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Who are the key individuals in your facility from whom you need support?
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Here are six quotes from the surveyor guidelines regarding activities that you can use to build your case.
1. "All staff are responsible for providing activities."
2. "Activities can occur at any time and are not limited to formal activities being provided only by activities staff, and can include activities provided by other facility staff, volunteers, visitors, residents, and family members."
3. "If not contraindicated, time the administration of medications, to the extent possible, to avoid interfering with the resident's ability to participate or to remain at a scheduled activity."
4. "Transport for residents who need assistance to and from activities should be provided."
5. "The facility may need to consider accommodations in schedules, supplies, and timing in order to optimize a resident's ability to participate in an activity of choice."
6. "Altering a therapy or bath/shower schedule to make it possible for a resident to attend a desired activity that occurs at the same time as the therapy session or bath is recommended."

Sample CMS Guidelines to Present
to your Administrator and Director of Nursing
Even though they are aware of these, you are in a more knowledgeable position to make Culture Change requests when you have the printed word of CMS substantiating the validity of your request. Search Google for updates.

F248 INTENT: 483.15(f)(1) Activities
“Non-traditional Approaches to Activities
Surveyors need to be aware that some facilities may take a non-traditional approach to activities. In neighborhoods/households, all staff may be trained as nurse aides and are responsible to provide activities, and activities may resemble those of a private home. Residents, staff, and families may interact in ways that reflect daily life, instead of in formal activities programs.”
   -“Activities can occur at any time, are not limited to formal activities being provided only by activities staff, and can include activities provided by other facility staff, volunteers, visitors, residents, and family members. All relevant departments should collaborate to develop and implement an individualized activities program for each resident.”
   -“Some medications, such as diuretics, or conditions such as pain, incontinence, etc. may affect the resident’s participation in activities. Therefore, additional steps may be needed to facilitate the resident’s participation in activities, such as:
   -“If not contraindicated, timing the administration of medications, to the extent possible, to avoid interfering with the resident’s ability to participate or to remain at a scheduled activity; or
   -“If not contraindicated, modifying the administration time of pain medication to allow the medication to take effect prior to an activity the resident enjoys.”
   -“Transporting residents who need assistance to and from activities (including indoor, outdoor, and outings).”
   -“For the resident with varying sleep patterns, activities are available during awake time. Some facilities use a variety of options when activities staff are not available for a particular resident: nursing staff reads a newspaper with resident; dietary staff makes finger foods available; CNA works puzzle with the resident; maintenance staff takes the resident on night rounds; and/or early morning delivery of coffee/juice to residents.

Welcome to this course sponsored by the Healthcare Training Institute. This course, which is part of our activity Management series, is not only intended for activity directors and activity staff, but clearly other departments can benefit from the content, which deals with gaining staff and department head support.

Our primary intent for this home study course is to provide quality education to foster your professional growth. The Healthcare Training Institute has provided quality education since 1979.

The author of this script is Cathy Zugel. She holds a masters degree in Social Work, a master degree in Education, has been a licensed nursing home administrator, as well as been an activity director in a 200 bed Intermediate/Skilled facility. Ms. Zugel is also a founding member of the National Association of Activity Professionals.

The purpose of the course is to assist you in getting support from staff and department heads in your facility. As individual concepts are presented, if the concept seems to be applicable to your situation, I encourage you to turn your CD player off and make notes regarding the application of the idea to your facility. Also each track is very content dense, so feel free to replay the track to review the content as often as needed.

For the purposes of brevity, most generally, I will use the term “resident.” However, if you deal with patients, consumers, clients, etc., transpose “resident” for the term that is the most meaningful to you in your work setting.

On this two CD set, we will discuss Administrator support; developing clout with nursing; conquering your conflict avoidance; priorities & strategies for your wish list; how to get ‘em to follow through; five ways to gain respect; getting PT, OT, and Speech schedule coordination; Grumbling, complaining, and over-apologizing; proven steps to getting cooperation; knowing risks; obstacles to gaining staff support; overcoming uncertainty committing to change; and tracking your progress.

