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Care Planning for Activity and Recreation Professionals

 

Introduction

Creating and implementing individualized care plans for residents in long-term care facilities is a very important responsibility of activity and recreation professionals. The recreation/activity assessment determines the content of the care plan. Not all residents will have an "activity-care plan", but most care plans should have "activity-related interventions" found in the comprehensive care plan. Care plans may be written regardless if a resident triggers on the MDS 3.0.It is important to set realistic, measurable goals, interdisciplinary interventions, and create care plans that are individualized. 

What is a Care Plan?

The RAI user manual defines care planning as, "A systematic assessment and identification of a resident's problems and strengths, the setting of goals, the establishment of interventions for accomplishing these goals."

Why write Care Plans?

  • Document strengths, problems, and needs
  • Set guidelines for care delivery
  • Establish resident goals
  • Identify needs for services by other departments
  • Promote an interdisciplinary approach to care and assign responsibilities
  • Provide measurable outcomes that can be used to monitor progress
  • Meet federal and state requirements
  • Meet professional standards of practice
  • Enhance the resident's quality of life and promote optimal level of functioning!

 What is a Care Plan Meeting?

 A forum to discuss and review a residentís status including any problems, concerns, needs, and/or strengths

Who usually attends a Care Plan Meeting?

  • MDS Coordinator
  • Nurse(s)
  • CNAís
  • Dietician
  • Rehabilitation Therapist(s)
  • Recreation Staff
  • Social Worker
  • Resident
  • Family Member/Guardian

When are Care Plans written?

  • A minimum of seven days after the MDS completion date
  • Some care plans warrant immediate attention
  • As necessary
  • Must review at least quarterly

The Role of the Recreation/Activities Department

  • Identify  the resident's leisure/recreation needs
  • l Identify barriers to leisure pursuit and help minimize these barriers
  • l Identify the residentís leisure/recreation potential
  • l Provide the necessary steps to assist the resident to achieve their leisure/recreation goal/s
  • l Provide interdisciplinary support by entering a variety of recreation interventions on various   (non-activity) care plans
  • Monitor and evaluate residents response to care plan interventions 

Components of a Care Plan

  • Statement of the problem, need, or strength
  • A realistic/measurable goal that is resident focused 
  •  Approaches/interventions the team will use to assist the resident in achieving their goal
  • Important dates and time frames
  • Discipline(s) responsible for intervention
  • Evaluation

Target areas for Recreation/Activities

  • Cognitive Loss
  • Communication
  • ADLS
  • Psychosocial
  • Mood
  • Nutrition
  • Falls
  • Palliative Care
  • Activities
  • Recreation Therapy
  • Pain Behavior
  • Restraints

Activity/Recreation Care Plan Samples

These are just a few samples. Remember, the most important aspect of care planning, is INDIVIDUALIZATION

 

Statements

  • Resident has limited socialization r/t to depression
  • Resident refers to stay in room and does not pursue independent activities
  • Resident is bed-bound r/t to stage 4 pressure ulcer and is at risk for social isolation
  • Resident demonstrates little response to external stimuli r/t to cognitive and functional decline
  • Resident enjoys resident service projects such as changing the R.O. boards
  • Resident becomes fearful and agitated upon hearing loud noises in group activities r/t to dementia
  • Resident has leadership abilities
  • Resident prefers a change in daily routine and wishes to engage in independent craft projects

Note: With the implementation of the MDS 3.0 statements will likely represent more of "preference-type" language.

Goals

  • Resident will respond to auditory stimulation AEB smiling, tapping hands, or vocalizing during small group sensory programs in 3 months
  • Resident will actively participate in 2 movement activities weekly in 3 months
  • Resident will remain in a group activity for 15 minutes at a time 2x weekly in 3 months
  • Resident will accept in room 1:1 visits by recreation staff 2x weekly in 3 months
  • Resident will socialize with peers 2x weekly during small group activities in 3 months
  • Resident will respond to sensory stimulation by opening eyes during 1:1 sessions in 3 months
  • Resident will actively participate in Horticultural Therapy sessions in the green house, 1x monthly in 3 months
  • Resident will continue to assist other residents in writing letter on a weekly basis in 3 months
  • Resident will exhibit no signs of agitation during small group activities 3x weekly in three months
  • Resident will engage in self-directed arts and crafts projects 1x weekly in 3 months

Interventions/Approaches

  • Provide a variety of music i.e. Big Band and Irish
  • Utilize maracas and egg shakers to elicit movement
  • Provide PROM to the U/E during exercise program
  • Involve resident in activities of interest i.e. singalongs, adapted blowing and trivia
  • Offer 1:1 visits in the late afternoon to discuss recent Oprah episode
  • Seat resident next to other Korean speaking resident during groups
  • Provide tactile stimulation i.e. hand massages and textured object i.e. soft baseball
  • Provide olfactory stimulation i.e. vanilla extract and cinnamon for reminiscing
  • Utilize adapted shovel and watering can during HT sessions
  • Provide easy grip writing utensils and a variety of greeting cards/stationary
  • Involve resident in small sensory groups i.e. SNOEZELEN and Five Alive
  • Seat resident near a window
  • Provide a variety of independent arts and craft projects
  • Provide adapted scissors and paint brush

Exercise

Imagine that you are a resident in a long-term care facility and you are bed-bound for a health-related condition at risk for social isolation and inactivity.  Write a goal and at least seven interventions/approaches that are relevant to you.

For a complete documentation package please visit www.recreativeresources.com/documentationforms.htm

 

 

 

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