Skip to main content

Being occupied: supporting ‘meaningful activity’ in care homes for older people in England


The benefits of meaningful activity in later life are well documented. Studies show that being occupied contributes to both physical and mental health as well as quality of life. Research also suggests that activity may be beneficial to people residing in care homes, including people living with dementia. This paper presents findings from a study which used the Adult Social Care Outcomes Toolkit (ASCOT) to measure quality of life in six care homes located in the south-east of England. The study found, like previous ones, that care home residents’ days were characterised by a lack of activity. Drawing on observations, interviews and focus groups with residents and staff from these homes, this paper attempts to understand why care home residents do not engage in meaningful activities. We reject the idea that these low levels of activity are a natural part of the ageing process or that they can be explained by notions of resident choice. Instead, the findings point to both insufficient funding and working practices within care homes as more substantive explanations. These explanations inform a discussion of how the low levels of engagement in meaningful activity could be addressed and residents’ quality of life improved.

Corresponding author
Address for correspondence: Nick Smith, Personal Social Service Research Unit, George Allen Wing, Cornwallis Building, The University of Kent, Canterbury CT2 7NF, UK E-mail:
Hide All
Baker, L. D., Frank, L. L., Foster-Schubert, K., Green, P. S., Wilkinson, C. W. and McTiernan, A. 2010. Effects of aerobic exercise on mild cognitive impairment: a controlled trial. Archives of Neurology, 67, 9, 71–9.
Ballard, C., Fossey, J., Chithramohan, R., Howard, R., Burns, A., Thompson, P., Tadros, G. and Fairbairn, A. 2001. Quality of care in private sector and NHS facilities for people with dementia: cross sectional survey. British Medical Journal, 323, 7310, 436–27.
Bäumker, T. and Netten, A. 2011. Funding: paying for residential care for older people. In Dening, T. and Milne, A. (eds), Mental Health and Care Homes. Oxford University Press, Oxford, 89100.
Beadle-Brown, J., Towers, A., Netten, A., Smith, N., Trukeschitz, B. and Welch, E. 2011. ASCOT Adult Social Care Outcomes Toolkit: Additional Care Home Guidance v2. 1. Personal Social Services Research Unit, The University of Kent, Canterbury, UK.
Beusher, L. and Grando, V. 2009. Challenges in conducting qualitative research with person with dementia. Residential Gerontological Nursing, 2, 1, 611.
Bherer, L., Erickson, R. and Liu-Ambrose, T. 2013. A review of the effects of physical activity and exercise on cognitive and brain functions in older adults. Journal of Aging Research, 2013, 3, 657508.
Bowling, A. 2008. Enhancing later life: how older people perceive active ageing? Aging & Mental Health, 12, 3, 293301.
Braun, C. and Clarke, V. 2006. Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 2, 77101
Brod, M., Stewart, A. L., Sands, L. and Walton, P. 1999. Conceptualization and measurement of quality of life in dementia: the dementia quality of life instrument (DQoL). The Gerontologist, 39, 1, 2535.
Brooker, D. and Surr, C. 2010. Dementia Care Mapping: Principles and Practice. Bradford Dementia Group, Bradford, UK.
Burton, E. and Sheehan, B. 2010. Care-home enviroments and well-being: identifying the design features that most affect older residents. Journal of Architectural and Planning Research, 27, 3, 237–56.
Cahill, S. and Diaz-Ponce, A. 2011. ‘I hate having nobody here. I'd like to know where they all are’: can qualitative research detect differences in quality of life among nursing home residents with different levels of cognitive impairment? Aging & Mental Health, 15, 5, 562–72.
Care Quality Commission 2016. How CQC Regulates: Residential Adult Social Care Services Provider Handbook. Care Quality Commission, Newcastle upon Tyne, UK.
Clare, L., Whitaker, R., Woods, R. T., Quinn, C., Jelley, H., Hoare, Z., Woods, J., Downs, M. and Wilson, B. A. 2013. AwareCare: a pilot randomized controlled trial of an awareness-based staff training intervention to improve quality of life for residents with severe dementia in long-term care settings. International Psychogeriatrics, 25, 1, 128–39.
Forder, J. and Allen, S. 2014. The impact of competition on quality and prices in the English care homes market. Journal of Health Economics, 34, 1, 7383.
Han, A., Radel, J., McDowd, J. and Sabata, D. 2016. Perspectives of people with dementia about meaningful activities: a synthesis. American Journal of Alzheimer's Disease & Other Dementias, 31, 2, 115–23.
