If you would like to submit a question to Innovation in Recreation vplatt@innovationinrecreation.com.

• Can you please tell me what standardized assessment tools work best in a long term care setting?
• On our resident’s participation records can I record groups along with everything else they do?
• Is it OK to adjust our regular program to take advantage of seasonal activities?
• Do you think it is appropriate to ask department managers to conduct a group programs?
• How can we be better prepared for our activities?
• At the facility where I work, I am finding that nurses are constantly interrupting activity programs by coming in to pass medications.
• I have a few residents who want to try some new activities but cannot tell me exactly what that might be.
• Can you suggest any special events that we can plan for the next few months that can include all the facility, staff and residents?
• Do you have any new ideas for volunteer appreciation week?
• I am going to be involved in the facility orientation program.
• I am working towards having a children's group come into my facility to do a program with my residents. How can I make the children feel comfortable when they come in?
• We have a few resident volunteers in our facility who do tasks on an individual basis. We would also like to start a volunteer group.
• Do you think it is best for one staff member to always complete one to ones with a resident or is it okay to have various staff members complete one to ones?
• For those residents who participate in individual activities, what ideas do you have in making sure they have all the individual supplies and assistance they need?
• Do you know of any websites that can give me some craft ideas for the upcoming holiday season?
• Can you give me some ideas for gardening activities to at least carry our group through the summer?
• My budget is only 150 dollars per month.
• Have you heard of the "montessori concept"?
• Do you have to document one-one visits?
• How do I become a consultant?
• I have a resident who has expressed interests in various activities but will rarely attend some of them.
• Please suggest some reading material for our summer reading group.
• I was just wondering what other facilities do for "National Volunteer Week" to recognize their volunteers.
• Please help me list some realistic goals for my activity department for the coming year.
• Sometimes it is very difficult to interview certain residents for their activity assessment, especially those who are have a lower cognitive functioning level.
• I am a newly hired activity coordinator at my facility with two existing employees.
• Would you happen to have a State Requirement as to how many/what kind of group per day and etc?
• I would like to know what the 5 domains for activity programs are and an example of each.
• Our Special Care Unit has been opened for around 6 years now and we can't seem to keep activity assistants in this unit-or we get some people who do not have a clue how to work with people with dementia.
• Is there a regulation on if our activities calender has to be displayed and what size it has to be?
• I would like to get more communication going on between volunteers.
• We schedule a time to do our residents' nails in a group setting.
• What insights can you provide with accurately completing N2 of the MDS?
• My consultant is forever recommending that I jazz up my calendar with creative programming titles.
• I have an Activity Assistant who has been at our facility for years and years. And for years and years she has conducted a Bible Study.
• If I become a "Special Care Unit Activity Coordinator" (if there is such a beast) will my Director be in a position to hire a part timer to help out on the other units?
• I have a few residents at my facility who are on hospice care. These residents often seem busy with hospice staff and family members. What should the activities department be providing to these residents?
• I have asked the residents what they would like to do for activities and they don't respond.
• How do you deal with other staff members that, while not physically abusing residents, do mock them, make fun of them, and laugh at them behind their backs, but in front of other staff members?
• I want to become an activity director.
• The care plan coordinator and I are always racking our brains to get these care plan dates correct.
• During the year I have had quite several times where I've had time off work due to sick leave.
• I run an intergenerational program with 10-12 residents and 3-4 preschool children.
• I feel it is a resident confidentiality issue to have a dietary list available in the cafe for our volunteers because of this.
• It's appropriate even if my volunteers in the Cafe are actual Residents?
• I'm running out of ideas to give new volunteers.
• Please suggest ways that I can be a more effective manager?
• Would you please define and explain Sensory Stimulation, Reminiscence Therapy, Reality Orientation and Validation Therapy?
• I have heard that Activity Directors can receive birthday cards for residents from the White House.
• What criteria do you use in evaluating whether or not a group activity is meeting the needs and interests of the attending residents?
• I feel very vulnerable during a Consultant visit. How can I change my way of thinking?
• Is it possible for you to summarize some common medications residents take, their potential side effects and precautions we should be aware of before engaging a resident in an activity?
• It is required by the state to have consultants or is this completely the option of management?
• My volunteer program needs help! Please suggest some places I might find volunteers.

Dear Consultant,
Can you please tell me what standardized assessment tools work best in a long term care setting?
- Rhonda

Dear Rhonda,
Hi Rhonda, There are all kinds of forms available to use for assessing residents. I find it extremely valuable to obtain thorough information on admission regarding a person's past and current leisure lifestyle, as activity care plans are to be based on interests, preferences, strengths, abilities and routines. In addition to activity history information, I also like to assess a person's participation levels, socialization patterns, psychosocial needs, needs for adaptations, communication patterns and mental status quarterly in conjunction with care planning. We have forms that we have developed through Innovation in Recreation and I would be happy to pass them onto you, should you like to take a peek at them. Just let me know. Otherwise, look at forms offered through Briggs...Alrighty???? Take care and thanks for the question. Vicki Platt
- Vicki

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Dear Consultant,
Dear Consultant, On our resident’s participation records can I record groups along with everything else they do during the day, even activities like socializing with other residents in the lounge area? Jackie
- Jackie

Dear Jackie,
Dear Jackie, Oh yes! Documenting every activity that you see a resident do during the course of the day gives us a good picture of what that resident prefers and how he enjoys spending his day. Groups are a part of the picture along with independent activities, family involvement, one to ones, etc… By looking at a resident’s participation record I can tell whether he prefers independent activity, group activities or both. I can observe his preferences as well as if he has been sick. Using codes such as active/passive/refused, etc… also gives us further information about the resident. So you can document activities such as talking on the phone, sitting outdoors, socializing with other residents, family visits and family outings, contact with animals, listening to the radio, and any other activity they enjoy. Just like our day is a mixed bag of activities so to our residents day should be mixed to give them variety. Document all activity that you observe the resident doing and hear about the resident doing. Rosann Moore
- Rosann

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Dear Consultant,
Dear Consultant, For the spring and summer I have decided to add a weekly gardening group as well as some picnics, barbeques, garden parties, and other outdoor activities. Is it okay to decrease a few other group activities until we no longer can do the outdoor activities? Tess
- Tess

Dear Tess,
Dear Tess, I think it is fine to increase seasonal activities while decreasing some other regular activities as long as residents are in agreement. This typically happens during the month of December when many holiday celebrations are going on. We sometimes have to rearrange a few programs in order for everything to fit in. It’s the same with summertime activities. We generally need to make some room for outdoor activities that residents can enjoy while the weather permits. One nice thing about seasonal activities is that it provides variety within our programs without a lot of changes. The types of outdoor activities that you have listed are the normal activities we all usually participate in during warm weather. Seasonal activities also assist residents in being aware which season it is. Enjoy! Rosann Moore
- Rosann

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Dear Consultant,
Dear Consultant, I want to add some educational groups to my program of activities. Do you think it is appropriate to ask department managers to conduct a group program related to their area of expertise? Betsy
- Betsy

Dear Betsy,
Dear Betsy, Oh yes, it is okay to ask department managers if they would like to conduct a group for residents. Who better to lead a group about nursing issues than a nurse or dietary concerns than the dietary manager? Residents always benefit from such educational opportunities. Many facilities already have other staff conducting groups in their area of expertise. Social services, dietary, nursing, and even administrators have all run groups at one time or another. Groups about such issues as Nutrition, Medical, Spiritual, Life Review, etc…these opportunities allow residents to stay informed and let them ask questions that they may have. At your next department managers meeting ask if anyone would consider conducting a group and what group they would like to lead. Once a month would probably be great or as often as residents request. If managers are unable, an assistant in that department may take an interest in it. You know the saying “It never hurts to ask”. Rosann Moore
- Rosann

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Dear Consultant,
How can we be better prepared for our activities? We sometimes get started late because we are gathering our materials or get distracted by something unexpected.
- Krista

Dear Krista,
Dear Krista, Being prepared is a must. Being prepared and on time gives your residents a sense of trust in you and the program. If you signed up for a class at a school or at a recreation center you would expect the instructor to be on time and have all of her materials ready for you to learn. If not, you might just want a refund! Our residents should expect the same. I understand that distractions always occur such as a family member stopping by or a resident needing something so here are some ideas to help you be better prepared. • The month before, when you are planning your calendar of events, start planning for the materials and supplies you will need. Make lists of supplies and materials and to which store you will need to get them from. For example, if you have crafts on your calendar weekly, plan what craft activity you will do and what supplies you need. Place all the supplies for one craft in a bag and label it. Then all you will need to do is take it and go (unless there’s prep work to be done). • Order materials from mail order catalogs monthly or as needed. • Set materials on carts ahead of time, so they may be wheeled out and ready to go. For example, if you have a weekly bingo leave all supplies on the cart during the week. If the cart is needed for other activities then keep bingo supplies in a crate and place on the cart when ready. Crates can be used for other supplies as well such as exercise equipment, sensory supplies, etc… • Be sure you have adaptive equipment for residents who need them and they are included in your supplies. For example, large print cards, large print bingo cards, microphone, etc… • Make it a habit to prepare your supplies at the beginning of the day or say 30 minutes before each activity. • Make each staff member in charge of certain activity groups. They can be responsible for materials and/or topics. Other staff can help gather participants. Rosann Moore
- Rosann

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Dear Consultant,
At the facility where I work, I am finding that nurses are constantly interrupting activity programs by coming in to pass medications. I was told that this is against HIPAA regulations and in general not allowed as residents have the right to participate in a group activity without being interrupted. Do you have any input on this subject??
- Melissa

Dear Melissa,
I hope by now you have resolved the problem of staff interupting residents during their participation activities. It just isn't right, is it? I use this analogy. Suppose you were at the movie theatre and someone interrupted you in the middle of the movie to give you your medication. It is no secret, you wouldn't like it and neither would the people around you. Not only are you missing out on the movie, but you might feel a little embarrased at that. Here is what I would do:

• Meet with the Director of Nursing and ask for his/her support.
• Inservice all staff on the importance of residents being able to participate in activities without interruption. IT IS THEIR RIGHT!
• Meet with new staff members at their orientation to stress the importance of resident participation in activity and their right to participate without interruption.
• During activities, if you see staff approaching, quietly and discreetly ask them to come back upon the conclusion of the activity. Afterall, it could only be a few minutes. A few minutes isn't going to sink the boat. Sooner or later, they are going to get the idea.
• Graciously thank staff for not interrupting. Never let a good deed go unnoticed.
• If, on the other hand, a resident does need attention during an activity, allow for the interruption to occur. Examples of reasons an interruption may be acceptable include: a resident in need of immediate attention or care, a physician visit who has limited time to work around the activity, a resident needing to leave for an appointment, etc. These are exceptions to the rule.
• Remind staff that if a surveyor observes a resident being interrupted during an activity, a tag could be cited.
• Also remind staff that it is up to us to work around resident schedules, not residents working around ours.

