Avoid Aging Parents Becoming A Burden
By Linda LaPointe, MRA
By not planning for the future we guarantee that we will leave our children with a tremendous burden. Just about the time they are preparing for their own retirement and their children's college education, adult children often are overwhelmed with decision-making for their aging parents.
As a long term care administrator I heard it daily,
I Dont want to be a burden to my children.
But unintentionally most of us make it even harder for our children by not clearly defining our wishes or preferences. We can help them out by asserting control over our future health care, residential choices, and even how we will die. There are specific and discrete steps we can take to shape our own destiny. Many of these tasks only take a few moments of your time, some take a little research and others may require professional assistance. None of them are extremely costly or difficult.
So why don't more of us do this type of planning?
Seniors are concerned about losing control of their life and being a burden to their grown children but many just don't know what to do. For instance, the majority of people want to die at home, but very few do. Become familiar with your options and make your preferences known while thinking clearly, while free from pain and prior to an emergency or crisis.
The loss of a parent is difficult enough for an adult child. We can save them additional grief by doing the following,
clean house: get rid of all the worthless clutter and unimportant stuff
prepare and organize those important papers and throw out the unimportant ones
prepare advance directives and tell others what they contain and where they are located
make our own funeral plans and ensure there are sufficient funds to pay for it
leave our legacy through writings, photo albums, heirloom assignment and recording of family stories
You can avoid becoming a burden to your children by taking control of your end of life with as much care, intent and forethought as you have lived the rest of your life.
Linda LaPointe, MRA is an ElderLife Matters coach and author of several products to assist families experiencing aging including the pamphlet, Don't Be a Burden: 100 Tips. Get free articles and information at http://www.sospueblo.com/
Let's Get Serious About the Nursing Home Tour
Tammy Gonzales, Life Coach
Before you tour your facility choices be sure you have done your homework. Go online and visit http://medicare.gov Medicare.gov. They have wonderful resources available to you for free. They are user friendly. Please see the end of this article for details.
To narrow down your choice between two or three nursing homes or just considering the only available nursing home to place your family member or friend, it takes two visits. Take someone with you and if at all possible take the person who will be moving into the nursing home.
Your first visit to the nursing home is what I call "Their Pitch".
Set it up for the morning anytime before 11:00 AM on a Saturday and plan to be there at least an hour. Get there 15 to 20 minutes early with a magazine or a newspaper and let the receptionist know you are there. Take a seat in the lobby and wait. This is not wasted time. Open up your newspaper or magazine and eaves drop without calling attention to yourself. Let your senses lead the way. Have you been offered refreshments? Does the facility smell? Does the interaction of others sound pleasant?
When you opened the front door into the nursing home did you smell urine, bowel movement, vomit or body odor? Did it to smell like flowers or antiseptic? Or like bad odors are being covered up by good odors. Broccoli, cabbage and brussel sprouts are the only offensive smells that come from the kitchen when they are being prepared.
After a short while close up your magazine or paper and receptive to your visual surroundings. If there is someone else sitting there try to start a conversation about the nursing home and find out what they think. Listen to the tone of their voice, watch facial expression and body language. By now the admissions coordinator or someone is going to invite you into their office or take you for a tour and give you "The.
When they take you into the office they are going to ask you questions. Names, name of potential resident, age, diagnosis, who their doctor is, where are they now, do they have Medicare, insurance, are you the health care power of attorney, do they have a living will, have you applied for assistance, how soon do you plan to place them here, etc. They are going to try to emotional connect with you as well. They are looking for potential problems too. Pleasantly answer their questions. If you have a few questions ask and be sure to ask if you can have a copy of an information packet or pre-admission packet.
So on to the tour. The tour is about showing you the best of what they have to offer. They will introduce you to everyone and show you the facility. Let "Their Pitch" happen and go along with it. Don't ask too many questions now because you will distract yourself from observations that you need in order to make a sound choice.
During the tour you will be introduced to the different department managers and shown their offices. You won't be expected to remember names and it is more important how they respond and take an interest in you. Also, during this tour pay attention to the interaction between staff and residents in every area you are toured through. This is important.
Observe the residents. Are their clothes clean and in good repair? Are they wearing footwear? Do the men look clean and shaved? Does their hair look cared for or is it a mess? Do the women have appropriate hairstyles (I have seen them put pigtails on top of balding 90 year olds)? Do they still have bibs on from their last meal? Does any one look cold and not have a sweater? Do you see a number of residents that are wet or smell of urine or BM? Do the hands look clean especially under the nails? Do the wheel chairs look clean and cared for with no sharp edges or tatters? Do the residents in wheel chairs look comfortable? Are residents in wheel chairs being pushed too fast or backwards? Are residents that are being walked rushed or are they allowed to walk at their own pace? Is a resident yelling out the whole time you are there?
The flooring should be clean and free from any debris. The walls should be clean. The lighting should be good. Carpets free from spots. Decorative items should look well kept. Drapery should be open to allow the natural sunlight in.
You will be taken to the nurse's station. The nurses should be pleasant and responsive to the residents and family members. Listen to their tone and responsiveness in their voice. Watch their body language as they acknowledge you or others at the nursing station. Is this representative of how you would like your loved one to be responded to?
