By Emily Good, MS, OTR/L, LSVT‑BIG Certified
Occupational Therapist
Pennsylvania Central3

It can be difficult to come up with meaningful occupations to use with our patients who live in a Senior Living Community (SLC). Meaningful occupations are essential to what we do as occupational therapists and how we serve our patients on a daily basis. We do our patients a disservice when we do not help them to find those meaningful occupations as they age. Many times our patients become trapped in feeling like there is nothing meaningful about their lives any longer and nothing important for them to do once they move into an SLC. It is our job as clinicians to encourage them and help facilitate the engagement of meaningful occupations again both on a daily basis and during our treatment sessions. 

Engaging in meaningful occupations is how our patients achieve health and well-being and participate in life. This engagement is the best description of the domain, process and core of occupational therapy. As occupational therapists, we believe that engaging in meaningful occupations promotes, facilitates, supports, and maintains health and participation in daily activities. The focus of occupational therapy intervention is to create and facilitate engagement in meaningful occupations that lead to participation in daily life activities and situations.

The Occupational Therapy Practice Framework identifies occupations as activities of daily living, instrumental activities of daily living, rest and sleep, education, work, play, leisure, and social participation. As therapists, it is our responsibility to dig into our patients’ pasts and find out what is meaningful to them. 

How to Identify Meaningful Occupations for SLC Residents

While creating our patients’ occupational profiles, we can identify meaningful occupations. Start by asking our patients and their caregivers or family about their past profession, hobbies, how they spent their time, what they enjoy engaging in now, and who or what is important to them. 

There are a few assessments from the Model of Human Occupation (MOHO) that can be used to assist in this process and help you gather information to make your treatment sessions as meaningful as possible to your patients. 

Frame of Practice

MOHO is a frame of practice that explains how each individual’s occupational engagement is motivated, patterned, and performed. MOHO assesses the person’s volition, habituation, and performance capacity. 

Volition is the individual’s motivation behind occupations, habituation refers to the patterns and routines that the individual’s occupations are organized into, and performance capacity is the individual’s physical and mental abilities that entail his/her occupational performance. Within MOHO, understanding the physical and social environments in which the individual is a part, aids in the understanding of the human occupation.

Assessment Tools

Sometimes it is difficult for our patients living in SLCs to feel that they can do anything meaningful anymore. There are many tools and assessments that can be utilized to aid in determining what is or was meaningful to your patients that will guide you in your endeavor to find meaningful occupations to engage them in during treatment sessions. MOHO provides many free resources to use.

The Interest Checklist is one of the easiest to use and find online. This checklist gives you a variety of information and looks at the individual’s level of interest in both the past ten years and in the past year. This provides information about past occupations and current. It also asks if the individual currently participates in the activity and if it is an activity that he would like to pursue in the future. 

There are 68 items including activities indoors and outdoors. The following are a few of the activities listed on the assessment: 

• Gardening and yard work
• Playing games
• Writing
• Dancing
• Engaging in holiday activities
• Watching TV or listening to music
• Housekeeping and cleaning
• Arts and crafts
• Singing
• Bird watching
• Exercise
• Woodworking
• Sports
• Academics
• Religious activities
• Photography   

Since the time of COVID-19, MOHO has adapted and created the Socially Distanced Leisure Interest Checklist. This checklist focuses on the individual’s level of interest and participation in each activity. There are a total of 11 categories which include:

• Indoor and outdoor health and fitness
• Creative activities
• Productive activities
• Solo leisure activities
• Computer games
• Activities to do with friends and family indoors and outdoors
• Socially distanced entertainment activities in the home and outdoors
• Educational activities. 

Some of these activities may be more suited to a younger demographic, but the tool can still be helpful in identifying what your patients find meaningful. 

Meaningful Occupations and Activities

When thinking about engaging patients that live in an SLC, it is important to take their environment into consideration. What physical aspects of their environment encourage engagement and what aspects hinder it? What social aspects of their environment encourage or hinder their engagement? What personal factors impact their engagement? 

Be sure to utilize the resources available. Talking with the activities staff can aid in creating opportunities for not only our patients but all the residents in the SLC. An individual’s performance patterns (i.e. habits, routines, roles, and rituals) must also be considered.

Activities to Use as Potential Meaningful Occupations Within an SLC

The list of activities below can be utilized to help find meaningful activities with your patients. When considering which activities to use, be sure to consider the patient’s performance skills, such as motor skills, process skills, and social interaction skills, as well as the individual’s client factors, including values, beliefs, spirituality, body functions, and body structures. 

