Keeping Residents Safe during
Outdoor Activities

Now that spring is coming to the northern part of the United States,
our thoughts turn to outdoor activities for the residents. This is a good
time to review some ways to keep the residents healthy and happy while enjoying some
fun in the sun.

Last year was one of the hottest summers on record. Having to stay indoors to keep
cool was difficult for the residents with heart conditions or respiratory problems. Even
residents without these problems were advised to stay indoors and out of the baking
heat and oppressive humidity. This can be hard when summer is usually filled with
outdoor activities and outings to the residents' favorite places.

Now is the time to plan outdoor games, picnics, barbecues, trips to see the residents’
favorite baseball teams play and other out trips, walks around the grounds of the facility,
sitting outside talking to visitors or the staff, etc. Now that the residents are able to
spend more time outdoors, the activity staff needs to build in some precautions when
planning outdoor activities. Exposure to the sun, insect bites, heat exhaustion, storage
and preparation of food, and dehydration can put the residents and facility at risk.

Before planning outings, work with the director of nursing to develop a protocol for the
different kinds of trips you would like to take. Agree on a maximum safe
temperature/humidity index. Determine chaperone ratios and when a CNA or nurse
should accompany the residents and activity staff. Develop a list of "necessities" that
must go with the staff on each outing – these may include a first aid kit and manual,
bottled water, insect repellent, sunscreen, latex gloves, incontinence products, hand
sanitizer, disposable wipes, etc. Purchase several backpacks to hold these items.
Backpacks are much easier to manage when pushing wheelchairs and escorting the
residents from place to place.

Many of the residents are on medications or have medical treatments that make them
very susceptible to the burning rays of the sun. Just a few minutes in the hot sun can
cause very serious burns. Remember that even on a cloudy day or when sitting in a
shaded area, you can get sunburned.

Before taking any resident on a summer outing or outdoors, check with the nurse to
determine if he or she is "sun sensitive." As a precaution, sun block should be applied
to all residents before going outside or on an outing where they will be outdoors for
even a short period of time. Sun block should be reapplied as directed on the bottle or
according to the facility's protocol. Sweating may cause the sun block to be affected;
therefore, reapply it more frequently on days when the residents sweat more.

Wearing a hat that shades the face and covers the head is advised. A baseball cap for
the gentlemen and a hat with a wide brim for the ladies works best. A sun visor may
shade the face, but it does not protect the scalp from burning.

A lightweight, long-sleeved shirt or blouse can help keep the sun's rays off of the
resident's arms. Residents who are sensitive to the sun should also cover their legs
and refrain from wearing shorts. Encourage these residents to substitute lightweight
slacks instead of wearing shorts, dresses, or skirts when spending time outdoors.
Encourage the residents to wear sunglasses while outdoors. Some diseases of the
eye cause the pupils of the eye to take longer to adjust from light to dark. This is also
true as we age. When helping a resident to go indoors, remind the resident to remove
his or her sunglasses before entering the building. It is also a good idea to pause for
several moments once inside the door, so the residents’ eyes will have time to adjust
to the diminished light. This is very important for ambulatory residents and for those
using canes and walkers. Talk to your administrator and ask to have benches near the
entrances to the building for the residents to sit in while their eyes adjust to the indoor

Ask the residents' families to purchase sunscreen, sunglasses, and a hat for their
loved ones. Remind the families to mark the items with the resident's name so they
won't get "lost" during an outing. It’s also a good idea to have the nurse keep the
sunscreen in the medication cart for those residents with dementia and make sure the
sunscreen is applied before the resident goes outdoors with the staff, family, or

Some residents like to go outside the facility by themselves and enjoy the fresh air.
Remind them to let their nurse know they are going outdoors. All staff should be
reminded to make sure residents sitting outdoors are okay, especially when they notice
someone has been out for a long time. The staff should make sure the resident is not
dehydrated or becoming sunburned. Encourage the resident to come inside for a little
while to cool off. Tell the resident’s nurse, if the resident refuses to come indoors and
bring the resident a bottle of cold water to drink.

