yunakitty

I have found the biggest thing that will get people to help is helping them. I know I can't help toilet people or that kind of thing, but anything else at all I can do, I do for the nursing staff. Getting people in and out of the dining room, getting tablecloths on the tables, getting bibs on people, fixing people drinks before the trays come out. I also try to keep an eye out for when the nursing staff is really swamped and they have a needy resident calling out. I've been passing by just to make copies but I'll snag the resident and push them along with me, talk to them the whole time and try to give them a little attention. Or I find something for the resident to do. Believe me, the nursing staff notices when you do these kinds of things, and if they have any sense of comraderie you'll notice they'll start to help you out. If not, then you just have to ask them directly. I know it's hard, and I'm really bad at asking for help. But in the past I've worded it like, "Hey, Vanessa, do you think you can get Mrs So and So while I get Mr A and Mr B?" That way, you are subtly pointing out that you're asking them to do just half of what you're doing, not piling more work on them while you do nothing. Make yourself visible and make friends with the staff, so that they will feel that you're one of them and not just "the bingo lady who has it easy and hides in her office all the time." (Yes, we've all been called that!) I know we all have a lot of paperwork to get done, but there is only so much I can do without getting cross eyed, so I step out and see what I can help with for a minute.

You can take them to restaurants but I would highly recommend being very choosy, scoping the place out first, taking as many family volunteers and staff as possible, and warning the restaurant staff first. We are very fortunate: there are two places close nearby that do not use their dining rooms at lunchtime (they serve in the bar/lounge area) but they will let us sit in the dining area. They give us pitchers of tea and water so that we can refill the resident's glasses ourselves. It's a great way to let the residents get out for a change of scenery without disturbing a whole restaurant. Because as much as I love my residents, I am a realist and I acknowledge that not everyone wants to deal with their behaviors and vocalizations. It's rude to just bring them to any old restaurant and plunk them down. The wait staff as well as other diners don't want to deal with it, and it's a dignity issue for some of the residents as well. Plus it could spell disaster to take them into a disruptive, loud environment like a busy restaurant and then have a resident have a meltdown. So please do attempt it, but be careful and take my advice.

Anyone want to help me brainstorm some fun names? They can't be too childish sounding because our home office would have a fit. Our dietary department recently started a fresh snack program and we're killing a bunch of birds with one stone by incorporating it with our morning and afternoon activities (free supplies for us, residents get their snacks, one less thing for nursing to do, and residents LOVE activities with food, so this is awesome!) But I'm running out of good names. Since it's almost every day, I don't want to reuse the same names too much. And the snacks are not consistent, so I can't be specific on that (like French Toast Tuesdays or something). Here's what I have so far: Hydration Station Relaxation & Refreshment Juice Bar Snack & Chat Coffee & News Fun in the Kitchen Kitchen Creations Anything else?

Yes, if anyone has any input, I'd also love to know.

That is an awesome idea! I did this the first year I was here (2007.) I did a different country every month and the whole month was loosely themed around it. Not every single activity was geared towards that country, but we usually had one big party where I dressed up accordingly and had decorations and food from that country, we usually had a few arts and crafts themed to it. And I'd try to find movies from the country, I'd play music from the country and read a story or poems from the country. Let's see, I believe this was the months and countries: July: Italy (no real reason) August: Mexico (no real reason either) September: England (no reason) October: Germany (Oktoberfest!) November: Canada (fall makes me think of maple leaves and syrup) December: France (because there are so many good French pastries to make for Christmas!) January: Australia (Australia day, and then you can have a summer party since it's summer in Australia!) February: China (Chinese New Year) March: Ireland (St Patty's Day) April: Japan (Cherry blossom season) And then I gave it up after that point. I ran out of countries. I think I might pick it up again next year because it's been long enough that everyone who participated has either died or can't remember (that's TERRIBLE, but sadly true.)

Yes, I actually do have a very talented guitarist/singer who plays every other Wednesday. He used to play every Wednesday but budget cuts forced me to reduce his performances (he's $100 a time.) My residents wanted something else musical in place, and since I can't play any other instruments but I can sing, I chose karaoke. They actually really like it and I've convinced girls that sing for fun at my dad's karaoke bar to come in and sing too. They like it because they get way more turns than at the bar and the guys telling them they are pretty are way less sleazy. We do a finishing number where we sing Don't Get Around Much Anymore and then New York, New York, while kicking like Rockettes. It brings down the house! This has become one of my favorite activities! Thanks for the suggestions, everyone! I'll be getting those.

