Free CEUs through Alzheimer’s Care Guide

Dietary and Nutritional Guide for Alzheimer's

Wake Up! A Sensory Stimulation Program

Wilfrid Gordon McDonald Partridge

Activity Planning Workbook

Mothballs In My Attic

Care Plans for Dementia Clients

Inservices to present for staff

Sensory Inservice

Products Listing

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August 2005 Issue

In This Issue:
1- Free CEUs through Alzheimer’s Care Guide
2- FTAG 248 is changing: ARE YOU READY?
3- New Products - Resident Rights Prints
4- Resident Right In-Service Now available.
5- Resident Council / Client Council Meeting Forms
6- Resident Councils, The Watch Dog for Resident Rights
7- Trending Resident Council Minutes
8- How to be prepared for state inspection and Resident Council?
9- Involving High Functioning (Room Bound) in Resident Council
10- Resident Council Products: Please see our web site for free resources.
11- New Products: We have 150 new sensory line of products by Abilitations/Spacekraft www.activitytherapy.com

FTAG 248 is changing: ARE YOU READY?

FTAG 248 is changing: Are you ready? “Activities: The facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental and psychosocial well-being of each resident.” If you are not familiar with F248 and 249 and the interpretive guidelines, you can purchase the book through American Health Care Association located in Washington DC, Titled, The Long Term Care Survey. Pay close attention to the interpretive guidelines. You can also purchase a video titled “surveying the activity department” through Heaton Resources. This is the training video for surveyors.

What this means in changes to come either in the regulation or interpretive guidelines, is that every single resident must have appropriate programs to fit their needs through large or small groups and one on one. Many facilities are still using one calendar instead of multiple calendars to fit the needs of the dementia clients and the low functioning. If you have not completed a population analysis and a calendar analysis, we strongly advise that you purchase these forms and make changes based on the findings from theses analysis. You can purchase at www.activitytherapy.com. Observe your programs just as a state surveyor would. Can every resident in that program participate. Walk around your building. Make a list of every resident who is not attending and determine why and implement programs to fit their needs.

One big change that every facility will need to address, is sensory rooms. All facilities will need to have sensory rooms. It’s not a state recommendation or a federal requirement. But in an average building size of 230 clients, you have at least 40 residents who can not participate in the currently scheduled activity because of their illness or cognition. Sensory rooms are recommended for this segment of your population. Many of these clients have been identified on your quality indicator report as “little or no activity.” A sensory room makes sense as it can accommodate large groups who need stimulation. The sensory room is not a warehouse room. There should be ongoing stimulation while the clients are in this room such as hand massages. You should be documenting in their care plans if they are attending the sensory rooms. Prior to care plan meeting document their participation in the activity notes or interdisciplinary notes. If you don’t have space for a Sensory room, try placing it against the back wall of your dining room.

Sensory rooms can be used for dementia clients, NPO programs, pain management, depression, end stage hospice, just to name a few. It is also an excellent room for families to spend time with their loved ones who can no longer communicate. Families who bring small children also enjoy this room as it’s interactive and fun. Staff should be encouraged to use these rooms for stress relief as facilities are required to provide stress programs for their staff.

We offer 150 sensory products, sensory room policy and procedures, in-services and care plans for sensory rooms at www.activitytherapy.com/store

Besides sensory rooms, you could also have fish tanks, aviaries, fake fireplaces, pet therapy, aroma therapy and pretty gardens to provide stimulation for your low functioning clients.

Additionally, long term care facilities are about 80% dementia. This clearly shows the need for dementia activity programming. Your facility may not have a dementia unit but that should not stop you from beginning a dementia program. If you need suggestions for activities, see www.activitytherapy.com. We also have several great books such as Wake Up and Activity Planning Work Book both offer excellent ideas for activities.

Facilities will need to look at hiring more staff for the recreation department in order to accommodate the changes to come. The surveyors will want to see more staff involvement, especially by the CNA’s. One big citation that we are seeing is for “lack of supervision in the day rooms.” Either no one is supervising the dementia or low functioning clients or the day rooms are too crowded with only one activity assistant in the room. This will no longer be tolerated. This is due to the increase in accidents and incidents in the day rooms that are left unsupervised during the day or at night or over crowded conditions and not enough supervision. Many facilities are now offering programs 7 days and 7 nights a week. We recommend ordering Surveyor Guidebook on Dementia, Evaluating Compliance with Regulatory Requirements which can be ordered through American Health Care Association.

