Quality of Life Programming

"On a Wing and a Prayer and a shoestring budget!"

Existing Standard Reference: Appendix PP SOM 483.24 (Rev. 225; Issued: 08-08-24)

The Requirement of §483.24(c) Activities is that the facility must provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community.

Intended to ensure that facilities implement an ongoing resident centered activities program that incorporates the resident’s interests, hobbies and cultural preferences which is integral to maintaining and/or improving a resident’s physical, mental, and psychosocial well-being and independence. To create opportunities for each resident to have a meaningful life by supporting his/her domains of wellness (security, autonomy, growth, connectedness, identity, joy and meaning).

Key action words that grab my attention of F679 are MUST, EACH and IMPLEMENT. So, what if I told you that CMS provides no allocated funding for this requirement but rather it is up to each facility to fund its activities program. Budgets from facility to facility range from no budget to $1,000's of dollars allocated. Quality and quantity also vary greatly. What does remain the same it each resident is expected to have an implemented activity program that meets the requirements intent. The program should be soundly based and constructive from lifelong and intimate knowledge of the person it is being designed for at a level of participation that can produce meaningful outcomes for that individual.

As with any functional post-acute system, it starts with the standard—in this case, regulation F679. The other elements of the system should be designed around this standard. These elements include the budget, needed supplies, assigned accountability, and designated responsibility for each task. Additionally, education modules, necessary documentation, quality measurement, tracking, benchmarking, satisfaction methods, and communication expectations are crucial. Most of these elements are implemented into policy and procedure formats that should be updated annually and as needed.

Ask yourself when is the last time that you've seen CMS or resident advocacy groups provide reasonable statistics related to activities programming much less one that has benchmarks and outcomes highlighted? Well, research is out there and there are a few specialty groups that do have focused information. For example, in 2016, Activity Engagement: Perspectives from Nursing Home Residents with Dementia - PMC; and Home - NursingHome411 1990's Fact-Sheet-Activities-Staff.pdf

Over my career I've had the pleasure to see and be part of some very meaningful and purposeful activities that not only changed the industry but changed lives. You've all heard of dementia care units as a touted specialized location for those suffering from memory issues. Back in the early 80's there were no such unit. So, on a wing and a prayer we created what we touted as the C.A.R.E. unit. The budget was simple, 80% census or more and the facility would make a profit. It was developed simply based on the understanding that environment would mean everything to our residents who needed to roam and be safe. The Controlled Alzheimer's and Related Disorders Environment (C.A.R.E.) unit was a prototype of today's care standard but with one exception - not electronic security benefits, monitoring bracelets nor locks. Yet it worked!

How successful was it without modern advances?

• Entry was by two doorknobs being turned in opposite directions which triggered problem solving thought and dexterity.

• Community living area and the dining areas were built so these integrated around the nurse / staff stations

• It was considered a 'privilege' for staff to be offered a position on the unit, and they were rewarded financially and with favorable schedules.

• Caregiver and nurse consistency was a key component and scheduled were consistent. It created a routine that the resident became familiar with and expected resulting in little to no acting out behavior triggers.

• Disruption to the CARE Units schedule were not tolerated unless absolutely necessary. This included staff, visitors and the residents themselves.

• A higher level of supervision was given to the food, snacks and hydration system by the on-site RD and staff of the unit. A high-level system that very few even know to provide in today's units. For example, each resident received their preferred meal for breakfast, lunch and dinner and was not limited to "what's on the menu today?" often practiced as the standard of care for facilities.

• Activities were carried out by ALL staff even the nurses and aides. They were expected to be part of the fun and were assigned their "special" person when they signed to become part of the CARE Unit. This meant that YOU focused on this individual to eat, drink, have fun, sleep well, walk, dress shower, etc. If there was an issue YOU were always expected to be part of the solution.

• 12-hour shifts were not the norm back then but that is what was implemented and proved to be effective. It was a start and end your day of work at 6:00 for day and night shift.

• The CARE Unit schedule was clearly defined for DAY and NIGHTTIME both for staff and resident. Everyone knew what to do and when to do it. If you were not part of the CARE Unit and worked in other parts of the campus you knew it as well. Loved ones knew and quickly found where their interactions were most rewarding and beneficial.

• It was where pet therapy was grounded and where raised garden beds and courtyard BBQs and horticulture thrived.

• The unit has 18 residents, and we opened its doors with a full census of both Medicaid and private pay clients. The waiting list grew to support a constantly full house.

  
  

The CARE Unit concept directly relates to fulfilling regulation 483.24 F679 and its intent of the activities program in the most comprehensive and thoughtful of system. Having the support and respect of all who work as a UNIT will deliver quality of life to each involved.

Share your activity program or UNIT success stories with us!

reta@cltcinc.com

Game on!