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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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in Long Term Care Settings

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Getting Closer to Home
by Debbie Hommel, ACC/MC, CTRS

The Center for Medicare and Medicaid Services (CMS) revised a number of guidelines
for Quality of Life which were implemented on June 12th, 2009.  These revisions focus
on twelve quality of life and environmental federal requirements for nursing homes.  
The changes are based on recommendations from the 2008 “Creating Home”
Symposium which was co-sponsored by CMS and the Pioneer Network.  These
changes strengthen the tenets of person centered care and home (not just home-like)
in our long term care facilities.  

The activity professional has long embraced person centered care as a standard of
practice.  We have always focused on the individual and what the individual wants.  We
have always strived to empower personal decision making and foster independence -
to the best of the individual’s ability.  Through our programs, including groups,
individual activities and spontaneous life experiences we are able to create home and a
feeling of belonging for the elders who reside in our facilities.   I wrote several articles
on person centered care and the activity professional for the Activity Director’s Office
which can be accessed in the archives of the web site.

The revisions to the quality of life guidelines introduce stronger examples of how staff
should meet the needs of the resident through person centered concepts in personal
approach, honoring the wishes of the resident and through environmental
adjustments.  You may not notice any “new” ideas in the guidance but more specific
language in defining how our care facilities should change to focus on the needs of the
resident not the needs of the facility.  These changes compliment the changes to F-248
which were introduced in June, 2006 when the regulations began articulating the
person centered philosophies.  As activity professionals, these changes strengthen the
importance of the individual choices we offer our residents through leisure and
recreational opportunities.  Here are some of the highlighted changes:

-The facility should offer napkins during meals instead of “bibs” or clothing protectors,
unless the resident requests otherwise.
  -The staff should sit next to the resident instead of standing over them while assisting
with eating.
  -The facility should not call the residents labeled names such as “feeders” or “g-
  -The staff should interact with the resident during care and meals rather than interact
with each other and ignore the resident or not include the resident in conversation.  
  -Staff should treat all residents with dignity, including residents with dementia.  The
guidance states that staff should not contradict residents who have dementia and may
be time disoriented.  The guidance suggests all staff should work toward
understanding the cause of resident behavior or the “hidden agenda” which may
stimulate a particular behavior.  

Self Determination & Accommodation of Needs
  -There is much emphasis on choice as truly decided upon by the resident including
choice in activities, schedules, eating, bathing, sleeping and life in general.  
  -There is much emphasis on tailoring the environment, including the resident’s room,
bathroom and common areas so the resident can function with as much independence
as possible.  
  -The revisions in these sections support F-248.  The revised guidance for activities
stressed assessment, identifying and meeting individual needs and structuring
approaches for independence and the highest level of functioning through specialized
programs and adaptation.  
  -“Homelike environment” is defined in the guidance as an environment which “de-
emphasizes the institutional character of the setting”.   This definition was expanded to
include “the nursing home should provide an environment as close to that of an
environment of a private home as possible”.  We are moving away from “homelike” to
  -In order to create home, the guidance suggests a facility should eliminate or move
away from use of the following:
          *Overhead paging and piped in music.
          *Using trays for meal service in the dining room setting.  Family style dining is the
way we eat at home.  
          *Institutional signage such as labeling work rooms or storage closets.
          *Medication carts.  The guidance points out that some innovative facilities are
storing medication in locked areas in the resident’s rooms.
          *Large, centrally located nursing stations.  
          *Mass purchased furniture, drapes and bedspreads which all look alike
throughout the building.  The guidance states some innovative facilities are inviting
residents to place some of their household furniture in the common areas to contribute
to the décor.          
     *Widespread and long term use of chair and bed alarms instead of their limited use
for specific residents for diagnostic purposes or to meet acute care needs.  The
guidance states these devices can startle the resident and constrain the resident from
normal repositioning movements.

  As the new guidance for the quality of life requirements are implemented, the activity
professional can play an integral role in training staff and leading the way in creating
home.   Quality of life, fostering relationships and creating a welcoming community has
always been a key component of what we do.  If you would like a complete copy of the
revised quality of life guidance, e-mail me at and I can
send you a copy.     Welcome Home!