I hope this helps a little bit, Melissa. Keep up with your galant efforts of creating a respectful and pleasant environment and home for your residents.
- Vicki Platt

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Dear Consultant,
I have a few residents who want to try some new activities but cannot tell me exactly what that might be. Any suggestions?
- Chloe

Dear Chloe,
Your best bet is to do some scouting, then have some “try outs”.

1. Scout for some new activities. I like looking at local recreation center and senior center catalogs for new ideas. Also check activity listings you may have on hand. Another good resource is other facilities calendars.
2. Present to residents your lists of new activities to see if anything suits them. Have them choose a few to “try out” to see if they like it. Schedule it on your calendar and invite those residents who asked for the new activities as well as other residents who might be interested. If residents like it you may want to schedule it more often. If they don’t like it at least you tried and go on to something different. Try at least one or two new activities each month for new and refreshing experiences.
3. If a certain new activity involves more skill than activity staff has in teaching it consider bringing in someone else to teach it. Ask other staff members, family, or residents if they have any skills and talent in any particular area and let them lead.
4. If the activity needs adaptations provide for it to allow residents to participate successfully.

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Dear Consultant,
Can you suggest any special events that we can plan for the next few months that can include all the facility, staff and residents?
- Pam

Dear Pam,
Here are a few ideas for special events:

• Consider forming a special events committee of staff, family, and residents who would meet and plan special events for your facility. When you receive input from everyone they are more likely to get involved.
• Plan some fundraisers that will earn money for something your facility wants or needs. Some facilities enjoy doing a craft sale around the end of November or the first of December. Have your residents and staff start now on making homemade crafts to sell at this event. You can form a special craft group to make holiday items. Check your local hobby and craft store because I’ve already seen holiday items available.
• Of course the fall is here and that means Halloween and other fall events. Consider pumpkin carving contests; scarecrow making contest (for example, which wing of your home can make the best, funniest, scariest, scarecrow); fresh vegetable and fresh fruit tasting events (such as an apple festival), etc…
• Veterans day could include flag raising ceremony, guest speaker, and/or special music to celebrate your veterans.
• Many facilities will plan an early family/resident/staff Thanksgiving dinner so that family members, who may not be able to attend Thanksgiving Day dinner at the facility or bring their resident out, may still share the holiday spirit. Get together with dietary and other staff members to plan and send invitations.
• Of course it’s never too early to start planning for the holidays in December. Start considering gifts, entertainment, trips, and any donations you may need to obtain. Have each wing decorate a tree with a theme and plan any religious celebrations as preferred by residents. Any staff member can participate in any of these events.

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Dear Consultant,
Do you have any new ideas for volunteer appreciation week? I'm in need of a plan.
- Janet

Dear Janet,
Depending on what you’ve done in years past here are some ideas:

• Using pictures of volunteers in action, create a slide show using a computer program or slides. Pictures with great sounding music will go together well and be a hit. Maybe you or someone you know has the equipment to put something like this together. It does take time so getting an early start is beneficial.
• Create a day to pamper volunteers. Offer lunch, footbaths, bring in a massage therapist, offer to have nails done, give flowers, etc… Any way you can think of to pamper someone.
• Create a “Volunteer Hall of Fame” by taking pictures of volunteers who have been there a great length of time and framing their picture. Hang pictures on the wall in a particular hallway or room. Place a name plate with it.
• During an appreciation lunch or dinner present each volunteer with letters of appreciation bound together in a journal. The letters should be personal letters of appreciation written by staff, family, and residents. Include pictures of the volunteer as well. During the lunch or dinner you might share some of the letters written. This would be a nice remembrance of their time spent at your facility. You may consider forming a committee to write and/or obtain the letters of appreciation. Your committee might consist of residents, family members, and staff.
• Having a speaker speak at a volunteer appreciation lunch or dinner is always a nice idea. The speaker can be a resident, staff member, family member or someone from your community.

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Dear Consultant,
I am going to be involved in the facility orientation program. I have a limited amount of time in which to make my presentation to the new employees. What do you think are the most important points to talk about?
- Beth

Dear Beth,
It's always a great opportunity when you can talk to new employees about the Activity Department and the importance of what you do for residents. Be friendly, open, and present yourself in creative ways so they will remember you. The following are some important points you'll want to get across.

• Express the importance of activities to the residents you serve. Discuss the physical, social, creative, etc... benefits that residents receive from being involved and how important it is to continue resident's life-long interests. Ask them questions like what would it be like for residents if there were no activities? What activities would they (the employees) want to continue doing if they were in a N.H.? Let them know we must meet the leisure needs of all residents.
  
  
• Talk about your facility program, both group and one to ones. Handout your monthly calendar. Highlight physical, creative, intellectual, etc... activities and other special programs. If you have time, take a walk with the new employees to show them where the large calendar, activity room, and where activity supplies are located.
  
  
• Talk about who's who in the activity department. How many people are staffed in activities, as well as how many volunteers who may have coming in.
  
  
• Discuss how all facility employees can be involved with activities. This is a big point because you need help in getting residents involved. All employees can invite residents to activities as well as escort them when they are able. They may have a good rapport with certain residents and can encourage those residents to attend a program. Ask them to help out with the activity when they can. Join in the program if time and their job allows. Ask them to let you know if a resident has a concern or request from activities. The sooner you know about a resident's need the quicker you can meet that need. Tell staff to feel free to offer individual activity supplies and let them know where they are located. Special events such as National Nursing Home Week, Holiday events, and other special events in your facility are usually facility wide events and include residents as well as employees. Lastly, ask staff to talk to the residents about activities. Help residents to get excited about attending programs by talking to them about it. Likewise, talk to residents afterwards about what they experienced at the activity and help them to relive the moment.

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Dear Consultant,
I am working towards having a children's group come into my facility to do a program with my residents. How can I make the children feel comfortable when they come in?
- Laura

Dear Laura,
That's great that you are having a children's group coming in to interact with your residents. Children have special gifts and a unique way of seeing life and making others see things from their point of view.

A visit to a nursing facility, especially if it is their first one might be a bit scary. However I do believe that being there with their group leader/teacher/parent and being with the other kids will make it feel less intimidating. They have the support of people they know. Therefore, I think it would be important for the kids to stay together as a group on their initial visit. I have seen in some facilities where kids visit with residents on somewhat of a one to one basis. That might be something they could do on future visits after they get to know a resident depending on the age of the children.

It would also be important for you to visit the school or place where they come from. Before they ever come to your facility provide them with information on what to expect when they come to visit your facility; for example, why residents live there, what kind of help residents need, what kind of things residents like to do, etc... Talk to the children and let them ask questions. Likewise let residents know what kind of children's group is coming in and what to expect.

Whatever programs you and the teacher or group leader decide on try to make it familiar to the children. The children will certainly be more comfortable with things from their world that they know and can relate to.

Some other advice would be to greet the children and their leader with welcome hearts. Also let other staff members know that you are having a children's group in and to welcome them and assist as needed. Introduce children to residents and help residents to welcome the children as well. Provide the children with special treats, stickers, or other special surprises to thank them for coming in. Let the children know how much you appreciate the visit. Last of all make it fun for all involved.
- Rosann Moore

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Dear Consultant,
We have a few resident volunteers in our facility who do tasks on an individual basis. We would also like to start a volunteer group. Have other facilities ever tried a group of this nature?
- Cameron

Dear Cameron,
Yes, there have been facilities, which have gathered residents into a group to accomplish volunteer tasks. The frequency of the group varies but usually will be planned one time per month. However, if you wish to create a group in your facility, plan it as often as your residents would be interested in attending. Some residents have a need to be helpful and enjoy accomplishing many tasks, especially those who have had a past history of volunteering.

Some common tasks have been everything from residents cutting out coupons from the Sunday paper for staff to helping with facility mailings. Ask your residents what tasks they would like to accomplish as a group. What is important to them in terms of helping others? Also what tasks does other staff need assistance with? What tasks are simple enough for residents to complete? After you've looked within your facility look outside to the community. Where is there a need? Look to non-profit organizations, churches, schools, etc... that are in need of volunteers. Ask them if there is something your residents might be able to do at the facility.

After finding the right tasks remember at some point to recognize your residents for their work. This can be with thank you cards, a special lunch, awards, or at your annual volunteer celebration.
- Rosann Moore

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Dear Consultant,
Do you think it is best for one staff member to always complete one to ones with a resident or is it okay to have various staff members complete one to ones? Sometimes it is hard for me to successfully complete every one to one on my caseload.
- Shelly

Dear Shelly,
It is hard to complete all of the things needed done in any given week. There's always so much to do! First of all, there is nothing wrong with sharing tasks that need to get done. If you need help ask for it or assign it to your staff. It sounds like you're already breaking up caseloads so that helps split tasks. But if you're carrying too many tasks pass it on to someone who has more time. Residents deserve the quality time.

