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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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Activity Questions
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for Activity Professionals
in Long Term Care Settings

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Regulations and the One to One Program
by Debbie Hommel, ACC/MC, CTRS

There has been much discussion in recent weeks on the various activity bulletin boards
about 1-1 activities or room visits.  What is the difference between 1-1 activities and
room visits – are they the same? Are they different? Who is appropriate to receive 1-1
contact or visits? What constitutes a 1-1 activity or a visit?  And, how do we find the time
to do these individualized activities?  A basic introduction to this subject can be found in
the archives of the Activity Director’s Office in the article “Organizing and Managing an
Individual Visit Program”.
 As activity professionals, we comply with standards established by State and Federal
regulations, facility policy, professional and personal standards of practice, and the
resident themselves.  Answers to some of the questions presented in the internet
discussion boards can be found within these various standards.  The Federal
regulations (F-248) use the term “one to one programming” in the guidelines.  
Additionally, some State regulations include mention of types of programming.  For
example, State regulations may mention that “programs shall take place in individual,
small group and large group settings”.   The term “room visit” is used in the guidance
for F-248 and defines specific interventions which can be brought to those residents
who do not leave their rooms. .  Using the term “one to one programming” would
include those residents who are out of their rooms but may also need individualized
programming approaches.  
 The Federal regulation (F-248) defines one to one programming as “programming
provided to residents who will not, or cannot, effectively plan their own activity pursuits,
or residents needing specialized or extended programs to enhance their overall daily
routine and activity pursuit needs.”  This answers the question as to who is appropriate
for one to one programs.    A thorough assessment will identify those residents
needing one to one activity.  This would include the resident who may not or cannot
benefit from group programs and the resident who is unwilling or unable to pursue
group programming.  Based on this definition, the alert and oriented resident who is
able to occupy themselves independently does not need one to one programming.  In
this situation, the activity professional will rely on personal standards of practice.  We all
know a resident’s status can change quickly and if we do not have a consistent one to
one monitoring system in place, a resident’s changing needs may be overlooked.  One
activity professional stated “everyone is a potential room visit” and I agree with this
statement.  Any resident who does not participate in the group routine, regardless of
functional ability or need, should be monitored.  The one to one contact should be
tailored to the current needs of the resident.  Those needing more intensive contact
should receive it as defined in the plan of care.  The more independent resident would
be included in shorter one to one contact for consistent monitoring.  
 The Federal regulations define content for one to one programming within the
interpretive guidelines for F-248.  It states “for the resident who prefers to stay in her/his
own room or is unable to leave her/his room: in-room visits by staff/other
residents/volunteers with similar interests/hobbies; touch and sensory activities such
as massage or aromatherapy; access to art/craft materials, cards, games, reading
materials; access to technology of interest (computer, DVD, hand held video games,
preferred radio programs/stations, audio books); and/or visits from spiritual
counselors.”  Ideas for one to one programming abound in books and on the internet.  
Many group activities can be easily adapted for use in one to one programming.  We
can develop the one to one program just as we would a group program, based on the
individual interests, needs and ability of the resident.  
 Finding time to conduct one to one activities amongst all the other duties and
responsibilities of the day is challenging.  Providing one to one programming should be
approached similarly to providing group programming.  Specific times for the one to
one program should be defined.   Specific responsibility for each resident needing one
to one programming should be assigned to specific activity staff.  Appropriate materials,
based on the needs of the residents, should be dedicated to the program.  Developing
the program in this organized fashion will be more efficient and minimize wasted time.
The Federal regulations suggest it is everyone’s responsibility to assist in meeting the
one to one programming needs of the resident.  All staff that comes in contact with the
resident has the potential to provide a one to one approach.  Any staff member can hold
a conversation, arrange for the right radio station to be playing, change the television
station to one of resident interest, and provide other simple quality of life interactions as
a part of their work routine.  Statements in the regulations which support this idea are
as follows:
  • “All relevant departments should collaborate to develop and implement an
    individualized activities program for each resident. “
  • “For a resident who is involved in individual activities in her/his room, observe if
    staff have provided needed assistance, equipment and supplies.”  
  • “The nursing assistant interview explores how the nursing assistant may
    provide supplies (e.g., books/magazines, music, craft projects, cards, and
    sorting materials) for activities, and assistance when needed, for residents’ use
    (e.g., during weekends, nights, holidays, evenings, or when the activities staff
    are unavailable).”

It is important to note that the activity professional might create and develop the one to
one approach, but all staff can assist in carrying it out as planned.  

“Creating an Individualized Visit Program” is an informative independent study
continuing education program which includes information about setting up the
program, ideas for the program based on functional needs of the resident and how to
involve volunteers in the program.  It is NCCAP approved for 7 continuing education