Debbie Hommel's A.D. Tips
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by Debbie Hommel, BA, ACC, CTRS, Executive Director of DH Special Services
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Executive Director
DH Special Services
About Debbie

Debbie Hommel, BA, ACC,
CTRS, 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.
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for Activity Professionals
in Long Term Care Settings

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What’s so Special about Special Care?
By Debbie Hommel, ACC, CTRS

Long term care is a business.  This truth is difficult for many activity professionals to
process.  We see our mission focused on making a difference, not turning a profit.  But,
if nursing homes were not run as businesses, there might be fewer places for our
elders to reside and fewer places for the activity professional to work.  Many facilities
are introducing specialized care units as a part of the business plan.  The long term
care market is very competitive and special care programs are seen as marketable.  
The activity department plays an important role in any special care program introduced
in the facility.  But, what makes special care “special”?  Is it is matter of locking the
doors to the unit?  Calling it a special name?  Hiring extra staff for the program?   
Special care concepts focus on four elements: the individualized focus of the unit, the
staff, the environment and the program.

Before any specialized unit is introduced, there should be a common understanding of
the scope of specialized care to be provided and the services to be introduced on the
unit.  Whether it is dementia care, sub acute (short term) care, or care associated with a
diagnostic need such as Ventilator Dependency or Hospice, the focus of the unit should
be clearly stated.  The philosophy of care should be defined, documented and agreed
upon by the administrative team.   The level of care and specific scope of services
should be defined and outlined in policies and procedures.  For example, to simply
state the unit will care for residents with dementia is not specific enough.  In dementia
care, different services are needed based upon the level of dementia the resident may
be experiencing.  Prior to introducing the unit, the administrative team needs show
strong commitment to the philosophy of care and agree to uphold the standard of
admissions and program implementation.  There should be a clearly defined
admission and discharge criteria for the unit which supports the needs of the
population served.  

Once the population to be served is defined, certain staff should be selected for the
unit.  They need to show they are capable and willing to meet the specialized needs of
the residents who will reside on the unit.  Certain populations, such as residents with
dementia, need staff that has certain aptitudes and qualities as well as knowledge and
skills.  The staff should be screened and selected based on needed criteria for the
unit.  Additional education and training should be provided to the staff to enable them to
function on the unit with success.  Education and support should be on-going as a way
to keep the staff focused and motivated.  

The hallmark feature of many special care units is the environment.  The dementia care
setting often simulates familiar landmarks and home oriented facades.  The layout of
the facility is designed for easy ambulation and safety.  Sub-acute units often resemble
upscale hotels and offer amenities such as computer labs and equipped recreation
rooms.  Tailoring the environment to the needs of a specific group is a way to maximize
services as well as provide the population with interventions and approaches specific
to their needs.

Finally, the activity program on any of these units will reflect the specialized needs of the
population.  The activity professional can readily utilize their assessment skills and
knowledge of therapeutic activities to create a program which is best suited to the
physical, cognitive and psycho-social needs of the individual.  Programming on a
dementia care unit may follow a daily routine and focus on life skill tasks, familiar
activities and themes associated with holidays and seasons.  Programming on a sub
acute unit may offer more in-room programming or programs scheduled later in the day
after the therapy schedule.  Supplies and equipment would also need to be tailored to
the needs and interests of the residents on the special care unit.

Specialized care units are becoming increasingly popular in long term care.  The activity
professional will continue to play an important role within the development and future of
the unit.  While the administrators and owners of the facility will view this as a smart
business decision, the activity professional can view this as another effective way to
meet the diverse needs of the residents placed within our care.  Through our special
care programs, we can create a community.  Regardless of length of stay, cognitive
status or physical limitations, through meaningful engagement in life, the resident can
be respected and treated with dignity while being recognized as the individual they are.