Susan

I just clicked on the link that Kate posted and scrolled down to F-248 (around page 75 or 76). I couldn't find it searching on the site either.

I got to it. I don't have the current guidelines on me at the moment but.... isn't this what we've been doing all along (or supposed to be doing)? I don't see what's different. Can someone point the changes out to me?

That's such a shame, Gina. I've been to your site and it's apparent all of the hard work you put into it. It's a great resource. Thanks for sharing it and for all you do for the activity profession

I'm in NJ. There has been so much done at all levels with this woman and because it's such a complex issue I'm sure the ombudsman's office has been involved. I was complaining about this volunteer ombudsman program we're involved with. I'd like to think other facilities who participate in this program have had better experiences than we're having.

Our facility is part of that volunteer ombudsman program. If you're not familiar with it, people from the community (ours is a college professor) take a short course to learn how to be "advocates" and come into the facility once per month to tell us what we're doing wrong or not doing. For us, it's awful. This woman continually goes to the chronic complainers, writes a report about all of their complaints and we have to write responses every time. She cannot go into resident charts and doesn't communicate with staff so she knows nothing about how much has already been addressed with the resident or that a resident has a history of chronic complaints. The residents of course see this as someone else to voice their complaints to so they're very vocal. I can't tell you how many times I've addressed the same problems to her in reports. We've tried talking to her, the Ombudsman's office and it doesn't do any good. I truly believe though, we haven't had any problems with the state with our "problem" resident because our documentation is very detailed and there's so much of it. As for a room change, she cannot afford a private room (she's medicaid) and there's no medical reason for her to have it. To be honest - I'm sure she'd find a problem with it eventually anyway. She'd be lonely would be one complaint for sure. She's just one of those people you can't please no matter what you do. My sympathies for the loss of your friend to a stroke

The state has been scrutinizing Quality of life for several years now in our state. Seems more and more each year. We inserviced nursing a number of times, posted lists of residents who needed to be in activities at certain times, wrote it in their care plans etc. Sometimes it works and sometimes they still scoff at it. We've had nursing assistants get the resident up, wheel them PAST the room where the activity was being held and put them in the lobby - out of spite! If your facility is anything like ours (and I'm sure many others), everyone jumps to attention when the state walks in the door and the next thing you know, EVERY SINGLE resident is in your activity. The dog and pony show begins! I got angry this past year because staff were putting residents in activities that weren't appropriate. For example, putting residents who were NPO in a coffee hour social, residents who were disruptive or so low functioning they didn't even know what was going on were also in there etc. Plus we had so much nursing staff help they were in the way! It couldn't have looked more unnatural. I'm shocked the surveyors didn't say anything. We have a Snoezelen room and the folks that were inappropriate should have been in there - not in a coffee social. As for other facilities getting deficiencies for other staff not helping out - I've heard about it too. Even had a surveyor mention it. But yet to see it happen. Just make sure if your residents are still in bed they have some kind of stimulation in there and get out that 1:1 cart while they're there and let them see you doing them! Just don't let them see a low functioning resident going for a long period of time with no interaction/stimulation. Trust me on that one!

Thanks for the responses, folks and you've addressed alot of the issues that we have addressed: To Crysty: There really isn't any family and the little there is (neice, nephew) rarely visit. She has a lady friend who has started to pull away from her because she is so demanding and this woman is elderly and has her own issues. The team actually came out and told her "if you don't stop the behavior we will help you find another facility where you will be happier". Even the MD was in on the meeing. It got that bad. This woman was actually faking seizures to get meds. To Stacie: You're absolutely right - this woman is not in the appropriate setting to address her needs. In fact, if the addiction wasn't an issue, she could live fairly independently. It's been addressed with her and as much as she complains about our place, she finds every reason not to leave (maybe we're not the snake pit she claims we are?). She needs to be in a more specialized facility. To Diana: I did read your post about the resident council president - with her in mind! Our residents won't say anything though. They'd rather just not attend. But who knows? Maybe the day will come when they do speak up. I can see many of the residents who used to socialize with her pulling away from her. You can bet her chart is bulging with volumes of documentation from all departments - which is what saves us during survey because she always is very vocal at the state run resident council meeting. I thank you all for your support - for now I just clench my teeth, smile and act as if her comments roll right off of my back (a reaction is what she thrives on). I'll tell ya - there's days I consider taking up drinking lol Thanks again

