ANOTHER new CMS guideline

Daytonite, BSN, RN · Jul 6, 2006

I agree 100% I would hate to be stuck in a chair wanting to go out but not allowed for one reason or another. But..on the other hand when I get old I am looking forward to just having to sit and watch tv instead of having to take someone out to walk. I hope by the time I reach the nursing home I have walked and ran all I am capable of and done all I want to do so that all that is left is sitting and watching tv.

OMG! :eek: I'm ROTFLMAO! Save a chair next to you for me! Screw Bingo, fingerpainting, and popsicle stick art! :roll

ktwlpn, LPN · Jul 6, 2006

What's with the federal government??? Here we go with another new CMS guideline...went into effect June 1. Tag 248...activities...yes ladies and gentlemen, your facility can now get cited at a G-actual harm level- .

That is exactly what we got dinged for,also someone in the kitchen was working on the tray line and left it to get something out of the fridge and did not change gloves. Nursing got lightly spanked for the "unnecessary drug" protocol regarding sleepers.Which I just don't get-we have had behavior monitoring in place for ages and it's the quality control nurse's gig to go to each unit and check for the proper documentation.As far as I know the nurses involved were not counseled in any way but we on day shift were told we need to check every am for any prn's that were given the evening prior and to make sure the documentation was completed....The residents and some families don't get it,either.I admitted a gal who have been taking a sleeper every night for 30 years.You should have been at the first team meeting with them....The activity thing is a freaking joke-our staff work Monday through Fri and each one has to do a Saturday on a rotating basis.Sat was always for whole house activities .Because the state focused on the folks that can't get up and go on their own those activies are now dc'd...The staff has to work additional weekend hours (are they having a fit) and a majority of their time is now spent one to one with un-responsive residents.I do think they all should be working every other weekend just as nursing does-however they all spend so much time on documentation and preparing for an activity that they never seem to have much time for the actual activity....Last LTC I worked in only the dept head did the MDS-the activity "aides" had a simple flow sheet for each resident. Their dept head said in the interview with the surveyors that "It's nursing's job to get the residents to the weekend activities" That was news to us-we have the bare bones staff on the weekends.....Oh well- They showed up on a SATURDAY MORNING this year-next year can't be any owrse then that...The woman on my unit is a former DON and what a sourpus miserable broad she is.....I hope she retires soon

night owl · Jul 9, 2006

when I get old I am looking forward to just having to sit and watch tv instead of having to take someone out to walk. I hope by the time I reach the nursing home I have walked and ran all I am capable of and done all I want to do so that all that is left is sitting and watching tv.

OMG! I'm ROTFLMAO! Save a chair next to you for me! Screw Bingo, fingerpainting, and popsicle stick art! :roll

This IS funny. The other day after the residents had breakfast, they were sitting in their geri-chairs/w/cs and snoozing. I said to the lady standing next to me, "Look at them all sleeping like babies... I can't wait for those days!" Lord knows we will certainly have earned the right to sit and sleep or watch TV. Where's that remote??? Better days are ahead! :biere:

weirdRN, RN · Jul 9, 2006

:yeahthat: Amen! Makes you wonder where it will ever end! There is just no getting ahead in this game and I am pretty anal about it all too. Unfortunately I have 20 years LTC experience - but nothing else. Not sure who would want me now.

There are lots of options. Nothing is forever. with 20years experience, I bet you could land a M-f 9-5 office gig if that was really what you wanted.

romie · Jul 9, 2006

I am really shocked at the negative attitudes of nursing towards the professional activity field! What ever happened to the PERSON centered organizing framework for nursing care? Isn't ACTIVITY a basic function of nursing? Get out your nursing theory books and re-read what Nightengale, Imogen King and other giants of nursing theory said about ACTIVITY.

To clarify, regulations regarding activity of LTC residents have been in place for years, only the guidelines have been revised. A major change in the guidelines is that the facility has to show some kind of evidence that other departments besides the Activity Department are involved in activity planning and implementation.

But remember that Activity is more than bingo, bible study and bunco! Every time a CNA walks into the resident's room, they could ask the resident if they want to watch TV. Each time a nurse looks in on a resident is an opportunity for reminisence. A laundry worker could give a resident his or her clothes to fold, a dietary worker can give a resident a table to set, provided the resident wants to engage in practical domestic activities and derives a sense of accomplishment and pleasure from being productive.

It is my hope that the new guidelines will cause subpar facilities to get tags and force them to hire additional activity staff and pay their existing activity professionals a decent wage. You would not believe that some activity directors make less than CNA's do! In the end, I sincely hope that the quality of life of all LTC residents improves. If you look at the best SNF, they all have amazing activity departments and interdepartmental cooperation.

weirdRN, RN · Jul 10, 2006

I am really shocked at the negative attitudes of nursing towards the professional activity field! What ever happened to the PERSON centered organizing framework for nursing care? Isn't ACTIVITY a basic function of nursing? Get out your nursing theory books and re-read what Nightengale, Imogen King and other giants of nursing theory said about ACTIVITY.
To clarify, regulations regarding activity of LTC residents have been in place for years, only the guidelines have been revised. A major change in the guidelines is that the facility has to show some kind of evidence that other departments besides the Activity Department are involved in activity planning and implementation.
But remember that Activity is more than bingo, bible study and bunco! Every time a CNA walks into the resident's room, they could ask the resident if they want to watch TV. Each time a nurse looks in on a resident is an opportunity for reminisence. A laundry worker could give a resident his or her clothes to fold, a dietary worker can give a resident a table to set, provided the resident wants to engage in practical domestic activities and derives a sense of accomplishment and pleasure from being productive.
It is my hope that the new guidelines will cause subpar facilities to get tags and force them to hire additional activity staff and pay their existing activity professionals a decent wage. You would not believe that some activity directors make less than CNA's do! In the end, I sincely hope that the quality of life of all LTC residents improves. If you look at the best SNF, they all have amazing activity departments and interdepartmental cooperation.

I admire your ambitions, and respect what you are trying to do. However, the facilities will not hire more/new staff. They will continue to burn out their existing staff with additional duties. And whether or not you appreciate it, activities are many of the things that people do everyday but do not document.

banditrn · Jul 11, 2006

When we had the meeting about this at our facility, I was thinking about what 'I' would want if I were a resident.

My #1 desire would be - to be left the heck alone!! I want to sleep late, drink coffee all day, and watch TV until 2AM. I don't eat breakfast now, so why would I want to suddenly start? I also don't play bingo, or do crafts, and I darn sure wouldn't want to make cookies - I hate baking!

I'd probably be labeled a recluse because I didn't want to go to activities.

CapeCodMermaid, RN · Jul 11, 2006

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".

CoffeeRTC, BSN, RN · Jul 11, 2006

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".

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

romie · Jul 11, 2006

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 · Jul 16, 2006

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, RN · Jul 16, 2006

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