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Swing bed activties?

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Hello, my name is Cheryl, I work in a 25 bed CAH in Burns Oregon as a swing bed coordinator/discharge planner. I'm in my final weeks of MEPAP 1050713 and I will be looking for new ideas for activities for our swing bed patients.

I have to admit this course has been very challenging for me as the swing bed/hospital setting is very different from lets say a nursing home for example, we don't have an activity room in fact we don't have anywhere for our patient's to go except the patio outside of the cafeteria. Otherwise all activties are 1+1 in the patient's room. I do have a cart on wheels that currently holds 1 card table and 4 chairs, cards, CD player's and a variety of CD's, curlers, hairdryer, fingernail polish, puzzels, tangle therapy, table top dry erase boards with colored pens, magizines, and a kindle fire.........any suggestions? Thanks in advance!

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Hi! My name is Brandy and I am an Activity Director for a CAH swing bed program as well, I am in east Texas. It sounds like you have a pretty good grasp on the basic activities. I would add thinks like manicure and hair style supplies, crochet and knitting supplies, word search, crossword puzzles, board games, dominoes(they love dominoes)I keep bibles becasue most of the patients love to read it or have me read it to them. I have a game I play for exercise, called noodle ball(take a swim noodle and cut it in half and toss a beach ball and let them hit it, good for hand/eye coordination/strengthening/fun. I just recently moved into a new facility and got an activity room but before that, I did alot of activities in the Patients' rooms. I also used the chapel and the dining room as often as possible. I try really hard to keep basic supplies for activities that the patients are interested in but, with the short term stay it is difficult sometimes. I still have a monthly activity calendar to offer suggestions, but I leave a blank spot just incase the patient chooses something different. email me whenever you like and we can trade ideas, it is hard to come across other swing bed programs! bmwansley@etmc.org

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Hi Brandy, thank you sooo much for replying and I love your suggestion with the "noodle". I would love- love to have an activity room, I wish we could take just 1 one our 25 bed/rooms and turn it in to one. I would feel like I could acutally make a difference in the program given that opportunity. But for now, I will continue to do my very best to make what I have work and build on it as I can. I have taken your  e-mail address down and look forward to talking in the future and here is mine, cnorton@harneydh.com.

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I’m an OT that has been ordered to supervise a swing bed activities program with a person providing the services not licensed. Do I co-sign notes, what is my legal responsibility. We have no protocols, or policies/procedures in place. I’m really concerned.

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Swing bed regulations are the same as Skilled Nursing Home regulations. I am going to assume here that you are the OT and being asked to also do activities with your residents. The regulations for activities are FTag679 and Ftag680.


§483.24(c) Activities. §483.24(c)(1) The facility must provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community.

INTENT §483.24(c)
To ensure that facilities implement an ongoing resident centered activities program that incorporates the resident's interests, hobbies and cultural preferences which is integral to maintaining and/or improving a resident's physical, mental, and psychosocial well-being and independence. To create opportunities for each resident to have a meaningful life by supporting his/her domains of wellness (security, autonomy, growth, connectedness, identity, joy and meaning).

DEFINITIONS §483.24(c) "Activities" refer to any endeavor, other than routine ADLs, in which a resident participates that is intended to enhance her/his sense of well-being and to promote or enhance physical, cognitive, and emotional health. These include, but are not limited to, activities that promote self-esteem, pleasure, comfort, education, creativity, success, and independence.
NOTE: ADL-related activities, such as manicures/pedicures, hair styling, and makeovers, may be considered part of the activities program.

