Pennie

Dealing With Elderly Anger Outbursts & Hostility As healthcare professionals many of us if not all has encountered a resident that is not having a good day. It is not all that unexpected however, in our line of work to experience outbursts and hostility mood swings. They may result from dissatisfaction, poor health, stress, pain, and a loss of dignity can easily lead to surprising and potentially harmful behaviors cause undue emotional hardships on both staff and residents alike. These scenarios are emotionally stressful for all parties and may need a considerable amount of energy, patience and empathy, to redirect. Research studies report that “mood disorders are frequent in old age and their prevalence is increasing with population aging.” https://companionsforseniors.com/2019/04/mood-swings-elderly-seniors/#:~:text=Another%20prominent%20research%20study%20notes,therapy%2C%20or%20a%20medication%20regimen Getting older can magnify our unique character traits, often in undesirable ways. Someone who was crabby in their younger years may be prone to full-on bouts of range in the aging years. Unfortunately, fellow residents and our professional staff members often are the target of these outbursts, and although in many cases it may seem at times as though there was no apparent clinical “trigger” such as a diagnosis of Alzheimer’s or prolonged chronic pain that may be attributed to the root cause; these behaviors are non-the-less and often enough, the most challenging to overcome. Know Your Resident That said, there are tried and true strategies and techniques that you will need to master to turn around a bad day into a pleasant (uneventful) good day. Below you can learn about several well described options that offer alternatives to reduce the tension and redirect even the most “crankiest of crannies” and help preserve your own mental wellbeing in the process. Simply stated, one of the most effective “tried and true” strategies is to know your resident. A thorough and comprehensive understanding of the elements that have potential to trigger your resident long before it leads down that unwanted behavior rabbit hole will always save the day. Clearly, this is not going to happen as quickly as one would hope for but with consistent observation/evaluation and comprehensive documentation such as Behavior Logs, will greatly identify the root cause of the problem be implemented in the resident Care Plan as Behavioral Interventions. Most importantly, be mindful to ensure that every staff member (all shifts and disciplines) are aware of these triggers. Communication and consistent unilateral Interdisciplinary staff support are major factors to this success story. Note that is can take up to “TWO” weeks for a resident to give up unwanted behavior because the behavior has become a coping pattern and is all the resident knows to find comfort. How to Handle Elderly Anger Outbursts The first step to dealing with these problems is to understand that these negative emotions are not personal. Pain and disease has an undeniably strong potential to cause very inappropriate behavior. The best strategy when dealing with difficult elders has a great deal to do with (Four C’s) - communication, clarity, consistency and compassion. Be mindful that optimum communication breakdowns between staff and resident may be further compounded by receptive and expressive resident impairments. Be consistent, repetition will enforce the concept of desired change. Cursing and Abusive Language Verbal abuse and harsh language can be an even more complicated story. Profanities that are “out-of-character” are often the result of Alzheimer’s disease, which can make it particularly difficult to manage. While there’s no cure for some conditions that present cursing and abusive language, mitigating the behavior can often be achieved by using distractions in the form of redirection. For example, divert your residents swearing bout by introducing another scenario that you are certain will be well received as more desirable and enticing by your resident. Example: “Mary I need your help today to make your favorite dessert – let’s go to the kitchen to get the ingredients ready.” Paranoia and Hallucinations Residents may believe that others want to cause them personal harm. In some instances the clinical team has already noted that the resident suffers from paranoia or hallucinations or another disorder that is a known root cause. It is not uncommon for paranoid behavior to be associated with a diagnosed disease such as Alzheimer’s disease but there are other illnesses that will also lead to paranoia. In these cases, the best solution to the problem of paranoid behavior is to try and use relaxation and validation techniques. Additionally, this may need to be combined with medication management. You generally won’t be able to convince someone what they’re experiencing is unreal, and doing so may increase the residents’ frustration or anger. Note that it is reasonable to go along with the residents’ allusion when the experience in of itself is clearly pleasant and does not have the potential to cause harm to self or others. Attentive patience and consistent caring oversight has everything to do with your residents’ success story and yours. “Perseverance is not a long race; it is many short races one after the other.” -Walter Elliot https://www.agingcare.com/articles/how-to-handle-an-elderly-parents-bad-behavior-138673.htm https://www.griswoldhomecare.com/blog/2015/july/dealing-with-elderly-anger-outbursts-hostility/ Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2022 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2810 US HWY 190 W Ste 100-A9 Livingston, Texas 77351

Hi Nicole I read a lot about this some time back. I am not sure where it stands now. May I suggest you go to our FB page & ask this question lots ppl using it. https://www.facebook.com/groups/117636186862

AlzheimerAwareness.doc View File File imported by an administrator Submitter Pennie Submitted 12/05/2011 Category Newsletters, Calendars, Forms, Puzzles, PrintOuts, FunFacts  

Hello, I am not sure about Ohio but in Texas if the resident has diabetes only the nurses or professional can trim residents nails. We use to do nails twice a week but we never cut them. If they are to long etc. the nurse was told about this & she/he would take of it.

