Activities Assistance

Be Specific

2007-04-24T10:52:00.000-07:00

With the CMS Guidelines that went into effect last year, we now need to be specific when we assess, care plan and note on the resident's. For example, if a resident enjoys listening to the radio what type of radio and the specific radio station does the resident enjoy. If someone else enjoys playing cards, which card games does he/she play?
By being specific and addressing the specific interests of your resident will assist you in devleoping their care plans and addressing their specific needs in their progress notes. You will need to review your assessments to ascertain if you are actually gathering the correct information for your documentation.

1-1 Activities

2005-04-06T12:18:00.000-07:00

Using the information that you gather on the Activities Assessment will assist you in planning activities for 1-1 activities, programs for bed bound residents, activities with 2-3 people or those that have a hard time planning programs for individuals.
Yes, planning. See developing programs for 1-1 residents takes as much planning as planning for a group event. All of which takes some time, thought and indeed planning.....Which makes this so difficult for most activities departments. This type of program means that you will be spending time 1-1 with the resident, not visable to the nursing staff or that you have to make sure that the Activities Assessment reflects what the resident is interested in and has skills in.
So with that in mind, what works for my department might work for yours, but on the other hand may not. It depends on the approach, what the resident is interested in and what you can provide for them.

For example, I had a resident who had been to museums and was a fine arts major in college. She was unable to make her needs known, but did open her eyes during care and when I would go to see her. So for her activity, I found an "Art Game" that had picutes of famous paintings. Once a week I would change the pictures on her wall (which was also placed at her eye level) and talk about the paintings and the artists. She would only respond with eye contact and I was never sure that she knew what was up. BUT this met her needs and her interests.

Another resident that enjoyed watching TV was visited 2x a week by staff with a TV schedule that was updated, blown up on the copier for the resident to see and a conversation about TV specials.

Both activities were done under the scheduled "Coffee Cart". Both residents had their needs and interests met, both residents participated in the scheduled 1-1 activities. They were assessed and their assessments reflected their particular interests and needs. Now that we have the internet both residents would have their programs updated and done ASAP!

Initial Assessment Form

2005-03-14T16:34:00.000-08:00

Activities Initial Assessment
Name_____________________________________ Date__________________
Room #________________ Diagnosis_________________________________

Marital Status Married Divorced Single (Never Married) __Other
Past Occupation(s) ____________________________________________________________________________________________

Religion Practicing Non-practicing Enjoys all religions

Registered to vote? Yes No Would like to vote here

Activities/Hobbies/Interests that this person likes to pursue as well as learn about. Please encourage him/her to attend these programs when announced

Hobbies

Gardening
Pets __________________
Family Events
Holiday Celebrations
Bird Watching
Boating
Camping
Hunting
Fishing
Cooking
Crafts
____________________
____________________
____________________

Favorite Game
_____________________

Casino Games
Crossword Puzzles
Word Searches
Reading
Travel
Dancing
Movies
Computers
Cards

Spiritual Needs

Services (attends regularly)
Bible Study
Meditation
Temple
Protestant Services
Catholic Mass and Traditions
Priest/Minister to visit 1-1
________________________
________________________

Sports
___ Sports Fan
Baseball
_______________________
Football
________________________
Basketball
________________________
NASCAR
________________________

Soccer
Horseshoes
Bocce Ball
Walking
Horse Racing
Snow Sports
Olympics

Card Playing
Poker
Bridge
Hearts
Solitaire
Spades
Rummy
___________________
___________________

Crafts
Knitting
Crocheting
_________________
Sewing
Painting
Ceramics
Scrapbooking
Woodworking
Writing
House Décor
Rubber Stamping
Model Making
Puzzles
Crafty Crafts

Games
Bingo
Board Games
_____________________
Casino Games
____________________

Activities that we have here that the resident would like to attend

Socials
Teas
Men’s Groups
Veterans Programs
Parties
Entertainment

Educational
Biography
Current Events
You be the Judge
Back to School
Science Programs
___________________
____________________

Community
Movies
Resident Council
Outings
Service Projects
Entertainment
____________________
____________________
_____________________

