THERE IS SOMETHING ABOUT THERE IS SOMETHING ABOUT “ACTIVITIES”“ACTIVITIES”

QUALITY IMPROVEMENT QUALITY IMPROVEMENT NURSE CONSULTANTS NURSE CONSULTANTS

WE’RE “MOVING” TOWARD WE’RE “MOVING” TOWARD CHANGE CHANGE

F248- ACTIVITIESF248- ACTIVITIES

F249- ACTIVITIES F249- ACTIVITIES DIRECTORDIRECTOR

ACTIVITIES- F248ACTIVITIES- F248

Facility Facility Ongoing program of Ongoing program of

activitiesactivities In accordance with the In accordance with the

comprehensive comprehensive assessmentassessment

Designed to meet the Designed to meet the interests and the interests and the physical, mental, and physical, mental, and psychosocial well-psychosocial well-being of each residentbeing of each resident

What’s An “Activity”?What’s An “Activity”?

Any endeavor other than routine ADLAny endeavor other than routine ADL Resident participatesResident participates Intended to enhance her/his sense of well-beingIntended to enhance her/his sense of well-being Promotes or enhances physical, cognitive, and Promotes or enhances physical, cognitive, and

emotional health.emotional health.

It takes more than one kindIt takes more than one kind

One-to-One ProgrammingOne-to-One Programming

Person AppropriatePerson Appropriate

Program of Activities Program of Activities

The all important assessmentThe all important assessment Obtain detailed Obtain detailed

information (even if information (even if the Activities rap does the Activities rap does not trigger). not trigger).

What are the What are the resident’s life long resident’s life long interests?interests?

What does the What does the resident prefer?resident prefer?

Are adaptations Are adaptations needed?needed?

Care PlanningCare Planning

Documented Documented identification of the identification of the resident’s interest, resident’s interest, preferences, and abilities.preferences, and abilities.

Any issues, concerns, Any issues, concerns, problems or needs problems or needs affecting the resident’s affecting the resident’s involvement/engagement involvement/engagement in activities. in activities.

Care Planning (cont.)Care Planning (cont.)

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

Care Planning/Measurable Goals?Care Planning/Measurable Goals?

What’s wrong with What’s wrong with this goal?this goal?

The resident will The resident will attend 3 activity attend 3 activity group programs a group programs a week.week.

CARE PLANNING (CONT.)CARE PLANNING (CONT.)

The care plan should also identify the The care plan should also identify the disciplines that will be involved in disciplines that will be involved in assisting the resident to carry out assisting the resident to carry out activities.activities.

CARE PLANNING:CARE PLANNING:AccommodationsAccommodations

Facilities need to consider Facilities need to consider accommodations in schedules, supplies, accommodations in schedules, supplies, and timing to optimize participationand timing to optimize participation

INTERVENTIONSINTERVENTIONS

Individualized, Individualized, based on: based on:

Resident’s Resident’s historyhistory

Resident’s Resident’s preferencespreferences

Resident’s Resident’s strengthsstrengths

Resident’s needsResident’s needs

INTERVENTIONS (CONT.)INTERVENTIONS (CONT.)

Reality orientation Reality orientation and large group and large group activities that activities that include residents include residents with with different different levels of strengths levels of strengths and needs are not and needs are not recommendedrecommended

INTERVENTIONSINTERVENTIONSAddressing Behavioral SymptomsAddressing Behavioral Symptoms

Take into account a resident’s Take into account a resident’s pattern of behavioral symptomspattern of behavioral symptoms

Activities should be presented Activities should be presented prior prior to when symptoms usually present to when symptoms usually present themselvesthemselves

Any Suggestions??Any Suggestions??

Resident constantly Resident constantly walkingwalking::

~ Provide a space and ~ Provide a space and environmental cues environmental cues that encourages that encourages physical exercise, physical exercise, decreases exit decreases exit behavior, and behavior, and decreases extra decreases extra stimulationstimulation

Any Suggestions?Any Suggestions?

Engages in name-Engages in name-calling, hitting, calling, hitting, kicking, etc…kicking, etc…

~ Calm, non-rushed ~ Calm, non-rushed environmentenvironment

~Structured, familiar ~Structured, familiar activitiesactivities

~ One-to-one ~ One-to-one activities/small groupactivities/small group

~ Exercise and ~ Exercise and movement activitiesmovement activities

Any Suggestions?Any Suggestions? Disrupts group Disrupts group

activities, activities, uncontrolled crying, uncontrolled crying, anger, sensitive to anger, sensitive to too much too much stimulation:stimulation:

~ Activities in which ~ Activities in which resident can resident can succeed, broken succeed, broken into simple steps. into simple steps. One-to-one, short, One-to-one, short, repetitive, slow.repetitive, slow.

Any Suggestions?Any Suggestions?

Resident goes Resident goes through other’s through other’s belongings:belongings:

~ ~ normalizing activities normalizing activities such as stacking such as stacking canned food onto canned food onto shelves, folding shelves, folding laundry, providing laundry, providing rummage areas in rummage areas in plain sight (e.g., a plain sight (e.g., a dresser)dresser)

Any Suggestions?Any Suggestions? Resident withdraws from previous activity Resident withdraws from previous activity

interests/customary routines and isolates in interests/customary routines and isolates in room/bed most of day:room/bed most of day:

~ Provide activities just before or after meal time ~ Provide activities just before or after meal time and where the meal is being served (out of the and where the meal is being served (out of the room) room)

~Providing in-room volunteer visits, music, or ~Providing in-room volunteer visits, music, or videos of choice. videos of choice.

~Encouraging volunteer-type work that begins in ~Encouraging volunteer-type work that begins in the room and needs to be completed outside the the room and needs to be completed outside the room.room.