View this email in your browser Dehydration and the Elderly A widespread blanket of increasing rising temperatures is expanding across much of the country. . . . And of course, hot weather always increases the risk of dehydration. Older aging populations are vulnerable to climate change-related health impacts for a number of reasons. The body’s normal aging process causes the body’s systems mechanisms that are meant to protect us from dehydration work less efficiently as we age. The elderly population does not have the same internal thirst signals with age progression and consequently do not take action to reach out for that much needed liquid consumption. Experts generally recommend that older adults consume at least 57.5 fluid ounces or 7.1 cups within a 24 hour period. https://link.springer.com/article/10.1007/s12603-009-0023-z NOTE: Elderly people should not be encouraged to consume large amounts of fluids at once but rather small amounts throughout the day. Factors that put older adults at risk for dehydration include (includes but not limited to): Chronic problems with urinary continence, which can make older adults reluctant to drink a lot of fluids. Memory problems, which can cause older adults to forget to drink often or forget to ask others for something to drink - even mild dehydration, can cause noticeable worsening in confusion or thinking skills. Mobility problems associated with aging, such as muscle and bone loss, which can make it harder for older adults to get something to drink. Older adults are more likely to be taking medications that increase the risk of dehydration, such as diuretic medications, which are often prescribed to treat high blood pressure or heart failure. Dehydration can also be brought on by an acute illness. Older adults are also more likely to have a chronic health condition, such as diabetes, that requires medications for treatment. Vomiting, diarrhea, fever, and infection are all problems that can cause people to lose a lot of fluid and become dehydrated. Dehydration also often causes the kidneys to work less well, and in severe cases may even cause acute kidney failure. Additionally, chronic mild dehydration may further exacerbate constipation problems. Physical signs of dehydration may include: high heart rate (usually over 100 beats per minute) low systolic blood pressure dizziness dry mouth and/or dry skin in the armpit less frequent urination dark-colored urine weakness delirium (new or worse-than-usual confusion) sunken eyes Caffeine and Dehydration Coffee or Tea please! We all know only too well how important it is for our seniors to enjoy a nice cup of coffee or tea while gathering in morning socials to shake off those morning cobwebs and get ready for the day’s events. Is there any other way to start the day? Technically caffeine is considered a weak diuretic. By definition, a diuretic is a product that increases the body’s production of urine. Hence water, or any drink consumed in large volumes, is a diuretic. It should be noted that urinating more does not inevitably lead to dehydration (excessive loss of body water). http://theconversation.com/health-check-does-caffeine-cause-dehydration-73965 Current studies suggest that caffeinated coffee or tea is not proven to be particularly dehydrating in people who drink them regularly. Caffeine, however, may worsen overactive bladder symptoms, so there may be other reasons to be careful about fluids containing caffeine for our senior population. Feel free to offer decaffeinated drinks but if an older person particularly loves her/his morning cup of (caffeinated) coffee, there is no reason why they cannot partake unless it is physician ordered to avoid such liquids. Help Them Stay Hydrated Here are some reasonable approaches to help your seniors remain hydrated during current rising temperatures: Identify continence issues that may make the older person reluctant to drink. Consider a toileting schedule, which means helping the older person get to the bathroom on a regular schedule. This can be very helpful for people with memory problems or mobility difficulties. Offer fluids in small amounts throughout the day; consider doing so on a schedule. Ensuring the appeal of the beverages you offer – they will drink more if they enjoy it. Determine if your senior prefers drinking through a straw. Enlist interdisciplinary staff in your efforts. Track in a journal how much the person is drinking; be sure to note when you try something new to improve fluid intake. Offer more fluids when the senior is ill (seek nursing oversight). Reducing Swallowing Problems by Making Liquids Thicker While you focus on actions to prevent dehydration issues be mindful of anyone with a swallowing disorder, often experienced in the elderly. Normal aging causes reduced muscle tone in the pharynx and esophagus and other changes that affect swallowing. Thickened drinks are normal drinks that have a thickener added to make them thicker. They are often recommended for people who can no longer swallow normal fluids safely, because normal drinks go into their lungs, causing coughing, choking or more serious risks such as chest infections and aspiration pneumonia (seek nursing oversight). More Ways to Keep Seniors Cool in Hot Weather Offer cooling snacks, like popsicles (use cupcake liner to catch drips). Place a cool washcloth on the back of the neck and a pan of cool water close by to periodically re-cool the towel. Meals should be cold like chicken or pasta salad instead of heavy hot dishes like pot roast. Encourage clothing that is lightweight and in light colored cotton so it’s easy to adjust to the temperature throughout the day by removing layers of clothing. https://dailycaring.com/10-tips-to-keep-seniors-cool-in-hot-weather/ Calendar Programs Older people can have a tough time dealing with heat and humidity. The temperature inside or outside does not have to reach 100°F (38°C) to put them at risk for a heat-related illness. Be mindful of the temperatures when planning programs. Restrict your events to locations that offer cool environments. For outings (when applicable), seek senior-friendly places that offer air conditioning (restaurants, shopping malls or stores, public library, art museums, movie theaters). Senior exercise programs may need to be shortened in duration and restricted to easy and simple range of motion programs to prevent over- exhaustion. Do not forget the hydrating liquids! Stay Cool! Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org This course takes you through the Activity Departments required documentation process from the Baseline Care Plan through the final creation of the Comprehensive Care Plan. Particularly focus is tailored to the individuality of the resident and that care plans are in no way intended to be “cookie cutter” care plans. An appropriate and useful care plan begins with an effective and complete individualized assessment. When designing a care plan for each resident the professional must ensure that multiple sources within the Interdisciplinary Team assessments are considered to address the resident’s specific needs. The care plan you write must address these issues. The care plan is a representation of the accumulation of the facility’s assessment process. It is the final compilation of the individual resident’s problems, needs, and strengths. The care plan definitively scopes the resident’s care treatment process, describing conditions to be treated, expected outcomes, and the specific customized care services to be rendered. This course is intended to help you to become more proficient and savvy when it comes to realistic and relevant care plan development. Workshop Objectives: Understand care plan relevance relating to resident treatment Learn how care plans have evolved historically Understand the development process leading to the care plan creation Understand how to implement SMART care plan goals Utilizing IDT assessment tools data for care planning Understanding resident rights in care planning participation Recognize the progress notes and care plan relationship Recognize the initial assessment and monthly calendar relationship Revising the care plan – why or why not Merging care plans – consolidate IDT members contributions When to use short term care plans Understand Rehabilitation care plans Workshop Content: Care Plan Overview – What is this document? The History of Care Plan Development Understanding SMART Goals The Process – Baseline Care Plan to Comprehensive Care Planning Reporting Timeliness Common Care Plan Mistakes Care Plan Examples General Documentation Principles Documentation Corrections About Your Instructor Celeste was involved in the startup of a medical adult day center in the role of Activity Director and worked closely with the Alzheimer’s Association, Massachusetts Chapter during to develop program modules to serve the Alzheimer’s diagnosed participants. She was exclusively instrumental in the successfully implementation of the center’s Child and Adult Care Food Program (CACFP); working with the state to create the centers reporting structure and standards for compliance to state specified regulations. Celeste was recognized for her business development contributions and was became the Centers’ Program Director. Celeste has served as consultant and “Guest Instructor” for Activity Directors Network since 2011- supporting the student educational experience in pursuit of Activity Director Certification. She is currently lead instructor for Activity Directors Network and author of the National Activity Professional Training Course (NAPT). Celeste continues to support educational opportunities as the author of The Activity Consultant’s Help Desk since its inception in 2018. This Activity Directors Network newsletter reaches a readership with interest in further developing of their professional knowledge base as senior care industry professionals. She has also written Continuing Education (CEU) courses and has authored the “Behavioral Health Programming Guide for Skilled Nursing Facilities”. Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2020 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2010 US HWY 190 W Ste 120 Livingston, Texas 77351

to all Activity Professionals - Most of you may know that Kathy Hughes has passed.Those of you who had the pleasure of being taught by her were indeed blessed, she was a mountain. Her family is gathering next week to celebrate her life at a family retreat she loved. Please take a minute to celebrate her legacy during your week, I'm sure she'll be close by... We Miss You! --- if you would like to send something to the family please email us at pbacon@activitydirector.com

From NAAPCC NAAPCC DOES MEET FEDERAL TAG #658 NOTICE TO ALL ACTIVITY PROFESSIONALS Contrary to a notice posted 7-1-20 sent out by another organization, NAAPCC DOES meet federal Tag #658 as it is written and will post the full regulation on our website. You can also find it at the CMS website. The regulation states that CMS accepts the standards of ANY accrediting body or State Association, not just NAAP. The Training courses accepted under F Tag 680 only have to meet State approval. They DO NOT need to meet NAAP's approval or be accepted by them. NAAP is a membership organization for Activity Professionals, just as there are other organizations for Activity Professionals. No organization has the authority to approve someone else's work or decide what CMS will accept, nor is that stated anywhere in the regulations. NAAP has their own education and it would be a conflict of interest for them to approve or not approve other courses. The Creators of the NAPT course have no obligation to hand it over to anyone else for review. While NAAP is mentioned by name in one section, along with several other entities in F Tag 658, it is not an exclusive recognition, and following NAAP's name is the word "etc", meaning other organization standards are also recognized, including State Associations and Accrediting bodies, which does in fact include NAAPCC. Please be assured the information released is inaccurate. CMS has been recognizing and accepting NAAPCC certifications since 2011 and they also accept any State approved course per F Tag 680. If NAAP chooses to not promote other courses or certifications, that is their right, but they have no authority to decide what meets regulations. Please read below! The Highlighted sections dictate how NAAPCC meets the regulation. NAAPCC Standards are posted on the website. Recommended resources for manuals, etc., are also located on our website. o F658 GUIDANCE §483.21(b)(3)(i) “Professional standards of quality” means that care