Dedicated to helping Activity Professionals
with the daily operation of their department.
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by Debbie Hommel, BA, CRA, ACC,
Executive Director of
DH Special Services.
Meeting the Activity Challenge

June 1st has arrived and so have the final changes to the activity guidance for F-248.  Activity
professionals have been talking about these changes for months and now it’s here.  If your nursing
home activity department has not read the guidance, nor begun to assess the need for any changes in
your department – now is the time to start.   But where do we begin?

The first step is to get a copy of the guidance.  Your department should have the final copy which is
available through the Internet, as posted on the NCCAP site (  Or I can email you a
copy (

There are several areas of focus within the changes, including individualized assessments, therapeutic
and individualized care planning, specialized and individualized programming, and the role of the
interdisciplinary staff in promoting and fostering involvement in leisure and recreation.  These are not
new concepts, but they are defined in more detail with many examples cited throughout the guidance.

One of the first areas you can review for compliance is to look at documentation.  Are your assessments
gathering enough individualized information for your department to create individualized care plans.   
Focusing on past life roles, their significance to the individual, specific leisure and recreational interests
and the need for any form of adaptation should be noted within the assessment.  Care planning is also
specifically defined within the guidance.  There are several pages of suggested activity based
interventions to address perceptual, cognitive, behavioral, physical and emotional needs.   Taking the
guidance with you to care plan meetings can assist the activity professional in upgrading care plans
appropriately.   As additional care plan interventions are noted, additional equipment and programming
may need to be introduced as well to meet the interventions.

The department should inventory supplies and equipment and compare available supplies to the
suggested materials noted within the guidance.  There are very specific references to the use of
magnifiers, amplifiers and other adaptive devices as a means to address specific limitations.  These
materials should be available within the department for ready access.

Departmental systems to ensure residents are engaged in programs according to identified need and
interest should be in place.  Methods to communicate identified interests to those individuals involved in
care and methods to ensure residents are participating in programs according to the plan of care should
be in place.  There has been much discussion the Population Needs Assessment, or any tool which
analyzes the categorical needs of the population and compares the identified needs to available
programs in the facility.  There are many analytical tools being introduced which define the population
and program in this way.  There is a sample system posted on the CMS training program for the new

Finally, getting the interdisciplinary team prepared and involved is probably the hardest step.  In order to
be successful in this task, full support needs to be obtained from the administrator and director of
nursing.  Without their support, it will be difficult to secure support from the rest of the team.  The
guidance offers very specific references to the responsibilities of the nurse, nursing assistant and social
worker.  In-services should be provided to the interdisciplinary staff and copies of the guidance, with the
appropriate section highlighted, should be provided to the team.

These changes will not occur over night.   Creating an action plan for your department is a good
approach.   The action plan should identify areas within the department and facility that need adjustment
in order to satisfy the guidance.   The action plan would include specific tasks to introduce change,
methods to introduce change and a defined time line of completion.   The action plan should be
developed with the administrator and director of nursing, as they should be involved in the plan also.  The
action plan will provide the facility with a focus and assist in keeping the team on task.

Communication with each other during this implementation period is also crucial.    As a profession, we
need to support each other and work through these changes in a positive and productive way.  The
Internet and e-mail is amazing vehicle to remain connected.  Use the many bulletin boards and email
chains to share information.   Most importantly, never lose sight of what is really important – meeting the
needs of our residents.
Let Debbie answer your
Activity Questions
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.
Music: "Alexander's Rag Time Band" furnished by Heart and Soul Music "Providing Quality Music for Nursing Homes"
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