 Speak Out!
July 16, 2009 (updated May 11, 2010)
Re-Creative Resources Inc. would like to know what you think of the following question:
What effects, if any, will the Culture Change Movement and the idea of the "universal worker" have on the activity and recreation profession?
Please email your response to Kim Grandal or you may anonymously post your comment on the guest book page of this site. Your answers will be compiled and posted here.
Articles to read regarding the Universal Worker
Check out this interview I did with a blogger, Jonathan Rosenfeld, from Long Term Care Living Magazine
Check out this interview I did with Kevin Kolus, Associate Editor/Online Editor of Long term Care Living Magazine, which resulted in the article, Activities Angst.
There is also another blog related to this subject that I recently learned of entitled, The Vanishing Need for Activity Professionals. You can find this blog at http://tinyurl.com/vanishingneedforactivitypros. PLEASE read these articles and comment.
May 12, 2010
With the epidemic we are about to face in terms of senior population and care, the need for properly trained and certified activity professionals is not just essential but should be completely mandatory. The "universal worker" may have much to offer and they can be an asset to assist with programs, but as far as having proper programs it is so important to have the knowledge to back it up what we are doing. Activity Directors and Recreational therapists obviously have a talent for what they do or they would burn out very shortly. However, the training and education that is required for an AD or RT to become certified is what gives us the knowledge not just to have person-centered care and "fun" but equips us with the knowledge in providing activities that stimulate cognition and senses which are so essential in helping with any regression. Any facility who would advocate a "by the seat of you pants" approach to recreational therapy is in for a rude awakening. You wouldn't ask a football player who is a great athlete to be a physical therapist without any training so why is it acceptable for activity professionals??? You wouldn't expect occupational therapy to consist of "hey I've used a spoon before, let me show you how to work that thing" So why do we expect someone to automatically get sensory stimulation? Thanks Kim for getting the conversation started!
May 12, 2010
To have a universal worker doing programming, my question would be to them, would they be burn out and stress and how are they going to be trained to do programming? What qualification would they need to run the activities department? How would the universal worker schedule work for programming for our residents? Wouldn't the residents be, even more confused? You run programming, you do cooking, you do house keeping and you even pass my medication. Where is that person I can trust to talk to share what's going on with me.
I thought we were going for a more consistent worker for our residents. What is going to happen to that?
It is great to cross train but not everyone has the patience to be an Activities Professional. I have seen people with the book sense, but when the time comes to implement an activity they have no clue how to do programming. I personally feel this is sad, and the residents are the ones loosing out on a great part of quality of life that we have to share with them.
Susette Warner, ADC
May 12, 2010
To be perfectly honest Kim i see how the nurses are in my facility especially on the unit I'm in charge of and they have no idea what to do when it comes to activities and how much it can really affect a person. Nor do they realize how you need to integrate all cognitive functioning levels in one program and how to judge a resident's response and if they are getting anything from the program. Plus with a universal worker I do not feel that there will be any time to establish good rapports with residents because you are too busy doing many jobs. Residents would possibly loose some social contact I feel.
May 12, 2010
The fact that each discipline has its own uniqueness - expertise in fact - it would be like any person being able to do the job of nursing simply because they took care of their Grandma when she was ill. That doesn't make me any more qualified to do the job than the universal worker is qualified to do the job of activities. The base/core knowledge for the activity profession (MEPAP) or the CTRS (NCTRC) means/ensures that a person has completed individualized training that addresses THAT specific discipline, in documentation and implementation - the universal worker concept diminishes the importance of having a qualified individuals in every facet of the health care industry.
May 12, 2010
Universal workers sounds like “Jack of All Trades Master of None." This is not the same as a Collaborative Professional Team Work. A professional has specialized knowledge based on extensive preparation. Being a professional does not happen over night. It requires many hours of study and preparation. Professionals are expected to maintain a high knowledge level and expertise. A professional firmly believes in staying current in their field. This means that a professional is committed to continued training and development. Professionals proivide the public a standard of practice.
In the early days of nursing homes well intentioned, caring women volunteered to provide socialization, knitting, crocheting, art, Bingo, &music by playing a piano for residents. They provided a valuable contribution. However education, leisure skill in a variety of areas, and experience created a profession for the delivery of professional standarized quality services in the name of progress. Quality of Life became a requirement for the operation of nursing homes particulary since they were receiving government money. However, regulations for quality of life & leisure services became required initially when criminal greedy owners of these facilities were
only interested in making money & horrible conditions were present in all areas of life from ADL, Food , & Cleanliness, in the name of Profit with no concern for abusive living conditions.