One area you will be taken to, will be the Rehabilitation area where physical, occupational and speech therapies are provided. How are the therapists interacting with the residents? Are there residents in the area alone? Is privacy being respected? Is it busy with activity or is no one there? Listen to find out if they have at least a full-time physical therapist and occupational therapist, it is important to know, as your loved one may require these services from time to time. Do they mention at least a part time speech-language pathologist? It is always good to have one available to screen your loved one if they ever begin to have speech problems or eating problems like swallowing.
Once at the Activities Department, observe what is going on each time you pass by. Make it a point to stop for a few minutes and observe residents and don't be surprised if
not every resident in the activities room, is not doing something. Are at least 25% of the residents doing something like reading, watching TV, or doing the activity that is going on at the time? Ask to see or have a copy of the activities calendar. Observe interactions.
The dining areas are a very important area to make observations. Check to see if they have more that one dining room or area? If the nursing home that you are at has 120 beds and is not specific to only Alzheimers/dementia residents, then there is a mix of residents functioning at different levels. There are usually three functional levels of dining: residents that can dine independently, residents that require cueing, and residents that need to be fed. Observe for the different types of dinning rooms or areas. If residents are dining observe for a few moments. Are they socializing, smiling, having a difficult time with the food? This is important because as your loved ones functional ability may decline and they may need cueing or to be fed from time to time. What is the facilities policy about residents dining in their room?
The tour guide (admissions coordinator) will show you a few resident rooms. Most of the time they will show you the rooms of clean, fairly independent, and continent residents with good family support, a well decorated room, not the room they would be admitting your loved one into. Facilities are limited to the number of private rooms they have. Most of the rooms are semi private with a private bathroom for the two sharing the room or a bathroom that is shared with the adjoining room. Look in the bathroom if you can. There is much to consider.
During the tour they will hopefully show you outdoor areas for the residents. Is it shaded from the sun? Is it partially protected from the weather like rain, snow, and wind? Do they have an area outdoors for residents who smoke? Are there seating areas? Is it visually appealing?
This is usually what happens during "Their Pitch". They ask you for information and you ask questions and make observations. Just like when you are with a salesman they want you to get emotionally connected with their facility.
At the closing be sure to thank them for their time and let them know that you will be in touch with them soon.
Before your second visit, try and read the information related specifically to the nursing home and what their expectations are of you and the resident from the information packet or a pre-admission packet you received. Then make a list of questions for the next visit. If you can't think of any questions, Medicare's publication Guide to Choosing a Nursing Home has questions on several pages that you can tear out and take along with you to what I call the YOUR Q&A VISIT.
Try to make YOUR Q&A VISIT unexpected on a weekday. Ask to speak to the admissions coordinator or some one who can answer some questions that came up. I will just tell you now, that if they respond timely to you at this visit that's how you will be responded to if your family member was in the nursing home. This is your opportunity to get your questions answered and to get any additional information that will help you make the best choice.
If you live in a small town this nursing home may be your only choice and you will learn to be a good advocate. However, if you live in a large town or metropolitan area you will have a choice of several nursing homes, pick the one that suits your loved ones needs and not your convenience.
I wish you the best of luck on your search. Thank you.
Bingo Is Not Just A Game!
By Jerry Lynn Daniels, ADC/ALF/MC/AD/EDU, CDP
** Article describing Bingo as an assessment tool. Food for Thought **
Bingo is very popular in geriatric recreational programming. It is the most requested activity in most seniors facilities or communities.
Activity Professionals for years have heard the dreaded "all you do is play bingo all day" from co-workers, friends and family alike. Bingo is not all they do but it is a very important part of their jobs. Although it is at times dreaded by professional caregivers, it should remain a part of recreational programming because of it obvious entertainment value. And of course we know if it were removed it could cause a revolt. There is a not-so-obvious reason as well. Therapists, nurses, social workers, friends, families as well as activities professionals should learn to use bingo as an assessment tool. The best part is that there are no fancy, expensive assessment packages to purchase. You use an activity which is already taking place.
Bingo can be used to assess a persons level of function in certain areas such as these:
Hearing. It will become obvious if someone is constantly asking that the numbers be recalled. or if a person who normally sits at the back of the room all of a sudden asks to sit closer to the caller. Visual cards may be required.
Sight. You may observe a person straining their neck or eyes. They may be leaning in closer to the card or may have many called numbers still uncovered.
Speech. A person must be able to yell "bingo" but must also be able to call out there numbers once they have won the game.
Cognition. A person may begin to have trouble finding the numbers once they have been called or may not be able to follow through with covering the number once called.
Fine Motor Skills. Fine motor skills must be used to manipulate the cards whether slide cards or traditional cards and chips are being used. They may repeatedly knock all their chips from their card or be unable to slide the covers into place.
Social Appropriateness. The persons ability to interact appropriately in a social setting is also assessed.
When using bingo as an assessment tool, one session will tell you a lot about the person. However, observing several games over a course of time is best. If you are a professional in one of the senior settings, learn to assess your clients using bingo. If you are a family member who is noticing some changes in your loved one, get them involved in games such as these. Not only will they help with socialization and entertainment but they may also help you to understand different aspects of your loved one's functional level.
There are many websites where you can create your own bingo cards. Just search "free bingo cards" or go to either of these sites http://www.print-bingo.com or http://www.dltk-cards.com
There are senior centers throughout Jacksonville which offer full activities calendars including bingo. For a listing of the City of Jacksonville Community Senior Centers go to http://www.coj.net/Departments/Recreation+and+Community+Services/Adult+Services/Community+and+Senior+Centers/default.htm
If you have any comments or questions regarding this article or a suggestion for an upcoming article please contact me at firstname.lastname@example.org.
