One facility’s unique approach to providing a fitness program helps residents grow in mind, body, and spirit.

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Perhaps the most valuable result of all education is the ability to make yourself do the thing you have to do, when it ought to be done, whether you like it or not.” Thomas Henry Huxley is credited with that quote, which is applicable to the big “E” word: exercise. When the healthcare team at Pennswood Village, a continuing care retirement community (CCRC) located in Newtown, Pa, first considered starting a land-based fitness program over 20 years ago, we were challenged by statements like, “I don’t even own 1 pair of slacks,” or “I only wear high heels,” or “I get my exercise by making the bed or washing the dishes.” So in 1990, when we attempted to actually institute a fitness program, first on the agenda was education. Later, we would add other “key” words in building a successful fitness program: conservation, options, team approach, supervision, continuity, and programming. Implementation of these “keys” became important, as did our mission statement: “To provide opportunities for growth and well being in mind, body, and spirit.”
       In February of 1992, we began our fitness program by using the physical therapy (PT) room in the morning (PT did not use the room until 1:00 pm). There is no doubt that the aforementioned “keys” helped the program progress from 9 hours per week to 25 hours per week and from 3 days per week to 6 days per week, all these changes within the first 3 months. Over the next 10 years, we continued to grow, adding participants, equipment, and staff. Pennswood had 350 residents when the program started in 1992, and approximately 200 of them would participate. We were bursting at the seams. To expand the community, plans were developed to add 105 more residents, 2 new apartment buildings, and a building to address our interests in wellness programs. In October 2003, we completed our new Passmore Center, which includes 2 pools, an aerobic room for class activities (ie, Tai Chi, aerobics, Yoga, etc.), men’s and women’s locker rooms, as well as a separate locker room for those who need assistance, and a lounge for relaxing before or after a workout. The large (2,400 square-foot) workout area includes 20 cardiovascular pieces, 13 Keiser® Inc. (Fresno, Calif) strengthening machines, the Keiser Stretch Zone™, 2 mat tables, an equilibrium area equipped with a balance bar, and accessories, such as dumbbells, thera-tubes, weighted balls, therapeutic balls, and a free-standing boxing bag. This is where those “keys” became important.

Education

       Over the years, I thought I had collected many “tools” for my “exercise toolbox.” However, in the early ’90s, much was happening that opened our eyes to exercise for the age group present at Pennswood—that being a mean age of 83. Dr. Evans and Dr. Rosenberg, with their book, Biomarkers: The 10 Keys to Prolonging Vitality,¹ and Dr. Fiatarone, with her benchmark article² on resisted exercise, made everyone aware of the untapped potential of exercise for seniors. We used their research as a springboard to first educate the staff, including field trips to Boston, Mass, to observe programs established by the aforementioned experts, attendance at fitness conferences where other noted speakers shared their knowledge, and returning to inform the residents of the importance of exercise, regardless of their ages. Supplemented by guest speakers and presentations, our team approach started with educating the board of directors and continued through the medical staff, administration, employees, and residents, so everyone understood the benefits of exercise. Once the educated resident was on our side, his or her participation as a team member and the ultimate benefactor of the wellness programs became a reality.

Conservation

       Simplicity is an important value in this Quaker-directed community, and the residents responded to the application of these principles in the wellness program. At that time, if our fitness program kept just 1 person out of the skilled area it would save $50,000 per year, and if we could keep 1 person out of the assisted living area it would save over $25,000. Avoiding a fractured hip through improved strength and balance would result in the saving of much pain, suffering, absence from a resident’s home and normal lifestyle, and, according to statistics, possible loss of life from subsequent complications—not to mention the money spent to care for that type of catastrophic event. When residents realized these benefits, it became easier to obtain their support when budgetary considerations for the Passmore Center were discussed.

Options

       Giving the residents choices allowed us to offer something for everyone. For example, we have over 10 options for cardiovascular training. If a resident is unable to perform on 1 type of machine because of physical constraints or a dislike for the machine, there are plenty of other chances to improve that important area of health. Traditional options for cardiovascular training like treadmills and machines from NuStep® Inc. (Ann Arbor, Mich), each of which we had 3, were supplemented by the inclusion of 2 cross-trainers, 2 rowing ergometers, 2 recumbent bikes, 1 upright bike, 1 conventional stepper, and 2 upper-extremity ergometers. Circuit training, the use of an exercise slide, aerobic classes on land, and aquatic activities are just some of the ways participants can address their cardiovascular/pulmonary needs.
       The natatorium was also designed with options in mind. Adjacent to our campus is a school with a pool. Since the opening of Pennswood Village in 1980, there was a faithful contingent of 10–12 residents who would swim laps in that pool. However, there also were some who wanted group classes and the comfort of a warm water pool. Knowing that 1 pool could not serve both interests, the decision was made to have 2 pools in the Passmore Center, a 65-foot pool (1,400 square feet) with up to 5 lanes and a warm-water pool (1,200 square feet) with a bench that includes whirlpools and a bubble couch. The lap swimmers and the participants in higher intensity level classes were happy and safe in their 81-degree-water environment, while those with arthritis and similar conditions enjoyed the comfort of the 94-degree warm-water pool.

