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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
  • Identify barriers to leisure pursuit and help minimize these barriers
  • Identify the residentís leisure/recreation potential
  • Provide the necessary steps to assist the resident to achieve their leisure/recreation goal/s
  • 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.

Care Plan Resources

The Recreation Participation Sheet by Re-Creative Resources  Inc.

Although CMS and the State of NJ do not regulate we take attendance for activity participation, Re-Creative Resources, Inc. feels it is extremely important to keep accurate records to ensure the residents needs and interests are being met. Participation records also serve as Quality Assurance and justification of our services. This two- page form is many forms in one! The front page includes a variety of recreational activities with a coding system such as A=Arts and Crafts, D=Discussion, and so on. Participation in groups as well as one to one programming is included. On the back, there is space provided to write care plan goals and interventions to communicate care planning issues to the Recreation staff. It covers a three month period (great to use in conjunction with writing progress notes). Each resident would have their own participation sheet. Bring this form to the Care Plan Meeting to write in all the details and keep in a binder in the recreation office. For more information visit http://www.recreativeresources.com/documentationforms.htm

The Recreation IDCP for Group Programs by Re-Creative Resources Inc.

With the institution of the new CMS Survey Guidelines for Activities, it is even more important to develop a system to communicate Care Planning decisions. Often times, the individual attending the meeting is not the one who provides the majority of the daily activities. This one-page checklist will help you do this. It includes a variety of group programs such as Resident Council, music, parties/special events, exercise, horticulture, arts and crafts, etc. with room for 16 residents. Simply bring this form to the Care Plan Meeting and check off the appropriate Recreation Interventions discussed in the Meeting. It can easily be altered to coincide with your Recreation participation Records as well.  For more information visit http://www.recreativeresources.com/documentationforms.htm

The Recreation IDCP for 1:1/In-room Interventions Form by Re-Creative Resources Inc.

With the institution of the New CMS Survey Guidelines for Activities, it is even more important to develop a system to communicate Care Planning decisions. Often times, the individual attending the meeting is not the one who provides the majority of the daily activities. This one-page checklist will help you do this. It includes a variety of 1x1 interventions such as: music, exercise, reminiscence, validation, sensory, snacks, etc. with room for twenty residents. Simply bring this form to the Care Plan Meeting and check off the appropriate Recreation Interventions discussed in the Meeting. For more information visit http://www.recreativeresources.com/documentationforms.htm

The Care Planning Cookbook for Activities and Recreation, 5th Edition,

The fifth edition of our best-selling resource for recreation and activity professionals! This book is formatted with a quick index and familiar three-column care plan design. In this newest edition you will find over 500 care plan goals amongst the 150+ care plans, all written for OBRA, MDS, Survey Guidelines and Quality Indicator compliance. New care plan goals have been written for various care plan styles: engagement and response based, satisfaction based, ability-based restorative goals and first person-voiced care plans. Cross-referencing has been included for Nurses Diagnosis coordination. Helpful exhibits include glossaries, abbreviation lists and MDS resources.

 

 


 
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