The Activity Director's Office
Dear Debbie: Archive #02
By Debbie Hommel, BA, CRA, ACC
Executive Director of
DH Special Services
24 OCT 2006

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ABOUT DEBBIE

Debbie Hommel, BA, CRA, ACC,
is the Executive Director of DH
Special Services. She is a
Certified Activity Consultant on
State and National level, with over
twenty-seven years of experience
in providing direct care and
consultation to long term care,
medical day care, assisted living,
and ICF/MR facilities throughout
New Jersey, New York, Maryland,
and Pennsylvania. She is an
experienced trainer and workshop
presenter, conducting a variety of
seminars throughout the Tri-State
area for the Activity Professional,
Administrator, and allied
healthcare professional. Debbie
Hommel is an active member of
Activity Professional Associations
on State and National levels. She
is ACC certified through the
NCCAP. She is a founding
member of the New Jersey Activity
Professionals' Association,
serving terms as Vice President
and President. She received the
Weidner Lifetime Achievement
Award in 1994 and the Monmouth
& Ocean County Activity
Professionals Life Achievement
Award in 1999.
Dear Debbie Questions & Answers
Posted from Newest to Oldest
We have 120 residents in our long-term care facility.  Our residents consistently break down as
follows:
  • 35% general population, able to voice preferences and participate in most activities
  • 35% cognitively impaired/dementia, able to indicate some preferences, needing small
    groups or one-on-one
  • 15% rehab-independent, short-term or completely able to pursue own plan for activities.
Is there any rule of thumb, particularly a respected, written one, for staffing ratios?
________________________

Question:  I am an new AD in a 78 bed long term facility. My problem is that the previous AD played
Bingo until everyone won. Now everyone expects a "prize" every time we play Bingo. This is killing
my budget!!! How can I change this without ruining a fun activity?

Answer:  
Boy, that is a tough one. One of the first lessons we learn is -  you don't mess with Bingo.  
Would it be appropriate to have a "heart to heart" with your bingo gang and tell them your feelings?   
Some alternatives may be to give coupons for every win and those with more wins would get better
prizes (have prizes with points attached so they would have to earn them) Therefore, they may hold
their tickets and save them up for a particular
prize?
What about an inexpensive consolation prize for those who participate but do not win - like a piece of
candy or something?  Not sure if your population would accept this but if they are alert and somewhat
reasonable, maybe they could suggest some solutions also.
________________________

Question:  Do you have any good forms that combine activity group attendance with 1:1 on the
back. I need to have a tool that my staff can keep monthly and then place in the residents chart.

Answer:
 I have forms but I would need your address to actually mail them. I do not have them on
disc.  I like to combine my room visits with my group program sheet.  The attendance sheet just has
an additional set of codes to indicate the 1-1 visit and activity.  Some facilities just mark the room visit
in a different color pen, to note it is a 1-1 approach.
________________________

Question:  I've recently have been given the Activities Director job.  I have little experience but a lot
of enthusiasm.  I have worked in the nursing home for 7 years, and know a lot about the elderly,
but I must say your  website has been a Gift from God! Not only did your ideas help me to get the
job but has also been a big help with bringing added bonus to the lives of our Residents.  My
Question is in fund raising for our Activities Dept.  I think all nursing homes could use some ideas
for that.  I look forward to hearing any and all ideas you might have!!

Answers:
 Hopefully, you have a budget and are just fund raising to supplement additional
purchases.  Every department should be allotted some funds and not be forced to raise their own
budget.  Having said that, involving the residents in any fund raising endeavor is a great activity for
them.  It is an empowerment type activity and some residents just love the idea of selling things and
managing a table.  Any funds raised should be clearly defined as to what the money is being used for
- either for a particular piece of equipment or a general resident activity enhancement fund.  Selling
food is often population, from donuts, to bagels, hot dogs, hoagies, or Otis Spunkmeyer cookies.  
Selling food on regular days conditions the staff and family to look for the food, so that seems to
work.  Selling balloon bouquets for birthdays and holidays is a successful fund raiser.  If raising
money for a particular piece of equipment, putting a large (very large) jar on the receptionist's desk
with a photo and sign describing what you are raising funds for on the jar often provokes people to
donate loose change.  One facility raised all the money for the $600 bell chimes this way.  A facility
wide bingo game is often successful.  Bingo cards are sold for $1 a piece and at some point the
bingo numbers are called over the loud speaker.  Numbers continue to be called until a winner is
announced.  There are commercial programs like books sales and  dollar stores that will set up a
store and give the department part of the profits.  Some facilities create gift baskets and sell raffles
once a quarter.  And we can't forget the infamous 50/50 raffle.  
________________________

Question:  We were asked by a family member to provide more evening activities. Of course
evening shift would have to help out as we have no recreation staff at that time of day. Your
website ROCKS!!!!  Thanks ....

