ALTERNATIVE SOLUTIONS
By Sandra Stimson ADC, CALA, CDP Executive Director,
Alternative Solutions in Long Term Care
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Sandra Stimson has experience as a
corporate consultant, Corporate Trainer
and National Speaker. Her experience
is in long term care, as Activity Director,
Director of Alzheimer's Units and
Assistant Administrator of a 550 bed
long term care county home.  She is
Co-founder of Pet Express Pet Therapy
Club, is a Life Replay Specialist.  
Sandra implements dementia units
nationwide.  Sandra has written several
books, Volunteer Management
Essentials for Long Term Care and Pet
Express Pet Therapy Program. Sandra
has been a facilitator for Alzheimer's
support groups and is the Awards Chair
for the NJ Association of Activity
Professionals.  Sandra is the Executive
Director of
National Council of Certified
Dementia Practitioners
http://www.nccdp.org  

Alternative Solutions in Long Term
Care offers resources for health care
professionals in many areas of dementia
care, care plans, Snoezelen products,
dementia activity calendars, adult day
care calendars, sensory calendars,
reminisce videos for dementia, activity
books, and dates to remember, party
supplies,
resources and links.
Sandra Stimson
for Activity Professionals
in Long Term Care Settings
admin@theactivitydirectorsoffice.com

Copyright 2004-Present
The Activity Director's Office
All Rights Reserved

Disclaimer
How can we encourage CNA participation in activities?

As an Activity Consultant and Dementia Consultant, what I see across the nation is lack of
involvement by the nursing assistants in daily scheduled activities. Activity professionals
are frustrated because of the lack of involvement. Nursing Assistants clearly do not see
this as part of their daily duties.  

So the big question is how can we get the nursing assistants involved in activities and
residents daily quality of life? That is a complicated question with no easy quick solution.
There are many systems that need to be put into place to encourage CNA participation.  If
we want them to participate, we as a staff have to participate first in their daily routine and
that means answering the call bells.  It’s not just their job! Any CNA will tell you that the
majority of call bells that they answer daily are for simple requests and are not medical
emergencies or direct patient care.  All staff must be involved in answering call bells. The
other area that Activity staff should be involved in is passing the trays or meal time set up.  
Nursing Assistants have packed schedules and often times; they see activities as an area
that they don’t have time for. If we expect them to participate in transporting and day room
activities, we have to be open to helping in these areas.

Let’s face it. A strong activity programs with nursing assistant involvement clearly drives
the survey process.  I think we can all agree on this! Clearly, Administrators have to look at
this issue and make some changes.

But to answer the question, how to get CNA’s to buy into activities, covering the day rooms
and assisting with transporting to the programs requires some systems to be put into
place. Often times, we hear that they don’t have time to transport but interesting enough
when the survey teams are present, everyone is transporting, helping out in the day rooms
and participating in programs. So it only makes sense that this can happen on a daily
basis. Activity professionals can not transport the entire facility by themselves.  Activity
professionals can not stop their program to go transport a resident to a program because
they were not ready when the scheduled program began. ADL’s is an important part of the
resident’s day and should not be rushed to get the resident to programs on time.  But once
they are dressed, the nursing assistant should bring the resident to the program.

The Activity Assistant can not be expected to run programs with no assistance in the day
rooms as they have many behaviors or residents at risk for falls to monitor.  If the activity
professionals are to have success oriented programs they need CNA involvement. If you
are a nursing home, the federal guidelines, F248 clearly state that all staff will transport
and be involved in day room programs.   

Because of the new guidelines F248, the burden is now on the Activity Directors to design
appropriate daily programs to fit all residents.  This includes, men’s programs, bed bound
programs, dementia programs, very low functioning programs, etc. This means more
programs with in the facility. If your community has not completed a Population and
Calendar Analysis, those tools are located at www.activitytherapy.com          

Here are some steps to take to get nursing assistant to buy in to the Activity
program.

1. We recommend every facility have a lead CNA. Most communities who have a Lead CNA
can attest to the buy in by the other CNA’s as the Lead CNA insures that the CNA’s are
involved in transporting, assisting in programs and supervision of the day rooms.
Companies such as CareOne and Spring Hills Assisted Living have tried this in several of
their communities and have shown that lead CNA’s programs work.

2. Insure you have proper coverage of CNA’s. Hard to get any CNA to assist with
transporting, covering a day room and assisting with activities if they have heavy case load
and not enough CNA’s scheduled or on duty .

3. Provide education about activities, the types of programs you offer and how to run
simple activities. Explain the expectation of the CNA when in the day rooms. Make sure this
also a part of general orientation. Often times CNA’s are not engaged in the activity
because we have not taken the time to show them what to do. If you don’t want to see them
sitting in the back of the room, explain your expectations.  They want to help. Utilize the in-
service at www.activitytherapy.com

4. Post a CNA schedule to clearly show the times the CNA is required to be in the day
room.  The unit manager would be responsible for creating a schedule.

5. Speak to the CNA’s about times a resident can attend activities. As we know there are
some residents that require a lot more time to complete Adl’s, dressing, medications as well
as schedules for other therapies.

