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Thoughts on solving the problems of resident transportation.

Activities may be a good idea, but getting residents to them can be a headache. Some suggestions for easing the pain.

As we all know, government regulations now require that residents who are capable should have the chance to be involved in activities outside the facility every month -- and, in some states, even more frequently. The risks, liabilities and sheer hard work involved in accomplishing this are obvious, and sometimes daunting. Activities personnel have major challenges here, but they are not alone -- or, if they are, they will most likely fail.

Working the activities program into the overall care plan is one management challenge; arranging transportation of the residents to the activities is, of course, another. Both, however, are tied together, as we've discovered at our 150-resident facility.

The basis of a successful out-trip program is to bring the nursing staff on to the activities providing team. For starters, this means educating the nursing staff, NAs and CNAs that activities will eventually make their jobs easier. A happy and content resident is often more cooperative, and that is a point worth emphasizing.

But getting the nursing staff involved goes beyond that. It is important that the activities personnel, whenever possible, engage nursing staffers directly in the activity, to join in the experience. Needless to say, short-staffing of a facility, or of a unit, is always a concern these days, but if there are enough residents being transported to virtually empty the unit, the CNAs can probably be allowed to not only help transport them, but to stay and participate. Recently, due to a couple of unseasonably warm days, we decided on the spur of the moment to treat residents to an ice cream social. Everyone, including the NAs and CNAs who work with them every day, got ice cream and enjoyed it. The value of shared experiences such as this in bonding the nursing staff and residents on a very human level should not be underestimated in contributing to the overall morale and effectiveness of the facility.

It is a given that some nursing staff should be along on out-trips to assist with the lifting and any other physical maneuvering of the residents that may be necessary. This should not be left up to volunteers, many of whom may be elderly themselves. Nurses' observational skills are also important if some of the residents tend to be wanderers. If anything, it is better to be overstaffed than understaffed on a trip, and DONs and activities directors must work together to try and make the necessary scheduling adjustments.

Activities calendar planning should involve the activities director and the DON as equal partners. As the DON is concerned with residents' clinical capabilities, the activities director should be aware of their psychosocial and educational needs. Further, his or her expertise in knowing how to meet these must be recognized. Guiding this teamwork is the resident's care plan -- the "Bible" of activities planning.

Beyond this, the NAs and CNAs should be kept apprised of the purposes of activities, and of how important they are to the success of their work. This topic is definitely worth an inservice in itself.

From the administrative standpoint, though, getting the nursing staff's cooperation is only half the battle. There is the question of arranging for the transportation service itself. Purchasing a properly equipped van is, of course, one option, but it can be a very expensive proposition for the average nursing home. The cost can range easily above $25,000. Beyond this, there is the cost of insuring the residents being transported. Coverage amounting to $1 million per person is not unusual in these litigious times. If the home is of sufficient size, or if it is combined with a Continuing Care Retirement Community, so that the van is kept on the road virtually full-time, such an investment might be worth looking into.

For more average-sized facilities, though, the good news is that the charter transportation companies are beginning to catch on to them as a potentially lucrative market, especially in view of the recent regulations on out-trips. The question then becomes choosing a charter company.

There are several factors to consider. For example, what are their rates? In the St. Louis area, we are finding full-sized, fully-equipped buses available for four-hour trips at about $350 to $400. At the lower end are smaller handicapped-equipped vehicles available for two-hour minimum trips at about $65 or so. Obviously these rates will vary from place to place, but not by very much.

Other factors include the amount of insurance they carry; how well the equipment is maintained (and this is worth a trip to company headquarters to find out); whether other long-term care customers are pleased with their service; and whether the drivers are comfortable dealing with this special kind of "passenger." The personalities of the drivers that we have used on out-trips have made a tremendous difference to their success; they're the fun they were intended to be.

A word about volunteers services. These are, of course, of tremendous help in providing companionship and maintaining residents' socialization skills. They do impose some administrative duties, though, that should be kept in mind. Regulations require that their hours be kept track of, and of course liability insurance is required to cover their work, especially if they provide driving services in facility-owned vans. (Under no circumstances should they use their personal vehicles to provide resident transportation, because their personal insurance will not cover them for this.) Facilities with large volunteer staffs sometimes find it necessary to pay a full-time volunteer coordinator to manage the complications.

Not to be neglected, finally, are the difficulties involved in the supposedly mundane business of transporting residents to activities within the facility. How many nursing facilities have I heard of where this has been left up to the activities personnel themselves -- an often arduous and demoralizing chore that cuts into both the time for an activity and the professional's enthusiasm for presenting it. Once again, the help of the nursing staff is invaluable, its participation should be welcome, and the rewards will prove worthwhile to everyone concerned.

Robert L. Schultz, ADC, is Director of Therapeutic Activities and Social Services at the St. Louis Altenheim Life Care Retirement Home, St. Louis, MO. He is state president of the Activity Directors Association of Missouri and a Board member of the National Association of Activity Professionals.
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Author:Schultz, Robert L.
Publication:Nursing Homes
Date:May 1, 1993
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