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Activities' angst

June 1, 2010
by Kevin Kolus, Associate Editor/Online Editor
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Editor's note: Kevin Kolus submits this month's editorial after intense reader feedback to a blog left him with unanswered questions. Read the original posting and comments at

This all started with one person sounding alarms. Kim Grandal, executive director of Re-Creative Resources Inc., has been openly questioning the culture change movement for the past few years a stance that is turning heads in confusion. Not many would fault the most positive movement in this field of having ill intentions. But do not mistake Grandal, a veteran of long-term care therapeutic recreation; she is arguing neither the benevolence of culture change nor its practicality. Her concern rests with the up-and-coming “universal worker” and the uncertain future it is creating for activity professionals.

In homelike culture change models, the universal worker has basic dietary, nursing, housekeeping, and activity responsibilities. Despite its unflattering “jack of all trades” moniker, the job class in theory creates consistent assignment, meaning residents see the same caregiver every day because that person is doing everything.

“I fear that we will abolish the field of therapeutic activities and recreation in long-term care based on the assumption that uncertified, unqualified individuals can facilitate meaningful activities,” Grandal said in an interview with a fellow Long-Term Living blogger. I ran the quote on our Web site in an April blog, asking readers if they agreed.

The next day I received an e-mail from an administrator, Dr. Timothy Legg, who points out that because of regulations, specifically F-tags 248 (Activities) and 249 (Qualified Activity Professional), universal workers meet federal activities guidelines.

Now I was confused by Grandal's argument. Universal workers, after all, seem OK by the letter of the law. So I contacted Vicky Surash of the Virginia Association of Activity Professionals. She says that while universal workers may be qualified under federal regulations to deliver activities, that is far and away from being certified. Worse yet, she says, is that the quality of the activities universal workers provide can border on unimaginative tedium: having residents fold clothes, assist with meals, set dinner tables. Yes, this is homelike but does it serve the residents well? “Chores don't exactly fulfill all of my needs,” Surash replies bluntly.

But the quality of activities provided by universal workers hasn't been documented. I don't even know how many universal workers are employed throughout the country, and neither do Grandal or Surash. What do they really have to fear?

Perhaps it's a perceived attack on dignity. Grandal and Surash view the universal worker not as a threat to their jobs, but as an insult. To them, the long-term care field has been devaluing their profession for years. Surash says in 2010 alone several accredited activities consultants have been denied opportunities to speak at national conferences. They are offended. But most of all, they worry residents will suffer unintended consequences. “Do we challenge our residents? Do we make their wishes come true? That's what activity professionals do,” Grandal says.

The onus has always been on providers to ensure residents receive quality care, and that includes stimulating, educational, and personalized activities. Whether or not Grandal's fears of the universal worker are valid, the field should open up to more collaboration with activity professionals, which is her true plea. After all, the last thing we need is another long-term care turf war.

Long-Term Living 2010 June;59(6):8



Will the universal worker also make sure they know which elders like to vote, get them registered for absentee ballots, arrange for them to vote, gather the veterans lists for special ceremonies and print up certificates for their service, find someone to file an elderly tax credit, signing their own name as the liable preparer in case something goes wrong, recruit volunteers from home, go shopping on no budget on their own time, with their own gas, go shopping for residents' snack food and toiletries, keeping several orders separate at the checkout, getting signatures, having a variety of documentation to correctly fill out to show that you actually did many things for them, but there's so much you do that you'll never get credit (or budgeted hours to do). However, that being said, I do like the idea of a small community house setting that makes the elder feel they should take responsibility for what they can, not just be taken care of and everything done for them, so they have no purpose.

The time is now to educate anyone and everyone regarding our role as the Activity Professional and what our skill and knowledge bases are as compared to the Universal Worker. Think of it like this: On a snow day, when many people call out due to the inclement weather, what roles do the Activity Staff often take on? In most cases the Activity staff help the residents with meals, make beds, clean up, minor ADL's, etc. The scheduled activities seem to go by the way side because the primary concern is getting the residents, washed, dressed, fed and all of their medical needs attended to.

Now, this is how I fear the care for the residents will be like under the facilitation of the Universal Worker. Quality of life will go by the way side and inactivity will increase. Jack-of-all trades, master of none, that's how I feel about the Universal Worker.

Don't let the elders lose their quality of life because it's a snow day every day in some culture change facilities!

Correct me if I sm wrong. I was made to believe that as an Activities Professional I should be providing indiviual theraputic programs that will enhance our resident quality of life of an older person. How will a universal worker have that time to provide that personal programming for an indiviual. Most people seem to think and feel it just all about calling Bingo. Let anyone who has that feeling take a walk in my show for a day. Tell me when the universal worker is busy washing dishes and mopping the floors who will be seen to the Resident tell me who???

Thank you Tim- I am glad you stated "does not represent" an end to the activity director. I appreciate the clarification. You stated, "From a regulatory perspective, F-249 requires the activity professional". Let me just point out that F249 refers to just the activity director, not the activity professional. This is a huge concern. Sadly there is no staff to resident ratio for activity staff in our federal regualtions, although some states, such as NJ, thankfully have it.