Continue reading on Examiner.com: Bingo is not just a game - Jacksonville elder care |
REFLECTING RESIDENTS' SPIRITUAL NEEDS IN CARE PLANS
By Sue Schoenbeck, R.N., Michael Rock, Jill Cullen, Carol Gabor
Authors: Sue Schoenbeck, R.N., is director of resident care; Michael Rock is administrator and chief executive officer; Jill Cullen is plan of care coordinator; and Carol Gabor is a social worker at Ingleside Skilled Nursing and Rehabilitation Center, Mount Horeb, Wis.
Far less is known about the human spirit than is known about the body and the mind. But issues of the spirit are important when caring for the elderly in long term care environments, as well as preparing residents, families, and staff for the death of a resident.
Therefore, it is judicious for the caregiving team to gather information about spiritual as well as physiological, mental, and psychosocial needs. Ingleside Skilled Nursing and Rehabilitation Center, Mount Horeb, Wis., has created a spiritual assessment tool congruent with the minimum data set (MDS 2.0) to help determine each resident's spiritual needs, which then can be addressed in the care plan.
to create your Spiritual Care Assessment...
Ingleside's spiritual care program is rooted in a theory of logotherapy developed by Viktor Frankl, a Viennese psychiatrist who survived several World War II concentration camps. He proposed that people can find meaning in life events, including suffering, and can transcend what fate bestows. Frankl believed that people search for meaning in life up to and often through the death event.
Asking questions pertinent to spiritual needs makes residents feel welcome to share their spiritual side. How a person chooses to live life is reflective of the spirit that lies within. By using an assessment tool to gather data, caregivers can build a care plan upon the experiences the resident values most and wishes to retain.
The Assessment Tool
The first part of Ingleside's spiritual care assessment tool (see box below) gleans information from the resident pertaining to concepts of a god or deity, religious practices, and helping others. Questions include: Do you usually attend church, temple, or synagogue? Do you find strength in your religious faith? Have you participated in or would you be interested in a Bible study group? Do you enjoy helping others? In what ways have you helped others?
Ingleside Spiritual Assessment
Part I: Activities
Name: _______________ Medical Record # ____________ Date___________
Concept of God
Is religion or a god important to you?
Is prayer helpful?
Does a god play a role in your life?
Customary Routine: Involvement Pattern
Do you find strength in your religious faith?
Do you usually attend church, temple, synagogue, etc.?
Are there any religious practices that are important to you?
Has being sick made any difference in your religious practices or prayer?
What religious books or songs are helpful to you?
Have you participated in/would you be interested in a bible study group?
Do you enjoy helping others?
In what ways have you helped others?
Recommendations for care plan: __________________________________________________________________________________
Assessor's Name _____________________ Title _______________
Source: Ingleside Inc.
Part II of the spiritual assessment tool (see box below) engages the resident in conversation about sources of help and strength, relation between spiritual self and health, and impending death. Questions in this section include: What are your personal goals? Do you want to participate in or assist with religious services at the facility? Are there roles you had in your life before that now are closed off to you? What has given your life meaning in the past? What gives your life meaning now?
Ingleside Spiritual Assessment
Part II: Social Services
Name ______________ Medical Record # ________ Date _______
Sources Of Hope And Strength
Who is the most important person to you?______________________
Are there roles you had in your life before that are now closed off to you?
If so, how do you feel about this?
What has given your life meaning?
What gives your life meaning now?
In what ways do others help you?
What helps you most when you feel afraid or need special help?
What is your source of strength or hope?
What are your personal goals?
Do you want to participate in and/or assist with religious services at Ingleside?
Relation Between Spiritual And Health
What do you think is going to happen to you?
Has being sick made any difference in your feelings or beliefs about God or religion?
Is there anything particularly frightening or meaningful to you now?
Do you want a bedside service? __ No __ Yes Clergy: Your own? ______
Parish _______ Phone _______ Other? _______
Parish _______ Phone_______
Do you want it in your room or chapel? _______________
Do you wish to be present or would you prefer it be held without your presence?
Are there any special words, prayers, songs, or thoughts you would like expressed at the service?
Recommendations for care plan: ___________________________________________________________________________________
Assessor's Name _____________________ Title _______________
Source: Ingleside Inc.
Once the caregiver has completed the resident interview, information from the spiritual assessment tool is incorporated into the individual's care plan. For example, when a resident reports prayer as a daily part of his or her past life, staff can include "provide private times for prayer" in the care plan. A resident with Alzheimer's disease for whom evening prayer had been a ritual can be guided by staff each evening in this routine. Staff can assist family members to record familiar prayers for playing to their loved ones. Furthermore, resident prayer and hymn requests can be incorporated into a weekly nondenominational service. If the assessment shows the resident is experiencing spiritual distress, care plan approaches may include pastoral counseling, psychotherapy intervention, and medication regimen evaluation.
But caregivers should not assume that residents' feelings will remain static. Entering a nursing facility does not mean a person stops growing and changing. Residents often reevaluate and change what they value.
Therefore, spiritual needs must be regularly monitored and changes to the care plan made accordingly to guide staff in providing the support the resident needs.
Bedside Closure Service
It is understandable that residents and families have heightened spiritual needs as death approaches. But facility management should remember that staff, too, will have intensified needs because of their close interactions with residents.
