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Imagine an activites room in a skilled nursing care center, and the typical scenes of Bingo, painting, and trivia come to mind. Those activities often involve a large group of residents, and those who are engaged are often alert and oriented.

 

Now imagine the residents who are not engaged. Some may just be uninterested in the activity, but others in this group may be residents who are not alert and oriented. In reality, these residents may be attached to a ventilator, and they present a set of physical and cognitive challenges that make it nearly impossible for them to engage not just in any activities setting, but in everyday life.

The Progressive Pulmonary Care Unit Quality of Life Program at FutureCare, which operates skilled nursing and rehabilitation centers in Maryland, aims to change that. More than just an activities program for residents with ventilators or tracheostomy tubes, it is a part of the healing process.

Farah Elvard is a registered respiratory therapist and director of respiratory therapy at FutureCare Homewood in Baltimore. After working on a ventilator unit in New York City and seeing the benefits firsthand, she came to FutureCare Homewood in 2007.

“We believe in telling every single person that there’s always a chance that we can wean them off the ventilator,” she says. “And we have really great outcomes on the unit that we are proud of.”

An important part of the weaning process, she says, is the activities program that comes with the Progressive Pulmonary Care Unit Quality of Life Program. It takes place for one hour three days a week, typically on Monday, Wednesday, and Friday, says Elvard. With ventilator units in tow, residents are brought in from their rooms to the activities area to participate in group and one-on-one activities.

Residents are broken into two groups. The first group is the center’s alert and oriented residents with ventilators or tracheostomy tubes. They can communicate and physically and functionally perform a task. 

They adhere to physical and cognitive functioning, and they often benefit from advanced activities.

Group two includes residents who are not alert or oriented and are unable to communicate their needs.

They are largely unresponsive to the calls of staff and others, and activities for this group enhance residents’ physical and cognitive abilities.

Sensory stimulation, textile stimulation, and music therapy are the programs used to enhance the physical and cognitive abilities of group two residents, says Christina Beadenkopf, director of activities at FutureCare Capitol Region in Landover, Md. Beadenkopf led the activities for the residents at FutureCare Homewood. She is preparing to launch the program at the Capitol Region location.

“The first group consists of residents throwing balls, dancing, coloring, and making decisions,” she says. 

“With the second group, you have to pay attention to their facial expressions, their breathing, why their body tenses up, etc.”

Brushing, she says, is one activity that can bring about this type of reaction in the second group. The activity consists of taking a soft bristle brush such as a paint or makeup brush and lightly brushing the resident’s skin. “You then watch their facial expressions,” Beadenkopf says. “Watch them squint their eyes or tense their movements.”

This small reaction could be a first step to enhancing the resident’s physical and cognitive abilities. “We want them to go off of the ventilator, that is our goal,” she says. “A way to work at that is if a resident is enhanced on a constant basis, and we help them train their mind to remember things by doing them over and over again.”

Teamwork is the key ingredient, says Elvard. “It’s not a one-person thing that makes this happen,” she says. “It takes the whole effort of the team.”

Just getting the residents to the program three days a week is a large coordinated effort from start to finish.

“It’s a big coordination between nursing and respiratory,” she says. “We have to make sure that everybody on the vent unit has received their morning care and medications, and coordinating with the other activities of the day, like showering, is important.”

Once the patient is ready to attend the program, the respiratory therapist is responsible for moving the patient from their room to the activities room, and they remain present for the duration of the program.

“The respiratory therapist is there to ensure that if someone needs to be suctioned then they are suctioned,” Elvard says. “Or if something is wrong with the vent, it is managed and addressed immediately.” Other staff in the room include the activities assistant. 

Once the activities have concluded, the respiratory therapist will send a text message to other therapy staff and nurse assistants, who help transport residents back to their rooms.

“You just have to be ready,” says Elvard. “We generate a schedule monthly, and we give one to activities, nursing has one, and we keep one in the respiratory office for staff. Everyone knows who goes out on this day, and we work together to make it happen.”

Success can be measured in a number of ways, says Elvard. “It’s if you’re in the group that’s not showing any alertness, and eventually we see that you’re actually moving to the music that’s playing. It’s when we speak to you, you’re starting to track. It’s when we say something funny and you’re starting to smile, there’s definitely a change.

“We’re dealing with vent patients, and that’s a big deal,” says Elvard. “Many long term care centers do not have ventilator units.”

The sensory stimulation from the program is just one of many things that contribute to the patient’s success and eventual weaning, says Elvard. Staff in other departments continue to reevaluate residents based on their evolving progress toward building endurance in their lungs.

“Can we give all the credit to activities?” says Elvard. “No. But it plays a major role—no ifs, ands, or buts about it—because you’re constantly stimulating these patients.”

Beadenkopf recalls a resident with a brain injury. After speaking with the resident’s sister, she found out the resident liked to listen to James Brown, so she started to play his music for her.

“Over time, I noticed her foot was moving when I played the song,” she says. As she became stronger, staff began to wean her off the ventilator.

“We saw she was starting to get better,” says Elvard. “A few minutes off the ventilator without having any issues, so she was getting stronger in that sense, and she was getting some type of rehab in the manipulation of her extremities.”

Eventually, the resident joined the larger group and was in a wheelchair, pushing herself down the hallway. She was eating food, and later, with the help of Elvard, she was able to attend the funeral of her sister.

“You have to believe in this program for it to work,” says Elvard. “We’ve had residents who were completely comatose, who are now playing Bingo and playing cards. Even though a resident may be comatose, they may still be able to hear, smell, and have a sense of touch. They’re with us.”