GUIDANCE §483.24(c)
Research findings and the observations of positive resident outcomes confirm that activities are an integral component of residents' lives. Residents have indicated that daily life and involvement should be meaningful. Activities are meaningful when they reflect a person's interests and lifestyle, are enjoyable to the person, help the person to feel useful, and provide a sense of belonging. Maintaining contact and interaction with the community is an important aspect of a person's well-being and facilitates feelings of connectedness and self-esteem. Involvement in community includes interactions such as assisting the resident to maintain his/her ability to independently shop, attend the community theater, local concerts, library, and participate in community groups.
Activity Approaches for Residents with Dementia All residents have a need for engagement in meaningful activities. For residents with dementia, the lack of engaging activities can cause boredom, loneliness and frustration, resulting in distress and agitation. Activities must be individualized and customized based on the resident's previous lifestyle (occupation, family, hobbies), preferences and comforts. https://www.caringkindnyc.org/_pdf/CaringKind-PalliativeCareGuidelines.pdf

NOTE: References to non-CMS/HHS sources or sites on the Internet included above or later in this document are provided as a services and do not constitute or imply endorsement of these organizations or their programs by CMS or the U.S. Department of Health and Human Services. CMS is not responsible for the content of pages found at these sites. URL addresses were current at the date of this publication.

The facility may have identified a resident's pattern of behavioral symptoms and may offer activity interventions, whenever possible, prior to the behavior occurring. Once a behavior escalates, activities may be less effective or may even cause further stress to the resident (some behaviors may be appropriate reactions to feelings of discomfort, pain, or embarrassment, such as aggressive behaviors exhibited by some residents with dementia during bathing16).

Examples of activities-related interventions that a facility may provide to try to minimize distressed behavior may include, but are not limited, to the following:

For the resident who exhibits unusual amounts of energy or walking without purpose:

  • Providing a space and environmental cues that encourages physical exercise, decreases exit-seeking behavior and reduces extraneous stimulation (such as seating areas spaced along a walking path or garden; a setting in which the resident may manipulate objects; or a room with a calming atmosphere, for example, using music, light, and rocking chairs);
  • Providing aroma(s)/aromatherapy that is/are pleasing and calming to the resident; and
  • Validating the resident's feelings and words; engaging the resident in conversation about who or what they are seeking; and using one-to-one activities, such as reading to the resident or looking at familiar pictures and photo albums.

For the resident who engages in behaviors not conducive with a therapeutic home like environment:

  • Providing a calm, non-rushed environment, with structured, familiar activities such as folding, sorting, and matching; using one-to-one activities or small group activities that comfort the resident, such as their preferred music, walking quietly with the staff, a family member, or a friend; eating a favorite snack; looking at familiar pictures;
  • Engaging in exercise and movement activities; and
  • Exchanging self-stimulatory activity for a more socially-appropriate activity that uses the hands, if in a public space.

For the resident who exhibits behavior that require a less stimulating environment to discontinue behaviors not welcomed by others sharing their social space:

For the resident who goes through others' belongings:

  • Using normalizing life activities such as stacking canned food onto shelves, folding laundry; offering sorting activities (e.g., sorting socks, ties or buttons); involving in organizing tasks (e.g., putting activity supplies away); providing rummage areas in plain sight, such as a dresser; and
  • Using non-entry cues, such as "Do not disturb" signs or removable sashes, at the doors of other residents' rooms; providing locks to secure other resident's belongings (if requested).

For the resident who has withdrawn from previous activity interests/customary routines and isolates self in room/bed most of the day:

  • Providing activities just before or after meal time and where the meal is being served (out of the room);
  • Providing in-room volunteer visits, music or videos of choice;
  • Encouraging volunteer-type work that begins in the room and needs to be completed outside of the room, or a small group activity in the resident's room, if the resident agrees; working on failure-free activities, such as simple structured crafts or other activity with a friend; having the resident assist another person;
  • Inviting to special events with a trusted peer or family/friend;
  • Engaging in activities that give the resident a sense of value (e.g., intergenerational activities that emphasize the resident's oral history knowledge);
  • Inviting resident to participate on facility committees;
  • Inviting the resident outdoors; and
  • Involving in gross motor exercises (e.g., aerobics, light weight training) to increase energy and uplift mood.

For the resident who excessively seeks attention from staff and/or peers: Including in social programs, small group activities, service projects, with opportunities for leadership.

