Dear Debbie:
By Debbie Hommel, BA,  ACC, CTRS, Executive Director of DH Special Services
Last Update
01 JUN 2009

ABOUT DEBBIE

Debbie Hommel, BA,  ACC, CTRS 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
with over twenty-seven years of 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.
Have a question you'd
like a professional
Activity consultant to
answer?  
Ask Debbie Hommel?
DEBBIE HOMMEL
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ACTIVITY DIRECTOR TODAY
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in Long Term Care Settings
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Copyright 2004-Present
The Activity Director's Office
All Rights Reserved

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Question:  I am interested in taking the necessary courses I would need to become an activity director.
Could you please tell me where I need to start? Many of the colleges I have questioned just do not seem
to be able to help me out with my questions. I have applied for financial assistance to take college
courses I just do not know where to go to get the education I am looking for based on the courses I will
need.  Your assistance in this would be very appreciated.

Answer:  If your goal is to become nationally certified as an activity director through the National
Certification Council for Activity Professionals, you will need to take a minimum of 12 college credits.  
You will need an English course of some kind - English composition, report writing or technical writing
course.  The remaining nine credits can be taken in psychology, sociology, art, music, communications,
gerontology, human services, biological sciences and many more.  You can get the complete listing of
accepted courses from the NCCAP certification standards which are down-loadable at the NCCAP web
site.  
www.nccap.org   They are listed on page 5 of the standards booklet.  

You will also need to complete the Modular Education Program for Activity Professionals as a part of the
certification process.  Depending on where you live, you could take the course in the traditional
classroom setting.  The instructors are listed on the NCCAP site as well, under approved instructors.  

The course is also available through independent study and other non-traditional means.  Those
instructors are also listed on the NCCAP site.  I offer the course in NJ and also through independent
study.  You can start the independent study course at any time.  Information about my courses is on my
web site.
 http://www.dhspecialservices.com/mepapindependentstudy.htm

If you have any additional questions, feel free to email me back.
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com
_______________

Question:
 Last year, there was a whole lot of commotion here at my job. My then supervisor and co
worker left and i was alone until they hired a new supervisor and i didn't realize that my certification for
ADPC EXPIRED. To no avail i was telling new supervisor of the classes and conferences to get my ceu's
and no answer. So now i am going to a conference in may and hopefully to the one in Cincinnati even if i
have to pay for it MYSELF. I also help my job pass with the state because of what i have learn from the
last conference with you guys.  Help me, is it too late?

Answer:  If the expiration date for your ADPC is within the past year - meaning it has not been longer
than one year since you let it lapse, you can renew by submitting the required 30 hours continuing
education and submitting your renewal fee and a late fee.  If you have been expired for more than one
year - you would need to re-apply again as a new applicant meeting the current standards.  Let me know
the date of when your NCCAP certification expired and we can go from there.
Debbie Hommel, ACC, CTRS
Www.dhspecialservices.com
_______________

Question:
 My name is .....,and I've been an A.D.  only two weeks.I am trying to plan something for
nursing home week.I am so lost. Any advice would be great.

Answer:  Hi, the American Health Care Association has a planning guide on their web site which might
help you.
 http://www.ahcancal.org/events/national_nursing_home_week/Pages/default.aspx
This year's theme is "Nurturing a Love that Lasts".

Many places pick a theme and do activities all week focused on that theme.  It is important to get the
interdisciplinary team involved in planning if the facility administrator wants a lot of big events.  A good
start would be to look at what they have done in years past.  

Here is another good site -
Mother's Day Central - since Mother's Day kicks off the week - http://www.
mothersdaycentral.com

Hope that helps and good luck, Debbie Hommel, ACC, CTRS www.dhspecialservices.com
_______________

Question:
 I am going to have a Roaring '20s party this fall for my fairly active seniors. I know the ladies
will want to wear at least have a hat for it.  Anyone have a simple how to do this? Need to start to budget
plan for it.  Any suggestions or have any other ideas to have ideas to make this event a
success? Will of course have music.

Answer:  Here is a great site listing much of the music of the era.
http://www.bassocantante.com/flapper/music.html

This site has good information about the culture and such.
http://alephnull.net/20s/index.html

Here is a great link for a Roaring 20's wedding theme but the ideas are very appropriate for your setting.
http://www.2.a-weddingday.com/articles/roaring20sweddingtheme.html

As far as a craft for the ladies hats, I would think getting some jeweled type headband material and
feathers would be an easy craft.  The typical craft store probably has lots of things which would lend
themselves to this craft.

Hope that helps and good luck,
Debbie Hommel, ACC, CTRS
_______________

Question:
 I have a chance at a position as activities director in a new retirement community residence.  I
have no credentials but have plenty of experience organizing and working with people in general.  Mostly
administrative but in Human Resources.  I want to know what will get me the job.  What will make me
stand out from the rest.  I have taken notes from this site and come up with my own ideas but what's
gonna get me the position????  Can you help me out?

Answer:  If this is more of an independent living community, the job of activities director is more of a
concierge - scheduling rooms, bus trips, special events and the like.  Your organizing skills and people
skills would lend themselves to this.  I would suggest putting a portfolio together highlighting some of
the organizational work you have done and relating it to the retirement community.  If you have ideas for
new programs, I would suggest creating a printed list of your ideas with some descriptions as to how
you would pull it together.  If this is a well elderly population, focusing on wellness, personal growth and
continuing life to the fullest would be the goals of the program.

