Pennie

Try not to over think it.. I had a couple of changes that always saved me, One was, I talked my admin into paying me to create my calendars and newsletters at home on my computer. He approved 6hrs a month on my check and that helped. Second was , when I created my activities calendar, I printed one extra for each resident, On the extra copy I would put a blank so that I could put a residents name and room number on the copy. In your case I would end up with 89 resident calendars in a folder, stapled together, that would go to each activity. Each resident in attendance would have their calendar activity highlighted to show attendance, non attendance due to vistor, participation level Red Green Yellow highlighters add a Blue and make your own color legend. Its a fast way to document who was in attendance, include notes. At the end of the month you have your attendance records and data for your careplan and progress notes. Each calendar for each resident in the folder will reflect the entire months attendance with notes, most can be documented with a quick swipe of the marker Here's a sample 3200.docx hope this helps Pennie We create a monthly calendar and newsletter available for download each month. Its a Membership, 9.95 month. http://activitycompanion.com You can use Printmaster or OnlyOffice free online to load our templates and edit to fit your facility.

Hi Chiquita -- welcome to AD World

Resident Thanksgiving Meal -- Staff Thanksgiving Meal -- December Resident & Family Christmas Party

Excess Disability – Independence with Alzheimer's by M. Celeste Chase, AC-BC, ACC, CDP, CMDCP When someone has Alzheimer's with presenting dementia, their cognitive function continues to decline but they still possess abilities. In fact, skilled healthcare professionals know that continuing to do as much as they can do at their current ability level stimulates the brain and may even help to maintain skills longer. However, family members unknowingly often cause "excess disability" when in their sincere earnest to be helpful, do everything for his/her loved one to make life less challenging for the dementia diagnosed individual. Excess Disability - "Use it or lose it" When you provide opportunities for residents to do for themselves it prevents those intrinsically rooted skills from becoming rusty and ultimately no longer usable. It cannot be overstated how important purposeful activities are when discussing dementia and topics referencing motivation and engagement. Purposeful activities focused on interests work harmoniously to entice and elicit responses essential to maintain the "use it or lose it" concept. As dementia progresses, older adults are capable of less and less. Helping them find self-motivated desires to participate in everyday tasks and activities can boost mood and improve quality of life and holds the power to raise self-esteem and reduce common dementia behaviors, like agitation, repeated questions, and anger. Adapting everyday tasks with purposeful meaning for the individual diagnosed with dementia will entice and encourage mental stimulation, and provide support as needed to help older adults maintain a sense of independence and accomplishment. That is something every one of us strive to maintain for as long as it possible. Why are Dementia Activities so Important? 1) Provides Daily Structure: A structured and consistent daily routine gives needed predictability and stability when the individual is feeling disoriented and confused. 2) Prevents Decline: Continuing to do as many activities and daily tasks as independently as possible helps to preserve innate skills for a longer period of time despite disease progression. 3) Improves Mood: The individuals capabilities continue to decline with disease progression. When individuals participate in everyday tasks can boost mood and improve overall quality of life. 4) Reduce Challenging Behaviors: Challenging behaviors present with less occurrence when opportunities are made available to engage the individual in positive oriented everyday distractions. Thereby, providing a means to release energy and unexpressed emotions. Supporting Remaining Skills Look for adaptive strategies & techniques that focus on strengths/skills that the individual still possesses. Allow the individual to retain as much control possible to help foster a sense of personal dignity. Integrate "chunking" methods - (break down tasks step by step) move to the next tasks in sequence only when the previous one has been completed. Attention span may be limited so plan programs of no more than 20 to 45 minutes of time segments. Programs are most effective when they are multi-sensory & spanned over consecutive days; first day – taste applesauce, next day – taste apple pie and so on (connects related theme to facilitate memory input). Incorporate events that "elicit" a response through use of basic sensory stimulation & awareness of his/her body movements. Sensory Integration would focus on any combination of the following: Visual (eyes) Auditory (ears) Proprioceptors (awareness of body position) Vestibular (balance) Tactile (touch, feel) Olfaction (smell) Gustatory (taste) Remember: Loss of memory creates an inability for the individual to remember what they did in the past for themselves to find amusement. However, this population may still have the ability to [be amused] well into the disease process. Strategies and Techniques Meeting the individual abilities will ensure greater success. Particularly when maintaining the overall goal to support opportunities for independence and accomplishment. Set-up: Pre-plan what is needed in a manner that cues the resident to complete the task independently. Example: Clothing – Place items in order of use: underwear and bra on top, shirt and pants under them. Visual distance supervision: Remain within the line of sight to supervise and assist when needed yet distant enough to allow the individual to complete on their own. Example: Drying dishes – stand within visual view to make sure the dishes are properly towel dried - replace the towel when it has become saturated with water. Prompting: Minimize verbal instructions, simply point to the next task in the sequence to give guidance. Example: Point to the place mat. When it is placed on the table, point to the plate or ask what's next? Verbal Cues: Provide gentle verbal "cues" only as needed to prevent frustration by stating simple directions for task sequence, allow time as needed for the individual to complete one task before you offer another cue to move onto the next task. Example: Bathing – Pick up the washcloth... turn the faucet on... wet the washcloth. Physical Guidance: Use "hand over hand" or "mirror" techniques to help guide physical actions. Example: Brushing teeth: Stand behind and place your hand over the individuals hand while holding the toothbrush. Gentle provide physical guidance for brushing teeth. Note: "Excess disability" refers to the loss of an ability that comes from something other than the disease or impairment itself. In dementia care, this generally refers to the loss of abilities that go beyond the physiological changes that are caused by the dementia. Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org BUY Now 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