Either way you prefer to complete one to one visits, with one person or various staff, I see pros to both. With one person doing one to ones with one resident they are more likely to be consistent in trying to meet that resident's goals for the one to one program. They will know the resident well as well as be a familiar and comfortable face to him or her. They know what props/supplies to take to complete the visit and they know what one to one activities that resident responds to best and how to attain the response.

By having various staff members complete one to ones for one resident it allows the resident to interact with more people and make new friends. A different staff member might also try new one to one activities, try new props, and new attempts at meeting the same goal. They will have a different perspective and therefore different ideas to allow the resident to respond to. Where one person completing the one to one tasks might become complacent a new face might be refreshing.

Either way you do it residents will benefit as long as they receive their scheduled quality one to one time.
- Rosann Moore

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Dear Consultant,
For those residents who participate in individual activities, what ideas do you have in making sure they have all the individual supplies and assistance they need?
- Leah

Dear Leah,
Here are some ideas:

1. After assessing residents for their interests, preferences, needs, abilities, etc... plan for which supplies and assistance they will need. Also, as part of the assessment, ask how, when, and where does resident prefer their individual activities? Do they prefer mystery novels delivered to their room? If so deliver a mystery novel authored by their favorite writer. Do they prefer jig saw puzzles in the sunroom? Then set up a table where a puzzle can be left out in the sunroom and put together at anytime.
2. Make it part of the resident's plan that staff and/or volunteer will visit resident as frequently as needed to provide supplies and assistance to be able to participate in preferred individual activity.
3. Leave activity supplies out and accessible and place a sign or signs around the facility stating where they are located.
4. Verbally let all staff, residents, families, and volunteers know where supplies are kept. Train staff and volunteers which supplies residents prefers and where to find them. Train as needed to assist resident in setting up and enjoying the activity, as well as where, when, and how to deliver the activity.
5. Make it a daily routine to pass individual supplies from a cart. Knock on resident doors and provide residents their preferred materials and assist in set-up as needed. Continue to assess any changes as needed. Provide for any adaptations such as talking books, large print books, large print playing cards, etc...
6. Consider placing an "Activity Communication Notebook" at each nurse's station. Ask staff to write the resident's name and any activity requests or needs they may have. This is especially good for evening staff to communicate with activities staff that they may not see as often. Activity staff should check the notebook daily and fulfill any requests. Train all staff how to use the notebook. Staff can also make any requests verbally.

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Dear Consultant,
Do you know of any websites that can give me some craft ideas for the upcoming holiday season? I don't have a lot of time to go to the stores and browse for ideas, but I do have a computer! Help!
- Susie

Dear Susie,
I did some research on the net and found many craft, food, and other holiday projects. Whether it's for your residents to do or for a fundraiser there are many free project instructions available. Here are a few you may wish to consider. If you don't find anything at the following websites that you like try typing in "holiday crafts" into your search engine and you will come up with many more sites to try. That's where I found the following:

• www.holidays.net/crafts.htm (crafts, recipes, coloring pages, holiday facts)
• www.geocities.com/kraftproject/home-holiday.html (special occasion crafts)
• www.hersheys.com/holidays/crafts/index.asp (make crafts from hersheys candies)
• www.mycraftbook.com
• www.fabulousfoods.com/holidays/xmas/snowfolks.html (craft and recipes)
• www.essortment.com/in/crafts.holiday/
• www.bhg.com (Better Homes and Gardens website)
• familyfun.go.com/arts-and-crafts/season/specialfeature/Christmas-ornaments-ms/

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Dear Consultant,
I want to start a gardening group at our facility but I don't have a lot of experience in this area. Can you give me some ideas for gardening activities to at least carry our group through the summer?
- Denise

Dear Denise,
Gardening is such a great activity especially for those residents who have been lifelong gardeners. Gardening provides opportunities for outdoor activities, enhances creativity, improves physical and cognitive skills, and provides opportunities for increased socialization and reminiscing. The following is a list of ideas for gardening activities.

• Plant flowers, herbs, seeds, fruits, and vegetables in outdoor raised beds, large planters, or small pots so that residents can easily reach them.
• Plant herbs in small pots that can grow outside in the summer and later be brought into the facility to enjoy during the fall and winter months.
• Dead head flowers. (Pinch off the old dead flowers.)
• Take cuttings from houseplants, let them root, then plant to make new plants.
• Plant peppermint, spearmint, and other types of mints. Enjoy the fragrances then later make tea from their leaves.
• Play games. Create trivia questions about plants or try to name plants from A-Z.
• Press flowers and use in craft projects.
• Make a meal from fresh grown vegetables.
• Watch videos about gardening.
• Reminisce about gardens. Use plants or pictures of gardens to reminisce with.
• Hold an art class outside and let residents' paint or photograph flowers, gardens, etc... Frame and display their art on a bulletin board.
• Paint flowerpots for facility gardens or for residents to give to someone. Then plant something in it.
• Plan a garden party with lemonade and fresh fruit.
• Take a trip to the Denver Botanic Gardens or other gardens in your area.
• Invite in a cook who does canning and show residents how to can vegetables, fruits, and jams or jellies.
• Write poetry using gardens as a theme.
• Show off the latest gardening tools, gadgets, ponds, waterfalls, etc...
• Take pictures of residents gardening and keep a gardening photo album.

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Dear Consultant,
I have recently been promoted from activity assistant to Life Enrichment Program Coordinator in an assisted Living. This Life Enrichment Program is for our memory impaired units that has 50 beds total over the 3 units. I actually need tripples of some items and varring items at different leaves according to the unit. My budget is only 150 dollars per month. I'm starting from scratch. Can you give me pointers? I am planning on doing a garage sale to purchase special outside items like a covered swing and grill for cook outs. But the every day items like bingo, videos, cd's etc all eat my budget fast. Are there places that give free things that could be adapted like the paint stirs for balloon volleyball for a program like this? Our new program launch date is March 1, 2005. Help - I have a lot of work to do and fast. I know that I can add things but I have nothing and the assisted living activity department has a budget of 300 per month and they are tapped too and it is hard to share 1 bingo set in 4 different locations at one time.
Help Please!
- Toni

Dear Toni,
I feel your frustrations with having such a limited budget, but you have to know, that I have consulted with some of the richest facilities and some of the more, shall I say, less financially fortunate facilities and the bottom line is not how much is in the budget but how creative you can get with your budget. I see a lot of waste in our more financially fortunate facilties. Here is what I would recommend:

1. Ongoing fund raising efforts - Bake sales, luncheon sales, holiday oriented sales (selling ceramic bunnies, for instance during the Easter season or balloon bouquets on Mother's Day), sponsoring a bowl-a-thon at a local bowling alley, and the list goes on and on and on. Fundraising gets easier the more you do them.
2. Contact local churches for Bingo donations. Generally speaking, churches will post a note in their weekly bulletins asking for donations and/or volunteers to assist with a program such as bingo. (I find that quarter prizes are generally the most popular prize you can give and will only cost you several dollars, depending on the number of times you offer bingo and how many games you play at each session.)
3. If you find you need certain items, often times posting flyers in staff break rooms, staff and visitor rest rooms, and/or listing items in a facility newsletter will do the trick. Human nature is to give. People just need to know what you need.
4. Local stores tend to be quite generous, too. Make personal vists to plead your case.
5. Keep a tight grip on how much you pay entertainers. Contact schools, music instructors, dog trainers, craft shops, museums, zoo, churches, civic organizations, and/or girls and boys clubs for volunteer entertainers. Gosh, the world is full of creative people just waiting to be invited to share their gifts.
6. Develop a family or community council. Solicit ideas from others as to how you can increase your wealth.

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Dear Consultant,
Have you heard of the "montessori concept"? If so, what is it?
-

Dear ,
The Montessori concept is based upon a method that began in the early 1900's to educate "unteachable" children. This concept has branched into long term care setting especially when working with dementia. It is designed to give opportunities to maintain currently levels of physical, cognitive and social functioning. The basic concept utilizes Montessori materials and techniques in leisure exploration in a failure free environment. Some basic principles include:

• Progression from simple to complex
• Progression from left to right and top to bottom
• Utilizing sequences (small to large)
• Learning through observation, followed by recognition and the recall or demonstration

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Dear Consultant,
I live in Toledo Ohio and have recently come up with some questions. Do you have to document one-one visits. If yes, how extensive. Also do you have to document special programming such as low function sensory group? I have been doing this for years and recently have been told by a supervisor that this is not necessary. Can you clarify? What are the State regs?
- Jennifer

Dear Jennifer,
In my mind, 1-1 Programs should occur with residents who have little or no control over their own leisure due to cognitive or physical limitations AND participate minimally in group activities. Generally speaking, a 1-1 program should be goal oriented (that is, what are you hoping the resident can or will achieve during your visit, such as initiate a conversation, establish eye contact for several minutes, complete a 5 minute exercise routine, answer 5 questions correctly, etc.). The program should be stimulating, using a variety of props. You be the judge to determine the length of the visit, depending on the resident's ability to tolerate and/or participate in the activity. A rule of thumb for visits are at least 15 minutes, 3 times per week. I recommend documentation of the program to include date, whether or not the goal was achieved, comments regarding the visit, amount of time spent and signature.

To answer you question about Sensory Groups, I do like to see how participants are progressing in the sensory program, and therefore, I recommend very basic outcome oriented documentation. Is it required? Not specifically in the Federal Regulations (OBRA), although tracking progress is a plus. You would have to look at your State regulations for specifics on whether special documentation is required.

Participation in both programs should be care planned for and resident progress for each program should be recorded in quarterly progress notes.