Answer:  
To determining what kind of evening programs you should schedule, you need to determine
which residents are up in the evening and what their specific needs or interests are.  If it is a
cognitively impaired population, they may need some diversion and solace after a long day.   Quite
movies, refreshments, comfort oriented programs are often effective with this group.
If it is your higher functioning residents looking for something to do, I would suggest conducting an
interest survey to get their ideas.  Often word games, movies, and the infamous bingo are
welcomed.   If it is the short term resident who is seeking additional programming, activities of
interest to the rehab resident are suggested such as community re-integration programs, groups to
ease transition home, happy hours, movies and higher functioning games are appreciated.
If you have other staff (non-activity) conduct the programs, you should have them take  a list of
attendance so you can ensure the programs are occurring and who is attending.
________________________

Question:  I want to be an activities director. What courses or training can I pursue on my own to
help enter into this field?

Answer:
 Many States offer the Modular Education Program for Activity Professionals which is a
specific training program for activity professionals working in nursing homes, assisted living and
medical day programs.  To find out the instructors in your state, you can visit the NCCAP site  
www.nccap.org and go to the instructor listing and find the instructors in your area.  There are also
individuals who do it through independent study and they are also listed on the NCCAP site.   If you
want to take college courses, any course in gerontology, psychology, communication, or group work
would be helpful.  You might also want to check out your State association, if your state has
one because they often have conventions and other trainings which are most relevant.  If I knew which
State you were from, I could provide more specific information.  Good luck,
________________________

Question:  I am an administrator of a LTC facility. How could I get a copy of the new guidelines for
activities? Thank you, ....

Answer:
  I could email it to you, if you give me your email or you can go to Recreation Therapy
consultants web site. They have it posted.
http://www.rec-therapy.com/ActivitiesGuidance.doc
________________________

Question:  Hi!  My name is  ..., I'm working in a facility as ACTIVITY ASSISTANT, my boss assigned  
me at sub-acute, can you give me some more ideas or activities for them? (because most of them
are not responsive.)

Answer:
 Hi, the short term resident can present some special challenges.  I had
written an article about programming for short term needs in a previous
month on this site.  You can access the information at
http://theactivitydirectorsoffice.com/DebbiesADTips_archive200603.html
________________________

Question:  I just want you to know that I introduced your website to about 40 Activity Directors in
my area this week at their quarterly meeting, here is Abilene Texas. Thank you for the work and
dedication you have obviously put into your website and for keeping it free for the people to
access. I almost cried when I saw how user friendly it is. Activity directors are so under
recognized, under paid, and expected to meet so many needs that they need to know someone
out there that can help them learn and grow. If the end result is nothing but knowing they are not
alone, it is worth it. However, it is so much more than that and all they have to be is willing to learn
and grow and as their social work consultant, I am so thrilled to invite them to do that. It is really
not possible to count the number of LTC residents you will impact through them, but what an
awesome person you are to care and to try. I hope your cup runneth over with all the material
blessings you can hold and that the greatest rewards are knowing at the end of the day, God can
say, "well done, my good and faithful servant." Thanks again

Answer:
 thank you for sharing your kind words. It is nice to know that my ideas are helpful.
________________________

Question:  Hi!  I was wondering if there is a limit of the time a resident sits in a location before the
activity starts.

Here is the scenario:

The activity aide went to gather residents for an activity.  She was gathering everyone by herself,
without help.

She brought one resident to the dining area, left her there to go gather another resident.  She
brought the second resident to the dining area, left her with the first resident and went to gather
another and so on until she had gathered all the residents.  The administrator is questioning the
amount of time it took her to gather the residents and the time she left the first and second
resident, third resident and so one alone in the dining area. He seems to think there is a time limit
the residents can be left alone. The aide was doing everything by herself.   I have never heard of a
time limit.

Do you know of a time limit or do you know of a web site I can contact for the answer.

Thanks for any help you can give me.

Answer:
 To my knowledge - there is no defined time limit for residents to wait for an activity.  I am
more concerned by the fact that only one activity person is transporting all those residents.  The intent
of the new guidance is that all STAFF (not just activities) assist residents to and from activities. If this
occurred, the waiting time would be reduced and reasonable.  I would share the new guidance with
your administrator and point out the several references which mention the role of the nursing
assistant and other staff in knowing resident group preferences and personally assisting them to and
from activities.  That would solve the waiting problem.  The waiting time should be tailored to each
resident's needs.  Residents with short attention spans and wandering behaviors, would not wait any
amount of time for an activity.  Other residents are content to wait if appropriate music or television or
diversional tasks are offered.
But, I say again - the problem is not the waiting time but the fact that your activity staff are the only staff
assisting residents to the program.
________________________

Question:  I am in the process of acquiring my ADC and need 23 hours of continuing education. I
would like to submit my application before the end of the year. Are there any online courses that
you can recommend to me in obtaining these hours. Is there a limit on how many hours you can
obtain through online courses? Thanks for your time.

Answer:
 I could find nothing in the NCCAP standards that limits the amount of hours that you could
be on line courses.  It only says any on line education that is used must be pre-approved by NCCAP .  
There are a few sites which offer pre-approved on line activity education.
http://www.medicalupdate.com/content/view/5/25/
http://activitydirector.net/
________________________

Question:  Hi, ... and I am the assistant activity director at ....  I have been using a computer
program, "Activity Planning Simplified", from Creative Forecasting, for right at one year now.  This
is a wonderful program for documenting participation, printing lists from certain criteria, and
helpful in many ways.  It suddenly stopped working and I have two tech support people working on
it but it is still not up and running!  I miss it and need it disparately!
Do you know of another computer program that may be comparable?