Best Laid Plans by M. Celeste Chase, AC-BC, ACC, CDP, CMDCP A best-laid plan refers to when things gone awry or simply stated, something that has not turned out as well as one initially had hoped for. The expression the best-laid plan carries the implication that one should not expect everything to always turn out as planned. Easier said than done… right? The idea that no matter how much thought or pre-planning gets devoted towards a certain task or endeavor and it may still turn out unsuccessful is disheartening to say the least. That said, when things do not go as expected, it is completely normal to feel as though someone has just taken a bit of a bite out of your self-confidence. Such is the scenario when the appropriate time has been dedicated to review resident assessments, history, clinical status and pursuits of interest to develop the perfect mix of calendar events for your resident. Surprisingly and low and behold – your resident does not want to participate in the event. In fact, your resident very unapologetically lets you know that your event was a total flop. Adding salt to the wound, that is the same resident initially expressed an interest and requested the event to begin with! Yikes yet again! It Happens Without a doubt, many of us if not all of us in this field have been there. Sincerely and earnestly planning what we believe to be on target “person centered” pursuits of interest. Only to have the very same residents who had asked for the program to flat out reject it. So what happens when those “best laid plans” go off the rails and turn out all wrong! When your plans hit the fan, you can either fuss about it and go negative or choose to take the opportunity to cultivate an optimistic viewpoint. How it that done anyways? It’s a question of rolling with the punches – and acquiring the ability to remain flexible – not take the rejection personally – and lastly, learning from the experience. “Adversity can - make you stronger!” Why? Humans have the capacity and the determination to avoid the same outcome previously experienced. Resiliency is a gift and one that we all posses - it’s time to pull up those boot straps ladies and gents and look at the process to find out why that well planned event was not well received by your resident. Resident Planning Committee Make it your mission to involve the residents in planning the calendar every time a new one needs to be created. The consistent and routine resident participation in planning events will lead to a number of great benefits for both you the professional and the residents you serve. Start the process by searching for two residents that seem excited about contributing ideas for calendar events. These two residents will become your “volunteer ambassadors”. These “ambassadors” should be good communicators, warm and friendly residents willing to personally visit fellow residents to talk about all the ways he/she can contribute to facility programming and thereby adding their valued ideas. This “buddy resident” system is a successful approach for both new and existing residents. New Residents Consider that newbie residents may be shy and undecided about starting interactions with the large existing (perhaps scary) group of residents. When the new resident is approached by two friendly, outgoing and happy residents; he/she may find it less intimidating and more likely open to be part of the Resident Planning Committee. Existing Residents “Buddy resident” system makes for great ambassadors to help current residents as well. The pair can help to revitalize interest and help fellow residents to feel valued once again. It just takes a couple of energetic residents to give a gentle nudge now and then. Committee Structure and Process If you have more than one resident interested in chairing the committee, ask residents to assume the resident chair position on a rotation bases. This gives everyone that desires to do so a turn and gives a well deserved break to those that have previously served as chair. Write the resident ideas for events on a white board – keep them up on the white board till the next meeting. Why? 1) This allows you to erase events after they have been put on the calendar. Thus, you can keep adding and erasing as you are able to schedule them in any given month. Additionally, this is a great visual for the resident to see his/her ideas actively go from the white board to the calendar and gives the resident a sense of achievement. 2) Visually displays what the Resident Planning Committee has created for all to see. This is particularly useful for memory impaired residents as they can become agitated or upset when they do not like or recognize a program idea even though they initially suggested it. NOTE: Memory issues are the commonly seen contributor relating to event rejection and refusal because the resident does not recognize what they asked for in the previous moments. 3) Residents can be fearful that their ideas may not be well liked by others. Create an “anonymous “idea box” to keep the identities of those that would not otherwise give up what they secretly want you to add to facility programming. Memory impaired residents may perhaps make up the majority of the group you serve. When a program event is rejected by this group, whether it was initially the residents’ idea or not, do not take it personally. Remind yourself that his/her behavior is a product of related memory issues. The most effective response for you as a professional is to quickly “redirect” your resident to something else to prevent further emotional or behavioral escalation. Know Your Audience Knowing who your audience means that you can adapt the content of your presentation to address the main concerns of your audience. Professionals leading a group of seniors regardless of the group size must know and understand why the group wants to be present, what motivates the group, and whether you are matching your information to their level of understanding and interests. It’s an ongoing day to day learning experience for the Activity Professional and we all know that you have the knowledge and the skills – Remember that you got this! The best-laid plans of mice and men often go awry. No matter how carefully a project is planned, something may still go wrong with it. The saying is adapted from a line in “To a Mouse,” by Robert Burns: “The best laid schemes o' mice an' men / Gang aft a-gley.” Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org BUY Now 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

Hi. your facility routine is definitely unique .. it doesn't follow regulation but it seems that the only thing missing is a way to communicate to the Coordinator the information from the Activity's Dept as to whether or not there is a significant change in activities. All departments know of the residents with significant changes within a facility, you might take a copy of the Sec F and mark the information as it pertains to each resident and leave it for the Coordinator before hand. Anything to promote teamwork, it makes life so much less stressful.. thanks Pennie " A significant change is determined by 2 departments usually nursing and dietary. Therapy also determines a significant change. Activities would not trigger, but reinforce one determined by the other depts. When you look at section F it would never change from the initial documentation. I know that the MDS would remain the same. Activities rarely triggers a significant change. Kathy"