Hope this helps you. And, thanks for much for visiting www.innovationinrecreation.com website!!!!!!
- Vicki Platt

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Dear Consultant,
How do I become a consultant?
- Cheryl

Dear Cheryl,
I got my start with consulting by working for a couple different corporations prior to kicking off my own business. That experience gave me some time to learn the ropes, if you know what I mean. Consulting is an interesting business. It is really fun, once you get the hang of it...but there is a fine line between offering support, encouragement and recommendations and coming across as a know-it-all, frustrating those that you are trying to serve. Here are some important tips for becoming a successful consultant:

• Education - I would suggest you obtain a degree in Therapeutic Recreation and acquire your certification as a Therapeutic Recreation Specialist or become certified as an "Activity Consultant Certified" through the National Certification Council for Activity Professionals.
• Experience - Be experienced! Work in the field as long as you can before jumping into the consulting role. It is best too to work in a number of facilities first. Each building has its unique characteristics and just when you have think you have seen it all, you see more.
• Regulations - Learn your State and Federal Regulations inside out and backwards. You have to know the regulations. I would suggest, then, when consulting to refer to regulations as closely as possible. Personal interpretations can get you into trouble.
• Mentor - It is to your advantage to mentor another consultant for advice and support. Though consulting looks easy, the first year tends to be very difficult learning the ropes. As years go by you develop and strengthen your style which invariably makes for a stronger, more effective consultant.
• Patience - Starting a business is never easy. It took me several years to establish accounts and develop a solvent business. Even today, after years of being in the business, the financial end of it is a struggle. Be prepared to deal with cancelled contracts, slow payers, and bankruptcies.

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Dear Consultant,
I have a resident who has expressed interests in various activities but will rarely attend some of them. Do I still need to plan for them?
- Sara

Dear Sara,
The answer is yes. We should still plan for activities resident has expressed an interest in even though they are rarely attending. I know it is difficult at times even when we put all of our best efforts into encouraging and inviting them. Other options need to be explored however, about why resident may not be as interested in the activity.

• Is the activity right for the resident in its current format? Maybe the resident enjoys the activity but not in a group setting. They may not enjoy crowds. Do they prefer to do it independently, in a smaller group format, or on a one to one basis? Change the format for the resident if necessary.
• Does the resident enjoy the topic you're presenting? For example, if the resident enjoys crafts do you present interesting and enjoyable craft projects for her to complete? Topics should be varied to meet many interests. Ask the residents what they prefer to do.
• Does the resident enjoy the way you present the topic? Topics presented by the group leader should be in an interesting and enthusiastic manner as well. The way the group leader presents a topic and the encouragement he gives to assist residents in participating makes a big difference. Are props used when appropriate? Does the group leader help residents to feel that they belong? Does he assist residents in getting to know one another and foster friendships? Does he sit resident where she prefers to be seated? Group dynamics is an important part of an activity. Residents must feel comfortable in this setting.
• Is resident distracted by health concerns or personal or family matters? Sometimes they may feel overwhelmed with other things and may take much encouragement to help them to participate.
• Is resident's physical or cognitive health declining? Do we need to use adaptations for the activity in order for resident to participate now? Staff may assist her in meeting her interests through a one to one program or visit if needed.
• Refer to resident assessment protocols for further assessment.
• Remember to update your progress note regarding all the options you are trying in attempting to meet the residents needs and interests. Note resident responses and if attempts are working or not. This will show that you are trying every effort to meet their needs and interests. Also document refusals to activities in residents participation record.

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Dear Consultant,
Please suggest some reading material for our summer reading group. We already enjoy "Chicken Soup for the Soul", but we're trying to broaden our horizons. Thanks!
- Linda

Dear Linda,
I checked with Chris at my local library for some short stories and she was very helpful. Although there are many to choose from the following is a list of just a few. They are however, sometimes longer than the 1-2 page stories you'll find in "Chicken Soup". I did not read all of the stories in the following books so you'll have to make your own judgment as to whether it is appropriate for your residents. (A couple of listings are ghost stories and one science fiction.)

By the way, you probably already know there are dozens of "Chicken Soup for the Soul" series if your residents like those. Also if your residents enjoy poetry there are many books of poetry that are short and easy to read that would be good for discussions. Check at your local library for other selections of reading materials you may enjoy. The librarians are very willing to help.

• Everlasting Love, Sparkling New Romances, by Jayne Ann Krentz, Linda Howard, Kasey Michaels, Linda Lael Miller, Carla Neggers.
• Classic Chillers, edited by E.M. Freeman. (Ghost stories)
• The Collected Stories of Arthur C. Clarke, by Arthur C. Clarke. (Science Fiction)
• Flowers in the Rain and Other Stories, by Rosamunde Pilcher.
• May There be a Road, by Louis L'Amour. (Collection of classic adventure tales)
• Fairy Tales and Fantasy Stores, by Louisa May Alcott.
• The Literary Ghost, Great Contemporary Ghost Stores, edited by Larry Dark.
• The Unabridged Mark Twain, by Mark Twain. (a few short stories, others are longer)
• A Treasury of Great Christian Stories, edited by Stephen Fortosis.
• Just So Stories, by Rudyard Kipling.

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Dear Consultant,
I was just wondering what other facilities do for "National Volunteer Week" to recognize their volunteers. I am a somewhat new activity coordinator and would appreciate some different ideas.
- Still New

Dear Still New,
The first thing to take into consideration is what your budget will be for volunteer recognition. From there you can decide what kind of celebration you can do.

Most generally we see facilities invite all of their volunteers to some kind of celebration or recognition event. Sometimes they serve dinner and dessert. A speaker may speak and volunteers are recognized by number of hours they have served over the year. They may receive a certificate and/or small gift. I have seen very imaginative party favors related to volunteering at these events.

Other facilities like to do a "Volunteer Tea" with desserts and drinks. They also recognize volunteers for their service with certificates and/or small gifts.

It's always nice to bring volunteers together to meet one another. And it's always nice to have a speaker, such as an administrator or activity coordinator, to talk about how important volunteers are to the facility. One year I spoke at a volunteer recognition dinner and ahead of time I went to visit many residents to ask them what they thought of the facility volunteers. I tape-recorded their answers, with their permission (I don't think I even used their names, just voices), and I played the tape at the dinner. All residents who spoke on tape were very appreciative and had great things to say and the listening volunteers seemed to receive it warmly. Having a resident speak is a great idea also because they are whom the volunteers wish to reach.

Always remember to recognize all volunteers that come into your facility, as well as resident volunteers, groups, family members who have helped out, pet volunteers, etc... Send out invitations by mail in advance so they have time to plan. Schedule it for a day when most will be able to attend such as a Saturday or a Sunday.

Depending on your budget and number of volunteers some other ideas include a pizza party, going out to dinner, sending thank you cards, giving certificates of recognition, putting together a slide show or video presentation of volunteers working with residents (adhere to any facility rules regarding photographs), and taking out a recognition advertisement in a local newspaper. I'm sure there are many more ideas out there. Activity coordinators and their assistants are always coming up with new and wonderful ideas.

One more idea for National Volunteer Week: Plan to recruit new volunteers by placing posters at the entrance to your facility regarding the need for volunteers. Place volunteer applications to be filled out by prospective volunteers at the front desk for their convenience. Do any recruiting you are able to do in your community as well.

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Dear Consultant,
Please help me list some realistic goals for my activity department for the coming year.
- Anne

Dear Anne,
Setting goals is always a great idea because it gives us something to strive for. You can have broad goals, for example, "Improve the volunteer program". But we also need specific approaches to meet the goals such as, "Place a Volunteers Wanted notice in each facility newsletter". So below I have listed both a broad goal (1st) and one specific approach (2nd) to get you closer to the bigger picture. Make changes if you wish or add more approaches. Check off each approach as you complete them.

• Organize office and storage areas: Pick one day each month to clean an office area/storage area. Organize, toss out, or pass it on.
• Increase volunteer program: Drop off "Volunteers Needed" flyers at places in the community such as churches, colleges, local library, etc... or wherever flyers are permitted.
• Improve employee, family, volunteer relations: Take an employee, volunteer, resident, or family member to lunch once a month to thank them for continued support and assistance. Or have a special lunch in your office area.
• Increase participation levels: Knock on all doors and invite residents to group activities. Ask all employees to help encourage residents. Engage all residents in the activity.
• Educate staff of the importance of activities: Schedule an activity inservice with the inservice director and/or participate in new employee orientation discussing the importance of activities.
• Improve documentation: Schedule specific times for all activity employees to document each day.
• Improve Programming: Make a list of how each activity program can be improved, ie: more interesting, more supplies or materials, new props, more ideas, etc... Act on the ideas.

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Dear Consultant,
Sometimes it is very difficult to interview certain residents for their activity assessment, especially those who are have a lower cognitive functioning level. My assessments look somewhat sparse on those residents. Any ideas?
- Laura

Dear Laura,
We seem to play the role of detective when completing activity assessments. It's very important to use all of available resources so we won't miss identifying anything important about the resident. Some information on residents is easy to find while other information is not. Do not expect that all completed activity assessments will be jam packed full with information, however, make every effort to find out all that you can.

All activity assessments are slightly different, but use the following information to identify background information, needs, interests, etc...

• Review the physicians order form for activity orders, current diagnosis, diet, treatments, etc...
• Review other department's histories and assessments ( including nursing, dietary, and social services) for additional information. Social services assessment will describe the resident's background, including past interests. I've often found useful information there.
• Discuss any questions you may have with your care planning team.
• Interview the resident, when at all possible. Some days are better than others for some residents. Return if it's not a good day. The first week of their stay they are assessed by so many staff members they may be tired. Remember, too, being assessed is even upsetting to some residents.
• Interview the resident's family and friends when they are visiting. Make a telephone call and/or consider sending an interest survey to the family in the mail if that is more convenient for those involved. I have even heard of some facilities placing the interest survey in the admission packet for families to complete.
• Observe the resident during the first seven days. What activities do they go to? Do they have visitors? From where? What adaptations do they need to participate successfully? What are their patterns? What seems to be most important to them? What kind of assistance do they need? Are they social with others? Can they participate in individual activity pursuits on their own? How does resident respond to people, cats, dogs, etc...
• What kind of décor do you observe in the resident's room? Can you identify anything about them from the furniture and accessories? For example, do they have religious items, family photos, books, magazines, or crafts? These all tell a story about the resident.
• Ask other activity staff or volunteers what they know about the resident. They may come up with something different than what you know. All observers see things with a different eye.
• Some residents, who are admitted from another facility, have paperwork sent with them that reflects their past situation and living arrangements. Review that paperwork.