It is important for staff members to recognize the signs and symptoms of dehydration in
order to promptly assure correction and prevention of complications. Without timely
correction, dehydration can lead to decreased functional ability, predisposition to falls
due to orthostatic hypotension, constipation, predisposition to infection, and death.
According to the chapter on "Dehydration: Prevention and Recognition" published by
Long Term Care Educator, staff members should be alert to the following symptoms:
•        Confusion;
•        Poor skin turgor (elasticity) – skin will feel warm and moist;
•        Dry mouth and dry furrowed tongue;
•        Decrease in blood pressure and increase in pulse; and
•        Decrease in voiding, scanty output and concentrated urine.
If any of the above symptoms are noted, steps should be taken as soon as possible to
have a nurse further assess the resident for dehydration and take corrective action as

Many people are allergic to insect bites, especially bee stings. The activity staff should
know who these residents are and what procedures should be followed if the resident
gets stung by a bee. When a nurse will be one of the chaperones, be sure he or she
takes a bee sting kit on the outing. During late summer and early fall when bees are
more of a problem, it would be wise to encourage the residents with severe reactions to
bee stings to remain inside the facility. It is also unwise to remain outside after dusk as
mosquitoes and other insects are more prevalent at this time.

It is very important to keep the residents hydrated while outdoors or on an outing. The
best form of hydration is water. Stay away from drinks with caffeine and alcoholic
beverages because these dehydrate the body. Be aware that residents often refuse
something to drink because they fear they'll have to use the restroom more frequently
and don't want to be a burden to the staff.

As we age, our sense of thirst decreases and by the time the resident feels thirsty, he or
she is already dehydrated. Giving the resident a salty snack, e.g., hot dog, soft pretzel,
peanuts, dill pickle, pizza, etc., will encourage the resident to accept a drink.
Involve the residents and family members in establishing and meeting hydration goals.
Make sure the residents, families, staff, and volunteers at your facility know the
importance of hydration, not only for the residents, but also for themselves.

Teach the interdisciplinary staff to use a direct, positive approach when administering
fluids. Avoid asking, "Do you want something to drink?" Instead say, "Here is some
cool, refreshing water for you Mrs. Jones." Older people may not feel thirsty and may not
recognize their need for fluids.

Consider giving residents water bottles (such as those used by athletes) to carry with
them while outdoors. On a regular basis, be sure to refill the residents' water bottles
with water or their favorite cool non-caffeinated beverages. If the resident enjoys iced
tea, consider making the tea with decaffeinated tea bags.

Leaving the facility's grounds and going to a forest preserve or park for a picnic can be a
lot of fun. Enjoying a meal outdoors is something the residents look forward to. Before
planning a picnic, meet with the dietary supervisor and review safe food handling
practices. Develop a protocol for outings that involve serving food. Make sure the
coolers you're using can maintain the proper temperature for the length of time needed.
A good rule is NEVER take any salad, sandwich, or dish containing mayonnaise.
Always dispose of leftover food that has been out of the cooler for more than a few

Barbecues are another favorite activity during the summer. When grilling chicken,
hamburgers, and other raw meat, make sure you do not serve food with the same
utensils used to cook the raw meat. ALL meat must be served well done, including
hamburgers. Facilities are being cited for serving the residents grilled hamburgers that
are partially cooked.

According to the surveyors, "serving half-cooked hamburgers results in a citation with a
scope and severity of D." According to the 1993 FDA Food Code, the internal
temperature of ground meat, e.g., pork or ground beef, should be 155° Fahrenheit. In
today's era of e. coli, "mad cow" disease, and other threats, the staff must be very
careful not to serve food that may prove hazardous to the residents' health and well-

To prevent heat exhaustion, keep the residents out of the direct sun whenever possible.
Have them wear light-colored, lightweight clothing, and encourage them to dress in
layers. Ask the residents to remove their sweaters and lap robes as the temperature
begins to rise or you notice the resident perspiring. Have the residents stop physical
activity and encourage them to drink a glass of water and rest for a while. Move any
resident to a cooler location if you expect heat exhaustion, but be careful that the area is
not too cold, as this will shock the resident's body and cause more problems.

As we age, our bodies have a more difficult time adjusting to temperature changes;
therefore, temperatures in the common areas should not be too cool. This can also
shock the system when coming in from the outdoors where it is very hot – 85+°
Fahrenheit – into the facility where it is 72° Fahrenheit.

If you are using buses to transport the residents on outings, make sure the buses are
air-conditioned. If this is not possible, make sure the windows open and there is
adequate ventilation while in the bus. Carry ice water and disposable cups on the bus.
It is also a good idea to take disposable washcloths along.

If the bus breaks down, try to get the vehicle into the shade and open the windows for
ventilation. If this is not possible, try to move the residents off the bus and into the
shade. Encourage each resident to drink a glass of water at frequent intervals. Wet the
washcloths for the residents to use on their face, neck, and arms – the evaporation will
help cool them. Another trick is to wet the washcloths and place the washcloth on the
residents' heads. The evaporation will help the cooling process.

