Program Proposal

Part 1- Needs Analysis

Introduction
The purpose of this paper is to propose an occupation-based program for individuals at
the 10th East Senior Center in Salt Lake City. Currently, there is no occupational therapist on
staff at this facility, which leaves some senior center participants with unmet occupational needs.
To better understand the diverse needs of this group of individuals and the center itself, a needs
assessment was conducted.
Setting
The 10th East Senior Center opened in the Salt Lake City foothills on Jully 11th, 1963 in a
middle class neighborhood. This center serves any person over the age of 60, with the average
participant aged around 75. People from all walks of life attend the 10th East Senior Center, with
participants varying greatly in socioeconomic status, health status and type of occupational
engagement. The Senior Center consists of many large community spaces including a gym with
stage, recreation room, weight lifting/work out area, art room, computer room, front desk, quiet
areas, library and lobby. There is also a park, tennis court and vegetable garden area. The Senior
Center is wheelchair accessible via accessible parking and ramps to both the front and rear of the
building. The building boasts wide hallways and is clutter free. The basement is accessed via a
ramp outdoors, although this is not a heavily trafficked area of the center.
Funding
The 10th East Senior Center is owned and operated by Salt Lake County Aging and Adult
Services and is one of 19 senior centers in the valley. Funding for the Senior Center comes from
federal, state and country sources in addition to donations. This money pays for transportation,

the lunch program and building maintenance. It also pays for the Senior Center staff which
includes: Brenda (program director), Shawn (manager), Kacie (office specialist), Cameron
(custodian) and Mariana (kitchen staff). The Senior Center also has many volunteers, without
which the senior center programs would likely cease to exist. The Senior Center also utilizes
court ordered community service volunteers and Title V employees. Occasionally, programs will
require additional funding, in which case the Advisory Committee, an elected group of about 15
individuals, will raise money.
Mission & Philosophy
The Salt Lake Country Aging and Adult Services state their mission as promoting
independence through advocacy, engagement and access to resources (Aging and Adult
Services, n.d.). Brenda, program director, expresses her mission as to always meet the
programming needs and desires of participants and to provide programs and education that
enable participants to maintain an active lifestyle in order to stay at home, safely. She also
hopes to provide meaningful volunteer opportunities. There is no philosophy stated on the Aging
and Adult Services web page. Brendas philosophy for programming is to work hard to create
programs and try everything while listening to the desires of participants.
Programs
The 10th East Senior Center offers a vast amount of programs. See appendix A for
Septembers calendar of programs. In addition to those programs, the Senior Center also offers
daily breakfast and lunch, weekly hiking, massages (reduced cost), and individual time to meet
with staff to discuss available resources. The most popular programs by attendance are daily
lunch (15-40 people) and live music with dancing (10-30 people). Programs change often based
on the availably of volunteers and program attendance. For example, bingo attendance is

relatively low (3-5 participants) and will likely not survive much longer. Language programs
and healthy eating classes are currently being developed.
Data Collection
Data collection for this needs assessment was obtained through semi-structured
interviews with participants and the program director. For a list of questions guiding the
interviews, see appendix A and B. Data were also collected via observation of Senior Center
programs.
Participant Perspective
There is a core group of about seven individuals who come to the senior center on most
days. Interviews were completed for all but two of these individuals. Each of them participate in
different activities but report primarily coming to the center as a place for community while also
enjoying quiet, solo time engaging in computer activities, writing or puzzles. These Senior
Center participants rarely attend the formal programming the center offers aside from lunch.
Three of these daily participants are currently experiencing homelessness. Peter, a participant
experiencing homelessness, is currently working as a landscaper and recently purchased a motor
home that was taken by police due to fraud of a previous owner. He wants to obtain a license to
sell insurance but has not begun the steps to study or take the exam. Connie, another homeless
individual, was recently discharged from a psychiatric facility. She reports a poor relationship
with her family and is currently in a relationship with Frank, a program participant that is also
homeless. Together, this couple has experienced difficulties with alcohol and drug use. Program
participants report being fearful of Connies explosive behavior. Connie also has significant
edema in her bilateral lower extremities that causes her to walk slowly with a limb as well as
pain in her left elbow.

