That’s Not Appropriate
By Debbie Hommel, ACC/MC/EDU, CTRS
One of the programs I led every day, as a new activity assistant, was morning exercise. I was given a Polka-Robics record to use for the program. (For those of you not born in archaic times – records or albums were plastic discs you used with a record player, and it played music.) I played the Polka-Robics record daily, along with some other exercise records in the department. One day, with the desire to make things more interesting, I decided to play different music. At the time, Disco was popular, and I brought in my Saturday Night Fever album. I explained to the residents that we were going to try something new and hoped they did not mind if we did not use the Polka-Robics album. Surprisingly, several of the residents clapped. I did not realize they were as tired of the Polka-Robics as I was. I proceeded to play “Night Fever” as it had a good beat and I had strategized some movement routines the night before.
As I began to play the song and introduce the routine, the residents immediately started moving in their seats. They followed my movements and a few even suggested a movement or two as we laughed and enjoyed the change of pace. At one point, the administrator was walking down the hall and heard the music playing loudly. She stood in the doorway of our room and did not say a word. Her face said it all. After she left, one of the residents said to me “You’re in trouble”.
Later that day, my director asked me to come to the office. I was written up for conducting “inappropriate” activities using my music choice. I explained how the residents were tired of Polka- Robics. I mentioned how the director always told me to “make the activities interesting”. I told her how much fun the residents had and some residents who rarely move, were moving to the music. The director repeated several times “that’s not appropriate”. The next day, we were back to Polka-Robics. A few residents did ask for that “new” music which I sadly told them we were not permitted to use.
It is not uncommon for people to label an activity, an intervention or an approach as “inappropriate”. Who is the final authority on appropriateness? How do we determine if an approach is appropriate or inappropriate? One definition of “appropriate” is that the item or approach is suitable or fitting for a person, purpose or occasion. How do we determine if something is suitable or fitting? It all comes back to person centered care. The person determines the appropriateness of the approach. The Federal regulations adopted this philosophy when they changed the term “age-appropriate” to “person-appropriate”. At one time, it was considered “inappropriate” to provide a person living with dementia a baby doll. It was perceived as treating the person as a child which impacted negatively on their dignity. Over time, it was realized that this intervention is effective with certain individuals who may be time disoriented. We have all seen the positive outcomes gained with proper implementation of a life like baby doll. It eases anxiety, generates reminiscing and engages the person in a past life role. The individualized approach and positive outcomes define this approach as “person appropriate”.
The person, their needs and response to the intervention classifies the appropriateness or inappropriateness of the approach. Conducting an individualized assessment enables defining and understanding the needs of each person. Maintaining the person’s dignity is also an important contributor to an appropriate approach. Staff may think they know what is appropriate but if the person is unaware of what is occurring and cannot be part of the decision, it leans toward an inappropriate approach. Dressing up for Halloween is a good example of determining appropriate vs. inappropriate. Some may think an 80-year-old person in a Halloween costume is inappropriate. However, if this 80-year-old person is part of the decision and wants to wear a witch’s hat, it is appropriate for that person. If the 80-year-old person is dressed in a Halloween costume without any awareness or being part in the decision, that is inappropriate.
Our profession has come a long way since my days of playing Polka-Robics records on a record player. When I first began my career in activities, we were confined to a very small appropriate box. There were clear lines defining appropriate versus inappropriate activities. Today, the activity profession has exploded out of the appropriate box. In some cases, it seems like anything goes. Slip and Slide, Glow Bingo, Foam Parties, Nerf Gun Target Shoot, and older adults on Tik Tok are just a few of the creative interventions being implemented. There remain some naysayers, concerned about safety and “appropriateness” of these activities. The smiles, the laughter and eager engagement demonstrated by participants proves otherwise. The activity profession provides opportunities to continue living life to the fullest. We are able to create these opportunities through individualized assessment and adapting approaches to the remaining strengths and abilities of the person.
Going back to my Dance Fever exercise group, the positive, active physical and emotional response to the music was the indicator that the music was appropriate. After that administrator left and I was promoted to Director (even though I had one disciplinary action in my file), one of the first things I did was to get rid of that Polka-Robics record. I am thankful for how far our profession has come and we now practice the mantra “age is just a number” every day.