Current Activities in Longterm Care
Kate Lynch, Editor
Current Activities
in Longterm Care
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activities, calendars,
therapeutic activities and
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An open letter to those in the Activities Profession,
from Bill Freiberg, Publisher, Current Activities.
 [June, 2007]

Surprise…! The CMS really is going to enforce their new Activities Guidelines (and their many
other new changes as well!)  So we, at Current Nursing, weren’t crazy to be writing about them,
after all!  And we think you’d better get on the bandwagon… fast!
(And hey… you can stop sending us all those hate-emails! The just don’t make any sense to
us at all anymore!)

Read on…!

Dear AD, (or DON):

For a long time, we’ve been wondering if we’re living in another dimension here at Current
Activities, and just couldn’t face reality.
Reason: In 2006, the CMS published its new surveyor Guidelines for Activities, and Guidelines
for Psychosocial Outcomes, that looked revolutionary... even earthshaking... to us.   

They require:

  • Personalized activities for each and every resident… even those in the later stages of
  • That the Activities program be responsible to make sure that each and every resident
    has proper visual aids, eyeglasses, hearing devices… whatever else they need for
    supportive equipment.
  • That activities need to be effectively therapeutic whenever needed… designed to help
    with problems or disabilities of each and every elder. And, says the CMS, these activities
    need to be proven effective.
  • Lots more.

That all sounded like a huge deal to us… we thought these new Guidelines would make major,
exciting, changes in the Activities profession and would hit like a bombshell out there.  So we
started publishing lots of information on it. We were really enthused.  And we were truly
amazed… flabbergasted is more like it… at the response we got: It ranged from a dull thud, to
occasional bits of “hate mail.”

For sure, we have gotten praise for our coverage of all this, and from some very highly
respected consultants and managers in the business. But, what shocked us, was the negative
e-mails from Activity Directors, telling us things like:

  • “Nothing will change.”
  • “AD’s don’t do therapy, so I wish you would quit writing about all this.”
  • “Surveyors won’t pay any attention to it...”
  • “I don’t think any publication should write about the new Guidelines… no one is
    equipped to handle them.”
  • “I don’t like to read magazines that write about all those changes.”
  • “They won’t be enforced.”
  • “There’s no money available to do all these things, so reading about them is a waste of

That sort of thing.

Plus, for whatever reasons, many of the various AD associations really didn’t react with the
challenge and excitement we expected, and the very low turnout at most of their events
continues, with a few exceptions. And teachers in the various AD college programs out there
seemed mostly unaware that anything had happened… and they’re supposed to be the
thought-leaders of any profession!

Wow.  If these kinds of rules were advanced in any other occupation we can think of, they’d hit
like an atomic bomb!  Why not in the Activities profession, we wondered? Maybe the
profession knew something that we didn’t…. that the CMS was just “blowing smoke” with all this
stuff, and we were too naïve to see it.

Well, I finally got a chance to check all this out with the CMS regulators themselves, in person,
at the recent SORIM/LTC seminar in Tampa. This stands for “Symposium on Regulatory Issues
for Management in Longterm Care.” Several top regulators from CMS were there to explain all
these new rules and regulations… in person.

The seminar was designed for DONs, and other managers in nursing homes, and involved
explanations of a host of new CMS rules and Guidelines… in Activities, Pharmacy, Medical
Director, and “Culture Change” programs, among others.  I personally asked one of  the CMS
regulators there “What’s going on here?… apparently, the word is out that the CMS isn’t really
going to enforce these rules…. Right?”

“That’s baloney,”  was the quick reply from one top regulator.   They will be strongly
enforced…. Congress is demanding it, they’re a basic part of the Code of Federal
Regulations…  and we fully intend to enforce them!

“This is a new era of “Culture Change” for the nursing home industry, and everyone better get
used to it!”

And, she told me that she didn’t have any idea why there hasn’t been a bigger reaction in the
Activities profession… that everyone should be taking all this very seriously, indeed.
Not only that, but regulators there told of a new computerized survey system that will eventually
be instigated in all states, that will require strick enforcement of all these new rules, and will
equalize surveys and enforcement among all the states.

We heard this message over and over again at this 2-day meeting… in both prepared
speeches, and personal conversations. (And they even mentioned the possibilities of
increased civil penalties for homes not in compliance. They’re really serious, this time!)
So, folks, unless the CMS is running one of the biggest bureaucratic con-games I’ve ever seen
in my journalistic career… I think we think the times they are a-changin’!

And, as the result, we think the Activities profession could well become one of the most
important in the longterm, geriatrics care industry, as it will be at the center of the new culture
change, quality-of-life factors that the CMS is instigating.


For you associations who are already taking this seriously, and have packed, enthusiastic
members at your meetings and seminars: congrats, you’re ahead of everyone else, and your
members will be professionally competent and very successful in their new future.
And for you college educators who are already getting up to speed on all this…
congratulations… you’re producing the ADs of the future. For those of you who are not… I
think you’ll eventually become irrelevant.

For you nursing home administrators who are already incorporating many of these new
guidelines and regs into your activities programming… that’s great. You’re elders must be very
happy to be in a home like that! For those of you who are not doing this… and still treating
your ADs and their program with a “second-class attitude” well… you may well find yourself in
real danger of not surviving in the years ahead.

And to all you CMS regulators and advisors, who have had the courage and foresight to make
things a whole lot better for our elders… you really have my heartfelt congratulations… and
strong encouragement to “keep hanging in there!”

And who will be the greatest beneficiaries of all this? Our elders, of course, who are depending
on all of us to provide the best possible quality of life for their remaining years… as a fitting
reward for a long and productive “life-well-lived!”
Stay tuned! There’s much more to come!

And… guess what?… you WILL need to know how to do “effective therapeutic activities” in the
future! So you can cease with all those types of emails…  get used to it!

Bill - [2007]

Subscribe to Current Activities Today!  Feature Story coming up in the July/August
Issue: Get ready… “Culture Change” is on the way, and ADs will be centrally
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