According to the Alzheimer’s Care Guide, July / August 2005 Issue www.care4-elders.com “An early draft of the proposed new guidelines stressed activities need to include those that are not childish, are mentally stimulating, are relevant to gender, are related to the resident’s areas of previous work and interests, allow for socializing, are conducted outdoors whenever feasible, are related to residents hobbies, are connected with the community groups and involve outings outside the residence, provide training in new areas of learning and more. In addition to all that, they’ll dwell considerably on making sure residents also have activities that are specifically therapeutic to their various individual medical situations and problem areas. Plus they’ll emphasize the types of equipment to be used in the various therapeutic activities and in improving the situation with residents who have impairments, such as hearing and sight.” This would include sensory rooms, pet therapy, aroma therapy, dementia activities, out door gardens, daily exercise and music programs, etc.

We strongly recommend this resource if you do not currently receive the Alzheimer’s Care Guide Activities Guide. You can order through www.care4elders.com or call 319 563 0642

Trending Resident Council Minutes

It is important to not only have a Resident Council meeting monthly but to trend the minutes yearly. This should be a yearly Q/A. Once a year, prior to your survey window, review all resident council minutes. Look for trends and repeated complaints. Often times when we survey facilities, we find that the Resident Council Minutes are not complete, lack appropriate responses and follow up for issues, and no proof that the issues have been resolved.

When a Resident Council Meeting is held. First make sure that the residents have complete privacy, by placing a sign on the door that says, “Do Not Enter, Resident Council in Session.” If a staff member is responsible for the meeting taking place, be sure that all residents are aware of the meeting. No staff member is allowed to enter the meeting unless invited. If staff are attending, have staff sit with the resident’s vs. lining up the staff in front of them. When you do this, it establishes department heads against the residents instead of everyone working together to resolve concerns and suggestions. Always have food and microphone.

Once the meeting is underway, insure that all participants have a copy of the last meeting’s minutes. The minutes should be typed in 14 point, not hand written in pencil. The minutes must show clear resolutions. Note the concern and what action was taken. The department head that the problem was addressed to should formally answer the concern and provide proof (in writing) that the issue was resolved. The department head should sign off on all issues with the date the issue was resolved, their name and title. The resolutions must be turned into the Activity Director or Social Work Director that runs the meeting at minimum a week prior to the meeting.

The resident council minutes should not identify a resident by their full name. Keep a separate piece of paper with the residents name on it for personal items that need to be addressed, such as leaky faucet. If it’s a resident right issue such as abuse or neglect, investigate this immediately. It is against their resident rights and right to privacy to place their full name on the minutes.

The minutes should be grouped in categories by departments to make the report easy to read and follow. If there are issues that can not resolved by the next meeting, state why and what action is being taken.

If you provide a written report to the participants, it cuts down on comments, like, “No one does anything about it, nothing is resolved!” Because they will have written proof in their hands that concerns and suggestions are taken seriously.

You should develop a form that list the concern or suggestion, department responsible for the item, resolutions, department head, date and signature. The cover page of your report should list: Date of meeting, Time began and Time closed, residents and staff in attendance, New Minutes and old minutes. But the actual concerns should be listed on a form that is easy to read, vs. a report style document. Forms are available at www.activitytherapy.com
Be sure to keep a file that contains the last three months of the council minutes and provide to state surveyors if requested.

One thing to pay close attention to is a Resident Council report that has no complaints, concerns or suggestions. No facility is perfect. Could this be a toxic environment and residents are afraid to voice opinions? Do they feel nothing is resolved? Are they afraid of getting someone in trouble by complaining? You need to hear it first vs. a state surveyor reporting this issue to you. You can’t fix it if you don’t know about a problem, concern or suggestion.

