Assisted
Living, Nursing Homes, Adult Day Care and CCRC’s
are being built faster than we are turning out
experienced, certified and qualified Activity Directors.
Activity Directors who are experienced are switching
facilities and types of communities they work in
for many reasons. When a new director begins at
a facility often times the director jumps right
in to make changes with no clear vision or plan
for the changes. Here are some recommendations
before making changes and to help guide the new
director through the process.
Administrators should require that the activity
director report back in 30 days with written plans,
objectives and goals the new director wants to implement.
One week is just not enough time to provide a sound,
well thought out and effective plan.
1. On the first day,
the Executive Directors should provide to the Activity
Director;
job description,
facility department head names & phone numbers,
past survey results, Resident Rights, survey expected
visit date, state regulations, federal regulations
(Long Term Care), JCAHO requirements, policy and
procedure manuals, budget, dates / times of facility
meetings and resident council minutes. Additionally,
the Activity Director should be provided with an
Activity Care Plan Book, MDS book, spend down sheets,
staff budgeted hours and past Quality Assurance reports.
If, you are participating in services such as Press
Ganey, the Activity Director would need to see these
results and understand this program. If, you have
a board, community service board, organizations committed
to your community and or clergy committees, the Activity
Director needs to have those names and phone numbers.
Dates and times should be set up for the Director
to meet with these special groups and organizations.
The Executive Director
should plan enough time to go over these materials
with
the new director. At minimum three hours should be allotted for this meeting.
Additionally, the Executive Director should provide
in writing concerns,
expectations and time frames for meeting these expectations
An Activity Director
should never begin the job without this information.
For
example, it is amazing how many directors have never read the state regulations
and pending regulatory changes. It’s important
to note any regulations that pertain
to the Activity Department, documentation, position requirements, dementia
unit,
pet therapy, volunteers and resident rights. The director should have an overall
basic understanding of all the regulations. If
the director is switching from
assisted living to nursing home or medical adult day care setting, it is even
more
important that they understand the regulations. All of these tools will assist
the
director in having a successful outcome.
If, you have a consultant,
arrange a time for the Activity Consultant to meet
with
the new director. If this is a brand new director and new to the field, you
may
want to bring in a consultant for a couple of months as they can provide clear
objectives and time frames for meeting goals.
This may seem like
a little thing, but make sure the director has
office supplies.
Provide a tour of the community and give inside information like the best place
to
park or restaurants to order food from. It is amazing how many Executive
Directors do not provide a department head luncheon to welcome the new
department head. Finally assign a mentor that the new director can go to for
questions. All of these tips will ensure the new
director gets started on the
right
foot and that the Administrator and Activity Director have clear objectives.
2. The Activity Director needs to complete a comprehensive
assessment of the community as well as population
and calendar analysis. These tools can be purchased
at www.activitytherapy.com
3. Conduct a population and calendar analysis. The
new director must know the residents, diagnosis,
back grounds, interests, cultures, spiritual interests,
leisure pursuits and therapy schedules, etc. This
would include types of residents you have in your
community such as very low functioning, dementia,
high functioning, short term stay etc.
In designing calendars
to fit the needs of the populations it’s important to know your population you
are designing programs for. You also need to know
what your competition activity programs. You would
not to loose a potential customer because the competition
has trips and your community does not offer community
trips. Planning the programs is extremely important
as it pertains to your populations. If you’re
an assisted living community who does not allow aging
in place, you may have very high functioning residents
who want more community programs, trips, speakers,
intellectually stimulating programs, self esteem,
wellness and empowerment groups. Where a nursing
home may have lower functioning residents who may
need more tactile, relaxation, reminisce, music,
spiritual programs, intergenerational programs and
sensory enrichment programs. A facility that cateors
to dementia residents may need a more structured
program that is heavy in exercise, music, reminisces,
relaxation, spiritual and life skills programs. A
facility that is strictly rehabilitation and sub
acute may need more one on one programs tailored
to the rehab needs and out comes.
A population analysis
would clearly show the types of residents living
in the community and will guide
the director in types of programs required, interest,
cultural, religion, past interest, cognitive abilities
and design a program for the specific types of residents
living in the community.
4. The calendar analysis is also very important.
Traditionally, facilities had one calendar to fit
the needs of the residents. We now know that approach
does not work. Planned programs need to be designed
to fit all residents. As well as independent activities
need to be offered. Calendars need to be developed
based on function and cognitive levels, as well
as past interest, cultures, spiritual and past
/ current leisure pursuits. The calendar analysis
looks at what you currently have and guides you
in what changes you need to make based on the population
analysis. The calendar analysis will also show
what specific activities are lacking or that you
have too much of.
5. Tour the community
to note which areas can be used for programs, times
of day
they can be used, size of room and location.
6. Conduct a comprehensive inventory Q/A. The new
director needs to know what supplies the facility
has and where the supplies are located. Determine
if there is an MSDS for each product. Are their adaptive
supplies such as adaptive paint brushes, magnifying
glasses, and large print books? Are all electrical
supplies inspected yearly by the Maintenance director?
Once this is determined supplies can be ordered.
Anything that is not in excellent working condition
should be discarded.
The new director must
clearly know the budget. It’s a huge mistake
on the part of administration not to let the director
know their budgets. How are they expected to stay
in budget, if they do not know what the
budget is? Additionally, they
have
to be able to run their departments and the budget has to fit the size population
you have and their leisure pursuits.
