yunakitty

Have you ever tried tossing a balloon around with them? I was pleasantly surprised that even my lowest functioning people could do that. The balloon is so light that even the weakest, most arthritic hands can make it move. And some residents who don't perk up for anything else will suddenly come alive when that bright yellow balloon lands in their lap. I've had more fun giggling sessions with them than I ever thought possible. I've found this is a great thing to bring this Assisted Living resident along with me to. She's pretty confused most of the time, but loves other people and always wants to help, so she makes a great person to sit in the circle across from me and keep the balloon moving. You can put on some fun, upbeat music too. Also, I do aromatherapy hand massages in the afternoons to service my lower functioning residents. I use lavender vanilla hand cream from Bath and Body Works, and just gently rub it into their hands while talking about how good it smells and what it is they're smelling. Hope that helps!

Wow...I didn't know you could get tagged for activities being interrupted. This is a constant problem for me. PT comes in and takes people (he's always really apologetic about it and asks if it's OK, but I almost always say yes because I know he has trouble getting their hours in because people nap so much here), housekeeping vacuums, staff and visitors talk and laugh extremely loudly in the next room....and on and on. I don't have an activity room; they apparently didn't think it was necessary in the floor plan, so I hold activities in the living room or the "country kitchen", but they're both very open and near areas where people get loud. It's funny, because actually today, I was trying to do Crosswords with the residents, and the nurse was yelling back and forth with a private sitter; they were laughing, howling, etc. Coupling with that, the housekeeper was running the vacuum right outside the room. I finally yelled, "Can y'all be quiet?! I'm trying to do an activity here," and immediately laughed it off; but it worked. They quieted down, and no feelings were hurt (I think.)

I know this was a while back, but I thought I'd tell you how it worked out... I do the makeup now. I have my makeup in a cute Vera Bradley messenger bag type thing, and I take it around with me. Sometimes I'm able to get everyone in one swoop; other times I can't and I have to go back later. (I drew someone's eyebrows on right before dinner last night, because I couldn't get them at any other time.) But it's a 1:1 activity, not group. Some days, the aides put makeup on them before I can get to them...if it's really bad, I discreetly wipe it off and start over. The staff now says that you can tell I'm on vacation, because no one has any eyebrows. Ha ha ha! I do get what every one was saying about the residents coming first and not to say "It's not my job." I totally understand that and I'm not that kind of employee. It was just that DON, she was always trying to push the envelope and aggravate me. Telling me I needed to toilet people, feed people, etc. But knowing her, she would have had me working as a CNA the next thing I knew ("But we're totally short! The residents will DIE if you don't help." etc) She was very reactionary. Yes, I say was, because she was fired in July. Everyone got tired of her craziness. We've since had 4 DON's come through...this current one is working out OK, and never asks me for cuckoo things. Thanks for all your suggestions! Oh yes, and I have one comment/question. How do you do face masks on residents? I know that I make a mess myself when I try to wash those things off in the sink at home...how do you get residents that are stiff to bend over the sink to wash them off? That's my only wonder.

