Inactivity in SNFs: How We Are In an Optimal Position to Elicit Change


This week is National Rehabilitation Awareness Celebration week. For the occasion, I have asked an OT, PT, and SLP to blog about the goal of increasing our patients’ joy rather than just function. I believe this is something that makes our jobs special and something worth celebrating. Please share your story in the comments below to continue the conversation.

Today we hear from Christine Ebrahim, an occuputional therapist student.

During my first encounter interning in a SNF, “Charles”, a long-term resident of the facility, would wheel himself into the therapy room to chat with me. In our brief but sweet encounters, he would share poetry he had written throughout his lifetime, emphasizing that nothing made him happier than to share his words with someone who appreciated them. He memorized the days I would be there and greeted me with a warm smile and a copy of a different piece he’d written.

The staff was not comfortable with Charles being in the gym since he was no longer receiving therapy, and wouldn’t be unless he experienced a decline in function. This was an understandable concern, as the small gym in the facility could barely accommodate those that needed care as it was. As Americans are living longer than ever and life expectancy is increasing every year, this has resulted into an overcrowding of SNFs – a phenomenon many of us are unfortunately all too familiar with (“Life expectancy”, 2014).

But Charles didn’t care about this. He was looking for an opportunity to meaningfully socialize during the long hours of the day. And for this reason, he told me, “I wish I was still in therapy.”

As therapists in a SNF, we generally work with individuals who are brought to us from local hospitals. It is absolutely important for us to provide the best quality of care for those on our caseloads.

But what about those not under our care anymore? What about the large quantity of residents who permanently reside within the facility, and are not given enough of a chance to express themselves, engage in personally-chosen or meaningful activity, or derive a sense of purpose through interaction or hobbies? What about those who are simply incapable or unwilling to be involved in the activity room? What can we—already busy enough as it is—do to help?

Meaningful Occupations

Occupational therapists have been trained to consider “meaningful occupations”, or activities, in every step of the therapeutic process. Researchers Christiansen, Backman, Little, and Nguyen (1999) confirmed the belief that people derive satisfaction from successfully accomplishing activities they find personally meaningful in their lives.

A well-known intervention study, the Well Elderly Treatment Program, found that the inclusion of a self-directed occupational therapy program aimed at maintaining and reintegrating older adults into their activities of interest had powerful and lasting therapeutic effects that radiated to numerous dimensions of their well-being (Jackson, Carlson, Mandel, Zemke, & Clark, 1998).

This focus on meaning is integral to the care of clients—regardless of our individual disciplines. I propose that we, as therapists, make it a primary aim to ensure that a client has the opportunity for these “meaningful occupations” well after discharge. This is so important, especially in a SNF where the chance for meaningful activity may be interrupted.

How to Plan for Meaningful Occupations

First, it’s important to establish a genuine relationship with a client, where we gather a sense of who they are and what matters to them. This relationship not only enhances the therapeutic process, but it builds an understanding about what will help them to thrive. If we are aware of what motivates them, we are much more likely to establish ways for them to use their time meaningfully—even well after discharge. This is especially important for clients, who will be living at the facility long term.

If we know what makes someone feel accomplished, purposeful, or provide a sense of being productive, we can make recommendations to them, their family members, or caregivers that can be implemented throughout their stay. In the case that a client does not have anyone, it is up to us – trained professionals – to ensure that this person will not be discharged to sit or lie in his or her rooms. This is where our knowledge of what the client enjoys comes handy.

Simple Solutions Facilitate Activity

A personalized calendar that is posted in a client’s room in a great way to ensure that activities they’ve chosen to participate in is visually reinforced. This can be supplemented with an agenda, photos of themselves completing the activities, a family member or caregiver who encourages activity participation, and other methods of motivation.

Those with little mobility, low cognitive function, or no verbal ability can engage in all sorts of activities that might be meaningful to them, as well. In fact, activities for people with dementia may be more important to their psychological well being than the physical and social environment they are in (Marshall & Hutchinson, 2001).

Charles loves writing poetry. Although he has difficulty writing nowadays, the activity can be adapted for him by consulting with a regularly-visiting family member and finding out whether this person would be willing to transcribe his words for him. Perhaps a schedule can be set to motivate Charles to produce work as regularly as he sees fit. From there, since Charles loves sharing his poetry, he can have copies made to disperse within the facility or mailed to those who would appreciate his work. This does not take a lot to effort to coordinate and provides him the opportunity to remain active in an area that reaffirms his purpose.

As we begin to think about the longevity of our clients’ care in therapy, we can become far more skilled in ensuring that they are taken care of well after they are discharged. Other caregivers need to be involved in the maintenance of meaningful occupation plans, but we are in an optimal position to get the ball rolling for our client to remain active, providing them meaning and purpose while residing in a SNF – long after we stop seeing them.


  • Christiansen, C.H., Backman, C., Little, B.R., Nguyen, J. (1999). Occupations and well-Being: A study of personal projects. American Journal of Occupational Therapy, 53(1):91-100. doi: 10.5014/ajot.53.1.91.
  • Jackson, J., Carlson, M., Mandel, D., Zemke, R., & Clark, F. (1998). Occupation in lifestyle redesign: The well elderly study occupational therapy program. American Journal of Occupational Therapy, 52(5), 326-336.
  • Life expectancy. (2014, July 14). Retrieved August 26, 2014, from
  • Marshall, M., & Hutchinson, S. (2001). A critique of research on the use of activities with persons with Alzheimer’s disease: A systematic literature review. Journal of Advanced Nursing, 35(4), 488-496.

Guest Blogger Bio
Christine Ebrahim is into her second year of completing her M.S. in Occupational Therapy at California State University, Dominguez Hills. She holds a special interest in the ethical treatment of clients, the application of the outdoors/nature into therapy, and neurorehab. Find her on Facebook or LinkedIn.

Rachel Wynn
Follow me

Rachel Wynn

Speech-Language Pathologist at Gray Matter Therapy
Rachel is a speech-language pathologist and creator of Gray Matter Therapy. She started making noise as a patient-centered care advocate in 2013. She believes great care happens when patients are informed and engaged.
Rachel Wynn
Follow me
  • Dean Metz

    Nice piece! I think patients bond more with rehab staff because we spend more quality time with them than any other professional. As cuts to staffing continue on all levels of care in SNF settings, nurses and CNAs barely have time to complete the tasks assigned to them, never mind take the time to really hear what a person’s real goals and desires may be. I can’t argue a single word of what you have written, nor do I wish to. My only fear is that it may be unachievable due to circumstances (business demands) outside of our control. Thanks for the reminder of why I do this work. Cheers, Dean