Programming for Deaf and Visually Impaired Elderly Vision and hearing loss are particularly prominent in the older adult population. The most common senses that are “lost” are sight and sound. These senses are specifically controlled by the visual and auditory cortex, respectively. It is possible to lose the senses of taste, smell, and touch, but these are much less common. While vision loss can have a profound negative impact on a person's perception of the world, hearing loss diminishes a person's mode of communication and can lead to social isolation. Leisure pursuits for the deaf and visually impaired aging are paramount to preventing feelings of isolation and lack of independence brought on by physical deficits. Visual and auditory loss can make everyday activities more difficult and significantly contributes to the sense of exclusion from society. Adapted leisure opportunities offer those moments of inclusion that seem to be without disabilities and significantly improves overall quality of life. Compensating for Sensory Loss Studies conclude that when you no longer need to use that part of the brain to process images (for example), more energy and processing power is shifted to the senses of hearing and touch. The brain automatically compensates to improve your ability to move through the world. Such is the case for blind individuals who often use a technique called “clicking”, in which they make small clicking sounds and then interpret the echo they hear to determine the environment around them. This echolocation technique can even allow people to determine specific objects and walk normally without bumping into walls or obstacles. Look for senses that remain intact to help your resident navigate and relate to his/her environment. Sense of Touch: Using the sense of touch feel the shape, surface texture, weight and size combined to identify the unknown object which cannot be seen. Sense of Taste: Offer a variety of food items and ask what ingredients can be identified. Often a specific food will be remembered from childhood days – encourage those memories. Sense of Smell: A particular fragrance can also evoke memories. Perhaps apple or pumpkin pie made with grandma’s love and care. A fragrance distinct to flowers, candles, colognes or spices can be identified and all may elicit memories from days past. The “Golden Rule”: Focus on the senses that still remain to lead the way to programming success. Tapping into the remaining senses helps to keep minds active by doing things that require inquisitive thought and intellectual problem solving strategies. Stimulating and success oriented programming allows residents to feel useful again, despite their physical disadvantages. The Hearing Impaired The hearing-impaired elderly are often at risk of having social challenges and not being able to fit in with mainstream groups. This is largely because “communication” is primarily language-based. But there are many available types of leisure pursuits for the hearing impaired that help foster communication and contribute to a feeling of community. A little ingenuity will go a long way towards the discovery of hearing impaired leisure pursuits. These include: Computer Skills: Computer savvy skills are integral for keeping up with those that are not close by. Studies have shown that older adult with computer skills were less likely to experience mild cognitive decline as they aged. Art: From drawing and coloring to painting and weaving, art promotes creativity and expression. Hearing-impaired adults can work with clay and ceramics, as well as all types of sewing activities. Bingo: Options for the hearing impaired are available. Such as large calling cards with a yellow background that can be held up for those who can't hear the numbers being called. Video Games: Video games are no longer just for children. Studies revealed that video games improve cognitive reflex and help to sustain cognitive processing for adults over 60 years of age. Board Games: Board games and card games are suitable for hearing impaired seniors. Generally hearing impaired with no visual loss can read game board “how to play rules”. Sports: Other options for those who are hearing impaired with good mobility include playing pool, foosball, bocce ball, and shuffleboard. Headset: If the resident is not completely deaf, a good set of headphones can make listening to music or audio books enjoyable again. The Visually Impaired Age-related vision loss is common as we grow older and can often be corrected with glasses, eye drops, surgery and other medications. Some eye conditions however, such as macular degeneration, glaucoma, cataracts and other diseases may evolve into blindness or partial-blindness presenting considerable challenges to those affected. There are many game products are available in adaptive versions for blind seniors. https://www.maxiaids.com/board-games Some of these games include: Monopoly: All of the properties and spaces are in large type and accompanied by braille. All of the cards are in braille and large print. The dice and money notes are in braille as well. Checkers: Each space and piece is marked in a way that the blind and visually impaired can enjoy this game just as much as sighted people. Bonus points for knowledge of braille not being required to play. Chess: There are bumps on the white pieces to differentiate them from the black ones and the black spaces on the board are slightly raised. Scrabble: There is an overlay grid that prevents shifting pieces, as well as braille markings on said pieces. Here are a few topic oriented books that may be of particular interest to the visually impaired: Touching the Rock: An Experience of Blindness - by John M. Hull Autobiography; instructive and profoundly touching. The Country of the Blind - by H. G. Wells A mountaineer named Nunez slips and falls into a valley cut-off from the rest of the world where inhabitants are all blind. If You Could See what I Hear - by Tom Sullivan Blind from birth, Tom tells you stories that will make you laugh out loud. Stars Come Out Within - by Jean Little Autobiography of Canadian children's author Jean Little, blind since birth. A Dolphin in the Bay - by Diana Noonan A young boy's relationship with a dolphin helps him overcome his fears. Tips for Communicating with Visually Impaired People In general, observe first -then ask if your resident requires help - ask for instructions on how they want you to help. Don't raise your voice – or be excessively louder than normal volume. Use normal language- there's no need to avoid words such as "look", "see". Don't point or say 'over there'- be specific; "It is on the bed to your left". Identify yourself as you enter- "Hi Mary, it's Linda". It is acceptable to describe colors, patterns and shapes. Never patronize- do not assume that you have to make things 'easy' for them. When walking, describe the terrain- number of steps, texture of walking surface (carpet, grass . . .). Always respect the person's individuality, dignity and independence. What Is Available? Reach out to clubs and organizations for those who are deaf to encourage individuals who are deaf-blind to participate in social activities to reduce isolation. YMCAs/YWCAs Church leagues/synagogue leagues Community leagues Local associations for the blind Ski for Light - https://www.sfl.org/ University- or college-affiliated programs Local deaf club Lastly, but most importantly- Remember that your program must be “interest based” and “person centered”. You will always have a successful program when you ask your residents to guide you. Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org ENROLL Now 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 ... Starts Tuesday October 1st ... 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

Hi Everyone!! I promised I'd be back soon!! Here it is, the Flyer.. please feel free to print it out and post it wherever laugh loving Seniors are!! And did anyone catch my offer for the First 5 100- year olds who have proper I.D. They get to enjoy the show for Free!! How bout that? See age does have it's benefits!! Nevertheless, I hope you have a marvelous weekend and that the sun is shining for you wherever you are!! P.S. Menu to follow soon... Always, I Live to Laugh! Bonnie Barchichat Executive Producer Senior Comedy Afternoons.com 714-914.2565 The Proud Bird P.P.S. Sponsor Opportunities are available.. you don't want to miss this show! Contact me directly and say you want to be a part of it, send me your info! ©2019 Senior Comedy Afternoons LLC. | 2313 Nelson Avenue, Redondo Beach, Ca. 90278

Meaningful Memory Care Planning Individuals afflicted with Alzheimer’s and dementia complications go through a number of different stages during the disease progression. Leisure pursuits are crucial for residents living with Alzheimer’s disease, particularly those which offer and encourage engagement opportunities and much needed cognitive stimulation. The Approach to discovering leisure pursuits to offer engagement and stimulation is the same as any resident assessment process with one very significant distinction: Look at what the resident can still do rather than what they can no longer do. Establish consistent routines. Why? The day is a little less scary when the daily pattern is predictable and somehow familiar. Many of us operate on autopilot whilst going about our daily business but memory deficits can cause a snafu in the normal retrieval process. Thus, even our firmly embedded auto pilot can malfunction. While structure and routine is important, there are countless opportunities to do “meaningful” things in unexpected places and times. Daily everyday tasks such as bed making, sweeping, dusting, and watering plants for example are small yet simple though they can provide rich opportunities for engaging residents who perhaps show no interest in bingo, movies, or other group activities. Planning Tips Continuously adjust and accommodate to match to the changing needs of the disease progression. Plan for times during the day when the resident tends to function at their best. Use adaptive strategies and techniques that focus on strengths/skills in which the individual still possesses. Allow the individual to retain as much control as possible to help foster a sense of personal dignity. Simplify tasks: break down step by step. Move to the next step in the sequence only when the first step has been accomplished. Attention span may be limited so plan programs in no more than 20 to 45 minutes segments. Programs are most effective when they are multi-sensory and spanned over consecutive days (facilitate memory input) and are connected to a related theme. Remember: Loss of memory creates an inability for the individual to remember what they did in the past for themselves to find amusement. However, this population may still have the ability to [be amused] well into the disease process. Incorporate events that “elicit” a response through use of basic sensory stimulation and awareness of his/her body movements. Sensory Integration would focus on any combination of the following: -Visual (eyes) -Auditory (ears) -Proprioceptors* (awareness of body position) -Vestibular (balance) -Tactile (touch, feel) -Olfaction (smell) -Gustatory (taste) Proprioceptors* sensory receptors in muscles, joint capsules and surrounding tissues, that signal information to the central nervous system about position and movement of body parts. Activity Starters The following list has been provided as inspiration and motivation only. You will need to look at the individual resident with a Dx of Alzheimer’s to create a “person centered” care plan uniquely suited to the skills that remain and the specific stage of the disease as per nursing assessment. Stuffed Toys Offer stuffed animals and other soft toys to cuddle. Check for any materials that could be removed and become a choking hazard. Baby Dolls and Baby Doll Clothes Provides opportunity to foster nurturing characteristics. The goal is not to dress the doll properly, but rather to “elicit” the desire to change the doll’s clothing whilst working on hand eye coordination. Pet Therapy Animals of varying types are well documented to improve well being and boost emotional connection to something other than themselves. Music and Movies Foster emotional connections via music, videos, and movies. Keep the time frame brief, only watch/listen for 5 to 10 minutes but if they are engaged, keep allowing them to enjoy the experience for long as continue to be engaged. Sensory Sensory deprivation is one of the hallmarks of Alzheimer’s disease. Use everyday objects to arouse one or more of the five senses (hearing, sight, smell, taste and touch), with the goal of evoking positive feelings. Exercise Any physical activity can be beneficial, from a simple walk to yoga. Use props, such as tambourines, clappers, top hat, streamers, maracas, batons, pom poms, stretch bands, scarves, or stretch bands. Bird Watching Hang a bird feeder that will not allow individuals to access the food. Provide chairs or benches to stop and watch the birds. Sunshine and Fresh Air Plan time for the outdoors (weather permitting) for 10-15 minutes. Supply sun protection with wide brim hats and sun lotion on arms and legs. Avoid the sun between 11 and 3 pm. Offer cool drinks. Read Aloud Studies reveal that those afflicted with Alzheimer's disease may be able to hear until very late into the illness. Read articles in magazines and newspapers that the person enjoyed in former times. 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. Copyright © 2019 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2010 US HWY 190 W Ste 120 Livingston, Texas 77351

