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The vanishing need for activity professionals

April 27, 2010
by Kevin Kolus
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Guest blogger Jonathan Rosenfeld posted a great interview recently with Kimberly Grandal, founder and executive director of Re-Creative Resources Inc., a long-term care therapeutic recreation and activities consultant/educator. With more than 15 years of experience working with elders—and numerous accreditations to her name—Grandal should be considered an expert in long-term care activities, which is why her response to one of Rosenfeld’s questions is so troubling.

Rosenfeld asked Grandal, “What are some negative trends (if any) in the nursing home industry?”

Here is Grandal’s full response:

I see more and more facilities adopting the culture change movement, which in theory is a wonderful approach to care. With this trend, however, I also hear more and more stories that certified and qualified activity professionals and recreational therapists are being replaced by the "universal worker." Often times you'll see more domestic type activities in these culture change homes, which is fine for some residents, but not for all—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.

Does the advent of culture change truly spell doom for activity professionals? We’ll most certainly try to get Grandal’s answer to this question, possibly in a future guest editorial of Long-Term Living. Until then, debate Grandal’s argument in the comments section, or send me your thoughts on the job security of activity professionals.

Kevin Kolus

Kevin Kolus


Kevin Kolus wrote for Long-Term Living when he was an editor. He left the brand in 2012...



With cultural change there is and will be more change in our field. Change doesn't mean the abolisment of activity professionals, it just means we will find new and different ways to meet the residents needs. Our population will change in the future, we wont' see as many farmers and homemakers, we will see the work force babyboomers who will have a whole different look at what activities means to them, and it is up to us as activitiy professionals to assess each individuals interests and needs and help those residents meet their needs.
Jill F

The Culture change movement is a great concept, but I don't see a universal worker being practical, at least not long-term. Training is needed, there's so much more involved in the Activity Profession than just calling Bingo. Each resident is unique, and unless you have the experience and training, handling everyday situations can be difficult. A universal worker doesn't have the proper knowledge to do care-planning, family/resident meetings, or planning activity calenders. Activity Professionals already have a full time job just doing what they do, usually with very little help from anyone else, so how could a Universal worker possibly take the place of an Activity professional?

In my opinion a Universal Worker cannot replace an Activity Professional. A worker has to go through structured learning about profession and be certified or licensed to be able to meet the standards for position. Universal Worker could be a substitution for some time but to be able to do assessments, activity programming, residents' care conferences, work closely with other members of interdisciplinary team they have to seek further education. They know how to do different and important things but maybe knowledge and understanding of things not deep enough to provide person-centered approach to care.

I've been an Activity Director for 6 months now. I went through CNA training and got my certificate. I've been with the same facility (SNF) for almost 4 years. I know how to handle demented person and have a few techniques I could use to re-direct and help them. I had a good training from our former ADC before I took the position and I handled it for 5 months the best I could.

Only now being in school for only 1 month I started to realize how much more to it. Now I could understand why certain things are done certain way. I's been only a month but it opened up my horizon so much. I know that after I finish my certification process I could fully call myself Activity Professional. It will give me clear identity. Being an AD Certified gives me the right to create a program and lead it as well. As to Universal Worker I think they would work under someone's supervision.

While I do not see the universal worker taking the place of an activity director, I can definitely see this idea being the demise of the activity staff.
I know of facilities that have gone this route. They laid off the activity assistants & gave the responsibility of programming and implementing activities along with all the paperwork to the activity director. Eventually, they got rid of the director and gave the responsibility to the social worker. What happened? A whole lot of nothing. STNA's were responsible for leading groups and implementing 1:1 visits, etc. Hahahahahahahahahahahaha.
Unfortunately, as facilities continue to cut resources and raise their expectations, we will probably see this kind of thing happening more and more often.

I think this is going to change all of us, I really dont know what to say about this. But I work at an ADULT DAY HEALTH CENTER, so normally we have very little time to have activity with clients on daily basis. But thats not all it, Ive learned having an Activity Professional at a center makes whole lot different than having a universal worker take over. Because off course activity professional has to be educated and well trained to know how to make clients enjoy being away from home. They are looking forward to have a wonderful safety day while they are with us. And have to make sure we know how to help them meet their needs. In our facility to me, activity is all day for some of them. And an activity professional would have the courage to guide other staff to spread out, help our clients not feel left out. Wether its talking to them, painting, playing any games that have their interest. So I think it dont matter the change our clients still have needs and interest that we activity professional needs to provide for them.