If this is a continuing care retirement community, with elders who are more frail and in need of support -
your programming will need to be more supportive in nature. Programs which allow them to utilize their
skills while not being inhibited by the possible physical or cognitive losses they may be experiencing.
Good luck,
Debbie Hommel, ACC, CTRS

_______________

Question:
 I am currently a Activity Director going on 11 years in the field.  I have three part time staff,
each with 5+ years.  We are going through a "burned out" phase.  What can I do to spark the enthusiasm
back into our department?

Answer:  It takes continuous effort to prevent what you say is happening to your department. It is great
you recognize your feeling of "burn out".  That means it is not too late! I have always been rejuvenated by
seminars and workshops.  I have many state association's workshops and conventions listed on my
site:  
http://www.dhspecialservices.com/seminars.htm   Check it out and see if your state has something
going on. It is good to get out of your building and re-affirm what you know and get new ideas.  If you
can't get out - buying some new books or resources also gets me excited again.  If that is not possible -
switch up the duties in your department.  You have all been there for a while - switch it up  and see how
that goes.  Make sure you take your vacations and days off.  Make sure you take your lunch breaks. I
know it is hard and we feel we need to work through and not take time off - but amazingly when you do -
things are fine when you get back.  And those days off do wonders for the spirit.
Debbie Hommel, ACC, CTRS
_______________

Question:
 I have been the activity director at a skilled nursing facility since July 2008. I have not attended
any classes for certification yet. I need to know what to chart when a resident has a diagnosis of 'end of
life measures'.

Answer:  There are a lot of approaches appropriate for the individual who is approaching end of life.  
However, they need to be individualized to the individual's interest and the actual physical state of the
resident.  You need to assess the resident, as you would any other, identifying needs and interests.  The
interests and past lifestyle choices can be integrated into the current approaches. If the resident was a
spiritual person, arranging for clergy visits would be appropriate. If the resident enjoyed listening to
music, arranging for music at bedside would be appropriate.  If the resident is in pain, offering solace
oriented approaches might be appropriate.  Assisting the resident to tie up loose ends is always
appropriate.  

As far as documentation, if you are skilled nursing - an initial assessment, progress notes, care plans
are the norm.  If you are doing extra things, episodic or focused charting in between might be relevant.  

Not sure if that is what your question was but I do have a lot of links on my site which focus on end of life
issues.
http://www.dhspecialservices.com/endoflife.htm
Debbie Hommel, ACC, CTRS
_______________

Question:
 Could you tell me some good websites where I could find donations of activity supplies? Our
facility has cut our budget so much, we have a 158 beds and it is difficult to keep our residents content
on the budget we have to work with. Thank You

Answer:  NCCAP just started a topic on their bulletin board for individuals seeking supplies or willing to
"swap".  You can post your needs there.  
http://www.nccap.org/BBIMG/index.htm

You can also network with your local stores.  I know they are sometimes willing to donate unsold
merchandise, after season, if you approach them in the right way.  Craft stores, Wal-Mart, and other
specialty stores have been known to do this.

I have found e-bay a place to find useful items for rather cheap - like games, craft supplies and such.  
I hate to suggest fundraising but many activity departments supplement their budget with 50/50 raffles,
basket raffles, and various sales throughout the month.  

I think many activity professionals are feeling the pinch of the economy in staffing and supplies.  
Hope that helps,
Debbie

_______________

Question:
 I am now working as a asst. activity director and i am interested in getting nationally certifed./ I
already have a 46 hr. certificate.

Answer:  If you took a 46 hour activity class between the year 1991 and 2001, and you have six years
experience within the past ten years - you could qualify for Track 5.  If not, you would have to go through
the newer route which would require you to complete the MEPAP course.

You can download the application at
www.nccap.org If you email me back with the date when you
completed your course and how much experience you have, we could figure out your next step.
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

_______________

Question:  
What are the requirements for licensor or registration for activity directors in North Carolina?

Answer:  According to State regulations for Nursing Homes, the following is
required:

The administrator shall designate an activities director who shall be responsible for activity and
recreational services for all patients and who shall have appropriate management authority. The director
shall:
  1. be a recreation therapist or be eligible for certification as a therapeutic recreation specialist by a
    recognized accrediting body; or
  2. have two years of experience in a social or recreation program within the last five years, one of
    which was full-time in a patient activities program in a health care setting; or
  3. be an occupational therapist or occupational therapy assistant; or
  4. be certified by the National Certification Council for Activity Professionals; or
  5. have completed an activities training course approved by the State.

If you are talking about medical day care centers or assisted living facilities, I am not sure.  I would
suggest calling the NCCAP state representative for North Carolina as I am sure she would know the
regs for the other settings.
  • Ginger Johnston  828-645-4297  828-683-8802 You can also check with the North Carolina State
    Activity Association.
  • Their web site is:  http://www.coap-nc.org/home.html

Hope that helps and good luck,

Debbie Hommel, ACC, CTRS
www.dhspecialservices.com
_______________

Question:
 In what website can I find state and federal regulations for the activity department.    

Answer:  This is a great web site that has it all. I use it often to find specific regulations by state.
http://www.hpm.umn.edu/nhregsPlus/index.htm
_______________

Question:  Have you ever heard of an activity calendar policy or procedure, we have just had a state
survey and they are requesting one.  No one has ever heard of this before, I have been an AD 8 years
now and this is the first I have ever heard of it.  Can you shed some light on this and if so can you give
me and example.  Thanks

Answer:  In my experience, when the state starts asking for policies - it usually means they are
questioning something.  They ask to see the policies to see what you say you should be doing
compared to what they are seeking during survey.  My other thought is maybe this has something to do
with F-248 and they want to see how you are integrating the guidance into programming.
In either case, yes - you should have calendar policies and procedures.