I was recently passed an interesting article from our instructor Kathy Hughes, ADC that I think we can all relate to. Nursing home food is often compared with hospital food and is rarely accused of being appetizing. However, the nationwide push to make care homes more person-centered has extended well beyond care and is now attempting changes in the dietary department. It may be hard for some to believe but prior to November 2016 family members weren’t allowed to bring outside food in. The value of sharing recognizable comfort food with a loved one in the throes of dementia could easily be recognized by the family, but couldn’t be executed until this all important CMS update in 2016 that was over 20 years in the making. According to the article: The new and modified regulations explicitly state that menus at facilities participating in the Medicare and Medicaid programs must now reflect the religious, cultural, and ethnic needs of residents, be updated periodically, and undergo review by a dietician or nutrition professional (who, according to the new regulations, have higher certification requirements than in the previous iteration). Also, for the first time, nursing homes can officially grow their own food or buy it directly from local producers, and allow residents to eat food brought in by friends and family. Finally, meals and snacks can now be served whenever works best for the residents, not just at designated feeding times. The changes these updates are making can be felt already in many homes, perhaps even yours. Rather than regular American staples day in and day out residents are now enjoying more ethnic foods being served right in their dining rooms. The ability to participate in CSA (community supported agriculture) programs opens a whole new way to plan activities for your community as well, providing pathways for field trips, vegetable, fruit and herb education, harvesting and preparation, increased health education and the lists goes on and on. Better food isn’t just about better taste and nostalgia either. Nutrition is critical in determining how one’s life will unfold particularly at this leg of life. Fresh and accessible food, from a variety of trustworthy sources increase intake in general and nutritional levels greatly. The article discusses many advantages to these CMS updates, but its central point remains that the boost in mental well-being received by these residents is really what counts. The ability to feel autonomous and to be reminded of the good times in life go a long way in contributing to joy. A care home should not feel like a jail and access to a variety of food and lifestyle experiences is a basic freedom. The updates are a huge step in the right direction however there is a stark difference between policy change and implementation. Positive effects are being felt as are the negative effects that variety can have on an ever decreasing dietary budget. The article references some worst cases scenario numbers that come in at less than $1 per meal. Think about that. Staffing issues also remain a concern that block many attempts above and beyond the norm of how things have always been. Even still, these changes are good changes and they were a long time coming. It allows residents to remain in contact with food, which is such a cornerstone of all of our lives and interactions therein. It is true progress and I for one was fascinated to read the article. I grew up in an Activity Department because my Mom was an Activity Director and I can remember the food vividly. I really hadn’t realized that food could be or was regulated in that way and that dietary had such restrictive guidelines and budgets (even though I should have because my Mom’s best friend Debbie was the Dietary Manager and she complained about it constantly!). I am glad to see these changes going into place and it gives me great hope about the type of facilities we are all pushing for together. The future is certainly brighter….and tastier. Article Referenced: Nursing home food is getting better. But the journey is far from over. by Jillian D' Onfro Nov. 27, 2017 Read the Article ENROLL Now 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. Activity Directors are the key to creating environments that we ourselves would be excited to live in. We envision facilities that feel like homes, not institutions. Facilities that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe providing the best education available, with the most talented teachers we can find, 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