Answer:
 The only other program that I know of that does that sort of thing is from TR Tips.
http://www.trtips.com/  I do not have direct experience in using it so I cannot say how effective it
is.  Sorry I cannot be much more help than that.
________________________

Question:  Hi, ... I am just wondering what the license requirements are for certification to be an
Activity Director in Mississippi.  Please help.

Answer:
 I am sending you the link for Mississippi department of health regulations. They say to be
an activity coordinator..."an individual shall be designated as being in charge of resident activities.  
This individual shall have experience and/or training in group activities, or shall have consultation
made available from a qualified recreation therapist or group activity leader".
It is not real specific but there is...
http://www.msdh.state.ms.us/msdhsite/_static/resources/119.pdf
You could print out the whole LTC manual from this site as well as other settings, if you choose at
this main site.
http://www.msdh.state.ms.us/msdhsite/_static/30,0,83,60.html
________________________

Question:  I'm looking for info on Resident council,I'm new as an Activities Director I was told that I
do not need to have a President,but I do need to hold a meeting is this right,can you help me with
this info,or where I can find the info. Thank you

Answer:
 The Resident Council is a formal group which is open to all residents.  They way it is
organized can be directed by the residents themselves.  If they do not want a president, it can be run
by open forum or with a resident chairperson. As long as the residents know their options and decide
together, it can be run they way they want it to be run.  It does not say in any regulation that the
meetings have to be monthly either.  But most people hold monthly meetings.  Again, if the residents
choose to meet more or less frequently, they can.  Whatever the residents decide, regarding officers,
how the meeting is run or frequency of meetings - should be documented in
the minutes as a discussion and resident decision.  Any staff who attend the meeting are invited
guests and need to know that.  They can't just assume they can come in and out of the meetings at
will.  The residents have the right to meet privately.  The minutes that are taken at the meeting should
follow standard meeting minutes with unfinished business and new business.
It is typical practice to go through each department, discussing residents needs or comments related
to each department.  Any concerns or complaints need to be communicated to the appropriate
department and it needs to be responded to by the next meeting, if not sooner.  Many facilities use a
formal "resident council concern form" which documents the concern and
allows for the department head to write the resolution to the problem.  The concern form is returned to
the council, shared at the next meeting and filed with the minutes.  It is good practice to keep all your
minutes filed into a binder, in chronological order.  The State may ask to see them during survey or if
they are investigating a complaint.  There is a great web site devoted to residents councils.
 http:
//www.residentcouncil.org/
They also sell a great book on this site - Resident Council Handbook
which pretty much tells you all you need to know about organizing and running a council.
http://www.
residentcouncil.org/book/the_book_order_form.shtml
 Good luck!
________________________

Question:  My name is _____ and I work in a psychiatric nursing home in __. I was wondering if
you or any of your activity professionals could help me to locate  a long lost story that would mean
so much to me and  a family member these days. Years ago I received this beautiful short story
about a shell and I believe it was entitled Shells, about a woman who was walking along the beach
shore and thinking of her mother, in a nursing home and despite that she was only a piece of what
she once was, she was similar to the broken shell in that they both were once vibrant and
beautiful things. Through the years each was worn down and became only a fragment of what
they once were. But the people in the nursing home were able to envision that once beautiful
shell...well that is the gist of it anyway...does anyone have it that I could copy? Thank you!!!!!

Answer:
 That sounds familiar and I did a brief looking around in my archives and came up with
nothing.  BUT - I will send out an email to my NJ email loop to see if anyone has it.  Also, this web site
- Alzheimer's Outreach is a wonderful site.  They have good resource information but also great poetry
about the losses and relationships with individuals with AD.  You can access
this site at
http://www.zarcrom.com/users/alzheimers/  I will keep looking and keep you posted.
____________________

Question:  I am looking to get certified to become an Activity Director.  I have not been able to find
a place or online certification in NH...could you please direct me in the right area?

Answer:
 Below is the only approved instructor in NH.  And you can access the on line educators on
the NCCAP web site.
http://www.nccap.org/about/educators/index.shtm

________________________

Question: I need to have inservices before the state come back do  you have any in-service
topics?

Answer:
 I am not sure what you are looking for?  Specific topics and what to say about the topic?  I
wrote an article about inservices in a previous month.
http://theactivitydirectorsoffice.
com/DebbiesADTips_archive200511.html
If you would give me more specifics about what you are looking for, I could better help.
________________________

Question:  Could you please help me with an exercise program for the elderly?

