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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Activity Questions
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for Activity Professionals
in Long Term Care Settings

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Defining the “I” in Interdisciplinary
by Debbie Hommel, ACC/MC/EDU, CTRS

One lesson I have learned while working in long term care is that most people feel their
job is the most important job in the facility.  In fact, some may believe an employee who
is very focused on achieving the goals of their specific job is a good employee.  Without
dietary preparing three meals a day, without nursing assistants providing the care that
is needed and without housekeeping keeping the building clean – chaos would ensue
and life in the home would falter.    This is traditional organizational theory and what we
know as departmentalization.

      Long term care is a different kind of organization because our business is caring for
people.  Although departmentalization has proven to be efficient, when caring for people
adjustments need to be made.   The business of caring for people is different than the
business of merchandising or sales.   The people or elders are not a commodity which
can be passed from department to department on a conveyor belt.  The residents are
individuals who have changing needs on a daily basis.  Additionally, in today’s long
term care communities, we are seeing increasing demands combined with decreasing
resources.  To meet the changing climate of long term care, facilities are moving from
the multi-disciplinary approach toward an interdisciplinary approach.

   Quality of life is an interdisciplinary concept.  One department cannot meet all the
quality of life needs of the resident.  Food, environment, social relationships, sense of
purpose and day to day activities all have an inter-related impact upon the resident’s
quality of life.  Person centered or person directed care is becoming the norm in many
care facilities.  The current Federal regulations emphasize interdisciplinary approaches
in F-248, defining specific actions the nurse, nursing assistant and other staff can
practice to meet the quality of life needs of our residents.  Even though mandated by
law, it is difficult to translate regulations into practice.  Many staff remain invested in
“their job” or task rather than the resident’s individual needs.    The activity professional
is challenged daily to ensure residents’ social, cognitive, emotional and spiritual needs
are met through meaningful and individualized approaches.  This can only be done with
interdisciplinary support and involvement.  

       Research has defined that there are better care outcomes and reduced costs
when an efficient interdisciplinary team is in place.  Unfortunately, generating this
“team” is difficult and requires constant effort amongst the team leaders.  In order to
truly create an interdisciplinary team of caregivers, we must begin with management.   If
the facility leaders do not embody a team philosophy of management, it will be difficult
to generate a team oriented approach to quality of life.  Here are some suggestions  re-
direct interdisciplinary care in your community:        
      -Make sure your own “house is in order”.  Assess the “team” in your department.  
Are authority, decision making and responsibilities shared amongst the activity team
members, with support and positive, open communication?  If the activity department is
not a cohesive team, it will be difficult to sell a “team” approach to others.
   -Assess the “team” attitude of your community.  Does the authority remain with the
department heads?  Is there a strict hierarchy of control?  When something goes
wrong, do the department heads point fingers or is there mutual support to solve the
problem?  Interdisciplinary integration needs to be established at the administrative
level, prior to moving to direct caregivers.
   -Create a “team plan” with your administrator and key staff.  Identify and agree to
specific actions the interdisciplinary team can practice within the scope of their
responsibilities.  The goal is to “be specific” and focus on the needs of the resident
rather than one department.  To simply say, staff need to “help with activities” is not
specific enough.  Specific actions may include: turning on preferred television or radio
station for the resident, assisting them to their preferred activities or interacting socially
with the resident while waiting for meals to arrive.  The concept of integrating these
simple approaches into staff members’ day-to-day routine is crucial.  They need to
know they do not have to stop doing their “job” to implement quality of life approaches.
   -Relate the benefits of interdisciplinary philosophy to improved outcomes which
contribute to the success of the facility.  Defining how the interdisciplinary model of care
is a positive marketing message would be appealing to ownership and administration.  
Defining how the interdisciplinary model of care can prevent falls, decrease weight
loss, and reduce behaviors would be appealing to the director of nursing.  
   -Conduct an interdisciplinary in-service, with the support of the administrator, director
of nursing and key staff.  If the in-service is conducted as a team, it will send a stronger
team message.        
   - The administrative team needs to give the interdisciplinary staff “permission” to
have fun and participate in activities and quality of life experiences.  The team leaders
need to lead by example and participate as well.  There is nothing worse than
scheduling a theme day where staff are invited to wear certain clothing (color or team
logo) and no one participates.  In facilities where the department heads participate, staff
participation increases dramatically.  
   -Know your regulations.  F-248 has devoted over six pages to specific
interdisciplinary, quality of life actions.  Share that information with key staff to gain
support.  (A copy of these six pages can be e-mailed to you, upon request.
   -Re-enforce positive actions.  Many staff do practice interdisciplinary approaches but
they go unnoticed.  When seeing staff caring for the person rather than focusing the
task, it should be acknowledged in some way.  Sincere compliments are worth their
weight in gold.  Formal recognition programs like giving out candy “hugs” or “kisses”
and similar tangible approaches re-enforce positive staff actions.  
       It takes time to change attitudes and behavior.  However, with administrative
support – it is possible.  Next month’s article will focus on generating interdisciplinary
involvement with the nursing department.  

None of us, including me, ever do great things. But we can all do small things, with great
love, and together we can do something wonderful.
Mother Teresa