ALTERNATIVE SOLUTIONS
By Sandra Stimson ADC, CALA, CDP Executive Director,
Alternative Solutions in Long Term Care
You need Java to see this applet.

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
The Activity Director's Office
New Activity Director- What to Do first?

Assisted Living, Nursing Homes, Adult Day Care and CCRC’s are being built faster than we
are turning out experienced, certified and qualified Activity Directors. Activity Directors who
are experienced are switching facilities and types of communities they work in for many
reasons. When a new director begins at a facility often times the director jumps right in to
make changes with no clear vision or plan for the changes. Here are some recommendations
before making changes and to help guide the new director through the process.

Administrators should require that the activity director report back in 30 days with written
plans, objectives and goals the new director wants to implement. One week is just not
enough time to provide a sound, well thought out and effective plan.

1. On the first day, the Executive Directors should provide to the Activity Director; job
description, facility department head names & phone numbers, past survey results, Resident
Rights, survey expected visit date, state regulations, federal regulations (Long Term Care),
JCAHO requirements, policy and procedure manuals, budget, dates / times of facility
meetings and resident council minutes. Additionally, the Activity Director should be provided
with an Activity Care Plan Book, MDS book, spend down sheets, staff budgeted hours and
past Quality Assurance reports. If, you are participating in services such as Press Ganey,
the Activity Director would need to see these results and understand this program. If, you
have a board, community service board, organizations committed to your community and or
clergy committees, the Activity Director needs to have those names and phone numbers.
Dates and times should be set up for the Director to meet with these special groups and
organizations.

The Executive Director should plan enough time to go over these materials with the new
director. At minimum three hours should be allotted for this meeting. Additionally, the
Executive Director should provide in writing concerns, expectations and time frames for
meeting these expectations

An Activity Director should never begin the job without this information. For example, it is
amazing how many directors have never read the state regulations and pending regulatory
changes. It’s important to note any regulations that pertain to the Activity Department,
documentation, position requirements, dementia unit, pet therapy, volunteers and resident
rights. The director should have an overall basic understanding of all the regulations. If the
director is switching from assisted living to nursing home or medical adult day care setting, it
is even more important that they understand the regulations. All of these tools will assist the
director in having a successful outcome.

If, you have a consultant, arrange a time for the Activity Consultant to meet with the new
director. If this is a brand new director and new to the field, you may want to bring in a
consultant for a couple of months as they can provide clear objectives and time frames for
meeting goals.

This may seem like a little thing, but make sure the director has office supplies. Provide a
tour of the community and give inside information like the best place to park or restaurants to
order food from. It is amazing how many Executive Directors do not provide a department
head luncheon to welcome the new department head. Finally assign a mentor that the new
director can go to for questions. All of these tips will ensure the new director gets started on
the right foot and that the Administrator and Activity Director have clear objectives.

2. The Activity Director needs to complete a comprehensive assessment of the community as
well as population and calendar analysis. These tools can be purchased at www.
activitytherapy.com

3. Conduct a population and calendar analysis. The new director must know the residents,
diagnosis, back grounds, interests, cultures, spiritual interests, leisure pursuits and therapy
schedules, etc. This would include types of residents you have in your community such as
very low functioning, dementia, high functioning, short term stay etc.

In designing calendars to fit the needs of the populations it’s important to know your
population you are designing programs for. You also need to know what your competition
activity programs. You would not to loose a potential customer because the competition has
trips and your community does not offer community trips. Planning the programs is extremely
important as it pertains to your populations. If you’re an assisted living community who does
not allow aging in place, you may have very high functioning residents who want more
community programs, trips, speakers, intellectually stimulating programs, self esteem,
wellness and empowerment groups. Where a nursing home may have lower functioning
residents who may need more tactile, relaxation, reminisce, music, spiritual programs,
intergenerational programs and sensory enrichment programs. A facility that cateors to
dementia residents may need a more structured program that is heavy in exercise, music,
reminisces, relaxation, spiritual and life skills programs. A facility that is strictly rehabilitation
and sub acute may need more one on one programs tailored to the rehab needs and out
comes.

A population analysis would clearly show the types of residents living in the community and
will guide the director in types of programs required, interest, cultural, religion, past interest,
cognitive abilities and design a program for the specific types of residents living in the
community.

4. The calendar analysis is also very important. Traditionally, facilities had one calendar to fit
the needs of the residents. We now know that approach does not work. Planned programs
need to be designed to fit all residents. As well as independent activities need to be offered.
Calendars need to be developed based on function and cognitive levels, as well as past
interest, cultures, spiritual and past / current leisure pursuits. The calendar analysis looks at
what you currently have and guides you in what changes you need to make based on the
population analysis. The calendar analysis will also show what specific activities are lacking
or that you have too much of.

5. Tour the community to note which areas can be used for programs, times of day they can
be used, size of room and location.

6. Conduct a comprehensive inventory Q/A. The new director needs to know what supplies
the facility has and where the supplies are located. Determine if there is an MSDS for each
product. Are their adaptive supplies such as adaptive paint brushes, magnifying glasses,
and large print books? Are all electrical supplies inspected yearly by the Maintenance
director? Once this is determined supplies can be ordered. Anything that is not in excellent
working condition should be discarded.