I just found this blog today. There are very interesting comments regarding this controversial topic. Let's be clear on something. I support Culture Change. I'm behind the philosophy of Culture Change and feel that there is so much good in it for older adults. Older adults deserve the very best indeed.

However, I do know that Activity Professionals are in fact loosing their jobs, only to be replaced by the Universal Worker. This is real and this is happening across the country. It has happended to close colleagues of mine. Certified Activity Professionals and Certified Recreation Specialists alike.

Even though facilities seem to be scaling down their Activity departments and using the Universal worker to provide activities, the Universal Worker cannot replace the certified activity professional or CTRS. Certified Activity Professionals receive specific training in the field-the Modular Education Program for Activity Professionals (MEPAP 2nd Ed) has evolved over the years and is now a fantastic class that teaches activity professionals a wide variety of skills and knowledge needed to provide individualized, quality, meaningful activities. Many certified activity professionals have varying college degrees and are also certified in other areas such as Music Therapy, Horticultural Therapy, Laughter Therapy, Remotivation Therapy and so on.

I even know of some facilties that are replacing the Activity Director with a Social Services Director who simply took whatever the state approved course is for activities in that state. Sadly, each state has varying qualifications for what is considered the state approved course so some states consider 45 hours enough training to be an activity director!

With this being said, I believe that the Universal worker should assist in activities-just as nurses aides and other health care providers do when providing an interdisciplinary approach to quality of life in a traditional long term care setting.

Also, many culture change facilities are offering less traditional activities such as work-related activities, domestic activities and such. These activities are great for some older adults but certainly not for all. It takes special training to provide Snoezelen and sensory stimulation as well as other therapeutic modalities such as task sequencing, forward and backward chaining, validation, remotivation, millieu therapy, resocialization, laughter therapy, aromatherapy, pet therapy, and so on...

I recently met a fantastic Activity Professional-Bryan Rife, who won a Best Practices Award from NCCAP (National Certification Council of Activity Professionals). Bryan coordiniates the Magic Moments program in which he helps to make wishes come true for the older adults at his care facility. Will the Universal Worker do that? Doubtful I say.

I do not think that Culture Change spells doom for the Activity Professional. If anything I see the Activity Professional becoming an even greater force in healthcare/LTC.
Culture change fundamentally is about giving residents choice - in everything from what they eat and wear to what activities they participate in.
Because of "choice" they days of Birthday Parties, Bingo and BIble Study ONLY are over. Oh yes those things are still there but so is the choice to do other things.
The Activity Professional needs to do an accurate assessment to determine individual needs, likes, desires, adaptations, level of functioning, etc. in order to build their activity program. It is then that we can offer those activities that a resident has always enjoyed to help them maintain their interests and level of functioning. It is the activity professional who can adapt activities to meet individual needs. But now I have created a program where my elders have choices of all those things they enjoy. At 9 am they now have a choice to go to Bingo, Tai Chi or Cake Decorating.
Universal workers are great, but their role is often to assist with the day to day ADL's and IADL's. If they happen to assist with and do shopping, cooking or a party that only enhances an Activity Professionals program, it does not destroy it.
Activity roles may evolve and encompass more or different things but the Activity Professional will always be a vital member of the interdisciplinary team and they should be embraced by other professionals and work together to provide the best programs and care for our elders.

I love the idea of the "Culture Change" implemented in nursing facilities. I do not believe it will do away with the activity professionals in this field. I believe it is just another way to enhance the lives of the residents. In this field of work an education is a must their is so much to learn, and with all the state regulations and guidelines. It is not a practical idea that one person can meet a residents needs it would be too stressful for the staff member.

I am an activity director and feel that the universal worker would be unable to conduct the activities department in an efficient manner due to lack of education, expertise and experience. It is important that an activity professional learn and implement culture change within nursing facilities. Through the certification process and state survey inspections I am well aware of what is legally required of residents in regards to activity pursuits, appropriate documentation and developing an effective and personalized treatment program based upon the individual, their behaviors and wants and needs. The universal worker would be unable to develop a program for example for a resident with dementia due to lack of understanding dementia behaviors. Therefore the activity professional is trained and educated on effectively implementing a structured program for residents based on the professional's experience and education. I believe that the universal worker is a means to save money in the long run by not having to pay a certified professional.

I am not sure how to respond to this because i have mixed emotions regaurding the subject.

Everything I have heard about culture change sounds great. A universal worker who is able to cook, clean, do activities and CNA work is a wonderful concept. However I can not see how that is practical.

I have worked in only one facility so my view is kind of narrow but i have been here for 9 years.