When writing in the topic about Bingo prizes, I started thinking about a question I've had. I have a lovely little lady with dementia. She's super pleasant and ambulatory. The only thing she really does that you can tell she's different is that she switches up words and says things out of sequence. Even though she's a Skilled Nursing resident now, I still take her on Assisted Living outings like dinners, because she's still totally appropriate for those things. This lady never misses an activity, unless she's out with family or at PT. She sleeps like a normal person, at night, and she's up all day and seldom naps. She's a delight to have at exercise (she can spike a balloon like nobody's business), fun at parties, always wants to help me set up and clean up, etc. However, there is one activity that I cannot have her at, and that is bingo. She talks. I'll say I-26, and she'll start reading her card loudly. "I-23, I-22, I-16, I-19, I-30, but no I-26." Or I'll call a number and she'll read a totally different number back as a question. It aggravates some of the other residents, as well as it slows down the game terribly. I've tried sitting right next to her so I can discreetly shush her. I've explained to her that she can't say anything during the game, because it confuses people, and that only I can talk. She'll say, "I know, but..." and babble about how her card doesn't have the number. And yes, I explain the game to her every time before we start = "I'm going to call random numbers. You won't have every number that I say. If you do have them on your card, you cover them up like so. If you don't, just wait and listen for the next number." I've explained how the numbers go under the letters. I've tried everything. But nothing stops the talking for more than a minute. It's just gotten to the point that I have to not bring her to bingo. Which is extremely difficult, because as I said, she's always out in the commons areas waiting for something to do. I have to take other residents right in front of her, and just not make eye contact with her or she'll get up and follow me. (She follows me around as it is, but I don't mind because she's so sweet.) And then I have nurses that bring her in halfway through the game, chiding me "You forgot Miss X!" I have to get up and whisper in their ear that she disturbs bingo, and they're always in disbelief, but they take her away nonetheless. But I feel bad, because this lady does not forget...she gets mixed up, but last month I was out for four days, and before I left I told her my sister was flying in that day from Holland. When I got back, the first thing she said to me was, "How was your sister's flight from Holland?" So I have a feeling that she's going to figure out she's being excluded. What do you guys do about pleasantly disruptive residents? Is exclusion the right answer? I feel like I'm making the best decision possible, because if she is there, she drags down the game for everyone else and even agitates our die hard bingo player, who is a chanter and a cusser when agitated. (She's told her, "Goddamn it X, you're a disgrace." to which Miss X, bless her heart, said, "I know, but I just can't figure out this card" in her perfectly refined New England accent. She is a sweetheart, through and through.) And any time I do exclude a resident, I make sure to do a 1:1 with them later (like I have people who can't come to the baking activities because they can't eat, and I feel like it's cruel to make them sit there and stare while everyone else eats cookies.) I'm definitely making it up to Miss X, because she attends every other activity and often sits in my office looking through my photo albums while I do paperwork. But I didn't know if you guys had strategies for "bingo talkers."

Ahhh...the people who win candy, eat it, and then whine 10 minutes later that they never get any...that's why I let them leave their wrappers right by the card. I point that out to them, and they stop whining. For at least 10 minutes anyway. I personally give out candy. Two pieces per win. Hershey's kisses, mini Reese's cups, peppermints, etc. I have to keep sugar free things too because I've got a couple of diabetics. Because the sugar free stuff is so expensive, I probably spend about $20 a month just for bingo candy. But we do play 1 hour 4 days a week, so it adds up. The killer is this one former resident who now lives in IL (she was here for short term rehab in July) comes over to play, and if she wins, she says "Everybody gets a piece!" I have a hard time telling her no (she's really pushy) so I end up giving away a ton of candy. Sigh. I haven't had many complaints about the candy. I've been the only director of this activity program since the place opened two years ago, so fortunately I'm not stepping in some one else's shoes. I should also point out I'm talking about Assisted Living and Skilled bingo. Independent Living has bingo once a week, and they pay to play, and win money back. My bingo is free (my residents don't keep money anyway.) I've only had whiny suggestions from private sitters. See, our place is pretty posh - all the residents are very wealthy - and a lot of them have private sitters paid for by the family. They crowd up the game...and not always to help their client play...but that's another gripe. Anyway, one was saying I needed to have Dollar General prizes...corporate would NOT let me do something like that. I can hear them now "It's not Marsh's Edge quality." Our residents have everything they need; almost all have active family that come to visit and bring toiletries, etc, or even in some cases I've bought a specific thing a resident wanted while out, and accounting billed it back to them. So they have no need for lotions and tissues. That's great in places where the residents would go without otherwise. I almost wish sometimes that I did have residents who were more needy - it's hard to give them anything they would want. So I stick to the candy. Everybody loves candy, as long as it's good quality candy.

I agree with this reasoning. I go by the 6 hour standard. Almost all of my residents are "Some." It's questionable whether or not to count time sitting in the living room and the TV is on, because they may or may not be watching it, even if they are looking at it. That's the biggest thing I struggle over when tabulating that time in my head...but when in doubt, veer towards Some, because "Most" can throw up a flag in some cases - they wonder if the person is overstimulated.

The position has been filled! Thank you!

