Put Down the Pool Noodle: On the Right to Do Absolutely Nothing

The rep by the pool

Picture the scene. You are on holiday. All inclusive. Hard-earned. You have found your spot by the pool, applied the factor fifty, arranged your book and your gin and tonic, and you are doing exactly what you came here to do: precisely nothing.

And then he appears. The activities rep. Polo shirt. Lanyard. Unshakeable optimism. Walking the perimeter of the pool with the energy of someone who has never once considered that other people's idea of a good time might differ from his own.

"Aqua aerobics in five minutes! Who's coming?"

You do not answer. You return to your book.

He comes round again. Slightly closer this time.

"It's really fun! Great for the core! You'll love it!"

You love sitting here. You are already loving it.

A third lap. The pool noodles are out. He is waving one in your general direction. He genuinely believes that if he can just get you on your feet, you will thank him for it. He is, by every measurable standard, wrong.

Now here is the question. How often does a version of that rep walk the lounge of a care home, interrupting a resident who was perfectly content where they were, convinced that what this person really needs is to be encouraged, cajoled, or gently pressured into an activity they have shown no interest in whatsoever?

More often than any of us should be comfortable with.

We are not all the same

This is, when you think about it, the most obvious thing in the world. And yet it is the thing that gets flattened most reliably by institutional thinking about activity provision.

Some people are energised by company and bustle. They want the group session, the communal table, the bingo and the sing-along. They feel better for being part of something and the more the merrier. Give them all of it.

Some people are not like that. Never have been. They are the ones at the party who find a quiet corner and have a long, satisfying conversation with one person rather than circulating. They are the ones who, on the night out, are perfectly happy sitting at the table discussing the menopause while Sandra keeps trying to drag everyone to the dance floor. They do not want to dance, Sandra. They are fine where they are.

These preferences do not evaporate when someone moves into a care home. They are not a symptom to be treated or a gap in the activity schedule to be filled. They are expressions of who someone is: their personality, their lifelong habits, the way they have always found comfort and pleasure in the world.

Kitwood was clear on this. Among his twelve forms of positive person work, the interactions that actively support personhood and wellbeing in people with dementia, he included relaxation: described explicitly as low intensity interaction with recognition that some people may like to relax in solitude. Not as a concession or a compromise. As a legitimate positive care interaction in its own right. Sitting quietly is not a failure of the activity programme. For some people, it is exactly the right thing.

The trouble with equating activity with wellbeing

There is an assumption baked into a lot of care home thinking about activities, and it runs roughly like this: engagement equals wellbeing, therefore more engagement equals more wellbeing, therefore if someone is not engaged in an activity they are in a worse state than they would be if they were, and it is our job to fix that.

This is not supported by the evidence. And it is not supported by common sense.

Wellbeing in dementia, mapped by researchers building on Kitwood's framework, is described in terms of comfort, inclusion, identity, occupation and attachment. Notice that occupation, in the sense of being engaged in doing something, is one of five equally weighted needs, not the primary one. Comfort, the sense of being safe, settled, at ease, is there alongside it. For a resident who is sitting quietly in a chair they have chosen, in a room where people they know are nearby, doing something or nothing that suits them, several of those needs may be very well met indeed.

A PMC review on meaningful occupation in dementia care makes a point that deserves to be printed and stuck to every activities team noticeboard: interests and preferences change throughout a person's life, including the meaning the individual attaches to occupations. And it identifies this as a reason to continuously explore which occupations are meaningful together with the person with dementia, not to assume that because activity is good, more activity is always better, and enforced activity is better still.

Research on engagement and social justice in dementia care settings, published in Health and Social Care in the Community, frames unmet needs for activity as a human rights concern. And it is. But so is the mirror image: the unmet need for rest, for quiet, for the legitimate withdrawal from the social world that introverts have always needed and that dementia does not take away.

Overprotection is its own kind of harm

There is a concept in care ethics called the dignity of risk. It is the idea that self-determination, including the right to make choices that others might consider suboptimal, is essential to dignity and self-esteem. The corollary, first articulated by Robert Perske in the early 1970s, is that overprotection carries its own harm. An oversupply of it, he wrote, can smother people emotionally, squeeze the life out of their hopes and expectations, and strip them of their dignity.

Perske was writing about intellectual disability, but the principle transfers directly to older age and dementia care. And it applies to activity provision in ways the sector has been slow to acknowledge.