What a complete waste
of money to order supplies that the facility already
has.
Once an inventory has been completed this will clearly show what supplies are
needed. The director should also prepare a wish
list of major purchases she
wishes
to purchase over the coming year such as computers, printers, piano, fish tanks,
sensory rooms, etc.
Additionally, note where
products are located for independent leisure pursuits
such
as computer / internet
access, library, games, puzzles, art supplies, videos,
CD’s, computer games, office supplies, etc.
Residents should have access to independent leisure
supplies. There should be a designated place that
residents can access these supplies “when awake” and
not be dependent on staff unlocking a closet or room.
7. Quality Assurance: For one week, the Activity
Director should document who is in program and
times the programs are beginning. Can everyone
participate and if not why? Are the programs beginning
on time and are their proper supplies. Are nursing
assistants assisting with programs? Are nursing
assistants assisting with transporting? Are there
clear lists at the nurses stations of program times
and which residents should be brought to programs?
8. Quality Assurance:
For one week the Activity Director should document
who
is not in program and
note the resident’s location. At 10:00 and
2:00 document resident names who are still in bed,
dressed but left in the room, dressed but left at
nurse’s station or in hallway. Meet with the
unit managers to determine why?
9. Quality Assurance:
Meet with activity staff and nursing to determine
residents
who are unable to participate in programs and why. This would also include
any residents who is ill, self isolator or refuses to attend programs.
10. Pull the group attendance, individual attendance
records and room visit attendance forms. Are these
current? Do you have these? There is no other way
to determine participation other than tracking group
and individual attendance. This is especially important
for residents receiving room visits. Are the room
visits happening? Are the room visits following the
care plans goals and interventions?
11. Quality Assurance: Review all charts to insure
that Initial Assessments, MDS, Care Plans and Activity
Notes are current, correct and up to date. Make
a list of any charts that are of a concern.
12. Meet with the resident
council as well as review old minutes. The Activity
Director
should look for
patterns and repeat concerns. Often times there are
not clear resolutions for resident concerns. Without
clear resolutions, residents believe that administration
does not care and that concerns go unresolved. Ask
the residents what their concerns, recommendations
and complaints are? It’s ok to ask! Don’t
we want to know first?
13. Meet with staff with in the first week and clearly
provide the expectations of the department, such
as programs starting on time, preparation for programs,
documentation expectations, etc. All staff should
sign in on a sign in sheet for every meeting. The
sign in sheet should clearly note using bullets the
agenda for the meeting. The director should find
out what concerns, suggestions and recommendations
the staff have and document this. Daily the Activity
Director should meet with the staff to go over changes,
new admissions, upcoming programs, etc. Recommend
purchasing a large hard back book (journal) vs. using
memo pads. This will help keep the director organized
vs. using many memo pads that require a search to
find a specific item. Highlight any item that needs
follow up and check off the item once you have completed
it. This hard back book should be used for all phone
calls requiring attention, meetings, department head
meetings, etc.
14. It’s important
to know the staffing schedule, days of the week
they are
working, hours they are working. Many communities
are learning quickly that they have to increase
these hours. Often time’s weekends have only
one activity professional working in the community.
Those hours need to be increased as a weekend
is no different than a week day. If you have four
full time workers Monday to Friday than you need
four staff on the weekends. You need proper activity
staffing for all the reasons you determined your
staffing patterns for week days. Determine what you are budgeted for and what you actually have.
15. Obtain the schedules
for the staff and volunteers and post it clearly
in the Activity
Office.
16. Determine who the
volunteers are and what protocols are in place.
In many communities
it’s amazing
that there are volunteers working in the community
and no one knows their name and worse, there is no
volunteer application on file. Every volunteer needs
a name tag; sign in procedures, clear chain of command,
volunteer policies and procedures, volunteer welcome
packets.. The new director should schedule a volunteer
meeting to meet with the volunteers and volunteer
clergy. After everything is completed in this recommendation
document, only than should the director begin recruiting
volunteers. The director should be getting a local
phone books and city news papers to familiarize with
the resources available in the local city. Policy
and procedures / welcome packets can be ordered through
www.activitytherapy.com
17. Q/A Pet Therapy:
Determine what pets are either living in the community
or visiting. Check to make
sure the health certificates are on file and current.
These should be updated yearly. Know the state regulations
pertaining to pets. Determine if you have policy
and procedures for Pet Therapy. Read the state regulations
regarding pet therapy, visiting pets and live in
pets.
18. The Activity Director
should meet with the directors of house keeping,
maintenance and dietary to understand
what the expectations are for their departments and
what their needs are in meeting the goals of the
activity department. For example, Activity Directors
can not give 30 days worth of food requests on the
1st of the month, as the director needs time to order
and plan the budget around these requests. The dietary
director should be getting these food requests at
minimum no later than the 20th of the month for the
next month.
Once this is completed, the Activity Director would
go over the typed report with the Executive Director
of the findings, plans, objectives and time frames
for implementing the goals. The Activity Director
should review this report with the Activity Department.
The Activity Director
should not throw out any files from the director’s
office but simply box it up and store at least
for one year. You never know
what you may be throwing out.
If these steps are taken the new director should
have a smooth transition into the new position and
will guide the director in the necessary steps to
be taken.
See www.nccap.org for Activity
Certifications and a list of instructors for MEPAP
Revised courses.
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