For the resident who lacks awareness of personal safety, such as putting foreign objects in her/his mouth or who is self-destructive and tries to harm self by cutting or hitting self, head banging, or causing other injuries to self:

  • Observing closely during activities, taking precautions with materials (e.g., avoiding sharp objects and small items that can be put into the mouth);
  • Involving in smaller groups or one-to-one activities that use the hands (e.g., folding towels, putting together PVC tubing);
  • Offering activities in which the resident can succeed, that are broken into simple steps, that involve small groups or are one-to-one activities such as using the computer, that are short and repetitive, and that are stopped if the resident becomes overwhelmed (reducing excessive noise such as from the television); Involving in familiar occupation-related activities. (A resident, if they desire, can do paid or volunteer work and the type of work would be included in the resident's plan of care,
  • such as working outside the facility, sorting supplies, delivering resident mail, passing
  • juice and snacks, refer to §483.10(e)(8) Resident Right to Work);
  • Involving in physical activities such as walking, exercise or dancing, games or projects requiring strategy, planning, and concentration, such as model building, and creative programs such as music, art, dance or physically resistive activities, such as kneading clay, hammering, scrubbing, sanding, using a punching bag, using stretch bands, or lifting weights; and
  • Slow exercises (e.g., slow tapping, clapping or drumming); rocking or swinging motions (including a rocking chair).
  • Focusing attention on activities that are emotionally soothing, such as listening to music or talking about personal strengths and skills, followed by participation in related activities; and
  • Focusing attention on physical activities, such as exercise.

For the resident who has delusional and hallucinatory behavior that is stressful to her/him:

  • Focusing the resident on activities that decrease stress and increase awareness of actual surroundings, such as familiar activities and physical activities; offering verbal reassurance, especially in terms of keeping the resident safe; and acknowledging that the resident's experience is real to her/him.

The outcome for the resident, the decrease or elimination of the behavior, either validates the activity intervention or suggests the need for a new approach. The facility may use, but need not duplicate, information from other sources, such as the RAI/MDS assessment, including the CAAs, assessments by other disciplines, observation, and resident and family interviews. Other sources of relevant information include the resident's lifelong interests, spirituality, life roles, goals, strengths, needs and activity pursuit patterns and preferences. This assessment should be completed by or under the supervision of a qualified professional.

NOTE: Some residents may be independently capable of pursuing their own activities without intervention from the facility. This information should be noted in the assessment and identified in the plan of care.

Surveyors need to be aware that some facilities may take a non-traditional approach to activities. In nursing homes where culture change philosophy has been adopted, all staff may be trained as nurse aides or "universal workers," (workers with primary role but multiple duties outside of primary role)and may be responsible to provide activities, which may resemble those of a private home. The provision of activities should not be confined to a department, but rather may involve all staff interacting with residents.

Residents, staff, and families should interact in ways that reflect daily life, instead of in formal activities programs. Residents may be more involved in the ongoing activities in their living area, such as care-planned approaches including chores, preparing foods, meeting with other residents to choose spontaneous activities, and leading an activity. It has been reported that, "some culture changed homes might not have a traditional activities calendar, and instead focus on community life to include activities." Instead of an "activities director," some homes have a Community Life Coordinator, a Community Developer, or other title for the individual directing the activities program.
For more information on activities in homes changing to a resident-directed culture, the following websites are available as resources: www.pioneernetwork.net;www.qualitypartnersri.org; andwww.edenalt.org.

Use the Activities Critical Element pathway and the guidance above to investigate concerns related to activities which are based on the resident's comprehensive assessment and care plan, and meet the resident's interests and preferences, and support his or her physical, mental, and psychosocial well-being.


My suggestion is that you hire a per Diem person who would provide activities and you can be the consultant. Therefore you could plan activities and teach a staff member how to do the activities.


Kathy Hughes, ActivityDirector.org

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On ‎8‎/‎23‎/‎2013 at 2:24 PM, cgnorton said:

Hi Brandy, thank you sooo much for replying and I love your suggestion with the "noodle". I would love- love to have an activity room, I wish we could take just 1 one our 25 bed/rooms and turn it in to one. I would feel like I could acutally make a difference in the program given that opportunity. But for now, I will continue to do my very best to make what I have work and build on it as I can. I have taken your  e-mail address down and look forward to talking in the future and here is mine, cnorton@harneydh.com.

I agree with what you are saying Brandy. I am in the same situation as you. I feel that I could do more of a service to the patients, I am open to suggestions?

Lorrie D

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