I have seen how stressful every department can get. when i start to think about combining jobs and duties together i feel that no matter how you do it something would have to give. One person can't do everything. So if you have a CNA who is now responsible for getting everyone up, dressed, brush hair and teeth, making beds, cooking, assisting those who need help eating, cleaning and doing activities with each of their resident, which in our facility would be about 12 - 15 people currently. That seems to be an awful lot to get done each day and with the attitude that i've seen that nursing is more important than activities, which one do you think they would throw out if they couldn't get everything done that day. For this reason I am aprehensive about it's implimintation in our facility. Only because I feel the current nursing staff feel that although activities are great they are not and important accpect in our residents lives.
In a culture change facility I think that the activity director would have to take on more of a monitoring role. They would do the initial assesment, and all of the other paper work required. From their they would relay the information to the universal worker. Then the AD would have to make sure that the things the residents want to do are being done by the universal workers.

Currently in our facility we have resident who are very active and i feel that they would have to give up some of this with culture change. But it would feel more like home that way. At home you don't have someone who plans your day for you. You don't have a monthly calendar of events. You would be more free and it would be more personal. That is why I am torn. It sounds like a great idea in theory and i know that it has worked in some areas.

I also want to clarify that I do not support the idea that the Universal Worker should replace the Activity Professional or CTRS. Quite the contrary in fact. In reading through some of the above comments, I think that some folks may have misinterpreted what I had stated. It is my fear (and a REALITY for many) that Activity Professionals and CTRS's will sadly and mistakenly be replaced by the Universal Worker, therefore the quality of meaningful and therapeutic activities will be diminished as well.

I am a nursing home administrator and a board certified music therapist heavily involved in nursing home culture change. I do not believe that culture change will be the demise of the recreation therapy professional. In our facility, universal workers do facilitate some activities - small groups, 1:1s, recreation/leisure, physical fitness, etc. However, they do not have the background in education or experience to complete our assessments, develop individualized programming, monitor to ensure programming occurs as scheduled, etc. Our future may include more interdisciplinary teams working together instead of separate departments (nursing, activities, dietary, social work) but the recreational therapy professional will always be a valuable and integral part of the nursing home team in my opinion!

I feel that with the changes that are coming in the future with more of direct care staff providing something in all areas of the residents life that their will be opportunities for activitiy professionals working hand in hand with these staff in meeting all the needs of the resident. Activity professional can surely bring something to the table that these others can' t and that is our expertise in the area of activities that they do not have training in. I know that nursing homes are wanting to implement these kind of caregivers that will provide many of the residents everyday needs in all areas but I feel that activity professionals will still be needed for providing well rounded care.
Mary Ann

I believe we need some good culture change in our facilities. I also believe that culture change for a person diagnosed with dementia, and a person who is alert and oriented differs quite a bit. Any qualified activity professional knows that people diagnosed with dementia need a schedule, scheduled activities, and really benefit from structure. With culture change alot of the structure/ scheduled activities are done away with,and they focus on one person at a time. Culture change is a great movement, we just need to e smart and adapt culture change to meet everyones needs. Who better to plan, schedule, and adapt activities to meet our residents needs than a qualified activity professional?

I am an activity director and do not agree with this at all. Yes culture change will affect us all, but it is definately not the end of the activity director. Univeral workers will lack the knowledge you need to deal with certain resident populations and you need someone with qualifications to implement appropiate programming to meet the needs of your residents. I also think that more and more companies are looking to hire someone with a CTRS or someone who has thier certification to run the activity department. The activity professional will not fade away if anthing their roles will become more important in the future.

I do think the Universal Worker spells doom for the Activity Profession... I think the Universal Worker is not realistic in that You expect one person to provide Nursing Care and ensure they are receiving therapeutic recreation and leisure programs. Give me a break.. Most nursing homes can barely provide the basic care needed to seniors. People tend to see Activity Professionals as having the "fun" job calling Bingo numbers and ensuring residents get to church.. With the Baby Boomer generation the Activity world is going to change, New and innovative Activity and Recreation programs are going to be needed and Professional Organizations like the NCCAP and COAP National need to stay on top of culture change!
Kudos to Kim for speaking the truth... She is being realistic!

Miguel, Southern California

i think that we have some culture change but is not to the point were we have to change our daily activities but i think that we will get prepared for any future change to meet our residents needs Im a cna and i know how stressful that is thats why i try to help as much as posssible with the resident that are active like this they wont miss any activity, we are waiting for our wii to improve our daily activities and a geriatric massage for our 1 to 1 residents gloria mondonedo.