Hancock, G. A., Woods, B., Challis, D. and Orrell, M. 2006. The needs of older people with dementia in residential care. International Journal of Geriatric Psychiatry, 21, 1, 43–9.
Hastings, A., Bailey, N., Bramley, G., Gannon, M. and Watkins, D. 2015. The Cost of the Cuts: The Impact on Local Government and Poorer Communities. Joseph Rowntree Foundation, York, UK.
Havinghurst, R. and Albercht, R. 1953. Older People. Longmans, Green, London.
Hearle, D., Rees, V. and Prince, J. 2012. Balance of occupation in older adults: experiences in a residential care home. Quality in Ageing: Policy, Practice and Research, 13, 2, 125–34.
Hellstrom, I., Nolan, M., Nordenfelt, L. and Lundh, U. 2007. Ethical and methodological issues in interviewing persons with dementia. Nursing Ethics, 14, 5, 608–19.
Hubbard, G., Downs, M. and Tester, S. 2003. Including older people with dementia in research: challenges and strategies. Aging and Mental Health, 7, 5, 351–62.
Ingham, H., Bamford, S. M. and Jones, G. 2015. The Costs and Benefits of Paying All the Lowest-paid Care Home Workers the UK the Living Wage. Joseph Rowntree Foundation, York, UK.
Krueger, R. A. and Casey, M. A. 2000. Focus Groups. A Practical Guide for Applied Research. Sage, Thousand Oaks, California.
Lawton, M. P. 1994. Quality of life in Alzheimer's disease and associated disorders. Alzheimer's Disease & Associated Disorders, 8, 3, 138–50.
Lloyd, V., Gatherer, A. and Kalsy, S. 2006. Conducting qualitative interview research with people with expressive language difficulties. Qualitative Health Research, 16, 10, 1386–404.
Lopez, R., Mazor, K., Mitchell, S. and Givens, J. 2013. What is family-centered care for nursing home residents with advanced dementia? American Journal of Alzheimer's Disease & Other Dementias, 28, 2, 763–8.
Lorenz, K., Freddolino, P. P., Comas-Herrera, A., Knapp, M. and Damant, J. 2017. Technology-based tools and services for people with dementia and carers: mapping technology onto the dementia care pathway. Dementia, 10.1177/1471301217691617.
Mansell, J. and Beadle-Brown, J. 2012. Active Support: Enabling and Empowering People with Intellectual Disabilities. Jessica Kingsley Publishers, London.
Matchwick, C., Domone, R., Leroi, I. and Simpson, J. 2014. Perceptions of cause and control in people with Alzheimer's disease. Gerontologist, 54, 2, 268–76.
Mental Capacity Act 2005. Mental Capacity Act. The Stationery Office, London.
Moore, T. F. and Hollett, J. 2003. Giving voice to persons living with dementia: the researcher's opportunities and challenges. Nursing Science Quarterly, 16, 2, 163–7.
Mozley, C. G. 2001. Exploring connections between occupation and mental health in care homes for older people. Journal of Occupational Science, 8, 3, 14–9.
My Home Life 2016. The My Home Life Transformation Package. Available online at [Accessed 14 October 2016].
Netten, A., Beadle-Brown, J., Trukeschitz, B., Towers, A., Welch, E., Forder, J., Smith, J. and Alden, E. 2010. Measuring the outcomes of care homes: final report. Discussion Paper 2696/2, Personal Social Services Research Unit, University of Kent, Canterbury, UK.
Netten, A., Bebbington, A., Darton, R. and Forder, J. 2001. Care Homes for Older People: Volume 1 Facilities, Residents and Costs. Personal Social Services Research Unit, University of Kent, Canterbury, UK.
Netten, A., Burge, P., Malley, J., Potoglou, D., Towers, A., Brazier, J., Flynn, T., Forder, J. and Wall, B. 2012 a. Outcomes of social care for adults: developing a preference-weighted measure. Health Technology Assessment, 16, 16, 1165.
Netten, A., Trukeschitz, B., Beadle-Brown, J., Forder, J., Towers, A. and Welch, E. 2012 b. Quality of life outcomes for residents and quality ratings of care homes: is there a relationship? Age and Ageing, 41, 4, 512–7.
Nolan, M., Davies, S., Brown, J., Wilkinson, A., Warnes, T., McKee, K., Flannery, J. and Stati, K. 2008. The role of education and training in achieving change in care homes; a literature review. Journal of Reseach in Nursing, 13, 5, 411–33.
Novella, J., Ankri, J., Morrone, I., Guillemin, F., Jolly, D. and Jochum, C. 2001. Evaluation of the quality of life in dementia with a generic quality of life questionnaire: the Duke Health Profile. Dementia and Geriatric Cognitive Disorders, 12, 2, 158–66.
Nygard, L. 2006. How can we get access to the experiences of people with dementia? Scandinavian Journal of Occupational Therapy, 13, 2, 101–12.
Office for National Statistics 2014. Changes in the Older Resident Care Home Population Between 2001 and 2011. Available online at [Accessed 21 September 2016].
Ohman, A., Josephsson, S. and Nygard, L. 2008. Awareness through interaction in everyday occupations: experiences of people with Alzheimer's disease. Scandinavian Journal of Occupational Therapy, 15, 1, 4351.
