At the heart of any nursing or assisted living home is the activity program it has for residents. It is an integral part of the cultural change movement and central to person-centered care. It is essential for resident quality of life. Nursing Home activities are governed by federal regulations called F-Tags. While Assisted Living activities are not as highly regulated, many facilities emulate the standards set for nursing homes.
F-Tag and ImplicationF-Tag 248 states that ”the facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psychosocial well-being of each resident.”
The intent is that:
- The facility identifies each resident's interests and needs.
- The facility involves the resident in an ongoing program of activities that is designed to appeal to his or her interests and to enhance the resident's highest practicable level of physical, mental, and psychosocial well-being.
More Than Just the Initial Assessment
The resident assessment begins to crack the surface of understanding what activities they could be interested in participating. But really knowing the resident goes beyond that.
- Involve the family to understand the resident’s interests.
- Do a "social history" of the person's life soon after intake. Find things they're proud and build activities around them.
- See other staff as a resource. Aides are with residents in their rooms and have a chance to talk to them at different times. Find out what they know about the resident’s interests. And remember under the new regulations, an activity does not just mean a group activity. It can take place in a room and be administered by any staff member.
- Visit the residents in their rooms and look at their photos and other display objects, and use those things as a starting point for conversation about interests.
- Ask them the things they have done in their life; what they are still hoping to do; something they would like to try again.
The stereotype of activities in elder care homes is playing bingo and watching television. Of course some progress has been made in the PR front as Wii games in nursing homes have become big media stories.
F-Tag 248 stipulates that activities should be relevant to the specific needs, interests, culture, background, etc. of the individual for whom they are developed.
In research by the Centers for Medicare and Medicaid Services (CMS), residents reported that independence and a positive self-image were central to their well-being. They want a choice of activities and “activities that amount to something,” such as those that produce or teach; activities using skills from residents’ former work; religious activities; and activities that contribute to the community home.
- Many female residents were homemakers. Folding laundry, doing dishes, sweeping, setting the table, and ironing….. these are tasks that many residents can still do with assistance.
- Elderly male residents kept everything working around the house. Let them help. Give them something to take apart and fix. They want to feel like they are contributing.
- Meals become central for many residents. Let them help plan your menu. Ask them to share recipes.
- Gardening and doing yard work may have been important. Let them plant a small garden.
- Let them tell you stories about the people in the pictures they have brought with them.
Even severely limited residents can have one-to-one activities such as talking to the resident, reading to the resident about prior interests, or applying lotion while stroking the resident’s hands or feet.
Activities can occur at any time, are not limited to formal activities being provided only by activities staff, and can include activities provided by other facility staff, volunteers, visitors, residents, and family members.
CMS also considers these items when evaluating the activity program.
- Medication administration, to the extent possible, should not interfere with the resident’s ability to participate in an activity.
- Residents should be notified of preferred activities.
- Transport should be provided for residents to and from activities.
- Functional assistance (such as toileting and eating assistance) needs to be provided.
- Needed supplies or adaptations, such as setting up adaptive equipment need to be considered.
Stretching and Reaching
Encouraging and supporting the development of new interests, hobbies, and skills is encouraged and well as connecting with the community through places of worship, veterans’ groups, volunteer groups, support groups, and wellness groups.
F-249, The Activity Professional
F-Tag 249 states that ”the activities program must be directed by a qualified professional who
(i) Is a qualified therapeutic recreation specialist or an activities professional who--
(A) Is licensed or registered, if applicable, by the State in which practicing; and
(B) Is eligible for certification as a therapeutic recreation specialist or as an activities professional by a recognized accrediting body; or
(ii) Has 2 years of experience in a social or recreational program within the last 5 years, 1 of which was full-time in a patient activities program in a health care setting; or
(iii) Is a qualified occupational therapist or occupational therapy assistant; or
(iv) Has completed a training course approved by the State.
The intent of this regulation is to ensure that the activities program is directed by a qualified professional. An activity director is responsible for directing the development, implementation, supervision and ongoing evaluation of the activities program. Directing the activity program includes scheduling of activities, implementing and/or delegating the implementation, monitoring the response to determine if the activities meet the assessed needs of the resident, and making revisions as necessary.
Activity professionals are the unsung heroes of the profession. They are called to do much and what they do positively affects lives and ultimately affects the image of the home. So while activities in theory are everyone’s responsibility, help yourself by hiring an experienced and certified activity professional.