Bingo! A new day for activities: F-Tag revisions require a focus on resident-centered care.

In June, CMS revised F-Tags #248, activities, and #249, activities director, to require nursing homes to use a resident-centered focus for the assessment, development, execution, and periodic reassessment of the types of activities residents find enjoyable and fulfilling. These new guidelines signal the need for a change in the way many facilities provide activities for their residents.

The days when activities programs were limited to bingo games and sing-alongs are long gone.

The revisions of F-Tags #248 and #249 in June signify an important step in the evolution of activities programs in long-term care. Nursing homes must now increase their focus on an individual resident's quality of life.

The new regulations governing activity programs mean your facility needs to seriously consider how it provides an ongoing schedule of activities designed to meet the interests and physical, mental, and psychosocial well-being of each resident.

Addressing individual needs

You should develop the activity program for each resident using that individual's comprehensive assessment and care plan, which highlights strengths and needs.

The activity program should

* provide stimulation or solace

* promote physical, cognitive, and emotional health

* enhance, to the extent practicable, each resident's physical and mental status

* promote each resident's self-respect by providing activities that support self-expression and choice

In order to support resident choice, your nursing home staff must query residents to determine which activities are most important to them. Here is a guide on how to gather resident preferences and translate them into a meaningful activities schedule that satisfies everyone's individual needs:

* Gather a listing of the preferences that the residents in your facility express for activities.

* Determine what percentage of residents is interested in each of the categories.

* Prepare a tally of the preferences expressed on the Minimum Data Set by using a manual format or a computer printout.

* Determine whether your facility covers all preferred categories, either through structured group programming or individual participation (either resident- or facility-initiated).

* Check whether the facility's calendar reflects program offerings in percentages corresponding with resident preferences. For example, if 85% of your residents express a preference for arts and crafts, are these types of activities offered weekly? Does your calendar offer bingo or other games almost daily even though only 10% of your residents express an interest in games and cards?

When you create activities, keep in mind the specific aspect of the resident's well-being that the program satisfies--his or her physical, mental, or psychosocial well-being.

Following is an explanation of different types of activities that satisfy three specific aspects of a resident's needs:

Programs that are purely physical in nature are essential to residents growing and retaining muscle mass and reinforcing therapy goals. They break down as follows:

Exercise programs

The benefits of exercise programs include improved circulation, digestion, and weight control, as well as a general feeling of well-being, increased stamina, and muscle strengthening. Exercise provides a variety of outlets to use props and music. They can include the following:

* Scarf dancing

* Movement songs

* Familiar movements (e.g., wood chopping, ringing bells, ironing, etc.)

More active sports in which some residents may be able to indulge include the following:

* Ball tosses

* Basketball

* Parachute play

* Kickball 

Walking programs

Your options will be based on the facility's layout and your location in the community. Examples of walking programs include the following:

* Strolling through the halls in the facility

* Using outside courtyards and grounds

* Taking walks within the immediate neighborhood

* Taking trips to special "walking" areas

* Walking down to the dining room or a secured courtyard

These programs are integral to help residents stay mentally alert or to prevent as much as possible the cognitive decline of residents with impairments. Assess the cognitive level of your residents to determine whether any of the following activities would serve as fulfilling mental stimulation:

* Reality orientation programs (group or individual)

* Intellectual games (trivia, name-that-tune, etc.)

* Reading (individual, in groups, or sharing reviews)

* Creative writing (poetry, stories, etc.)

* Art or music appreciation

With CMS' new surveyor guidance focusing on how nursing homes should spotlight residents' psychosocial out comes, activities that foster good psychosocial health are critical.

Try the following activities to achieve positive psychosocial outcomes among your residents:

* Remotivating

* Reminiscing

* Providing outlets for creative crafts and art

* Spotlighting residents' lifetime interests, hobbies, and achievements

* Encouraging letter- or card-writing to friends and family

Activity program pitfalls

The regulatory expectations for activity programming continue to increase, especially as the emphasis on residents' quality of life also increases.

Nursing homes must move beyond activity programs designed simply to occupy the person and create a diversion. Instead, the activity professional is now being challenged to participate in restorative care efforts ranging from exercise programs to behavior-management and drug- and restraint-reduction programs.

Surveyors are on the alert for programming deficits. They can be related to an individual resident, which are assessment and care planning issues, or to the overall effectiveness of the programming, which are quality assessment and improvement issues.

It's time to reevaluate your activities programs if you see any of the following red flags in your facility:

* Lack of choice, preference, or programming

* The failure of staff to inform residents of activities

* The failure of staff to encourage attendance

* Lack of transportation

* A program design that does not reflect the needs of the individual or group

* A program not adapted to residents' functional abilities--Debbie Ohl

Debbie Ohl, RN, LNHA, is the founder and president of Ohl & Associates, a long-term care education and resources company in Cincinnati. A consultant to long-term care providers throughout the nation, she is the author of Activities for Resident-Centered Care: Complying with F-Tags #248 and #249, published by HCPro, Inc., in 2006. Contact Ohl at 513/522-6041 or [e-mail].