Re-Creative Resources
By Kimberly Grandal, BA, CTRS, ACC, Executive Director
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Executive Director
Re-Creative Resources
About Kim

Kimberly Grandal, Founder
and Executive Director of Re-
Creative Resources, Inc., is a
strong advocate for the field of
Therapeutic Recreation and
Activities, with over fifteen
years of experience working
with the elderly in numerous
management and consultant
positions.  She is an Activity
Consultant Certified and a
Certified Therapeutic
Recreation Specialist. Kim is a
member of the New Jersey
Activity Professionals
Association and the New
Jersey/Eastern Pennsylvania
Therapeutic Recreation

In 1990, Kim graduated from
William Paterson University
with a BA in Sociology and
later studied gerontology
courses at Union County
College and Therapeutic
Recreation courses at Kean
University. Throughout her
career, Kim has been the
Director of Therapeutic
Recreation for several long-
term care facilities, including
one of NJ’s largest.

In 2006, Kim founded Re-
Creative Resources Inc. She is
a speaker for various state and
local activity associations such
as NJAPA, MOCAP, and
NJACA, as well as the Society
of Licensed Nursing Home
Administrators of NJ. She also
offers lectures for Re-Creative
Resources Inc., local colleges,
and community groups, and
provides consultation and
support to numerous facilities
in the state.

Kim is the editor and writer for
the “The Rec-Room", a
monthly newsletter published
by her company. In addition,
she writes monthly articles for
the Activity Directors Office
newsletter, and has contributed
articles to Creative Forecasting
Magazine, and The
Continuing Care Insite

Kim is a recipient of the
Kessler Institute of
Rehabilitation 1997 Triumph
of the Human Spirit Award.  
Her passion is to promote the
field of Therapeutic
Recreation and Activities and
to unite Recreation Therapists
and Activity Professionals. Kim
currently serves on the NJAPA
board as the Chairperson for
the Legislation Committee.
Resources Inc.

Re-Creative Resources, Inc. is
committed to enhancing the
lives of long-term care
residents through the use of
Therapeutic Recreation. We
provide a variety of services
such as Therapeutic
Recreation seminars,
in-services, resources, form
development, program analysis
and development,
consultation, and support for
activity professionals and
recreational therapists. A
selection of downloadable
training materials and forms
are available for your
convenience as well as a free
job posting site.
Subscribe to Kimberly's Newsletter
See Kim's You-Tube videos (Click Here)
MDS 3.0 Section F Preferences for Customary
Routine and Activities
The Top Ten Questions Asked by Activity
By Kimberly Grandal, CTRS, ACC/EDU

1.        I don’t see section F on the quarterly? When is section F completed?

Section F, Preferences for Customary Routine and Activities, is completed any time a
comprehensive assessment is conducted:
•        Admission Assessment
•        Annual Assessment
•        Significant Change Assessment
•        Significant Correction of a Prior Full

2.        Who completes section F?

Which individual or department is completing various sections of the MDS 3.0 varies
from facility to facility. There are reports of Activity Professionals completing the

•        All of the resident interviews, in addition to section F
•        Some of the interviews (mood, cognition, and/or preferences)
•        None of the interviews or sections of the MDS 3.0
•        Some facilities are training each member of the IDT to conduct the complete
interview and then taking turns in conducting the interviews.
•        The most common, however, appears to be that the Activity Professional is
completing all of section F.

3.        Do I still have to do quarterly notes even though section F is not in the quarterly

Just because section F is not included in the quarterly MDS, does not mean the Activity
Department shouldn’t continue with their quarterly progress notes or other episodic
notes. It is very important that the Activity Professional monitor each resident’s
responses to activities and any activity interventions in accordance with the care plan.
Quarterly and episodic notes help the Activity Professional to determine if changes
should be made to care plans or if a change in the type of programming provided is

4.        Should I change my Activity Assessment?

Many Activity Directors are changing their Activity Assessments to be more compatible
with the MDS 3.0.  It’s really an individual choice. Look at your current Activity
Assessment and be sure it doesn’t have any old MDS 2.0 language. If so, you may want
to remove that and replace with current MDS 3.0 language. The Activity Assessment
must provide the assessor with information that is necessary to plan a program of
activities for the resident based on the resident’s individual need, interests, and
preferences. Areas to consider include but are not limited to:

•        Current, past and potential activity interests
•        Potential barriers  to activities such as psychosocial, cognitive, physical or health
•        Family and community involvement
•        Activity adaptations, modifications , adaptive equipment
•        Cultural, language, education, religious, and spiritual considerations
•        Special skills and strengths
•        Recommendations or referrals

If you are looking to change your Activity Assessment to be more compatible with the
MDS 3.0, then check out Recreation Therapy Consultants. They have a new Activity
Assessment form available.