This came up in discussion in our morning clinical meeting, and I thought I'd throw it out here and see how other AD's handle it. I currently don't have any volunteers that come by themselves; all my volunteers are like pet therapy dog owners who I walk around and join in the visit, or school kids that come and sing or do activities with the residents, with me there. We already established that when I get some that want to do things when I'm not there, they will have to go through a background check. My ED wanted to know if they needed to have PPD's done. The DON had no idea, and we are currently without a HA, so we couldn't ask her. But then this started a big discussion of why a sporadic volunteer would have to have all that done; family members don't. The social worker said that it was different; family members are known to the residents and the residents are willing to take that risk that they are TB positive or a criminal, or whatever. But the ED countered that family members of Mrs. X often sit at the dining table with Mrs. Y there, and Mrs. Y didn't invite them nor is she willing to take a risk. We're just really unsure of where to draw the line. Obviously, we're not wanting to PPD every family member that comes in; but we're wondering if it's necessary to do that for volunteers that might come a couple of times only. I'm afraid of scaring them off by requiring all that stuff, if it's not 100% necessary. I have a hard enough time getting any volunteers - we are on the farthest end of an island; we have a rep in the community for being a lah de dah wealthy place, so no one wants to give their time to us; they'd rather donate their time to struggling nursing homes. Which I totally understand, but the new company that bought us out last year (Senior Living) has cut my budget drastically. They made me cut most of my paid entertainment but are putting a lot of heat on me to have this jam packed calendar and to get more volunteers. I'm struggling as it is, it's just me in my department, and the Resident Services assistant comes over and covers my two days off every week. They keep telling me I need to get more volunteers, but I'm sort of at a loss since everything I try comes up with nothing. I can get school bands in to perform, but that's about it...I need people that want to come in a lead a bingo game in the evening, or that sort of thing... Honestly, I'm not even sure what I'm looking for or what to ask of volunteers, if and when I get any. I've been in this position for 2 years, but we had a tiny residency for most of it, so it was no big deal for me to handle it all. But now we're getting more and more people (thanks to our great new marketing director) and I know I need "volunteers" but I don't know what to ask them to do. I'm afraid to ask too much or ask something weird and lose them. What do your volunteers come in and do? Sorry if this is a really dumb question, but I'm floundering here. I'm just used to doing everything myself.

This is an especially good point. I came from working in a pharmacy before, so I didn't have many dressy work clothes, and didn't have the budget to go out and buy a whole new wardrobe right from the start. But I've slowly acquired a nice assortment of professional looking outfits (thank you, petites department at JC Penneys! Affordable and nice looking!) Anyway, the point is, I've noticed that I get a lot more respect these days, and although part of it is because I've been at it almost two years now and I'm not the same scared girl as I was, I do believe that clothes make a big difference. Not just when it comes to coworkers, but from family, volunteers, and even residents. I keep aprons for covering up my clothes when we paint and such, and I wear khakis and polo shirts for outings where I'm really going to be moving, but the rest of the time, I wear dress slacks, nice blouses, tailored suit jackets, and pearls. Yeah, maybe I look silly doing exercise with them, but I know to plan to wear blouses with a little stretch and breathability on the days when we do exercise! Our facility is "upscale" so we're strongly encouraged to dress this way. Anyway, when I've met other activity directors, they look a little messy. I'm sure not all are, but you have to hold yourself and dress yourself like you believe that you are "somebody" to the facility. Though I hide behind "I'm just the bingo lady" when I have a troublesome family member nagging me to "use my sway" to get something done the way they want it, I know that I'm not just the bingo lady. Other staff members often say, "Well, she knows the residents better than anyone, so..." when it comes to a discussion on how something should be done or something being changed, etc. It's nice that they say that - and I back it up by always being out there, having that face time with the residents. I do know the residents better than anyone (sometimes better than their own kids!) And that should be true of an AD. But that's a really good self evaluation checklist you've made. I see a couple of things that I could improve on (being aware of other regulations.)

Ooh, that's some pretty touchy stuff. I'm dealing with a difficult resident right now too. I try to redirect her attention onto helping other residents. Doesn't always work, and sometimes she just annoys them as much as she annoys me . Still, it's worth a try. Also, consider shutting and locking your office when you have planning to do, if possible. I personally do not have a lock on my office door (there is a mechanical room that can only be accessed from my office, great planning there!) but I still shut the door when I have work to do. Keeps the visitors down a lot as they assume I'm out. People sometimes still turn the knob and come in, and then I'm out of luck. Though my unwelcome visitors are mostly staff wanting to chat. I do have residents come down the hall looking for me, but very infrequently, and you can always not answer when they knock. Hope that helps.