Spiritual
Protestant Service
Catholic Mass
Bible Study
____________________
____________________
____________________

Intergenerational
Elementary School/Highe School/University visits
Reading Programs
Home School

1-1 and Individual Activiites
Bedside and Small Group

Reading/ Talking Books/
Newspaper/ Magazines
type___________________
Crossword Puzzles
Crafts
Snack/Soup/
Refreshment Cart
Wheeling/ Walking
Current Events
Family Events
Tea Cart
Trivia
Card Playing
Word Searches
Helping Others
Listen to Radio
Visits with Staff/Volunteers
______________________
TV Specific Programs
_______________________
_______________________
_______________________

Decorates Own Room
Goes out on own
Family visits regularly
______________________
_______________________

Preferred Activity Setting

Own Room
Day/Activity Room
Inside Nursing Home/off Unit
Outside Nursing Home
Community Programs on own
Family Events
Needs Assistance from Staff to
get to programs (transport to and from)
Read calendar to him/her
Favorite Snack/Food __________________
Favorite TV _________________________ Other Interests

John T

2005-03-03T15:48:00.000-08:00

John T

John was admitted to your facility with Parkinson and the inability to speak. He can make his needs known by hand gestures. He has an estranged daughter who lives out of town and will not be able to come and visit. He is an ex-boxer and more than likely has Parkinson due to the boxing. He is able to push the wheelchair around on his own using his good arm and his foot. He also has had a CVA affecting his right side.

How do we go about learning about what John would like to do? How can we learn about what he enjoys doing and what he would like to do? How can we document our conversations with him?

Carrie

2005-03-03T10:54:00.000-08:00

Carrie

Carrie will be celebrating her 100th Birthday next year. She owned a grocery store in the neighborhood. It was a gathering spot for all the neighbors. She was married twice and outlived both husbands. She enjoyed her church functions and was an elder in the Pentecostal church. She was also active on her political committee, for which she watched the polls every year. She has five children who all live close by and state that they will visit often. However, since admission they have only visited to bring in her belongings.

She was admitted on a ventilator along with a fractured right arm. She also has MRSA and VRE. She is in a private room, has been very demanding of nursing staff and is always on the call bell. Nursing has requested that Activities give her something to do.

What type of activities, that you currently have on the calendar would she be interested in? How can you adapt her situation to include activities of interest??? How do we go about getting her interested in her new living situation.

Ethel

2005-03-02T09:38:00.000-08:00

Ethel

Miss Ethel is 84 years young, she is a member of a Bridge Club that plays every week. She also enjoyed shopping and baked. She was a career women who never married, she worked for a law office as the secretary for the founding members of the law firm. She also trained other secretaries. She has traveled around the world, has scrapbooks of pictures and journals of all her trips. She has a nephew who lives four states away and stays in touch via phone to the facility.

She has MS and has been an active member in her community support group. Due to the loss of control she is confined to a wheelchair.

Looking at your current activities calendar, where would she "fit in"?? What would you provide for her considering what your activities calendar looks like right now.

Sam

2005-03-01T14:35:00.000-08:00

Resident Personality

Let's discuss "Sam" for a moment. Sam came to the nursing Home with an amputee, bad diabetes and COPD. He has some mild confusion and has lived at the VA for the last three months since the amputation. Sam was born in late 1929.

His social history includes an avid crossword puzzle fan, doing the daily puzzle in the daily paper. He puttered about his house, fixing things and doing all the "traditional" husband projects and tasks. He mowed the lawn, washed the cars, took the trash out, walked the dog and enjoyed a good barbecue with his family. He also enjoyed fishing and is a former Navy lieutenant. He enjoyed his job, but did not have a "best friend". He went to social events planned by his wife and enjoyed family gatherings. When he was younger he would stop and have a drink with co-workers on Friday evenings before returning home.

He has four children and a wife who visits twice a week for the day. So based on your current activities and what you have on your calendar, where would Sam fit in? Would he be going to a whole bunch of activities? Would he be coming to Bingo??? How about Men's Club????

What do you think? Post your comments here.......

