Making the Transition from Activities to Recreational Therapy and Activities

1. Making the Transition from Activities to Recreational Therapy and Activities October 2009 MDS 3.0

2. The Purpose of Activities in the Nursing Home • Prior to OBRA ’87, • To divert attention and fill the time. • After OBRA ’87 • Elevated services to provide therapeutic programs to meet the physical, mental, and psychosocial needs as well as providing diversional activities to meet the interests of residents.

3. New Survey Guidelines CMS revised the interpretive guidelines for F248 which became effective June 1, 2006. These guidelines emphasize: • Comprehensive assessment to determine mental, physical, and psychosocial needs • Individualized interventions to meet the identified needs • As well as the interests of each resident.

4. A key component in meeting these guidelines and providing the highest quality of care to the residents of nursing facilities. Recreational Therapy

5. What is Recreational Therapy? “Therapy ordered by a physician that provides therapeutic stimulation beyond the general activity program in a facility and physician ordered services which must include the frequency, duration, and scope of treatment.” -Centers for Medicare and Medicaid (CMS)

6. Minimum Requirements of a Recreational Therapist State license or national certification as a Certified Therapeutic Recreation Specialist (CTRS) or Therapeutic Recreation Assistant working under the direct supervision of a CTRS. -CMS

7. Recreational Therapy services are treatment services designed “to restore, remediate, or rehabilitate in order to improve functioning and independence as well as reduce or eliminate the effects of illness or disability.” American Therapeutic Recreation Association

8. Recreational Therapy • Active treatment provided: • In a small group (1 to 4 staff to client ratio) or in a one-to-one setting • Used to meet a care plan goal or objective • With a reasonable expectation for improvement • Time limited

9. Benefits & Outcomes • Reduces falls and injuries related to falls (Buettner, 2001). • Reduces disturbing behaviors exhibited by individuals with dementia which leads to decreased use of psychotropic medications and chemical restraints (Buettner & Fitzsimmons, 2003; Buettner, Fitzsimmons, & Atav, 2006; Fitzsimmons & Buettner, 2003a).

10. Benefits & Outcomes • Relieves pain (Finch, 2006; Richeson, 2004; Stumbo, 2006). • Decreases the symptoms of Depression and Anxiety (Passmore & Lane, 2006; Lynch, 2006; Fitzsimmons & Buettner, 2003b). • Decreases apathy (Fitzsimmons & Buettner, 2003b).

11. Benefits and Outcomes • Improves muscle strength and balance (Sayers, 2005; Mobily, Mobily, Raimondi, Walter, & Rubenstein, 2004; Wolf, Feys, De Weerdt, van der Meer, Noom, Aufdemkampe, 2001). • Improves functional abilities which • results in decreased use of nursing resources. • allows individuals to live in lesser level of care (ATRA, n.d.)

12. Benefits & Outcomes • Teaches skills needed to return to the community through community reintegration programs (Lewis, 2006) • Addresses clinical issues identified by the Quality Indicators offering non-pharmacological interventions (Buettner, 2000). • Improves subjective well-being and quality of life (Janssen, 2004; Richeson & McCullough, 2003).

13. Current & Future Implications for Recreational Therapy • MDS 2.0 • Recreational Therapy included under Section T as a data gathering tool but does not impact RUG scores. • Recreational Therapy influence RUG scores through participation in Restorative Nursing programs.

14. In The Future…October 2009 • MDS 3.0 • Recreational Therapy is included in Section O. which includes other rehabilitative therapies (Physical Therapy, Occupational Therapy, Music Therapy and Speech Therapy). • Will impact the RUG scores affecting the level of Medicare reimbursement.

15. Need to Update:Policies & Procedures • Staffing: roles and responsibilities should be defined. • Conducting Recreational Therapy and Activity Programs • Recreational Therapy and Activity Documentation • Emergencies

16. Policies & Procedures to update: • Recreational Therapy Assessment • Community Integration Outings • Animal Assisted Therapy vs. Animal Visitation • Recreational Therapy and Activity Program on a continuum • Recreational Therapy Treatment Protocols

17. Added Roles for the CTRS: • Expert clinician (work with the most difficult to engage to improve QOL and function), perhaps co-treatments, or under restorative nursing. • Trainer and educator: teach staff how to maintain residents active lives; aftercare depends on this. • Researcher: use evidence based practices for behaviors, falls, pain, depression, functional gains, and other quality indicators. • Supervisor: provide interns with RT role models and supervisor of other staff. • Culture change liaison: bridge between medical care and homelike active lifestyles.

18. Next step: • Upgrade to Recreation Therapy (RT) and activities in LTC. • Update policies & procedures manuals. • Prepare protocols for RT practice when MDS 3.0 begins. • Prepare referral forms and educate about RT as an option.

19. Permission to plan • Requesting permission to upgrade from our current activities offerings to include recreational therapy. It is the wave of the future!