bigchris

Trixie, I agree with you on the point that highly active residents can sometimes be difficult to CP. In addition to answering your reply, I am going to elaborate with the monthly CP question on the forum, but first let me adress your question. When I first started in activities, the highly active residents were a Catch 22 for the surveyors ( in GA) when I would introduce a highly active resident, the surveyor would say that I focused on that particular resident and that the others were neglected. Of course this wasn't true...in fact the highly active resident gave me more of a challenge because thier needs were more "sophisticated" from my other (149) SNF residents! I had to be very creative with her and create activities that she enjoyed along with the lower function residents. These included "therapeutic service opportunities" AKA volunteering amongst others. Now with that said. The highly active resident is a common element for those who have larger populations, the reasons that they are in our SNF's vary greatly and most of us have dealt with the highly involved at one time or another. When we care plan for these residents it would be easy to make a laundry list of the 502 things that the resident does in thier day....but wait! With the shift in regs, we can't just keep them busy anymore, we also need to provide benefit!!! AHA, but there is the rub....how do we define benefit??? Here is what I do (disclaimer, it is only a suggestion) WHen I have highly active residents, my tendency is to provide opportunites for them to help others. For instance, my crafters make cards, decor, etc. For those residents who don't have families. They "adopt" 2 or three and do things for them. Then I careplan that portion in addition to the other activities that they do. I also include a small synopsis of thier medical history and whatever interference that the activities may have. If they are benificial/harming. I then put a small snippet in with actual quotes from the resident interview about how they feel (psychosocial wellbeing) when they do for others. And that usually is the care plan. In addition, for those who plan thier day. I ask them to write it down for me, this goes into the chart and provides an example for anyone who wants to know. I do this because several years ago, a surveyor accused me of being a fibber when I told her about an active resident. You can care plan for this if you like, but a simple sentence in your progress notes should be sufficient. I hope this helps, let me know what you think!!!! bigCHRIS

Question from another forum: If Nursing has addressed vision and hearing difficulty, do I need to care plan as well? Yes you do..... To be specific, each department will address the issue as it relates to the services that the specific department provides. In activities, we need to explain what issues and adaptations we will make for the specific resident. For example, lets say that this resident was an avid reader and wants to remain that way, but suffers from Macular Degeneration. CP, may sound like this.... Ms. Smith is a former librarian who prefers reading and other simaler pursuits. Act. Department has provided Books on tape each Monday and Wed, for variety and a magnifier for in room.....etc. Nursing would address thier own area and so do we... Until next time. Chris

Yes you do, for instance if the resident has vision issues related to ADL's then the Nursing staff would address that. Any issues regarding activity participation and the deficit need to come from you, along with an explanation of what alternatives you will offer. BC

Come say hey!!! visit the Care Planning Forum Click Here

Activity Assistant needed in 137 bed facility in Atlanta, GA Area. We are looking for an energetic, creative and customer service focused individual to help develop a growing program. Experience is not the most important aspect of this job, but it is a plus. Must have excellent understanding of the importance of customer service and the senior population. For a more extensive job description, or for further questions please contact Chris at bigchris1974@hotmail.com

Activity Assistant needed in 137 bed facility in Atlanta, GA Area. We are looking for an energetic, creative and customer service focused individual to help develop a growing program. Experience is not the most important aspect of this job, but it is a plus. Must have excellent understanding of the importance of customer service and the senior population. For a more extensive job description, or for further questions please contact Chris at bigchris1974@hotmail.com

I have heard from some of you with your stories about simaler situations. I would like for you to share them here instead of in a sheltered fashion. I think that it would help us all! Chris