6. Provide a list to the nursing stations of the residents who need assistance in
transporting.  State which programs you would like them to attend, the times of the
programs, the dates of the programs and locations of the programs.  Most CNA’s realize
the importance of quality of life and the impact recreation plays and will work hard to get
the resident ready in time for a program. This schedule should be updated by the Activity
Director on a monthly basis.

7. Post a calendar in the day rooms that clearly shows the programs. A calendar should be
posted in the resident room so the CNA is aware of the schedule.  

8. Make sure the CNA understands the programs that are listed. Especially in Assisted
Living where often times CNA’s are asked to conduct the programs. They need to
understand what the program is and where the supplies for this specific program are
located. They need to have options, in case they are asked to conduct a program and the
residents are not interested.  An option might be a sing a long. The Activity Director should
be checking up on the CNA’s to make sure they know what to do. If they find the program is
not going on, take the time to find out why. Sometimes, it is simply that the Nursing
Assistant could not find the products for the activity.  

Insure there are adequate supplies for when residents are “awake”. There should be
adequate supplies in all day rooms so nursing assistants can provide appropriate tactile
items, games, music or relaxation and reminisce movies. Each day room should be
equipped with memory boxes, dolls, magazines, things to fold and sort and music tapes.  
Any items that are torn or broken should be discarded. Know your resident, so you can
purchase appropriate supplies for the residents. As each dementia resident is unique and
different, what might interest one resident may not interest another resident.

9. Ownership by the unit managers for quality of life activity programs.  Often times, the
Unit Manager has so much to do that they are not aware of who is getting to the programs.
It takes only a minute to walk over to the day room and observe if the CNA is present.  The
Unit Manager should observe who (residents) is in programs and especially who is not in
program and take the time to find out why. The Unit Managers should take the time to
explore why residents are not in the day room.

As many care plans now address activity interventions and supervision for those residents
with behavior issues or at risk for falls, it makes sense that there has to be a CNA in the
day room to carry out the supervision. Unit managers should be aware of any resident who
is not participating in programs and why?  There has to be programs for everyone. The
Unit Manager should walk the floor at 10:00 and note any resident who is still in their room
or bed, left in the hallway or at the nurse’s station. Explore why?

The Unit Managers must make it clear that once a resident is dressed that the residents
are brought to the programs unless they decline the activity.  Often times, residents are
placed at the nurses station for supervision, but if the day rooms have proper supervision,
it makes sense that the residents are brought to the day rooms. The nurses really can’t
provide adequate supervision at the nurse’s station due to phone calls, medication pass,
dressing changes, etc.

10. Have weekly socials and invite all the CNA’s to come and participate. Especially when
there is entertainment and deserts, you are sure to get their buy in.  They enjoy this as
well.  This way, the Activity staff is getting extra help during the socials and entertainment.  
Generally at special events there can be 30 residents with only a few activity Staff. If most
residents are at the special event, there should be no reason why the nursing assistants
are not the special event.   

11. Most Director of Nursing, recognize not only the importance of quality of care but see
the value in Quality of Life Activities.  They need to play an active role with the Unit
Managers in insuring that the nursing assistants are helping with activities, transporting
and providing coverage in the day rooms. I know of no DON who would approve of
dementia residents in a day room with no supervision. Activity staff can not be in the day
rooms at all times as they have additional responsibilities such as care plan meetings,
initial assessments and room visits. Additionally, there has to be “relaxation time” for the
residents. During these ‘down times’, nursing assistants can provide the supervision.

12.  Administrators have to take an active role in insuring that the Activity Departments
have enough Activity staff to carry out daily (including weekends), programs to fit the types
of populations living in your facility and that the Administrator has buy in from the nurses
and nursing assistants. MBWA manage by walking around. Walk around at 10:00 and 2:
00. You should not see residents in their rooms dressed, left in the hallway, left at the
nurse’s stations or in crowded day rooms with only one activity assistant.

13. Insure the initial assessment is placed on the chart and filled out completely. The
nursing assistants should be required to read the Initial Assessments and understand their
past occupations, religion, leisure pursuits, etc.

14. Care plans should have interventions from the Activity Department. The Care Plan
should include the nursing and nursing assistants. For example; you may have some one
care planned for weight loss. The intervention might be to “invite resident to food related
programs”. The nurse would be on the care plan to “provide treatments prior to the event”.
Nursing Assistants intervention may be to, “remind resident of food related program and
transport to food related programs.”     

15. In many states Activity Associations have CNA of the year. Take the time to nominate a
CNA who goes the extra mile in helping with activities. Even if your CNA does not win, you
can post the nomination in your local paper, facility paper and recognize the CNA within
your facility. The nursing assistants would be thrilled.

16. Thank the CNA for their help in assisting with transporting, helping in the day rooms
and participating in programs.  A “Thank You” goes a long way.   

The CNA’s love their patients and most feel that activities are an important part of their
day. If systems are put into place, change may be slow to come but change can happen,
especially when this type of positive change is best for the resident’s quality of life.  
The Activity Director's Office
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