TIP OF THE WEEK
Activities approaches for residents with behavioral symptoms
§483.15(f) Activities – §483.15(f)(1) “The facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psychosocial well-being of each resident.”
To comply with this federal regulation, the facility must (1) identify each resident’s interests and needs and (2) involve residents in an ongoing program of activities that is designed to appeal to their interests and to enhance their highest practicable level of physical, mental, and psychosocial well-being. [1]
The following recommendations for activities that address behaviors are excerpted from the curriculum of a summer 2006 training related to individualized care tenets using the Holistic Approach to Transformational Change (HATCh) Model.
For the resident who is constantly walking:
- Provide a space and environmental cues that encourages physical exercise, decreases exit behavior, and reduces extraneous stimulation
- Seating areas spaced along a walking path or garden
- A setting in which the resident may manipulate objects
- A room with a calming atmosphere, (i.e., music, light, and rocking chairs)
- Provide aroma(s)/aromatherapy that is/are pleasing and calming to the resident
- Validate the resident’s feelings and words.
- Engage the resident in conversation about who or what they are seeking
- Use one-to-one activities, such as reading to the resident or looking at familiar pictures and photo albums
For the resident who engages in name-calling, hitting, kicking, yelling, biting, sexual behavior, or compulsive behavior:
- Provide a calm, non-rushed environment, with structured, familiar activities such as folding, sorting, and matching
- Use one-to-one activities or small group activities that comfort the resident
- Listening to their preferred music
- Walking quietly with the staff, a family member, or a friend
- Eating a favorite snack
- Looking at familiar pictures
- Engage in exercise and movement activities
- Exchange self-stimulatory activity for a more socially-appropriate activity that uses the hands, if in a public space
For the resident who disrupts group activities with behaviors such as talking loudly and being demanding, or the resident who has catastrophic reactions such as uncontrolled crying or anger, or the resident who is sensitive to too much stimulation:
- Offer activities in which the resident can succeed
- Break the activity into simple steps and involve small groups
- One-to-one activities that are short and repetitive, and that are stopped if the resident becomes overwhelmed (reducing excessive noise such as from the television)
- Involve in familiar occupation-related activities. (A resident, if he or she desires, can do paid or volunteer work and the type of work would be included in the resident’s plan of care, such as working outside the facility, sorting supplies, delivering resident mail, passing juice and snacks, refer to F169, Work)
- Involve in physical activities such as walking, exercise or dancing, games or projects requiring strategy, planning, and concentration, such as model building
- Involve in creative programs such as music, art, dance
- Involve in physically resistive activities, such as kneading clay, hammering, scrubbing, sanding, using a punching bag, using stretch bands, or lifting weights
- Slow exercises (e.g., slow tapping, clapping or drumming); rocking or swinging motions (including a rocking chair).
For these and more activities that address behavioral symptoms, click here to download Unit 2 (ZIP 3.14 MB) and select Module 2. To download the entire Individualized Care Curriculum, go to the MedQIC Individualized Care Curriculum.
Last week’s tip referenced regulations that do not apply to the state of Ohio. Currently, the state of Ohio does not provide regulatory guidance specific to bathing practices. We apologize for any confusion this may have caused.
RESOURCE SPOTLIGHT
The History and Evolution of Quality in Healthcare
Part of a webinar series focused on Quality Basics, this educational session is an overview of the history and evolution of quality improvement in healthcare. Learn about the events and the individuals that shaped healthcare quality improvement into a specific discipline. Presenter: Nancy West, RN, MPH, CPHQ. Recorded 1/29/2008.
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OHIO KEPRO EVENTS
INDUSTRY EVENTS
NAVIGATING THE MDS THROUGH THE OHIO MEDICAID REIMBURSEMENT SYSTEM
May 1, 2008, 8:30 a.m. to 4:45 p.m. ET
Speakers: Claire Spellmire, RN, BSN, and Karen Jennings, LNHA, MHA, from the Case Mix Section, Bureau of Long Term Care Facilities, Office of Ohio Health Plans.
Cost: Free
For more information or to register, call Cheryl Robertson at (614) 466-9088.
Space is limited to two per facility.
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