Educate the residents, family members, staff and volunteers about outdoor safety
issues through the facility newsletter and/or in-service training. Volunteer to speak to
the family council, or be part of a CNA in-service training, and share this information.
Many of the tips contained in this article apply to everyone and are important
considerations for those living and working with seniors in all types of settings.
National Association of Activity Professionals
Founded by Activity Professionals for Activity Professionals...
Join Today!  You can download and mail in this application with your payment
Join our Activity Director
Community message
board and network with
Activity Professionals
across the country. This
is a free service.
Be sure to subscribe to
Activity Director Today
E-magazine for the
latest news and more
about your profession.
Only $19.95/year
At Resident Shopping &
More you will find
clothing and more for
your residents.  
Also, you
will  find Activity
Department supplies
Activity Director
Novelties features
promotional materials
and gifts for you, your
residents, your facility
and your Department.
Be sure to visit.
Activity Director
Excellent Resources for
Activity Professionals
Featuring supplies for
parties, holiday
celebrations  and
special events
Click Here
About NAAP
Founded by Activity Professionals
for Activity Professionals...

NAAP is the only national group that
represents activity professionals in geriatric
settings exclusively. NAAP serves as a
catalyst for both professional and personal
growth and has come to be recognized by
government officials as the voice of the
activity profession on national issues
concerning long-term care facilities,
retirement living, assisted living, adult day
services, and senior citizen centers. NAAP
is nationwide in scope with a growing
membership in Canada and Bermuda.

The National Association of Activity
Professionals recognizes the following

The quality of life of the
client/resident/participant/patient served is
the primary reason for our services.

The strength of NAAP lies in the diversity of
its members.  NAAP recognizes the rich
cultural, and educational backgrounds of its
members and values the variety of
resources represented.

The strength of NAAP also lies in the
development and promotion of scientific
research which further defines and supports
the activity profession.

NAAP values the development and
maintenance of coalitions with
organizations whose mission is similar to
that of NAAP's for the purposes of
advocacy, research, education, and
promotion of activity services and activity

NAAP values members who become
involved at the state and national level to
promote professional standards as well as
encourage employers to recognize them as

NAAP affords Activity Professionals across
the country the opportunity to speak with a
common voice...

NAAP successfully worked with members of
Congress to secure a change in the nursing
home reform title of the 1987 Omnibus
Budget Reconciliation Act (OBRA).
Through our efforts, it became mandatory
that an activity program, directed by a
qualified professional, be provided in every
nursing home that receives Medicare
and/or Medicaid funds.

NAAP was the only professional activity
association to participate in HCFA's
workgroups that revised OBRA's interpretive
guidelines now in effect.

NAAP provides assistance at the state level
to promote certification of activity
professionals, working toward uniform
professional standards for activity practice.
NAAP Mission
To provide excellence
in support services to
activity professionals
through education,
advocacy, technical
assistance, promotion of
standards, fostering of
research, and peer and
industry relations.
There are so many benefits when you
belong to NAAP!  Each member will
receive a newsletter which will give the
updated reports on Government Relations,
Special Interests, International Updates,
Professional Development, Nominations,
Standards of Practice, Financial Updates
and a Membership Report. Along with this
comes an update from our President, Susan
Rauch and Executive Director Irene Taylor.

Members will also receive a discounted rate
at the Annual Conference which is held in
March/April of each year.

Effective JAN 1, 2006 membership dues are:
  • Active Membership = $59 USD
  • Associate Membership = $65 USD
  • International Membership (outside
    US) = $65 USD
  • Student Membership = $49 USD
  • Supportive Membership = $99 USD

Email us for more information at

Join Now!
Click Here to Download a
Membership Application
P.O. Box 5530
Sevierville, TN 37864
phone (865) 429-0717        
fax (865) 453-9914        


PLEASE NOTE: Any opinion, advice,
statements, offers or other information or
contents expressed or made herein by third
parties is neither endorsed nor adopted by
the National Association of Activity
Professionals unless otherwise stated. NAAP
is neither responsible for nor warrants the
accuracy or reliability of any such opinion,
advice, information or statement made or
offered by third parties in this publication
(website). NAAP has the right, but not the
obligation, to monitor and review the
content that it feels violates the terms of its
understanding with the third party: violates
the policies and purposes of NAAP; or is
defamatory or otherwise deemed


PLEASE NOTE: The articles set forth in this
publication are for informational purposes
only. Nothing contained herein shall be
construed as legal advice. The statements
made herein are those of the respective
authors and are not necessarily an
expression of the views of NAAP.
Providing Internet Resources
for Activity Professionals
in Long Term Care Settings

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