This course is entitled, "Step-by-Step Proven Techniques to Get Department Head & Staff Support." So, how do you get department heads and staff to support your activity program? First, let's talk about how I am going to define "support" for the purposes of this course. I am going to talk about support specific to three areas. First, as you know, surveyor guidelines are telling the surveyors to look for all staff, including CNAs, to be involved in the provision of activities to the resident. Secondly, medication schedules, shower schedules, therapy treatment sessions, etc. are to be scheduled in such a manner as to accommodate residents' attendance at activities, as long as it is not counter-indicated in their treatment plan. Third, surveyor guidelines specifically mention "transporting residents who need assistance to and from activities." This level of support sounds good in a state surveyor’s interpretive guideline manual, but how do you encourage this support from department heads and staff to happen in your facility?

What does it mean to you to have department head and staff support? Let me brainstorm with you for a minute regarding some possible questions you may have. See how many of these you have already thought of. First let’s start with… “How do I get my Director of Nursing to talk to the charge nurse to create a medication schedule that enhances participation in activities?” Or… how about… “How do I get the speech, physical and occupational therapists to schedule treatments that optimize resident attendance in an activity of their choice?”

First, let's start by making a partial list of key individuals in the facility from whom you need support. The director of nursing in most facilities is your key for getting medication and shower schedules changed to facilitate resident's participation in an activity. The director of nursing can also facilitate CNAs conducting activities with residents. Your dietary supervisor is the key person whose support you not only need to order the punch for your next party; but also to follow through with taking action regarding resident's complaints about the food.

Also, as mentioned previously, you need the support of the therapist to schedule around your activities and not during them for residents wishing to attend. And last but not least, of course, is your administrator. If your administrator can see the value of your program receiving support from the director of nursing trickling down to the charge nurse and to CNAs; the dietary supervisor; the office manager; and the therapist; would you agree that half your battle is won? So, let's spend the rest of this track talking about how to get support from your administrator.

Would you agree that your administrator has been hired not only to run a quality facility, but also a facility that meets the two C's? By the two C's, I mean Compliance and Census. Compliance, of course, means compliance with state and federal regulations. And by census, I mean how full or empty the beds are in your facility. Clearly, if you have too many empty beds for too long, your facility would need to close. So, how full or empty your facility is, is a definite priority to your administrator. So, what difference do Compliance and Census make to you? Well, a lot.

This is how you might approach your administrator to gain support using the concept of the two C’s. Let's take the first C, that of Compliance. First of all, you need to know what you are required to be complying with. Would it be appropriate to ask your administrator for a copy of the most recent surveyor's interpretive guidelines for activities; or should you have these prior to your meeting? You might state that you want to make sure that your department is well-prepared for the next survey, and in order to do this, you would like to see the guidelines upon which your department is evaluated. These guidelines are updated every few years, and the trend after June 2006, has been to place increasing emphasis on activities. Sometimes corporations provide their facilities with a three ring binder containing the latest copies of surveyor interpretive guidelines for each department. Or to get the complete guidelines yourself, do a Google web search.

Because your administrator is interested in compliance, you may want to bring some written evidence to the meeting regarding what is required of you department. Here are six quotes from the surveyor guidelines regarding activities that you can use to build your case, so to speak, for needing support.
1. "All staff are responsible for providing activities."
2. "Activities can occur at any time and are not limited to formal activities being provided only by activities staff, and can include activities provided by other facility staff, volunteers, visitors, residents, and family members."
3. "If not contraindicated, time the administration of medications, to the extent possible, to avoid interfering with the resident's ability to participate or to remain at a scheduled activity."
4. "Transport for residents who need assistance to and from activities should be provided."
5. "The facility may need to consider accommodations in schedules, supplies, and timing in order to optimize a resident's ability to participate in an activity of choice."
6. "Altering a therapy or bath/shower schedule to make it possible for a resident to attend a desired activity that occurs at the same time as the therapy session or bath is recommended."

I’ve just proposed that you approach your Administrator, corporate consultant, Director of Nursing, or another individual you view as being at the top of your facility organization ladder regarding getting support for some of these regulatory changes that were made back in 2006.

However, in your position as an Activity Director, do you find yourself choosing to “go along to get along” rather than experience any kind of potential conflict? If so, you’ll be especially interested in the next track, which assists you in getting over your possible phobia regarding a potential conflict. So to get administrative support, talk to your administrator about being in compliance with CMS guidelines. And regarding the second “C” of census, if you comply with the above six points, census will probably increase due to word of mouth marketing regarding how home-like your facility is.

On this track, we discussed using the Two C’s, Compliance and Census, to gain the support of your Administrator.

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