I'm concerned that administrators will see this Universal Worker role as a financial savings opportunity. This is in fact happening. Some Activity professionals are indeed being replaced by the Universal Worker and the quality of programming is declining. No, not in all Culture Change facilities, but some. I want the word to get out that facilities need to keep certified activity professionals and recreation therapists on staff, in addition to the activity/recreation director.

In my opinion, this is not a war about "TURF". It's simply an opportunity to raise awareness that certified activity professionals and recreation therapists receive specialized training for what they do in LTC and cannot be simply replaced by the Universal Worker and the residents/elders deserve the best quality of life and leisure programming available.

I believe as RT/TR that we are responsible for the activities we provide to our clients. We are the ones that recieved our education in the field of TR. That as professionals, we make meaningful activities happen. Having another individual do our job, degrades this profession and the professionals out there. We are liable for our professional services. Some Jack of all Trades should NOT be doing our job and it is certainly not the quantity but QUALITY of our service.

I was the Dr. Legg mentioned in the article and I did point out that the requirements at F-248 definitely spoke to integration of activities, however, missing from the article was my point about the activity director & F-249. I will cut & paste from the original e-mail that I sent:

"From a regulatory perspective, F-249 requires the activity professional". I did also note that "the movement towards culture change represents and "end" to the activity director, only an end to the turf-wars that currently exist in many SNFs between disciplines".

I did not mean to imply that the "universal worker" could take the place of the activity director. The requirements found at F-249 are quite clear in terms of "who" can direct the activity program AND what the responsibilities of the activity director are.


Thank you for representing our profession.We must stand together.I will support you 100% of the way!
Live,Love and Laugh-
Debra Christians,ADC
NJAPA Corresponding Secretary

I just saw the problem, it should have read "DOES NOT represent an end to the activity director.."

I do believe the concept of a universal worker would be great, but I do not feel they are going to have the proper time to devote to the residents & quality programming of interest. Under the current tags everyone is responsible for activities not just the activity staff, this has already been implemented, we are still going to need that one person who can devote all of their time just to this specific area or the quantity of work is going to suffer not just the quality.

Here is a different point of view. I feel I am as much of a universal worker as I am activity assistant. It is I that takes that few seconds to walk into a room when a resident wakes up hollering because they are confused as to where they are, what time it is, etc. It is I who stops in the hallwall to just say hello, and answer a question or two. It is I who gives a hug as the resident tells me good night. I know the aides work hard as do the activity director or professional as you may call them. But where I work, I am the one who runs all activities, who cleans up her messes, who sweeps, who goes and gets and returns residents to their rooms. All this while the directory grabs a notebook and claims she has so much paper work to do, only she is sitting outside smoking, or noone can find her. She is never on time, never has a clue as to what items is needed in advance of an activity, etc. I have been in a facility since I was a young girl and the stories are neverending, I see aides ignore lights, bells, screams, etc. So I say here here, bring on that universal worker who loves their job, who cares about each of these residents like they are family, and lets treat them as the valuable person they still are. I see many residents loving the idea of one person being resonsible that day, of helping out. Sure would cut down on all those folks sitting beside a nusing station just waiting.. Bring it on....

The Universal worker should then have to take the state approved activities course or at the very least take the Modular Education Program for Activity Professionals in order to be able to meet the regulations and guidelines for Activities. I have seen this "project" at a well known facility and it amazes me that the activities "staff" still has to transport residents to and from "services" and they are still responsible for providing activities as the Universal worker is busy taking care of care needs that supercede activities even those that the "elders" want to do. The "neighborhoods" did not have activities available at the time that was posted and some of the "elders" were upset because they had planned their day around that activity. The Universal workers cancelled the activity shortly thereafter because they were busy and the activities staff was not available. (The activities professional was making breakfast as the Social Worker was busy)
In this effort for culture change have we included the "elders" in the decision-making and can they decide if they even want this change? Are they on the facility committees or are we assuming that this is what they want. Perhaps in a couple of years we will really appreciate their contribution. Activities professionals have embraced this "culture change" way before it became a "craze". We did what our consumers wanted and we provided programs that they want now. We meet their needs and interests on an individual basis and providing quality of life comes first and isn't cancelled.

That article was in response to an interview I had done. If I had written it, there would be a different tone. Regardless, it gets the word out that activity pro's have specialized training and skills-something that the universal worker will likely not have. I can't say what I think is going to happen or when. I do know that more and more facilities are scaling back their activity departments since the universal worker takes on the role of activities and other dept's. As activity professionals, we need to educate anyone and everyone about the importance of trained and certified activity professionals-especailly the administrators. Please share this Activities Angst article with your state activity associations and anyone you know in the field. If we all share our thoughts regarding this article and the role of the Universal Worker in long term care, we can start spreading the word. If we stay silent, we are allowing the Universal Worker to slowly diminish our role as the Certified Activity Professional.