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Dear Consultant,
I am a newly hired activity coordinator at my facility with two existing employees. I am wanting to make some changes in workloads in our department. Do you have any suggestions for making these changes so that I don't create too much havoc?
- New Kid on the Block

Dear New Kid on the Block,
It's always difficult coming in and being the new kid. But everyone new steers a different course and along with a new direction comes change.

It's always a bit scary when you know change is about to happen so my first thought is to tell your employees that there will be some changes made. Include them in the change process by meeting with them. Ask them what changes they think need to be made. Ask them what their goals are for themselves and the department. Find out what their interests and talents are. What do they think their strengths and weaknesses are? What groups would they like to lead? What groups do they least like to lead?

You will have better leaders in your department if all are involved in helping you to create a new direction and can envision the course you are steering. You will have a more supportive staff if you realize they have goals for themselves and you assist them in achieving those goals. You will create a supportive environment by caring enough to include them in the change process. If conversations at your meeting turn into a complaint session, as they sometimes do, ask them for their solutions instead. Of course, ultimately, the decisions are up to you but at least by listening you will be a better- informed decision maker. But do tell them you will keep them informed. There's nothing worse than trying to guess what's going to happen. I sure hope these thoughts help you with your decisions.
- Rosann Moore

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Dear Consultant,
I have a question to ask of you and as long as I've been in this field you'd think I know or understand but my new Administrator would like me to add more to my calendar on weekends and evenings. I have no problem with that but staffing wise we are stretched.. Anyway what I wanted to know is, would you happen to have a State Requirement as to how many/what kind of group per day and etc. I now have 5 groups/day with sometimes two staff, 4 groups on Sat. and 4 groups on Sun. and thats with only one staff member on weekends. Anyway I'd greatly appreciate any information you could give me to let him know that I do have all the requirements on the calendar concerning ie physical stim. educational, social and etc.
- Evelyn

Dear Evelyn,
There are no specific regulations (Colorado State or Federal) that specifies the number of groups required for each day, including weekends and for evenings. Sounds to me like you are offering alot of groups, probably more than the average facility, and that you should be proud of. For evenings, I generally recommend at least one evening a week, not church related. I would, though, be asking your residents during a resident council meeting if they would like you to offer additional groups and see what they say. If they are wanting more, then we can find out what they would like and adjust your calendar to accommodate their wishes. I am wondering what is motivating your administrator to make such a request??? Ya hate to appear defensive or resistive to his request, so keep as open minded as possible. And...as far as the types of groups to offer...keep a balance with the 5 activity domains of physical, social, creative, intellectual, and spiritual activities. Offer outings, rotating who attends...have a group specifically geared towards your lower functioning residents. Offer intergenerational programming as well as pet visits. And, of course, resident council once a month.
- Vicki

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Dear Consultant,
I would like to know what the 5 domains for activity programs are and an example of each.
- Stan

Dear Stan,
The five Activity Domains and examples of each are:

1. Physical - Exercises, Walks, Basketball, Golf, Darts, Pool, Bowling, Swimming
2. Intellectual - Current Events, Trivia, Book Club, Movies, Spelling Bee, Crossword Puzzles
3. Creative - Crafts, Cooking, Ceramics, Gardening, Music, Dance, Poetry, Drama
4. Spiritual - Religious Services, Bible Study, Rosary, Hymn Sing, Minister Visits
5. Social - Woman's Tea, Men's Club, Parties, Entertainment. Table Games, Card Games

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Dear Consultant,
Our Special Care Unit has been opened for around 6 years now and we can't seem to keep activity assistants in this unit-or we get some people who do not have a clue how to work with people with dementia. Our administrator, Director of Nursing, and the Board have assigned me as the new "SCU Program Director" and everything will come out of nursing budget and the Activity Department will not have anything to do with the unit. I have worked as a cna for 15 years, almost always in dementia units. I only have one year of college, but I have also had three years in Activities (also in dementia units), attended the Train the Trainer workshop, as well as other training provided by our local Alzheimer's Association. We are now trying to find out what I need to qualify for this position for the State of Illinois. I know they have a program for Activity Directors to become certified. Do I need this or do I need recreational therapy -or is that one in the same? The only problem the Activity Director has with this new position seems to be that I may not be qualified, but don't you have a certain about of time that you can work with certification pending? In the past two months, staff, residents, and family members have praised us ( I have outstanding cnas, geri-helpers, and nurses to work with) on how the program has enhanced our residents' lives and we are really enjoying trying to make a difference. I am willing to go back to school or whatever I need to in order to become certified. Can you tell me the best way to go? Thanks!
- Michael

Dear Michael,
Congratulations on the improvements you have made in your program within the last couple of months. With a strong team, anything is possible. Keep striving to move forward in providing a strong recreational and leisure experience for your residents. Be reviewing resident interest surveys and plan your program according to needs and interests. As far as qualifications are concerned, you will have to contact the State of Illinois for specifics on state regulated qualifications. As far as the Federal Regulations are concerned, if you have "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", you are qualified Federally. So, relax until you find out if the State regulations require additional experience and education. And, Michael, keep attending workshops, reading, attending classes to increase your knowledge base. On-going education is an important key to success! :-) Thanks for writing.
- Vicki

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Dear Consultant,
>Help, we are remodeling the public area of our nursing home, therefore our ugly cork board that displayed our 38" by 54" hand written calender is being replaced. We would like to have a nice wooden framed display. Is there a regulation on if our activities calender has to be displayed and what size it has to be? Also do you have any idea on a company that sells display cases for this situation? Thank you for your advice!
- Becky

Dear Becky,
How about that, Becky, though I have been in Colorado for about 25 years, my home town in Emporium, Pennsylvania. :-) Here is what I would recommend. If your small activity calendar is typed out on a calendar program from a computer, you may be able to take it to a local print shop and have it enlarged for posting, generally at a very reasonable cost. I have seen calendars blown up as much as 5' X 4'. (Use the printer in which engineers or architects use when blowing up blue prints.) This gives you a beautifully printed, easily read calendar. Unless Pennsylvania has specification in the State Regulations, all that is required is that the calendar is large and prominently place in the facility. Generally, too, small calendars are posted in resident rooms. As far a bulletin boards are concerned, check local office supply stores, or have your maintenance department build you a board of which supplies can be purchased at a local building supply store. Nice hearing from you, Becky. Good luck with your endeavor!
- Vicki

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Dear Consultant,
We have a good volunteer program at our facility with lots of volunteer involvement. I would like to get more communication going on between volunteers. I would like volunteers to meet one another and share information (especially if they work with the same resident). Besides the annual volunteer recognition do you have any suggestions of how I might accomplish this?
- Juaria

Dear Juaria,
My suggestion would be to hold a quarterly volunteer meeting. You might call it a "Volunteer Informational Coffee" or "Volunteer Educational Tea" with the purpose being communication and training. Send a flyer out inviting all volunteers, serve coffee/tea, snacks, and hold it at a convenient time for most volunteers. On your meeting agenda you can include introduction of volunteers, recognizing a volunteer of the month (or quarter), information sharing regarding the facility, any changes taking place, new programs, concerns, suggestions, and a short educational session. Educational sessions can include discussing medical conditions in general and activities and adaptations that can be used to make visits successful. During the meeting also include time for volunteers to share experiences and ask questions. After the meeting might be a good time to introduce volunteers who work with the same resident to each other. You may also want to hold a small meeting between you and volunteers who work with the same resident at a different time. Provide any ideas or suggestions to them as needed. To further the lines of communication between you and the volunteers you might consider a quarterly Volunteer Newsletter if you're not already doing one. Include any important information. It doesn't have to be fancy, a one page flyer would work well. Okay! As I am closing this letter out I am thinking of more ideas for your meeting so here goes:

• Try keeping your meeting light and fun while still providing the information needed.
• Make it a potluck if you'd like.
• Try also giving your meeting a theme such as Broncos or Western and ask them to dress up.

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Dear Consultant,
We schedule a time to do our residents' nails in a group setting. Recently, a pharmacy consultant told me that this should not be done in a group setting as it is a dignity issue. We're just painting & removing polish, not cutting, cleaning, etc. In my 16 years as an activity director & consultant, I have never heard of this being an issue. Any comments? Thanks!
- Donna

Dear Donna,
I would have to strongly disagree with your Pharmacy Consultant that doing Manicures for residents in a group setting is a dignity issue. I am extremely sensitive to dignity issues and this just isn't one of them in my mind. The Federal Regulations make no specific reference to this topic. You might check your State Regulations, but I suspect you will not find it in there either. In my 20 years of experience in this buisness and consulting in 16 states, I have never seen this sited as a deficiency. If you want to get some back up with this in writing, address this concern at your next resident council meeting and point blank ask your residents what they think about this and record their response in the minutes. My guess is that if they thought this was an issue, you wouldn't have any takers for the group in the first place. Additionally, and just for you information, I do have some facility Activity staff cutting and cleaning nails. Though I discourage this as an Activity responsibility, if it needs done, it would be a dignity issue not to accommodate the resident. I would, however, avoid cutting the nails of a diabetic resident. So there ya have it, Donna. It is nice to have other professionals looking out for your best interests. Graciously thank your Pharmacy Consultant. But, don't deny your residents with this wonderful social and esteem building opportunity. Long live Beauty Hour!!!!!!

