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Section 17
Paper Balling Success Stories

Table of Contents | NCCAP/NCTRC CE Booklet

Paper balling is an excellent activity for the most mentally impaired to your more alert residents who have stiff finger movement.  Paper balling is exactly what it sounds like.  The resident crumples paper into a ball.  Here's how this activity works.  Have a resident with more capability tear newspaper into quarter sheets.  This is the ideal size to be crumpled into balls. Stack the torn newspapers to the resident's left, if the resident is right handed or if their right hand is their "better" hand.  Then ask the resident to crumple the paper into balls. Of course, make sure hand movement is not counter-indicated in their Care Plan.  (A counter-indication would be a statement, for example, that the resident needs to keep his or her hands immobile while healing from a recent break.)

As the resident balls the paper, he or she puts the balls in a grocery bag place to their right.  Do you recall the adaptation challenge above in the Push Ball section?  Here is an example of making an item higher to enhance the resident's success.  I find a way to make Paper Balling a little more of a challenge is to vary the height of the grocery bag into which the resident is dropping the paper balls.  I like to use a grocery bag because of its flat base, large opening, and stiffness.  If it is cuffed several times at the top it will create a lower reach for the resident.  I had a resident once to whom I said, "Joe, I bet you can reach higher than this."  So I uncuffed the bag part way, which of course made it taller.  This created a situation that encouraged the resident to reach his arm not only out but up as well.  This reaching was beneficial due to his decreasing ability to straighten his arm out.  As you can see this activity supports a possible PT and/or OT Care Plan Goal.  The last track of the DVD contains a slide showing a resident reaching over to her bed to drop the paper ball into the bag.  This bag was intentionally placed away from the resident due to her request, once the benefits of stretching her arm out were explained.

I have found residents who are extremely alert have surprised me by being very happy to do this nonsensical, non product producing activity; because they want to do something to keep the movement in their hands that they have.  So to motivate your resident, with whom a hand exercise approach works well…
1. Lay a stack of newspapers, torn into quarter sheets, on the over-the-bed-table in front of them
2. Say to the residents, “Time for your hand exercise.” 
3. They then ball the paper balls one at a time and drop them into the grocery bags.
One drawback to Paper Balling is that the resident usually ends up with a certain amount of ink from the newsprint on their hands.  About 80% of the residents I have used Paper Balling with did not even notice, or if they did notice, did not care because they wanted to exercise their fingers.  However, for some residents who have a concern about getting "dirty hands," you might see if they would be able to participate, or be interested in, one of the Clay activities presented in Volume Two.

Residents as Volunteers!
Who tears the newspaper into the convenient quarter sheet size?  A very important point here is to have a resident not involved in Paper Balling tear the papers into quarter sheets.  You are really missing out here if you do not have a resident tear these for you, if you have one who is able.  The reason I say "missing out" is because if you or your assistant sit in your Activity room and tear them yourselves, which of course by far is much easier, you deprive a resident of a potentially successful experience.  In addition, you also deprive that resident of an opportunity to be a volunteer for your Activity Department.  I feel residents who still have a certain level of alertness can be provided with a successful experience from knowing they are helping out another resident who has less capability.  This concept clearly enhances the CMS “Person Appropriate” concept regarding the fact that “Activities should be relevant to resident’s specific needs, interests,” etc.  Some residents have a need and interest to help others.

I feel it is extremely beneficial to have one part of your activity program supporting another part of your activity program. In other words, you have some residents who are tearing the newspaper sheets into quarter pieces, and the advanced-stage Alzheimer’s residents doing the Paper Balling.  In short, you are using your more capable residents, if you have them, as volunteers to prepare the paper for your less capable residents.  I find some resident volunteers like to know they are still able to help others out who have less capability they have.

Snowball Fight:  In one facility I consulted to, they used the paper balls to have a Snow Ball Fight.  The Activity Director tied a string across the living room from pillar to pillar.  The residents were divided into two teams and they threw paper balls across the room.  After a certain length of time, the side that had the least balls on its side was the winner.  Of course you make up some verbiage telling everyone they are a winner.  The staff got involved also helping resident throw balls back on the other side once they had landed.  Lots of fun… lots of laughs!  However, of course, select only the residents who will not be traumatized by all the movement and confusion.

Residents with whom to try these Activities

Culture Change Implementation: Place Paper Balling or Tearing in Activity Project Bag left in resident’s room for CNA, volunteer, staff, etc. use.