Can you guys help me compile a list of "old timey songs" that the residents will know? Our population is on average about 85, ranging from one 71 year old to a 101 year old. I got a karaoke machine and my father is a karaoke DJ so he has or can get every song ever made, but I don't know what to tell him to get. "Old stuff" is not working, ha! So far, I have: Let Me Call You Sweetheart Bicycle Built for Two/Daisy Don't Get Around Much Anymore New York, New York I know the last two are not really OLD, but they all sing them when our bi-weekly entertainer comes and does them. So I added those. They are a hit and we always end the karaoke session with them, but I need more stuff! Don't get me wrong, I have a lot more songs (about 300) but they are mostly recent stuff from my personal collection and a bunch of country stuff we got for Wild West Month. I also have My Fair Lady and Phantom of the Opera soundtracks, which they love. What do your residents like to sing?

I would say that anyone who went on the last outing is on the "wait list" for the next one. That is, they have to sign up on a separate sheet, and if there are still any openings, then the first people on the wait list get to go.

I get $700 per month, for 6 Memory care, 10 AL, and 15 Skilled nursing residents, so 31 residents. That's $22.50 a month per resident, or 75 cents per person, per day. That sounds like a lot but it's not; because we're an "upscale" for-profit place. So they expect everything to be really high end (no cheesy decorations or crafts). AND, we don't get donations of anything hardly ever because we're not in need. I spend $200 of it a month for two performances by a guitarist/singer who is worth every penny. The rest goes to bingo candy (sugar free is SO expensive!), party supplies and decorations, and the biggest money eater is staff meals on AL outings. We go out to eat 4-7 times a month, and while I do pay for everyone upfront, the resident's meals are charged back to them on their monthly bill. (There is NO way I could afford that, these people drink $10 glasses of wine at lunch and always have to have a dessert! They easily spend $35 on lunch EACH!) BUT, I do have to take my meal and my driver's meal out of my budget. Since we go to kind of ritzy places, that takes a bit of money. Our limit is $15 each at lunch at $25 each at dinner, and we get pretty darn close every time, since these places are pricey and also once you consider tax and 20% tip. So I might spend as much as $200 a month for our meals on outings. Ouch. I don't know anyone could manage on $200 or less a month...I guess you just get by. But I'm also guessing you're a "traditional nursing home" and people's expectations are not sky high like they are here.

Ah, I know just the thing. It's a DVD by Yoga Zone. http://www.amazon.com/Yoga-Zone-Meditation...843&sr=8-24 There are two sessions. The music and narration is really good. http://www.amazon.com/Yoga-Zone-Conditioni...8828&sr=8-4 Also, this DVD is an active yoga one, but the last 10 minutes is meditation and relaxation and it's so good. I used to do it every night before bed (and I probably should start again!) He talks about imagining someone pouring warm oil over your head and shoulders...and his voice is so relaxing...zzzz.... http://www.youtube.com/watch?v=7qeLr6y6pTM I found a clip of it on YouTube.

Another thing that other staff members constantly "don't get" is going on meal outings. I have had so many snide, jealous remarks about my lunch outings. When it gets really bad I offer to take that smart mouthed staff member with me. After their meal has gone cold because they have to escort someone to the bathroom; after they break up the bitter disagreement between two residents ("I ordered that!" "No, it's MY food!"); after they have to do the desperate corralling of ten slightly to severely confused people (who are all different speeds with walking) in one direction, etc, etc; they never make comments about "you get to eat for free, wah wah," any more. Ha! Definitely a taste of what it's like will get people to understand better.

I only take AL residents that can get around by themselves, use the restroom by themselves, etc, on outings where we have to get off the bus. I have bad luck with staff cooperation and volunteers and though I do have family members occasionally "jump on the bus" at the last minute, I can never count on having any help so I limit it to the AL residents. I have about 10 residents on each outing of this type, just me and the driver, so the ratio is 1:5. Now, once a week, my assistant and the driver do scenic drives with all residents being invited, even the lowest functioning Skilled nursing residents as well as memory care. Like they say, even if you're the one driving the bus, I'd have a second staff member to make sure no one tries to stand up, etc. Nursing staff helps load and unload them, and the trip is kept to an hour or under to limit bathroom needs. There are usually about 12 residents and the two staff, so that's 1:6.