Activities Planning

2005-02-28T12:09:00.000-08:00

Needs and Interests

Assessing a resident for activities should be a journey into their past interests, dreams and leisure skills. While we are all defined by "what we do" for a living, we still have talents way beyond the job that paid us. We enjoy spending an evening with our family helping with homework, we love to watch re-runs of "The Honeymooners" or we have a hobby that we use to reduce the stresses of the day. On the weekends we look forward to fishing in our favorite pond or we make that extra pot of coffee and gossip with our neighbors. All are interests that residents would like to continue to enjoy. Do we look for that on our assessments? Do we ask the questions that will assist with meeting their needs?

Many times we find out that residents participated in Community Groups only in their obituary. Did we find that information out during their assessment? Did we ask their loved ones about their accomplishments? Did we make those accomplishments known while they lived with us or are we mentioning them at their Memorial Service?? Does your assessment include areas for this information or are we still referring to their medical condition?
Do we seek out information that actually reflects the interests? Would a resident like to continue their "schooling"? Would a resident like to accomplish something totally different in their life time. Have we probed into what those "dreams" are? Are we adapting the activities to meet those interests?

If a resident is interested in going to the Louvre in Paris, what have we done to accomplish that dream? Do we have reproductions of the paintings hanging in their room? Have we gone to the website and gotten information for them? Do we periodically change pictures and make sure that they can go to the local art galleries? What, as activity professionals, do we do to adapt their environment to meet their interests?

Are we using the Activities Assessment tool to it's fullest potential? Are we just repeating the information that can be found in other sections in the chart? Are we really looking into a residents life or just recording information because we "HAVE TO"??? Does our staff know why they are doing this? Do we use these assessments to plan activities or are they gathering dust in the charts?

Are we using all the resources we have to meet the residents needs? If a resident came to your facility tomorrow with late stage dementia, wandered and had a social history of riding horses what would you do? Who would you contact? Where would you look for a place to take him/her to see horses or how would you go about getting them a ride on a horse? Would you get movies about horses? Would you get pictures or magazines? Are there resources that you would look for? How about a resident that Ballroom danced?

See the Activities Assessment is not just a piece of documentation that "HAS TO GET DONE" it's a document that should be the key to a residents soul. It should be the key to the soul of the activities department.

The Basics

2005-01-11T19:22:00.000-08:00

The Basics
The Activities Assessment has a variety of information that is unique to the activities department. It should reflect the leisure patterns and skills of the resident. These basics cover should give a snapshot of the resident for the Medical Record. The assessment basics would include the following:

A. Name of Resident
B. Date of Assessment
C. Residents Room Number
D. Diagnosis that affects residents participation in Activities
E. Work History
F. Marriage status
G. Primary Language
H. Signature of Individual Completing Assessment

Some of the above information is obvious. The first three are part of the Medical Record. In some circumstances this information not only appears on the front of the form, but also on the back of the form. Some facilities also require that the resident's number appear as well.

diagnosis
The diagnosis of a resident should be those that directly affect the residents ability to participate in activities. For example a resident who has a diagnosis of depression may still enjoy their leisure pursuits but their diagnosis of Multiple sclerosis may impede their ability to continue their interest in crafts. On the other hand the reverse might be applicable and their depression causes them to stay in their room and not participate in a craft program. The professional would need to visit with the resident several times to assess which diagnosis either physical or psychosocial would affect their continued interest in leisure pursuits. A full list of diagnosis is available in other parts of the Medical Record for future reference and should be used as a guideline for the activities assessment, not necessarily transcribed over again.

Work History
The residents work history defines who the resident was. Many activities assessments merely reflect the company or general work of a resident. A person who worked for the local car plant could have done a number of various jobs. They could have been a foreman, the plant nurse, a secretary or an assembly line worker. Through an interview with the resident one needs to find out what exactly the resident did. Also there are a number of people who had various jobs. Remember Miss Jones in the previous chapter who did her job because she had to and didn't particularly enjoy it. An interview with the resident may yield a hobby or a volunteer job that better reflects the residents definition of themselves in society. Stating the work, but reflecting their avocation on the assessment will assist with designing an activities program that best reflects the psychosocial needs of the resident.