They basically outline content of program, methods of delivery, how residents are assisted to programs
according to need and things like that.  Susan Newell of TR Tips has a great P & P book and you can
buy the CD as well which allows you to revise the policies for your facility's needs.
You can check her resources on her web site.  
http://www.trtips.com/trtips.net/index.html
Hope that helps and hope you did well on your survey.
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com
_______________

Question:
 I'm not very sure who I should be asking to speak with, but I am currently looking to work
towards receiving my Activity Directors Certification. I currently am working at a nursing home in  NJ. I
have been there for almost 2 years and just decided that this is something that I am interested in
working on for my career. I was informed today from a residents niece that there is a Home Study
program that I could take to receive my cert. Do you know how I can enroll in that? I would like to know
how much it will cost, and also what I would need to do to begin. Thank you so much for your time. I
Look forward to hearing from you.

Answer:  I do offer the course through independent study and it is approved through the National
Certification Council for Activity Professionals.  It can be started at any time and you have one year to
complete the each part. The course is divided into two parts and each part has six lessons.  The course
involves reading, doing projects, interviewing residents or clients and staff, internet research and
viewing of videos.  I have information about the program on my site.
http://www.dhspecialservices.com/mepapindependentstudy.htm
If you have any specific questions, feel free to email me.
Debbie Hommel, ACC, CTRS
_______________

Question:
 Do you feature any forums (or know of any), where one can report unscrupulous behavior on
behalf of Activities Director(s)?

Also, does your page have a section for those seeking employment?

Answer:  My site - DH Special Services has a job board.  Jobs are posted and sent out to an email data
base at no charge.
 http://www.dhspecialservices.com/jobboard.htm

As far as unscrupulous behavior - do you mean unscrupulous behavior of the activity director?  Or activity
staff?

If the activity person is NCCAP or NCTRC certified - there are ethics they must abide by. It says this in the
NCCAP code of ethics about unethical behavior and reporting it. "If it is found that a Certified Activity
Professional is not adhering to the NCCAP Code of Ethics --- through written reports, through “doctored”
documents, etc, --- the certification will be rescinded or denied. The mechanism for review in such
instances will be through the Certification Review Committee, the Executive Director, and finally
the Appeals Committee." If you are referring to unscrupulous behavior of other staff, I would suggest
contacting your State Department of Health if it is violation of State regulations and your State
Ombudsman's office if it is a violation of resident rights.  Your facility should have a complaint phone
number posted in a public place for staff, families and residents to access.
Hope that helps. If not, email me back,
Debbie Hommel, ACC, CTRS
www.dhspecialservice.com
_______________

Question:
 I work in a long term skilled nursing home with 130 beds. The administrator has told me to
no longer start a quarterly note with quarterly note but instead put observation summary. She said some
of the rules changed in October of this year [2008]. Can you fill me in?

Answer:  I would suggest asking for a copy of the rule change?  Could she be referring to the new MDS
3.0 that is coming out?
What State do you work in?
It is hard to comment without more information.
Debbie
_______________

Question:
 I am an A.D.in an Assisted Living in the State of Oregon. I have recently been told by the
facility Resident Care Coordinator, that I must purchase alcohol and tobacco upon resident request.

I feel strongly opposed to purchasing alcohol for a resident, as it can increase the risk of the resident
falling, being injured or worse. Should this happen, in addition to the guilt I would carry, I am afraid I
could be personally sued, no matter how much liability insurance the facility carries. As you know, We
live in a very litigious society.

Do you know if Activity Directors are required to make purchases of alcohol for residents or if it falls
under a "Resident's Right"?

Can I legally be forced to do this if I have moral and/or safety concern?  Can you provide me with a web
site or information I can take to my administrator to help my case against this practice?

Answer:  Assisted living regulations vary from state to state so I cannot point out a specific regulation in
your state. I do know the residents have the right to drink and smoke if they so desire. But, the resident
needs to show they are capable of pursuing this on their own and in a reasonable way and it won't
cause them harm. In NJ, the resident has a complete assessment upon admission and if the resident
likes a cocktail or wants to smoke - the skills associated with those tasks are identified and assessed.
If the resident has the appropriate skills and judgment and there is nothing medically contraindicated,
they are permitted to do those things and should manage them on their own. If the resident proves they
are not making good judgment - drinking too much, smoking in their rooms, etc. - then the medical team
will move in and establish limits and stronger supervision.  It sounds like your facility has established a
POLICY whereby you are the designated one to make those purchases. I would also think there are
other policies regarding the decision who you can buy for and how it is stored and distributed.

Why can't you share your concerns about the falls and being sued with your administrator. I am sure
there is an appropriate answer for that.  If it is a moral dilemma you are facing - meaning ethically you
are against alcohol and smoking in general - professionally, you will have to come to terms with that. I
would think if you feel that strongly about it, there should someone else in the building who could pick up
these items for the residents. Another consideration is to schedule a bus trip a few times per month to
the local liquor store so these residents can make their own purchases.

Sorry I cannot be much more help than that. If anyone else has a similar situation or a better answer -
feel free to write in the Dear Debbie column.
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com
_______________

Question:
 I have been a director of activities for 6 months. I have a nice program going for our 35 or so
residents. I recently started a book club. The residents who's short term memory can be as little as 1
minute want to be a part of this group. How do I get them to read and retain like the other half
of the group. OR with such a small population how do I break the group in half with out hurt feelings.

Answer:  It is definitely more therapeutic to have smaller groups which are based on functional ability.  
But, if you have a small center and only 35 residents - that is sometimes hard to do if you are the only
person conducting programs.