and services are provided according to accepted standards of clinical practice. Standards may apply to care provided by a particular clinical discipline or in a specific clinical situation or setting. Standards regarding quality care practices may be published by a professional organization, licensing board, accreditation body or other regulatory agency. Recommended practices to achieve desired resident outcomes may also be found in clinical literature. Possible reference sources for standards of practice include: • Current manuals or textbooks on nursing, social work, physical therapy, etc. • Standards published by professional organizations such as the American Dietetic Association, American Medical Association, American Medical Directors Association, American Nurses Association, National Association of Activity Professionals, National Association of Social Work, etc. • Clinical practice guidelines published by the Agency for Healthcare Research and Quality. • Current professional journal articles. Our credentials are recognized by CMS under F tags 658 and 680. If you have any questions or concerns please call the office at 303-317-5682 or email us at naapcc.office@gmail.com. We're here to assist you in any way we can. NAAPCC NAAP Credentialing Center 17840 Weymouth Ave, Parker CO 80134 United States You received this email because you signed up on our website or made a purchase from us. Unsubscribe

CMS UPDATE- Nursing Home Visitation Read Full Document Visit CMS.gov American Healthcare Association's Shelter in Place: Planning Resource Guide for Nursing Homes Keep Residents, Staff and Family Members up to date with this blank Covid-19 Newsletter Template. Made simply for your convenience: Step 1: Click on Button below Step 2: Fill in sections with your info. Step 3: Hit print or email. Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2020 Activity Directors Network, All rights reserved. Our mailing address is: 2010 US HWY 190 W Ste 120 Livingston, Texas 77351

View this email in your browser Turmoil has certainly visited the world over the last year and it has thrown systems that have been in place for years wide open and exposed areas that are working and areas that are in need of massive social change. One of these areas is in the care of our elderly. Activity Directors have been shifted into the forefront of this pandemic within the walls of your facilities. Your importance in maintaining peace and stability in the lives of those you serve has never been more evident as you are each being called upon to perform tasks that you would have never thought possible only a few months ago. The flip side to upheaval is the renewed ability to put the pieces back together in a better way. I am sure you have thought of many areas over the years that could be improved upon or had many ideas of things that could be introduced that would be game changers. I think now is the time for us to all come together as a profession and start working towards some of these changes for the betterment of all. In light of this shared mission, I wish to dedicate today's Activity Corner to looking at some of the ways we can move in that direction as a team of loving individual's working on improving the industry. NOTE: Some of these ideas will not be possible to implement in the current situation we find ourselves in. However, these are ideas that can be worked towards over time and perhaps the planning and groundwork can be laid now. Be the Change... Activities are so much more than just activities. The way we spend our time determines the thoughts we have, the feeling we feel, the strength of our immune system, our overall longevity and the direction of our energy. What could be more important then that? There are many activities that you universally offer that are pertinent to your communities, such as faith-based activities and crowd pleasers, such as BINGO and trivia. However, you can dig even deeper and insert activities that can truly inspire and transform the inner and outer world of your residents. These activities may share some universal threads, but in order to uncover your specific direction you must include your residents in the discovery process and then build programming around it. Some areas that are proven to enhance the lives of all people, regardless of age, are: Family Health Faith Nature Community Personal Sense of Responsibility Let us look at these in turn to get a better idea of how you can enhance them through your strategic activity planning. Family Ask anyone with any level of true life experience what matters most and you will undoubtedly here family at the top of the list. These are our people, our tribe. Without them all the money, success or materialism in the world means nothing. How can we bring family into the picture more? We must appeal to the residents' family members by creating programs that entices them to make time for it. We need to create something that brings value to both the resident and the family. The resident's family members are extremely busy and involved in the busyness of middle age and this is somewhere we can help. Here are some ideas to get you going: Family Volunteer Day- Bring the kids and teach them the importance of volunteer work. Share stories or videos of the difference that can be made. Offer a certificate of achievement to each participating member so that they can take pride in being of service. Family Night- Host a fun monthly event that offers family activities. Plan movies, plays, carnivals, etc. Bring in a balloon animal artist or caricature artist... Something that offers excitement for the children. Focusing on the children is what will bring everyone together. It is a shared goal for the children to have fun. Well Being Lectures- Invite experts in well being topics to come and speak with your residents and family members. Choose a topic that you feel would be most helpful for your residents. Perhaps a lecture on brain health, forgiveness, preparing for death, loving communications, etc. Any area that would benefit both the residents and other participants. You want to generate open discussion. You could even have your Social Worker make some time to work with the families as a service. There can be many hidden resentments that could have built up throughout a lifetime that you may be able to facilitate a