Answer:
 Exercise and movement programs are sometimes hard to get started with the elderly.  The
resident have many excuses or reasons why they don't want to or can't participate.  The first step in
getting the residents interested is finding a snappy name for the program.  There is a wide gamut of
names people use such as Moving to Music, Sittercise, and Grooving with Gary (or some other name
that goes with the group leader's name).  Selecting the right music is another important feature.  
Music is a great motivator and just hearing the right tune facilitates movement.  Experimenting with
different types of music is encouraged.  There are some modern tunes, with
the just the right beat, that are successful in movement groups. The exercise program should follow
standard procedures for any exercise group - including a warm up, main exercises and cool down.  
Using props is another way to motivate interest.  Scarves, feather dusters, exercise bands,
exercise sticks, balloons, and soup cans are all interesting props.  Using imagery within the
movements is often effective.  Correlating the imagery with the season is fun.  For example, reaching
up and picking apples from the tree during the Autumn months is one exercise.  Or rowing a boat
movement is appropriate for the summer time.  Creating a story out of the
movements is also effective and involving the residents in suggestion movements or next parts of the
story keeps interest.  Hope this helps.  Some of the basic activity books list many simple sitting
exercise steps.
________________________

Question:  Hi, I am new to this site and am getting lots of new ideas. I am SSD and activity director
in a 50 bed nursing home. My heart has always been in activities (I started out as cook in a
hospital 30 some years ago!) Have no training as SSD just hands on and feel robbed with time in
activities . It is one of the problems that we face when census goes down five more residents and
I will be full time activities. I want to know all I can about the new regs we were given ideas from
the management. Any thing that you know that would help? I have always hated filling in the day by
day resident activity form I feel it is a waste of our time as we document so much in the charting. I
live in ___. Love the residents and want the best for them .
Thanks for all you do for us!

Answer:
 Thank you for your note.  I applaud your enthusiasm.  To stay abreast of information - you
should seek out your local and state activity associations.  They should be actively sharing
information about any changes.  There are many web sites (like this one) that discuss the changes
as well as activity publications like
Creative Forecasting and Current Activities in LTC  that have
articles regularly as well. If you need more specific information, feel free to email me back.
________________________

Question:  I need to get a good copy of a policy and procedure manual for volunteers.  I also need
to know if there is a copy of some regulation on getting volunteers PPD's.  Does this mean the
volunteer who comes weekly, monthly, or just once in a while now needs to have routine PPD's.  I
need to know what is expected.  Also, what do I do when a volunteer group just shows up in
regards to PPD's?  Is there a certain website with information, etc.?  I enjoy your website!  Thanks
for all of your help!

Answer:
I have a lot of volunteer links which may answer some of your questions on my web site
http://www.dhspecialservices.com/volunteerlink.htm
As far as a policy and procedure manual - there is one from TR TIPs that is very good and it has a
section on volunteers (as well as activities).  You can check that information out at
http://www.trtips.
com/
As far as regulations for volunteers and PPD's, I do not think there are any.  They are visitors to the
home and not every person who comes through the doors has a PPD.  I'm a consultant in nursing
homes and other settings.  It is up to the facility to define policy and follow it through. It is good
practice to have all volunteer groups submit basic information about themselves.  You can have an
individual volunteer application form and a group application form. Good luck,
________________________

Question:  I have to do an all-staff in-service re: the regulation changes and was hoping you can
help me out.  I just don't want to bore them to death and smirk at some of the suggestions CMS
indicated in their guidelines.  Any ideas?

Answer:
 I would suggest having your administrator and director of nursing conduct the in-services
with you.  The guidance is nothing to smirk at and they need to know these are Federal guidelines -
not something you are making up.  I would suggest cut and paste the section of the guidance that
references the role of the CNA and other staff to give to them. It comes to about six pages.   If you have
put some things in place for them to use and reference (activity supplies, information cards, etc.)
bring them to the in-service to show them what is available to them.  A guessing game with resident
history information is often well received.  Select residents who have been at the
facility for a long time and most of them should know.  Obtain individualized information about their
back ground, including their occupation, birthplace, bits of information about their past.  Describe the
resident and see if they can figure out who it is.  They get excited when they are able to identify the
resident.  If they are unable to identify the resident, you can use that to impress how important it is to
know the residents as the people they are.  Good luck!
________________________

Question:  Hi Debbie...I was so glad to find this section of the site...I really need some advice!  I
have been an AD for about 2 years now, and have worked in LTC for 15.  Activities are where I was
meant to be!  However, the first place I worked, a Manor, had 120 residents ranging from
vegetative state to fully independent.  The place was TERRIBLE as far as administration...I left
every day crying.  But, I was always busy, sometimes working 80 hours a week.  I left there
because of Administration, and found the MOST WONDERFUL HOSPITAL to work at.  It has been a
huge change though, since I only have 7 Extended Care residents and a few Skilled that come and
stay for a few days then go home.  And the Extended residents are all very grumpy, don't want to
leave their rooms, sleep all day, confused and refuse nearly all activities...I need some ideas for
these ladies...I feel I am not "making a difference" and "doing worthwhile work".  The things I
have had success with are:  Nail care, holiday dinners, church services, visits with my 5-year old
son, & pet therapy.  I would LOVE to do some of the things I did at my other facility, such as:  Tai-
Chi exercises, crafts, indoor gardening, cooking, ladies club, movie night, farmer's market, state
fair celebration...do you think I just need to let these things go?  I really
want to listen to my ladies and do activities for THEM, but I feel so frustrated that they refuse
these fun things.  I do understand that I need to plan activities based on their interests and
abilities, but they have had the same AD for 30 years who did NOTHING with them!!!  I am just so
frustrated.  Any advice would be greatly appreciated.  Thank you so much.

Answer:
 I am glad you found a place that can appreciate your efforts.  Many activity professionals
experience frustration when they implement a new idea and the residents are less excited than we
are.  We do have to occasionally remind ourselves - it isn't about us but about them and what they
want.  But, in your case, if the residents are used to a low level of routine programs - they may be in a
rut. I would not give up on introducing new ideas but maybe you need to slow it down.  Be thankful
they do like some activities, as you mention.  I would suggest discussing your ideas during Resident
Council and give them choices in picking some of the new ideas.  Maybe they would be more
committed if they feel in control.   Possibly creating some mystery around new activities, announcing it
as "Monday's Mystery Program" or "Tuesday's Surprise" might intrigue a few of them. I would not do
too many surprises in a month but a few per month might be fun.  I think as some of the new ideas
are well received, the word will get out.  Re-doing an interest inventory survey might identify some
interests they have but have been overlooked.  Introducing programs that they have done in the past,
might re-kindle old interests. Introduce some incentives during certain activities, such as a door
prize.  Door prizes (something simple like a free hair dresser coupon) get people excited.  Bring
some of the group activities to them in their rooms.  Many of the things you mention can be conducted
in room.  If they enjoy the approach while you are in their room, you can relay how much more fun it
would be in a small group.
Hope this helps and good luck, Debbie
________________________

Question:  I wanted to know if you have a current list of any activity director conferences that
might be going on around the country?  I have been an activity director for 2 years now in a 62
plus independent living facility.  I am in the process of getting my certification.  Any help would be
appreciated....

Answer:
 I do not think there is any one web site which lists all state conferences.  You need to visit
the individual state associations web sites and they often have them listed.  I have a bunch of state
association web sites listed on my activity  association page.
http://www.dhspecialservices.
com/associations.htm
________________________

Question:  I plan to organize a game room to be used by a group of younger, independent
residents, who usually prefer not to get involved in group activities throughout the day, but
"complain" that there is nothing for them to do. They prefer to have "something to do" that will be
apart and different from the usual programs designed for the elderly residents. I would like to
keep the game room only for the use of the younger residents. Will not be this considered
discrimination? Am I aloud to even consider restricting other residents from coming into the
room? The younger group will have to take the responsibility of running the room in a orderly
matter, independently, almost without assistance. Will this be OK? What should a policy say about
a special group, such as in our case: younger residents (65 and under)? With sincere
appreciation....

Answer:
 That is a tough one.  I would agree to creating a space and program for the younger
residents.  One can understand their reluctance to attend programs designed for an older
population.  But banning people from the room based on age or any other reason does cause some
hesitation.  That is something you should discuss with the social worker as it is a rights issue. I
worked with a facility that created a similar room for younger residents with a particular diagnosis.  
The room stayed locked except during program hours and was supervised by activity staff.  The elder
residents were engaged in their own programming at the same time and did not notice or take
interest in the room or the program.  I also worked with another facility that created this gorgeous,
inviting living room which was equipped with a computer, Internet access, great
supplies and a stocked pantry.   This room was created for the short term residents.  However, the
long term residents who also resided on the unit wanted to use the room and were not allowed.  That
was not appropriate . Work with your social worker and just make sure enough alternate programs
and resources are suitably dedicated to the other residents.
________________________

Question:  I'm trying to find information for the Rap convention in Columbus for Oct. 2006. I  need a
form so I can turn into my facility, please let me know where I can get it.
Thank you

Answer:
 You can check with the RAP web site.  http://www.rapohio.org/  They have a section about
registration form being available in July on the site, but it is not posted yet.
________________________

Question:  I need some ideas for exercise classes. Also, I need ideas for crafts. Thank You

Answer:
 I think music is a great motivator and tool to use in exercise programs. Using different types
of music to provoke different types of movement, create moods, go with the holidays and seasons
can keep the exercise group fresh.  Using props such as balloons, scarves, ribbon poles, and other
bright objects with items to swing to the music is another successful
approach.  Using imagery in the movement, such as washing clothes, hanging clothes, ironing
clothes as a way to get them moving is also fun.  Having the residents take turns leaving activities
also keeps people involved. Regarding crafts, there are many resources. The many programming
periodicals (Creative Forecasting, A New Day, Activity Connection.com, and Current Activities in
Longterm Care) always have great craft ideas which are appropriate for our elders.  I also have a craft
page on my site which might help you.
http://www.dhspecialservices.com/craftsites.htm
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Question:  Debbie, our company is getting pretty strong about our knowledge of the mds.  I am
having some trouble with it.  I can fill out my section but some trouble determining how to know
why assessment reference dates are set on certain schedules, etc.  Well thanks.