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Dear Consultant,
What insights can you provide with accurately completing N2 of the MDS?
- Kathy

Dear Kathy,
This is my take on it. N2 deals with the amount of time a person is engaged in group or individual activity (watching TV, visiting with friends or family, reading, listening to music, sitting in social areas, smoking, etc.) during his/her free, awake time, This question seeks information on quantity, not necessarily what you may consider quality. So, for example, a resident is awake and free (not eating, not receiving care, not being involved in therapy, etc.) for 6 hours a day. Your response to this question would go as follows.

If this person is involved in some form of activity for:

• Less than 2 hours (out of 6 hours of free, awake time a day), the response would be "Little" or,
• 2-4 hours (out of 6 hours of free, awake time a day), the response would be "Some" or,
• Over 4 hours (out of 6 hours of free, awake time a day), the response would be "Most".

It is difficult for me to fathom how a person could be involved in no activity at all during their free, awake time, but if that were the case, "None" would be the correct response.

Remember, the response of "Most", "Little" or "None" requires additional assessment in writing to determine if a problem exists. If you determine that a problem does exist, a resident's care plan should reflect the problem, identify a resident oriented goal and staff approaches for assisting the resident in meeting the goal and/or resolving or minimizing the problem.
- Vicki

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Dear Consultant,
My consultant is forever recommending that I jazz up my calendar with creative programming titles. Can you help me with suggestions?
- At a Loss for Titles

Dear At a Loss for Titles,
I tend to make the same recommendation. An interesting, fun, creative sounding calendar is the first step to enticing a person to attend an activity. Let's open this question up to others and see what they can come up with. I will set up this Topic on my site: www.innovationinrecreation.com on the Bulletin Board page under "Creative Programming Titles." Come check it out and just see how creative your fellow professionals can be.
- Vicki

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Dear Consultant,
I have an interesting question for you. I have an Activity Assistant who has been at our facility for years and years. And for years and years she has conducted a Bible Study. This Bible Study has always been and still is well attended by residents. Recently, my administrator informed me that it is really not appropriate for an Activity Assistant to conduct Bible Study and that I should recruit a volunteer. She thinks we could be perceived as promoting religion in our facility. She also believes that finding a volunteer to do this group should be easy and that the Assistant's time would be better spent offering other programs to residents. What do you think?
- Rita

Dear Rita,
First, I would like to say that in my 20 plus years of experience in Long Term Care, this is the first time a question like this has been posed to me. Way to go for being the first.

Now, to address your question.

Per OBRA Regulation, Tag 248, our 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." Additionally, the regulation also poses a question as to whether or not our "formal activity program includes activities that reflect cultural and religious interests of the resident population." Colorado State Regulations, Chapter V, Part 9 dictates that we offer, among other categories of activities, "spiritual" activities. With this, we are all in agreement, spiritually related activities are a requirement of regulation. And, I hope we are all in agreement, too, that we would be remiss in meeting the needs of our residents without offering spiritually related activities, regulation or not.

We know that in years past, we were inundated with religious activities. Community members felt sorry for 'those old folks in the rest home." Spiritual volunteers were a dime a dozen. But, this is no longer the case. Ironically, the trend today in this business is that we are lacking strong, meaningful spiritual programming for our residents. Volunteers, including spiritual volunteers, are few and far between. Many facilities today can't even find a church to conduct a Sunday service, let alone offer a meaningful Bible Study that our residents can relate to.

Now I am not a religious fanatic, but I gotta tell you, we are missing this boat. Most residents are experiencing their final stage of life. Many have had strong, life time religious convictions. Once they get into a n
- Vicki

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Dear Consultant,
Our facility has three distinct units, one being a Special Care Unit for residents with Alzheimer's Disease. We have three staff members in our department. When I came aboard several years ago, I was assigned primarily to work the Special Care Unit. At that time, team work and programming were lacking. Since then, the overall tone of the unit has improved greatly. We now have our own calendar. I have worked very hard with the CNA's to implement a "team approach". The nurses are supportive and have seen an enhanced quality of life for residents. It all sounds peachy keen....BUT, here is my problem. I feel more loyal at times to teaming with my nurses rather than my Director. She is wanting to pull me off the unit to help her with programming in other areas of the facility, of which she and the other assistant have been unable to adequately cover. She is frustrated with my resistance to do so. The programming on my floor will decline. My question is, "Are there Special Care Unit Activity Coordinators that work under the direction of the nursing department?" If I become a "Special Care Unit Activity Coordinator" (if there is such a beast) will my Director be in a position to hire a part timer to help out on the other units?
-

Dear ,
I have been thinking about you and your email wondering in what direction I should go with this. It is surely a difficult situation, isn't it. My gut says to stay loyal to your Director. You are in a good place, having earned the respect and cooperation of your fellow workers. You have built a team on your floor and are working side by side to enhance the lives of your residents. To answer your question, though.... Yes, I do consult in some buildings where nursing coordinates a unit, with activities and other staff members working directly under that coordinator, but, every unit is unique in it's own way. The goal is to create a consistent, predictable, comfortable unit and program for your residents.... And, it sounds like you have done that. What I have also picked up from you is that you have not been able to bond with your Director, which is a shame. Just like the team you helped create on your floor, you need to help create a team feeling within your department. Your Director has lots of responsibilities, in addition to conducting groups. I see more and more Directors doing administrative jobs and becoming less and less available to do the job they were once hired to do, and that is to work directly with residents. What a shame, but it is reality. I also suspect if it were possible to hire additional staff, your Director would have done so already. So, given that, there are about 120 residents in your building. That means that your 40 residents are doing pretty darn good, but the needs of the remaining 80 residents are being sporadically met. Eaks. That just can't be. Try to be more flexible. Continue to coordinate the program on your floor, soliciting the help of the nursing assistants to cover for you when you are not available. Go to your coordinator in the morning. Open yourself up to helping a bit more with activities for the other 80 residents in your building. You will earn your wings by doing so. Each and every resident deserves
- Vicki

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Dear Consultant,
I have a few residents at my facility who are on hospice care. These residents often seem busy with hospice staff and family members. What should the activities department be providing to these residents?
- Mary

Dear Mary,
It used to be my perception that when a resident was placed on hospice care they were close to the end of life or would be bed bound. And although this may be true in some cases there are many residents that are up and about and still have energy to fulfill their day. I've learned much through my own grandmother who was a nursing home resident and placed on hospice care. She lived for eight months while on hospice care. Some days she went to a few activities, some days none. But she always enjoyed being invited to activities and having staff and family members visit.

We may also think that residents are so involved with hospice care that their activities attendance might be minimal if any. Although this may also sometimes be true hospice support may not continue all day long. Residents may have a nurse, nursing assistant, social worker, chaplain, or volunteers that visit. It may be daily visits, twice a week, etc. Each case is different depending on resident need.

My point is that we still need to be providing and offering activities on a daily basis like we would all other residents. Continue to invite residents to activities daily especially the ones you know they've always enjoyed. The resident may or may not feel up to attending. You will have to assess each situation and how ill the resident is.

If needed the resident may be placed on a one to one visit for support if daily groups are too much. When deciding one to one activities look at their past and current interests. Or, if appropriate, ask the resident what activity he/she might enjoy experiencing. Some other ideas to consider are relaxing and comforting activities such as taking walks/wheelchair rides outside, reading bible passages or other favorite books, journaling(the resident may wish to have assistance in writing down or recording thoughts or stories), provide gentle massage or lotions rubs to hands and arms, offer and set up tea/coffee and a snack when
- Rosann Moore

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Dear Consultant,
My activity program needs updating. I have asked the residents what they would like to do for activities and they don't respond. What can I do to make the program more interesting?
- Donna

Dear Donna,
You are very wise to turn to your residents first for input into the activity program since it is their program. We always recommend holding an activity planning meeting monthly with residents to get their input into the next month's program. However, I also have been involved in residents meetings where sometimes the residents do not respond, do not give any suggestions, or say that everything is going just fine. And you know what? That is okay too because residents may be satisfied with the current program which is what we want them to be. The one thing you will want to do at these monthly meetings is to keep minutes to show that you are asking for input from residents and document any responses, suggestions, and requests that they have. Always follow-up and put into action the residents suggestions the following month or whenever feasible.

A few other ideas to get input into your program is to survey 5-10 different residents monthly on an individual basis. Keep copies of surveys. You can also survey family members.

One thing to keep in mind is that the program should be interesting to your residents. And sometimes what interests them may not be interesting to you. They may be satisfied when we are not.

Here are some other ideas I hope you will find helpful:

• Look at the past and current interests of your residents. Plan from those interests.
• Introduce one new activity each month. Take a look at a local Recreation or Senior Center program to spot any new ideas. Can any of these be adapted to meet the needs of your residents?
• Introduce new props into each of your existing programs. For example, what new props can you introduce into your exercise group to make it more fun? How about scarves, ribbons, bean bags, balls, weights, parachutes, a different type of music, etc...What about your Reminisce Group or Current Events Group, etc...?

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Dear Consultant,
How do you deal with other staff members that, while not physically abusing residents, do mock them, make fun of them, and laugh at them behind their backs, but in front of other staff members?
-

Dear ,
This is a tough question! But I will do my best to give you my thoughts. First, a question I would like to ask is "Are you being overly sensitive?" I have observed staff members laughing at situations or residents not intending to be mean or disrespectful, but needing to release some emotional stress by making light of a situation. This brings to mind when I was a student volunteer at a facility. I overheard some employees laughing at a client. I thought it was horrible! But after some years of on the job experience, I realized that sometimes "you have to laugh or you'll cry." Our jobs can be difficult. Many people use different methods in dealing with the things they see everyday.

