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June 1st, 2006 has arrived and so have the
final changes to the activity guidance for F-248. Activity professionals
have been talking about these changes for months and now it's
here. If your nursing home activity department has not read
the guidance, nor begun to assess the need for any changes in
your department - now is the time to start. But where do we
begin? The first step is to get a copy of the guidance. I
can e-mail you a copy if you do not have one.
There are several areas of focus within the
changes, including individualized assessments, therapeutic and
individualized care planning, specialized and individualized
programming, and the role of the interdisciplinary staff in
promoting and fostering involvement in leisure and recreation.
These are not new concepts, but they are defined in more detail,
with many examples cited throughout the guidance.
One of the first areas you can review for
compliance is to look at documentation. Are your assessments
gathering enough individualized information for your department
to create individualized care plans? Focusing on past life roles,
their significance to the individual, specific leisure and recreational
interests and the need for any form of adaptation should be
noted within the assessment. Care planning is also specifically
defined within the guidance. There are several pages of suggested
activity based interventions to address perceptual, cognitive,
behavioral, physical and emotional needs. Taking the guidance
with you to care plan meetings can assist the activity professional
in upgrading care plans appropriately. As additional care plan
interventions are noted, additional equipment and programming
may need to be introduced to implement the interventions. The
department should inventory supplies and equipment and compare
available supplies to the suggested materials noted within the
guidance. There are very specific references to the use of magnifiers,
amplifiers and other adaptive devices as a means to address
specific limitations. These materials should be available within
the department for ready access.
Departmental systems to ensure residents
are engaged in programs according to identified need and interest
should be in place. Methods to communicate identified interests
to those individuals involved in care and methods to ensure
residents are participating in programs according to the plan
of care should be in place. There has been much discussion of
the Population Needs Assessment, or any tool which analyzes
the categorical needs of the population and compares the identified
needs to available programs in the facility. There are many
analytical tools being introduced which assess the population
and program in this way. There is a sample system posted on
the CMS training
program for the new guidance.
Finally, getting the interdisciplinary team
prepared and involved is probably the hardest step. In order
to be successful in this task, full support is needed from the
administrator and director of nursing. Without their support,
it will be difficult to secure support from the rest of the
team. The guidance offers very specific references to the responsibilities
of the nurse, nursing assistant and social worker. In-services
should be provided to the interdisciplinary staff and copies
of the guidance, with the appropriate sections highlighted,
should be provided to the team.
These changes will not occur over night.
Creating an action plan for your department is a good start.
The action plan should identify areas within the department
and facility that need adjustment in order to satisfy the guidance.
The action plan would include specific tasks to introduce change,
methods to motivate change and a defined time line of completion.
The action plan should be developed with the administrator and
director of nursing, as they should be involved in the plan
also. The action plan will provide the facility with a focus
and assist in keeping the team on task.
Communication as a profession during this
implementation period is also crucial. Activity professionals
need to support each other and work through these changes in
a positive and productive way. The Internet and e-mail is an
amazing vehicle to remain connected. Use the many bulletin boards
and mail chains to share information. Most importantly, never
lose sight of what is really important - meeting the needs of
our residents.
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