The new director must clearly know the budget. It’s a huge mistake on the part of
administration not to let the director know their budgets. How are they expected to stay in
budget, if they do not know what the budget is? Additionally, they have to be able to run their
departments and the budget has to fit the size population you have and their leisure pursuits.

What a complete waste of money to order supplies that the facility already has. Once an
inventory has been completed this will clearly show what supplies are needed. The director
should also prepare a wish list of major purchases she wishes to purchase over the coming
year such as computers, printers, piano, fish tanks, sensory rooms, etc.

Additionally, note where products are located for independent leisure pursuits such as
computer / internet access, library, games, puzzles, art supplies, videos, CD’s, computer
games, office supplies, etc. Residents should have access to independent leisure supplies.
There should be a designated place that residents can access these supplies “when awake”
and not be dependent on staff unlocking a closet or room.

7. Quality Assurance: For one week, the Activity Director should document who is in program
and times the programs are beginning. Can everyone participate and if not why? Are the
programs beginning on time and are their proper supplies. Are nursing assistants assisting
with programs? Are nursing assistants assisting with transporting? Are there clear lists at the
nurses stations of program times and which residents should be brought to programs?

8. Quality Assurance: For one week the Activity Director should document who is not in
program and note the resident’s location. At 10:00 and 2:00 document resident names who
are still in bed, dressed but left in the room, dressed but left at nurse’s station or in hallway.
Meet with the unit managers to determine why?

9. Quality Assurance: Meet with activity staff and nursing to determine residents who are
unable to participate in programs and why. This would also include any residents who is ill,
self isolator or refuses to attend programs.

10. Pull the group attendance, individual attendance records and room visit attendance
forms. Are these current? Do you have these? There is no other way to determine
participation other than tracking group and individual attendance. This is especially
important for residents receiving room visits. Are the room visits happening? Are the room
visits following the care plans goals and interventions?

11. Quality Assurance: Review all charts to insure that Initial Assessments, MDS, Care Plans
and Activity Notes are current, correct and up to date. Make a list of any charts that are of a
concern.

12. Meet with the resident council as well as review old minutes. The Activity Director should
look for patterns and repeat concerns. Often times there are not clear resolutions for
resident concerns. Without clear resolutions, residents believe that administration does not
care and that concerns go unresolved. Ask the residents what their concerns,
recommendations and complaints are? It’s ok to ask! Don’t we want to know first?

13. Meet with staff with in the first week and clearly provide the expectations of the
department, such as programs starting on time, preparation for programs, documentation
expectations, etc. All staff should sign in on a sign in sheet for every meeting. The sign in
sheet should clearly note using bullets the agenda for the meeting. The director should find
out what concerns, suggestions and recommendations the staff have and document this.
Daily the Activity Director should meet with the staff to go over changes, new admissions,
upcoming programs, etc. Recommend purchasing a large hard back book (journal) vs. using
memo pads. This will help keep the director organized vs. using many memo pads that
require a search to find a specific item. Highlight any item that needs follow up and check off
the item once you have completed it. This hard back book should be used for all phone calls
requiring attention, meetings, department head meetings, etc.

14. It’s important to know the staffing schedule, days of the week they are working, hours
they are working. Many communities are learning quickly that they have to increase these
hours. Often time’s weekends have only one activity professional working in the community.
Those hours need to be increased as a weekend is no different than a week day. If you have
four full time workers Monday to Friday than you need four staff on the weekends. You need
proper activity staffing for all the reasons you determined your staffing patterns for week
days. Determine what you are budgeted for and what you actually have.

15. Obtain the schedules for the staff and volunteers and post it clearly in the Activity Office.

16. Determine who the volunteers are and what protocols are in place. In many communities
it’s amazing that there are volunteers working in the community and no one knows their
name and worse, there is no volunteer application on file. Every volunteer needs a name
tag; sign in procedures, clear chain of command, volunteer policies and procedures,
volunteer welcome packets.. The new director should schedule a volunteer meeting to meet
with the volunteers and volunteer clergy. After everything is completed in this
recommendation document, only than should the director begin recruiting volunteers. The
director should be getting a local phone books and city news papers to familiarize with the
resources available in the local city. Policy and procedures / welcome packets can be
ordered through
www.activitytherapy.com

17. Q/A Pet Therapy: Determine what pets are either living in the community or visiting.
Check to make sure the health certificates are on file and current. These should be updated
yearly. Know the state regulations pertaining to pets. Determine if you have policy and
procedures for Pet Therapy. Read the state regulations regarding pet therapy, visiting pets
and live in pets.

18. The Activity Director should meet with the directors of house keeping, maintenance and
dietary to understand what the expectations are for their departments and what their needs
are in meeting the goals of the activity department. For example, Activity Directors can not
give 30 days worth of food requests on the 1st of the month, as the director needs time to
order and plan the budget around these requests. The dietary director should be getting
these food requests at minimum no later than the 20th of the month for the next month.

Once this is completed, the Activity Director would go over the typed report with the
Executive Director of the findings, plans, objectives and time frames for implementing the
goals. The Activity Director should review this report with the Activity Department.

The Activity Director should not throw out any files from the director’s office but simply box it
up and store at least for one year. You never know what you may be throwing out.

If these steps are taken the new director should have a smooth transition into the new
position and will guide the director in the necessary steps to be taken.


See
http://www.nccap.org/ for Activity Certifications and a list of instructors for MEPAP
Revised courses.
BACK      HOME