35 replies to this topic

[ActivityGal]

Hi all,

I am in need of some help and clarification. I have been reading the posts about the new guidelines, and I have taken some seminiar classes on them. However, I am still lost. I know that there are some newer things that need to be incorporated in the programs, but I am confused about Care Plans. I am a newly certified CTRS, so I have no consultant at my facility. I rely on others for my information. Other facilities in my are are talking about how they had to go through a whole revamping in their facility. Now that has me concerned, that I am interpreting things the wrong way. I know that the goal has to focus on the resident's outcome, and not just participation.
I would really appreciate some examples that you all are using in your facility. I know that the goal "res will attend activities 3x's per week" is not going to fly with the new guidelines. That's fine, I have never used that goal. To me, that is an example of participation. Here are some of the examples that I use currently.

1. problem - Res had decreased lower body strength
goal - Res will attend exercise and complete 5 sets of upper body exercises as demonstrated by AA

or

2. problem - Res needs to maintain her current cognative functioning
goal - res will answer 5 trivia questions at 80% accuracy weekly with minimal verbal clues from AA.

These are just 2 examples of goals that I use. Would anyone please share some other examples, and also let me know if what I am doing is correct. I am highly concerned that I doing this wrong. All your help will be very valuable to me.

Thank Your

[chip]

Hey ActivityGal.. the main focus on the New Guidelines is to bring your facility, your staff, together and create a more community like care facility. They would like everyone in the facility to get to know the residents in the same way you and your staff do. You have the ms.Jones who always helps out at bingo, the two that always fight, the ones that sneak food, mr.Brady that was in the war, lots of war stories, lots of family, the ones that sit by the door and wait for family that never come. They would like the entire facilty to participate in helping each and every resident to feel less like a nursing facility and more like a retirement community, decrease the stress and depression, less transition shock for home to nursing, decrease the loss of life roles stress, embrace each resident more like a person.. develope Person Appropriate Care.
Where in the past the nurses aides would not engage the residents for fear the DON would gripe.. the New Guidelines direct your entire facilty to report and document any extra activity, any requests, any self set goals (i.e. resident would like to write family or would like to practice walking after surgery) these should be documented and added to a progress note, an updating assessment, wound into the careplan, social services should be brought in..
We have developed a series of forms in our FTag Course to help with the reporting and documentation,
One: Extended Assessment Form to add new interests, (i.e. Ms. Jones has express the want to write letters to home, add this to your assessment that she likes to write letter, send cards, contact family about supplies, provide supplies, make use of the nurses aide or a volunteer if she cannot write, include in a letter writing club if she can )
Second: Multi Dept Participation Form to document any off calendar activity, some facilities are making these forms available at the AD Office, In and Out box, some on a floating clip-board, some have a clip-board at each dept station, dietary, maintenance, nursing, admin, receptionist, some are keeping the records in a folder on the back of a closet door. These forms will help the AD (community cooridnator) to document and to update assessments to further direct Person Appropriate Care, Ms Jones would like a radio, collects dolls, likes cards.

We have been consulting ADs to FIRST start on the gathering of information, extend assessements, document new interest and self set goals. Conduct InService sessions to redirect and inform facility staff on the new direction of Person Appropriate care, and full facility involvement, include instructions on any new techniques in documentation and forms. Once you start this new direction you careplans will shift to a more person appropriate verbage.

Concern. Ms Jones will need to maintain cognitive levels, she has expressed a self-set goal to communicate with family more through mail which will increase her activity and abilities.
Strategy&Goal. Encourge and involve Ms Jones in group activities cards, collecting groups, setup and take down of activities, contact family for radio, letter writing supplies, family mailing addresses, instruct Nursing Aides, AD Staff, Volunteers to encourage, challenge and to help with writing letters, Inform ms Jones of opportunities to assist with parties, entertainment, she has expressed the want to be helpful, retired teacher.

This is kind of a drawn out careplan just to give you an idea of the direction you need to be moving. The Concerns/Problems, the Strategies and Goals will all be pretty much the same therapies as always, it will be the facility involvement and Person Appropriate approch that will change.. The Third Form we have developed in our Ftag Course is a NonSchedule Participation Summary to help document the off calendar activity. From the example above.. it would be impossible to cover the range of participation incluced in the Careplan, this is where the MultiDept Particpation Records and a Extended Participation Summary will help you to document Faciltity wide activity, by you, your staff, facility staff, volunteers, familty members .. all of the combined efforts of everyone, documented, will satifiy state, that you and your facilty did indeed meet your CarePlan Goals..

