MDS Alert

A mock inspection in time can stave off F248 and other tags.

Surveyors increasingly have their eyes on activities programming to see if it promotes quality of life, resident choice, and positive care outcomes. To make sure your activities are up to all of those tasks, consider doing a mock survey based on the acronym RAID, a tactic used by Presbyterian Homes and Services (PHS) in Princeton, N.J. An activities director at the organization came up with the RAID name because "it feels like a raid when surveyors come into the building," said Judith Porter, RN, director of health services at PHS, in a case study presentation at the fall 2008 American Homes & Services for the Aging annual meeting.

The various components of the mock survey review -- and what you should target in the RAID -- include:

R = Resident

The mock surveyors look at residents themselves and their participation in the activities, noted Porter. As part of this process, look at the care plan to see if it's individualized to a particular resident based on his past and current interests and history and current ability, advises Reta Underwood, a long-term care consultant in Buckner, Ky.

Quick litmus test: "If you can't look at an individualized activities care plan and guess who that person is -- it hasn't been individualized," stresses Underwood. Generic group activities may not accommodate a  sident's specific interests. For example, a music activity featuring Mozart might not hit the spot for a resident who really likes a particular band or group, Underwood cautions. An individualized activity might involve helping the person load a portable music device with the band's songs, says Underwood.

Real-world example: One resident expressed an interest in cars, and when asked what type of car, she said that she loved mustangs, relays Anthony Cirillo, a long-term care ombudsman and resident experience  consultant in Huntersville, N.C. So the activities director designed an activity where one of the staff members brought in his convertible mustang and would give the resident a ride in the parking lot. "They made a little bed for her in the car," Cirillo says.

Is the area in which activities are held sufficient to meet the residents' needs? "Do they have enough area if they want to leave so that the whole activity isn't interrupted?" asked Porter in her presentation. Keep in mind, adds Underwood, that "some people prefer large group activities, whereas some like smaller groups or individual activities in their room or other locations."

The mock surveyor interviews quite a few residents to see if they feel like the facility offers the types of activities they want, Porter reported. This approach can preempt complaints and give the activities staff fresh ideas.

If an activity fizzled with residents, take a closer look at whether it provided enough incentives for participating, suggests Underwood. "Bingo works well because it has a social aspect, prizes -- and people can easily play the game." By contrast, a group activity involving coffee and reading the newspaper might not offer many reward factors, she cautions. "You usually find that participants will drink their coffee, which may be their reason for coming, and then they leave or stop paying attention."

Tip: You can tweak or narrow the focus of an activity that otherwise falls flat. For example, jazz up a newspaper discussion group by focusing on a particular article about a local special event that a group of residents is really interested in and that's a focus of other activities, Underwood suggests.

The mock surveyor at Presbyterian Homes and Services looks to see if the residents' charts include initial activities assessments and quarterly assessments. The reviewer makes sure documentation shows that activities staff participated in the MDS and care plan process and helped address quality indicators/measures, Porter advised.

Example: You can include activities staff in non-pharmacological pain management strategies, advises Susan Gardiner, RN, director of clinical services for the Illinois Council on Long Term Care. "A lot of facilities have a pain cart that has books, aromatherapy, music therapy, etc., to take to residents' rooms, says Gardiner.

"The goal is to reduce anxiety and improve mood and a sense of control."

Are there sufficient supplies to service the residents during an activity and alternative supplies if a resident wants to do something other than the planned activity? asked Porter. The activity director at PHS has developed little boxes that include various types of supplies, such as office supplies in one and flower arrangement materials in another and so on. Then she can pull those out for a particular resident to meet his individual interests, Porter reported.