Marital Status
The resident's marital status is also self explanatory, but in today's day and age it may not be the "traditional" information that you are looking for. A single never married resident may have children, a married resident may have been divorced longer than married and not have any children of their own. The actual status of a resident may give you clues to who to talk to for further information. Imagine for a minute that Elizabeth Taylor is your resident, where would you begin?

Primary Language
A resident may not be English speaking, but can comprehend English. Knowing this information would provide the activities department with a way to go about adapting activities for this resident. There would also be an opportunity to provide cultural programming to meet this particular residents needs.

Additional Information
You might want to include additional information in the beginning of your assessment that can be easily accessible for you and your staff to address immediately.

A. Registered Voter
B. Clubs/Associations Belonged to
C. Home Town
D. Places traveled to

Registered Voter
Residents in facilities can vote and should be afforded the opportunity. Upon completion of the assessment or during the assessment process you can register a resident according to your area's procedure. There have been many discussions in facilities about the capacity of a resident to vote. Activities departments are usually the ones that assist resident's with filling out their application and arranging voting in their facilities. Many facilities act as polling places and can benefit from having them onsite. Also there are deadlines for registration that can be found at your Board of Elections. Take a moment to familiarize your department with the information available in your area. If in doubt you can contact your League of Women Voters for assistance and questions.

Club/Associations
Many resident belong to church, civic or social organizations. This information may come from a resident or their family members. It is a vital key to finding support for the resident and your activities department. A resident who was a member of the American Legion may want to go there for an event or to socialize with others. The American Legion might have resources that can be used in your facility for a number of residents.

A resident who plays Bridge is always a challenge. They might have belonged to a Bridge studio in your community or played with others at the local Senior Center. By asking where and with whom they played Bridge you might be able to set up a game at your facility for them. You might also be able to find additional resources at your library, find a computer game of Bridge or online.

These are examples of some of the clubs/associations that residents might belong to there are hundreds of others available within your community. A list of some of the community clubs/associations can be found at your library or at your Chamber of Commerce.

Home Town
A resident that comes to live with you may be there because their family lives near your facility, but was not brought up in your area or even lived in your area. Many Baby Boomers retire to other parts of the world. Knowing their home town and getting their local paper or getting articles off the internet for them to keep in touch with friends and family may give you an extra hint as to their leisure interests and pursuits.

Travel
Now that the Baby Boomers are starting to come into facilities, travel is part of their social makeup. Foreign travel, domestic travel or going to visit friends and families has become a way of life. Places traveled would indicate the vast interests and the resident's lifestyle.
A resident who spent their leisure time camping in National Parks or a resident who went to Disney World can indicate what they are most interested in. A resident who experienced foreign travel be it through the military or as a leisure pursuit would have a variety of interests in an activities program. Using this information on an assessment will assist you in developing programs that meet their needs and interests.

Leisure Interests
There are as many leisure interests as there are residents. Developing a form that would reflect the multitude of interests can vary from facility to facility. Annually updating your assessment form to reflect your current population allows you to assess and find activities that would most interest those who will be participating in your activities. The check list that follows can be adapted to meet your resident needs and your departments programming needs. It can also reflect those activities that your facility offers. As each facility is different there may be activities that you offer that residents may be interested in. You can list them as well when interviewing the resident and their families to ascertain the types of activities that would be appealing to an individual.

A checklist can serve many purposes including reminding the assessor what interests to inquire about. It can also be included as part of the total assessment process. Upon evaluation of the assessment the assessor can then check the areas where a resident has the particular leisure skills or has expressed an interest in learning new skills. This checklist should be a tool that is used to expedite the assessment process.

A narrative section of the assessment will allow the assessor to evaluate the information gathered. Looking at the strengths and the abilities of the resident to participate in a variety of programs the assessor would then complete the initial assessment process.

Activities Documentation

2005-01-11T19:09:00.000-08:00

Welcome to Activities Documentation

Throughout this "blog" you are welcome to contribute to the conversations concerning "Activities Documentation" for those in Long Term Care. We will start with the Initial Assessment process and continue on with all of the paperwork required for the Activities Professionals.