Any Suggestions?Any Suggestions?

Resident Resident excessively seeks excessively seeks attention from staff attention from staff and/or peers:and/or peers:

~ ~ Include in social Include in social programs, small group programs, small group activities, service activities, service projects with projects with opportunities for opportunities for leadership.leadership.

Any Suggestions?Any Suggestions?

Resident lacks Resident lacks awareness of awareness of personal safetypersonal safety

ANY SUGGESTIONS?ANY SUGGESTIONS?

Resident has delusions and Resident has delusions and hallucinatory behaviors that are hallucinatory behaviors that are stressful to him/her:stressful to him/her:

Activities that decrease stressActivities that decrease stress Activities that increase awareness of Activities that increase awareness of

surroundingssurroundings Offer verbal reassuranceOffer verbal reassurance

F- 249 Activity DirectorF- 249 Activity Director

Directs your Directs your activity programactivity program

Qualified Qualified therapeutic therapeutic recreation recreation specialist specialist or or activities activities professionalprofessional

Activity DirectorActivity Director

Licensed or registered by State (if Licensed or registered by State (if applicable)applicable)

Eligible for certification as a therapeutic Eligible for certification as a therapeutic specialist or as an activities professional specialist or as an activities professional by a recognized accrediting body on or by a recognized accrediting body on or after Oct. 1 1990 after Oct. 1 1990 oror

2 years2 years experience in a social or experience in a social or recreational program within the last 5 recreational program within the last 5 years, 1 was full-time in a patient activities years, 1 was full-time in a patient activities program in a health care setting program in a health care setting oror

Activity DirectorActivity Director

Qualified Qualified occupational occupational therapist or therapist or occupational occupational therapy assistant therapy assistant oror

Has completed a Has completed a training course training course approved by the approved by the StateState

““Take A Walk In My Shoes”Take A Walk In My Shoes”

Directing the development, Directing the development, implementation, supervision and ongoing implementation, supervision and ongoing eval of the activities programeval of the activities program

Involvement in the comprehensive Involvement in the comprehensive assessmentassessment

Contribute to comprehensive care plan Contribute to comprehensive care plan goalsgoals

Scheduling the activity programScheduling the activity program Monitoring the response to the programMonitoring the response to the program

Surveyor Guidance/ IntentSurveyor Guidance/ Intent The facility identifies The facility identifies

each resident’s each resident’s interests and needs; interests and needs; andand

Involves the resident in Involves the resident in an ongoing program of an ongoing program of activities that is activities that is designed to appeal to designed to appeal to his or her interests and his or her interests and to enhance the to enhance the resident’s highest resident’s highest practicable level of practicable level of physical, mental, and physical, mental, and psychosocial well-being.psychosocial well-being.

Surveyor Guidance/OverviewSurveyor Guidance/Overview

Activities program is based on the Activities program is based on the resident’s comprehensive assessmentresident’s comprehensive assessment

Resident’s Views on ActivitiesResident’s Views on Activities~ relevant and valuable to their quality of ~ relevant and valuable to their quality of

life and considered a part of their dignitylife and considered a part of their dignity~ need to amount to something and be ~ need to amount to something and be

meaningful to the residents’ livesmeaningful to the residents’ lives~ residents with dementia are happier and ~ residents with dementia are happier and

less agitated in homes with many planned less agitated in homes with many planned activities for them.activities for them.

Surveyor Guidance/AssessmentSurveyor Guidance/Assessment

What are the What are the resident’s life long resident’s life long interests?interests?

What does the What does the resident prefer?resident prefer?

Are adaptations Are adaptations needed?needed?

Surveyor Guidance/Care PlanningSurveyor Guidance/Care Planning

Info. from the Info. from the individualized individualized assessment is used to assessment is used to develop the care plandevelop the care plan

Objectives should be Objectives should be measurable and focus measurable and focus on the resident’s on the resident’s desired outcomesdesired outcomes

All relevant All relevant departments departments collaborate not just collaborate not just activities.activities.

Surveyor Guidance/Care Surveyor Guidance/Care Planning/Planning/AccommodationsAccommodations

Look for facility consideration of resident’s Look for facility consideration of resident’s schedule to optimize participation in schedule to optimize participation in activitiesactivities

The need or assistance to travel to The need or assistance to travel to locations of activitieslocations of activities

Provision of adaptive equipment/supplies Provision of adaptive equipment/supplies when needed to attend activitieswhen needed to attend activities

Assistance with ADLs to optimize Assistance with ADLs to optimize participation in activities.participation in activities.

Surveyor Guidance/Interventions Surveyor Guidance/Interventions

Identify whether Identify whether the resident has the resident has issues for which issues for which staff should have staff should have provided provided adaptations.adaptations.

Surveyor Guidelines/InterventionsSurveyor Guidelines/InterventionsAddressing Behavioral SymptomsAddressing Behavioral Symptoms

Activities should be Activities should be presented presented prior prior to to when symptoms when symptoms usually present usually present themselves.themselves.

Surveyor Guidance/InterventionsSurveyor Guidance/InterventionsAddressing Behavioral SymptomsAddressing Behavioral Symptoms

Look for evidence of encouraging physical Look for evidence of encouraging physical activities for a resident that is constantly activities for a resident that is constantly walkingwalking

Look for facility provision of organizing Look for facility provision of organizing tasks for a resident who goes through tasks for a resident who goes through other’s belongingsother’s belongings

Look for the offering of social programs Look for the offering of social programs and opportunities for leadership for and opportunities for leadership for residents who are attention-seeking.residents who are attention-seeking.

REFERENCEREFERENCE

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