These areas will also aid in documenting the benefits of each activity and why it is meaningful to the patient. 

• Attending planned activities within the SLC to assist the patient in social interaction and engagement in the activity. 
• Provide the patient with materials needed to engage in cleaning their room, if they are safe (dusting materials, broom to sweep, cleaning wipes to clean the bathroom, etc). 
• Making a birdhouse or other small woodworking project (many easy kits can be found at your local craft store) 
• Sewing, crocheting, or knitting can provide increased sense of purpose by making something for a family member or friend, or donating to a local organization or hospital 
• If there is space in the SLC where the patient can use a kitchen or kitchenette and the patient is safe using these areas, baking or cooking with them. Create a small meal for them to share with family coming to visit or bake cookies to share with other residents. If no kitchen is available, use recipes that do not require any baking (i.e. no-bake cookies or desserts)
• If physical activity is something they enjoy, engage them in yoga, chair yoga, or walking activity. Have them keep track of their steps and set a challenge with a prize to “win” once they hit so many steps. Make a scavenger hunt for them to find certain items around the SLC, or enjoy a walk outside while picking up trash/litter on the property, naming flowers, or identifying other objects they see or noises they hear.
• If they used to enjoy grocery shopping, set up a small grocery store inside their room or another area of the SLC. You can incorporate money management into this task, and address many different areas. 
• If there are laundry machines accessible, assist the patient with completing laundry tasks or folding laundry and putting it away, or helping to organize a linen closet in the therapy gym.
• If the patient enjoys crafts, make wreaths to share or sell, cards for family at holidays and birthdays, a sign for their room door, jewelry to share with others, pictures to hang, and coloring pages (these can be framed and hung in their room), make gifts for their grandchildren, paint rocks for a garden, etc. 
• If the patient likes to play games or activities more on their own, engage them in putting puzzles together, teaching them to play solitaire, collecting different items/souvenirs, etc.
• Find out what the patient used to do for work and incorporate this into a therapeutic activity 

Activities to Engage Patients who Live in a Memory Care Unit

These activities can also be utilized with patients living in an SLC, but can easily be graded up or down to challenge each patient appropriately. 

• Stuffing envelopes with newsletters or putting stamps on envelopes 
• Washing tables or dishes 
• Dusting
• Putting away laundry, helping fold towels, sorting colorful socks
• Gardening (pulling weeds)
• Trying to see how many different plants and flowers are outside
• Checking walking paths for sticks/leaves or counting bricks on the patio or buds on a bush
• Sorting sugar/Splenda/tea bags/hot cocoa packets or desk supplies (rubber bands, paperclips, etc) 
• Putting cute erasers on top of pencils
• Filling pencil cases w/ predetermined amounts of items (2 pencils, 3 crayons, a rubber band)
• Organizing file folders alphabetically 
• Separating deck of cards by suits or putting them in number order or color
• Playing music from their era and asking if they want to dance
• At Easter time have the patients sort plastic eggs by color or help you fill them with items 
• Making pasta or large bead necklaces 
• Using a fabric box with lots of different types of fabric-silk, lace, felt, velvet, wool, acrylic, etc, -they can touch, feel, fold, and sort by color
• Beach ball-they can sit and kick it, roll it, toss it, etc. 
• Matching game-simple, using shapes or pictures to combine sensory stimulation and thinking skills
• Enlarge a picture of something the patient enjoys or himself, laminate it, cut it into 4-10 pieces, and have them put the puzzle together. 
• Sanding a piece of wood 
• Arranging pots and pans on a shelf
• Decorating cupcakes or cookies 
• Helping to wrap gifts, fill gift bags, or place bows on packages 
• Creating a fishing game with pool noodles and zip ties 

The challenge is set. How will you begin to engage your patients in meaningful occupations? One of my favorite activities I’ve used is a hunting game. My patient was an avid hunter. Using a Nerf gun and little army men and other targets, we created a “shooting range.” He really enjoyed this activity. I was able to grade the activity to increase the difficulty by changing the surface he was standing on, being stationary versus mobile, putting weights on his arms, and placing the targets at different heights and distances. He found great satisfaction from the activity, demonstrated improvements in balance, strength, posture, and coordination, and was asked to complete the activity in future sessions. 

When we engage our patients in activities that are meaningful to them, everyone benefits and has more fun during the treatment session.