Family and staff perceptions of the impact of the long-term care environment on leisure

Alzheimer's disease is a debilitating disease affecting the brain, including emotions, judgment, information processing, memory, and the ability to learn. As the disease progresses, simple activities of daily living become more and more difficult. Alzheimer's disease is one of the most common reasons for institutionalization among older adults. The transition from a home to a long-term care facility has the potential to decrease functioning ability; however, leisure activities are an aspect of resident care that is used to promote an enhanced quality of life. The purpose of this study was to investigate how the institutional environment impacts leisure opportunities and choices of individuals with Alzheimer's disease in a long-term care facility, from the perspectives of staff members and family caregivers. Self-contained focus groups were utilized for this study. This type of focus group provides very rich data that can be useful without reliance on other methods. This study used a semistructured approach for conducting focus groups and the interview guides contained broad questions that attempted to elicit information about the impacts of the environment on leisure. The questions focused on physical, social, and psychological influences in the environment that impacted on leisure involvement. Thirteen individuals who met the predetermined criteria were contacted to participate in the research study. Ten individuals participated in the study: 5 family caregivers and 5 staff members. The following themes represented the issues that were relevant to leisure involvement from the perspective of the family members: Lack of staff, family involvement, concerns for well-being of loved one, physical environment, and opportunity for leisure was limited. The following themes represented the staff members' voices from this study: Staff-related issues, environmental issues, discrimination of individuals with Alzheimer's disease, and lack of family support and education. The findings in this study were examined from an ecological perspective in which the long-term care environment was categorized into the microsystem, mesosystem, exosystem, and macrosystem. Most of the findings related to the microsystem and mesosystem, or the immediate environment, which can be somewhat controlled by the participants. Although there were learnings at other layers, such as the macrosystem and exosystem, individuals in this study had little control over these layers of the environment, but collectively they may be able to initiate wider changes. The learnings that emerged from this study could potentially improve the long-term care environment, which addressed some of the issues identified by the participants. Increasing communication through the collaboration of staff members and family caregivers at the facility was an important learning that addressed some of the issues identified by participants. Family caregivers voiced concerns about the staff members not being knowledgeable about their loved one's past, or taking time to find out what the individual was interested in. Communication among all parties involved will be very beneficial to aid in enhancing the microsystem, where most of the issues developed, to make the environment more conducive to leisure. The therapeutic recreation professional should provide leisure education to staff and family members, as well as provide tools and resources to both family and staff members to assist in enhancing involvement in leisure in residents with Alzheimer's disease.