healing for. Achieving this would free your resident and their families. Health A Healthy body feeds a healthy mind and vice versa. A snack laden with sugar in the morning could inadvertently lead to agitation in the afternoon. The body processes chemicals in ways that directly affect well being. This can be easily seen in new bodily systems, such as those of a child, but they are there for us all at any age. Health makes us feel better, which leads to more empowered thoughts and actions. Consider how unstoppable you may have felt when you attempted a healthy new program. The key, and the tricky part, is maintaining this routine. There are ways you can commit to revamping your program to focus on healthy body, healthy mind. Some ideas are: Create a Wellness Program- Have your residents design and wellness program that commits to the well being of the entire facility. This may mean you all commit to healthy snacks during activities, that you offer a wellness associated activity 3 times a week, time spent in nature is incorporated weekly, invite different members of the community to start walking programs, host varied workout routines, discuss health issues, etc. There is so much that can be included with your dedication to making it a part of your planning. Language- There is much that can be inferred to through use of language, accurate or not. Try and be hyper aware of the language you may be using when conversing with your residents. We all need to be told that we matter and to be encouraged to reach beyond what we believe is possible. If you believe in your residents strong enough and long enough that will begin to change how they feel about themselves. Use encouragement with everything you do. Build activities around self-worth and love. Post affirmative message and visuals around the facility as constant reminders. A facility full of love will take off and create more outward and inward love then you can even imagine. Faith The world can get incredibly heavy if you believe you are meant to take it all on by yourself, this is where faith comes in. This is where strength is built, and comfort can be found. However, the traditional faith model that is mostly utilized in out facilities does not always address every individual's needs for faith. Faith comes in all shades of love and therefore your programming must reflect this level of inclusivity if it is meant to have an impact for all. For this reason, we must understand the faith of each of our residents and determine how to serve those needs. Some of our residents may not have faith or follow religion. They must be included as well. Aside from religious activities that involve different religions we can bring faith in by other means for those that are not served by that model. Some ideas include: Positive Psychology- Introducing activities that are meant to boost positive psychology can increase faith in oneself and faith in the world. The Dalai Llama has been quoted as saying that his religion is happiness. This may resonate with some of your residents. Faith in Oneself- Faith helps to explain the unknown and offers the idea that the strength to overcome is within. This can be done through many means, not just a specific doctrine. Try and create activities that are somewhat challenging so that the resident can build confidence in themselves. You could pair residents together and have them offer support to one another. You could have residents reminisce about past hardships and review how they were able to overcome them. There are many ways that faith in oneself can be nurtured. Consider what experiences you have had that showed you your strength and try to utilize your own personal lessons. Nature Nature can slow us down and connect us to the reality of life. Nothing is as serious as it seems, and nature reminds us of this. It literally grounds us and helps alleviate the cloudy thoughts floating around in our psyche. Notice how the birds live in the moment. Reflect upon the strength of the trees or the power of water falling from the sky and nourishing and cleansing all. Notice how the seemingly weaker plants (ie the grass) can bend without breaking through the most powerful of storms. A powerful way idea to consider this connection is: Earthing- Earthing is simply placing your bare skin in contact with the energy of the Earth. This means you dig in the dirt with your hands or you place your bare feet on a patch of Earth. This contact facilitates an ion exchange that is incredibly important to the health of our body, minds and souls. Create an Earthing Zone outside of your facility that encourages contact with the Earth. Community We all know that community involvement is key to keeping our resident's morale up. The tricky part is keeping the community as excited and passionate about this exchange as possible. Somehow you must find a way to keep your community programs fresh and alluring. Perhaps you can invite the community to share some of their hobbies, you could host a mentor program, or Adopt a Grandparent, you could host recycling drives or neighborhood watch groups or yard sales, etc. Maybe you can host a fundraiser that will provide a playground area on your facility's grounds that would be open to all the children in the surrounding community. There is a way to bring the two worlds together and the exciting part is using trial and error to get there. Set your intention and you will be shown the way that works best for who you serve. Personal Sense of Responsibility This is a biggie for us all. We all want to feel needed and useful. Incorporating ways for this to happen may be a little tricky in an environment where most needs are already provided for. Some ways that personal responsibility may be enhanced are: Pets- Caring for a pet goes way beyond simply keeping busy. There is an exchange of love and gratitude between the two that is so healing. The pet could be a bird or fish tank. It could be a small coy pond or an outside cat. Check with your facility to see what is possible and then enlist your residents to help care for the pet/s. Making a Difference- Your residents have the benefit of a long life well lived and can see the bigger picture better then most. Ask them for ways that the facility can be improved upon and encourage them to be a part of the solution. This may look like giving