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  1. The History of Almshouses to Nursing Homes The first almshouse in United States history was founded in Boston, Massachusetts, in 1622. The original Boston Almshouse was burned down in 1682 and was rebuilt away from the heart of Boston nearly a decade later. Upon entering the almshouses in Connecticut, patients were whipped ten times. There were similar institutions developed from 1725–1773 in Pennsylvania, Rhode Island, Virginia, and New York. At the Pennsylvania Hospital, some "lunatics" were chained to a cellar wall or wore primitive straitjackets. One of the biggest problems with almshouses is that they were rarely self-sustaining. They were costly to run, and the capacity of the inmates to pay for their own keep by working at the farm, or working at the almshouse itself, was greatly overestimated. There were not enough staff, facilities were not kept up, and the poor kept coming. The Evolution 1860 Before the American Civil War, local officials regulated almshouses and did not ensure the people inside them were being cared for in the proper way or given the time they needed for help. It was not until the 1860s that more progressive states such as New York began to create boards that regulated, inspected, and reported on almshouses. 1884 The statistical analysis of the Massachusetts almshouses showed four in the city of Boston and 225 almshouses throughout the state. These almshouses housed nearly 7,000 people. Of these residents, 700 were believed to have a mental illness. Half of these almshouses did not house children. Almshouses were often multiple small terraced houses or apartments providing accommodation for small numbers of residents. The units may be constructed in a "U" shape around a communal courtyard. Some facilities included a chapel for religious worship. 1878 The Newark almshouse opened in September 1878 as a branch of the Syracuse State School. It was located on 104 acres of land within the town of Newark, New Jersey, and held around 853 patients. The nine dormitory buildings that housed the patients were able to hold anywhere from 45 to 130 people. There was also a small hospital within the almshouse that could hold up to 30 patients. There were not many employees, only about 110, to take care of the hundreds of young women admitted to the almshouse. Patients were committed to the Newark State School by superintendents of the poor as well as judges who declared them insane or feeble-minded in court. By the end of the 1800s, almshouses began to be replaced by asylums and institutions. Before the nineteenth century, no age-restricted institutions existed for long-term care. Rather, elderly individuals who needed shelter because of incapacity, impoverishment, or family isolation often ended their days in an almshouse. Placed alongside the insane, the inebriated, or the homeless, they were simply categorized as part of the community's most needy recipients. Centuries in the Making 19th Century In the beginning of the nineteenth century, women's and church groups began to establish special homes for the elderly persons. Often concerned that worthy individuals of their own ethnic or religious background might end their days alongside the most despised society, they established—as the founder of Boston's Home for Aged Women (1850). Throughout the 19th century almshouses were a last resort for those who were poor, disabled, and elderly. Residents experienced mistreatment, destitution, and inhumanity. Almshouses continued into the 19th century, until activists sought to remove children, the mentally ill, and the developmentally disabled from all almshouses and increase the number of institutions, hospitals, and asylums for them to reside in. In 1910 the state of Massachusetts, reported that 2,598 persons resided in such asylums. The great majority of these individuals were widowed and single women who had lived their entire lives, or at least a great proportion, as citizens of the state. Despite the name changes and the rosy descriptions that filled the institutions' annual reports, most people hardly looked upon the almshouse as a satisfactory solution to the demands for long-term care for the elderly. By the 1950s, the intent of policymakers to destroy the hated almshouse had clearly succeeded. Most poorhouses had disappeared from the landscape, unable to survive once their inmates no longer received federal annuities. As a result, and due to the lobbying of public hospital associations, Congress amended Social Security to allow federal support to individuals in public facilities. According to investigations of the industry in the 1970s, many of these institutions provided substandard care. Lacking the required medical care, food, and attendants, they were labeled "warehouses" for the old and "junkyards" for the dying by numerous critics. 