Unfortunately, I've had the same experience as bluesnowwhite. There is too much complex button play for my residents to handle. I only have very elderly residents (85+), and almost everyone is either too low of cognition to get it or too cramped up with arthritis. The baseball works because they just have to move the remote. Sadly, we usually end games in a tie of 0-0, but at least the game moves. It took me over an hour to play one game of bowling with one resident, because it was so hard for her to get the hang of releasing the button on the back. And on top of that, every time you mess it up, you have to press the A button to try again. So that confused her more! I think it's a wonderful thing, and I continue to to it twice a week in the hopes that they will get it, but so far it's pretty frustrating.

1. Does your facility involve live musical entertainment in its activities programs? ----Yes, a weekly guitarist for 1 hour, and an every other week pianist for 30 minutes 2. If not, is there a specific reason...would you consider using live musical entertainment? ----N/A 3. If you utilize live musical entertainment, do you use volunteers only, paid entertainers or both? ----Paid - $100 each time for the guitarist, and the pianist is already paid $150 each week to come for the IL side, he just splits it every other week and comes to us first 4. Are there any specific types of music your clients especially enjoy? ----Anything they can sing along to. I have to admit that I don't recognize a lot of the songs, but the residents do, and that's what matters. The guitarist plays a lot of old folk songs (I recognize Harvest Moon and Mr. Bojangles) and the pianist plays more classic stuff like New York, New York, The Girl From Ipanema, etc 5. Are there any specific songs you think musicians should have in their repetoire? ----I think it's a good idea to know a lot of holiday songs. We asked our guitarist to try to focus on that all through December, and while he did play a couple of seasonal songs each time, he stuck to his regular set for the most part, which was disappointing. 6. Is there anything you wish musicians would do (or not do) when they perform at your facility? ----OK, this is a big one for me. We are actually getting ready to fire the guitarist. He is so rude. Yes, he is talented, and yes, the residents like him, but he is so full of himself. He doesn't want anyone to talk or get up or do anything while he is performing. The problem is that um, hello, we're a retirement community, residents need stuff in the middle of the show, or you have to explain to a resident what's going on when they suddenly go "Where am I? I need to pick up my kids." Also, his performances are weekly "cocktail parties" - we started calling them that because we tried having a open bar at first, but the residents are really not interested in it. So we have sodas and a fruit and cheese tray done very fancy. Well, they all want something to eat, and some of them need help eating, like they can pick food up and put it in their mouth OK, but the glass is too heavy to hold, so I need to go over every few minutes to each one that needs assistance and lift the glass up to them so they can drink out of the straw. He acts so irritated when I do those things, and he's even said rude things before. (Oh yes, and I would bring the residents to the room early and feed them first, but he comes 30 minutes early to tune up and practice, and I don't feel right making them sit there during the whole show with the refreshment table just gleaming at them "You can't have any.") Anyway, one time during a performance, a new resident had come in that day, and I hadn't met him yet. He was walking the hall right then, and I got up and went over to him (out of the actual room, but still close) and introduced myself and we talked. When the guitarist finished the song, he came over and said "Um, the show is over here, we all really need to save our visiting for afterwards" or something like that. I was really new then, so I didn't call him out on it. At the Halloween show, we were behind the counter (behind him) at the sink, discussing how to thicken a Coca-Cola for a resident on thickened liquids. We were talking in low voices. When he finished the song, he turned to us and said "That was a really wonderful song. You could have enjoyed it if you hadn't been talking" and then he went right into another song. We were just stunned, but again, let it pass. But recently, he was rude in front of my assistant when I wasn't there (I'm usually not there - I have him come every Friday, which is one of my off days, because I can't stand him), and she told the Resident Services Director about it, and so she asked me if he is like this and I had to tell her yes. What he did this time was a resident had a visitor arrive during the show. This resident always sits near the doorway, and she and the visitor greeted each other and talked quietly for a moment because they hadn't seen each other in a long time. The guitarist stopped his song and said "You two need to do your visiting in the other room, OK?" That was the final straw. We're now looking for another performer to replace him. He was fired from Sea Island for similar behavior, which we knew when we hired him, but it was OK at first. So yeah, what I don't like entertainers to do is be too full of themselves. 7. Any other thoughts, ideas or comments? ----It's a good idea to meet with the AD before your first performance (or even for a minute before each performance) when no residents are around to learn about any resident quirks. I had to explain to them that one resident chants "Right right right" and "God Help Us" over and over, but that's just her thing, and she does like to sing along, so if you keep the songs coming, it minimizes how much she can chant. I have another resident with hx of CVA and Parkinsons who is mute for the most part, but will start screaming out of the blue. That's the kind of thing that's good to know ahead of time. Otherwise, you'd be all, "Oh my god, what's wrong? Should we call an ambulance?!?" when the resident is totally fine.

My DON (who always is dreaming up stuff for me to do) is being really insistent about me starting a daily "Grooming class" for AL. She says that all nursing homes do this, and that it's the activities staff that does it, not nurses. This is the first time I've worked in long term care, but my boss has been at it for 10+ years and says she hasn't heard of that. Basically, she wants me to get the three ladies that live upstairs together every morning and put on all their makeup for them. Couple of problems there...first of all, that's personal care, so it's the nurse's job to assist them. If they even need help, which they all can do it themselves with occasional coaching. I have put makeup on residents before, but it was when we were about to go out for lunch and they needed a little fixing up and ASKED me for help. But I can't have a class at a certain time EVERY single day to do this. Secondly, we are a person-centered care place, so they get up at all hours -sometimes at 7am, sometimes not until 2pm! I can't be on hand to do their makeup whenever they get up! We have a very small population because we're fairly new (5 in AL, 7 in clinical) so it's just me over here. I work Sat-Wed and our Activity assistant, who is part time and we share (my boss is the Resident Services Director for independent living, and I'm the AD for healthcare) comes over on Thursday and Friday to do my program for me. If we had a larger population, say 50 people, I might have an assistant working with me most days, and she could do that for the ladies while I set up to do the normal morning activity for everyone, like exercise or watercolors. I just don't have enough residents to have more than one morning and one afternoon activity, and I can't do this "grooming class" as the only morning activity for AL, since that's not fair to the two guys that live up there. This is all stemming from a very vocal and very unhappy daughter of one of the residents. She has extremely high, unreasonable standards for her mother. She has screamed at staff and flipped out because we sent her mother out with a shirt with a stain on it (like a tiny dot!) and when her mother's makeup isn't done to her standard (never mind that her makeup is old and not the right tones for her, and we've asked her to get new stuff but she doesn't, she thinks we ought to wave our magic wands and make it work.) The thing is, this is not going to satisfy her, because nothing will. She is just a very miserable person and she is guilty about "putting her mother in a home" so she takes it out on us in anyway she can. For the record, this resident always looks great: very cute outfits, lipstick on, hair done twice a week, and she participates in so much; and even goes on independent outings! (She moved from over there 6 months ago.) I do have some facials, makeovers, and manicures activities planned throughout this month in response, but the DON pulled my boss aside yesterday and complained that she had told me to start a grooming class and that I hadn't, and that when she asks me to do anything, I just look at her. (That's because she's not my boss, so I don't have to do what she says, and she is very argumentative, and I don't want to start an argument with her in the morning meeting, so I just say something non-committal and move on.) But see, my activities are fun stuff. We're going to try different facial products and sample new things. A grooming class is very run of the mill ADL's, not fun, which is what I feel activities should be. So, am I just being ridiculous? Do you guys do grooming classes? My boss says not to do it, and I'm not going to, but I'd just like to hear what you guys have to say.

Well, I may not be the best to give advice, as I'm in a continuing care facility and I only have 10 people (6 AL, 4 Clinical) to do activities for. But, since no one else has said anything yet, I guess something is better than nothing. Do you have any assistants? That will make a big difference. To start, you need to look over your resident's interest assessments. Whoever you replaced, if you're lucky, kept files and you'll already have copies of these. If not, look in their charts under activities; if you still can't find them, then you'll have to get the info yourself either from other areas of the chart (social services, admissions) or interview the residents yourself. The kind of activities to have varies wildly depending on your population. You have to do what they want to do. Your standard senior population is going to want bingo, arts and crafts, baking, mild exercise, musical activities, movies, gardening, and games. But, you may find that your particular population likes dancing or something else. You have to provide at least 1 morning and 1 afternoon activity, with some evening and weekend. If you are truly the only one, obviously you can't be there 7 days a week. So, the two days you are not there, you can plan activities that the nurses can easily implement, or self-directed activities. For example, leaving a movie with the nurse on Friday with a post-it note "Play at 1:30 pm Saturday, movie matinee" Ask the nurses to try to round up people who want to watch, or to just remind people at lunch that a movie will be playing at 1:30pm. Other things to do are "sunshine visits" ie the nurses offer to take them to sit outside for a while. Good luck getting nurses to cooperate with you (they feel overwhelmed already and may balk at being asked to do extra) but under F248, activities are the responsibility of the entire facility. You just have to plan, set up, and supply. You could also set up painting materials on Friday afternoon, and put "Creative Painting" on the calendar for Saturday morning. Obviously, there are a lot of residents who need direct assistance with things like that, so those kind of activities mostly work with AL type residents. Which is why it's best to have at least 2 people on the activities staff so that someone is there every day. I'm not sure how many floors you have to do activities on, but since I'm sure that you can't do activities for 70 people at once, let's use a three floor model. You could have morning exercise at 9am on 1st floor, 9:45am on 2nd floor, and 10:30am on 3rd floor. Do exercise for 30 min each place, and you have 15 min in between each one to set up and get people together. You may have to adjust that time to more if you don't have good nurse support. You will really really have to plead for nurses to ask residents themselves if they want to go to exercise, and then take them to the room at the time the activity is. Because there is no way you can ask and transport that many people. Then, in the afternoon, you could have bingo at 1pm on 1st floor, 2pm on 2nd, and 3pm on 3rd. By doing this, you'll have your "bare bones" requirements. However, if you do have other staff, you can flesh out the calendar with other activities. Say you have 2 assistants, then each one of you could stay on a floor and have the schedule: 9am Exercise 9:45 am Arts and Crafts 10:30 am Sing A Long If you want each staff member to stick to one activity, then you could have Mrs. A teach Exercise, Mrs. B teach Arts and Crafts, and yourself lead the sing-a-long, and stagger the times like: 1st floor 9am Exercise 9:45 am Arts and Crafts 10:30 am Sing A Long 2nd Floor 9am Sing A Long 9:45 am Exercise 10:30 am Arts and Crafts 3rd Floor 9am Arts and Crafts 9:45 am Sing A Long 10:30 am Exercise You'll have to work it out yourself how early you need to start before each activity setting up and getting people. If you are always starting late and rushing, you'll have to have more time. You'll have to adjust depending on when meetings are. By this model, you have from whenever you come in to 8:45 am to work on paperwork, then between 11:00-ish and 1pm you can have lunch and work on paperwork, and after 4pm you're free to go home or finish up paperwork. The best (and easiest) way to document who came to what is to make up a chart, sort of like an attendance roster like they have in schools, that has each residents name, and you can write in the name of the activity and the date, and mark their attendance. A for Actively Participating, P for Passively, D for disruptive, X for refused, B for asleep, and U for unavailable. You can keep that in a binder, and use it to transcribe into their chart for the weekly progress note. For example, you might look at the attendance for that week and see that Mr. A has been coming to every bingo, but is always disruptive. He always refuses exercise, and comes to some of the sing-alongs and art activities. You could write Weekly Progress Note Resident attends bingo regularly but is disruptive. Will continue to redirect him and talk to nurses about possible solutions. Resident continues to refuse exercise, will continue to encourage. Resident attends sing-a-longs and arts and crafts occasionally. Resident seems content with current activity level. Will continue to monitor. That's just an example. In that imaginary scenario - the cause of his disruptive behavior in bingo could be a hearing problem, so you can meet with nurses to make sure they put in his hearing aid every day, especially before activities. Many residents take them out at meals. You might want to move him right to the front, or consider getting "Bingo calling cards" that have the number in HUGE font, that you can hold up as you say it. By the way, that's based on a real situation I had. A resident would constantly talk during bingo, asking what the number was and often saying it back incorrectly, which not only held up the game but confused other residents, as they would hear me say N33 and then hear him say "N43??" and they'd get mad at him. You can also use those attendance logs as a place to jot stuff down - "Residents express interest in starting a bridge club" "Residents don't like current exercise program - need to change up routine." and act on those things later. Believe me, it is so important to write stuff down when you think of it because you often won't remember it later otherwise. Well, I hope that's a start - let us know a little bit more about your situation and we might be able to give more specific advice. Good luck!