Each of the other daily participants report high satisfaction with the senior center and report no
problems with and ADL or IADL engagement.
The majority of program participants that attend the senior center come for the program
they are interested in and then leave. Each of these participants reports no problems in ADL or
IADL engagement and report high satisfaction with the programs offered. These participants
come to the center typically for one to three programs weekly. Each of them cannot identify any
additional programming needs. At least three participants state they attend this particular senior
center, even though they are closer to a different center, because it is a very friendly environment
and it has the programs they desire. Throughout interviewing participants, the conversation
shifted from the guided questions to the participant sharing their story and passions.
Administrator Perspective
Brenda is able to flow with the changing needs of the participants. She states that
originally this senior center was in the middle of a primarily senior neighborhood. She believes
that the surrounding area has become younger on average over time. She also observes that the
programming desires have changed drastically, shifting from bingo and sedentary activities to an
emphasis on staying active. She also reports that in the past many more participants would attend
the senior center all day. She has seen the shift to seniors coming to attend only the program they
are interested and believes the overall health and business of modern seniors attributes to this.
She says people are living longer, healthier lives and they want to spend time doing other things
in the community rather than be at the senior center all day. Brenda believes there is a need for
occupational therapy in many individuals that attend the senior center and identifies a woman
with chronic back pain and Connie (addressed above) as therapy candidates. Shawn, the centers
manager, identified one man who feels unsafe living independently as another candidate. This

individual has been unable to be interview further to contribute to this needs assessment. Brenda
also believes it would be beneficial to share information with program participants on adaptive
equipment.
Authors Perspective
After observation and interview at the senior center, it seems there is a need for many
occupational therapy services. The 10th East Senior Center provides so many programs that an
additional weekly program would likely get lost in the shuffle. Similar to Brenda, I to observed
the quick coming and going of the majority of participants. It seems there is a trickle of
participants present throughout the day, which tapers in the afternoon hours. I have found there
to be a hugely diverse need for occupational therapy addressing cognitive health, depression,
social skills, alcoholism/drug addiction, financial management, low vision
adaptations/compensation, aging well, general occupational engagement, chronic pain
management, home safety and transportation options. While the needs are diverse, none of the
needs above were reported or observed as necessary by more than one or two participants at this
senior center. This figure would increase drastically when considering all the Salt Lake senior
centers. The most apparent need at the 10th East Senior Center would be assisting the high
number of homeless participants. As mentioned above, three daily participants are homeless.
Additional people that are homeless attend this center occasionally. These people seem to come
for a few days and then be gone for several months. These seniors are at high-risk for illness or
death due to physical and cognitive decline while surviving in intense Utah elements.

Part II- Literature Review

Overview

A literature review was conducted to ensure the proposed senior center program is based
in evidence. As suspected and confirmed by this review, the needs of seniors vary greatly and
encompass virtually every occupation. Despite diverse needs, research supports there are key
interventions that can be utilized to target this population as a whole. These interventions each
support occupational engagement and include decreasing depression, ensuring a safe home
environment, increasing social skills, using mindfulness in everyday life, ensuring proper
medication use and empowering individuals that are homeless to engage and make life changes.
Importance of Maintaining Identity
Identity maintenance is a persons ability to preserve a sense of who one is. Individuals
that are able to achieve this in later life will likely experience greater quality of life (QOL).
Occupational engagement can directly impact an individuals identity (Plastow, Atwal &
Gilhooly, 2015). Seniors have great potential to experience loss of identity due to decreased
occupational engagement secondary to cognitive, physical or social deficits. According to Letts
et al. (2011), this loss of engagement not only impacts the individual, but also their caregiver.
These authors findings demonstrate the important need to provide holistic, occupation-based,
client-centered interventions to senior center participants in order to facilitate the greatest
individual occupational engagement in order to maintain quality of life as aging occurs.
Key Areas of Interventions
Depression. Fulbright (2010) states that as many as 25% of community-dwelling seniors
report depressive symptoms in a given year. While only two participants and the 10th East Senior
Center reported depression in their interviews, the above statistic provides reason to believe there
are likely others at the senior center experiencing depressive symptoms. An individual
experiencing depression may also have a loss of identity. Fulbright found that depressive