Progress Notes by Kathy Hughes, ADC ActivityDirector.org Recently there has been conversation on social media sites concerning the need for activities to complete progress notes on a quarterly basis. This can also mean a quarterly and annual reassessment of the resident. Let us look at what a “Standard of Practice” is for Activities: Standards of Practice are a “how to” of a discipline. They can include policy statements, standard operating procedures, activity practice protocols and procedures for specific activities. Policy statements clarify the scope and authority of activities stating who, what and when an activity takes place. It also covers the scope of practice for the activities department. A scope of practice may be that activities cannot diagnose a specific disease or disability. The Standards of Practice also include the documentation requirements as set forth by the federal government and regulations of each state. These standards may not appear in the Activities section of the regulations but may appear in the Clinical records portion of the regulations. A policy is written by the Activities Director for the Activities Department. Once a policy is instituted the Activities Department must abide by what is written. A procedure is how the policy will be performed and how the Activities Department will do the activity. When being inspected, a surveyor might look first at the federal regulations then the state regulations and if there is a question then the facility policy and procedure. In the past some facilities received a deficiency when they did not follow their written policy and procedures. We have looked at the federal regulations for the US and found information that there were some references to progress notes for all disciplines, but not activities specifically. Although there are no regulations for having to do quarterly progress notes for activities, it is a Standard of Practice for the Activities profession. It is also a policy and procedure in most nursing homes. Surveyors are directed to look at “Physician’s, nurse’s, social worker's and other staff members progress notes, as applicable” in many areas of the CMS (Center for Medicare and Medicaid Services) regulations. “Other staff members progress notes” would be where the Activities Department falls. State by State Regulations Some state regulations specifically state that quarterly progress notes are required by the Activities Department. There are other states that only follow the CMS Regulations. It would be up to the Activities professional to find their specific state regulations for the need for a progress note. Here is a link to the “Clinical Records Regulations” for each state: http://www.hpm.umn.edu/nhregsplus/NH%20Regs%20by%20Topic/NH%20Regs%20Topic%20Pdfs/Clinical%20Records/category-administration-clinical%20records-final.pdf You can access your state regulations for activities by using this link: http://www.hpm.umn.edu/nhregsplus/NH%20Regs%20by%20Topic/Topic%20Quality%20of%20Life.html#statecompare You can also go directly to your state Department of Health and do a search for your specific regulations. In Summary... The Activities Department should do quarterly progress notes as a Standard of Practice. We have valuable information to share with the staff, the physician and the other teams. The residents have unique needs and interests that need to be documented and their progress in activities could impact their medical conditions and their progress in the facility. In our never ending quest to be accepted as a valuable member of the facility team writing progress notes, actively contributing to the care plan and having a detailed Initial Activities Assessment lets others recognize the Activity professionals as a modality to improve the residents quality of life. Have a question for Kathy? Email questions and comments to kathyhughes@activitydirector.com. Thank You. ENROLL Now 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. Activity Directors are the key to creating environments that we ourselves would be excited to live in. We envision facilities that feel like homes, not institutions. Facilities that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe providing the best education available, with the most talented teachers we can find, 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

There is generally some level of dread when state comes in for a survey. No matter how prepared you are there is always a chance that something could not go according to plan or there may be something you have overlooked. We often see members of the network discussing this possibility on social media and there seems to be a need for some Quality Assurance. For this reason, we have created a couple of forms for you to use as an evaluation tool. It allows you to get some perspective, evaluate your direction, adjust accordingly and improve your department and the lives of your residents. It’s a win, win that helps replace the dread of a survey with the excitement of being on top of it. How To Use These Forms There are two forms that will need to be completed on at least a quarterly basis. Use your judgement as to whether this time frame needs to be adjusted. Quality Assurance: Activity Program Review Utilize this form to evaluate your overall department’s performance. Each quarter have a different person complete it. For example, each quarter you could survey one of the following community members: family member, assistant, volunteer, admin, other department head, receptionist, a resident, a nurse and so on. This will give you a great deal of perspective and helps foster a sense of inclusion and teamwork in your work environment. Quality Assurance: Resident Quality Assurance Utilize this form to evaluate the level of quality that your department is delivering to each resident. It would be impossible to survey every resident every quarter. For this reason, survey at random a good cross section of your population and do the best you can. In Conclusion, making use of these two forms as part of your department's policies is one of the best things you can commit to. Evaluation is such an important component to motivation and creativity. When you ask your community to get involved with what you are trying to accomplish things can only improve and your vision can only gain clarity. These forms are complimentary from BEST SELLING book The Activity Directors Bible by Pennie Bacon. Click the link below to Download Quality Assurance FORMS BUY Now 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. Activity Directors are the key to creating environments that we ourselves would be excited to live in. We envision facilities that feel like homes, not institutions. Facilities that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe providing the best education available, with the most talented teachers we can find, 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 Our Network. Copyright © 2019 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2010 US HWY 190 W Ste 120 Livingston, Texas 77351 ------------------------------------------------------------------------------------------------------------------------------- Dementia Care - Critical Pathway Forms Help Identify Programming Deficiencies

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, to 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 the necessary 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 dry mouth and/or dry skin in the armpit less frequent urination dark-colored urine 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 cob webs 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 his/her 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 a cooling snack 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; seek senior-friendly places that offer air conditioning (Restaurants, Shopping Mall or Stores, Public Library, Art Museums, Movie Theaters). Senior exercise programs may need to shortened in duration and restricted to easy and simple range of motion programs to prevent over- exhaustion. Don’t forget the hydrating liquids! Stay Cool! Have a topic request or question for Celeste? Send them over to Celestechase @ activitydirector.org Introducing a NEW course from Best-Selling Teacher Kathy Hughes, ADC... ENROLL Now 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

---------------------------------------------------------------------------------------------------------------------------------------------------------------------- View the Seminar Brochure Behavioral Gerontology and Activity Approaches (Final) (1).pdf View and Print the Application Behavioral Gerontology and Activity Approaches Form (1).pdf