Don't quote me on this, as I'm not an expert, but I was a teenage worker. I was allowed to work up to 25 hours a week when I was 16. I remember getting a work permit from the school board which proved I was still attending class or whatever. I don't see why it would be anything as little as 10 hours. If she was 14, maybe. But 16 should be able to work quite a bit, as long as it's evenings and weekends.

I don't think you have to worry about charting for independent residents. We are a continuing care facility, and my counterpart in the independent side (called the "Resident Services Director") does not chart anything for them. I believe she keeps track of participation as in, "14 people went on the museum outing," "35 people came to Casino night," etc. And as for the poster who said they were stumped as to how to write progress notes, I'll give you an example. Here's one, word for word, that I wrote on one of my Skilled residents who is mobile and participates in AL activities. --- Res. is very active in activities. Attends AL walking club and exercise almost daily, and also likes bingo, music, games, and social events. Very forgetful and easily flustered, but very pleasant and cooperative. Goes out with wife approx 5x a week, and they also attend AL outings 3-4x a month. Res. may become agitated and restless when he is worried about something upcoming; staff reassures him that he is not late, and directs him to his calendar and clock to see how much longer he has. This may need to be repeated often. Res. is content with current level of activities. --- I think anyone reading that would get a good snapshot of what he's like, and how to approach him. Does that help? As for progress notes, I write them on each monthly attendance log, like a monthly summary and review, then put it in the chart; unless there is a major change or issue, and I write that in the chart immediately. For example, here's what I wrote when we had a problem with a resident on outings. -- Today res. became very agitated and disruptive on scenic drive outing. Began cursing at other residents and chanting constantly. The disruptive behavior is normal for her, and has been seen at other activities and outings, but this was extremely hard on the other residents. Res. will not be taken on group outings for the sake of the other residents. Res. has two private sitters that take her out for coffee, lunch, and drives about 3-4x a week, so res. is still able to get out of the building frequently. Will possibly attempt another group outing in the future if resident's behavior improves at other activities. -- (Side note: It hasn't. She is the thorn in my side, constantly chanting God help us and snapping at other residents during activities. But her sitters bring her to everything, and it's a battle to get her removed without compromising her dignity. What a struggle.)

Thanks for all the input, guys. As for the dangerous power chair resident, I had brought it up at morning meetings, and other staff had seen it, but the family didn't want her to lose her freedom - well, she ran over her foot and broke it. She's now in a standard chair. Which causes a new problem because she is 250 lbs and hard to push. Bleh, it never gets easier. I've put a freeze on trying to take skilled and memory residents on "get off the bus" outings for a while; as the one I planned and let the DON and admin know about 4 weeks ahead of time, then reminded several times before, it came down to time to go and I had no help. A PCA was called at home and convinced to come in to help, but the DON made a big deal about how much it would cost, etc, and it was such a nightmare. At any rate, I am very lucky because my new assistant expressed interest in doing "don't get off the bus" outings on Thursdays. (That's one of my days off.) That's a doctor's appt day, but the main driver will be doing those in the minivan, and our part time driver will come in for 3 hours in the afternoon to take residents out in the bus. So, this appeases many people. Now, Mondays are exclusively for taking them to lunch, dinner, or shopping. Thursdays are for Skilled and Memory care (and AL can get on too if they want); just scenic drives, stopping for ice cream and eating it on the bus, etc. So now there is an outing for EVERYONE once a week, and my AL residents don't have to miss out on their weekly outings either. Since we have a picnic on a Wednesday and our standing Wednesday reservation at their fave restaurant that is closed on Mondays, AL has TEN outings this month! But as for the other, I'm trying to get better about asking for what I need explicitly, and holding people to it instead of trying to be Mrs. Nice A.D. and back off "oh, it's okay, no big deal, we'll manage" when people flake out on me. It's just hard because sometimes it feels like no one takes me seriously because I'm "just the bingo lady" and I'm not as important as other disciplines.

We are also in the process of culture change (thought we were already a Person-centered care facility, now we're just working toward it correctly) and I adopted two cats this past week to live on the Memory care unit. I talked to the residents and most of the staff beforehand and they were fine with it - so the cats moved in, and the residents love them - except this one lady who suddenly says she's allergic, and the 3-11 PCA also claims to be allergic and made me shut them up in an empty room (with food, water, and litterbox, of course.) I left a note for the 11-7 PCA to take them out, but when I got here at 8am, they were still locked up...argh... We are trying to work through this for the sake of the residents... Any advice? The things is, I don't think these people are really allergic. I don't see any sneezing, watery eyes, etc. My husband is horribly allergic to cats and you know right away - he gets a kind of red rash on his neck, his eyes and nose run, and he sneezes and coughs constantly. I'm mildly allergic, but taking Claritin year round for my pollen allergies seems to eliminate most of the problem. Not seeing any symptoms in these people. I just feel like they're claiming that because they don't want to have to deal with them or are afraid - which is ridiculous because they are the sweetest, calmest cats I've ever seen, and I don't ask anything of other staff - I have been checking the litterbox 5-6 times a day and cleaning it, I manage their food and water, I brush them...all they have to do is make sure they don't step on them...the cats don't even approach people they can tell aren't interested. People just want to be a problem sometimes...

And I think everyone needs to remember that not every resident needs 1:1 visits. We have several residents that have family and friends in and out constantly (yeah, I know, what a blessing; there are others that family has NEVER been by in two years.) It was demanded of me by a former DON that I spend 15 minutes with every resident EVERY day. We only had 9 residents at the time, but even with that, 9x15 is 135 or just over two hours, not counting travel time in between each resident and considering the time for reattempts if the resident is not available - that was impossible for me to squeeze in between 2 hours of activities in the AM and 2 in the PM, with set up and meetings and paperwork...you get my drift. You're all in the same boat. Anyway, I'm so glad she's not the DON now that we have 20+ residents in 3 units. I do 1:1's for my ones that don't respond well to group activities and don't have visitors, as well as a couple that just really like me. So that's 1 on memory care, 3 on Skilled, and 2 on AL. I count the visits we make with the therapy dog as well. There is one resident that I get about an hour in with - in 3 minute snippets throughout the week! Hey, whatever works.

Well, I don't know if there is anything in particular you need help with or just random suggestions, so I'll just go with random! My assisted living residents really love "Happy Hour" which is on Monday evenings at 5:15 (dinner is at 6pm.) I get a big bottle of white zinfandel from the kitchen, a tray of cheese, crackers and fruit, as well as some sodas for the non drinkers. That is probably their fave activity of the week. They love socializing and snacking. I try to keep the conversation going if it stalls, asking people about their colleges, where they grew up, etc. Everyone loves to talk about themselves! Also, we have Walking Club every day at 10 am. I have 4 people that always participate in this every day. I follow it with an exercise class three days a week. We have bingo three days a week, we do arts and crafts once or twice a week. I have found that they like stuff with a purpose much better than just painting paper - ie, painting small flowerpots, little wooden boxes (you can get these for $1 at Michael's) or even painting cut out wooden shapes that I then hot glue to thumbtacks and stick on my bulletin board.

We had a Wii Tournament with kids from the local elementary school today. It was really lively and noisy but worth it! The kids were split into teams, playing the Big Brain Academy Mind Sprint, and one kid would hold the remote while the others called out answers. The residents really weren't quick enough to answer along with them, but they really enjoyed seeing the kids having so much fun!

Thank you for this; I will pass it along to my dog lady.

I've used the Wii a lot with varying success. The best thing I've found is Big Brain Academy, which was actually purchased for the independent living residents and they didn't really care for it. There are two games that are really great on there - Fast Focus and Speed Sorting (I think they are called.) You can get to them in the practice area; one is under Analyze and one is under Visualize. Fast Focus is a picture of an animal that appears out of focus or fragmented, and it slowly becomes visible. For both games, I operate the remote and let them say what they think it is there (there is multiple choice underneath). At first, they have trouble, but they slowly get the hang of it. There are 3 skill levels that I move up through as they get better at it. It's really adorable what some residents say (my favorite little lady said, "Hmmm...he looks...tigerish" of a tiger.) The Speed Sorting one shows four pictures, and then a question or label; like there will be a picture of a frog, a flower, a bird, and a camera, and the thing is "Plant Matter." So you'd pick the flower. There are also three skill levels to this, which eventually includes things like "Largest", "Smallest" "Second Largest", "Fastest", "Second Slowest" etc. They really like that one, but not quite as much as Fast Focus. The speech therapist absolutely loved that my Alzheimer's residents were playing it - she said it was great for cognition. I keep the Wii set up in the Memory Care unit now and there is a PCA who loves to play it with them. I borrow the Wii out of there a few times a week for the other units, but it's great for in there because they will play it for hours, and it's a game where they can't lose the pieces! As for the Wii Fit, I have one at home too, and I've considered bringing it in for my AL residents to try. They are all ambulatory and have moderately good balance (considering that they are 80-90.) I'll let you know how that goes. Another thing I want to try is racing. Anyone know a good game they might be able to do? Seems like if I bought the steering wheel, they would be able to understand how it worked.

