THERE IS SOMETHING ABOUT “ACTIVITIES”

THERE IS SOMETHING ABOUT “ACTIVITIES” QUALITY IMPROVEMENT NURSE CONSULTANTS

WE’RE “MOVING” TOWARD CHANGE • F248- ACTIVITIES • F249- ACTIVITIES DIRECTOR

ACTIVITIES- F248 • Facility • Ongoing program of activities • In accordance with the comprehensive assessment • Designed to meet the interests and the physical, mental, and psychosocial well-being of each resident

What’s An “Activity”? • Any endeavor other than routine ADL • Resident participates • Intended to enhance her/his sense of well-being • Promotes or enhances physical, cognitive, and emotional health.

It takes more than one kind • One-to-One Programming • Person Appropriate • Program of Activities

The all important assessment • Obtain detailed information (even if the Activities rap does not trigger). • What are the resident’s life long interests? • What does the resident prefer? • Are adaptations needed?

Care Planning • Documented identification of the resident’s interest, preferences, and abilities. • Any issues, concerns, problems or needs affecting the resident’s involvement/engagement in activities.

Care Planning (cont.) • Activity goals based on measurable objectives (i.e., resident’s desired outcomes)

Care Planning/Measurable Goals? • What’s wrong with this goal? • The resident will attend 3 activity group programs a week.

CARE PLANNING (CONT.) • The care plan should also identify the disciplines that will be involved in assisting the resident to carry out activities.

CARE PLANNING:Accommodations • Facilities need to consider accommodations in schedules, supplies, and timing to optimize participation

INTERVENTIONS • Individualized, based on: • Resident’s history • Resident’s preferences • Resident’s strengths • Resident’s needs

INTERVENTIONS (CONT.) • Reality orientation and large group activities that include residents with different levels of strengths and needs are not recommended

INTERVENTIONSAddressing Behavioral Symptoms • Take into account a resident’s pattern of behavioral symptoms • Activities should be presented prior to when symptoms usually present themselves

Any Suggestions?? • Resident constantly walking: ~ Provide a space and environmental cues that encourages physical exercise, decreases exit behavior, and decreases extra stimulation

Any Suggestions? • Engages in name-calling, hitting, kicking, etc… ~ Calm, non-rushed environment ~Structured, familiar activities ~ One-to-one activities/small group ~ Exercise and movement activities

Any Suggestions? • Disrupts group activities, uncontrolled crying, anger, sensitive to too much stimulation: ~ Activities in which resident can succeed, broken into simple steps. One-to-one, short, repetitive, slow.

Any Suggestions? • Resident goes through other’s belongings: ~ normalizing activities such as stacking canned food onto shelves, folding laundry, providing rummage areas in plain sight (e.g., a dresser)

Any Suggestions? • Resident withdraws from previous activity interests/customary routines and isolates in room/bed most of day: ~ Provide activities just before or after meal time and where the meal is being served (out of the room) ~Providing in-room volunteer visits, music, or videos of choice. ~Encouraging volunteer-type work that begins in the room and needs to be completed outside the room.

Any Suggestions? • Resident excessively seeks attention from staff and/or peers: ~ Include in social programs, small group activities, service projects with opportunities for leadership.

Any Suggestions? • Resident lacks awareness of personal safety

ANY SUGGESTIONS? • Resident has delusions and hallucinatory behaviors that are stressful to him/her: • Activities that decrease stress • Activities that increase awareness of surroundings • Offer verbal reassurance

F- 249 Activity Director • Directs your activity program • Qualified therapeutic recreation specialist or activities professional

Activity Director • Licensed or registered by State (if applicable) • Eligible for certification as a therapeutic specialist or as an activities professional by a recognized accrediting body on or after Oct. 1 1990 or • 2 years experience in a social or recreational program within the last 5 years, 1 was full-time in a patient activities program in a health care setting or

Activity Director • Qualified occupational therapist or occupational therapy assistant or • Has completed a training course approved by the State

“Take A Walk In My Shoes” • Directing the development, implementation, supervision and ongoing eval of the activities program • Involvement in the comprehensive assessment • Contribute to comprehensive care plan goals • Scheduling the activity program • Monitoring the response to the program

Surveyor Guidance/ Intent • The facility identifies each resident’s interests and needs; and • Involves the resident in an ongoing program of activities that is designed to appeal to his or her interests and to enhance the resident’s highest practicable level of physical, mental, and psychosocial well-being.

Surveyor Guidance/Overview • Activities program is based on the resident’s comprehensive assessment • Resident’s Views on Activities ~ relevant and valuable to their quality of life and considered a part of their dignity ~ need to amount to something and be meaningful to the residents’ lives ~ residents with dementia are happier and less agitated in homes with many planned activities for them.

Surveyor Guidance/Assessment • What are the resident’s life long interests? • What does the resident prefer? • Are adaptations needed?

Surveyor Guidance/Care Planning • Info. from the individualized assessment is used to develop the care plan • Objectives should be measurable and focus on the resident’s desired outcomes • All relevant departments collaborate not just activities.

Surveyor Guidance/Care Planning/Accommodations • Look for facility consideration of resident’s schedule to optimize participation in activities • The need or assistance to travel to locations of activities • Provision of adaptive equipment/supplies when needed to attend activities • Assistance with ADLs to optimize participation in activities.

Surveyor Guidance/Interventions • Identify whether the resident has issues for which staff should have provided adaptations.

Surveyor Guidelines/InterventionsAddressing Behavioral Symptoms • Activities should be presented prior to when symptoms usually present themselves.

Surveyor Guidance/InterventionsAddressing Behavioral Symptoms • Look for evidence of encouraging physical activities for a resident that is constantly walking • Look for facility provision of organizing tasks for a resident who goes through other’s belongings • Look for the offering of social programs and opportunities for leadership for residents who are attention-seeking.

REFERENCE • State Operations Manual (Pub. 100-07) Centers for Medicare & Medicaid Services (CMS) Manual System, Provider Certification Department of Health & Human Services (DHHS)

THERE IS SOMETHING ABOUT “ACTIVITIES”