This book gives you the latest information about working in long-term care facilities, assisted living centers, and adult day health centers. It is also an excellent reference for working in retirement communities, community centers, and wellness programs. The information includes: *The latest information on the survey process, including the new F-Tags *Designing person-centered activities for all cognitive levels and physical abilities *Culturally appropriate environments and resident rights *Programs for your unique setting *Assessment, care plan, and documentation guidelines *Specialized programming for less-responsive clients *Federal regulations and accreditation standards *Your role as an advocate for families and significant others *Working as an interdisciplinary team member This book is important for: *Activity Professionals, Social Services Professionals, and Recreational Therapists *Administrators, Directors of Nursing Services, and Staff Developers *Other professionals currently in convalescent care, assisted living, adult day programs, community centers, and retirement communities *Activity Professionals enrolled in approved professional training courses *Consultants who want up-to-date information about the current regulations for activities, recreational therapy, and social services *College classes for students studying gerontology and health sciences *Workers in related service fields (community-based recreation programs) who want to know more about their clients and how to design wellness-based programs Caring for the people we serve is rewarding and meaningful work. Aging well and quality of life issues are at the core of our work. Providing activity programs specifically designed for each person we serve fills a universal need for empowerment. It is an invaluable, hands-on resource with practical, down-to-earth information on the latest changes to federal regulations, including the new F-Tags and the emphasis on the culture change movement. As the positions described in this book continue to increase in responsibilities and importance, we will continue to provide the resources you need to work as a professional and provide quality care. Chapters Table of Forms ix Index of Activities xi Acknowledgments xiii Purpose xv 1. Introduction 1 What Has Changed 1 Culture Change in Long-Term Care 2 The Settings in Which We Work 4 What's in this Book 8 Terminology 10 2. The People We Serve 13 Theories on Aging 13 Demographics of the People We Serve 15 Myths and Realities of Aging 2000 18 Older Americans Act 20 Imagine Yourself at 84 20 Psychosocial and Behavioral Health Issues 20 Diagnoses and Chronic Disorders 29 MDS List of Active Diagnoses 30 The Diagnostic Intervention Grid 31 Neurological Disorders and Psychiatric Disorders 41 Sensory Loss 45 Saying Goodbye: The Way We Grieve, the Way We Die 46 Hospice 48 3. The Work We Do 51 Our History 51 Professional Organizations 54 Professionalism 55 Activity Professional 56 Activity Consultation 62 Social Services Professional 62 Recreational Therapist 70 Teamwork 74 4. Resident and Facility Environment 75 Cultural Competency 75 Cultural Environment 80 Personal Environment 81 Spiritual Environment 82 Physical Environment 82 Working Environment 88 Environmental Assessment Form 88 5. Meaningful Person-Centered Activity Programs 93 The Wellness Tree of Life 93 Person-Centered Activity Programming 97 Discovering the Person 98 Cognitive Activity Levels 102 Designing Physical Activity Programs 105 Physical Function and Common Medical Disorders 108 Activity Needs Assessment 110 Activity Review Forms 118 Social Services Review Form 123 OBRA '87 Interpretive Guidelines Tips 126 6. Meaningful Person-Centered Activities 129 Activity Suggestions 129 Participant, Activity, and Leader 130 Culturally Accessible Activities 130 Challenges and Techniques of Group Work 134 Leisure, Leisure, Leisure 135 Leisure Room 136 Person-Centered Activities 138 Activity Supplies 139 Activity Analysis 141 One-to-One Programming 143 Multi-Sensory and Multi-Level Theme Activities 145 Theme Weeks 145 Intergenerational Programs 150 7. Specific Programs for Dementia and NCDs 155 Sensory Integration and Sensory Awareness/Sensory Stimulation 155 Programming Overview 155 Sensory Integration 156 Sensory Stimulation 160 The Sensory Box 180 Activities for Individuals with Cognitive Impairments 181 Orientation Book 182 8. Programs for Individuals with Mild to Moderate Cognitive Impairments and Dementia 191 Validating Activities 191 Remotivating/Reminiscing Activities 195 Resocializing Activities 197 Men in a Women's World 210 9. Short-Term Stay: Rehabilitation-Oriented 215 Cognitive Stimulation and Retraining Activities 215 Short-Term Rehab Activities 223 Community Integration Activities 227 10. Documentation 229 Documentation Principles 230 Introduction to Required Documentation 231 Activity Documentation 237 Social Services Documentation 238 Recreational Therapy Documentation 239 11. Assessments 241 Initial Assessment 241 Barbara's Story 243 