Is your activity program ready for survey?

Surveyors are looking more closely at activity programs to ensure that they are adequately serving the needs of the nursing facility residents. Since the new guidelines for F-tags 248 and 249 were implemented on June 1, 2006, many facilities and activity departments are being hit hard because of nonqualified directors running programs and poor staffing ratios to handle the ever-changing needs of today’s residents.

We are all facing many challenges and changes, including tougher and more punitive state and federal surveys. The residents we serve are making greater demands due to the huge array of needs each one has, compared to 10 years ago. The baby boomers are arriving and they want more, need more, and expect more. Families, too, are more informed when they are looking for placement for their family members.

The nursing facilities that will continue to flourish are the ones that strive to meet all of their residents’ needs. This means reaching beyond the basics. It’s more than feeding, dispensing medications, and providing good activities of daily living (ADL) care. It means tackling the problems of socialization, spiritual life, and friendships, and that we continue to provide for each resident emotionally, mentally, spiritually, and physically.

During new employee orientation at my facility, Palm Valley Rehabilitation and Care Center in Goodyear, Arizona, I always share the importance of each department working together. I also discuss the fact that OBRA has ensured us recognition as a true profession and that we are vital to the ongoing existence of each resident because of the quality of life we bring them. Quality of care and quality of life should be looked upon as equals. If quality of care were to outweigh quality of life, you would have well-cared for residents, but depression, isolation, and behaviors would run rampant because they would feel that they have no real reason to live. Balancing the scale results in happy, well-adjusted people who receive good care and want to live life to its fullest.

Let’s look at your program and the survey process. If you are just turning on the television, showing videos, and having bingo one night a week, your program will not meet your residents’ needs, nor will the surveyors brush lightly past your programs. Why? If that is all you do or if you only offer two activities per day, the program does not constitute a satisfactory activity program.

Surveyors are looking at the activity program more and more, and they have certain “red flags.” If they see happy, satisfied, and busy residents with lots going on, chances are they will leave you alone. If, however, there are long stretches of nothing going on and you and your staff are “out of sight,” the surveyors will probably begin to dig and delve into your program, your space, your charting, and your paperwork. Some key areas of evaluation include:

  • Whether the activity area is too small or too noisy. You need to make sure your areas are adequate in size to meet the needs and requirements of your population and that your activities are not constantly interrupted by outside noise, incidents, or staff activity (running vacuums, shift change, etc.)

  • Whether long periods of time go by with no activities scheduled. No one expects you to do activities 24/7, but each day’s calendar should include a variety of activities that residents can choose from—and some should be available during the morning, afternoon, and evening time periods, seven days a week.

  • Whether supplies are sufficient to meet residents’ needs. Facilities should make sure that there is enough money in the activity budget to give the staff the tools they need to develop a creative and exciting program.

  • Whether residents appear bored, sleep through activities, or do not attend. Activities should be designed to meet residents’ interests and abilities. Often, facilities or staff blame low attendance on residents “not being interested,” but this can’t be used as an excuse anymore. If the residents are not interested, then the facility is not providing a program that meets their needs. If they are sleeping through the program, they are probably not stimulated adequately and are in the wrong activity.

  • Whether activities actually insult the dignity or intelligence of residents. Activities should be designed to meet residents’ interests and abilities. Often, residents can be found sitting around a television watching children’s programming or kiddie videos—or worse, violent talk shows. Providers should be offering classic movies, the news, or other programming the residents would enjoy. However, watch what is shown on a dementia unit. Real news can be very disturbing to people with dementia, and videos and music are more likely to appeal to them.

  • Whether the facility routinely cancels activities or does not follow its schedule. Not only must you create an exciting, interesting calendar, you must actually stick to it. While some circumstances are unavoidable, you should strive to follow the calendar. Just because you don’t feel like doing something (e.g., bowling) doesn’t mean your residents don’t want to.

  • Whether there is observation or documentation of specialized programs for bed- or room-bound residents. You must provide for all residents at your facility and not just those who can actually make it to the activity room. Surveyors are focusing more and more on room-bound residents and what you are doing for them. Are you providing sensory enhancement and stimulation? Music and relaxation? Mentally stimulating activities, such as word puzzles, cards, books on tape, videos? How about independent crafts? Pet therapy? Chaplain visits?

  • Whether facility staff invites and helps residents to the activities. All staff should constantly encourage, invite, and escort residents who are interested to the activities (and, thanks to the new Interpretive Guidelines, it is the facility’s responsibility to escort people to activities and not just activity staff). Those who can come on their own are becoming fewer in number, and those who need encouragement and assistance are on the rise. Of course, people have the right to refuse, but be sure that they are truly refusing.

  • Whether staffing levels are sufficient to meet resident needs and interests. The activity department must be staffed appropriately and with enough manpower to provide the types of programs residents need and deserve. You should also develop a volunteer program to supplement the activity staff.

  • Whether activity staff are the only ones involved in activities. It is up to every staff member and not just the activity department to help see that residents are getting the assistance they need to become involved in the activity program. An encouraging word from a housekeeper, CNA, or administrator is sometimes all they need to become involved.

What are you doing to make sure that your activity program is the best it can be? Are you an advocate for your residents and does your administrator back what you do? If not, you need to sit down and re-evaluate your program and become a stronger voice for each person in your facility. The Activity Professional should be treated as a true professional with the expertise to manage an activity department that meets every resident’s needs.

Diane Mockbee, BS, ADC, is certified by the National Certification Council of Activity Professionals and is President of the National Association of Activity Professionals (NAAP), with 1,400 members, as well as a member of the Arizona Association of Activity Professionals. She is employed by Palm Valley Rehabilitation and Care Center in Goodyear, Arizona and is the Activity Consultant at Ridgecrest Healthcare Center in Phoenix.

For more information, phone (623) 536-9911, ext. 212. To send your comments to the author and editors, e-mail

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