I've been in the recreation/activity profession for almost 20 years now and have had my share of difficult residents (as I'm sure we all have had). I've never had a problem looking beyond the difficult behavior and continuing to work with them as I would anyone else... until now. We have a resident who is fairly young (60's), very cognitively intact who has had a very rough life which no doubt contributes to her behavior. She's also had a long history of addiction to prescription pain killers. This woman is just plain mean and very manipulative. The whole facility has jumped through hoops for her to make her happy and every time she stabs them in the back. My staff have gone so far out of the way to accomodate her, provide activities, oppportunities for her only to have her bad mouth them or make nasty remarks to surveyors about them. She makes negative comments about her care (and trust me - she's pampered) at every opportunity and tries to play one staff member against another. The team has confronted her on numerous occasions about her behavior but it doesn't help - it gives her even more attention which she enjoys. She's resident council president as well. I've given her projects like being in charge of decorating for holidays, "managing" monthly bake sales, running activities and with all of them (except the resident council position) she's dropped within a short time.... but then complains she has nothing to do. She attempts to "take over" every group my staff try to run and the other residents aren't liking it. No one can get a word in edge-wise with her around. God forgive me, but I don't like this woman at all and find it very hard to even speak to her. What's even sadder is, most of the staff (even administrative staff) feel the same way as I do. Has anyone else been in this kind of situation? Like I said, In almost 20 years I've never felt this way about a resident - I'm almost ashamed to admit that I do!

What you want to do is find out what they've enjoyed doing prior to the stroke and adapt that activity so they can continue to do it. There are so many adaptive devices out there to purchase and many you can "rig" on your own. C clamps are great for holding down craft projects, as is that rubbery shelf liner you can get at most dollar stores. When I worked in a physical rehab we managed to adapt just about anything! We even had our patients tying bows and knots with one hand for crafts. What specifically do you need? I'm assuming because you said your folks have hemiparesis you're just talking about physical issues. Am I correct?

A friend of mine dealt with the same thing and it stinks! What I have found since I've been an AD is that many of the 20-something people I've hired had a very poor work ethic. They called out alot ( especially on weekends), tended to be lazy and unmotivated. I'm not making a blanket statement - don't get me wrong but that's just what I've found. I tend to look for a more mature person now and when I do find one, they're usually much more reliable.

The bottom line is YOU are the Director and when state comes in and your program takes a hit, guess who takes the heat? You! I had the exact same problem - I had a person who was in the department for many years and extremely resistant to change. Our population was declining and she was still doing high functioning programs which only about 5 could participate in. I had a few others who were just as resistant to what I was trying to do. I had a meeting with all of them and told them finally the program was going to run a certain way and if they didn't like it they were free to go elsewhere. I had to start writing people up for not doing what they were supposed to (yes, they were inserviced ad nauseum). The one person went as far as to try to sabotage everything we were trying to change. She had all of the high functioning residents complaining and turned some of our volunteers against the department. She eventually resigned. Unfortunately when trying to motivate people positively doesn't work you have to take a stand. It's the activity director's neck that goes on the chopping the block when the department isn't doing what it should be doing. Good luck to you - it's not easy.

We did "An Evening of Appraisals" (basically an Antiques Roadshow). We paid a local appraiser $150 for the evening. We sold tickets to staff and family members for $15.00 per item they wanted appraised. It was a great success - we not only covered the cost of the appraiser but made a couple hundred bucks profit! :hammer: