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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in Long Term Care Settings
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Progress Note Basics
by Debbie Hommel, ACC, CTRS

Documenting resident/client response to interventions is an integral part of the care planning
process. This review of progress is known as a progress note.  There are many regional
variations as to how often, where and what should be documented.   Most nursing homes
document review of the care plan on a quarterly basis, in coordination with the MDS Quarterly.  
Most medical day care centers also adopt a quarterly time frame.    Facility policy should
define specific practice as to the timing, means and method of reviewing the care plan.

The activity professional should rely on professional standards to guide appropriate content. It
is also important to keep in mind - the purpose of the progress note, which is to document how
the resident/client is responding to care and treatment. The following areas may be included
within any routine review of progress:

*  Reassess resident/client for change in functioning compared to original assessment or last
review. Has the resident/client improved or declined in functioning?

*  Review resident/client participation within the activity program. Focusing on responses to
activities and behavior within the programs is encouraged.

*  Review response to any specific interventions, such as room visits, sensory programs or
specialized activities for special needs. Again, we want to focus on how they are responding to
the interventions, rather than simply stating interventions were offered.

*  Note any barriers to implementation such as resident/client refusal or unavailability.
In addition to professional standards which guide our profession, the activity professional who
works in nursing homes needs to reference the guidance for F-248 which indicates the care
plan revision should include:

  • Changes in the resident’s abilities, interests, or health;

  • A determination that some aspects of the current care plan were unsuccessful (e.g.,
    goals were not being met);

  • The resident refuses, resists, or complains about some chosen activities;

  • Changes in time of year have made some activities no longer possible (e.g., gardening
    outside in winter) and other activities have become available; and

  • New activity offerings have been added to the facility’s available activity choices. For the
    resident who refused some or all activities, determine if the facility worked with the
    resident (or representative, as appropriate) to identify and address underlying reasons
    and offer alternatives.

I
nterdisciplinary Notes vs. Department Specific Notes vs. Episodic Notes

Regionally, there are various practices for documenting progress. In many states, the
interdisciplinary team note is a popular and effective practice. The team note is a collaborative
note, which includes information from each care plan team member. It reflects information from
all disciplines and gives a complete picture of the resident/client's progress.  The team note
documents a more integrated picture of the resident/client and minimizes repetitive information
found in each disciplines entry.

In some locations, separate progress notes are entered by each discipline. The individual
professionals document progress from their perspective. Separate notes allow for a thorough
review of progress in each area, however sometimes provides overlapping information.
The same information would be entered in either note, depending on your facility practice.  
The discussion of levels of participation, response to interventions, barriers encountered and
outcomes noted could be entered in either the team note or the activity based progress note.  
Federal regulations do not mandate department specific progress notes, as long as a
discussion of progress and participation is noted somewhere in the chart.  Again, facility policy
and procedure would define where the note is entered.

Episodic Notes, also known as Incident Charting, Focused Notes, or Clinical Entries, are notes
entered in response to an event or incident. The note is entered when the incident occurs and
focuses on facts and issues related to the incident. Episodic notes should include enough
information (such as what the incident was, what the caregiver did in response to the incident,
who was informed of the incident, and if the care plan needs to be adjusted) to cover the
incident adequately.

Progress notes are an important part of the therapeutic process.  They provide on-going
information regarding resident/client status, progress and participation in life of the facility.
They ensure continuity of care and justification for care and services provided.   
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