each of you and what you would need for meaningful leisure if you moved into a LTC home? What would you want your leisure to look like?
  • Share your discussion with the larger group.

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Meanings of Leisure from the Literature

 An older couple dances and smiles.

Leisure is an Experience

“It is the quality of the experience of doing the activity, not the activity itself, that makes it leisure. Leisure is mainly motivated by intrinsic reasons, that is, the activity is chosen because of the meaningful qualities it holds for the individual. Therefore, leisure is primarily an experience.

(Kelly, 1982)

 

Leisure is an Expression of our Humanity

Of all species, humans are the biggest players of all. We are built to play and built through play. When we play, we are engaged in the purest expression of our humanity, the truest expression of our individuality… It energizes us and enlivens us. It eases our burdens. It renews our natural sense of optimism and opens us up to new possibilities… Play is the vital essence of life. It is what makes life lively (Brown, 2009).

Ask the group to consider that this quote is similar to the assertion made by Dr. Charlie Sylvester over 25 years ago. Sylvester argued that leisure has intrinsic value as an expression of life itself. He said,

The main distinction separating the functional and expressive sides of life rests in the difference between simply being alive and being vitally human.

When faced with illness or disability or other life challenges, leisure provides a space not only for natural healing but for being -for celebrating who we are and providing a means to continue to live life despite illness, disability or challenges. The research presented in this workshop  supports this notion and suggests that the most meaningful leisure experiences according to persons with dementia can only happen when they have opportunities to reveal and engage the expressive sides of who they are as human beings. One of the research participants associated with this project said,

[leisure is] when the heart is at ease and happy, when the mind is calm, and when the soul feels like singing.

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Leisure is Well-Being

Leisure provides the opportunity to consider the kind of life a person wishes to live, permitting reflection on the personal meaning of well-being and how it might be achieved… leisure provides the opportunity to do those things people consider meaningful and worthwhile… leisure allows people to reflect and to realize the personal values that constitute their well-being (Sylvester, 1992).

Leisure is a Human Right

Leisure is among a new generation of human rights. Like other rights, awareness and acceptance of the right to leisure will require time… It will necessitate individuals sufficiently courageous to challenge the status quo. Serious consideration of the right to leisure, moreover, will call for reform in therapeutic recreation. What calling the field of therapeutic recreation ultimately chooses to hear, however, and how well it responds, remains to be seen. History will be our judge, as time will either tell on us or about us (Sylvester, 1992).

We must reach beyond therapy and diversion and embrace leisure (Carson, 2013).

Leisure...is the celebration of freedom at its crowning point (Sylvester, 1987, p.81).

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Part 6: Living and Celebrating Life through Leisure Project

The Living and Celebrating Life through Leisure project is a Participatory Action Research Project. Using an Authentic Partnerships approach we brought together persons living with dementia from the John Noble Home Day and Stay Lead Program,  family care partners, recreation professionals from a range of settings including community, day programs, and long-term care homes, Alzheimer Society staff, and researchers. We worked together to consider the notion of leisure and its meanings for persons with dementia, LTC, the Alzheimer's society and researchers from the Murray Alzheimer Research and Education Project, Brock University, and the University of Waterloo.

One important tool emerging from this project is the Photographic Discussion Guide.  This guide is an invaluable tool for recreation professionals to work with persons living with dementia to find out what sort of leisure experience is important to their needs, history and desires. 

Information on how to access the Photographic Discussion guide will be posted soon!

Below is a short video explaining Authentic Partnerships and their value in working to enhance care for persons living with dementia.

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Part 7: Consider New Possibilities

In this part of the intensive, the group is asked to think about what an ideal future for leisure might look like through discussion and small group exercises.

Together with the group, consider what would it mean if we did things differently, thought about leisure differently? What would be the possibilities of leisure? Use the chart below to guide your discussion.

New Possibilities
From and Emphasis on   To an Emphasis on
Assessment as a One-Way process to Dialogue- and Relationship-Centered 'Getting to Know Each Other'

Functional Domains

(cognitive,physical, social, emotional, spiritual,psychological)

to Valued Leisure Experiences
Functional Limitations to Abilities, talents, gifts, aspirations
Activity Interests to Knowing the Whole Person
Diversional or Therapeutic to

Meaningful engagement

Complete Small Group Exercise #6, participate in Dot-mocracy and complete Small Group Exercise #7 below.

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After Exercise #6 is complete participate in a 'Dot-mocracy' exercise:

  1. Take five minutes and circulate among the new possibility themes generated during exercise #6.
  2. Choose the new possibility or possibilities for leisure that energise you the most.
  3. Place your three ‘sticky dots’ beside your favourite new possibilities – you can put all dots on one or beside three separate ones
  4. Depending on the number of small groups, choose the themes with the most votes, and complete Small Group Exercise #7, below.

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Moving Forward

In this final section of the intensive, participants are asked to set goals about how they will support meaningful leisure in the future.  Ask the group to use the handout below to complete the following sentence:

In order to support the meaningful leisure experiences of those with whom I work, I plan to...

References

Brown, S. (2009). Play: How it shapes the brain, opens the imagination, and invigorates the soul. New York, NY: Penguin Group.

Canadian Therapeutic Recreation Association(2013). About CTRA. Retrieved from http://www.canadian-tr.org/About 

Bernstein, M. (2002). 10 tips on writing the living Web. A List Apart: For People Who Make Websites, 149. Retrieved from http://www.alistapart.com/articles/writeliving

Sylvester,C. (1987). Therapeutic recreations and the end of leisure. Philosophy of Therapeutic Recreation, 1,76-89.

For more information on any of the PiDC Alliance initiatives, contact Sian Lockwood, Knowledge Translation Specialist.

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