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. http://digg.com/2017/sex-ratio-america-map “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. NOTE: 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. Train Hobby Club – The collection for the train hobbyist is numerous, everything from the train itself to the landscape and surrounding villages will keep your resident busy. Look for a location in the facility where you can leave the train convoy permanently set up for residents to watch throughout the day. Men’s Choral Group – Rehearse all time men’s favorite songs to musical accompaniment or acapella style. Let your residents listen to past male entertainment groups (Miracles, The Four Tops, The Platters, etc.) Car Talk – Collect car magazines and new car brochures and solicit a discussion about new cars vs. the old cars, foreign vs. domestic, manual vs. automatic transmission, 2-door, 4-door, convertibles, etc. Car Wash – A simple hose, bucket, soap, sponges, and towels is all that’s needed. Solicit facility staff members to volunteer their car for washing. Each resident may choose whether to wash, rinse, dry, or just watch the scrubbing and polishing busy work. Rope Tying – Former professionals and wanna-be ship mates will enjoy trying and re-trying various rope techniques to get it right - while sharing sea worthy tales. If there is no sea captain in the crowd just purchase the many rope tying teaching books out there and dawn your sailor hat to get the ship moving. Santa's Workshop – Doll houses, airplanes, train kits, bird house, mailboxes etc., make for a super great Santa Shop assembly line. Finished product can be donated to non-profit organizations such as Toys for Tots during the holidays. Your men will love knowing how meaningful their labor of love will be to a child. Sports Time – Watching a live or a pre-recorded horse race, ballgame, boxing match on a big-screen will get the crowd in the mood. Set out peanuts, popcorn, and pretzels. Serve non-alcoholic beer and soda. NOTE: Keep in mind any issue with potential chocking risk/consult with nursing. Competitors Club – Horseshoes, bean bag tosses, badminton, bocce ball, and balloon toss are fun games that involve a lot of movement while encouraging interaction, socialization, and teamwork. At the Movies – Ask the residents to select a film (a western, war movie, or mystery). Schedule a matinee or an evening showing. Supply hot-buttered popcorn, movie-style candy, and soda (if permissible- relating to potential chocking/consult with nursing). NOTE: War movies may be triggering for some residents. Be sure to vet your residents for potential behavior relating to aggression that may be triggered from viewing war movies. Honoring Veterans – Military veterans are often eager to exchange stories about the war days as a way to bond and honor veterans and the past memories. Create a list of “military positions” held by your residents and post in an easily visible location to honor their service. Casino Night – Organize a game of dominoes, checkers, chess, or a card game (poker or Blackjack). Be sure to decorate with all the ambiance and glitz and glamour to set the tone. Arches ranging from roulette wheel to gleaming gold circle to let the residents make an entrance. Tool Bits – Provide a variety of different sized nuts, bolts, and washers and a few empty containers. Either direct the resident to sort the items or assemble the items and start up a conversation and provide pictures about what each item might be used to make. NOTE: Be aware if there is any evidence whereas you believe that your resident may want to ingest non-consumable items. Trade Show – Journey out to a local hardware store, such as Home Depot or Lowe’s. Make a project list and ask the men to find the supplies to complete the job. Many men enjoy discovering new tools and many will spend countless hours at a hardware or home-improvement center. Shoe Shine – Contact a local shoe shop to enlist the tradesman to come to the facility to show off his craft to the men of the house. Your residents can wear their Sunday best shoes for this shoe renovation. Offer newspapers, magazines, books for reading while resident shoes get a new lease on life. The smell of shoe polish may evoke memories and provide opportunities to reminisce. Card or Coin Collection Club – Many men collected and traded baseball cards or coins when they were young. Gather a collection of baseball cards or coins and set up a sorting/organizing station. Obtain detailed information about the items to share with the residents. Encourage the men to talk about their baseball or coin favorites and share how they acquired their treasures. Career Day – Gather a collection of photographs with a focus on jobs, occupations, and careers. (Also consider: colleges, military service, sports activities, clubs or organizations, hobbies or leisure activities.) Encourage the resident to discuss the photographs and their past employment. Pass around various hats representing different careers and ask residents to talk about which occupation they think the hat belongs to. Share information about each career such as, educational requirements and potential earnings. Have a topic request or question for Celeste? Send them over to Our MEPAP 1 & 2 Courses Begin Aug 6th, required for NCCAP Activity Director Certification. Contact Us at ActivityDirector.org - 1.888.238.0444 - admin@activitydirector.net 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

Bucket of Games 1 Bucket of Games 2 SALE Ends Aug 5th 1.888.238.0444 Our NCCAP MEPAP 1 & 2 Begins Aug 6th - Make sure your Activity Staff is qualified before your next Survey 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. Activity Directors are the key to creating environments that we ourselves would be excited to live in. We envision facilities that feel like homes, not institutions. Facilities that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe providing the best education available, with the most talented teachers we can find, 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

Activity Directors Network Online Classroom Visit ActivityDirector.org or call us at 1.888.238.0444 Our Online MEPAP Classes start Tuesday August 6th 2019 We are now enrolling! FREE CE Course for All August Students Person-Centered Planning Made Easy 8 Credit Hours Activity Directors Network is the premiere online provider of the MEPAP classes with almost all of our students passing the NCCAP national exam. We have taught students from all 50 states, Canada and England. Activity Directors in Long Term Care, Nursing Homes, Assisted Living Facilities, Adult Daycare, Swing-Bed Hospital Care, Recreational Care and PACE programs can take the NCCAP MEPAP Courses. Our MEPAP 1 is the most widely accepted Activity Director Training course in the US. Make sure your Activity Staff is qualified before your next Survey, The Centers for Medicaid and Medicare (cms.gov) State Survey of Senior Care Facilities follow Federal Regulation F680-F679, Surveyors Guideline In some States this course meets all of the Minimum State Requirements under Federal regulation F680, Check with your State Regs and your facility for any additional Continuing Education requirements. ------------ Taking a course Online is a very interactive way to learn. Not only do you benefit from a professional Activity Director Instructor, You also share the knowledge and networking with your entire class. Our Classrooms Lead Instructor, Kathy Hughes ADC, has over 40 years of teaching the NCCAP Certification course experience, as one of the original MEPAP Certification Training Course Authors, Kathy has the "know how", the experience and the resources to train you and your staff to provide innovative activities to your residents as well as learn about the regulations that effect the delivery of activities. Our Guest Instructors - Swing-Bed Specialist, Ruth Martanis - Adult-Day Health Specialist, Celeste Chase ACC CDP Once you experience the Online Classroom setting you'll wonder why you didn't try this sooner. ----------- The 24/7 Chatroom and the Class Forum are just two of the ways each and every Student can reach out to the entire class to either ask for help, offer some advice or share their particular journey with the class. You will enjoy networking with activity professionals who share their ideas and knowledge throughout the course. Our online class lasts 4 months, a 180hr course, 90hrs Class Study/90hrs of Practicum (Fieldwork). Cost is $600 - Payment Plans are available. If your facility is paying, simply sign our Purchase Order Agreement to verify payment. Ask about our "Self-Paced Format" that will allow you to expedite the training or extend it out for a year to help accommodate a busy life..... To Get Started . visit ActivityDirector.org and download the MEPAP 1 Enrollment Packet . fill out the enrollment forms, fax them in and you're ready to go. (fax 1.866.405.5724). Be sure and use our "Military Family Discount" $100 off any Military family Download a Enrollment Packet, fill out the forms, fax it to us. 1+866-405-5724 Enrollment Packets MEPAP 1 MEPAP 2 Click HERE to have the Enrollment Packet emailed to you. Be sure and use our "Military Family Discount" $100 off any Military family EZ Payment Plans Available - Call or email us to set up a plan that will work for you! Email Us - admin@activitydirector.net ** FREE Course requires a paid Enrollment 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. Activity Directors are the key to creating environments that we ourselves would be excited to live in. We envision facilities that feel like homes, not institutions. Facilities that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe providing the best education available, with the most talented teachers we can find, 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 Our Network, Pennie

