[michelle126]

Originally Posted by CapeCodMermaid

I didn't see any negative thoughts here about any activities professional and I'm all for giving residents the best quality of life, but let's get real. We have 10 residents per CNA on the day shift and now we're expected not only to do all the personal care, meds, treatments, charting, family meetings, meet with the docs AND now do activities? It's a lovely thought and some of it might work in an Eden-type facility, but given the budgetary constraints and the time constraints I don't think we can let all the residents "do their own thing".

What happens on the 3-11 shift when there is one cna per 15+? Its nust

[romie]

The new CMS interpretive guidelines are simply that---new guidelines for surveyors to aide in interpeting the already exisiting regulations regarding activity. It is not about making nursing staff force elderly ladies to go to bingo people!! Everyone already knows how hard everyone works in LTC. I also realize that some surveyors wont be satisfied even if everyone had complete 1:1 ratios.

In my facility, every single resident has a care plan for activity, regardless of their function, interest in formal structured groups and irregardless of how long they will be with us. We have long term, rehab, assisted living and dementia care. Now, for the poster who said that she wanted to be left alone to watch TV, skip breakfast, ect, I would care plan her as prefers self directed activity, her need is for the staff to respect her activity preferences and her goal will be to express satisfaction with activity pursuits with no expressions of lonliness. For those residents with tons of visitors who is satisfied with her visits and don't need activity intervention, her care plan would state that she is satisfied with her leisure time and that her family structures her leisure. Save yourself a little trouble and give yourself some credit for the work that family is doing. If half of your residents are legitmate "loners", just make sure they are careplanned as being loners and make sure you don't give them a reason to tell state surveyors they are bored because nobody ever checks up on them to offer activity interventions.

Now the key is that each and every resident recieves a thorough activity assessment. Just because you want to be left alone doesn't me it is appropriate for every resident, especially residents with dementia. Would you not provide medications or treatments to a person with dementia simply because they wanted to be left alone? The activity care plan and interventions are based on that individual's assessment, not what staff would prepare for him or herself.

Activity interventions are also extremely useful in dementia care as far as reducing the need for psych meds and restraints-- rather than dope someone up because they keep trying to stand up and walk when they are unable to use their legs, or trying to elope, give them some meaningful tasks to do. Granted, you aren't going to cure them of their tendancy to be unsafe or elope, but if may offer some relief. The CNAs at my facility have been amazed at the activity based interventions I have shown them. Activity Intervention=Less annoying resident+happy nurse and CNA.

Finally, everyone it seems is getting diagnosed with depression these days. What does Dr. Phil, Oprah and every self-help book say about dealing with depression? Get off the couch and get moving--do something, get hobbies, get a life! So if your residents are diagnosed with depression, try getting them involved with both solitary and group activity pursuits. (This is in addition to any pharmocological inteventions that may be prescribed).

[achot chavi]

I agree with "Romie"- and we too have a care plan on every patient for activities. I consider it as important as any medication or blood test!!
I'm not going to spell out the obvious benefits of this new regulation but I will say that we can help with ADL's, ensure that the patient is getting proper medical care, a nutritious diet etc and still lose the point.
In any event it really never helps complaining about the things we can't change so I propose that we dive into this new reg with healthy enthusiasm and ask for more staffing in order to ensure compliance before the budget for extra staffing in order to comply properly goes to the Recreational staff!!
BTW a great idea is to photograph the patients during the activities and post the pictures on a tasteful bulletin board so that the patients, families and anyone "visiting" can see the good job that you're doing!

[CapeCodMermaid]

Ask for more staffing??? You might as well ask to be queen of France.

[Gabie Baby]

Originally Posted by catlady

Yah, can you just see one of those alert residents whining to the state that they got left off the last Wally World outing and now they're depressed--F-tag coming!

I wish I could say hang in there but I can't. I'm going back to acute care myself, and I don't want to come back to LTC. [b]You can never work hard enough or try to anticipate enough. You are always standing on the edge of that cliff LTC isn't about taking care of the elderly any more. It's about paper compliance and an institutionalized need for perfection that no one, even perfectionist me, can ever achieve. You never start out at 100%, you always start out at zero and have to prove yourself every day. You did a good job yesterday, and that means nothing today because you're starting at zero again. I hope you find something that will deserve your talents.

So how is long term care any different from acute in these areas?

[achot chavi]

Originally Posted by CapeCodMermaid

Ask for more staffing??? You might as well ask to be queen of France.

I've worked in several facilities (over 20 years) and I always make it my business to get along and befriend the administative staff (I never criticize and I stay supportive- with a little patience it works in my favor and I am able to get services for my patients and/or staff that we wouldn't have had otherwise) . I have learned that new guidelines that require additional hours of service (such as this ) frequently results in EVENTUALLY increasing staff hours in order to properly fulfill the requirement. Many facilities are already in compliance and they would be wise to let that fact be known, but if your facility has just thrown a new slew of responsibilities your way that will take time and manpower- you put up a brave face to start (be supportive- after all we WANT to be in total compliance) then show administation that it is stealing time from other (important) tasks- leading to an increase in pressure sores, infections, med errors,staff burn-out or fatigue. I usually keep a log of what my nurses are busy with every hour of the day in order to show administation that they are not just lazy (and I warn staff to look busy and not be caught on many long cigarette breaks and never be disrespectful of the administation). When I present it to administation, I explain that we want to give quality care etc but there is just a limit to what we mere humans can be pushed to. I do not criticize and if administation turns me down the first time I keep a smile on my face (never get angry it doesn't help) and ask them to think about it. I also present info on courses that are available to train my staff for this new responsibility. After all activities are not just Bingo- they are supposed to be therapeutic and effective. You wouldn't just blindly pull 5 pills out of the med drawer and give them to a patient and claim that they are receiving excellant medical care!!
I usually get a compromise ( not the queen of England!) and my staff appreciates it, administation appreciates it (beleive me there is more money there than you can imagine) and the patients benefit so the families appreciate it- we all come out a winner.
Lastly document, document, document and show photos of the patient enjoying the new activities on a bulletin board!