WHY LEISURE?
OT practitioners often use supplemental modalities such as heat, ultrasound, or exercise activities to improve the quality of a client's therapy outcomes. There is a large body of research that supports the many benefits of leisure, so why not use it as a therapeutic modality?
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The Research - Kuykendall, Tay, and Ng (2015)
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A meta-analysis was performed to evaluate the relationship between leisure participation and subjective well-being. Those who participated in more leisure reported statistically significant higher well-being than those who participated in less leisure. In addition, participants who were satisfied with their leisure participation and who were part of the retired population were more likely to have improved overall well-being.
If leisure participation has the potential to improve the overall well-being of residents in SNFs, why would we not use such an effective tool?
THE PROBLEM:
OCCUPATIONAL DEPRIVATION
Older adults living in SNFs are at a high risk for occupational deprivation. Occupational deprivation is a state in which people are hindered from engaging in meaningful occupations due to factors outside of their control (Whiteford, 2000). Most residents in SNFs would like to maintain their previous leisure participation, but are not given the opportunities or support they need to engage in leisure activities (Causy-Upton, 2015; O'Sullivan & Hocking, 2013).
Although many SNFs offer activity programs, residents are unable to choose which activities take place, therefore challenging their personal autonomy. Occupational deprivation is negatively impacting the physical, mental, and emotional well-being of residents in SNFs.
THE FACTS:
BENEFITS OF LEISURE
The literature demonstrates the many benefits of leisure participation for older adults in SNFs. Listed below are some of the most significant benefits.
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Sources: Causey-Upton, 2015; Janssen & Grabanski, 2019; Kuykendall et al., 2015; Lee & Hwang, 2018; Lipovcan et al., 2018; Newman et al., 2014; Rousseau & Vallerand, 2008; Schenk, Meyer, Behr, Kuhlmey, & Holzhausen, 2013; Schulz, Schulte, Raube, Disouky, & Kandler, 2018; Simone & Haas, 2013; Watters, Pearce, Backman, & Suto, 2013
ENHANCED COGNITIVE, PHYSICAL, AND MENTAL HEALTH
OPPORTUNITY FOR POSITIVE SOCIAL INTERACTIONS
FIND MEANING, IDENTITY, AND BELONGING
SENSE OF PERSONAL CHOICE AND CONTROL
INCREASED LIFE SATISFACTION
FEELINGS OF COMPETENCE AND PURPOSE
PERSONAL ENRICHMENT AND SELF-EXPRESSION
FULFILL A VARIETY OF OCCUPATIONAL ROLES
OCCUPATIONAL THERAPY'S ROLE
What makes occupational therapists uniquely equipped to address leisure with older adults in SNFs?
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- We specialize in helping people engage in personally meaningful activities.
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- We view clients holistically, including physical, mental, emotional, cognitive, and social health. Leisure addresses all of these areas.
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- We provide creative, occupation-based interventions, and leisure is an area of occupation.
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- We are trained to adapt and modify activities based on individual abilities. Leisure activities are some of the most diverse and adaptable activities.
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- We are an evidence-based profession, and there is a large body of evidence that indicates the overall benefits of leisure for health and well-being.
BARRIERS TO OCCUPATION-BASED INTERVENTION
Many barriers to client-centered and occupation-based intervention (OBI) have been identified in the literature (AOTA, 2019b; Asaba, Nakamura, Asaba, & Kottorp, 2017; Bekhet & Zauszniewski, 2014; Reynolds, Volkmer, Jewell, & Russell, 2019; Che Daud et al., 2016).
Work Culture
Some work cultures are not supportive of OT practitioners who are striving to incorporate occupation-based, client-centered practice.
Client Factors
​Residents in SNFs often do not understand the role of OT or the value of meaningful therapy tasks. Some residents may wish to rest or take part in facility activities instead of engaging in OT sessions. Pain and fatigue can discourage residents from participating in OT sessions.
Habits
OT practitioners are more likely to implement interventions they are comfortable using. Being in the habit of using the same assessments and interventions is a major barrier to occupation-based intervention.
Productivity Demands
OT practitioners are expected to meet high productivity standards, which creates a scarcity of time. This results in OT practitioners being discouraged from taking the time to plan and implement client-centered, occupation-based interventions.
Lack of Funding and Resources
Many SNF therapy departments have limited funding. Although it would be ideal to have therapy spaces to practice everyday occupations, these spaces are very expensive to create.
Blurred Professional Boundaries
OT practitioners use a comprehensive approach to assess clients and design interventions. However, some interventions may appear to be similar in scope to recreational therapy. Despite the amount of complex planning put into these interventions, the blurred lines between these professions may create confusion about the unique value of OT.
Lack of Confidence
Occupation-based intervention is taught in professional programs, but many OT practitioners are trained during fieldwork to focus on a person's diagnosis rather than a client's interests, motivations, and goals. This decreases their confidence with occupation-based intervention.
Reimbursement
Many OT practitioners do not think they can be reimbursed for occupation-based intervention. OT practitioners are often compelled to bill for high volumes of treatment time rather than justifying OBI in their documentation.
Multidisciplinary Knowledge
Team members from other disciplines may not know the value of meaningful occupations. This results in a lack of support for OBI and a lack of referrals to OT services.
We would like to acknowledge that we believe OT practitioners have the best of intentions, but not always the best circumstances available. We understand that these barriers may make it very difficult to implement client-centered, occupation-based interventions. We encourage you to explore the rest of our website for insights and information regarding creative ways to use leisure as a therapeutic modality!