Team Approach

       The Passmore Center is a success because of the contributions of many: an executive director who enjoys exercising and even assisted in selecting the appropriate equipment, a CFO who has dropped 45+ pounds through his daily exercise routine, a board that supported the project from its inception through completion, and a health team that is very supportive in every effort of the fitness staff.

Supervision

Residents Exercising at Pennswood Village

       We placed safety among our priorities and felt that supervision by qualified personnel was essential. Our present program has a staff of 1 fitness instructor and 5 assistants, all certified as personal fitness trainers. We are able to assess and train our residents, motivate and encourage them, monitor their technique and progress, and keep them safe. On more than 1 occasion, our staff has anticipated and avoided potentially dangerous situations. In addition, we have several residents who are visually or cognitively challenged and need verbal and/or physical guidance to complete the programs. One blind resident enters the fitness room with the help of her guide dog and then completes a thorough exercise regimen, including the treadmill (we placed braille on the controls so she can be independent) as well as strengthening and equilibrium routines. She is 1 of many residents who benefits from the supervision of our staff, even just in filling out the exercise sheets maintained by each resident to show exactly what the residents did. The staff can then mark their progress and monitor those who have not tried to progress with their programs. The relationship between the staff and residents has evolved into a mutual respect. Some residents even call staff to say, “I’m awfully sorry I can’t make it today, but I’ll be sure to be there tomorrow!”
       Staying with the theme of safety, we made the decision that there would always be a lifeguard on duty when the pool is open. To that end, we contracted with the NAC, the Newtown Athletic and Aquatic Club, to manage the pool. They supply us with all the lifeguards, instructors for our classes, and a pool manager to ensure that all goes well in the natatorium. After open admission to our inexperience in managing a pool, this was an easy decision.

Continuity

       Pennswood Village has several levels of support for its residents, ranging from the resources available to those living independently in their apartments to those receiving care in the assisted and skilled areas. The Passmore Center is a great environment for the former group, due to its location and availability to those apartment dwellers. However, the center is not close to the skilled and assisted living areas, so a decision was made to maintain the original fitness location, staff it with 2 trainers, and continue the fitness program on Monday, Wednesday, and Friday mornings. Referred to as the Passmore Annex, it fulfilled our obligation to allow all residents, regardless of their level of care, an opportunity to participate in a fitness program. The commitment of our nursing staff to ensure the residents fulfill that opportunity is commendable.
       The continuity of our program is 1 of our unexpected yet pleasant outcomes. Our staff rotates from the main fitness room available to our independent living residents to the fitness area specifically for our assisted living and skilled residents located in our health center, and they act as aides and supportive personnel in our PT department. While our healthy independent living resident may have the misfortune of hospitalization and then return to his or her apartment, staff members will have possibly seen that resident when he or she was healthy, performing in the main fitness room; during his or her PT time, as he or she recovered from the acute phase of illness or surgery; in the secondary fitness area, as he or she went from our health center to his or her apartment; and then again post illness/surgery, when he or she resumed working out in the main fitness room. There is written communication throughout this process, and the fitness staff members see the progress and continuity first-hand.

Programming

       The aforementioned specific classes in the aerobic room and the 17 different pool classes supplement the general activities and exercises performed in the fitness room and pools. Despite the high volume of residents participating, the administration has been eager to promote beyond the residents. Pennswood Village has an inter-generational program with its neighboring elementary and secondary private schools, whereby Pennswood residents have traditionally participated in activities at the 2 schools and students from the 2 schools frequented the Pennswood campus for activities. The pools have offered just another means of sharing experiences. Pennswood is a unique community when it comes to sharing. The Passmore Center is open to the immediate family members of residents. It is great to see the residents in the pool with their grandchildren or a resident and his or her son or daughter working out on adjacent treadmills. Relatives of residents look forward to visiting Pennswood Village, not only for the social opportunities but also for exercise.
       Pennswood Village has the good fortune of having a significant number of people—over 600 at press time—waiting to move into the community. In an effort to give those on the waiting list an opportunity to not only use the facility at the Passmore Center but also a chance to meet and socialize with their future neighbors, we have designated certain hours for their use. There is a nominal charge, but some who live close by take advantage of this opportunity.
       In planning the center, there were strong feelings by the residents that the staff members should have their chance to use the new facility. Despite the popularity of the center with the residents and their families, we have been able to establish very generous hours for the staff and their immediate families as well. We have established the Pennswood Employee Exercise Reward System (PEERS). If an employee exercises an average of 3 times per week for a 3-month period, the reward is a voucher for food at the coffee shop, and his or her name is placed in a drawing for a free T-shirt—just some added incentive for the staff. This has been an excellent perk for attracting and retaining staff, not to mention the value of having healthy staff members.
       Although we are always striving to improve and advance in our wellness program, Pennswood Village has been very fortunate in its evolution from a “wishlist” of swimming and exercise ideas to its present Passmore Center. While we are careful to respect the wishes of the residents in their personal goals for the future, we have given them choices for addressing immediate and long-term quality-of-life issues. It is fitting that our Passmore Center motto is “Wellness for Life.”