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Complying with F-tag 248

November 1, 2009
by Joan Flannigan, ACC
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At a glance…

Complying with the “Activities” F-tag is a win-win for the facility and the surrounding community.

Quality of life” is a term reflective of our ethnic heritage, lifestyles, personality, and achievements. Acting on the premise that “life is activity,” residents in healthcare settings have needs and desires to be recognized as individuals with purpose, choices, and meaning in life just as those of us who live independently in the community.

This article shares some simple, easy-to-implement all-staff training and communication tools that will build confidence and ensure that your staff understand its responsibilities and the need to comply with the Centers for Medicare & Medicaid Services (CMS) F-tag 248, “Activities,” which states:

The facility must provide for an ongoing program of activities designed in accordance with the comprehensive assessment, the interests, and the physical, mental, and psychosocial well-being of each resident.

The Surveyor's Interpretive Guidelines for this regulation has many clear indicators with the need to review the staff's (not just activities) knowledge of and its involvement (supportive and/or interactive) in the individual resident's activity assessed interests and needs as indicated on his or her plan of care (e.g., one to one, group, and special events programs).

One of F-tag 248's criteria is that activities are “person appropriate.” These include, but are not limited to, activities that promote self-esteem, pleasure, comfort, education, creativity, success, and independence.

Activity planning

The Activity Director should routinely provide in-service training to all staff on the above specifics that require a facility's team approach to daily activities and/or programs. Everyone needs to:

  • understand what their programming role is so that each resident has an opportunity to reach his or her highest level of achievement and satisfaction.

  • know how to ensure and engage residents in their individual plan of care activities.

  • establish a daily activities communication routine to keep residents informed of program changes, provide reminders for residents to check the activity calendar for time and place of favorite programs, facility news updates, promote holiday and special events, provide contact with self-directed residents assigned for any activity changes or needs, and encourage the use of adaptive and supportive devices or equipment. Activity rounds are scheduled each day on the monthly calendar before the first daily program starts. Establish a method to ensure that issues uncovered during rounds that require a follow-up have been completed.

  • develop a “Cultural Lifestyle” Assessment (CLA) tool, which provides valuable benefits. The activities and social service staff collaboration with this assessment's content and completing the policy and procedures process has had good results. Suggested assessment categories for questions include community service involvement, military service, and psychosocial issues (e.g., What makes you happy…sad…mad…or uncomfortable?). Also ask about family heritage, favorite memories, favorite things to do, and personal likes/dislikes (colors, flowers, pet, vacation scent, holiday, or sport).

The resident's adjustment to new surroundings is often a difficult process that affects the family and staff as they attempt to help the resident adjust. Having personal information on the CLA form from the day of admission has had a positive effect on the adjustment process.

Many facilities have designed a staff communication system with a “Resident Interests/Needs Notebook” for each unit by inserting the CLA form in a plastic sleeve in the notebook. A sign-in form is in the book to track and/or validate that staff have followed the instructions to review each form. The notebooks are kept in a secure area in the unit and are only available to staff. Staff benefits by increased knowledge with a better perspective and understanding of each person they provide services for.

Recommendation outcomes

Facilities that have implemented the above-mentioned recommendations (reflective of “Activities” meeting regulatory compliance) have indicated that they have enjoyed multiple benefits. There was an increase in the team approach with communication and an increased awareness of staff's role in daily activities. Because of their involvement with activities, staff has watched what the residents are really capable of doing in a happy, fun environment. There is increased job satisfaction and confidence in their daily work routines. Both residents and staff are experiencing more meaningful interactions and conversations.

Community involvement

The following list of resources should be helpful in the development of innovative activities that enrich and educate your residents, while adding enjoyment to their lives:

  • Contact local universities and community colleges to see if instructors are available to teach classes focusing on geographic/historical topics related to culture and ethnicity.

  • Local historical societies often have speakers who can display items that stimulate memories and discussions about the residents' various heritages. Other topics might include antiques, the arts, and historical films.

  • Visit your chamber of commerce for a list of local clubs. For example, antique car clubs have shown cars with its members dressed in the clothes of the era-a great special outdoor event. A horticulture/garden club can assist with gardening projects, and bring in flowers for floral design classes. A bridge club will help the residents form one of their own.