Long-Term Care Survey Alert

Hint: Think of activities as part of the big picture.

As John Donne famously said, "No man is an island"--and your activities program better not be either. Not if you want to survive a tough new survey guidance that can leave you stranded with F tags.

Surveyors are now armed with a survey investigative protocol for activities and a revamped mindset for how activities should meet residents' overall needs.

The survey bottom line: To say "resident will attend activities of choice" isn't going to fly as a care plan, according to the survey guidance, emphasizes Joanne Hayden, PhD, a quality-of-life specialist in Indianapolis.

The revised guidance notes that selected activities are used as answers to the resident's issues rather than an answer to what activities the resident is going to be in, advised the Centers for Medicare & Medicaid Services' Karen Schoeneman during a CMS-sponsored Webcast, "Surveying the Activities Requirements." Surveyors should not look at specific activities goals but the whole comprehensive care plan, she emphasized.

Examples: If a resident has skin breakdown, care plan interventions might include increasing liquids during activities, said CMS Webcast presenter Barbara Quinlan, activities director at Daughters of Israel in West Orange, NJ. If a resident falls, the facility might encourage him to participate in exercise programs to improve mobility, she suggested. Staff should also consider the time of day for involving the frequent faller in activities. "Some residents experience patterns of falls" at certain times of day.

Focus on nutrition: One resident  wasn't eating well in spite of a lot of different interventions, relayed Susan Harris, assistant executive director at Daughters of Israel. The care team had noted that the resident ate well at activities when staff served sweet foods and pick-up food items. So the team added sugar to some of her foods and provided sandwiches and soups in a mug for daily meals. And the interventions resulted in the person eating better and gaining weight, said Harris.

For a special care unit, Harris implemented an "old-fashioned ice cream cart" that the care team often uses as an activity intervention for people losing weight.

Promote Self-Esteem, Sense Of Meaning

Key example: Heritage Park Nursing and Rehabilitation Center offers every resident an opportunity to participate in a resident-run business making and selling dog biscuits. The group sells the biscuits to pet stores, local restaurants and businesses--and takes orders through an e-mail address, says Jane Steele, DON for the facility in Wooster, OH. 
 
A group of residents came up with the idea for the business, which makes use of their previous job experiences in everything from banking and bookkeeping to transportation and homemaking. The "residents make the biscuits from scratch, choosing the colors and making seasonal shapes," Steele tells Eli. They also decide how to spend the proceeds, she adds. For example, the group recently bought chicken meals for all the residents as a special treat.

Maintain Functional Gains  From Rehab

At Daughters of Israel, the rehab therapists recommend specific activities as a restorative measure after therapy ends--especially if the person is going to be with the facility long-term, said Quinlan. For example, playing Bingo promotes use of fine motor skills, hand-eye coordination and number recognition.

Participating in a painting group might be perfect for someone who enjoys that kind of activity and also needs to maintain range of motion after rehab for an injured and arthritic arm, says Pamela Toto, MS, OTR/L, BCG, chairperson of the American Occupational Therapy Association Gerontology Special Interest Section.

Toto heard of one facility with an Eden program that brought in a horse for a patient to groom, which improved the patient's shoulder range of motion.

Think outside the rehab box: Other strategies that can promote functioning and help residents hold onto or even improve what they were able to do in therapy include the following, according to Pauline Franko, PT, MCSP, president and owner of Encompass Consulting & Education LLC in Tamarac, FL.

• Bowling, which can help the resident with balance and coordination--especially if the person bowls standing up.

• Wheelchair obstacle races. These can help the resident improve his ability to maneuver.
 
• Transferring patients from their wheelchair to a regular chair (with or without arms) to participate in activities.

• Conducting dancing groups for simple group dances (hokey-pokey).

• Word games, which can help memory and language skills, Franko says.