Leisure in residential aged care: exploring understandings

<p dir="ltr"><b>Background</b> <br>Leisure, mandated through Australian Aged Care Quality Standards, is enacted in residential aged care facilities (RACFs) across Australia; however, little is known about the nature of leisure and its enactment in this context. While occupational roles that have a leisure focus have a long history and can be traced to the beginning of the twentieth century, they have achieved only partial success in being recognised professionally in the United States, and have struggled for recognition in Australia. Leisure workers (LWs) themselves are an unregulated group of aged care staff with low visibility in the literature that relates to aged care. Research studies that have involved LWs and their work have tended to focus on individual interventions trialled against usual leisure practice, with little attention to elucidating this usual practice. <br><b>Objective</b> <br>This doctoral work has sought to illuminate the nature of leisure and its enactment in the context of residential aged care (RAC), posing the research question: What are ways leisure is constructed in RAC in Australia? <br><b>Methodology</b> <br>This study uses Charmaz’s version of grounded theory methodology, which is particularly useful when addressing a subject that has largely been unexplored. Methods such as coding, constant comparative analysis and memo writing keep the findings close to the data. The methods assist with the systematic formulating of theory, from the ground up, providing an interpretation of participants’ worlds that is data driven. The participants of this study were staff who worked in RAC in a leisure focussed role. They were recruited from the University of Tasmania’s Understanding Dementia Massive Open Online Course (UDMOOC) completers. Eighteen participants engaged in semi-structured interviews that were recorded, transcribed verbatim and analysed using GT methods. <br><b>Findings</b> <br>Findings are presented in the form of concepts generated from the data, which relate to the foci, purposes, and processes of leisure. Leisure was found to focus on residents’ personal interests, the maintenance of their strengths and capabilities, the support of relationships, and connections to the outside world. Purposes of leisure relate to the experience of pleasure, spiritual fulfilment, and to keeping busy and diverted. Leisure was operationalised using processes that supported knowing the person, by undertaking formal assessments, through time spent with them, and through observation of their behaviour. Kinds of knowledge considered relevant to leisure related to residents’ interests, routines, functional capability and significant relationships. Findings also relate to leisure processes that link to the planning and undertaking of leisure. Leisure is planned with a consideration of individual and group ability. Engagement in leisure for residents is enhanced through activity modification, and through drawing into engagement those less able, through the creation of additional pathways to engage. LWs’ own engagement, and a mindfulness of resident independence, also feature among leisure processes. <br>The Leisure Theory of Connectivity, derived from the study findings, consists of the three key categories of familiarity, empathy, holism, and the core category: connection. Leisure in the context of RAC is firstly familiar in nature, providing a sense of the continuity of life and supporting the endurance of identity through engagement in pursuits that relate to the person’s history. The second key category, empathy, refers to LWs’ empathetic and relational practice that is a contributor to operationalising leisure, driving and guiding leisure planning, and assisting with discerning and sustaining engagement. The third key category, holism, recognises the multidimensional nature of the person and the interrelationships between these human dimensions. Leisure is framed to simultaneously affect physical, social, emotional, psychological, and spiritual dimensions in an immersive way. The core category, connection, portrays the experience of connection as central to leisure that considers ability. Engaging in leisure is an immersive experience that is holistically stimulating and that grounds the person in the present. It connects the individual to others, through the sustenance of significant past relationships, the nurturing of friendships with fellow residents, and through a fostering of relationships with LWs. Through its focus on biography that considers earlier ways of life, past roles and interests, leisure also supports the endurance of the self. <br>This research that provides a data driven understanding of the nature of leisure and its enactment in the context of RAC, contributes towards making this phenomenon visible. It elucidates the complexity of leisure, positioning “connecting” as central to its experience, and framing “activity” as a conduit for connection. Leisure that is meaningful and appealing, connects to present, to self and to others. The multiplicity of the purposes of leisure, and the importance of connection mean that activities that fall under the banner of leisure in RAC are a broad church and can include pursuits traditionally classified as leisure as well as work chores, social interaction, physical exercise, and spiritual experiences. The kind of strengths-based approach that LWs report using is associated with the support of identity, which assists with the preservation of a sense of self and supports self-determination. This research describes how connecting in empathetically delivered leisure that is familiar in nature and holistically experienced, replenishes the self, is meaningful, and contributes to purposefulness in life. This study also reveals the skilled nature of the LW role and its function in leisure enactment which contributes to the recognition of an occupation that, although prevalent in RAC, is not widely recognised. <br><b>Conclusion</b> <br>This interpretive work has the potential to raise the profile of leisure, which is relatively invisible in the aged care sector, and to further the development of this field. It portrays leisure as complex, and leisure work as skilled. This work provides foundational knowledge that has the potential to influence leisure enactment, opening up this field of study for further research. The knowledge generated through this study has implications for the education and training of LWs so that their understanding of leisure and their role is extended.</p>