The Downside of Dimensions of Wellness and Participation Data in Senior Living

The current senior living engagement model mirrors the work originating in 1976 by Dr. Bill Hettler where he focused on six dimensions: emotional, occupational, physical, social, intellectual and spiritual. 

As we have said many times, this theoretical model does in fact serve as a guide for programming specialists to plan and create a well-rounded understanding that we are complex, individualistic, holistic people and one size will not fit all. Recognizing the concept of the dimensions, ranging from 4-8 dimensions is helpful, but it cannot be our only strategy.

Why? 

This article is not about trying to disprove the efficacy of a wellness model, rather illustrate the potential confusion and undue complexity resulting in tech based solutions and resources potentially reporting invalid, unreliable, and inconsistent data. Let’s keep this simple and look at the process that leads to the problem.

An engagement professional sits down to create the monthly calendar. What old things will I keep and continue, what new things will I add? Every month, this is the drill.

The Activity Planning Conversation:

If it occurs everyday at the same time, should it go on the calendar? Not sure…Hmmm, if I do not put it on the calendar will one person forget that we have Coffee and Newspaper club at 8am every morning? I better keep it. Besides we are short on staff and the calendar seems bare. This will help to meet the required six activities for the day.

Next, I need to pick a dimension. I somewhat understand the dimensions from onboarding documents. The platform is telling me to pick one from the drop down. Coffee and Newspaper, I think it could fit in one of these listed below: 

Social

Intellectual

Personal

Entertainment

Snack

Three definitely fit, but what is it really? I think intellectual…but there are people who do not read and actually just talk, so perhaps that is social. And some just come for the coffee or show up when we decide to add some donuts, so that is a snack. Maybe it is all three. Maybe I should select two. Okay social and intellectual it is. Oh wait, I can give a percentage to each, like primary and secondary. That’s kind of cool. Let’s do 60/40. But wait, some come and sit outside the group and read their own paper and never talk, just drink the coffee. That makes it personal.

BAM! Added to the calendar! Once the activity is completed I log my nine attending participants. Next, check their involvement level, if I want to. Engaged, passive, rejected, no answer. Great, moving on. While watching, people appeared to be engaged. I think. But what is the threshold for engaged vs passive? 

I realize next month when planning the activity it is mostly social because few read, just converse. I continue to collect data on people that attend. However, the data is compromised and does not match the original data. All we know is that residents do something, but not certain from a longitudinal view.

A new engagement professional starts. They review the calendar and put their own philosophy in action. Reading and learning is intellectual. Personal bias and experiential decision making come into play with every different person performing the job causing variation in one’s interpretation of the dimensions of wellness. The concern is these dimensions are not locked down in the platforms

P.S. Management…this is why making the calendar takes longer than you think. It’s overly complex for a seemingly simple task.

One thing we know is accurate, based on memory or a list, is who attended. Best case scenario. We can identify if this event/activity is “successful” by desire and participation. But, we do not know why people attend, or keep coming back. If we look at their profile we see the only thing Ms. Jones attends all week is Coffee and Newspaper.  She is excelling 100% at whatever we categorized the activity. We may report to her family, discuss in meetings and determine she is highly engaged socially, but the other five, six or seven dimensions are not represented. Maybe we should ask her to come to exercise. Scenario # 2 - Ms. Jones' apartment is the farthest from where the event takes place. She does this every morning to ensure she gets in her daily walk, but we don’t know that. Her motivation is physical wellness.

Moral of the Story - Every activity is a personal decision and experience for the person in attendance. Why do we believe we should determine what label we give that person for attending? 

Have You Heard the Saying “Bad Data is Worse than No Data”? 

Engagement is the most nebulous, ambiguous department in senior living. Decisions are often made on emotions, assumptions and stories. When we make decisions and they fail (totally fine) or succeed, we lack concrete data to determine the why? It is almost impossible in a non-controlled environment to create standardization when using the dimensions of wellness in programming. 

Why? 

Because we do not have an industry standard. Whereas operations, sales, dining, and maintenance are different. A meal served is a meal served. Inventory ordered vs inventory left is quantifiable. A move-in is a move-in and a move-out is a move-out. Overtime hours are overtime hours. Turnover is a whole number that you can calculate longitudinally. A role vacates, you have an open position. It does not matter the why (unless promotion is a variable that you do not count against). A room/apartment turn is a dollar and time expense. A toilet replacement takes 1 hour and the cost of the toilet is X. 

Should we completely move away from dimensions of wellness? Not exactly, but we are urging you to pull your participation reports in your platforms by activity, attended, non-attended, and labeled dimension. If you are not comfortable with Excel or reports, ask your platform/provider to send it electronically, and then give it to someone in your finance department to review.

Look at the mean participation at community and enterprise level? Are you satisfied with that number? What should it be? Are there multiple activities with the exact same name that fall under different dimensions? Are there activities still on the calendar every month that have zero attendance? What does this do to your average attendance (mean)? What can you phase out, or report better on? How many people attending are the same 15 residents skewing your data? Break down total attendance by individual residents. Who did not attend anything this month? That is your exception. Go start with them and see what may be missing.

Exception Reporting is the Best Time Saver for Engagement Professionals

Why is participation tracking difficult? Is it possible for one person to take attendance at every activity, in real time, not to mention organic or simultaneously occurring? And what about on weekends or other days when there is no engagement staff, how is attendance accurately recorded?

The process is broken, not necessarily the design of systems seeking to capture this data. All of these platforms can capture, report and spit out 100% accurate data. That is their intention. The process of how, and the resources we have to capture cause the data to be unreliable and inconsistent. 

Here are 5 Tips to Help Resolve Participation Data Discrepancies:

Tip 1 -  Only track participation data on what you intend to do something with the results.

Tip 2 - Focus on one piece of data at a time, and make changes to accommodate opportunistic findings.

Tip 3 – Standardize programs in each dimension. Bingo is always social. Reading is always intellectual. Exercise is always physical. Do not deviate.

Tip 4 - Reduce the options for labeling an activity. Do we need to have a label for snack or meal if we already capture dining metrics?

Tip 5 - Add in resident referrals from your CMS as an indicator of successful resident experience. Heck, just focus on that for determining what communities need assistance with programming.