Answer:
 I am going to send you some links to the CMS (Federal Government - where the MDS
comes from) web site.  You can download and print out the whole MDS manual if you like.  Your
facility should have a hard copy somewhere but if they don't, you can print it out from the Internet and
have your own copy. This first page is a chapter on the due dates of everything.  There are
charts which explain everything.
http://www.cms.hhs.
gov/NursingHomeQualityInits/downloads/MDS20rai1202ch2.pdf
This is the page that has all the listings of the entire MDS manual. It is listed on the bottom of the
page.
http://www.cms.hhs.gov/NursingHomeQualityInits/20_NHQIMDS20.asp#TopOfPage
If you need any additional information, email be back.
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Question:  I took the basic course in 2002.  I only took a couple of CEO courses. I want to take
more and wonder if I need to retake the course again to re-certify myself?

Answer:  
If you took your course from a qualified teacher and it has an approval number, it should be
OK.  Look on your certificate to see if it has an NCCAP approval number.   As far as becoming NCCAP
certified, you need to visit the NCCAP site  (
www.nccap.org) and look up the standards.   There are
different tracks you can qualify under and it all depends on your work experience,
education and continuing education.  If you have any other questions, feel free to contact me again,
Debbie
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Question:  I'm a new activity directer in a nursing home. Help IElderCaree new  ideas.

Answer:
 Welcome to the exciting world of recreation and activities.  This is a growing field and if you
enjoy your job - you will always have a place to work.    There are many activity based web sites on the
net with lots of program ideas.  If you go to the link page of this site, they have lots of activity sites
listed.
http://theactivitydirectorsoffice.com/WebLinks.html
Also, when you visit each activity based site - they all have a link page of their own.  You won't have
enough time to peruse them all, that is for sure. You should subscribe to the recommended
programming periodicals -
Creative Forecasting  http://www.creativeforecasting.net/  
and also consider
A New Day http://www.ggapublishing.com/index.html   If you go to both of their web
sites, they will both send you a complimentary copy for review.  Also, be sure to visit
ElderCare
Activities Guidelines
at  http://www.activities4elders.com/ There is also a great web site called
Activity Connection which you need to subscribe to, but has lots of ideas.  http://www.
activityconnection.com/  I think you can get a free trial month also.  Between all of them, you will have
more programming ideas than you can use.  But you will need to determine if they are appropriate for
your resident's level of functioning and ability.  There are also several news groups for activity
professionals, including
http://groups.yahoo.com/group/activityleadershipforseniors/ and http://groups.
yahoo.
com/group/ActivityChat/  and http://groups.yahoo.com/group/activityprofessionalsonline/
If you sign up for these groups, you will get e-mails daily with conversations and information from
other activity professionals.  They offer new ideas and a forum for questions if you have them.
Hopefully, that will get you started. One final thought, involve your residents in developing the
program, if you haven't already.  Surveys, meetings and 1-1 discussions with your residents can
provide you with helpful information regarding programs they have enjoyed in the past and also have
not liked. Good luck and have fun!
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Question:  I have taken the 36hr activity director course through the GA nursing home assistant. I
have been an activity Director (CTRS) at my facility for 7 years. I  am 26 and love it. I was
wondering though if you had and information about activity therapist- recreational therapy
courses or online courses. I would love to have that certification and training too. I am always
looking for ways to make the lives of our residents better and I think this would help. If you can
help or know some information it would be appreciated. Thank you

Answer:
 Continuing to educate yourself is a good plan. I have been in the field almost 30 years and I
continue to take courses regularly.  To clarify something - taking a 36 hour course does not make you
a CTRS. I am not sure if I understood what  you meant by what you said in your question.  To obtain
that certification, you need a 4 year degree in therapeutic recreation, complete an internship and then
take a national exam.  If you did all that - you would need continuing education to maintain that.  If you
have not done all that and are seeking national certification through the National Certification Council
of Activity Professionals - you could do a
couple of things.  They have a Track 5 which you might qualify for.  If you completed your 36 hour
course between the years 1991 and 2001, have 6 years experience in the past ten years and have
completed 30 hours of continuing education- six of which would have to be on activity documentation -
you could apply for NCCAP activity director certification.  This track is only
valid until 12-06.  After that, you would need to take the entire MEPAP course and have college credits
to qualify. You can download this information from the NCCAP site
http://www.nccap.
org/about/downloads.shtm
They also have instructors who teach the courses on line listed on their site.  http://www.nccap.
org/about/educators/index.shtm
Hope that helps and good luck with your quest to become certified.
________________________

Question:  Where I can find a list of  seminars and conferences for 2006 for activity directors?

Answer:
 Depending on where you live (which state), I could refer you more specifically. I have a
bunch of things listed on my site
http://www.dhspecialservices.com/seminars.htm
If your state association has a web site, I would suggest look there.  Let me know what state you are
in and I can tell you if I know if they have a site.
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Question:   I work at an independent senior apartment complex.  Do you have any ideas on where I
can purchase bulletin board art that would be more for seniors and not offensive?