residents free space to air grievances, or weekly group counseling sessions. It might involve giving residents more freedom throughout their day or offering more snacking options. Allowing residents to vote on things such as weekly programming, or the meal one day a week, or the movie selected, etc. There are so many areas that could involve them and their opinions that would help them to feel personally responsible for the well being of every resident. You can even create an advocacy program where a resident helps to serve another resident that is less able to advocate for themselves. There are so many options. What you do is so much more then host activities. You are directly responsible for the mental well being of each and every resident and that is no small task. But the good news is that you don't have to do it alone. We can all pull together, residents included, and change the world! We can all wake up with a renewed passion and common goals that transform the status quo. You are needed now more then ever, and we believe in you and the power you have within. We invite you to write us with your thoughts and ideas and passion! We want to be involved and help you, the game changers, as much as we possibly can. The world is wide open and ready, and we know you are too. www.ActivityDirector.org - 1.888.238.0444

CMS has a New Grant underway to strengthen safety and health outcomes for nursing home residents and to improve quality of life by equipping nursing home staff, administrators and stakeholders with technical tools and assistance to enhance resident care. Click to Apply for Grant money below . View this email in your browser Self-Care for Those Giving Care Indisputably, COVID-19 has increased the level of stress and anxiety across all walks of life. This frightening and highly contagious adversary is particularly weighing heavily on our front line healthcare professionals and they are feeling the conflicting hardship of helping those they care for while at the same time ensuring their own safety. But you need to know that you’re not alone and there are some things you can do to help mitigate the negative effects on your overall well-being. American Psychological Association (APA) notes that managing stress early on can prevent long-term mental health troubles. “If you start to feel an acute increase in anxiety, depression, or other condition, consider seeking professional help sooner rather than later, if possible.” The following are some strategies and preventative measures to help you take action to integrate self care while giving care to others. The Art of Self Support Self-care and engaging in strategies to help maximize wellness isn't always easy, especially for busy healthcare professionals. This highly contagious disease does not discriminate over race, age, nor global logistics and so it is more imperative than ever for healthcare professional to commit to carving out time for their own self-care. Self-Support Strategies: Take breaks from watching, reading, or listening to news stories and updates (including social media; hearing about the pandemic repeatedly can be upsetting). Take care of your body. Take deep breaths, stretch, exercise or try meditation. Try to eat healthy, well balanced meals. Get plenty of sleep and avoid alcohol. Carve out time to unwind. A hot bath works wonders. Connect with others. With today’s abundantly available technology you can continue to talk with people you trust about your concerns and how you are feeling. Source: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fmanaging-stress-anxiety.html The Value of Self-Care Have you ever heard some of these caretaker clichés? 1.) Take care of yourself first or you will have nothing left to give others. 2.) We can’t give what we don’t have. 3.) Taking care of ourselves is taking care of them too. We can all agree on the value of self-care. That said, it is interesting to note that healthcare professionals are often the ones that often forget or completely dismiss self-care practices altogether. So don’t forget to care for yourself so you can better take care of others. Self-Monitor for Stress: Along with self-monitoring for physical symptoms of Covid-19, assess yourself for emotional symptoms. Look for signs such as irritability, insomnia, fatigue, headaches and digestive problems. Be aware that it’s normal to be experiencing some manifestations of anxiety (such as restlessness and difficulty focusing) during this period of exceptional uncertainty. Practice Self-Care: Healthy activities can help maintain equilibrium in trying times. Exercise, eat healthy foods, maintain a sleep schedule, pray, dance in the living room. Stay Personally Connected: Despite social distancing and quarantines, we can stay in touch via telephone, FaceTime, Zoom meetings and other platforms. Set up group chats with friends and relatives to keep grounded in your personal lives and allay the concerns loved ones might feel about your work with a high-risk population. Sharing the Facts About COVID-19 and understanding the actual risk to yourself and people you care about can make an outbreak less stressful. When you share accurate information about COVID-19 you can help people feel less stressed and allow you to connect with them. Meditation Meditation and daily affirmations are a great way to get your own self-care program jump started. The time needed to pursue either can be flexible and easily retrofitted to accommodate your demanding schedule throughout the day. There is a variety of meditation practices that you can try. “Meditation” actually refers to many different practices. In the West, the most well-known set of practices is “mindfulness meditation.” That means paying attention, purposefully and non-judgmentally, to your experience in the present moment. Studies have shown meditation to benefit on so many levels: Reduce stress Control anxiety Promotes emotional health Enhances self awareness Lengthens attention span May reduce age-related memory loss Improves sleep Pain management Decrease blood pressure Lastly but certainly not least, meditation can generate kindness. . . and that’s an added blessing that all of us welcome in our everyday lives. NOTE: Headspace, the meditation app, is offering free access to healthcare professionals this year. Affirmations Affirmations are