With residents with cognitive impairments, reading shorter stories or items from the Reader's Digest
might be something they could discuss.  It is the longer, extended reading they might lose interest in or
fall asleep.  A mixed group could enjoy some of the short stories or jokes in Readers Digest.  The
Chicken Soup stories are also short.  Another suggestion is to stop every few paragraphs and discuss
what is read.  This breaks up the monotany of extended reading also.  Using visual cues with the
readings, such as images, photos or pictures to correlate with the reading keeps their interest as well.  
As far as retaining the information, that just may not be possible.  But, they can still be a social part of the
group, participate in the discussion at the moment and read (as that may be a residual skill that
remains).  Good luck!
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com
_______________

Question:
 I am currently an agency-employed caregiver working in people's homes. I find helping the
elderly to be both spiritually rewarding and enjoyable.  I've worked for this company for almost two years,
and took care of my own mother for 11 years before that.

I have a bachelor's degree in English. How would I go about getting the necessary education to become
a certified activities director? How expensive would it be? What kind of financial aid is available?

Answer:  You should check out the National Certification Council for Activity Professionals. They have a
certification program which is a combination of education, work experience and continuing education.  
You can download the standards and see where you need to focus. They also have scholarship
information noted on the announcements page.  You can also contact the MEPAP instructors in your
state.  They might be able to help you with where courses are located and such.  There are quite a few in
Texas but I guess that is because you are such a big state!
http://www.nccap.org/cgi-bin/Instructor-State-Reps/Instructor.pl?
mydatabase=Instructor&State=Texas&order_by=LName&order=abc
Feel free to email me back with any questions,
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com
_______________

Question:  
Help, I am an LPN. I applied to a job for activities Director in a Day center for seniors. Many
are lower functioning and have mobility issues. I am developing programs and have allot of experience
with the therapeutic process. I seem to be a natural at the job. They hired me knowing I did not
have certification now they are saying they want me to get the certification. On top of that I am 8 credits
shy from my associates in business as I was transferring nursing credits to get the degree after my
divorce. ( BA IN Health care management) They have not offered to pay me for the course and it is allot
on top of my other schooling I am wanting o finish.( its allot on my plate) I am in south Florida and any
advice would be helpful. I d not know if it is necessary or what would be best for me to do. I like the job
but thought they were fine with my LPN status .

Answer:  Unfortunately, I do not know the state regulations for day programs in Florida.  I would suggest
you contact the NCCAP instructors in Florida and they should be able to clarify regulations and what you
need for your position.  


Sorry I am not much more help.
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

Feedback: " It  worked out well. They checked and no additional certification was needed . LPN scope of
practice is broad enough.  Thanks for responding,"
_______________

Question:  I am an A.D.in an Assisted Living in the State of ______. I have recently been told by the
facility Resident Care Coordinator, that I must purchase alcohol and tobacco upon resident request.

I feel strongly opposed to purchasing alcohol for a resident, as it can increase the risk of the resident
falling, being injured or worse. Should this happen, in addition to the guilt I would carry, I am afraid I
could be personally sued, no matter how much liability insurance the facility carries. As you know, We
live in a very litigious society.

Do you know if Activity Directors are required to make purchases of alcohol for residents or if it falls
under a "Resident's Right"?

Can I legally be forced to do this if I have moral and/or safety concern? Can you provide me with a web
site or information I can take to my administrator to help my case against this practice?

Answer:  Assisted living regulations vary from state to state so I cannot point out a specific regulation in
your state.  I do know the residents have the right to drink and smoke if they so desire. But, the resident
needs to show they are capable of pursuing this on their own and in a reasonable way and it won't
cause them harm.  In NJ, the resident has a complete assessment upon admission and if the resident
likes a cocktail or wants to smoke - the skills associated with those tasks are identified and assessed.
If the resident has the appropriate skills and judgment and there is nothing medically contraindicated,
they are permitted to do those things and should manage them on their own. If the resident proves they
are not making good judgment - drinking too much, smoking in their rooms, etc. - then the medical team
will move in and establish limits and stronger supervision.

It sounds like your facility has established a POLICY whereby you are the designated one to make those
purchases.  I would also think there are other policies regarding the decision who you can buy for and
how it is stored and distributed.  

Why can't you share your concerns about the falls and being sued with your administrator. I am sure
there is an appropriate answer for that.  

If it is a moral dilemma you are facing - meaning ethically you are against alcohol and smoking in
general - professionally, you will have to come to terms with that.  I would think if you feel that strongly
about it, there should someone else in the building who could pick up these items for the residents.  
Another consideration is to schedule a bus trip a few times per month to the local liquor store so these
residents can make their own purchases.

Sorry I cannot be much more help than that.  If anyone else has a similar situation or a better answer -
feel free to write in the Dear Debbie column.
Debbie Hommel, ACC, CTRS  
www.dhspecialservices.com
_______________

