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.