5.        What exactly triggers activities in the MDS 3.0?

•        Any 6 items for interview for activity preferences has the value of 4 (not important at
all) or 5 (important, but cannot do or no choice) as indicated by any 6 of F00500A
through F00500H is coded a 4 or 5.
•        Any 6 items for staff assessment of activity preferences item L through T are not
checked as indicated by any 6 of F0800L through F0800T are NOT checked.
•        The Mood Interview reveals the resident has little interest or pleasure in doing
things as indicated by: D0200A1=1.
•        Staff assessment of resident mood suggests resident states little interest or
pleasure in doing things as indicated by: D0500A1=1.

6.        What is the difference between the Resident Assessment Protocols (RAPs) and
the Care Area Assessment (CAAs)?

RAPS and CAAs are very similar in the respect that both:

•        Review MDS and gathered data
•        Involve decision-making and care planning
•        Determine triggered care areas and assess further
•        Include documentation in the medical record

The major difference between the RAPs and the CAAs is that there is no mandated
assessment tool/ protocol like there was with the MDS 2.0 RAPs. Now facilities may
choose to use CAA resources (Appendix C) and/or current standards of practice,
evidence-based or expert-endorsed resources to conduct further assessment of
triggered areas.

7.        Do I have to care plan if the resident is alert and oriented and codes a 4 (not
important) or 5  (important but can’t do, no choice) in the Activity Preferences Interview
and triggers in activities?

One of the ways in which CAT number 10, Activities, will trigger is if the resident
interview for activity preferences is coded with a total of six 4’s or 5’s. If the resident is
alert/oriented and codes a 4 (not important at all), it just alerts us that we should look
into it further. It could be that the resident is indeed alert/oriented, but is there some type
of psychosocial factor or health issue that is the underlying cause of the resident
answering a 4? Or is it that the resident answers 4's because he/she simply has no
interest in those preferences being asked of him/her and may have other interests
instead, such as crafts, exercise, computers, etc? Or if a resident codes a 5 (can’t do or
no choice) this may indicate the resident has perceived or actual barriers or has
developed a sense of learned helplessness. The primary concept of the CAA process
is to look for those underlying causes and contributing factors.

The decision to care plan or not will vary depending on the CAA analysis and findings. It
is also important to note that just because a resident triggers in activities, doesn’t mean
we have to care plan for it. It is equally important to note, however, that just because a
resident doesn’t trigger in activities, doesn’t mean we shouldn’t care plan. The decision
to care plan or not is truly based on the resident’s problems, needs, preferences,
strengths and the IDT’s findings and recommendations.

8.        What do I do if the resident cannot or refuses to answer the interview questions?

If the resident doesn’t answer a preferences question, or answers with an incoherent or
nonsensical response, then the assessor is to code a 9. Three code 9’s and the
assessor is to stop the interview and complete the staff assessment for customary
routine and activity preferences.

9.        What type of documentation do I need to do for the CAAs?

CAA responsibilities, how it is facilitated, and where it is written in the medical record,
will depend on facility protocol. Further assessment in a particular area should be
within the scope of training or practice of the discipline filling out the section.  CAA
process must be interdisciplinary and involve the resident/significant other.  CMS clearly
states that CAA documentation must include:

•        Nature of issue/condition.
•        Causes, contributing risk factors, complications.
•        Need for referrals and/ or further evaluation.
•        Factors that must be considered in developing individualized care plan
interventions including appropriate documentation to justify the decision to plan care or
not to plan care for the individual resident.
•        Resources used - Facilities may have written policies/ protocols/ standards of
•        Completion of Section V (CAA Summary).

10.        Where can I watch the VIVE
•        Order the video for free from CMS at
•        Watch the video online:

For more MDS 3.0 education, news and resources for Activity and Recreation
Professionals visit