However, we must be reminded that there is a time and a place to release stress. What kind of influence must a person have on a new employee witnessing this behavior? What would family members feel like if they over heard a staff member laughing at a resident. And even worse, what must a resident feel if he/she observes staff acting this way? We all know this just isn't right! Someone with authority must talk to these employees. Laughing at and mocking residents is offensive, as our residents deserve the utmost respect. If staff members are not called on their behavior, they automatically think it is acceptable.

Another thought is to offer sensitivity training. Help staff "feel" what it is like to walk in the shoes of a resident. This can be done by restraining staff members in wheel chairs, feeding each other pureed food at lunch time, using ear plugs, Vaseline on glasses, etc. Brainstorm ways of helping our staff members remain and/or regain sensitivity towards those we are hired to care for. Sensitivity training should occur during new staff orientation and during an annual inservice.

I really don
-

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Dear Consultant,
Hi my name is Evany Greene and I want to become an activity director. I have completed two years in college and i don't know what to major in to become that... can you please help me and tell me what i need to do. I volunteered for 2 years in a nursing home and loved it. I moved to daytona beach and worked in a nursing home and really enjoyed it but I had to go back to school so i had to leave. I really enjoy the field so can you help me....
- Evany

Dear Evany,
We are always looking for good people to be activity directors!!!! What I would suggest is to go to my site, hit links and click on the National Certification Council for Activity Professionals. There you will find information regarding certification as an activity coordinator. If the school you are attending offers a recreation program, go for it. If not, I suspect any type of human service degree and/or classes would help. Good luck to you!!!!!!

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Dear Consultant,
The care plan coordinator and I are always racking our brains to get these care plan dates correct. We laugh about it, but have our differences. An initial care plan should be in place within the first 14 days of admission; however, the actual care plans are determined 21 days after admission, correct? Then it should be three months after that 21 days? Or is it three months after date of admission? It is pertinent for the Activity Director to have that initial Care Plan? Typically, I don't use care plans unless I trigger something on the MDS. Otherwise, I basically work off of other's care plans on areas that need to be improved. When a resident does not have an Activity Care Plan, I basically complete what's called a "Activity Plan" which summarizes what the resident does in his/her leisure time and my care plan interventions from other departments goals. It's okay to write a care plan whenever a problem arises, as long as the target date matches up with the other target dates. It is okay to update a care plan and discontinue at any time when you have noticed the goal has been met or not appropriate anymore. I hope this information is right. I need some reassurance and help to clarify my beliefs. Can you help me or link to websites that would be able to explain this in laymen's terms?
- Traci

Dear Traci,
All of these dates do get confusing, don't they? Well, let me give you my interpretation.

• Initial Care Plan must be started on admission and completed with the interdisciplinary care planning team within 21 days of admission.
• Quarterly reviews are due 3 months following the care planning conference review date
• Though facilities my vary in policy, it is my recommendation not to create an activity problem if there isn't one. Activities does however need to have approaches on other interdisciplinary problems. I generally recommend that activities get involved with problems such as: Communication, Cognition, Mood and Behavior, Hearing, Vision, Mobility, Nutrition, and Restraints. You can do this by adding your discipline to existing approaches and/or writing additional approaches that will assist the resident in meeting his/her goal and resolve the problem.
• Opening a problem when you trigger the MDS is wise. But, remember, that the MDS primarily deals with quantity of participation rather than quality. If you believe the residents' quality of participation is compromised in some way, you may also open a problem dealing with that issue.
• Problems can be identified, discontinued and/or updated on the Overall Care Plan any time at all. And yes, it is a good idea to match target dates.
• Since I don't recommend an activity problem in the care on every resident , I recommend in the activity section of the chart to develop and "Overall Activity Plan" of activities in which you will encourage the resident to participate in the next 3 months. This Plan should be reflective of residents needs and interests.

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Dear Consultant,
During the year I have had quite several times where I've had time off work due to sick leave. Whenever I come back from leave I've copped the blame regarding there not being enough activities. I don't think this is fair as management should be looking at replacing me. I have just come back from leave once again and the same thing has happened - complaints. My manager and the Human Resources Manager want to meet with me to discuss these issues. I'm worried I'll lose my job?
- Activity Coordinator

Dear Activity Coordinator,
First, I must say that I am sorry about your health problems. It sure makes it difficult to remain cheerfully and gainfully employed when you are are not feeling well and must take time off. I wish you good health in the future!!!! Secondly, as we both know, when you are out sick, the activity program certainly must be compromised. The compromise effects the quality of life of each and everyone of your residents. Sad, but true. Management must, without a doubt, examine this, or they are doing a disservice to the residents. You might be the most wonderful Activity Coordinator that walks the face of the earth, but if you are not there to do the job, that become inconsequential. Your residents need, depend on and deserve the highest quality program daily. In our business we know reality is that some won't be around tomorrow, so today must count!!!!! What I must compassionately say to you is, look at your situation with an open mind. If you need to take some time to get healthy again, take that time! You might even consider a less demanding position for awhile. If your health is stable, be convincing with management that your situation is improving, that you love your residents, you love your job, you are good at your job, you need your job and you will give it your all!!! I wish you well!!!!!!!!

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Dear Consultant,
I work in a long-term care hospitals with the geriatric population. I run an intergenerational program with 10-12 residents and 3-4 preschool children. The residents are fairly cognitively impaired, and cover their social graces well, however, they require very simple tasks. I've tried baking, bowling, and arts and crafts (which basically is always the same routine, gluing objects and some coloring). I would like to do more things, however, I don't know what kind of things to do with this group.
Please help. Thanks.
- Jennifer

Dear Jennifer,
There is no better combination than the elderly and children. Gee, I can certainly say, that is where it's at!!! You say your residents are cognitively impaired, but did not mention their functioning level. I am assuming most are in the initial stages of Alzheimer's disease. Yes? I applaud you for attempting activities such as baking, bowling, crafts and such. Sounds like you are willing to do whatever. Keep in mind, that when you find an activity that works for this group, stick with it. It is usually the leader that gets bored with an activity before the participants do. But, lets explore other ideas to see if anything strikes your fancy. I like matching up residents with children, then offering children's activities with the residents supervising and observing the children.

• Read children's stories and encourage discussions
• Draw, color, paint
• Mold clay or play dough
• Cut pictures from magazines and make poster collages
• Play games. 3-4 year olds might like Candy Land, Chutes and Ladders and Memory Games
• String Cheerio's to hang on trees outside the facility
• Go on an outing to McDonald's. The residents might enjoy watching the kids play while having lunch
• Go to a playground or put up a swing set at your facility
• Teach/Sing children's songs, recite nursery rhymes, make a game out of finishing the nursery rhyme.
• Watch a Disney Movie together. Popcorn and Lemonade would be a nice treat.
• Clip coupons and put in a box for staff members
• Make homemade ice cream
• Cut out and play with paper dolls
• Play with Barbie Dolls
• Do "Elmo's" exercise video
• Build Lincoln log house, play with tinker toys or Legos
• Put simple puzzles together
• Sort objects by color or shape
• Match socks

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Dear Consultant,
I am an Activity Director at a skilled nursing facility in Illinois. We have recently opened a cafe for residents, staff and visitors as a means of relaxation and just hanging out. I am a CTRS and have been in the field for quite some years now, however in different settings. This is my first SNF I have been employed at. I am wondering if you have a easy suggestion as to how to monitor residents who are diabetic and/or thickened liquids who purchase items from our cafe. The majority of our volunteers in the store are residents themselves. I feel it is a resident confidentiality issue to have a dietary list available in the cafe for our volunteers because of this. I was told to have an orientation for my volunteers explaining what each diet means and informing them to refuse sale to these individuals with special diets. First of all, I know the concern is the safety of our residents. I understand that we need to control their diets; however wouldn't it be considered a resident rights issue if I instruct my volunteers to refuse sale to those who are diabetic. I feel that our resident who are thickened liquids are more at risk for aspiration/ pneumonia than our diabetics. Our dietary department does have a signed consent by those residents who refuse to abide by their specialized diets; however the DON does not feel that is legally binding. Can you help me with any type of suggestions as to how to monitor this.
Thank you for your help,
- Traci

Dear Traci,
This is how I handle special diets.
When serving food that is not non-compliant with a resident's special diet:

1. Quietly mention to the resident that the food being served is not in compliant with the diet ordered by their doctor.
2. Offer the resident a comparable alternative.
3. If they still want what is being served to the general population, quietly mention the risks associated with them going off their diet, such as, their blood levels would go out of whack, or they could choke.
4. If that doesn't work, guess what? It is that resident's right to have what is being served.!!!! So, I would be serve them the food offered.

Now, take precaution and use common sense:

• If this food would seriously harm the resident, I would involved a nurse and/or dietician. We certainly don't want a resident to go into a diabetic coma or aspirate to death for eating a piece of chocolate cake.
• If a resident has a tendency to go off his/her diet regularly, be certain that this problem is addressed in the care plan, with approaches to the care plan to include the steps listed above.
• Also, it is most appropriate to for you to have lists privately available to volunteers who serve food. All of this should be explained to volunteers during an orientation.

Hope this helps. If you have any more questions, let me know. And good luck to you!!!!

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Dear Consultant,
It's appropriate even if my volunteers in the Cafe are actual Residents? Wouldn't that be a resident confidentiality issue?
- Traci

Dear Traci,
I would say that those residents should be treated like your other volunteers, which means that they go though some orientation as well, including confidentiality. If they are able enough to work in the Café, I would say that they can understand the importance of confidentiality and can make attempts to follow the procedures I have outlined earlier.

Also, I am now suspecting that we are only talking about a problem with a resident or two. Is that so??? Cuz, this just doesn't seem to be much of an issue in other facilities. Might have to have a pow pow with those residents who are non compliant with their diets and see what you can all agree/compromise on. Sometimes we make more of an issue with diets than is necessary, but don't know for sure in your case.