Once a year, review and trend all the resident council minutes. Begin by taking a piece of paper and writing down in a column every resident concern, recommendations and issue. Next place a hatch mark next to the item, if, it comes up more than once. If it does, how have you resolved this issue? For example, the resident complains over and over again about the food. Did you begin a Dietary Committee? Or there is on going complaints about the temperatures of the food such as being too cold? Did the Dietary department conduct a quality assurance addressing temperatures? These responses, investigations and quality assurance reports need to be included in the resident council resolutions.

Once you have identified repeated concerns, you must work to eliminate this issue. Generally, the dietary department takes the most criticism because of many reasons. The food may not be prepared or seasoned the way the resident may have prepared the item at home. Some concerns can be resolved.

There are some administrators who do not want a lot of complaints at the resident council or do not want additional Empowerment Groups such as Activity Planning Committee, News letter Committee, Trip Planning Committee and Dietary Committee because of the belief that all residents do is complain. We stress the importance of having as many empowerment groups as possible. Its shows a healthy emotional environment vs. a toxic environment where residents live in fear of retaliation if they complain. It also shows that you value their opinion, makes them feel they have self worth and provides something to look forward to. The other thing to note is its better to hear a concern at the meetings vs. having a state surveyor bring it to you. Its better that you hear it first. Residents don’t need our permission to meet informally or formally. So, why not plan these empowerment groups and encourage participation. Minutes from these empowerment groups should be included in your resident council meetings.

If, the resident council meetings seem over powered by Dietary Issues, than begin a Dietary Committee. Let the residents have input in planning one meal a month, eliminating items that residents overall do not like and adding new items to the menu. The Dietary Director could bring samples to the meeting of new items the department is looking at. Also bring cook books for residents to look at in planning a Resident Choice Meal. This type of committee builds strong rapport with the Dietary Director and empowers the residents to play an active role in this area.

How to be prepared for state inspection and Resident Council

If you’re holding monthly resident council meetings and are following up on every issue immediately, you will have no surprises. If you have not implemented more empowerment groups and the environment is toxic, than it can be guaranteed that the first time you hear of an issue will be from a state surveyor. There should be no surprises during an inspection. We caution you not to pump the residents for information about the “group meeting” with the inspectors.

Action steps to prepare for state inspection:
1. Trend the resident council minutes.

2. Begin asking the exact same questions the surveyors will ask in the group meeting. These questions can be found in the Long Term Care Survey Book. The page is found in front of the book and is titled: Quality of Life Assessment, Group Interview. Document the questions and responses. Assisted Living does not have federal guidelines but it is recommended that Assisted Living and Adult Day Care follow the same guideline questions for your council meetings. You can purchase the book from American Health Care Association in Washington D.C.

3. Each month review one resident right with the Resident Council. Ask the Social Worker to review the resident right. Place the resident right to be reviewed on the Activity Calendar in bold print and in the newsletters.

4. Provide a form for high functioning residents who do not attend the meeting to complete. The form should ask for their suggestions or concerns. Do not give their name at the meetings. Present their comments at the resident council meetings.

5. Keep a folder of all resident council meetings and label this folder, “State Surveyors Ready File.” This file contains the resident council minutes with resolutions and activity calendars. For the activity calendars, bold anything on the calendar that you want surveyors to be aware of such as trips, intergenerational events, pet therapy, empowerment groups, etc.

6. Meet with your volunteer ombudsman if you have one. Each time the volunteer is in the building, have an exit meeting and document all concerns or suggestions and follow up. The volunteers do complete written reports of each visit and submits their reports to their volunteer coordinator with the agency they are working for. In turn, these are submitted to state surveyors. The volunteer ombudsman should not be attending the resident council meetings unless invited. Families should never be allowed to attend these private meetings.

7. Hold monthly Administrators Tea’s for the highest functioning residents. This should be a very formal event, with china and a special snack. This is not a complaint session rather a time to gather and discuss an issue, such as how the residents planned for a special holiday in their home. Have an topic to discuss and props to go with it. It should be 45 minutes long. This provides a forum to build a relationship with the administrator and sets the tone for an “open door policy” to the administrator. Residents will come to the administrator if they develop a rapport

8. Prepare a list of the residents names who will be attending the group meeting with the inspectors and keep in this folder. It should contain 5 resident names. Do not invite the entire resident council to the surveyor’s group meeting.

