Current Activities in Longterm Care
Kate Lynch, Editor
www.activities4elders.com/
KATE LYNCH
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Person-centered activities: What it means according to the CMS’s new guidance

Activities are very important to your elders, not only because they provide opportunities for
enjoyment, personal satisfaction, and social contact, but also because, researchers say, they
can improve elders’ overall well-being.

For this to be possible, however, and meet the requirements of the Centers for Medicare and
Medicaid Services (CMS), activities need to be offered within programs developed individually
for each elder, and be person centered.

The CMS specifically states that residents should be involved in “an ongoing program of
activities that is designed to appeal to his or her interests, and to enhance … physical, mental,
and psychological well-being.”

What are person-centered activities?

Look at the differences among your residents. Each one has their own character, history,
preferences, little habits, and so on. None of them are the same. A person-centered activity –
also referred to as person-appropriate activity – is simply one that is shaped around those
attributes that make each elder unique and special.

“Person appropriate, refers to the idea that each resident has a personal identity and history
that involves more than just their medical illnesses or functional impairments,” says the CMS.
“[So] activities should be relevant to the specific needs, interests, culture, background, etc. of
the individual for whom they are developed.”

Remember, this applies to any activity and any resident, including those with dementia and
those at the end of life.

A three-step approach

There are three steps you need to follow to make sure an activity is person-centered.

Assess. First, you need to find out about those attributes that make each elder a unique
individual. This means getting to know them and what makes them happy.

You need to obtain, says the CMS, “sufficient, detailed information, to determine what activities
the residents prefer, and what adaptations, if any, are needed.”

You can find lots of useful information simply by asking your elders. This is what is called a
resident’s activity assessment, and it includes current and past interests, preferences, needs,
skills, and history.

Here are some things you may want to ask about:

•  Past jobs, educational achievements and military, community, or religious involvement.
•  Preferred sports, hobbies, readings, movies, characters, authors,         actors, and
sportspersons.
•  Favorite activities (e.g., music, dancing, singing, reading, reminiscing, games, puzzles,
painting, exercise, gardening, trips).
•  Volunteer groups/projects the elderly would like to join in.
•  Skills they would like to learn, such as how to use the computer or how to play an instrument.

You can gather further useful information by talking with family members and friends. And
remember, your own observations on what the elder finds pleasure doing are very valuable,
too.

Select the activity. This means using the information, you have gathered to choose an activity
your elder will find meaningful, pleasurable and satisfying.

Make it happen. Finally, you need to address any issue that prevents the resident’s
participation in the activity, like poor eyesight, hearing problems, dementia, or being unable to
talk, walk, or use hands. It’s important, says the CMS, to take steps to make the activity
possible, regardless of any limitation the person may have.

So, for example, you may need to:

•  ensure that those who need eyeglasses and/or hearing aids wear them;
•  use the hand-on-hand technique with those with hand difficulties; or
•        set up a word chart for residents with speech difficulties.

All staff involved

All this should be a team effort. The CMS says the activities don’t have to be formal
interventions involving only activity directors. All staff, including nurses and assistants, should
be involved in delivering them at any time of the day that suits the elder and should involve
family members (including young children), friends, volunteers, and other residents as much
as possible.

A few practical examples:

• Mr. Smith has been a proud train driver all  his life, and he loves crosswords. He has hand
tremor and can’t see well. A good example of person-centered activity would be a crossword
with words relating to trains. Write instructions in large, bold letters to facilitate reading.  Place
a rubber matt underneath the crossword and give Mr. Smith a large-body pen to make writing
easier despite the tremor.
•         Mrs. White used to be a dance teacher and is a great admirer of Dean Martin. She has
dementia and is wheelchair bound. A modified dancing activity would be nice, in this case. Sit
on a chair next to Mrs. White, and with Martin’s “That’s Amore” playing softly in the
background, place your arm around her shoulders and         move together gently to the
rhythm of the music.
•         Mr. Brown has Alzheimer’s disease and paces incessantly         with no apparent reason.
He believes the facility is the school where he used to be headmaster and thinks the residents
are his schoolchildren. You may want to ask him to walk with you around the facility delivering
books. This is an example of person-centered activity, which will also make him feel useful,
thus enhancing his self-confidence and sense of purpose.

Remember, the way you treat your elders during the activity is also very important. Treat them
the way you would want to be treated: with kindness and respect. Be warm, pleasant, and
supportive.

References

1.  Department of Health and Human Services, Centers for Medicare and Medicaid Services,
CMS Manual System Pub. 100-07 State Operations Provider Certification, March 2006.
2.  Hellen C.R., Alzheimer’s disease activity-focused care, Butterworth Heinemann, Second
Edition, 1998.
3.  McClendon M.J., Smyth K.A., Neundorfer M.M. “Survival of persons with Alzheimer’s
disease: caregiver coping matters,” The Gerontologist, August 2004, 44(4):508-19.
4.  Kolanowski A., Buettner L., Litaker M., Yu F. “Factors that relate to activity engagement in
nursing home residents,” American Journal of Alzheimer’s Disease and Other Dementias,
January-February 2006, 21(1):15-22.
5.  Kolanowski A., Litaker M., Buettner L. “Efficacy of theory-based activities for behavioral
symptoms of dementia,” Nursing Research, July/August 2005, 54(4):219-28.
6.  Smyth T. Caring for older people. Creative approaches to good practice, Macmillan, 1992.


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