Therefore, Ingleside holds a bedside closure service to comfort those left behind. Part II of the assessment tool provides information about whether or not a resident and family want a service and what they would like incorporated into the service.
The service is designed not only to honor the resident in the manner requested, but to give staff the opportunity to say good-bye and to share with family, friends, and the departed some of the good times experienced together.
For example, at an Ingleside bedside closure service for a man who communicated only by repeating two syllables, certified nurse assistants (CNAs) told family members how they had learned what the resident wanted by his intonation of the two syllables. Another CNA thanked the family for the opportunity to care for a man who had taught her she wanted to make a career of helping people with speech impairments. A housekeeper commented he would miss joking around and seeing the resident's broad smile.
Ingleside staff has assembled a bedside closure service guide that includes some of the songs and prayers most frequently requested by the facility's population. This guide is printed in large type for ease in reading. A staff-written prayer book is given to each new resident and staff member to help people find words with which to pray together.
In 1995, Ingleside conducted an exploratory descriptive study of the value of its spiritual care program for residents, families, and staff. Results indicated that the program led to increased knowledge of and response to residents' spiritual needs. Impending deaths were more openly discussed, leading staff to communicate with residents about their last wishes. The quality of life near death was enhanced as individual wishes were honored.
Families also benefited. Positive written responses have been received from the families of residents for whom a bedside closure service was held.
A daughter wrote on behalf of her family, "We felt the service for Mother was helpful and thoughtful. We felt she was liked and respected although we know she was a trying woman."
Giving spiritual care offers staff the opportunity to get to know the spiritual side of the residents and, with residents and families, explore the meaning of life.
Activities for Men
While walking through most Long Term Care facilities you will easily take note that the ratio of female versus male residents is significantly tipped towards the female population. Women residents outnumber men at the rate of about 2 to 1 (partly due to the fact women live longer than men). Contributing factors that tip the scale further is that it is not uncommon to find that approximately 80% of the staff is also female and the majority of visitors in general are female as well. Men are simply outnumbered in Long Term Care facilities.
“this map of America shows the male/female sex ratio for all the states and
counties — It's worth noting that, at a glance, the most populous counties in
America seem to tilt towards female”.
Upon further glance it may appear that a vast number of activity calendars have more programs geared for women than men. Activity calendars often do reflect a variety of feminine-based domestic activities such as cooking, baking or “unisex” geared activities. One might speculate that Activity Directors focus on meeting the needs of the majority (female) residents but it is more the case of how much more challenging it is to create male oriented programs than it is for the female persuasion.
Consider some of the following factors that contribute to the increased challenge in planning for men’s activities.
Of the less than 30% of male residents in Long Term Care facilities, approximately 1/3 of the population present with less ability to communicate than women due to their respective medical or mental status.
Some men suffer from strong fear of failure; particularly relating to starting a new skill in which they may appear incompetent to others.
Men of past generations may feel embarrassed or self consciousness relating to their particular disability and how it may cause unsuccessful outcomes.
Career responsibilities that have long since pasted may leave a sense of loss or void that may damage self-esteem, and instill feelings of uselessness.
All of the above are useful information when planning for men’s activities but are only a fraction of the possible scenarios that today’s Activity Director needs to consider while planning for a balanced and purposeful activity calendar.
Additionally, there are lifestyle differences that contribute to men’s personal attitudes regarding leisure pursuits between white collars versus blue collar workers. White collar workers engaged in less physical job related labor, shorter work hours and benefited from higher paying salaries than blue collar laborers. Thus, white collar workers were more likely to feel more energetic, have additional time in the day for leisure choices and possessed the financial means that allowed him to select from a range of interests and pursuits.
Below are some considerations that may help you to best identify how to plan for men’s activities, specific to Blue Collar Workers.
Men put in exhaustive long hours and often were left with little or no time for leisure pursuits thus they tend to be lacking in leisure related skills.
What little available free time in any given day was spent with family members, particularly with their children.
Minimal earnings did not allow for financial means to spend on leisure activities.
Starting Point – the assessment /gender reviewed:
Most likely you already have a standardized assessment form. Take some time to review your assessment form and activity check sheet and take note of the types of activities that may be more specific to male residents. You can create a framework of questions that will help you probe for more details regarding his preferences. As you check those areas of interest expressed by your resident make it your mission to elicit and document more information describing what makes his specific selection particularly appealing.
Example - Resident selects Sailing: Questions to ask:
Can you describe what your sailboat looked like?
Where is your favorite sailing destination?
What time of day do you like go sailing?
Who do you like to be with when you go sailing?
How often did you go sailing?
How do you take care of your sailboat?
Your resident’s answers can be used to engage him in a conversation at a later time about this past time experience and will aide in re-affirming a particularly meaningful memory. Men of this generation often thoroughly enjoy exchanging stories of past days of glory, sports or children and grandchildren’s accomplishments. Look within your male population to group residents with common denominators that you can foster in friendship and mutual camaraderie.
Once you incorporate your residents noted interest/s in the activity calendar and highlight care plan objectives you are well on your way to providing for the needs and interests of your resident as a unique individual within the facility community - thereby meeting federal laws for nursing homes.
Men might be the minority in this club but given the opportunity, appropriate resources and a thorough comprehensive assessment, men may not only be able to participate but contribute greatly by adding to the overall program enrichment through a well balanced activity calendar schedule.
Although the Activity Director professional will primarily focus on planning these activities keep in mind that the ALL staff members are charged with ensuring that the needs and interests of each individual is met to attain or maintain the highest practical physical, mental, and psychosocial quality of life possible. Such programs are essential to the health and well being of all men and women living in Long Term Care facilities today.
Below are a number of ideas for your consideration but remember, that you’re objective is to find a “match” between your resident’s needs and interests to the many potential ideas you come across.
Kathy Hughes, ADC
Article in NCCAP NEWS - email@example.com
Modular Education Program for Activity Professionals (MEPAP)
The entire course is one of the components for NCCAP Certification - Visit NCCAP.org for Certification info
Begins the 1st Tuesday of Every Month - Now Enrolling! @ www.activitydirector.org Online Classroom
The "MEPAP" (Modular Education Program for Activity Professionals) was first designed by NAAP and NCCAP as a course that met the unique needs of activity professionals in long term care. Many educational programs available at the time did not have the components that many activity professionals needed to deliver activities services to those that they served. The need to have an educational opportunity for activity professionals to learn specific information that can only be of interest to those working in long-term care. Documentation, medical aspects of aging, management of an activities and volunteer department, marketing activities, program planning, implementation and evaluation were of utmost importance to those who were delivering activities to their facilities.
Through the years NAAP and NCCAP provided many opportunities for individuals to take training in order to assure our consumers that they would be taught the pertinent information and that all would learn the basic skills required for activities. Instructors updated their skills regularly and attended training courses. The MEPAP Instructor was given manuals and information that would assist them in developing their courses to meet the educational needs of the activities professional. The MEPAP course was being taught across the country to many individuals who wanted to update their skills and learn all about the activities profession.
NCCAP's MEPAP Re-engineering Committee then took on the task of re-engineering the MEPAP to meet the current needs of the activities
profession. As we all know, changes in regulations, interpretive guidelines and the level of resident needs encourages all of us to increase our skills as professionals. Many activity professionals needed to hone their management skills and their delivery of activities to today's increased consumer awareness of activities.
With the advent of the Baby Boomers moving into long term care it was important that the MEPAP reflect those individual needs and interests.
The MEPAP now is being offered in traditional face-to-face venues across the country as well as "non-traditional" venues such as home study, video and online courses. All pre-approved instructors have been teaching the original content of the MEPAP and December 31, 2007 they will all be re-engineered to meet the current requirements. This course will include an increased awareness of current challenges facing the activity professional of the future. NCCAP's Re-engineering Committee is aware that changes in the future will also be needed in order to assure consumers that their NCCAP certified activity professional has the skills and knowledge to meet their needs and interests in their long-term care experience.
Requiring the entire MEPAP for NCCAP certification as an ADC, ADPC and ACC went into effect starting January 1, 2007. This requirement was part of the NCCAP strategic plan to assist with the evolution of the activities profession. By successfully completing the MEPAP, an activity professional will have the tools to implement a program that is specific to the ideals and needs of their facility and activities department.
MEPAP is a continuous process of education and refinement of the profession. It is a step toward legitimizing the profession and a step toward a national standard of professionalism. The original authors, original NAAP and NCCAP Boards and those who were charged with bringing the profession into the new millennium were prophetic in their desires to see the profession evolve into a realm that is equivalent to all those professions involved in long-term care. The current authors, NAAP and NCCAP Boards are looking forward to the future of the activities profession. Their dedication to the evolution of a relatively new profession is amazing and we thank them for their professionalism.
The Core Competencies that are available in the MEPAP 2nd Edition cover the range and depth of the activities profession and it's uniqueness in today's long-term care continuum.
MEPAP is the course that has been able to fill in the areas of educational needs for those who want to join the activities profession and those currently working in the activities profession. The NCCAP Board and committees realize that a continuing education opportunity to provide the consumer with an activity professional who is able to meet their needs and interests is part of the professional standards.
The "Modular Education Program for Activity Professionals", (MEPAP) is now a requirement for NCCAP Certification. This requirement is part of the strategic plan for NCCAP to eventually have a national exam for Activity Professionals. For those currently NCCAP certified, this will not effect your certification, however, if you let your certification lapse then you will have to meet the current NCCAP Standards, which could include taking a national test.
MEPAP will continue to grow and continue to be updated to meet the changing needs of consumers and the long-term care market. We are looking forward as well as thanking all who are working toward making the activities profession a great career for many.
HIPAA for Activity Directors
By Chris Loga - (copyright)
In the past year and half, one of the scariest words for activity directors has been HIPAA! Throughout my travels, I have seen many of my colleagues shudder at the thought of a new set of rules and regulations.
The good news is that HIPAA is not as scary as it has been made out to be. I have written this article specifically for activity directors and activity personnel. Since most of us are the makers of calendars, newsletters, banners, bulletin boards, etc., we need to know about the HIPAA policies.
The following article will hopefully ease your mind about HIPAA regulations. That way, you will be able to have your calendars, banners, bulletin boards and posters, while being in full compliance with all of the regulations.
What is HIPAA?
HIPAA or the Health Insurance Portability and Accountability Act was enacted in 1996 to help the federal government regulate the transferability of health insurance and to empower the government to fight fraud and abuse in long term care.
So what does that have to do with Activities?
In addition to the issues of health insurance, HIPAA was initially designed to regulate individually identifiable health information that was transmitted electronically. Since then, thePrivacy Rule that is defined by HIPAA has expanded that concept.
