Outing Advice

[yunakitty 2]

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.

[tsmith 0]

You do have your hands full with only 22 residents that would sound very easy to work with but, I would try to have your lower functioning resident go out for the scenic bus trips and your more higher functioning residents go on the trips were you would go shopping or out to eat. Unless you have the help to take your lower functioning out to eat I think you maybe pushing the button a little bit. There are a lot of safety issues that come in to play. Maybe if you want to take those residents out request family go with yo or met you at the place to help and assist you. Also get started on your volunteers so that when your are going out

with one group they could be with another group at the facility.Maybe they more higher functioning. Maybe a reminiscing, or a sing-along or a Bingo game for them while they lower functioning need your attention on the trip. Don't forget the new Tag is coming and the nursing department will soon be able to help us with activities. Good Luck!

[kminick 0]

We do outings at our facility. Our activity director tries to schedule at least two outings a month. We try to take different people each time. We usually take 2 to 4 residents at a time, depending on the staffing. We do outings on holidays, Christmas mostly to see the lights. We do a outing to the community fair, but go in the morning, visiting the animals and going through the craft building. I hope this will help you.

[Sue 0]

It sounds like you have a lot going on without a lot of support. But rest assured, you can bring your skilled people on an outing. I have brought many skilled residents out, but it does take a lot of help. Keep working with your DON, and stress to her the need for an aide to help change a resident if needed, transfer, etc. At the same time look for outside volunteers. You could use private aides of residents who you are bringing, and definitely look to family members. You will have to plan well in advance, but it can be done. I have even had family members who were so touched that I brought their loved one out, that they volunteered for other trips even when their loved one was not involved. If the resident is a member of a church, you might find a volunteer there. Also, you might have 1 or 2 residents in your assisted living who could help push a wheelchair if you explained to them that these residents will not be able to go out without help. Aim small for the first time. With extra volunteers you will have less seats for your skilled residents, but that's okay. I had a lot of success taking residents to the small museums near me. If you work with the museum ahead of time they are often willing to go an extra mile and may even have volunteers to give a tour or help push. The small museum is good, because for this group a shorter visit (about an hour) in a smaller area is easier to manage. But, be sure you tour the place ahead of time to see if you can easily get wheelchairs in and out. I've had to use freight elevators at small places, but it worked. And the smaller places are much less likely to have crowded areas. The movies could be another option. This may sound terrible, but it is an option: when I first started, an aide was not available, so the aides were instructed to double up on incontinence products for the residents going out. You do what you can. The scenic outings are great, but think about augmenting them a few times a year with a small museum or other historic site. I hope that helps. It was quite successful for my group.

 

On a different note, the resident who you described as being a bit dangerous with her power chair worries me. This should be an issue to bring to your Morning Meeting or Care Planning Team. When we had concerns, we had the therapy department give them a driving test to see if they were capable of safely driving the power chair. If not, they were not allowed to use them because of safety concerns. This should be addressed in a family meeting. If this person goes out with you, you will definitely need a volunteer to be with them and guide her every move.

[yunakitty 2]

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.

[spartans 0]

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.

[spartans 0]

Outings have been limited at our two facilities due to the cuts. Our van is now used for transporting residents to doctors appointments. It is hard to plan an activity outing for two buildings. I post on my activity calendar: Outings are subject to change d/t inclement weather or appointments.

One thing we did last month was get a menu from a resturaunt and order the food to be delivered to the facility instead of going out for lunch. More people could participate.