Answer:
 I use several holiday catalogs and find lots of things that are not juvenile or childish.  You
usually just have to look around. The catalogs that I use are M & N
http://www.mninternational.
com/Index.cfm?
Shindigz which is also Stumps and they have a lot of nice theme things. http://www.shindigz.
com/index.cfm   I also visit the local party stores and they often have decorations which are not
childish. Hope that helps.
________________________

Question:  I am new to the Activity Director job.  I was wondering if you had any form that would
make my life a little easier.  Maybe some preprinted care plans. RAP's, anything would be
wonderful.

Answer:
 There are a few books on documentation that would help you.   Recreation Therapy
Consultants, out of California, have a couple of good books that have care plan samples and RAP
notes.   They have the Care Plan Cookbook which has sample care plans for every activity or activity
related issue possible.  They have the contributing trigger, problem, need, goals, and
interventions.   They also have a Dementia Care planning book, which is new and is also excellent.   
They have the RAP Handbook for Activities which gives sample RAP notes for many condition.  You
can purchase them all via their web site at
http://www.rec-therapy.com/index.html
Hope this helps
__________________________

Question:  The facility I used to work at had a page that read Examples and Recommendations of
# of Activity programs weekly, stating there should be 5 physically stimulating, 5 cognitively
stimulating a week, etc.  Is this part of the guidelines, because I don't seem to find it.  I am starting
at a new facility soon and want to make sure I am doing everything right.

Answer:
 The guidelines (State or Federal) do not define specific activities per number.   The
regulations usually say activities and programs should be introduced and based on resident need.  
That would be different in each facility.  Most likely what you had was a corporate policy or protocol.
Some companies put standards like that in place for their directors to follow.
__________________________

Question:  How many hours per week is required for an activity coordinator/director in a skilled
nursing facility?

Answer:
 There are no hours defined by Federal regs. The Fed guidelines state the department "will
be directed by" but do not state full time or not.   State regs vary in their definition.   In NJ, the regs
define how many activity hours are required per resident but it does not specify director hours.  In
many states, there are no specific hours cited - the regs just say a qualified person  will be
responsible and the hours will be "adequate". Sorry I am not much more help than that.
__________________________

Question:  Where do you go on the Internet for the broadcast of the new activities web.  Also I
need to do some CEU's from home, my facility don;t send us to workshops and I worked hard to
get my ADC and don't want to loose it thanks.

Answer:
 You need to go to the CMS (Center for Medicaid and Medicare Services) web site.   http:
//cms.internetstreaming.com/  You need to sign up for an account and then it will let you in.  Then you
sign up to view the CMS training on the web site.  It is free. There are a few sites to get independent
study training from home.  But these cost money.
https://shop.medicalupdate.com/cart.php?
m=product_list&c=4
and http://www.activitydirector.net/modules/articles/article.php?id=12
__________________________

Question:  I'm looking for a website or information on creating an  inservice on the importance of
activities. This would be directed towards CNA's and how they can help getting residents to
activities. As in appearance, changing shower schedules so that a resident can attend, facial
expressions and body language to encourage residents.

Answer:
 I don't know of any one specific web site that has that information.  When I have done those
kinds of in-services, I have demonstrated how getting the resident to programming makes the
nursing assistant's job easier in the end. Physical activities (ball toss, exercise, etc.) improve range of
motion and mobility - making it easier to assist in ADL's and eating.   It also tires the resident out so
they sleep better at night.   Cognitive activities (word games, discussions, etc.) keep the resident's
mind alert.  This allows the resident to be more responsive to the CNA and able to make quicker
decisions.  The special programs we have for cognitive loss (sensory and
diversional) keep the resident occupied, reduce negative behaviors and stimulate more awareness
which also make the CNA's job easier.  Spiritual activities enhance the residents feeling of well being
and contentment - possibly making them less demanding and unpleasant during care.  Basically,
you can go through each category of activity  - site the benefits to the
resident and then translate them to how that improved functioning in the resident will make the CNA's
job easier.   I would do this with actual materials from the specific activities and involve the CNA's in
defining the potential benefits through their participation in the activities. A separate in-service could
focus on communication and how to ask the resident to attend.  Role play, skits and guessing games
could demonstrate the right and wrong way to encourage participation.
Another in-service could focus on the individuality part.   I have done a few in-services already which
have been very successful.  By creating a matching game or "this is your life" game to discuss each
resident and what they like, the staff see the resident in a different light. A "life story" is created for
several residents and is read to them. Then, they have to guess who it is.  I have broken the CNA's
into teams, given them bells to ring when they know the answer and it has worked well.  They are
pleased when they know the resident more than they thought and then they are surprised to hear
some of the interesting things about residents they didn't
know.

We need to get creative with these in-services and I think we need to break them down into smaller
sessions.  Sometimes cramming too much information into one session is ineffective.
__________________________

Question:  I would like to know if you have info on an Activity Consultant in my area...Visalia
California...I could really use one.