21st Century In the twenty-first century, nursing homes became a standard form of care for the most aged and incapacitated persons. Nearly 6 percent of older adults are sheltered in residential facilities that provide a wide range of care. While these aging individuals no longer face the horrors of the almshouse, the development of the modern-day industry reflects its historical roots. In establishing monthly annuities for the old and disqualifying all residents of public institutions, the creators of Social Security took direct aim at the despised poorhouse. In shutting the almshouse door, policymakers gave birth to the modern nursing-home industry. https://en.wikipedia.org/wiki/Almshouse https://www.4fate.org/history.pdf Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org Next NAPT Class for Activity Director Training December 7th Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2021 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2810 US HWY 190 W Ste 100-A9 Livingston, Texas 77351
  2. View this email in your browser Resident Rummaging, Hoarding, Hiding It is not unusual to step into a secured Alzheimer’s’ unit where you observe someone actively rummaging or searching through cabinets, drawers, and any number and any manner of subjectively intriguing storage areas, even closets and the refrigerators. It is also a common practice for residents to hide coveted items in the most peculiar places that they will likely be unable to remember later. Although the behavior can be concerning and disruptive, it provides engagement at best but can easily turn into a safety risk. Proactive measures must be implemented to ensure safety that provisions concerning this behavior prevents potential hard to self or others. It is not recommended that you eradicate opportunities for this behavior as it often helps the resident to dissipate anxiety, offers engagement and in fact often helps your resident to feel useful. Note: The behavior might have some level of logic behind the action. Residents often set about this behavior because they are actually looking for something specific, although unable to neither identify nor describe that illusive item. Understanding the Basics According to the Alzheimer's Association, hoarding and hiding behaviors usually begin in the early to middle stages of the disease, and often stem from trying to have some control in their lives. Rummaging, meanwhile, may occur when an individual with Alzheimer’s disease believes something has gone missing. More specifically, the Alzheimer's Association identifies a few possible causes -- psychological, medical and environmental -- for rummaging, hiding, and hoarding, including: Physical changes within the brain leading to confusion, memory loss and impaired judgment The individual senses loss of control The desire for a sense of security or feeling that they may "need" something Seeing and touching things gives them comfort Fear of losing items or being robbed Inability to distinguish between valued and disposable items Boredom, lack of stimulation, and difficulty initiating new activities Reasons for Rummaging Behaviors Boredom: Rummaging behavior may spring from boredom; particularly when opportunities are not abundantly available for engagement. These busy “seekers” are doing just that – keeping busy with something that is found to be self occupying- even when the behavior behind their quest becomes unwanted and has the potential to increase safety risk to self and/or others. Note: In fact, the old adage applies here: “negative attention is better than no attention at all”. Try to quickly understand and recognize what is causing the behavior and measure your response appropriately to prevent that unwanted behavior. Coping Mechanism: Rummaging can be a coping mechanism in response to the disorientation typically caused by dementia. The behavior can occur when the resident is trying to reassure him/herself or self-soothe with familiar items or when they are trying to fill a void or need, like eating when hungry. Loss of Useful Contribution: Consider that what looks like rummaging could also be a way for the resident to feel that they are doing something productive or helps them to feel useful in some way. In the days past, your resident may have fallen into that “problem solver” or “fixer” personality. These characteristics almost are always the reason for “busy seekers” to search for anything that is perceived to be lost items. Triggers: In some cases, the resident with dementia might start rummaging in response to a “triggering” event. The ability to understand the circumstances that “trigger” the unwanted behavior before it occurs puts you way ahead of the game to support a peaceful environment for your resident. Source: https://dailycaring.com/9-ways-to-manage-dementia-rummaging-behavior/ Note: Consider creating a “behavior log” to record the time of day, the surrounding environment, the individuals involved and the type of event to see if there is a repeated situation from which the resident becomes agitated. You will be looking for repeated patterns to determine what circumstances instigate the behavior. “An ounce of prevention is worth a pound of cure” Rummaging Freedom [Safe Zone] Treat rummaging as an opportunity for engagement. Include items like clothing, socks, copies of memorable photos, a fake checkbook, reading books, greeting care, or a wallet filled with old receipts, credit card “look alike” and fake money – anything that could spark interest. Hobbies or career related items from the resident history are sure to peak interest. Themed boxes like a sewing or knitting drawer, a sports basket, a costume jewelry box, a tool box, or any music related items, etc. Always show the resident where to find his/her themed box so as not to elevate anxiety levels. Review the following for more ways to create a “safe zone” for resident rummaging: Keep the person with Alzheimer’s from going into unused rooms. This limits his or her rummaging through and hiding things. Do a search to learn where the resident often hides things. Once you find these places, check them often, without the residents’ knowledge. Keep all trash cans securely covered or out of sight. Alzheimer’s residents may not remember the purpose of the container or may rummage through it. Check trash containers before you empty them, in case something of value has been hidden there or thrown away by accident. Note: A resident that often disposes of dentures, hearing aids and/or glasses can make for a very unhappy family member. In addition, loss of such adaptive devices has the potential to further increase resident agitation and increase unwanted behaviors. More ideas to ensure safety and less disruption as follows: Lock up dangerous or toxic products, or place them out of sight and out of reach. Keep backups of frequently lost items to prevent the start of yet another frantic search. Example: Several similar look-a-like handbags stored out of sight will do the trick when the original one becomes lost. You will always be viewed as the hero when you help your resident find that missing handbag. Remove spoiled food from the refrigerator (if accessible) and cabinets. Food gone bad simply becomes a doctor’s visit when consumed due to the resident's lack of judgment and/or sense of taste. Make commonly used items easy to find. The resident behavior may be valid if they are looking for something specific, but can’t find it. This is particularly frustrating when the resident is unable to explain nor describe what they are looking for. Consider putting things in clear containers or specific drawers and label contents. Or keep similar items together, like similar clothing in the same drawer – underwear, tops, bottoms, socks, etc. Failed attempts to stop a resident from hiding, rummaging, hoarding, and or re-organizing things can cause increased agitation and paranoia for the resident that is bound and determined to engage in such behavior. You can mitigate agitation and manage the behavior through creative and inventive ideas that allow the behavior while maintaining a safe and less disruptive environment. In doing so, the resident will regard you as a supportive partner rather than viewing you as someone that is interfering - - and that’s exactly where you want to be. Reference: https://www.nia.nih.gov/health/when-person-alzheimers-rummages-and-hides-things?utm_source=NIA+Main&utm_campaign=8c48100ffd-20190409_rummaging&utm_medium=email&utm_term=0_ffe42fdac3-8c48100ffd-7499965 Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2021 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2810 US HWY 190 W #100-A9 Livingston, Texas 77351
  3. Lockdown Continues .. All of our CE Classes On Sale! 33% Off - As long as we are stuck inside we might as well make the most of it. New CEs by Celeste Chase, AC-Edu-BC, ACC, CDP, CMDCP , The Care Plan - A Road Map This course lays out the Care Plan procedure in a Person Centered dialogue, not the same old cookie cutter care plan, Explore new insights and planning tools to re-invent your way of thinking about care plans. New from Instructor: Allision Bennett, ADC/TXC Hosting a Bible Study One thing you do not want to do is to host a Bible Study with a group of elderly folks and not know your stuff !!! This course provides the basics of studying the Bible so that you will have some foundation to be better prepared to share with your residents. Studying the Bible can help you see the hope and joy that only Jesus can bring. New from Instructor: Gloria Hoffner Science for Seniors This course will guide you step by step in the use of everyday materials such as vinegar and baking soda to help residents discover their world. Instructor: Haley Burress "Must Play Well With Others: Training Your Team and Other Departments" Federal and State guidelines require Activity Professionals to train all disciplines on how to assure that each resident gets a great quality of life. However, in all types of care settings, this can be a challenge for even the most accomplished Activity Professional. This course will teach you a variety of ways to inspire, encourage and lead your team, as well as passing on that inspiration to different disciplines too. You will have the opportunity to learn how to train in a short amount of time, how to structure in-services, and how to keep Activities at the forefront of everyone’s mind. Instructor: Dr. Alison Ward "Therapeutically Enhanced Group Activities" This workshop focuses on relevant literature, experiential exercises, and skills that an activity professional would need to “therapeutically enhance” an activity group. This workshop rose out of a concern that older adults in the nursing home were not provided with enough opportunities to grow and develop. It incorporates theories of lifespan development, tenets of life review, existential-person-centered psychology, and basic listening skills. The intent is for activity professionals to use the knowledge, skills, and attitudes they have gained from this workshop to “enhance” their reminiscence-based activity groups. Visit Activity Directors Network ActivityDirector.org Our National Activity Professionals Training courses for NAAPCC National Certification Begins Aug 4th - Now Enrolling - The NAPT Course provides an 8wk Advanced Activity Training Course giving you the training and knowledge to Pass your National Exam, plus it also provides you with all 36 CE credits, both published and live to meet the NAAPCC Certification requirements for National Certification. Do you have 1yr of experience in the past 3yrs working with the Elderly, Assisting, Directing, Volunteering? Do you have a High School diploma or equivalent? Will you be able to Pass the National Competency Exam after you finish this class? A. yes Will you have the 36 Required Published CE credits and Live Credits to Meet Path 1 and 2 for NAAPCC National Certification? A. yes NAAPCC AP-BC National Certification could be within your reach! Call or Email NAAPCC Credentialing Center at 303)-317-5682 naapcc.office@gmail.com "The Affordable Choice" The certifications for Activity Professionals recognized under CMS.gov F Tag 680 are the NAAPCC AP-BC & AC-BC, NCCAP ADC & ACC, CTRS, OTR, and COTA. Visit https://www.activitydirector.org/classroom and Fill-Out an Enrollment Form to save your spot. Also be aware that we have an OwnPace option if your Schedule is "a little crazy" The NAPT National Activity Professionals Training is taught by Celeste Chase, AC-BC, ACC, CDP, DMDCP - Celeste is NCCAP & NAAPCC Certified Educator and she was also Kathy Hughes Assistant for 8yrs, Our late Instructor. The Course Provides all the CE Requirements for Path 1&2 - NAAPCC Standards One Class, One exam, One National Certification NAAPCC "The Affordable Choice" Contact NAAPCC.Office@gmail.com Phone: 303-317-5682 Let their counselors reassure you you're on the right Path to National Board Certification See if you qualify! Check NAAPCC Standards NAAPCC Est. 2011 is the only Activity Credentialing Council that follows the ICE NCCA Standards for Accreditation They are NON-Profit. NOTE: SCAPA and Georgia Society will only advocate for NAAPCC National Board Certification. California, West Virginia, several States have NAAPCC Certified Instructors teaching Advanced Activity Programs for NAAPCC National Certification, Its your Choice! Your Affordable Choice . While you are enrolled and working towards any Accredited Certification Requirements you meet the F680 regulations set forth by the CMS.gov to insure each Activity Professional can complete their accrediting bodies standards. Here is the Federal Regulation For Activity Professionals from CMS.gov Most States do not have a State License or AD Register, these States are governed by F680 (most States) Section (ii) A . The Activities Program must be directed by a Activity Professional who is Eligible for Certification as a therapeutic recreation specialist or as an activities professional by a recognized accrediting body on or after Oct 1 1990. American Healthcare Association's Shelter in Place: Planning Resource Guide for Nursing Homes Keep Residents, Staff and Family Members up to date with this blank Covid-19 Newsletter Template. Made simply for your convenience: Step 1: Click on Button below Step 2: Fill in sections with your info. Step 3: Hit print or email. Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2020 Activity Directors Network, LLC All rights reserved. {suite_name} {reg_total} {member_posts} {suite_url}
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