Quality of Life

Let's take a moment to explore what a person does in their lives. We are defined by what we do for a living, how we spend our family time and our passions. These define who we are and what we will become. When a resident enters a long term care facility they are defined in medical terms and terms that are measurable. Their Quality of Life has been replaced by their physical or cognitive needs. This role change can prove to be quite daunting to anyone. Those who have been in the hospital for any length of time can attest to this role of “patient.". The medical model looks at what we are unable to do and assists in getting us “better". There is a beginning, treatment and a cure. Quality of Life is a continuum of life, it has no beginning, no treatment and certainly not a cure. It cannot be a specific, measurable goal. It defines our being and how we see ourselves.

The activities department is charged with a task of looking at areas that are hard to measure. We are asked to assess a person's leisure skills and how they relate to others under very unique circumstances. If a resident comes to our facility without a structured leisure past, it is difficult to place them in programs that meet their needs. If a resident, on the other hand, was a social butterfly and has a vast support system of leisure pursuits that can be equally challenging. So where are we placed in order to meet their interests?

A resident was admitted to a facility with a perceived interest in music. According to the Social Worker admitting her, she played the organ and piano for a living. Miss Jones not only taught music, she played at the movies theater during the age of silent movies. She was well known in the community for her musical reputation. The Social worker extolled all of Miss Jones' musical background insisting that the activities department bring her to every musical event. It just so happened that the evening that Miss Jones was admitted to the facility there was a volunteer coming in to play the piano for a sing-a-long. The staff brought Miss Jones down to the program. She was a slight woman, wore fluffy slippers and had thick glasses and was transported to the program in her wheelchair. The activity director placed her in the front row so that she could watch the volunteer play the piano. The AD also asked her if she would like to play the piano after the program. Miss Jones looked up from her wheelchair and stated “I will take care of the piano,". The program ended and the AD wheeled Miss Jones to the upright piano in the middle of the room. The AD then proceeded to transport residents back to their floors. While taking several residents in the elevator there was a building shaking crash. It sounded like a truck had side swiped the building. Windows rattled and staff proceeded to see what has happened. The AD returned to the area where the musical program had taken place to gather more residents to transport back to their floors. There in the middle of the room sat Miss Jones with the piano dead on the floor. She was swinging her feet and had a huge smile on her face. The Activities Director asked Miss Jones what had happened. Miss Jones replied, “I told you I would take care of the piano. I had to play the piano for a living and hated every moment of it. I have always wanted to do that!”

This speaks volumes about properly assessing a residents leisure interests. The assessment is a tool that looks beyond what we are and where we have been. It should look at where we are going and what interests us as a person. We all have interests that change as we age. These lifetime interests may adapt themselves to our current abilities. Some residents may have enjoyed traveling, but as they got older the ability to travel has decreased due to physical limitations. But their interest in traveling has not diminished, just reading a travel book or reading a map may bring that interest to life.

There are a variety of assessments that are designed to look at the residents needs and interests. These are the key to unlocking the Quality of Life for the residents. The Professional Activities Assessment should address the residents lifestyle, leisure skills and be a window into which the Activities department plans programs that reflect their particular population. An example would be that residents who have lived in a rural setting may have life skills that include gardening and canning vegetables while those who have lived in a urban setting delight in going to a Farmers Market to buy fresh vegetables.

The Professional Activities Assessment process should also take into consideration family “traditions”, ethnic preferences, and a “historical” reference for planning activities. Discussions with residents, families and friends complete the total picture of the residents lifestyle. A family member may have some indications of what the resident is interested in, however, it may not be the complete picture.

Many residents have relatives who are acting as the “historian” for the resident upon admission. These relatives may remember that their Aunt enjoyed baking cookies for them when they visited. In reality the Aunt actually baked only when they came to visit and had a hidden stash of store bought cookies that she was crazy about. Does this mean that the Aunt enjoyed baking? Maybe, but may have enjoyed the process of getting ready for the visit and wanted to make the house smell welcoming. A mother who worked and raised her children may have enjoyed the solace of reading a book while her children were at the beach. The children may remember that Mom liked the beach. In reality Mom enjoyed reading romance novels. So the Professional Activities Assessment is a tool that continues to evolve long after being completed.