I'm not sure what to do here for Father's Day. I only have 10 male residents on all units combined (3 on AL, 7 on Skilled) and they're wildly varying functioning levels, awareness levels, and interests. At least with women, a tea party is liked by 95%. But it's harder with men. I don't really have the budget or help to do anything big like a cookout....I'm still thinking.

Wow, those are some great ideas! Thank you for sharing!

I also had a Mother's Day Tea Party (two, in fact; one at 2pm for Skilled and Memory care, and one at 3:30 pm for AL.) They were also a big hit. It's amazing what a difference a tablecloth and vase of flowers will do! I need to get my own tea set though. We always just use coffee cups from the dining department, but I think tea cups would make it fancier. I had a tea party on Easter that was really successful as well. Tea parties never fail, it seems!

I need some advice about managing multiple areas and calendars. We have a memory care unit (3 residents currently), Assisted Living (6 residents currently) and a Skilled unit (13 residents currently.) I know it seems like it would be extremely easy to manage with such a small population, but it's actually rather difficult. With a lot of people, you would have more overlaps in interest, and actually, say, have enough people into knitting or bridge or whatever to make a group. I tend to have one person really into one thing, and the next person really into something different, etc. Well, my main problem comes from not knowing which activities to put on more than one calendar...see, for example, I have musical entertainment twice a month, which occurs on the AL unit for space reasons. I put it on the Skilled and Memory care calendars as well, and go get interested people and bring them up, or have a PCA bring them up. Also, I have things like Crossword Challenge and Wii Games in the Skilled unit, but I put that on the AL and Memory calendars as well, in case any of them might be interested. I do outings every Monday (and occasionally Wed if I get the driver), and most of the time they are "AL only" because they are lunch and dinner outings. My skilled outings are things like scenic drives with maybe ice cream from somewhere, because I don't get any help on these outings (believe me, I've tried to ask and plan in advance, but the DON always flakes out on me and at the last minute can't spare any staff to go) and I can't possibly unload several people in and out of the bus and into their wheelchairs all by myself. ( I am 5'2", 110 lbs, and I have two injured shoulders from a previous job.) Plus they can't feed themselves, and not only is that a logistical problem, it makes the AL residents, who are relatively "with it", uncomfortable to be grouped together with lower functioning people. The AL residents have told me this. Well, anyway...there are a few select people from Skilled and Memory that I invite on these outings. The one from Memory is a former resident of AL - very confused, but can "fake it" well enough to get along on an outing. One of the ones from Skilled is a man who really belongs on Memory, and he's just like that Memory resident. Ambulatory, can feed himself, can follow and remember simple instructions, etc. There is another Skilled resident, a man in a power scooter who is mostly independently active with his wife, who is an IL resident. He is totally "with it" and I allow him to come when he's interested, as we can take him in his power chair on the bus. I don't put the food outings on the Skilled calendar though, because I have a few aggressive personal sitters who will try to force their resident on me (people who cannot feed themselves, and one woman is totally disruptive to activities - chants loudly over and over and snaps at people) OR there is this one resident who is in a power chair, but really shouldn't be, because she runs over everything, into walls, her own feet, etc, and she can read the calendar and has been waiting in the lobby to go on scenic drives, which is fine, but if I put the lunch outings on the Skilled calendar for the benefit of the two residents that go, she would definitely read them and be ready to go. I cannot take her, because she's a danger to herself and others. It is hard enough to manage a group of 6 or 7 ambulatory residents when one walks extremely slow with a walker and another walks extremely fast and has a 1 minute memory...she will run ahead and go in the restaurant, then forget why she's there and order a table for one. Very hard to keep these outings from turning chaotic, even without extra problems. But anyway...I get flak from the other staff about not having these outings (and other activities like Walking Club) on the Skilled calendar so that the people that are appropriate can go, and also so that the Skilled staff will know what's going on and will have the resident ready. As it is, like I've said, I tell the resident individually and remind staff that morning that we are going. I've been the AD here for two years, but this is my first time being an activity director, or even working in long term care. So I have no idea what the norm is, and if I'm "doing it right." Please give me some insight as to how you handle multiple calendars and multiple functioning levels.