DEBBIE HOMMEL'S AD TIPS
Dedicated to helping Activity Professionals with the daily operation of their department.
by Debbie Hommel, BA, CRA, ACC, Executive Director of DH Special Services.
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DEAR DEBBIE:
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.
DEBBIE HOMMEL
THE ACTIVITY DIRECTOR'S OFFICE
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for Activity Professionals
in Long Term Care Settings
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The Activity Director's Office
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Disclaimer
WRITING CARE PLAN INTERVENTIONS
By Debbie Hommel, ACC

Last month, we discussed the basics of writing therapeutic goals.   This month we will follow
the therapeutic process through to care plan interventions.  One important point to re-visit is
to remember that the goal is always something the resident or client will do (action,
response, behavior) and the interventions are actions the staff takes to assist the
resident/client to achieve the defined goal.  

It is also suggested that interventions be….

  • Specific – activity types and locations; specific adaptations and special approaches
    to meet special needs and limitations of individual residents; content of sensory
    approaches and content of room visits; specific materials to utilize, if using specific
    materials for a resident.
  • Individualized - The resident's past interest and history should be reflected in the
    interventions.  Specific types of music, hobbies, television shows, diversional tasks,
    routines, coping mechanisms, motivational approaches should be noted.  
  • Relate to resident need and problem - The interventions should be specific to the
    problem, not generic additions to the care plan
  • A good hint to keep in mind is: Add what you are doing for this resident that you
    are doing for no other.

Interventions are NOT:

  • Typical approaches that are standardized and offered to the general population.
  • Standard of practice approaches which are part of professional technique for all
    residents (i.e. “encourage attendance”, “provide calendar”, “and praise participation”).

When Do we intervene?

  • When triggering in activities (as noted on the MDS), we should determine if the
    activity concern is a result of a larger problem (i.e. cognitive status, immobility,
    declining physical status, etc.).  If so, we would intervene in the larger problem, with
    interventions.
  • If we trigger in activities and there are no problems where we can intervene, we can
    add a problem or need ".  If this is the case, we would define the problem or need and
    add a goal and interventions.
  • If we do not trigger, we should review the care plan and determine areas we may
    assist through activities. Just because we do not trigger, does not mean we do not
    need to support other issues on the care plan, if relevant.

The activity professional can intervene in many interdisciplinary issues such as…..

  • Communication: How we may adapt programming and 1-1 visits for activity
    communication; special approaches we may use in activities to foster improved
    communication.
  • Behavior: Specific diversional tasks and activities that may assist in minimizing the
    behavior, diverting the behavior or preventing the behavior from occurring.  If any
    activity or situation causes or contributes to a behavior, it should be included also, as
    something to avoid.   
  • Falls:  If the falls are occurring during daytime and program areas, involving the
    resident in activities for diversion and supervision.  Specific tasks which could be
    offered to distract the resident during non-activity periods.
  • Cognitive: Specific types of activities that may provide routine and support the
    resident needs; methods to adapt and approach the resident; how the activity needs
    to be broken down and adapted for success; signs to look for in determining overload.
  • Pain: Relaxation and soothing activities, diversional tasks and any activity that can
    distract the resident from chronic pain.  
  • Ambulation and need to improve physical functioning: Physical activities to
    attend; define the area of the body that will be focused on and how the activity will be
    adapted to allow use of the body.
  • ADL functioning : Physical activities that may exercise the part of the body that
    needs strengthening; introducing ADL sensory approach to the more cognitively
    impaired; inviting to grooming activities; activities that allow problem solving and
    decision making.
  • Mood and psycho-social well being: Inviting to activities that will allow interaction
    and development of peer relationships; inviting to activities that allow accomplishment
    and expression.  

If you work in long term care, the guidance for F-248 (which was introduced last June 1st,
2006) offers several pages of suggestions for interventions.  Copying those pages of the
guidance and using them during the care planning process is recommended.    Look at
every problem and think how activities services can compliment the goal or assist in any
small way to resolve the problem.  If we can help, specifically note what will be done and
how.  The care planning process is  a means to communicate with the interdisciplinary
team.  The intent of the new guidance is to generate interdisciplinary involvement in quality
of life.  The care plan can be a vehicle to involve the team in this new way of thinking.   
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