So basically, a large amount of information that is crucial to Nursing homes can now be covered under HIPAA(2). Since activities personnel deal with personal resident information, one of the areas for disclosure could be the activities department. In addition, the penalties for violating these rules are pretty steep ($100 to $25,000 per year, for each violation), so pay attention.
Is you facility a Covered Entity? You decide.
The only facilities that will need to adhere to HIPAA are called Covered Entities. Covered Entities are defined as the following: Health care providers, Health Plans and Health Care Clearinghouses and Business associates. Each of these groups is expected to follow the guidelines that are described in HIPAA. Those groups that do not fall under the Covered entities description may not have to follow HIPAA.
Here it is in English. There are four basic groups that need to worry about the HIPAA regulations; in this article I will only look at one, the health care provider.
In general a health care provider is a nursing home, rehab facility, hospital or any other facility that provides skilled or intensive care.
If you are not sure if your facility is a covered entity , please ask your administrator for clarification!
Personal Health Information-The nitty gritty of HIPAA
In terms of HIPAA, the information that they are worried about is called Personal Health Information or PHI. It can be best described as: any information that identifies an individual, that is received or created by a facility that contains information about the past, present or future physical or mental health of an individual. PHI can also include information on payment for medical services-however, I am intentionally staying away from that topic in this article.
This information is normally found in medical charts and billing files, however, it can be found in bulletin boards, Photos, Calendars and Birthday Cards, Activity Rooms and Common Areas and Activity Progress Notes. It is the highlighted areas that I will address in this article specifically.
Each facility should have its own policy that is given to the resident on admission and to the staff who work at the facility. It is also not a bad idea for the activity department to follow a higher standard in regard to privacy, since we usually deal with the residents on a personal level, including but not limited to: family issues, special requests from the resident, newsletter articles, etc.
Now that all of the legal stuff is out of the way¦
Now, you are sure that your facility is a covered entity and you know the definition of PHI. There are several ways to keep your department and residents safe with HIPAA regulations. This is especially true when you realize that there are different ways to change medical information that are allowed under HIPAA regulations. First, lets look at the instances in which it is OK to reveal PHI.
Generally, the facility may provide PHI to family members, friends and clergy, such as:
1) The residents name and room number
2) The general condition of the resident-(e.g.- Ms. Smith is having a good day today, she went to Bible Study on her own. Not: Ms. Smith is feeling good because we gave her a double dose of medicine.)
3) The residents religious affiliation.
In the following examples, we will look at some ways, in which it is not allowed to disclose medical information
1) As you walk down the hall you hear 2 staff members- I saw Mr. Jones last night and his delusions were really bad! Besides being gossip, this is also disclosure of PHI and a violation of HIPAA.
2) As you are entering Care Plan information on your computer, you are called away; you leave the computer on with the information on the screen, Once again a violation, since anyone can come by and look at the computer.
3) You are expecting a fax from a hospital about an incoming resident; you do not pick up the fax until the day after. Once again, who can see the information? Remember, there are several ways to violate HIPAA regulations.
So lets recap¦we know that there are several ways to reveal information about residents, but what about information that we use everyday in our activity plans, bulletin boards and other publications?
Well, lets take it piece by piece.
1) Photos “ most facilities have a standard form in which the resident gives permission to take their pictures and is kept in the chart. This allows us to use a basic picture for whatever we need. However, if you put the residents name with that picture, you will be violation HIPAA. If you need to use a name (on a bulletin board for example) all you really need to do is ask the resident for permission and document it!
2) Calendars and Birthday cards- The best way to avoid the HIPAA regulations with regard to Birthday cards and calendars is simple. PHI can be de-identified by removing the birth year from any information. For example: Happy Birthday to Joe Smith -6/15! There is no other medical information that should be used on a calendar anyway so simply remove (diagnoses, dementia items, etc.) from the calendar.
3) Bulletin Boards and Miscellaneous- In almost every case with PHI if you take the proper steps to ask permission, you can prevent any confusion. If you have pictures, avoid putting names with them. If you must, get explicit permission and document. If you avoid using PHI with regard to residents you are in the clear.
4) Activity Rooms and Common areas- It is fine and dandy to use pictures of residents in your common areas. Please remember that no medical information can accompany the pictures. Do not identify residents by room or unit, especially if that resident resides on a memory/dementia care unit.
5) Activity and Progress Notes- All progress notes should be in the individual chart of the resident. If there is documentation outside of the chart, it needs to be shredded or placed into the chart itself. Pure and Simple¦
In general, HIPAA is nothing to be afraid of for any Activity Director. The regulation was enacted to prevent privacy issues for residents of Nursing and Skilled care. If your activity department uses common sense to prevent improper disclosures you should be fine. Please feel free to use this article as a reference tool and double check with your administrator for individual questions.
[b]Activity Department Program Design & Evaluation[/b]
By Karen Connelly, TRS/TXC
Activity Department Program Design & Evaluation
from the book - "[url="http://www.activitydirector.net/shop/index.php?act=viewProd&productId=128"][b]Activity Department Guide for Assisted Living Facilities[/b][/url]" by Karen Connelly, TRS/TXC
Questions to consider about an Activity program. Asking the right questions during a Job Interview or providing information about your current program, the list below will help you prepare. Learning what to evaluate about an activity program will help you in many different aspects of the Activity Profession.
Do you know your Activity Program? ...