Activity Assessment 245 Social Services Assessment 249 Recreational Therapy Assessment 254 Standardized Scales and Assessment Tools 254 Discharge from the Nursing Home 258 12. Resident Assessment Instrument: MDS + CAAs 261 Purposes of the RAI 261 Overview of the RAI Process 262 Conducting the Interview 265 The MDS for Reimbursement 277 13. Care Planning 279 Time Frames 279 Components of the Care Plan 279 Types of care plans 280 Revising the Care Plan 284 Care Plan Examples 285 Sample Activity Care Plan Entries 286 Other Resident Care Plan Considerations 288 14. Monitoring the Treatment Plan 289 Monitoring Tools -- Activities 289 Monitoring Tools -- Social Services 293 Quarterly Review 293 Annual Review 298 Other Considerations for Documentation 299 Health Insurance Portability and Accountability Act (HIPAA) 303 15. Councils 305 Resident Council 305 Family Council 318 16. Volunteers 321 Activity Department Volunteers 321 Social Services Volunteers 322 One-on-One Friendship Programs 323 17. Quality Assurance and Performance Improvement, Infection Control, Risk Management, and Emergency Preparedness 325 Quality Assurance and Performance Improvement 325 Infection Control, Tags F880-F883 333 Risk Management 334 Emergency Preparedness 338 18. Management 341 Resident's Rights 341 Restraints 350 Behavior Management 351 Time Management 361 Budgets 363 Policies and Procedures 364 OBRA '87 Regulations 366 Surveys 386 Survey Groups 393 Medications in the Elderly 398 19. Summary 401 A. Abbreviations 403 B. Minimum Data Set and the Resident Assessment System 405 C. Care Area Assessments 453 References and Further Reading 471 Index 477 Elizabeth (Betsy) Best-Martini Elizabeth (Betsy) Best-Martini is a Recreational Therapist specializing in the field of gerontology. She has a Master of Science degree in Recreation Therapy / Administration. She is also a certified Caner Exercise Specialist. Her consulting firm, Recreation Consultation & Fit For Life has provided recreational therapy consultation to over 200 retirement communities, skilled nursing settings, sub-acute settings, and residential/assisted care facilities in Northern California. Betsy has trained over 800 qualified activity professionals in Northern California. In addition she provides one-to-one recreational therapy to clients needing assistance and assessment in the areas of physical activity. Betsy is a well-known presenter at national and state conferences for activity professionals and recreational therapists. She has been an academy faculty member of the American Therapeutic Recreation Association. Her three publications are being used nationally and throughout Canada as training manuals for Activity Professionals and Recreational Therapists: Long-Term Care 7th Edition, Exercise for Frail Elders, and Quality Assurance for Activity Programs. Betsy is a certified fitness instructor through the Senior Fitness Association. She writes a fitness column called "Let's Get Moving" for Creative Forecasting. She teaches two strength-training classes with older adults weekly in addition to teaching a certification class for students interested in becoming fitness instructors with frail elders and adults with special needs. She also provides training in Exercise for Frail Elders and Adults with Special Needs. When enjoying her own leisure, she can be found gardening, hiking, exercising, and spending time with her husband, family, and many pets. Mary Anne Weeks Mary Anne Weeks has worked as a Social Worker (SSC) in nursing facilities since November of 1982. At that time, few facilities in California had yet realized a need for such a discipline so there were no "rules." Fortunately, Mary Anne had long ago, in 1965, worked as a summer intern in a prototype retirement home in Rochester, New York. Her past experience in this setting with various levels of care made the environment in nursing settings more familiar to her. In the meantime, she had also received an undergraduate degree from the State University of New York, Genesee and pursued graduate work at University of California, Berkeley where she completed her Master Degree in Public Health. Mary Anne lives in Sonoma, California, with her husband and two children. She is a Social Service Consultant in the specialty area of social services and is a lecturer at the community college level. Priscilla Wirth Priscilla Wirth is a Health Information Consultant for long-term care facilities. She is a Registered Health Information Administrator, receiving her degree from Seattle University. She has been in the health information profession since 1980. Her Bachelor of Science degree and Master of Library Sciences were received from Northern Illinois University. Priscilla is currently practicing in Sonoma County, California, and is a member of the American Medical Record Association, the California Health Information Association, and the Network of Health Record Consultants. She is a lecturer at the community college level.
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