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How Many Activities Must Be Offered


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I am a Rec Therapist working in a 90 bed LTC facility. Governmental cuts in Medicaid has hit us hard and forced our facility to make some major cuts, one of which was in my department. I had two activity aides, one full time, one part time. Now both are part time. I do not do thier scheduling as they are CNA's so the scheduling office takes care of that. The schedule for September just came out and out of 30 days I only have the girls 12 days to help with activities. The other 18 days I am on my own! This is all new since the cut backs and I am very worried as to how I will be able to provide quality activities for 90 residents by myself! Because I have all the other responibilites of the AD, care conference, progress notes, care plans, calendars, etc., I took my concerns to the DON who is my supervisor. She got the state regs out and because they state that activities only have to be offered during hours of convenience to the residents, mornings, afternoons with "some evenings and weekends", she is suggesting we cut some of our weekend activities. Currently we offer three activities on Sat and three on Sun. Her solution is two weekends a month, activities as is. The other two weekends, no activities on Sat and only church on Sun which is provided by volunteers from local churches. This would be set until Human resources and myself can set up a voulunteer program. Currently we two volunteers that come in fairly regularly but they set their own schedule and we work around that as they are retired, have families come from out of town, age related health issues etc. We live in a very small rural, tourist area where many of the locals head south for the winter so this will pose a problem as winter approaches. Volunteers are great but our experiences with them is that they come and go and don't last (mainly due to age, younger generations here work two jobs to make ends meet so no time to volunteer). My concern is that the residents are going to become bored and possibly lose interest in the activities we do offer. The more time they spend in their room, the more they get used to it, the harder it is to get them involved, that as well as many of our residents need assistance to participate in activities. It is going to be difficult to provide a quality activity to so many in the alotted time with just one person. Any suggestions? Thank you in advance!

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I feel for you, you're in a tough spot. I have been where you are when working for a large corporate nursing home chain here are some suggestions.

1. Immediately you MUST talk with all department managers and enlist their help. You will need their help and the help of their staff i.e. transporting residents to/from groups, setting up independent recreation i.e. movies, card clubs, craft groups and using busy boxes when residents display sundowning, are not appropriate for the groups scheduled, etc. State will be looking for this...

 

2. Take a look at your residents and assess if you have anyone in house who may be able to help. Some higher level residents do a great job calling bingo numbers in our SNF, this enables the activity staff to float amongst the group assisting with cards, passing prizes, etc.

 

3. Assess your residents awake periods- I mean really take a look at this. When is 'primetime' for activities at your facility. For most of us we schedule a group in the AM and one mid afternoon. I would bet if you take a look around your facility you will find that many of your residents, especially those who really NEED activity interventions are sleeping/in bed during group times- my experience has taught me that this is especially true during the afternoon. You may need to restructure your activity times to coinside with resident awake times. Take advantage of the time preceeding meals- tableside chats, a quick game of 'B column only bingo, the list is endless. This will eliminate the transporting time (CNAs will have brought them out for the meal- we all know they bring them to their dining areas at least an hour before serving time), and will keep the residents occupied before meals.

 

4. Talk with the staff person doing the schedule for the 2 CNAs you have access to... You need to be a bit more in involved in setting their schedule. Also, explore the possibility of taking the 2 part time positions and creating 1 full time staff position. Just be aware of the hit you'll take in creating a benefit eligible position.

 

5. Volunteers are great.... BUT- we all know the truth. They take tons of time in training, retraining, retaining and supervising. So be picky... don't take on any 'needy' volunteers i.e. staff's children, young adults. I would concentrate more on increasing the involvement of other departments vs. getting volunteers in.

 

6. I recently went to a seminiar sponsored by the BQA (Bureau of Quality Assurance- "STATE"), their answer back to an activity director who asked "How many weekend activities do I need to have on my calendar?", was "Saturday should look like Thursday" meaning you must have groups on the weekend. If state visits and so much as one resident says, "It is boring here on Saturday" you can bet the surveyors are going to do some digging, if they notice that falls occur more frequently on Sunday than any other day of the week, they will look at the activities available. Be sure that everyday- yes, even Sunday, you have something for the Saints and the Sinners. Meaning, having only church available on Sunday is not a good idea- what if 7 of your 90 residents never went to church.

 

7. Welcome a state cite. That's right. Accept that you are only 1 person, you cannot do it all. Accept that you can train the other staff, make activity supplies available and recruit every volunteer in your county BUT none of them will do the job like you and none of them will know the needs of the residents like you do. You are the professional. Unfortunately, it has also been my experience that when working for certain facilities the focus is on $$$. Sometimes the only thing that will get their attention is a cite. If activities gets cited folks will notice- just be sure to have a good 'CYA' (Cover Your A**) file documenting all you have done to try to make things work following the cuts.