Answer:  
I would suggest contacting NCCAP, as they have a listing of individuals who are certified
consultants who might be able to help.  Also, check out the approved instructors in your state as often
they are also often consultants, as well as instructors.  The page on the NCCAP web site which might
help is
http://www.nccap.org/about/educators/california.shtm
There is also a State organization in California which might help you. Their web site is http://scaap.
net/  Michelle Nolta is also a consultant in California who is a national speaker
and has written a few books.  You can contact her at
NOLTA5RTC@aol.com.  She might be able to
refer you to some people, if she cannot do it herself. Good luck
__________________________

Question:  I need to know where I can get the 6 hours of documentation I need to complete track 5.
I have everything else except that I've been in activities for 16 years. My job title at the present
time is a rehabilitation therapist in an Alzheimer's unit.

Answer:
 What state do you live in?  There are a few places offering the six hours on line. This is an
email listed on the NCCAP site which offers the course on line
ActivitiesAssist@aol.com
__________________________

Question:  I would like to know more about what an activity director's role in a nursing home
setting is.  What is the job description........can you help me with this information?

Answer:
 The main function of the activity director is to plan, organize and implement a full range of
therapeutic programs which focus on the resident's leisure, recreational and individual quality of life
needs. We do that through a complete assessment of each resident where we collect pertinent
information which is used in creating that overall program.   The activity director is responsible for
supervision of the activity assistants who are assigned to the department, who carry out the program
plan.  Other duties may be administrative and include attending meetings, managing the budget,
overseeing the volunteer program,  ordering and maintaining supplies for the department and
maintaining professional knowledge and standards within the department.  Here is a web site which
goes through the whole program planning process.  
http://www.housing.ufl.edu/RA/Activity%
20Planning.htm  One of my previous columns on this web site was focused on "what does it mean to
be a professional" and that might also give you some insight as well.
__________________________

Question:  I am a Certified Activity Director in Indiana.  I work for an Assisted Living Facility.  I am
being asked to be a consultant for two of our other facilities.  Isn't there a form that I need to fill
out about my visit to leave for state to check when they do a survey?

Answer:
 Hi, that is an exciting opportunity for you. I am not familiar with Indiana assisted living
regulations - so I can not specifically answer to the State part of the question.  However, any
consultant should leave some sort of record or report of the visit.  Whether it be through a form or a
formal, typed report sent to the facility after the visit - some record of the content of the visit and
recommendations should be documented and left with the facility.  Some corporations have a
consultant form that should be filled out, so you would also check with the corporation (if you are
working for one).  If not, you can make up your own form or just write a narrative report covering all that
was reviewed.  Good luck.
__________________________

Question:  Could you please give me some ideas for a.m. activities?  I have been reading current
events from the newspaper for several months at 8:30 a.m. as they come out of the dining room
but they are now loosing interest and my groups are getting smaller and smaller.

Answer:
 Hi,  the best way to identify programs that might interest your residents is to conduct a
survey.  Create a list of various ideas and discuss them with your group including those who do not
attend, with the potential to interest them in the new programs.  Routines are important, but variety
keeps interest.   Although a brief discussion of current events is a good start, offering a follow up
activity seems appropriate.  Many facilities follow up current events with an active group or exercise
and then conclude the morning with a main program.  The main program will vary from reminiscent
programs, crafts, gardening, cognitive games, or any number of programs of interest to elders.  There
are many program ideas on the Internet, on all the activity sites, as well as in standard activity books
you might have.  Theme activities (focusing on seasons, holidays or special days throughout the
year) are also fun ways to maintain interest and introduce variety.
If you need additional information, feel free to email me back.
__________________________

Question:  Our facility is a 28 bed short-term sub-acute unit.  Our residents arrive with a
discharge plan after a hospital   plan.  Most have scheduled Rehab at least twice a day.  All are
self directed.  I am at a loss for interesting activities that will stimulate and or entertain them
through out their stay here.

Answer:  
I would agree it is difficult to motivate this type of resident in leisure and recreational
pursuits.  You need to determine your role on the unit. Are you going to assume an active role in the
rehab process and coordinate therapeutic programs which would carry through rehab goals?  Or are
you going to assume a more diversional or solace oriented role, occupying the
resident as needed during the non therapy time.   If assuming the active therapy role : cooking, crafts,
exercise, community re-integrative programs, introduction of adaptive equipment and other such
approaches should be offered. If assuming a supportive role : movies in room, 1-1 visits with an
equipped activity cart, 1-1 spiritual visits, refreshment carts and other approaches that could be
offered while the resident rests in bed during non-therapy time. Hope that helps.
__________________________

Question:  Do you have a list of in services that you have done? Could I find anything on line or get
it in a book? Thank you for your help with this.

Answer:
 If you look in the archives for my section of this web site.  I wrote an article about activity
based inservices in November of 2005.  Hope that helps.
__________________________

Question:
 I have heard that there new guidelines for surveyors. Where can we find this
information and how do we get a copy of it. Any info you can give would be great.

Answer:
 Hi, they are now available on line. http://www.nccap.org/BBIMG/index.htm when you go to
this site - they also have the power point presentation to train the surveyors you can down load.
There will also be a training offered on the CMS website on April 7th. You can access this info on
http:
//www.cms.internetstreaming.com
 The NCCAP Bulletin Board has a discussion group for the new
guidelines.  I check there often to see what is going on.  
http://www.nccap.org/BBIMG/index.ht
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