No, but I think I've met you! When I saw the name "bigchris" on the board it immediately made me think of the guy that taught several parts of my AD course in Stockbridge in November. Now I'm pretty sure that had to have been you! You are wonderful and we all really learned a lot from you. I don't have any advice for you, but I guess you could ask any Admin's you know for advice. Good luck! Oh yeah, I'm Olivia from Marsh's Edge on St. Simon's Island. (The one with 8 residents... )

We have two different paid musical entertainers that come to our facility, and I have only ever left them alone with the residents for a couple of minutes at a time. I leave for things like to check on a resident who wasn't quite ready to leave their room when the music started, but I want to give them a chance to come for at least part of it, so I'll pop back in and escort them out. I don't think it's a good idea at all to leave them alone. When I do leave, I'm comforted to know that the nurses station is just a few steps away from where he's playing. Plus, the music is so good that there are often other staff members in there enjoying it too. For independent and assisted residents, I think it's fine, but definitely don't leave the room for good when it's skilled or dementia residents. Plus, I think it's your job to be in there enjoying it with them. Ie, singing along and encouraging them to do so as well, or swinging arms with or even dancing with the residents. I feel like it's a really easy activity for me to do, so why not enjoy it? I get breaks between activities (hopefully, depending on how many meetings I have to go to.)

I have been badgering my ED for approval for one of these for months. It came up in the last Activities meeting (with the HA and DON there) and everyone agreed we need one and now we're all going to whine until we get one. Of course, part of the problem is the availability...even if I get approval to buy one, then I have to FIND one.

Is it a legal requirement to have resident council in a closed room? My admin says so off and on, but the problem is with our floor plan, there are no large closed rooms. It's made to have a homey feel, and thus, no square activity rooms. (Which I'll tell you, is not a good idea. You need a room with tables!!) We have a country kitchen in the counter that seats 4, 4 armchairs, and a couch. Then we have a living room with a large circular table with four chairs around it, a couch, and two arm chairs. We only have 8 residents right now, and it's a crunch to get them all in either room for anything. Especially when we have an entertainer and he has equipment to set up! I can't imagine if we had 20 residents. (We have 5 skilled and 3 AL, who we bring down to do activities. AL has its own living room and country kitchen, as does Memory Care, so if we were full activities would be split, I'm sure.) Anyway, I typically do it in the country kitchen immediately after bingo. There is no door to shut but it is set back a ways from the nurses station. I have to talk pretty loudly as we have two residents who are hard of hearing but won't wear their hearing aids, so I don't know if the nurses can hear or not. I understand that the idea of having it in a closed room is so that the residents will feel comfortable saying anything. We have a conference room near the admin's office, which at one time she stated was where we should have it. The problem is that it is a small room with a huge table, and these overstuffed manager chairs all around it. I'd have to move them out of the room to fit wheelchairs in. Which isn't that big of a deal, but it is hard to get my residents to come out of their rooms and go the 10-30 feet to the country kitchen. Getting them to go down the hall for something "boring" is not going to happen. Oh, and the admin always said to do it there until there was a conflict with a meeting she wanted to have in the conference room and res council. THEN she was OK with it being any old where.