 

Sorry I rambled so much and good luck!

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Sorry Ella, one other point to make. Does your facility have a marketing team/Admissions Director? Make the point with that person that the facility may need to concentrate more on marketing to the private pay resident. Of course in order to attract that customer you NEED a good activity program. If your facilities private pay count was higher it would not hurt as much when medicaid/medicare dollars are cut.

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I am also having the same problems as listed above. I am the ONLY activity person at my facility. I have no assistants and the CNA's are not receptive to helping with activities. I also have three separate units to do activities on, Gen.Pop, Alzheimers and psych. I leave activities for the resident's on the weekends but they have to see the nurse to get them. The nurses simply don't want to be bothered. I have to have three separate calenders for three separate units. I have no one to do Church on Sundays (I have sent letters and made more phone calls then I care to think about). I am severely suffering from burn out after only 8 months on the job and suffer guilt when my residents complain of being bored on the weekends. Any words of encouragement from anybody would be a great help. I am starting to feel like my residents would be better off with someone else as activity director.

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I think most of us are in the same boat. I have 60 residents, no assistants. The State requires 14 hours of programming per week per resident, one scheduled outing per month, one special social event per month, and all activities must have therapeutic aspects. The CNA's are not interested in assisting with activities. And I understand that. I spend nearly every free minute I have researching, shopping, crafting---and yes, I bring paperwork home to get it done. I do my calendars and newsletters at home, and sometimes my charting. During the last guest council meeting, they requested quilting. So, I contacted the local Quilter's Guild, and they were kind enough to come and get the ladies started. They provided lap quilts that the ladies tacked. And, so, I thought, well, you have tons of fabric---this would be a great time to get rid of some of it. I added quilting to the calendar. First meeting, only 2 showed up and we didn't get a lot accomplished in one hour. Next meeting was scheduled from 10-4 because I didn't have time to drag everything out and put it away for one hour's worth of sewing. 12 ladies showed up! And, I thought, ALL RIGHT! I found out real quick that their fingers weren't as nimble as we thought, and their vision was not clear enough to sew a straight seam. But, they could lay out the fabric in interesting patterns. And they can tack. And they really enjoyed themselves. They chatted and laughed, which reminded me of my own childhood spent in the quilting room with my Mother, Grandmothers and Aunts. So, I have spent my weekend pressing fabric and cutting it into 5" squares. Why? Because I love my residents. As we all do. And I'm not sure who gets more joy from it----me or them. But, when I need a break, I tell my Administrator. Together, we arrange for me to take 3 days off in a row. I love what I do, and I live, eat, and breathe activities. But, I also know that I can't run full steam 24 hours a day, 7 days a week all the time! She knows that I must have time to re-fuel, relax, and rejuvinate. But she also knows that I will do whatever it takes to provide quality programming that is meaningful. I think it's all about balance. I am fully aware of my "tired" point and my cycle of energy. So, what does all this have to do with you? I think you are at a "tired" point and you need to step away for a few days. Stay at home. Do anything you want to do or nothing at all. Pamper yourself. Read a good book. Sleep late, take a nap during the day. I spend one whole day a month in bed, reading and sleeping. Find your comfort zone and snuggle in. You will be amazed what a little r&r can do for you. I hope you get the rest you need. And I'm sorry to be so long winded but I do lots of thinking aloud when I'm on the computer! :)

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Talk to your residents at council. What do they want? I have independant activities scheduled on Saturdays....outdoor time, gardening, puzzles, old movies on the big screen. I have things available but don't have to be there. On Sundays there is church at 2:00pm and coffee at 3:00 the kitchen sets up the coffee as they need a scheduled snack. I would start with your 'complainers' What do they want? Can you pair them with another resident? I have three ladies who play dominos. Can you get an individual activity for them?....word search, cross word, movies, large print books etc. Can you get restorative involved? They have to work with many of our residents six days per week. So we have an exercise group and both get to count it.

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Thank you to everyone for your input! Yes I am tired! I just got this position as my AD was out on maternity leave (since Feb) and I have been doing her job as well as mine. She came in mid July, told us she took another job closer to her home. I was offered the AD job mid Aug and then was hit with all these changes! I am going to give it my all, as with all of you, my residents come first, I love them dearly and want what is best for them. I hope I can work out "all the bugs" before things get too bad! Thank you again for all the input!

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