Question:
 I am an out of work Activities Director. I do have ADC status. I have about
5 years experience as a director. Most of my work was in Adult Medical Day Care. I've also been in the
Assisted Living setting. My last position was as the dementia unit coordinator in Assisted Living. Due to
the economy, that facility downsized by putting that added responsibility on one of their nurses There are
32 residents on that unit and they have no activity staff."sometimes" they will send one of the activity staff
from the Assisted side over to do an activity When I was there I did the activities along with all of my other
responsibilities. The Personal Care Aides were supposed to help with activities. They did not want to
(and honestly did not have the time.) So they resisted in every way. Since I left I have had family
members call me (I did not leave my phone # or keep contact with anyone there) and say how bad
things are going and that I was the only one that engaged the residents and all they do is sit in front of
the television now. They have gone to management to ask if they could bring me back. Management told
them that they felt the need to go with an RN in that position. The bottom line is that I need a job. I have
gone through every facility in the South Jersey area with either phone calls, sending resumes, filling out
applications, and a few interviews. Financially I need to work full time in a management position. I am 57
years old and wondering if this has sometimes swayed a company's decision. I know that also one of
the decisions were made because the other applicant was bilingual. I'm wondering about taking the
course for CALA. Do you think this would make me more marketable? Do you have any other
suggestions? I have to work at least another 10 years and senior citizens, especially the dementia
population are my passion. I'd appreciate any help you can give.
Thank You

Answer:  It does sound like you have had a tough time finding a position.  It is hard sometimes making
the transition from one facility to another.  Regarding a few of your comments...
As far as taking the CALA course - not sure how that would help you obtain an activity director position.  I
know the CALA positions are not easy to come by.  As far as age discrimination, that is hard to say also.  
It is a fact of life that facilities sometimes hire younger people because they can pay them less. It isn't
necessarily your age but your years of work experience and national certification that warrants a hirer
pay. Is it right? Is it fair?  Of course not, but in today's economy - facilities are seeking cost effective ways
to meet their requirements.  

I would suggest you critically assess your resume and interviewing skills.
Is your resume professional and appropriately written?  If it is not, it won't pass the initial screening
process. During your interview, do you focus on your skills and abilities or have you commiserated about
your past positions and downsizing?  

I would also suggest organizing a professional portfolio to bring on your interviews.  The portfolio
showcases your work. It would have sample calendars and newsletters you have done which would
show your computer ability.  It could contain photos of some events or programs you have organized.  It
could contain letters of recommendation or commendation from families.  It could contain your
certificates.  You want just enough information to showcase your work and abilities.  You don't want too
much but just enough.  

One final suggestion would be to call some of these facilities where you have interviewed and not gotten
the position.  Ask them why you were not selected and maybe that will give you insight into your
presentation during the interview which would make you more successful next time.  
Hope that helps and good luck,
Debbie

_______________

Question:
 If my ARD date is 2/20/09 Can you please tell me when the proper time is to document on my
progress notes. Also after the documentation is done, can the ARD date be changed?

Answer:  According to the guidelines for the MDS which you can find on the CMS web site http://www.
cms.hhs.gov/NursingHomeQualityInits/downloads/MDS20rai1202ch2.pdf

It says :
"The Quarterly assessment must be completed no later than 14 days after the ARD. That is, R2b can be
no more than 14 days from the ARD (ARD + 14 days).

Once the ARD has been established, it is the last day of the observation
period"   when they reference quarterly assessment - they mean the quarterly
MDS.  So, your note can be done in the time frame after the ARD and before the quarterly MDS is slated
to be done.  Your progress note should support what is coded in the quarterly MDS.  So, if your ARD is
2/20 and your care plan meeting is 2/28 for that person - you would have to get your note done prior to
the meeting.

The ARD is established in accordance with the MDS, when it is filed and such.  This web site talks about
instances when the ARD is changed.  
http://www.adldata.com/References/CMS_SOM/3.3.A_-
_MDS_Identification_and_Background_Information.htm
When the current documentation is done - the new ARD will reflect the next time the MDS quarterly or
annual is due.
Debbie

_______________

Question:
 My corporate office has asked me to document differently on my progress notes to capture
more money. Evidently if the resident is awake morning and evenings there is a greater amount of
payment. My question is On the amount of time the resident is awake in the evenings. The MDS book
says if the resident is awake at 5:00 till 10:00 (or bedtime if its earlier) to check that they are up. So if the
Resident is up for supper, stays up till 7:00 I check that they are up. Is this correct?

Answer:  Yes, that is correct.
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Question:
 I was recently told by our corporate office during a "mock" survey to start looking "outside the
box" even if it means leaving the "comfort zone" Also start planning activities for the baby boomers. Any
ideas? They will be back in 30 days to see what I've come up with.

Answer:  Reading into what you are saying - they said - it seems to me they might be suggesting your
program is a bit traditional or not creative.  When people suggest "out of the box" thinking - it usually
infers "be more creative".

Regardless of how creative they want you to be, you should not lose sight of the needs of your
residents.  Sometimes creative programming is more for marketing than meeting the needs of the
residents.

In any case, there are lots of new ideas out there that are more "state of the art" such as individualized
clubs (travel groups, Red Hat Society, special interest groups), educational opportunities (guest
speakers, trips to museums, lectures), theme programs (there are many theme based activity sites
available for ideas) and new resources (there are so many books, publications and activity supplies
now geared specifically toward geriatric interests).  The Wii is a hot new program that a lot of facilities
have bought into as well.  Not knowing your current program plan - not sure if any of these ideas are new.
The second thing you might consider is what has your budget been and how has that impacted upon
your ability to develop programs.  If your programming for the cognitively impaired is minimal, some of
that might be related to a lack of supplies.  A good program for the cognitively impaired needs sensory
materials, diversional materials and appropriate games and books for that population. If your budget
has been limited, that might have limited your program in that area.  Granted much can be created from
found materials and ideas off the internet (sensory boxes, reminiscing cards, etc), but again, there are
so many cool things now for programming which make our job easier.

There are plenty of programming resources which provide countless ideas on the subject. There is a
"Dear Debbie" letter I recently sent back where I listed all the sites.  So check out the Dear Debbie
archives.  