Activity Directors Network Online Classroom Visit ActivityDirector.org or call us at 1.888.238.0444 Our Online MEPAP Classes start Tuesday August 6th 2019 We are now enrolling! FREE CE Course for All August Students Person-Centered Planning Made Easy 8 Credit Hours Activity Directors Network is the premiere online provider of the MEPAP classes with almost all of our students passing the NCCAP national exam. We have taught students from all 50 states, Canada and England. Activity Directors in Long Term Care, Nursing Homes, Assisted Living Facilities, Adult Daycare, Swing-Bed Hospital Care, Recreational Care and PACE programs can take the NCCAP MEPAP Courses. Our MEPAP 1 is the most widely accepted Activity Director Training course in the US. Make sure your Activity Staff is qualified before your next Survey, The Centers for Medicaid and Medicare (cms.gov) State Survey of Senior Care Facilities follow Federal Regulation F680-F679, Surveyors Guideline In some States this course meets all of the Minimum State Requirements under Federal regulation F680, Check with your State Regs and your facility for any additional Continuing Education requirements. ------------ Taking a course Online is a very interactive way to learn. Not only do you benefit from a professional Activity Director Instructor, You also share the knowledge and networking with your entire class. Our Classrooms Lead Instructor, Kathy Hughes ADC, has over 40 years of teaching the NCCAP Certification course experience, as one of the original MEPAP Certification Training Course Authors, Kathy has the "know how", the experience and the resources to train you and your staff to provide innovative activities to your residents as well as learn about the regulations that effect the delivery of activities. Our Guest Instructors - Swing-Bed Specialist, Ruth Martanis - Adult-Day Health Specialist, Celeste Chase ACC CDP Once you experience the Online Classroom setting you'll wonder why you didn't try this sooner. ----------- The 24/7 Chatroom and the Class Forum are just two of the ways each and every Student can reach out to the entire class to either ask for help, offer some advice or share their particular journey with the class. You will enjoy networking with activity professionals who share their ideas and knowledge throughout the course. Our online class lasts 4 months, a 180hr course, 90hrs Class Study/90hrs of Practicum (Fieldwork). Cost is $600 - Payment Plans are available. If your facility is paying, simply sign our Purchase Order Agreement to verify payment. Ask about our "Self-Paced Format" that will allow you to expedite the training or extend it out for a year to help accommodate a busy life..... To Get Started . visit ActivityDirector.org and download the MEPAP 1 Enrollment Packet . fill out the enrollment forms, fax them in and you're ready to go. (fax 1.866.405.5724). Be sure and use our "Military Family Discount" $100 off any Military family Download a Enrollment Packet, fill out the forms, fax it to us. 1+866-405-5724 Enrollment Packets MEPAP 1 MEPAP 2 Click HERE to have the Enrollment Packet emailed to you. Be sure and use our "Military Family Discount" $100 off any Military family EZ Payment Plans Available - Call or email us to set up a plan that will work for you! Email Us - admin@activitydirector.net ** FREE Course requires a paid Enrollment 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. Activity Directors are the key to creating environments that we ourselves would be excited to live in. We envision facilities that feel like homes, not institutions. Facilities that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe providing the best education available, with the most talented teachers we can find, 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 Our Network, Pennie

Activity Directors have traditionally planned and understood the importance of continuing their resident’s religion within the facility. Often multiple religious activities are planned weekly in order to meet the needs of those they serve. Things they are changing, though. According to a study conducted by the PEW Research Center from 2012 to 2017, approximately 27% of U.S. adults identify as ‘Spiritual but Not Religious’, with 75% identifying as both. This may seem like a vague identification and it certainly leaves the Activity Director in uncharted waters when it comes to planning activities for it. First, we must understand what ‘Spiritual but Not Religious ’ means. It is defined as a life stance that does not believe that organized religion is the best or only path to personal spiritual development. In other words, spiritual people prefer a more customized approach, which can add another layer of complication while trying to plan for multiple people. The spiritual quest is ever evolving and the direction it goes in comes from the resident’s internal ques within. One week they may wish to work on past regrets, while the next week finds them guided towards meditation or mindfulness. Spirituality is not a one size fits all in the same way uniform religion is. For this reason, the Activity Director will need to stay in close communication with their residents and take their inspiration from their needs. In order to make your job a bit easier we have provided a list of suggested spiritual activities that may help guide you and your resident as you take on this noble quest. Spiritual Activity Starters Meditation and Yoga- There are numerous guided meditations available for purchase or free on YouTube. Jason Stephenson is a good place to start. Research a guided yoga program that suits your residents. There is such a thing as chair yoga, which might be ideal. Mindfulness- Practicing being in the present moment during daily activities. Create activities that keep the resident tuned into what they are doing. This would include activities that require concentration such as painting, crafting, puzzles, playing an instrument, or learning to do familiar things in a new way (i.e. writing an entire letter using their non-dominant hand). Slant these activities towards the spiritual side of things and make it known that the overall goal is to remain mindful and alert. Shadow Work- According to Lonerwolf (a respected site that specializes in soul work), "shadow work is the attempt to uncover everything that we have disowned and rejected within our Shadow Selves". These are all of the things we dislike about ourselves or were taught to dislike, perhaps even impulses that would be considered vile if carried out. This is deep work and Lonerwolf recommends that you attempt shadow work only after establishing a strong degree of self-love. Spirituality Book Club- Spiritualists love a good “self-help” book. There are so many fascinating books on the topic and many can be found directly through the publisher or on Amazon. Some of my favorite spiritual publishers and authors are Hay House, Sounds True, Eckhart Tolle, Michael Singer, Brene Brown and Wayne Dyer. A book by any of these authors is sure to generate much reflection and communication for the book club. Conscious Dancing- This basically involves free style dancing. Turn on some tunes and encourage your residents to move freely to the music. They may feel embarrassed to do this, as most of our lives are dictated by socially acceptable behavior, however you can make the difference in their comfort level by displaying your own. This could also be undertaken in smaller groups until participants feel more free and confident. Another option is to begin by having the resident remain seated, close their eyes and move their arms freely. Overtime you will have a room full of free birds! Chanting- Chanting is another one of those activities that can feel silly to do at first and this makes it a bit off putting to many. However, it is believed that as you are chanting something is slowly transforming within you. I would recommend beginning by having residents listen to a chanting video or audio on YouTube to warm to the idea of chanting themselves. Set the tone by dimming the lights and having residents close their eyes and focusing on the chant. Chants are generally in another language so make sure you select the right one for your residents and inform them of the translation. In Closing... These are just a few of the possible spiritual activities you could plan for. The most important thing is that you allow for flexibility and modifications to suit your residents. The ‘Spiritual but Not Religion ’ mindset is one of fluidity and honoring oneself. The very fact that you are attempting to modernize your program to encompass all belief systems is admirable and so beneficial. You can be certain that as spirituality gains broader acceptance and becomes more mainstream you will be called upon to adapt your calendar. Some of these practices will benefit many of your residents, spiritual or not, therefor beginning to incorporate these ideas now will surely serve you and your department now and in the very near future. Namaste (I bow to you). Resources: https://www.pewresearch.org/fact-tank/2017/09/06/more-americans-now-say-theyre-spiritual-but-not-religious/ https://lonerwolf.com/shadow-work-demons/ https://www.spiritualawakeningprocess.com/2014/11/10-fun-spiritual-things-to-do.html Enroll Now NCCAP MEPAP 1&2 Starts Aug 6th - 16week Online Class required for NCCAP Certification. Instructor: Kathleen Hughes, ADC,EDU http://www.activitydirector.org At-Your-Own-Pace format available to Start Anytime - Take upto 1yr. 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. Activity Directors are the key to creating environments that we ourselves would be excited to live in. We envision facilities that feel like homes, not institutions. Facilities that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe providing the best education available, with the most talented teachers we can find, 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