1. Who are your residents?
2. How many residents are in your facility?
3. What is the average age of the residents?
4. What types of disabilities affect your residents?
5. What is the ratio of male to female residents?
6. What are the socioeconomic, occupation and education characteristics of the residents?
7. What are the religious backgrounds of the residents?
8. Where did the resident live before coming to the community?
9. Who is the activity staff?
10. What are the activity staffâ€™s responsibilities and skills?
11. Possibilities of increasing your activity staff?
12. Can the other staff help with programming?
13. Are their volunteers?
14. What are the guidelines regarding volunteers?
15. Are the families involved?
16. Are there intern students?
17. Activity Areas
18. What rooms can the Activity Director (AD) use and, what is the evaluation of the space?
19. What community facilities might be available?
20. How would you rate the equipment and supplies available?
21. What equipment and supplies are you lacking?
22. What is the current budget, and policies regarding expenses, for the activity department?
23. What is the process of increasing budget?
24. Is fund raising possible?
25. Is the Activity Director a Department Head and, if so, what responsibilities does that role require?
26. Who carries out activities when the Activity Director is unavailable?
27. Does the Activity Director have current a Material Safety Data Sheet notebook and has this program been explained?
28. Does the AD work weekend or evenings?
29. Who is responsible for activities scheduled for the weekend and evenings?
30. Does the facility have a fund for continuing education and what is the policy?
31. What is the Resident Council policy?
32. What is the change of activity policy?
33. Is the AD required to work directly with Alzheimerâ€™s patients?
34. Is there a set schedule for the programming?
35. Does the AD have current Alzheimerâ€™s training?
36. Does your facility have in-service requirements for the activity department?
37. Does the facility require the AD to be certified by the state?
38. Does your facility provide adequate storage space for your activity program?
39. Has your administrator provided you with the state regulation?
40. Has your administrator provided you with your job description as well as staff job descriptions?
41. What are your facility rules on making food outside of the kitchen? BBQ, etc.?
42. What are your facilityâ€™s rules regarding taking residents out of the facility in your own car?
43. Does the AD drive the van for activities and residentsâ€™ appointments?
44. Does the facility have a current program in place for transportation?
45. Is the AD required to transfer patients and, if so, has the AD been properly trained in this?
46. What is the outing policy?
APPROACHES, ACTIVITIES AND INTERVENTIONS
IN RESPONSE TO BEHAVIORS OF PEOPLE WITH ALZHEIMERS AND SENILE DEMENTIA Carly Hellen, Rush Alzheimer's Disease Center
Research the presence of antecedent to the behavior; what was happening prior to the onset of the behavior
Look for environmental elements that cause do contribute to the behaviors; surroundings, noise, activity, people, etc..
Try to determine the reason for the behavior, if possible
Have all staff responded the same manner when addressing behaviors
Share in successful approaches, activities, interventions with all staff, put information in prominent place on care plan
Don't over reacted to residents behavior; don't use words or tone voice that scold, punishes, chastises, etc.
to further identify possible approaches and interventions...
VERBAL ANXIETY (FEELING LOST, SCARED, I DON'T KNOW WHAT TO DO)
Redirect to object, activity, prop, conversation
Use touch in a gentle, reassuring way
Take residents to the most familiar setting on unit to sit in relaxed and feel more secure
Reassure with familiar props, locations, activities, etc.
Involve resident in positive peer relationships, perhaps with someone who needs to reassure or nurture someone else
If asking what's wrong, use validation to listen for the reason underlying the anxiety, then try to resolve
Involving normalization activities resident is capable of doing
Allow residents to sit in area where staff are working to feel he or she isn't alone
REPETITIVE CALLING OUT; YELLING, SCREAMING
Use slow, rhythmic music, lifelong favorite music.
Give resident a busy box, scrap book, props to occupy attention and interest
Spend one on one time in quiet, and non-distracting area; use soft voice so that perhaps resident will have to stop yelling to hear you
Use the resident's name and look directly at him or her in trying to calmly breakthrough
Assess whether the resident is in pain, discomfort, has a need that can be met
Assess whether something or someone in environment is causing the behavior
Try to involved in singing instead
VERBAL ANGER; ABUSIVE LANGUAGE
Distract and redirect
Introduce singing instead
Introduce a "favorite" of the resident; activity, music, food, person
Involve in craft or physical activity were anger could be expressed in nonverbal manner
Involve in social settings that clearly cue the use of manners or appropriate social skills
Do not react with shock, schooling, anger, parental tone
EXPRESSION OR DISPLAY OF SADNESS; DEPRESSION
Use validation therapy techniques to find a reason behind the behavior, don't ask "why"?