symptoms decreased in individuals that reported making friends at senior centers. Conversely,
those who reported lack of senior center friendships experienced increased depressive symptoms
(Fulbright, 2010). Gibson, DAmico, Jaffe and Arvesman (2011) found social skills training
using role-playing, groups and individual therapy increased social skills while decreasing
psychiatric symptoms in community dwelling adults . Social skills training was found to be most
effective when addressing a particular topic, such as assertiveness, beginning/maintaining a
conversation or non-verbal skills. The 10th East Senior Center currently has a communication
class, but does not offer any one-on-one assistance addressing the specific social skills an
individual lacks.
Mindfulness interventions have also been shown to decrease depression and anxiety
(Williams, Teasdale, Segal, & Kabat-Zinn, 2007). Mindfulness includes meditation and mindful
movement (yoga and mindful walking), in addition to educational practices. Mindfulness was
also shown to improve chronic pain, which was reported by two senior center participants. It has
also been shown to increase adaptation to illness and overall quality of life. Participants reported
positive responses to mindfulness (Hardison & Roll, 2016; Williams, Teasdale, Segal, & KabatZinn, 2007).
Medication management can also play a vital role in managing depression. As many as
30%-50% of people with chronic health conditions improperly take their prescribed medications.
Researchers increased medication compliance by setting medication related goals and identifying
strategies to achieve the goal. (Schwartz & Smith, 2016). An increase in medication compliance
can help an individual manage their depression. Since seniors are more susceptible to acquiring
illness or having a chronic condition, medication management is applicable to many seniors
(Sahyoun, Lentzner, Hovert, & Robinson, 2001). It is important to examine the diverse barriers

to proper medication management including cognitive decline, poor vision, lack of motivation,
weakness or lack of understanding of importance of medication. Ensuring seniors are able to take
their mediations accurately will help maintain occupational engagement and prevent sickness,
hospitalizations or even death.
Homelessness.
Herzberg and Finlayson (2001) state the needs of individuals that are homeless are
diverse and include employment, affordable housing, money management, social skills and
identifying/utilizing community resources. These authors believe that occupational therapists are
uniquely equipped to address the diverse needs of people that are homelss(Herzberg &
Finlayson, 2001). In a study completed by Helfrrich and Fogg (2007), it was found that
functional skills training improved outcome scores in self-care, money management, food
management and community participation.
Fisher and Hotchkiss (2008) helped homeless individuals engage in meaningful
occupations in order to empower them to takes steps towards ending their homelessness.
Empowerment is the process of supporting others in the development of self-initiative and
independence, so that they can make wise decisions, manifest health and productive behaviors
and increase self-fulfillment and well being (Fisher and Hotchkiss, 2008, p. 65). These authors
believe disempowering factors such as poverty, substance abuse, physical abuse, violence, legal
problems and limited social support lead to occupational deprivation. Through the use of goalsetting, motivational interviewing and offering opportunities for occupational engagement,
Fisher and Hotchkiss observed improved mood and motivation among participants.
Empowerment could be utilized to assist many of the 10th East Senior Center participants begin