I don't want to tick anyone off, but I am going to play a little devil's advocate. I do this as an activity director/consultant/and guy that likes to play devils advocate. I am at a new facility and I am basically bulding fresh. I was challenged ( and still am with 2 ) by a handful of non english speaking residents in the facility. I heard some comments that were not nice to the resident so there was a spark for me to do something. I already new some "basic" spanish so i was OK with that. But I also recruited some volunteers to come in daily and talk with the residents. I am still challenged with Farsi and Vietnamese, but we will get there. I tell that story for this. THe comment that I heard was basically racist about the fact that we had to "deal" with these residents. I got mad. But it also got me thinking.... How would you feel if you were in a foreign place and could not speak???? You couldn't tell anyone that you were hungry or cold or hello??? I talk so much, I would go crazy!!!! What I am trying to say, without getting off track. Is that we should provide for all of the residents, no matter who they are or what thier ability. The regulations and I hope that the surveyors, have this in mind when they ask you about your foreign residents and what you do. I know that it can sometimes be a hassle to change/learn/modify, for one or two people. But we do what we do, and that is part of what we do..... Make sense? BC

I think that this is an issue in every facility at one time or another. My first step in the process is going to the DON and explaining the whole thing. The fact that the regs have shifted is not really the issue. Unless the CNA is helping a resident into/out of the activity or aiding them , it is an issue of courtesy. The DON should handle this... Now, with that said, sometimes it doesn't happen..... I had one CNA that liked to show out for everyone and test the waters. SHe tried this one day when I had some bad mojo, so as I was leading a craft class she came in and told a resident that she had to leave ( the resident wanted to stay)....any way. I got up in front of 25-30 people and said " Attention please!!! Ms. ______ has something important to tell us! " Of course, this put the CNA in her place ( yes I know it was wrong, and I feel really bad, really I do) but I was in a mood and I had it! THe CNA did not interrupt any other activities, in fact none did. BC

I totally feel your pain, I am in a new situation too and I am getting frustrated daily. I am trying to deal with it but it is soooooo negative. Today my assistant resigned so it didn't start well today..... BC

Update- As I re read this post I want to tell you that it is paying off, We have state in the building and they went over my docs!!!! More as I get it. BC

I know that mst of this will be common sense but there were some that were surprised by my response to two of our residents........ Note to those Male AD's- Although I am not as experienced as some, take this post to heart, it may save you someday. All, I have two female residents who are mentally unstable, mainly with male residents and staff. One of the residents whom I will call Ms. A has made numerous claims of being raped by "someone". Yes we have gone through all of the steps, calling the ombudsman, state, and psych. However, by GA state law, EVERY claim needs to be investigated to the fullest. Granted, I have not been investigated but it did raise my awareness and as an educator for the state, I wanted to warn other males. Res. #2- Is desperate for sexual contact regardless of her condition, she is hyper sexual and makes inapropriate comments to male staff. Once again, men be supervigilant of this type of resident for the same reasons!! I say this for simple reasons, I have had residents with dementia, think that I was thier ex-husbands, boyfriends, etc. It broke my heart when one of my residents, thought I was her ABUSIVE ex- husband. A relationship that was caring at one point, was heartbreaking the next. I had to stay away from a person that I had cared for over 4 years. Guys, be safe and use the following safe guards for residents that may have a cognitive shift: 1) Never go into this type of residents room alone. I grab anyone I can get, preferably a higher level nurse or staff member. 2) If there is no one, stay at the threshold of the door until you can find someone. 3) DOCUMENT, DOCUMENT, DOCUMENT. 4) See #3. 5) Add careplan initiatives to provide if you cannot yourself. 6) Do not let your guard down. It will only be trouble. Let me know what you think. Chris

My policy for court ordered community service is very simple, I don' t allow it. My feeling is this. I am in charge of 137 very frail, fragile residents and "most" people who have court ordered service have done something to break the law and there is a chance that they will do it again. That is my feeling, and I stick with it every time someone asks to serve at my facility. I know that there are people who say that those who break the law deserve a second chance, to those I say my residents are my responsibility, if you want ot give a criminal a second chance, take them to your facility. Sorry, but those are my beliefs, I can't risk the safety of the residents.... Big Chris

