Current Activities in Longterm Care
Kate Lynch, Editor
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Current Activities
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in Long Term Care Settings

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The Activity Director's Office
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New CMS regulations on unnecessary medications for elders
coming up

The Centers for Medicare and Medicaid Services has sent a letter to its surveyors advising
them of major changes in its “Guidance for Unnecessary Medications” (F329) and a re-write of
the entire Pharmacy Services section, whereby they collapsed the current regulations in three
tags: F425, F428 and F431.

Revisions to the regs are extensive and include several pages of new guidelines relative to
medications for the elderly, including considerable new information, charts, and so on,
designed to avoid unnecessary medications for residents.

The new regulations s are set to become effective December 18. In the meantime, readers can
get an advance copy of the new regulations on the CMS Internet site at www.cms.hhs.

New Survey Compliance Tool from Alternative Solutions
Alternative Solutions in Long Term Care has developed a comprehensive Survey Compliance
Tool for Activity Departments, says Sandra Stimson CALA, ADC, CDP, executive director of the
consulting firm.

According to Stimson, the tool was developed to assist Activity Directors to objectively look at
their department and determine areas that needed to be improved.  These are the same areas
that Federal Surveyors and State Surveyors will be looking at and includes: Documentation,
Care Plans, Attendance, Initial Assessments, Calendar Programs, Room Visits, Special
Programs, MSDS, Special Adaptive Products, Resident Council and Management Styles.

Stimson says the Survey Compliance tool is an extensive document, and simply asks the
Director specific questions regarding the Activity Department.  Each area that the Activity
Director determines is not in compliance would be areas that the Director would need to work

For example, the Survey Compliance tool asks questions specifically related to room visits.  
How many residents require room’s visits and specifically what does the care plan and
attendance record indicate? Often times, Activity staffs are not documenting room visits or
specifically what was provided and the room visit can be in direct contradiction to the care plan
interventions and goals.

Another example would be to determine if there are MSDS for all products. Often times this is
an area that is over looked.  

In addition, the Survey Compliance tool can be used in conjunction with the Population and
Calendar Analysis. The population analysis tool provides a chart to document the exact types
of populations you have in your community.

For example, the population analysis may determine that you have 20 very low functioning
residents, and comparing it to the calendar, the findings may show that the activity department
does not offer enough programs for low functioning or dementia residents.

The findings from the calendar analysis and population analysis would drive the planning
process of the activity calendars.

The Survey Compliance tools should be done on a yearly basis and long before your survey
window to allow time to implement changes, adds Stimson.

The Survey Compliance tool, Population and Calendar Analysis tools can be purchased at

Helping your elders with reading abilities
improves their depression

Researchers at Arlene R. Gordon Research Institute, New York, examined the relationship
between use of assistive devices, disability, and depression in 438 visually impaired elderly,
who were followed over a period of six months.

Visual loss resulting from various conditions (age-related macular degeneration, glaucoma,
cataracts) is the most common disability in old age, affecting one in five elderly over 65 years
of age (20 percent) and one in four (25 percent) of those over 75.

Twenty-three percent of all visually impaired elders use some form of vision-assisting device,
in addition to glasses, to accomplish daily activities, according to data from the National Health
Interview Survey and Assistive Device Supplement.

Assistive devices can be optical (magnifiers, telescopic lenses, magnified television screens.)
Adaptive devices include such things as talking books and appliances, large-print materials,
telephone aids.

The researchers, led by Dr. Amy Horowitz, found that use of optical devices was associated
with significant reductions in disability and depression, thus supporting the functional and
psychological benefits of these devices. No improvement in depression was observed for use
of adaptive devices.

Researchers think the reason for the improvement in depression with the assistive devices, is
that they’re primarily used to improve the elders’ reading ability… and that’s one of their most-
favored activities.

“For older adults, losing the ability to read is one of the most devastating consequences of
vision loss,” says Horowitz. “Because most optical devices specifically target near reading…
[they] allow these valued activities  to be continued.”

The new Centers for Medicare and Medicaid Services (CMS) guidelines for activities surveyors
give activity directors, and their support staff, the responsibility for making sure all their elders
have proper glasses, or other visual assistive devices.

The findings appeared in September in the Journal of Gerontology: Social Sciences.

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