Most inpatient wards now state that their goal is to return people to the community. Therefore, they should be designed around preparing people for community living. However, it still seems that some are focused on keeping clients and staff comfortable where they are. As a result, clients end up spending most of their day doing activities that they will not be able to do in the community.
- Full cable TV on the ward. I don't even have full cable TV, because I do not feel like I can afford it. Clients spend most of their days watching the TV, which makes things nice and comfortable for them and for staff. What are they going to do with their time when they cannot afford cable?
- Cigarette rationing. Staff handing out cigarettes to clients one at a time on a certain schedule e.g. one an hour. Again, this makes things nice and comfortable for the client and staff. The client does not run out of cigarettes and start bumming them from other people,which usually results in conflict.
- Horticultural therapy. Great idea - I have read articles about the therapeutic benefits of gardening. However, when clients leave, most are going to be living in apartments without access to a garden. How about learning to take care of a plant or two in containers instead of a large outdoor garden?
- Sheltered work programs. These can give clients a great feeling of productivity. The only problem is that these are no longer available in the community, and the research that I have read suggests that if anything, participating in a sheltered work program decreases a person's ability to find and keep competitive employment. I can see how this would happen, as I saw workers miss doing their job for several days, with no consequences. Many inpatients are not mentally stable enough yet to obtain or maintain competitive employment, but how about focusing on supported volunteering which can be maintained after discharge?
- Computers with internet access on the ward. I am a bit undecided about this. I believe that learning to use technology is quickly becoming an essential ADL, and part of our role is to ensure clients have equal access to this technology, and the opportunity to learn to use it. However, my clients generally cannot afford computers and internet access, and must learn to use public use computers. I think it may be a good idea to have computers on the ward to be able to teach people to use them, but it needs to be followed up by teaching people to access public use computers e.g. take regular fieldtrips to the library to use the computers there.
- Unrealistic activities. Often clients are shuffled from one group to another - their time is scheduled for them. They become used to being told what activity to do instead of choosing. I have spoken to many people who have told me that they enjoyed doing crafts in hospital, but have not done them since discharge. Often the materials are too expensive or too difficult to obtain. Clients participate in elaborate meal preparations including main dish, side dish, dessert, and sometimes even appetizers. In the community, my clients are always looking for inexpensive one-pot meals. One frequent activity was taking clients for "drives", and sometimes stopping for coffee. Very few of the clients will ever have the opportunity to go for drives in the community.