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My dad was born in June 1928 as part of the Greatest Generation, enlisting in the U.S. Army upon graduating from high school. He was stationed in Italy during the cessation of hostilities and still talks about his two years of service as though it were yesterday.
Dad raised our family in a suburb of Buffalo, NY, where he worked as an industrial engineer in various manufacturing settings. He helped me with my Sunday morning paper route, taught my sisters and me how to ski during our long winters, and drove us to the beach in the idyllic summers of western New York state. We all hold these memories close to our hearts.
My parents eventually became snowbirds, shuffling seasonally to the west coast of Florida. With the passing of my mom fifteen years ago, my two sisters and I were aware of the statistic that, after the loss of a long-time spouse, the life span of the remaining person averages two years. Thus, we supported Dad when he settled into a small house in an age-restricted community with the intention that he would continue to live a meaningful life with maximum independence.
Dad beat the odds and enjoyed an active single life in Florida for over a decade. Then the COVID-19 pandemic descended upon us. This disrupted our schedule of monthly visits and severely curtailed my dad’s social routine of dining out and tri-weekly trips to walk on the treadmill at the fitness center.
The Pandemic and the Activities Profession
At the same time, as the CEO of the National Certification Council for Activity Professionals (NCCAP), I heard horror stories from our members about the severe impact of COVID-19 on older adults. These stories were driven in large part by the limitations imposed for infection control. Isolation, loneliness, and depression, along with increased mortality, were spiking.
Like all long-term care staff, activity professionals were affected by the pandemic. They faced limitations on group activities and social gatherings; most programs were curtailed. However, the Centers for Medicare & Medicaid Services never suspended the requirements of F679: that activity professionals provide an ongoing program to meet the physical, mental, and psychosocial well-being of each resident.
While serving on the front line of the pandemic, individuals who were accustomed to caring only for the psychosocial well-being of elders were now required to don personal protective equipment. Many were assigned new and unfamiliar tasks, such as communicating the final goodbye of a dying resident with family members via Zoom or FaceTime. Like other providers of care, many activities staff chose to retire or quit when the demands of overtime and the stress became unbearable; others would die from COVID-19 themselves.
To support our members, NCCAP promoted a variety of adaptations created by activity professionals. This included programs such as hallway bingo, room-based sing-alongs, and carts laden with various one-on-one activities. We even had a video go viral on how to deliver activities into the room of a resident using the internal cable TV system.
The pandemic also allowed us the opportunity to introduce care planning that integrates both clinical and social care. For example, Dr. Steven Buslovich, a New York–based geriatrician, medical director, and advisor to NCCAP, uses what he calls “behavior rounding.” In addition to medical care, he includes music therapy, pet therapy, and life-enriching activities in care planning that have been shown to reduce agitation and anxiety. Most significantly, these nonpharmacological interventions have resulted in his communities using less than half of the New York state average and less than a third the national average of psychotropic drugs (KaleidaHealth, “Medical Minute: Behavior Rounding,” Feb. 2019, https://bit.ly/3EYwMwq).
Caring for My Dad
I looked to my profession for guidance on the long-distance care of my dad during the pandemic. I wanted to know what was the best way we could remotely support him in activities of his choosing that would encourage his independence and ensure he continued to live a meaningful life.
My dad fiercely defends his identity and autonomy, which are two important aspects of wellness. When the Florida Veteran’s Affairs (VA) announced that veterans over 65 years would soon receive the COVID-19 vaccine, my dad wrote letters to the state governor and the VA medical director advising that vaccines be distributed based on date of birth. He quipped, “Why should a 92-year-old have to get in line behind young 60-year-olds?” He considered his letter writing a victory when he was grouped with a cohort of 20 veterans aged 85 years and older. He was even more proud of the fact that he was the only one who did not need assistance walking to get his vaccine.
Fast forward two years into the pandemic: my dad developed neuropathy in his lower legs requiring the use of a walker. He directly blames the need for his walker on COVID-19 shutting down his access to his treadmill at the fitness center. After several falls, it was no longer safe for him to age in place at home. I am fortunate that our family agreed on a plan of care in advance, and he now lives with my younger sister and her family. At the same time, we witnessed him experience sadness and disappointment when he had to transition out of his home and choose what few belongings he could take with him.
Fortunately, I was again able to draw on the wealth of experience within NCCAP. We have a collection of spirited members who have spent decades applying resident-directed, person-centered care across long-term care settings. Motivated by a calling to serve others, many activity professionals use our Modular Education Program for Activity Professionals as a guide for life-enriching activity programming (Activity Advisor, MEPAP, https://bit.ly/3SJHhYq). The pandemic afforded NCCAP the opportunity to update our certification curriculum with best practices that address isolation and psychosocial well-being.
Our family has been able to introduce many effective approaches learned from my work with activity professionals. These include the practical application of the person-centered principles of Pioneer Network, specifically to recognize each individual’s preferences. We especially encourage my dad to maintain his long-time friendships, and we ensure his living environment supports his needs. His mental acuity remains strong, mostly through his voracious reading of history books, doing crossword puzzles, speaking to his few remaining friends, watching Jeopardy, and video calling his grandkids and great-grandkids.
At the end of the day, we know it’s up to him to engage in activities of his choosing. He obviously has his own reasons to stay motivated, taking his daily laps around the house with his walker and performing his seated physical therapy with stretch bands and free weights. He is still the active dad who taught me to ski. Recently, we expressed our concern that he often seems to be in a rush. He winked at us and replied, “At 94, every minute counts.”