Hope this helps, it is just an example, but it will give you an idea of where you need to be heading..

Chip@activitydirector.com :-)

[Stacy]

Hi Activity Gal,

Chip did a good job explaining. They are really looking for Person Centered Care. An example that was given on the CMS broadcast to the surveyors was, resident "A" worked on a tug boat all his life, his hearing is impaired. One of the things he express in his activity interview was that he liked to look out the window rain or shine. You can give a care plan stating that the resident will look out the window during the day. Part of your approaches can be - to take him around the facility to see what area he likes the best, the CNA's can be sure he is up at a certain time etc. They are looking for you to incorporate you assessment into your plan of care. You documentation is the key. If you document it, that is what they will be looking for.

[wubby1963]

Hi does any one have a form they want to share for interdisciplinary charting on things that other staff do with residents. We might be using a form if I can find one that suits our purpose.

Thanks
Suzie in Iowa

[crystal]

wubby1963, on Aug 23 2006, 06:23 PM, said:

Hi does any one have a form they want to share for interdisciplinary charting on things that other staff do with residents. We might be using a form if I can find one that suits our purpose.

Thanks
Suzie in Iowa

Hey Activity Pals,
I use a form called an Activity Logs. This form my staff write down what they visit with the resident, What TV station they put on for the resident, & and so on. I let my staff & family know that this is a way for me & state know what the staff is doing with the resident and what the resident is doing. I have this form in every residents room. One for each resident. Each month I use this to help me chart what my residents are doing in their rooms and thru out the building. I hope this helps you out. I do not put these forms in the charts I have a folder I keep them in.

[DjHAWKY]

they have a pack of forms for the new guidelines in the Activity Bookstore on this site. has the staff participation logs, and assessment form with extended area for self direction and updates.. same ones we use here..

[mizncg8r]

good day to all,
I too was shot down. The company I work for wants no roug forms. Let alone more work for others. But I would like a copy of the form anyway. Thanks Tracy
mizncg8r@tampabay.rr.com

[smrldrobles]

DjHAWKY, on Sep 4 2006, 09:49 PM, said:

they have a pack of forms for the new guidelines in the Activity Bookstore on this site. has the staff participation logs, and assessment form with extended area for self direction and updates.. same ones we use here..

Hi !
I just join in today. I am also concerned with the new guidelines.
I just recently had and Inservice with the whole staff about team work, and the new guidelines. But I need some type of form to capture the extra things staff is doing with the patients.

[DjHAWKY]

Hi smrld.. the forms have assessments with new doc area for updates, multi dept participation logs, we print these out and put them on a clipboard that floats any staff leading a discussion, observing a self directed activity.. volunteers even fill these out. we have them in our Volunteer pack.. we give them to the family members to pencil in anything they discuss any wishes expressed.. the note resident reaction, times.. dates.. they are 3per sheet.. I am taking them directly from the clipboard and filing with my participation records..making notation in Progress notes.. updating assessements.. creating careplanning therapies as I go.. its helping tremendously .. I have even started a seperate sheet to start grouping similar interests for clubs, tourneys, functions.. If I can get my residents participating in self directed group functions..clubs and what not I will be more a community coordinator.. merely providing support for my groups.. I have 2 very established functions meeting weekly.. and have been offering membership/participation to new arrival-residents.. now if I can get a few culture oriented groups going.. that can help me to understand their backgrounds and needs .. I will have pretty good thing going.. :-P

[khancock]

I am not a newly trained CTRS, but am new to Long Term Care and Activity Directing the last five years. I used to write individual attainable, personal goals for each resident, as I would for people in therapy, but then I was shown the other way to list PGA's and it seemed a whole lot more general than I liked, but it's what I've been doing the last couple of years. It now almost sounds like the new reg's are actually what I was doing previous for goal writing, which is how I like to do them. I've tried to attend a seminar for the recent regs, with no avail due to my time constraints. I have no assistant, or steady volunteer to help me run a program with 110 residents, but I am freaking out that what I'm doing is not right--from a therapist stand-point, I know it's not right. It's been very difficult to get the other disciplines involved and getting them to understand that we all have to be on the same page and help with these new rules. It's going to be a hard transition because they as well don't want any extra work--it's hard just to get them to be excited for the residents or even help me to get residents to their desired places during the day. I've seen the new reg's for sale on this website, but my budget is so constrained I can't afford to purchase them. I may have to buy it myself, so I can get started with this process. Sorry for the long windedness, but any suggestions would be greatly appreciated.

Thanks
K.Hancock CTRS