Involve in or use something from residents lifetime that has offered enjoyment or comfort
Do and say things that make the resident feel of value or special
Involve in activities that you are certain residents can be successful in doing; give genuine praise
Acknowledge and accept what the resident is expressing
Use music: sad music may help you release feelings; happy may offer distraction
Use something to offer comfort to, to cuddle, pat, tactile stimulation
SHORT ATTENTION SPAN; EASILY DISTRACTED
Break the activity into short sections
Use a lifelong, normalization, familiar activities
Use of props, pictures, materials to assist in holding resident's attention
"Roving" activities; take the activity to where the resident is on the unit, rather than time to keep the residents attention in an activity group or area
Use of resident "jobs"/ roles in activity; making it important to stay involved
Put out materials and allow or assist resident in going from "station to station"
Manual activities; task oriented activities; tactility stimulating materials
Seat in group or at a table or in an area in a way that the resident faces the fewest number of distractions
Change activity, approach, tone of voice that you notice resident is losing interest
As you notice increase in distractability, ask resident a question or give one on one to regain interest
Good mixture of passive to active activities
Involve in physical or movement activities
Set up a "wandering trail" with interesting things to stop look at and/or do long away
Normalization activities: sorting jewelry or stocks; tying laces; untying or unknotting socks; sorting and folding laundry; sweeping; testing
Use activities that can occur while walking
Set up "comfort" areas (chair, pillows, couch, music playing, things to look at) that draw resident in to rest
Involve in a roaming choir or rhythm band while walking
ELOPING (PURPOSEFUL ACTIONS TO LEAVE AREA OR BUILDING)
Walk with the resident using a non-directed conversation to distract or calm resident
Setup planned walking activities
Involve resident in tasks of the unit- making beds; sweeping, pushing cart with staff
Disguise the unit's exits
Assess times of day this happens; look for environmental cues -such a staff leaving to go home-and eliminate
Involve in activity prior to this time of day
Involve in activities that match the reason the resident has to leave-cooking, work, childcare
REPETITIVE PHYSICAL MOVEMENTS
Activities that naturally involve repetitive movements-sanding, dusting, stuffing
Rhythms band; dancing; movement to music; exercise
Work oriented repetitive activities: sorting, stapling, stamping, cutting, folding
PHYSICAL COMBATIVENESS, AGGRESSION
Remove resident from the situation to calm, quiet area without making a big deal about it
Massage. Stroke or hold residents hand, it he or she will allow. Brushing hair
Dancing, singing, rhythmic music, clapping, marching
Physical activity with gross motor movements, and safe props, if any; walking; ball activities
Repetitive manual activities like crumpling or tearing newspaper for stuffing
Give the resident something safe-non breakable-to hold
Find ways in which the resident could have some element of control in the situation
Normalization or repetitive activities that can be done alone
Give the resident some space; Decreased stimuli in the environment
Use of smells or foods that are soothing or comforting
RUMMAGING; PILLAGING; HOARDING
Therapeutic "purses", bags, etc. filled with belonging that the resident can keep
Display items that can safely be picked up and taken by the resident; pegboard with collection of hats on, jewelry that belongs to the unit
Don't simply take something away from the residents; "trade" it for acceptable item
When coming into a resident's room to check their hiding places, ask "I've lost my ______________: I'd like to look for it here. Please help me look for it."
Adjust activity in staff schedules providing more things to do and staff to intervene at this time of day
Use refreshments at this time today
Have staff be very conscious and careful about the way in which they leave the unit at this time of day
Suggest family visits at this time, if possible
Use normalization and helping types of activities
Consider a psychosocial group to address through group techniques/ relaxation techniques
INAPPROPRIATE SEXUAL BEHAVIORS
Redirect attention to other things
Seek family's knowledge about cause of behavior, give support to family, especially to spouse or resident
Provide private area for more appropriate behavior
Use clothes with closures that aren't easily accessible to resident
Try variety of types of clothing to determine whether resident will leave some types on
Give resident things to do/ manipulate with hands; tactile stimulation props, busy box, board, apron, pillow
Don't scold; calmly redress resident
: Identify the stressor(s) can eliminate or reduce as much as possible; take preventative action :
Identify resident's "symptoms" leading up to reaction, and intervene at that time
Use a consistent approach whenever dealing with catastrophic behavior
Use enough-but not too many-staff to intervene in as calm a way as possible
Determine successful ways to redirect residents and communicate these to all of the staff working with the patient
[b]A Fundraiser Story[/b], author unknown...
A way to conduct a fundraiser for the Activities Department in the facility with the help of the employees and staff.
A good time of the year for this fundraiser is spring. Place an Ad in your local paper, in your newsletter, call all of the churches in your area and anyone else that you can think of to tell them about your up coming Craft Show.
Contact crafters in your area, pass out flyers at local craft shows to inform the vendors of your upcoming Craft Show. i.e. 6 foot table space or booth space (determine the size) for rent for $15. Tell them that they will get to keep all of their profits. Be sure that you inform them it will be well advertised, via newspaper, newsletter, signs, flyers and posters.
Prior to the big Craft Show Event have Craft Days as an activity. Have your residents create items to sell at your craft show.
[b]Ask local businesses for donations of items you can sell.[/b][list]
[*]Local Florist for flower arrangements
[*]Hair Salons, Dollar Stores, Retail Chains for products
[*]Bakery, Grocery Stores for cakes, cookies etc.
[i]Be sure to involve family and staff members by asking them to donate baked items that you and your residents can sell.[/i]
[b]You can also sell tickets for items that can be won and/or raffled[/b].[list]
[*]Ask local reatil stores for gift certificates,
[*]Ask the video store for DVD's
[*]Local resturants for gift certificates
Decorate boxes or cans to serve as ticket collectors. Place them in front of the items to be given away and/or raffeled off. Draw one ticket out of each box/can at the end of the day for the winners name(s). You will want to consider if the person needs to be present to win or not.
If not then be sure to get names and phone numbers, so that you can contact the winner(s). Let them know if they need to be present or not.
This event is done yearly at our facility and is a hugh money maker for activities. It grows bigger every year. I recieve phone calls months in advance from people wanting to rent a table/space. People call asking when it will be beause they don't want to miss it, these are buyers. The residents enjoy meeting people from the communiy that they might not otherwise get to meet and they also enjoy the shopping.