The final comment about the "baby boomers" is usually related to a sub acute program that might be in
your facility. Having computers with internet access, more progressive crafts such as scrapbooking and
beadwork, book club discussions and more current topics and movies are appropriate for that
population.  There are many articles out there on the subject and here is just one.
http://hcpro.com/LTC-
227209-4564/Preparing-for-baby-boomers.html

Again, not knowing what you are currently doing - it is hard to offer suggestions.  But, there are so many
resources available to our profession and noted on the Activity Director's Office web site and my web site.
http://www.dhspecialservices.com/links.htm

Some are for free and some cost money. Part of your action plan could include a budget for some of the
new games, resources and supplies that are out there.
Good luck,
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

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Question:
 Hello...I am wondering about the continuing education requirements for activity
professionals.  Are there a certain amount of hours needed per year for both full and part time
employees.  Thanks.

Answer:  Continuing education is only mandated if you are nationally certified through the National
Certification Council of Activity Professionals (NCCAP)or the National Council   of Therapeutic
Recreation Certification (NCTRC).  If you are not certified through either certifying body, there are no
mandated hours you would have to have.  It is good practice to go to seminars and such to keep you
focused, introduced to new ideas and to validate what you already know - if you are not certified.  
Hope that helps. If not, feel free to email me back, Debbie Hommel, ACC, CTRS
www.dhspecialservices.
com

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Question:
 I'm looking to become an Activities Assistant. I live in the Philadelphia PA area. Where can I
go for education and not have to be certified. I have been volunteering at a Sunrise facility (retirement
community) for a year. I have an Associates degree in Therapeutic Recreation in 1987. I heard that it
looks good on the resume to have recent education.

Answer:  Technically, there are no regulations for the position of activity assistant.  With your recent
volunteer experience and education (even if it was a few years ago), you can certainly apply for paid
positions in your area.  If you are interested in the MEPAP course which is the nationally accredited
course which enables you to become nationally certified, here are the instructors in your state:

If you are just looking for some one day programs, I do have some independent study education
available on my web site.
http://www.dhspecialservices.com/independentstudypage.htm

I also have one day programs and seminars listed on my site as well.  Our NJ State association has a
two day convention coming up at the end of April which is in Windsor Township which is just over the
border into NJ from PA.
http://www.dhspecialservices.com/seminars.htm

You also might want to investigate the Pennsylvania Activity Association which has educational
programs also.
http://www.papactivitypro.org/index.html

If you have any other questions, feel free to email me back.
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

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Question:
 I am going to do some volunteer work at a nursing home in my community. Have never done
this type of work before, but love to work with people and am very excited to have a chance to do this. I
work full time during the day so I am planning on going there in the evenings after dinner. I do not have a
degree in this type of work. I am planning however to take some classes in the future. Until then, any
suggestions on how to get started would really be appreciated. I am not really crafty. Just a plan old
person with not any talents, but the love of people. I really just want to talk and visit with them, especially
the ones that don't have anyone. Thank you so much for your help.

Answer:  I started out my career as a volunteer visitor as well. It is a rewarding experience for sure.  You
don't give yourself enough credit when you say you don't have any talents.  Being a people person and
having good social skills is a talent.  I would think your volunteer coordinator or director of activities will
introduce you to some residents who would appreciate a visitor or two.  Usually, those types of folks are
more social and would welcome a conversation with a visitor.  I think most people have more success if
they bring props or things to talk about.  Photo albums, newspapers, magazines and such give
opportunity for topics to be introduced.

The activity department should have some materials you could borrow such as reminiscing books or
cards, trivia books and other types of word games.
Your visit should reflect on the needs and interests of the residents, so knowing a little bit about them
would also help.  There are some great reminiscing materials you can print out for free on the internet.
The NY public library has an amazing collect of images and documents that could be printed out for free
and used in a visit.

http://digitalgallery.nypl.org/nypldigital/explore/dgexplore.cfm?col_id=482

Penny Postcards from just about anywhere http://www.rootsweb.ancestry.
com/~usgenweb/special/ppcs/ppcs.html

Old retro ads which could be printed out.
http://www.plan59.com/main.htm

I also have a page on my web site with lots of seasonal web sites where you could print out trivia and
information related to the various days in a month.
http://www.dhspecialservices.com/themesites.htm

Finally, if you are looking for some formal information, I have a book and an independent study program
on my site about a 1-1 visit program and it has lots of ideas.
http://www.dhspecialservices.com/timewellspentbook.htm

Hope that helps and good luck!
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

_______________

Question:
 Our residents just voted in a new resident council consisting of president, VP, secretary and
treasurer.  Please let us know the responsibility of this council.

Answer:  There are many resources you can use to help your council develop.  The Activity Director's
Office has an archived article I wrote on the subject you could read.
http://theactivitydirectorsoffice.com/DebbiesADTips_archive200610.html
I also have a good book on councils on my web site.  It includes a discussion of the roles of the officers.
http://www.dhspecialservices.com/residentcouncilbook.htm
And I have an independent study program on Developing a Resident Council on my site as well. It is
approved for 4.5 NCCAP hours and you get the book with the program.
http://www.dhspecialservices.com/residentcouncilindependentstudy.htm
Good luck,
Debbie

_______________

Question:
 I have worked in activities for about two years now. I absolutely love it and am always looking
for more/betters ways to run my department. However, we have run into an ongoing problem. The
Activities Assistants take on so much, as you probably already know, and our facility's ways of
documents the residents mentality and social life is becoming struggling. It is the assistants job to have
a calendar for each Resident on the front they must record which scheduled activities each Resident
attends, on the back they must record: therapy sessions, showers, when the get family visits, and so
on, the back they must fill in at least 3 lines for each day. Not only do they have the front and back
calendar but they also have a one to one paper that they must fill out for each Resident every day!!! I am
looking for a new way to document all this so it will be easier for the assistants and so our book work
will stop getting so behind!! But I just cant find a thing?!?  Any ideas?