to plan and initiate steps to end homelessness. Through empowerment and connection to
resources, these individuals will be able to begin to change their current state of homelessness.
The disempowering factor of poor social support was also emphasized in other studies on
individuals that are homeless. Gray, Shaffer, Nelson and Shaffer (2014) aimed to change the
social networks of individuals that are homeless to contain fewer people with substance abuse
problems. They found this improved client-reported social network quality. Thomas, Gray,
McGinty and Ebringer (2011) utilized art as a way to provide an opportunity for individuals that
are homeless to engage in occupation. They found this promoted social inclusion, engagement
and observed participants increased desire for wellbeing.
Fall Prevention and Home Modification. A major focus of occupational therapy with
seniors is fall prevention and home modification. Clemson, Cumming, Kendig, Swann, Heard
and Taylor (2004) used Stepping On, a seven-week multi-faceted program, attempting to reduce
falls. Over the program course, therapists and participants address vision, home hazards,
medication management, planning and exercises. After program completion, they found that
increasing lower extremity balance and strength, and improving environmental safety led to a
reduction in falls in over 300 study participants. Li, Harmer and Fitzgerald (2016) utilized tai ji
quan, a form of tai chi, in Oregon senior centers in order to improve functional balance. This
program resulted in a 49% decrease in falls. This program did not address environmental
concerns related to falls. Both of these studies also reported a reduced fear of falls in the senior
participants, which had been preventing them from engaging in occupations (Clemson,
Cumming, Kendig, Swann, Heard &Taylor, 2004; Li, Harmer & Fitzgeral, 2016).
Stark, Somerville, Keglovits, Smason and Bigham (2015) found home
modifications/adaptations such as raised toilet seats, grab bars, shower chairs and reduced

ground clutter improved daily occupational engagement and enhanced function in people with
chronic health conditions. They also proposed that home modifications provided by occupational
therapists were more effective than modifications provided by other professions. While current
research supporting this is lacking, it is believed this may be due to occupational therapists
unique ability to consider each aspect of an individual and their context (Stark, Somerville,
Keglovits, Smason & Bigham, 2015).
Summary
Through the data collection portion of the needs assessment, the senior center participants
revealed their diverse needs and desires for occupational therapy. Observation exposed a large
homeless population at this senior center. The literature showed that these individuals may
experience many different issues causing homelessness and led me to believe multiple
approaches to occupational therapy would be impactful. Through the use of functional skills
training, social skills training and empowerment, I believe a reduction in homeless seniors is
possible. In the needs assessment participant interviews, two seniors reported high levels of
depression. These participants were unsure what was causing their depression, and the literature
suggests the causes can be variable and include lack of social support, poor medication
compliance or lack of positive coping skills. Literature suggests mindfulness is beneficial in
reducing depression. Once I began to thinking about medication management related to
depression, I realized this could be a large barrier to engagement in many seniors, especially
those with chronic conditions. Literature also revealed the importance of addressing fall
prevention and home safety. One senior reported feeling unsafe in his home, and without proper
evaluation of both the participant and his context, his feeling will not be understood. After
observing seniors in the activities provided by the senior center, mobility becomes a large

concern. It is imperative to ensure seniors maintaining strength and endurance and utilizing
adaptive equipment when necessary. Through the use of the above key intervention areas, a vast
number of occupational therapy services could be available to participants at the 10th East Senior
Center. Each participant will require careful evaluation, thoughtful planning and likely a
combination of the above intervention areas. Ultimately, the provided research-based
interventions could enable increased occupational engagement in each senior receiving services.

References
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PressAppendix A: Calendar of events- September

Appendix B: Questions asked program participants.

How long have you been coming to this senior center? How often?
Do you live around here?
What programs do you attend?
What programs would you like to see?
What is the senior center missing?
Who do you live with?
What do you enjoy doing?
Are you able to take care of yourself at home? If not, why? What problems?
Are you familiar with occupational therapy?
Appendix C: Questions asked program director.
What is the purpose of the senior center?
What is your mission and philosophy?
How are seniors defined?
What are the characteristics of this group?
How are programs funded?
Who are the staff?
How are volunteers used?
How do you come up with new programs?
How has the center changed over time?