positive statements that can help you to overcome self-sabotaging, negative thoughts. Identify the thoughts or behaviors that you'd like to change then come up with positive, credible, and achievable affirmation statements that are the opposite of negative thoughts. Repeat your affirmations several times a day, especially when you find yourself slipping into negative self-talk or engaging in negative behavior. Positive affirmations can be used to combat these often subconscious patterns and replace them with more adaptive narratives. Source: https://positivepsychology.com/daily-affirmations/ The art of viewing self-care as something other than a selfish act is rather difficult thing for healthcare workers to accept but the simple truth is that self-care pursuits “benefit everyone”. . . the healthcare workers’ family, fellow colleagues and associates, and ultimately caring for ourselves benefits the residents we serve. Thank you for all you do! Sources: https://www.healthline.com/nutrition/12-benefits-of-meditation#section12 https://www.vox.com/future-perfect/2020/3/18/21181644/coronavirus-covid-19-mindfulness-meditation-anxiety https://www.mcknights.com/blogs/the-world-according-to-dr-el/managing-staff-anxiety-in-the-time-of-covid-19/ https://www.vox.com/future-perfect/2020/3/26/21193122/coronavirus-mental-health-doctors-nurses-covid-19 https://www.mindtools.com/pages/article/affirmations.htm Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org CMS Technology Grant Civil Money Penalty Reinvestment Program A CMP is a monetary penalty the Centers for Medicare & Medicaid Services (CMS) may impose against nursing homes for either the number of days or for each instance a nursing home is not in substantial compliance with one or more Medicare and Medicaid participation requirements for long-term care facilities. A portion of CMPs collected from nursing homes are returned to the states in which CMPs are imposed. State CMP funds may be reinvested to support activities that benefit nursing home residents and that protect or improve their quality of care or quality of life. What CMP Funds Can Be Used For CMP funds may be used for (but not limited to) the following: Assistance to support and protect residents of a facility that closes or is decertified. Time-limited expenses incurred in the process of relocating residents to home and community-based settings or another facility when a facility is closed or downsized pursuant to an agreement with the state Medicaid agency. Projects that support resident and family councils and other consumer involvement in assuring quality care in facilities. Facility improvement initiatives, such as joint training of facility staff and surveyors, or technical assistance for facilities implementing quality assurance and performance improvement programs. As part of its continued commitment to the nation’s most vulnerable populations, the Centers for Medicare & Medicaid Services (CMS) has launched the Civil Money Penalty Reinvestment Program (CMPRP) to improve quality of life by equipping nursing home staff, administrators and stakeholders with technical tools and assistance to enhance resident care. CMPRP is one of several initiatives CMS has underway to strengthen safety and health outcomes for nursing home residents. Apply for Grant American Healthcare Association's Shelter in Place: Planning Resource Guide for Nursing Homes Keep Residents, Staff and Family Members up to date with this blank Covid-19 Newsletter Template. Made simply for your convenience: Step 1: Click on Button below Step 2: Fill in sections with your info. Step 3: Hit print or email. Our MEPAP 1&2 Courses 2 Course Formats www.ActivityDirector.org - 1.888.238.0444 Structured Class (16 Weeks) - Begins the First Tuesday of each Month Self Paced Class (13 Weeks-1 Year) - Enroll and Begin Anytime Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2019 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2010 US HWY 190 W Ste 120 Livingston, Texas 77351

I don't know how many of you are looking at FaceBook at this time but there are so many clever AD's out there. I am loving the ways they are doing the "Carts". For example: Coffee & Donuts, Happy Hour, Easter Cart, Bread Cart (this one was very clever, she actually baked bread on halls & then put fresh bread in cups & passed out to residents in their room. The smell!). Another thing I thought was clever was asking family members to come by & bring the kids. They (the kids/family member) stay on outside of facility & resident on inside. They face each other & using painter tape make a tic-tac-toe pattern on the window. Each person has wipe & write marker (You can place a basket of these on outside of facility) they play a few games. However one of my tabulate favorite was this: A resident was sitting in the facility at a window with a cell phone & her family member brought her lawn chair & sat on the other-side of the window with her cell phone. They sat facing each other & had a conservation.

As far as having a group activity this varies from facility to facility. Some are not allowing any activities outside of the residents room. I have heard from a few AD's where they are allowed to have a group activity as the area they are holding the activity in is a large room & they are able to keep residents the required 6 feet apart. But none are allowed to have more than 10 residents in any type group activity. The biggest thing on FB for a while was the hallway actives, however it seems that it is mostly a thing of the past too. The best thing at this time is to follow the procedure that your facility has set in place.

Do you have questions about infection control procedures? questions about masks, gowns, respirators, gloves and visiting room to room? This document outlines the Guidelines CMS.gov has issued to State Surveyors concerning State Inspections For Nursing Homes During the COVID-19 Outbreak. F-880 Take a minute to read the document and Print out Pages 10-28, the Nursing Home Checklist Tools, to help you evaluate your facility. Activity Directors Network NCCAP Approved MEPAP 1&2 Flexible Practicum Extension for COVID-19 Activity Director Courses Enroll Today! MEPAP Part I & MEPAP Part II Starts 1st Tuesday of Every Month - or - MEPAP Part I - OwnPace & MEPAP Part II - OwnPace Starts Any Time Take Up to a Year!

COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers A.D.N. will continue to provide updates from CMS to keep you informed. The following portions has been extracted from CMS bulletin to highlight areas of immediate concern to you – please see the following link for the full article. Source: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf The following blanket waivers are in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency declaration. For general information about waivers, see Attachment A to this document. These waivers DO NOT require a request to be sent to the 1135waiver@cms.hhs.gov mailbox or that notification be made to any of CMS’s regional offices. Long-Term Care Facilities and Skilled Nursing Facilities (SNFs) and/or Nursing Facilities (NFs) 3-Day Prior Hospitalization. Using the authority under Section 1812(f) of the Act, CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a SNF stay, which provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations, or are otherwise affected by COVID-19. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (this waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances). Reporting Minimum Data Set. CMS is waiving 42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission. Staffing Data Submission. CMS is waiving 42 CFR 483.70(q) to provide relief to long-term care facilities on the requirements for submitting staffing data through the Payroll-Based Journal system. Waive Pre-Admission Screening and Annual Resident Review (PASARR). CMS is waiving 42 CFR 483.20(k) allowing states and nursing homes to suspend these assessments for new residents for 30 days. After 30 days, new patients admitted to nursing homes with a mental illness (MI) or intellectual disability (ID) should receive the assessment as soon as resources become available Physical Environment. CMS is waiving requirements related at 42 CFR 483.90, specifically the following: - Provided that the state has approved the location as one that sufficiently addresses safety and comfort for patients and staff, CMS is waiving requirements under § 483.90 to allow for a non-SNF building to be temporarily certified and available for use by a SNF in the event there are needs for isolation processes for COVID-19 positive residents, which may not be feasible in the existing SNF structure to ensure care and services during treatment for COVID-19 are available while protecting other vulnerable adults. CMS believes this will also provide another measure that will free up inpatient care beds at hospitals for the most acute patients while providing beds for those still in need of care. CMS will waive certain conditions of participation and certification requirements for opening a NF if the state determines there is a need to quickly stand up a temporary COVID-19 isolation and treatment location. - CMS is also waiving requirements under 42 CFR 483.90 to temporarily allow for rooms in a long-term care facility not normally used as a resident’s room, to be used to accommodate beds and residents for resident care in emergencies and situations needed to help with surge capacity. Rooms that may be used for this purpose include activity rooms, meeting/conference rooms, dining rooms, or other rooms, as long as residents can be kept safe, comfortable, and other applicable requirements for participation are met. This can be done so long as it is not inconsistent with a state’s emergency preparedness or pandemic plan, or as directed by the local or state health department. Resident Groups. CMS is waiving the requirements at 42 CFR 483.10(f)(5), which ensure residents can participate in-person in resident groups. This waiver would only permit the facility to restrict in-person meetings during the national emergency given the recommendations of social distancing and limiting gatherings of more than ten people. Refraining from in-person gatherings will help prevent the spread of COVID-19. Resident roommates and grouping. CMS is waiving the requirements in 42 CFR 483.10(e) (5), (6), and (7) solely for the purposes of grouping or cohorting residents with respiratory illness symptoms and/or residents with a confirmed diagnosis of COVID-19, and separating them from residents who are asymptomatic or tested negative for COVID-19. This action waives a facility’s requirements, under 42 CFR 483.10, to provide for a resident to share a room with his or her roommate of choice in certain circumstances, to provide notice and rationale for changing a resident’s room, and to provide for a resident’s refusal a transfer to another room in the facility. This aligns with CDC guidance to preferably place residents in locations designed to care for COVID-19 residents, to prevent the transmission of COVID-19 to other residents Home Health Agencies (HHAs) Requests for Anticipated Payment (RAPs). CMS is allowing Medicare Administrative Contractors (MACs) to extend the auto-cancellation date of Requests for Anticipated Payment (RAPs) during emergencies. Reporting. CMS is providing relief to HHAs on the timeframes related to OASIS Transmission through the following actions below: - Extending the 5-day completion requirement for the comprehensive assessment to 30 days. - Waiving the 30-day OASIS submission requirement. Delayed submission is permitted during the PHE. 13 Initial Assessments. CMS is waiving the requirements at 42 CFR §484.55(a) to allow HHAs to perform Medicare-covered initial assessments and determine patients’ homebound status remotely or by record review. This will allow patients to be cared for in the best environment for them while supporting infection control and reducing impact on acute care and longterm care facilities. This will allow for maximizing coverage by already scarce physician and advanced practice clinicians and allow those clinicians to focus on caring for patients with the greatest acuity. Waive onsite visits for HHA Aide Supervision. CMS is waiving the requirements at 42 CFR §484.80(h), which require a nurse to conduct an onsite visit every two weeks. This would include waiving the requirements for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan, as this may not be physically possible for a period of time. This waiver is also temporarily suspending the 2-week aide supervision by a registered nurse for home health agencies requirement at §484.80(h)(1), but virtual supervision is encouraged during the period of the waiver. Read Full Article Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org Our MEPAP 1&2 Courses 2 Course Formats www.ActivityDirector.org - 1.888.238.0444 Structured Class (16 Weeks) - Begins the First Tuesday of each Month Self Paced Class (13 Weeks-1 Year) - Enroll and Begin Anytime Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network.