9. Prepare “Do Not Enter Signs Resident Council in Process” for all doors leading into the room where the surveyors will be meeting with the residents.

10. Type up the names of the residents (5) who will be attending the group meeting and present to the surveyors during the entrance meeting. It’s is good to provide the resident names so that they are aware in advance of who will be attending the meeting. You only need 5 names. It is a sampling of the residents who attend the meeting and it should include the executive council if you have a president and vice president.

11. Work now to recruit a President and Vice President of the resident council.

12. Play a monthly resident rights bingo.

13. Yearly update the charts to show residents have been advised of their resident rights.

14. At every council meeting, note in the minutes that you have discussed where the resident rights are posted.

Resident Councils, the Watch Dog for Resident Rights

Sharon McIntyre, ACC - Executive Director

The Resident Councils of Washington
Recently resident leaders of the Resident Councils of Washington gathered to review the organization’s purpose and mission. It became clear to the group that although most should know who residents are, the group concurred that it is important to educate others to dismiss the myth of “ageism” and “disability” as it is associated with an individual living in long-term care.

The group defined residents of the Resident Councils of Washington as to (1) people living in assisted living and nursing homes (2) the eyes and ears and voice of their friends, roommates, and family members of long-term care & (3) organized to ensure and strengthen rights, self worth, independence and values. The group recognized individuals residents by their beliefs, interests, education, passions and began to share stories about their past, through careers and families. Age and disability became secondary to the discussion.

Rights we are born with are often challenged as our healthcare and environment changes and we become more dependent on others. We do not check our beliefs, interests and skills, education and passions at the door as we enter an assisted living or nursing home. These possessions we carry with us for life so why does it seem increasingly important that we focus on our rights? These are rights that we are born with such as the right to participate in our own plan of care, manage our own finances, right to privacy and to freely communicate with others to name a few. Survival elements may seem to have the highest priority such as shelter, food, water and medical care but as we all know, these elements do not define the individual. Residents still cherish the right to make a difference, to contribute, to help others who cannot.

A resident council’s primary purpose should be to create opportunities to execute meaningful decisions. The group should have the potential to identify needs and interests, prioritize their top issues and take action. The group provides the forum for residents to share in private their ideas and concerns. The process of sharing their talents, beliefs, passions and education may be more important than the outcome, but having tools to continue to make a difference builds self esteem and residents begin to gain back what they may have lost or what might be perceived by others as low priority.

Resident councils can effective, ensure residents rights, build self esteem and voice concerns of their friends who cannot. Resident councils are first and foremost for residents building on their rights of life, liberty and the pursuit of happiness even though all residents have rights guaranteed, under the U.S. Constitution and the Bill of Rights. Resident councils have the potential to empower, inform and stimulate residents. We must not give up on Resident Councils as the answer and right to meaningful decision-making. What other opportunities are there?

The Resident Councils of Washington recommends their book, The Resident Council Handbook as a guide to help residents create or restructure resident councils in health care facilities. It is available through activitytherapy.com.

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Kaleidoscope Company

AgeCare, LLC.

Cambridge Health Care

Alzheimer's Project of Tallahassee, Inc

Hodes, Ulman, Pessin & Katz, P.A.

Bergen Regional Medical Center

Dorson Home Care, Inc

Bettye Williams Prints

Resident Councils of Washington

Certified Nursing Assistants

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The Canterbury at Cedargrove

The Buckingham at Norwood

Stratfod Manor

Windor Gardens

The Fein Group

Creating Moments of Joy

Dementia Relaxation Videos

Ethics Resource Company

GoodLife Adult Daycare

Parkway Manor Health Center

iconlogic

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Galleria del Lago

Families of Loved Ones

Mothballs In My Attic

The Activity Director's Office

Elder Rage

Quality Care Consulting Company

Idyll Arbor Long Term Care Resources

Accu-Trace, LLC
Employment Screening Services

New Lifestyles
The Source for Seniors
Area Guides to Senior Residences and Care Options
www.newlifestyles.com

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