By Kevin McElroy, Administrator
Avalon Garden Nursing Home
St. Louis, MO
314-752-2022

Nursing Homes are facing numerous challenges and changes as we move into the new millennium. State and Federal surveys are getting tougher and more punitive. Assisted Living and other retirement communities are taking away more slices of an already small pie. And the consumers themselves, our residents, are demanding more services and care than even a decade ago.

The nursing homes that will survive in the future are the ones that realize it is their job to meet all of their residents needs. It isn't just about feeding, changing, and medicine anymore. It is about socialization, spiritual life, and friendships as well. It is making sure residents are satisfied emotionally as well as physically.

One of the ways nursing homes achieve this is through a vibrant, diverse activity program. Activities tends to be one of those areas that is extremely easy to implement yet seems to get overlooked by many homes. Activities is not putting in a movie in the VCR and having a bingo game once a week. A true activity program should be designed to meet the residents social, spiritual, and emotional needs.

And the activities program is an area that state surveyors will be paying more attention to in the future. Here are the "10 red flags" that surveyors will look for in regards to activities:

1. The activity area is too noisy or too small. You need to make sure that you have areas that are adequate to meet the needs of the residents for that activity, and that the area is not constantly being interrupted by outside noise or incidents.
   
   
2. There are long periods of time with no activities. No one expects there to be activities taking place 24 hours a day, seven days a week. But each day on the activity calendar should include numerous activities the residents can choose from, and should be taking place during the morning, afternoon, and evening times.
   
   
3. There are insufficient supplies to meet resident needs. Facilities should make sure there is enough money in the activity budget to give the activity staff the tools they need to put on a creative, exciting activity program.
   
   
4. Residents appear bored, sleep through activities, or do not attend. Facilities can no longer blame low attendance on the residents "not being interested." If the residents are not interested, then the facility is presenting an activity program that is not meeting their needs! Activities are designed for the residents, not for the staff.
   
   
5. Activities insult the dignity, intelligence, and/or age of the resident. Activities should be designed to meet the residents interests and abilities. I have seen many homes where residents are sitting around a television watching children's cartoons or children's television programming. There is nothing wrong with allowing residents to watch TV if they want. But instead of "Sesame Street," put in a classic movie, the news, or other programming that the residents say they would enjoy.
   
   
6. Facility cancels activities, or does not follow schedule. It is up to the facility to ensure that not only they create an exciting, interesting activity calendar, but that they actually follow it! While sometimes things may come up that make changes unavoidable, for the most part the facility should strive to follow the calendar.
   
   
7. No observation or documentation of specialized programs for bed/ room bound residents. The facility must provide activities for all residents, not just the ones who are able to make it to the activity room. Also, ask if there are things you could do for the resident who is bed bound to make the day seem more promising, such as bringing in books on tapes, movies, or daily 1-to-1 visits.
   
   
8. Facility staff does not invite or help residents to activities. The facility has more responsibility than just putting up an activities calendar. Staff should be constantly encouraging residents to attend activities, and helping those who need help to get to the activity. The resident always has the right to refuse to go to an activity, but sometimes residents need a gentle nudge to encourage them to get involved.
   
   
9. There is insufficient staff to meet resident needs and interests. The activity department must be staffed appropriately to make sure there is enough manpower to put on the type of programs residents need and deserve. Facilities can also work on developing a volunteer program to supplement and support their activity staff.
   
   
10. Activity staff are the only ones involved with activities. One of my catch phrases I use a lot is "it's not just one person's responsibility, it is everyone's responsibility." This holds true with activities. It is up to everyone to help ensure residents are getting involved and getting the assistance they need to participate in activities. From the housekeeper to a CNA to the Administrator, sometimes an encouraging word is all the resident needs to get involved.

A successful activities program requires everyone's help and assistance. We are hired to meet ALL of our residents needs, and this includes activities. Encourage and support your residents to get involved, make friends, and socialize with others. This will not only help their emotional health, but a positive mood will help their physical health as well. Your help can make an activity program more dynamic and interesting for all of your residents.