Again, I would stress that a resident has as much right to make bad decisions for him or her self as you and I do. Protecting them and keeping them safe is our job, and we do our best to do so, but we can't take away their rights!!! Really and truly!

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Dear Consultant,
I work in a 50 bed low care residential facility, I have around 10 regular volunteers but I'm running out of ideas to give new volunteers. I don't know whether to get them to start their own group or assist me. I want to utilise them better.
- Donna in Australia

Dear Donna in Australia,
Thanks for the question.
10 regular Volunteers, huh? Good for you! I know a lot of facilities that would love to have such a nice core group of "do-gooders". You certainly must be doing something right! It is great to hear, too, that you have new Volunteers coming through your doors. So with you, recruitment does not seem to be a problem.

The challenge you face is to assign Volunteers to jobs that ultimately meet the needs and interests of your residents, while freeing you up to perform and excel in your job responsibilities. As we all know, without good organization of the Volunteer Program, this can be a challenge.

My suggestion to you would be to advertise for and develop a Volunteer Auxiliary. Part of the responsibility of this Auxiliary could be to discuss the needs of the facility, including the activity program as well as the needs of your Volunteers. Once needs are assessed, the Auxiliary could put a plan together to address how to proceed.

Ideas for Auxiliary projects could include:

• Volunteer Recruitment - Where , what, when and how.
• Volunteer Orientation - Discuss what a volunteer needs oriented to? Who will orient new volunteers? What kind of handouts are needed? Who will design and print the handouts?
• Volunteer Training - Brainstorm what types of ongoing training might be needed for volunteers? Who will help with the training? How often will you offer training?
• Volunteer Supervision - How will volunteers be supervised? Will they need to sign in and out? Do they get an evaluation after so long on the job and regularly there after? (Ya know, everyone appreciates a little feedback.)
• Volunteer Recognition - How often will you recognize your volunteers for their services performed?

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Dear Consultant,
Please suggest ways that I can be a more effective manager?
- Marie

Dear Marie,
Rather than to suggest ways to be an effective manager/leader, I thought it might be more beneficial to ask questions in order for you to examine the type of leader you are now and the type of leader you would like to become. Everyone has a different managerial style and you'll need to develop one that is comfortable to you. (I've use manger/leader interchangeably).

Describe how you would lead/manage. What do you think are your strengths/weaknesses as a leader? What does being a leader mean to you? Do you know someone who is a great leader? What attributes makes them a great leader? How do you think your employee's perceive you? Do you lead by example? Is your communication with others effective? Do your employees communicate effectively with you? Do you examine ways in which you can connect with others? How can you help others to reach their highest potential? List ways in which you can be supportive. List ways in which others can support you. What do you envision for the future of your department? Do you delegate or do you feel you must do most things yourself? What can you do to relinquish some duties? Do you encourage, praise, educate, share, defend, discuss, and negotiate? Do you know what motivates your staff? Do you provide structure? Do you make others feel good about themselves?

These are just a few questions, hopefully that will lead you to some answers. Managing is a constant learning experience. But remember, that leaders lead, they have a vision. They guide others to discover and explore the road that lies ahead.

"If you want to build a ship, don't drum up the men to gather wood, divide the work, and give orders. Instead, teach them to yearn for the vast and endless sea."
- Antoine de Saint-Exupery, The Wisdom of the Sands

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Dear Consultant,
Would you please define and explain Sensory Stimulation, Reminiscence Therapy, Reality Orientation and Validation Therapy?
- Carla

Dear Carla,
Thanks for the question. Hopefully this will help.
Sensory Stimulation is the use of props to stimulate the senses, whereby:

• enhancing a meaningful experience, feeling or emotion
  and/or
• rekindling a memory linked to or associated with the sensation

Sensory Stimulation can be successfully incorporated into a small group setting or during 1-1's. We find that offering themes to your sensory stimulation groups assists with this process. Ideas for themes could be: motherhood, summer fun, various holidays, gardening, etc.

Reminiscence Therapy is considered a "Life Review" and is a normal and important part aging. People need to come to terms with events and feelings they may not have had time to reflect upon and think through when they initially occurred.

Research shows that people who undergo life review are less withdrawn and apathetic than those who don't.

People who reminisce together:

• Generate a sense of continuity by linking that past to the present
• Share various periods in history
• Convey cultural heritage
• Communicate family tradition, folklore and legend.
• Build self esteem
• Resolve conflicts and fears
• Reflect and reassess life achievements
• Promote intergenerational understanding
• Combat isolation while encouraging social interaction

Reality Orientation is an old theory based on the concept that a person with dementia can be presented facts and accept those facts to be true, whereby feeling a sense of relief and comfort. Generally speaking though, reality orientation does not work, its use can be cruel to the person with dementia
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Dear Consultant,
I have heard that Activity Directors can receive birthday cards for residents from the White House. Is this correct, and where can I get the address?
- Margie at Medallion East in Colorado Springs

Dear Margie at Medallion East in Colorado Springs,
Yes! You sure can! Send a letter/fax with the resident's name, what day the birthday is on, and where to send the birthday card. These greetings are available for individuals 80+ years, and for couples celebrating anniversaries 50+ years. Activity Staff are able to submit lists of residents every 3 months. The address/fax number is as follows:

Greetings Office
Office of The President
White House
1600 Pennsylvania Avenue
Room 39
Washington D.C. 20005
Phone #: (202) 456-1414
Fax #: (202) 395 1232

NBC
30 Rockefeller Plaza
Room 352
New York, NY 10112
Attn: Willard Scott
Phone #: (212) 664-4444

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Dear Consultant,
Obviously, group activities are very important! What criteria do you use in evaluating whether or not a group activity is meeting the needs and interests of the attending residents?
- Activity Coordinator

Dear Activity Coordinator,
Yes, with as many residents as you have to work with, groups are very, very important. Nobody has enough time to do a large number of One to Ones consistently! In addition, there may only be one group a week a resident attends, therefore, we must insure that they get as much out of that group as possible. So, here is what we look for when observing groups.

1. Announcements: It is imperative that you announce activities every morning and at least 15 minutes prior to the start of the group. This is your way of informing residents and staff that a group is about to begin.
   
   
2. Appropriate for Attending Residents: Many spectator groups are appropriate for just about anybody. But, are their residents in your group that are disrupting others, unable to track or focus with the group, sleeping, insulted by the material being presented?????? Remember, it is best to target certain residents for certain groups. Large numbers do not always reflect a successful program.
   
   
3. All residents engaged: If a resident attends your group and you plan to record their attendance, be certain to include them in your group. Use their names frequently, tap knees to keep people involved and awake, and use adaptive devices if necessary to enhance participation. If a person has a hearing problem, seat them next to the speaker. If a person is unable to hold onto a project, use a c-clamp. If a person cannot see small print bingo cards, enlarge them. It is important that all participants function as actively and independently as they very possibly can.
   
   
4. Props: Planning ahead and using lots of props to support the topic at hand will certainly enhance the effectiveness and excitement of your groups. We must rely on a variety of ways to stimulate and hold attention! If you are discussing the news, slow down, cut out headlines and photos. (The NewsCurrents program is expensive but excellent!!!)

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Dear Consultant,
I feel very vulnerable during a Consultant visit. How can I change my way of thinking?
- Activity Coordinator

Dear Activity Coordinator,
OK, first of all, let's get one thing straight here. The Consultant works for you! It is best if you set the priorities and direct the focus of the visit. Following are some suggestions of how you can do this:

1. Documentation - Does our documentation reflect each individual resident? Can the care plans be more interdisciplinary in nature and if so, how? What about residents who do not participate in activities, do I need to have a care plan for them, if so, how should it read? Are the MDSs being completed accurately? Is there a more efficient and effective way to chart? Are there any short cuts for documenting on Medicare residents? How do other facilities record participation? Do I have to track active and passive participation? Am I suppose to release restraints and if so, how do I record that I have done so?
   
   
2. Activity Program and Calendar - Do you think the calendar offers enough variety? Are men's groups required and if so, how can I get the men to participate? What can I do for my lower functioning residents? Is it appropriate to offer activities during meals, if so, what would you suggest? Can I count Lawrence Welk on television as a weekend activity? How often do I need to take residents on outings? What kind of activities can I plan for a resident who is deaf? I am bored with my calendar, what are other facilities doing? Can you observe our groups today and provide us with some feedback on how to make them as fun and therapeutic in nature as possible.
   
   
3. One to One Programming - Am I required to offer 15 minute One to One visits three times per week? What if the resident does not respond or refuses my visit? What can I do for residents when they are sitting idle? What kinds of props can I use during my one to one visits? Can volunteers chart on my One to One forms? Can you go with my Assistant on One to Ones and see if there is anything else we can do to increase the resident's responses.

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Dear Consultant,
Is it possible for you to summarize some common medications residents take, their potential side effects and precautions we should be aware of before engaging a resident in an activity?
- Activity Coordinator

Dear Activity Coordinator,
Hopefully this will help.

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Dear Consultant,
I work in a nursing home as the Activity Director. I am certified. My facility does not now or ever plans to hire any ACC 's (activity consultants) to come in and give guidance to the activity program. I feel I need this service to keep the program fresh and to know what others are doing. It is required by the state to have consultants or is this completely the option of management?
- Becky

Dear Becky,
Well, it is always a plus to be certified. So congratulations on that. I am sure that with your education and experience, you are doing just fine with programming. But, just fine isn't always enough. We are in the people business. We are constantly striving to meet the needs and interests of each and every one of our residents in a unique, uplifting, therapeutic manner. So, staying fresh, innovative and in compliance with regulations, I might add, is very important.

You asked if it is required by the state to have a consultant. The answer to your question is NO. It is not required, if you are qualified or certified. Does that mean that anyone who is qualified or certified does not have a consultant? The answer to that questions is NO, as well. In fact, the majority of the facilities we consult in have Certif