It is a good idea to be as specific to the resident about thier preferences of activities. WHich activities are more effective and any breakthroughs/declines that the resident has. You should document as much as possible...for example. I progress note for at least 5 residents each day based on what we did that day. I do this because each morning we metion the residents who have issues and I try to see them specifically. According to the new regs, you should have other documentation from other departments based on the activities that they are doing. With this, I have attendance logs for other departments and I debrief with them after the activity. Hope this helps, Chris

Hey ya'll , As some of you may know I am at a new place and I wanted to do something to celebrate National Nursing Home Week. Normally, we have a big party and we cook out. Well, this year, I didn't pick a theme. I am doing a regular homestyle cookout and shin dig for the celebration.... Am I lame? BC

I know that I will hear from the dieticians.... But the new place that I am at has a ton of weight loss so I am going to add some treats to my Bingos as well. I am going to do lollipop bingo and cookie bingo.

There is usually a difference between the Quarterly Note and the Progress Note. In my mind, the Quarterly note is done when the MDS/CarePlan is done. It is a "check up" on the resident every QTR. In my charts, a Progress note is done whenever I notice a decline/progressive step for the resident in conjunction with the programming that I offer. I don't have a set minimum/limit on when and where I do this ( we have a program that adds it to the charting) so if I am doing/not doing something right. It gives the other team members a heads up on my programs. For instance, I had been given a "project" last week. A resident who wandered constantly out of activities and would not stay focused according to the other staff. I took her on and have been making progress, little by little with the help of therapy. We have been working with her and I have been able to have her in 4 consecutive activities for the duration, both small group and large group. So I put this in her chart. It lets the others know that we do change lives. Let me know if I explained it.... BC

Did anyone else notice that I can't type!!!! My buddy littleChris has some good ideas too. He does one with Peppermints as a prize.

Stace, Drop me an e mail and I will give you some tips. I am at a new place and I am also working on the Care Plan section of AD.net. When I hear from you we can talk. Bigchris

In my instance, I am also management so I do pressed slacks and pressed shirt, either long sleeve or golf. And some comfy shoes. It can mean dress or what they call casual sneakers. If you have doubts, I would look at some business web sites for help. If still confused, talk to your administrator. I can say this....in my years as a manager, I can see a definite change in our "outside" customers faces, when they see me dressed nice vs. my work clothes. Hope this helps. bigChris

Kat, can I have a copy of that research paper????? I think it would be a great read! Anyway, pen. I would say that yes....Bingo is a tremendous "social" activity. At my place we talk to each other in between games, we joke and laugh. And we share the win with each other. So I think it would definitely qualify. Pen another thing: As you know I left a conservative facility and came t omy new place . Anyway, my buddy and I (hey littlechris!)have had a running "argument" that Bingo in the NH is not gambling, because the residents do not pay to play.... What do you think???? BC

As some of you know, I have come to a new facility in the hope that I can build a bigger program. Well, I am getting involved and I am realizing that the "Bingo" factor is very big!!! My question is this... I know of about 10 variations of the regular form of Bingo, e.g Peppermint bingo, Auction Bingo, Picture Bingo, etc.... But I wanted to hear if any of you have great ideas about how to offer a change to the rut that my new folks have had for 2 years. Are there any ideas out there? I would like ot know!!! Let me hear it! bigChris

We do one each year, but it serves several purposes. 1) For the residents who may not want to have testing done ( i.e some independent, HUD, etc.) 2) As a marketing tool and a community project and 3) as a fundraiser for activities. I can tell you that in the beginning it was plenty hard to do, but you will learn as you go and become more organized. Now it is a simple process that has big returns. BC

We had a group of officers for our facility until they thinned out and could no longer preside over the hearings. With that, I became the mediator of the group, which is very hard when they talk about your programs! Anyway, the regs do not state that you need to follow Roberts Rules of Order. You simply need a venue for residents to express concerns in a bias free environment. Maybe a Town Hall? Maybe a formal meeting? You will need to decide. I do suggest the following: 1) Have as many staff that are involved present each meeting. 2) Take precise notes/minutes. 3) If possible, keep a lucid/high function on as an advisor/board member/council member. I hope this helps. Bigchris