New Mandated Patient Driven Payment Model (PDPM) PDPM is one of the initiatives resulting from the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act). In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM) which is the proposed new Medicare payment rule for skilled nursing facilities. This model is intended to replace the current Resource Utilization Group (RUG-IV) system with a completely new way of calculating reimbursement and is slated to go into effect beginning October 1, 2019. Under PDPM, therapy minutes are removed as the basis for payment in favor of resident classifications and anticipated resource needs during the course of a resident’s stay. PDPM assigns every resident a case-mix classification that drives the daily reimbursement rate for that individual. The currently utilized Resource Utilization Group, Version IV (RUG-IV) billing will end on September 30, 2019. PDPM will be a significant shift in how SNFs are paid, and facilities need to start preparing for the change. PDPM: Removes therapy minutes as a determinant of payment and creates a new model where payment is linked to differences in clinical characteristics. Creates a separate payment component for Non-Therapy Ancillaries (NTA), using resident characteristics to predict utilization of these services Focuses on clinically relevant factors and ICD-10 diagnosis codes to determine payment The implementation of PDPM will be one more step towards moving reimbursement for care from volume to value. As payment shifts from therapy focus to clinical characteristics focus, there will need to be more detailed documentation to support the medical condition. Under currently utilized RUGs, there are approximately 20 items on the MDS which impact reimbursement. Under PDPM, there will be approximately 160 items which impact reimbursement. MDS Implications - Patients over Paperwork PDPM emphasizes patients over paperwork, as it eliminates the current (MDS) schedule. MDS assessments will be more streamlined under the PDPM model. Only two required assessments: the five-day assessment and the discharge assessment. The five-day assessment must be completed between: Days one and eight and will be effective for the entire length of stay unless an optional assessment is performed. Each facility may need to revise the systems currently in place to make sure that the information critical to reimbursement is recorded accurately on the five-day assessment. Missing an item on the five-day MDS will impact reimbursement for the entire resident stay. Note: Current 14-day, 30-day, 60-day and 90-day assessments will be discontinued. Discharge assessments will not impact reimbursement―however; this is where therapy notes will be reported. If a resident leaves the facility and is away from the facility for less than three days, then the stay is considered the same admission. If the resident is away for more than three days, the admission is considered a new admission, and the Non-Therapy Ancillaries (NTAs) and therapy payments are returned to day one payment. HINT: NTA’s are a long list of diagnostic categories and clinical support services needed to care for those patients that may be more medically complex or demonstrate a higher acuity. NTA’s are calculated, upon admission, by assessing a patient’s clinical profile. Facilities will have the option to perform an Interim Payment Assessment (IPA) should the resident’s clinical characteristics change. This assessment must be completed within 14 days of the change in characteristics and can affect reimbursement. This assessment is similar to a significant change and will only be used as such. Under PDPM, cognitive testing will become more important. Specifically, the Brief Instrument for Mental Status, or (BIMs) which is completed in order to satisfy Section C: Cognitive Patterns on the Minimum Data Set (MDS) to effectively guide care planning for residents with confusion or a cognitive impairment. Knowing whether a resident has a mild-to-severe cognitive impairment will truly impact: Care planning and the interdisciplinary team’s approach, and SNF revenue – by increasing the Case Mix Index related to the SLP component under PDPM. NOTE: A cognitive impairment requires more resources; thus it will pay more in the new system. The MDS has been an important tool in driving resident care over that last 30 years, and continues to be relied upon for quality data but it has primarily been utilized as an assessment tool to drive the plan of care with little impact to reimbursement. However, with the implementation of PDPM and the shift from therapy-driven reimbursement to clinical characteristics as the basis for reimbursement; the MDS will become vital data to obtaining proper reimbursement. The Activity Department The elimination of 14-day, 30-day, 60-day and 90-day assessments will alleviate some documentation stress and allow all interdisciplinary departments to spend more quality time in resident interactions. However, with this change, the Activity Department will need to spend more time on the daily documentation process. The daily progress notes need to more clearly detail how the resident pursues activity interests and their level of engagement. Surveyors will be looking for more details in this new process, especially with one-to-one documentation. The new PDPM revised reporting is said to fit into a broader push by CMS toward “patient-centered” reimbursement models that more accurately measures and matches payment rates to the residents’ needs. Remember, it is critical for services to be driven by patient need, not administrative or payer mandates. The Nursing Department Under the soon-to-be retired Resource Utilization Group (RUG) system, therapists often dictated a resident’s overall care plan, as their services formed the backbone of Medicare reimbursements. But with therapy no longer driving the reimbursement narrative, nurses will once again return to clinical characteristics of the resident’s individual needs. Nurses may also become individual facilities’ point people for handling the new reimbursement paperwork burdens. Accurately recording residents’ diagnoses and specific medical issues will be vital to receiving the proper compensation for the services — and while experts are split over the exact coding expertise needed to get the job done — front-line nurses and Minimum Data Set (MDS) coordinators will need to be perfect when performing initial assessments. Summary In short, therapy hours will no longer drive reimbursements. Providers will receive Medicare payments based on their patients’ care needs, bringing the focus back on individual residents and away from meeting volume benchmarks. The same story is playing out across the industry to realign incentives around patient characteristics rather than running up the tab on the volume and intensity of services. Resources: https://skillednursingnews.com/2019/03/pdpm-101-what-skilled-nursing-providers-need-to-know-now/ https://avalere.com/insights/strategic-imperatives-for-skilled-nursing-facilities-preparing-for-new-payment-system https://www.ahcancal.org/facility_operations/medicare/Pages/PDPM-Resource-Center.aspx https://electronichealthreporter.com/what-is-the-patient-driven-payment-model-how-skilled-nursing-providers-can-get-ahead-of-pdpm/ https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/MLN_CalL_PDPM_Presentation_508.pdf https://www.berrydunn.com/blog/is-your-revenue-cycle-team-ready-for-medicares-patient-driven-payment-model-pdpm https://www.berrydunn.com/blog/new-patient-driven-payment-model-from-cmswhat-to-expect-and-what-to-do Have a topic request or question for Celeste? ---------------------------------------------------- ENROLL Now --------------------------------------------- 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. --------------------------------------------------------------