When we override a person's expressed preference for quiet or solitude in order to involve them in a scheduled group activity, we are not protecting them. We are overriding them. The intention may be kind. The effect is paternalistic. Research on autonomy in residential care settings published in PMC is explicit that even people with moderate to advanced dementia retain the capacity to articulate their values and preferences and maintain a strong desire to remain central in decisions that affect their daily lives. A desire to sit and watch the afternoon light come through the window is a preference. It deserves the same respect as a desire to play the piano.

The problem with the pool rep is not that he organised aqua aerobics. The aqua aerobics is genuinely great for the people who want it. The problem is that he kept coming back to the people who did not. That insistence, however cheerful, is not care. It is imposition.

What getting old actually feels like

Here is a thought experiment. You have worked for forty, fifty years. Raised children. Managed a household. Dealt with the relentless demands of adult life. And now, at last, you are in a place where no one needs you to do anything, where your time is yours, where you can sit in the warmth and be still.

A sit down, it turns out, is underrated. After decades of business, the freedom to simply be, without agenda, without expectation, without the next thing clamouring for your attention, is not nothing. It is something quite profound.

For people who have reached later life, especially those who have lived long and full lives, the ability to rest without guilt is not emptiness. It is arrival. The pleasure of having nothing in particular to do, and being in a comfortable chair with a cup of tea while doing it, is a genuine and quietly radical form of wellbeing.

The evidence on quality of life in dementia consistently identifies mood and the sense of comfort and safety as the most significant contributors to subjective wellbeing. Not activity levels. Not engagement scores. Mood. Comfort. The felt sense of being settled in one's environment.

A resident who is sitting quietly and appears content is not a problem to be solved. They are a person whose needs are, in that moment, being met.

How to tell the difference

Of course, none of this means that withdrawal is always fine and that the person sitting alone in the corner is necessarily happy to be there. The skill, and it is a genuine skill, is in reading the difference between chosen quiet and lonely isolation, between contented stillness and unaddressed distress, between a person who is at peace and a person who has given up.

That distinction is not made by checking whether someone is participating in the scheduled activity. It is made by knowing the person: their history, their personality, their lifelong habits, the way their face looks when they are content versus when they are struggling. It is made by sitting with them quietly for long enough to feel the quality of the silence. It is made by asking, gently and without agenda, whether there is anything they would like rather than assuming that the programme on the notice board is the answer.

A resident who has always been an introvert is not deteriorating when they prefer the armchair to the group session. A resident who loved their own company and their own thoughts throughout their life has not lost something when they seek those things now. They are, in the language of Kitwood's personhood framework, exercising a form of identity continuity. The person they have always been is still visible in the choices they are still making.

Honour that. Do not ride around the pool with a noodle, trying to convince them to be a different kind of person.

The practical implication for care homes

The question to ask of every person in your home is not are they engaged enough? It is: are they living in a way that suits them?

For some people that will mean a full diary, group sessions, one-to-one activities, regular outings and as much stimulation as the day can hold. For others it will mean a quiet chair, a preferred television programme, a cup of tea at the same time each afternoon, and the freedom to decline the aqua aerobics without anyone taking it personally.

Both are valid. Both deserve documentation, care planning, and genuine staff understanding. The person who wants to do everything and the person who wants to do nothing are equally telling you who they are and what they need. The job of the care team is to listen to both of them with equal respect.

Kitwood's positive person work explicitly includes relaxation. It is there, in his list, alongside play and celebration and creation. Not as a default when everything else has been refused. As a legitimate, valued, care-positive interaction in itself.

A care assistant who sits companionably beside a resident who is happy to be quiet, offering presence without pressure, is doing excellent dementia care. They do not need to be redirected to the activities room. They are already there.

A final word about Sandra

Sandra, we should be clear, is not the villain. Sandra genuinely loves dancing. For Sandra, a night out without dancing is barely a night out at all, and her enthusiasm for getting everyone on the floor comes from a place of wanting to share something she loves.

The problem is not Sandra's love of dancing. The problem is the assumption that everyone else's best night looks like Sandra's best night.

Some of the people sitting at that table are having a wonderful time exactly where they are. The conversation is good, the drinks are cold, and there is a real pleasure in watching the room from a comfortable chair. They do not need rescuing from their own contentment.

Care homes have their own Sandras. They are often warm, energetic people who genuinely care about residents and genuinely believe that engagement and stimulation are the route to wellbeing. They are not wrong about that, for the residents who want those things.

They are just wrong to assume it is true of everyone.

The goal is not maximum activity. The goal is the right amount of the right thing for each individual person, which for some people, some of the time, is a peaceful chair, a warm room, and the dignity of being left in peace.

That is care. And it does not require a pool noodle.