I just want to know what everybody else does in terms of outings. My healthcare admin and DON are constantly nagging me about outings and wanting me to take EVERYONE. I should tell you now that I have only 8 residents (we are a new facility.) I work on the healthcare side, that is, Assisted Living, Clinical, and Memory Care. We have 3 AL and 5 clinical. Our 3 AL people can get around pretty well, one walks unaided, one uses a power scooter/walker, and one uses a walker very slowly. In our clinical, all but one are wheelchair bound. The one that is not is totally confused all the time. Two of our clinical people can''t feed themselves, and another regurgitates randomly. So, as you can imagine, I can't take these residents out to restaurants. It would be embarrassing for them, plus our DON is always stressing that only nurses/CNA's are allowed to feed. So even if we were to take them to the restaurant and feed them, I'd have to have a nurse go with me. There are typically 2 CNA's and 1 nurse in Clinical, and 1 nurse/CNA in AL. I have put in requests at the beginning of the month that I need to have a nurse go with me. My DON always calls and tries to convince me I don't need a nurse, that she can't spare anyone, and when I insist that I do, she decides that that resident is not appropriate for an outing after all. But I still get nagging about not taking everyone.... I mostly take only the AL residents places where you have to get out and do something. I take Clinical people on Scenic Drives (like yesterday, and I had two Clinical people actually go.) We live on a resort island so there is a lot to see. We go out about 4 times a month. Usually it's one scenic drive/tour, one movie at the theater, and one or two restaurants. I have also gone for ice cream and once we ate a snack in the park. I just can't have 5 people in wheelchairs when there is just me and the chauffeur to push people. My second week on the job, we did take EVERYONE to a restaurant (my boss, the IL AD also went) and it was a nightmare. You just can't get everyone inside at the same time, and when you have confused people, they get really upset at all the hassle. One resident at that time had to be on a pureed diet and the place claimed they didn't have a blender for the soup to make it smoother, plus this resident is a very proud woman and gets agitated easily, so she was embarrassed and angry and was chanting "God help us" over and over again. Other residents that are "with it" enough to tell what's going on are very uncomfortable by her and seeing her being spoonfed by her personal aide (who thank god showed up and fed her, then took her home separately.) That was the first and only day that I ever went home and cried. I'm sorry to ramble and rant. I'm just wondering how you guys, with 100+ people, handle this? What do you do? Do you have criteria of who can go? Do you get volunteers or staff to help? How many people can you take at a time? Would you take someone who had to be spoonfed to a restaurant (fancy restaurant - I should tell you now that we are "upscale" and cater to an affluent population, so they don't want McDonald's - and I know that the HA would have a fit if "Lunch at McDonald's" was on the calendar she gave out to potential residents with marketing materials.) Or do you mostly only take people who can move around by themselves (even if very slowly), feed themselves, and basically know what's going on enough to enjoy it? ETA: Plus, what is your typical percentage of participation? I try to explain this concept to the HA and DON... yes it seems pathetic that I only took two residents to lunch, but that's 25% of the population. So it's like taking 25 if we had 100. I don't think the state is going to shut us down because of this, but they act like I'm just making tags with everything I do. They think since we only have 8, why can't all 8 go? Oh, and the residents say they DON'T want to go. I respect their wishes. But then the DON goes in behind me and needles and needles them "But it'll be sooooo fun! Come on, let's get up!" and practically start dragging them out of their room. It's not like I'm leaving behind people who WANT to go. They don't want to go.

I don't really have any input at QA, and I've questioned my need to be there (and at every other meeting - I am on EVERY committee -no joke) but I was told it's so I can be aware of issues in the facility. I rarely have any QA issues. The only ones I can remember is noting that we needed an automatic door going into Clinical (you had to open the door with your back and pull the wheelchair in sideways.) That was six months ago, and it took the five months of me mentioning it was still a problem every month for them to "fix" it - they propped the door open. The other issue was our newest resident's daughter was very vocal about the calendar not reflecting her mother's interests (it was made before she arrived.) She was a retired painter and needed more art activities than what we were providing. I acknowledged it, and the next month's calendar had more painting and crafts.

Working half a day isn't possible for people like me that have to travel out of town to see their families. My facility had a Christmas movie in the morning and a Christmas service in the evening. I agree with those that say one day is not going to negate all our hard work the rest of the year. I don't feel like my residents were suffering without me, but then again, all of my residents have families that actually either came and got them, or came by and visited. I could see how you might feel bad for lonely people who don't have anyone. But, the nurses have to be there to take care of them anyway, so they can handle doing simple activities like putting in a movie. That's wonderful if you can be there and have Christmas bingo and presents for everyone, but I'm really the only activity staff for the healthcare side of my facility. I work for resident services, so all my co-workers are on the independent living side, and of course they were off, and I can't work every day.