Phinney, A., Chaudhury, H. and O'Connor, D. L. 2007. Doing as much as I can do: the meaning of activity for people with dementia. Aging & Mental Health, 11, 4, 384–93.
Popham, C. and Orrell, M. 2012. What matters for people with dementia in care homes? Aging and mental health. Aging and Mental Health, 16, 2, 181–8.
Prince, M., Knapp, M., Guerchet, M., McCrone, P., Prina, M., Comas-Herrera, A., Wittenberg, R., Adelaja, B., Hu, B., King, D., Rehill, A. and Salimkumar, D. 2014. Dementia UK: Second Edition – Overview. The Alzheimer's Society, London.
Ramcharan, P. and Cutcliffe, J. R. 2001. Judging the ethics of qualitative research: considering the ‘ethics as process’ model. Health & Social Care in the Community, 9, 6, 358–66.
Robertson, J. 2014. Finding meaning in everyday life with dementia: a case study. Dementia, 13, 4, 525–43.
Ronch, J. L. 2004. Changing institutional culture. Journal of Gerontological Social Work, 43, 1, 6182.
Rostgaard, T., Brünner, R. N. and Fridberg, T. 2012. Omsorg og Livskvalitet I Plejeboligen. 12, 3, 1150.
Sands, L., Ferreira, P., Stewart, A., Brod, M. and Yaffe, K. 2004. What explains differences between dementia patients’ and their caregivers’ ratings of patients’ quality of life? American Journal of Geriatric Psychiatry, 12, 3, 272–80.
Schreiner, A. S., Yamamoto, E. and Shiotani, H. 2005. Positive affect among nursing home residents with Alzheimer's dementia: the effect of recreational activity. Aging and Mental Health, 9, 2, 129–34.
Sherrington, C., Whitney, J., Lord, S., Herbert, R., Cumming, R. and Close, J. 2008. Effective exercise for the prevention of falls: a systematic review and meta-analysis. Journal of the American Geriatrics Society, 56, 12, 2234–43.
Shippee, T. P., Henning-Smith, C., Kane, R. L. and Lewis, T. 2015. Resident- and facility-level predictors of quality of life in long-term care. Gerontologist, 55, 4, 643–55.
Smit, D., de Lange, J., Willemse, B., Twisk, J. and Pot, A. M. 2016. Activity involvement and quality of life of people at different stages of dementia in long term care facilities. Aging & Mental Health, 20, 1, 100–9.
Smith, N., Caiels, J., Forder, J. and Beadle-Brown, J. 2015. The Development of a Semi-structured Interview Version of the Adult Social Care Outcomes Toolkit (ASCOT). The Quality and Outcomes Research Unit, The University of Kent, Canterbury, UK.
Smith, P. J., Blumenthal, J. A., Hoffman, B. M., Cooper, H., Strauman, T. A., Welsh-Bohmer, K., Browndyke, J. and Sherwood, A. 2010. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosomatic Medicine, 72, 3, 239–52.
Steeman, E., Tournoy, J., Grypdonck, M., Godderis, J. and Dierckx, B. 2013. Managing identity in early-stage dementia: maintaining a sense of being valued. Ageing & Society, 33, 2, 216–42.
Stenner, P., McFarquhar, T. and Bowling, A. 2011. Older people and ‘active ageing’: subjective aspects of ageing actively. Journal of Health Psychology, 16, 3, 467–77.
Tak, S. H., Kedia, S., Tongumpun, T. M. and Hee Hong, S. 2015. Activity engagement: perspectives from nursing home residents with dementia. Educational Gerontology, 41, 3, 182–92.
Thomas, R. 2006. A general inductive approach for analyzing evaluation data. American Journal of Evaluation, 27, 2, 237–46.
Torrington, J. 2009. The design of technology and environments to support enjoyable activity for people with dementia. ALTER, European Journal of Disability Reseach, 3, 2, 123–37.
Towers, A., Smith, N., Palmer, S., Welch, E. and Netten, A. 2016. The acceptability and feasibility of using the Adult Social Care Outcomes Toolkit (ASCOT) to inform practice in care homes. BMC Health Services Research, 16, 1, 523.
Townsend, P. 1962. The Last Refuge. Routledge, London.
Trukeschitz, B. 2011. What matters ultimately: Quality of results in long-term care and support. Kurswechsel, 2011, 4, 2235.
Warburton, D., Whitney Nicol, C. and Bredin, S. 2006. Health benefits of physical activity: the evidence. Canadian Medical Association Journal, 174, 6, 801–9.
Welch, E., Palmer, S., Towers, A. and Smith, N. 2017. Why are relatives of care home residents reluctant to ‘rock the boat’? Is there a culture of acceptance? Working with Older People, 21, 2, 124–32.
Wilhelmson, K., Andersson, C., Waern, M. and Allebeck, P. 2008. Elderly people's perspectives on quality of life. Ageing & Society, 25, 4, 585600.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Ageing & Society
  • ISSN: 0144-686X
  • EISSN: 1469-1779
  • URL: /core/journals/ageing-and-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 10
Total number of PDF views: 118 *
Loading metrics...

Abstract views

Total abstract views: 785 *
Loading metrics...

* Views captured on Cambridge Core between 11th July 2017 - 16th August 2018. This data will be updated every 24 hours.