Dedicated to helping Activity Professionals with the daily operation of their department.
by Debbie Hommel, BA, CRA, ACC, Executive Director of DH Special Services.
To Care Plan or Not to Care plan
By Debbie Hommel, ACC

There has been much debate on some of the activity based bulletin boards about the need
to write an “activity” care plan for “every” resident in the facility.  Some facilities have made
it a policy to mandate an activity specific care plan (meaning an activity based problem,
activity specific goal and activity interventions) for every resident – regardless of their
functional or cognitive status.  Maybe this is in response to the specific references to care
planning within the new guidance for F-248.  

Before putting in all the time and effort to create individualized activity care plans for every
resident who resides in the facility, the activity professional should consider the following
-If the decision to add an activity care plan for every resident is based on the new
guidance, it should be noted that nowhere in the guidance does it say we have to have
such a care plan.  All references to care planning within the guidance support the
interdisciplinary model of care planning.  Most references in the guidance refer to the care
plan as the “comprehensive care plan” and refer to activities involvement as the “activities
component” of the care plan.  It does not say anywhere there needs to be a separate
activity specific problem, goal or interventions.  
-The act of separating the activity component from the comprehensive care plan (through
a separate activity based care plan) does not support the integrated, interdisciplinary
intent of the new guidance.  If the activity department separates the activity based
interventions from the main comprehensive care plan, symbolically –it minimizes the
responsibility and involvement of the team in implementing quality of life interventions.  
-If we use the comprehensive care plan as the activity care plan and integrate activity
based interventions throughout interdisciplinary issues, the team can be more readily
involved.   An integrated approach to quality of life and activity participation is a team
responsibility, as is stated throughout the new guidance.

Some activity professionals make the mistake of thinking “if the resident has not triggered I
do not need to care plan anything”.  Nothing could be further from the truth.  Many of our
residents do not trigger (which is another discussion) and if we used that as criteria to care
plan, very few residents would have any care plan interventions at all.   The guidance
states that many residents would most likely benefit from some sort of activity care plan
intervention.   In order to achieve this, the activity professional needs to review the entire
care plan to see where we can assist or integrate.  The guidance has over five pages of
suggested care plan interventions to be considered for a variety of interdisciplinary
issues.  The goal of the activity professional is to imbed quality of life and activity based
interventions into as many interdisciplinary care plan needs or concerns as relevant.  

What does one do if the comprehensive care plan offer minimal means to integrate quality
of life or activity based approaches?  Some facilities have simplified their care plans a
great deal and have adopted the philosophy that if it is a “standard of care or standard of
practice” it should not be on the care plan.  The activity professional would need to
evaluate if the individual resident had some special needs regarding activity involvement or
quality of life that went beyond standard of care, even if the resident did not trigger.  In that
case, the activity professional should introduce the need to the care plan team and within
the care plan, actively involving the care plan team into the new concern or need.    Care
plans can address needs as well as problems.  If a resident is in a special program or has
specialized interventions developed to meet a specific need, it should be noted with the
care plan.  More importantly, the team should be a part of that care plan as they should be
ensuring the resident is assisted to the special group or the specialized interventions are
implemented consistently.  

Care planning trends come and go.  We must also keep in mind the regional differences
and requirements from State to State.  But as activity professionals, we need to rely on our
knowledge of therapeutic care planning and the regulations to guide us.  Our ultimate goal
is to address the needs and problems of our residents and clients through an integrated
team approach.  The new guidance encourages collaboration, communication and a team
approach to quality of life.
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.
Providing Internet Resources
for Activity Professionals
in Long Term Care Settings

Copyright 2004-Present
The Activity Director's Office
All Rights Reserved