Answer:  When you say the assistants record on the back of the calendar therapy sessions - do you
mean PT and OT?  That kind of therapy?  And you say showers?  
I don't see the point of tracking that information.
My only guess is, you are trying to identify things that prohibit the resident from attending activities?
As far as tracking family visits, that is fine because it is an activity.
You say you must enter three lines for each person on the back of the page - I am not sure where that is
coming from because there are no regulations that would require a number of lines.  Maybe it is a
facility/corporate policy?

You are right to question why you are doing some of the things you are doing.  We have to remind
ourselves what we need to monitor and what is the most efficient way to track it.  We need to monitor
implementation of care plan interventions and monitor resident participation in activities (group, 1-1,
etc).  I personally don't like the calendar method (monthly calendar and highlight what they go to).  I just
don't think it allows easy tracking and it gets messy - it is just my opinion. I prefer a three month or more
grid which allows an entry for each day. What the resident does is coded.
There can be codes for the activity types and the resident's response to the program. This is where you
would note they were unavailable or visiting with family or refused to attend.  I have also had good
success combining my 1-1 documentation into the main book. The attendance sheet for those needing
1-1 is copied in a different color - like a bright pink. This highlights the need for 1-1 and staff enter 1-1
contact with a similar code.  You have to do what works for your department in terms of efficiency and
communication.

It has to be efficient in entering the information as well as reviewing it later to assess content.  Possibly
you and your department can brainstorm new ideas for a more efficient method of documenting
attendance.  Double check your state regulations but I doubt there are any specific references to how
you should monitor participation and response other than you should be doing it somehow.
Good luck,
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

_______________

Question:
 I have been asked to supply a budget for the year for activities department. Is there copies of
suggested items or list for me to use.

Answer:  I looked through several of my basic activity books and only found one book which had a very
comprehensive listing of suggested supplies and equipment for the department.  The Activity Services
Manual by Susan Newell, MA, CTRS has a great listing in one of the glossaries of her book.  You can
purchase this book at
http://www.trtips.com/trtips.net/index.html

You can also make your own list by working from the various catalogs that are available to the activity
profession.  Create specific categories such as physical, cognitive, social, intellectual, etc., and create
lists of supplies needed for each type of programming.  
Hope that helps,
Debbie Hommel, ACC, CTRS

_______________

Question:
 I am certified activities  director. I there somewhere that I can go online to get a copy of my  
certificate?

Answer:  If you mean your NCCAP certification, you can email them at info@nccap.org and they can
probably re-issue your certification.  If you are talking about your MEPAP certificate, you would have to
contact your original instructor to see how they would issue a copy.  I do not know of any place on the
internet where you can print it out.  If you meant something else, email me back,
Debbie Hommel, ACC, CTRS

_______________

Question:
 I am about to be a college graduate. I  have experience working as a therapeutic recreation
aide and think I  am qualified to become certified as an activity director but am having  some problems
understanding the process (how to take the test and  where to find a MEPAP courses). I very much like to
work with the  elderly and would love to further my hire-ability by becoming  certified. Any advice or
information you could give me would be  extremely helpful. Thank You for your time!

Answer:  The current process to become a certified activity professional through the National
Certification Council of Activity Professionals does not include a test.  Currently, the requirements
include work experience, some college credits, continuing education credits and the MEPAP course.    
NCCAP is working on a nationally driven test, so in the future this may be the case, but not right now.

To find an instructor in your state, visit the NCCAP web site. They list
instructors by state.  
http://www.nccap.org/about/educators/index.shtml
If you need any further information, feel free to email me back.
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

_______________

Question:
 I am thinking of joining the NAAP, but I have one question.  What is the difference in the Active
and Associate membership?

Answer:  If you are employed in a position of activity professional (in any capacity) you would join as an
active member.  If you are currently not working, retired  or a student or a senior citizen - you would join
as an associate member.  I am not exactly sure what an associate member does not get or cannot do
as opposed to an active member.  In our State association (which is modeled after NAAP), associate
members cannot hold office and that is about the only difference.  But, if you are working - you would
automatically join as an active member.
Debbie

_______________

Question:  I find my residents have a hard time with word scramble.  I created this form and was
wondering if it was to easy.  Please reply I would like to know before I try it.

Answer:  You never know till you try it.  What is the harm in giving it a go?
But, I can see where you left out spaces between the words they are supposed to find so it does make it
easier for someone to spot the words.
Debbie

_______________

Question:   I am looking into my second career and I want Health Care.  I also want to work with the
Elderly.  Can you suggest any schools or programs for me look into.  I need a career that moves around
and is active.  Activity Director has been on my radar but I need schooling.  Any suggestions will be
greatly appreciated.

Answer: Hi, welcome to activities.  You have found the right job if you are looking for something that
requires you to move around and be active.  

The best way to start is to look into the MEPAP course - the Modular Education Program for Activity
Professionals, 2nd Edition. It is a training program which provides lots of good information to prepare
you in this field.

There are instructors in most states and also independent study or on line versions of the course.  You
can access information about the course and instructors at the NCCAP website.
 www.nccap.org
What state do you live in?
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

_______________

Question:
 I am currently working on a dementia unit for people who have end stage
dementia/alzheimers.  I am trying to come up with a daily flow to be posted. Not a calendar , but more of
an overview of what goes on through out the day in the activity room. I am thinking of leaving it open for
creativity to avoid the monotony of the same old thing.  Do you have any ideas?? Have you used these
types rather than a specific calendar?

