Today's activity is called "word worm," and the subject is "things to do on a rainy day." Outside the window of the nursing home, thin columns of rain are dripping off the roof.

Inside, a dozen old people pull their wheelchairs into a circle and watch a cheerful activities assistant named Mary write a list of letters on the whiteboard. Then she turns to the group and asks, "What can you do on a rainy day that begins with the letter 'A'?" At first there are blank stares all around, but finally a woman near the window shouts out a word: announce

The people in the chairs have spent the past half hour taking turns throwing small balls toward a plastic basketball standard, the kind you might find in a preschool. Now, as it continues to pour, they watch Mary move through the alphabet. On the board, the list of things to do on a rainy day grows to include dog, fruit, open, vote.

"W," says Mary now, looking around the room.

The woman near the window calls out an answer: Waiting.

Indeed, sometimes it seems that waiting — for someone to visit, for mealtime, for someone to do something for you — is a central activity of people who have become too frail to manage their own lives.

In the past 10 years, Tony Morrison has visited nearly every nursing home from Springville to Logan as executive director of the Center for Human Potential, a Salt Lake company that provides psychotherapy to residents of nursing homes and assisted living facilities. He's talked to hundreds of residents whose moods mirror national studies showing that between 40 percent and 80 percent suffer from some form of depression.

Some of this depression is lifelong, some the result of the compounded losses of aging. But sometimes, Morrison says, depression is exacerbated by the nursing home itself and the choices lost in the process: whom you get to sit with at lunch, when you get to bathe, how you get to spend your days.

"As much as possible," he says, "if choice can be preserved, that can have an impact on mood."

Choice is central to the newest buzzword of the nursing home industry: culture change. Typically, when nursing homes have embraced the concept (beyond the more cosmetic but still crucial changes that try to make nursing homes look less like a hospital and more like a home), the choices have been about food: Mealtimes and menus are now more flexible and varied.