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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. Relax¦ 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. All other information that I do not address, should be covered by your facility, in its Privacy Policy. 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. Please note: it is the responsibility of every employee to keep resident information confidential with regard to every aspect listed above. It is also the responsibility of each employee to know what types of information are covered under the HIPAA policy and under facilities privacy policy. Please educate yourself to the specific information in those policies in addition to using this as an education tool! 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? ... Resident Profile: 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? Activity Staff: 9. Who is the activity staff? 10. What are the activity staff’s responsibilities and skills? 11. Possibilities of increasing your activity staff? 12. Can the other staff help with programming? Volunteers: 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? Equipment: 20. How would you rate the equipment and supplies available? 21. What equipment and supplies are you lacking? Budget: 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? Activity Director: 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 Alzheimer’s patients? 34. Is there a set schedule for the programming? 35. Does the AD have current Alzheimer’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 facility’s rules regarding taking residents out of the facility in your own car? Transportation: 43. Does the AD drive the van for activities and residents’ 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 IN GENERAL: 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) Approach slowly 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. Use refreshments 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 Inter-generational activities Good mixture of passive to active activities WANDERING, PACING 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 Dancing 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 Redirection 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." SUNDOWNING 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 STRIPPING 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 CATASTROPHIC REACTION : 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] By Unknown [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. Step One... 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. [/list] [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 [*]Book Stores [/list] 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.