Answer:  Many memory support units are based on daily routines and it is found to be effective.  The
routine should include a balance of active and passive stimulation, varied structured and unstructured
programs and integration of life skills and daily living tasks.  For the routine to work, the staff need to be
trained and committed to the process.  Sometimes, if they don't put their effort into it - the routine is
overlooked and residents are left to sit ldly throughout parts of the day.   When integrating activities into
the routine, I still think it is appropriate to have a weekly or monthly calendar for the specific types of
programs that are planned.  For example, if the main activity time is ten and two or thereabouts, the
calendar would reflect specific programs at that time- to prevent monotany - as you say.    Another option
is the define categories of activities at specific times and to have a supportive list of various programs
that would fit that category of activity.  Not sure if I am explaining myself well enough - but to answer your
question - yes, a daily flow is a good idea but balanced with specific plans to make sure seasonal,
theme and varied programs are offered.
Good luck,
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

_______________

Question:
 I was wondering when you do activity participation sheet do you mark everything u see Res
doing even independent as watching t.v., walking and talking or only group activities they attend in your
daily log?

Answer:  I think you could go nuts trying to log everything the resident is doing in their waking hours.  I
would think documenting actual group participation and 1-1 staff and volunteer visits should be
sufficient.  There is nothing in any of the regulations that govern content or method of participation
records.  The regs imply we need to be monitoring them and ensuring any care plan interventions are
implemented as written.   The progress notes could discuss how the resident spends their day -
independent leisure, etc.
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

_______________

Question:
 I think i sent you an e-mail to your dear Debbie column i am sending you this copy on my e-
mail to make sure you get it

Well like i said i have been working in this facility for over 13 yrs have been promoted many times i
started here as a CNA  moved up in that department from training tech to coordinator Then i was moved
up to central supplies now My Administrator and DON thought i would do well with the activities position i
am a person that sees an opportunity to better myself and will take that step forward but i have no
academic background no resources to start with the last activities director was in the same boat so as
for training i was dead in the water i have and was given a non functional department as for
documentation i am getting on the job training from the SS dept. and the MDS coordinator as to what to
put in the charts how to document and assessments( admission ,quarterly )for activities i have many
resources from group activities to one on ones i do bingo have various people coming in veterans clubs
church groups elderly communities volunteers and all the resources i get online  so my dept is now a
functional one all that is fine and dandy but if the state comes in I'm just some CNA that was put there to
fill a position i was told that if the facility had 90 residents some rules did not apply but i really need to
have something under my belt i have checked the links on your page and have the info on what is
required is there an online website i can use to get certified or do i go to the nearest community college
and start from there.......

Answer:  There are three instructors of the MEPAP course in Florida and they could definitely help you
find a course location near you.  

You are right to want to seek formal education for your position.  The activity profession has grown
remarkably and although creative and caring people are the backbone of what we do, there is a need for
formal knowledge and education.  The MEPAP course will provide you with that.
If you have any other questions about education or certification, feel free to email me back.
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

_______________

Question:
 Hi I am a 54 year old grandmother who has found herself out of work. I work as a home
health aide for 9 year in the 80 and 90. I enjoy working with the elderly. I know I can't do all the pull and
lifting it take to be an aide again. But I would like to get in the activity director field. I know I need to start at
the bottom and work my way up. However I not sure how to do this. I have found training but I do need to
get a job now and work my way up as I train. Do you know how I would do this. I live in the Nashville TN
area. Thank you

Answer:  To become a director, it is a combination of work experience and education.
You can acquire both at the same time.  So, finding a job is a priority and a great way to acquire helpful
experience in the field.  Completing the MEPAP is the next step as well.  Many facilities sponsor their
employees in taking the course, so as you go on interviews for activity positions - certainly share your
interest in pursuing your education and becoming certified one day.  Ask about their education
reimbursement policies.  

Good luck and if you have further questions in your process, feel free to email me back.
Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

_______________

Question:
 I wanted to first thank you for your website. I wouldn't have been able to do my job for the past
3 years without it. You are a Godsend!

My employer now wants me to take the certification for AD. I've wanted to have that opportunity but
honestly, I'm scared! I am 54 years old; haven't gone to school in 30 + years; poor memory. How much
memorization is there in the courses. I plan to do it at home.
http://www.ourchurch.com/member/g/grammysroom/

Answer:  Your letter was forwarded to me by the ADO staff.

I would like to encourage you to consider the MEPAP course.  First, 54 years old is not too old to learn.  
You might be a bit rusty in the school department but once you get back in the swing of things - you will
do fine.  I teach the MEPAP course in NJ and I have people of all ages take the course.  Kids right out of
high school all the way up to more mature people well into their 60's.  My oldest student was 74 and she
ran circles around some of the "youngsters" as she called us.  Age is just a chronological marker.  If this
is something you want to do - you can achieve this is you put your mind to it.

In my regular class - which meets in a classroom setting - we don't do much memorization.  The
students have to study for the tests but we go over the information in class and there are assignments to
go with the information so it isn't like the information is not familiar by the test day.
In an independent study situation - it is most likely the same thing.  You do reading, assignments and
projects on your own time.  You would have to study for the test but that is about it.  
If you need any more information about the MEPAP or the certification process, feel free to email me
back.

Debbie Hommel, ACC, CTRS
www.dhspecialservices.com

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