Nursing home reform took place from public outrage when these conditions were publicized.
A universal worker is a way to hire cheap labor, so owners could make more profit. The motivation is not quality motivated. I fear what public officials presently do in the name of saving money when these savings are not fair to the public they serve. In the the news it was mentioned Governor Patterson of NY approved large wage increases for top staff officials while laying off workers & certainly not providing wage increases to the line hard working staff.
Raises should not be given to the special interests of public officials with the tax money
the public contributes. The public needs to have more say on how the money they contribute for taxes is spent. The Department of health needs to be lobbyed to maintain qualification standards for health care employee's. When Toyota sold cars with inferior cheaper parts, the quality of that brand lost the trust of the public & people died. Some generic medications although cheaper can not provide the consistency of the orignal brand. I am concerned that nursing home owners will achieve causing harm to our profession and the public we serve in the name of profit. Nursing Home owners through their political connections with government officials may lower standards for staff, and the progress of improved health care achieved will be lost.
Arnie Idelson CTRS, LCAT, CMT, LCAT
May 12, 2010
The effects of the Culture Change Movement and the idea of the "universal worker" is a fancy way(in my opinion) of companies saying "How can we do more with less?" Therefore, someone says, "let's make up this new job and we will save so much money" because really that is the bottom line. Make money, we're happy, don't make money, not so happy. What is sacrificed? Those jobs(like activities) that no one really knows about or understands so therefore it will be cut. My company I work for does not recognize the educational efforts of an Activity Professional because it would cost more money to keep them certified and do of campus continuing ed. If I want to go to a workshop, I am not reimbursed for my hours that I spent there. I will be paid for my mileage and the registration fee, but nothing else. "can't afford it." Is the usual answer.
Our culture is shifting, there is no question or control over this. But wouldn't it be nice that this shift be embraced and looked at pro-actively rather than negatively? There answer is the Universal Worker. Yikes. I really think that we as an organization need to step up our efforts to let not only the health care community know, but everyone know about the importance of an Activity professional. Education and awareness help so much.
May 12, 2010
Kim thanks for addressing this question. I completely agree with you that on paper the universal worker seems great, but reality is that no one will fallow it, nurses and cna's already feel over worked and will not want to increase their work load by adding "bingo" (because you know that is all we do) .
The universal worker will be a jack of all trades but the master of non, and beyond the risk to the field of activities is the risk of our residents quality of life.
May 12, 2010
I have been very concerned about the role of activities in the culture change movement and the universal worker concept. How do they SNF's get around the F-tag 249?
I really think it is time that the feds were talked to about this, because the intent of the regulations is to have better trained/qualified activity staff, not less! They need to revise the regulation - all they need to do is change the OR 2 years experience to AND two years experience! And they need to add some language about the education/training of the assistants, as well, so it isn't just the AD out there with a bunch of NAC's!
May 12, 2010
Although we are converting to culture change, with dept. heads wearing many shoes, at present we do not have the universal worker/with a specific group. That is similar to our ACU, but there is a nurse and 2 aides, under the director. some of the higher functioning ones on ACU do participate in meal prep and cleaning, but not many. As far as staff- well, who does have enough? I like the idea of the residents feeling part of a small community; especially with dementia, making their world smaller and more personal keeps them more focused and less likely to act out. They are also more likely to feel less self-conscious about participating-such as those who do well in therapy groups but hole up in their rooms otherwise. But even in our "consistent staffing" efforts, people do call in, there might be vacations, days off, etc.; there always has to be a backup, and several other potential problems that could throw off the plan.
Right now, in our ACU, the aids do the activities, worked into attending to personal needs, and if that universal helper is all there is, who will tend to the special needs of the lower functioning people while the meal is being cooked, someone needs toileting, someone else is about to fall, someone else is wandering and not programming? In the rest of the traditional hallway-layout building, it would be quiet a challenge to group them with similar medical needs, physical levels, cognitive levels, and certainly to find a group that have similar activity interests. I could see, and that happens now, that they take into account the amount of staff needed for transporting, caregiving, medication needs and even physical levels, but finding 10 of them that actually all like to do crafts as a group? You might have 4; what do you do with the other 6 at that time? Personally, I never would have thought I could work in healthcare because I was afraid to do anything medical (afraid of hurting someone with a wrong decision) and I have a terribly embarrassing and quick gag reflex, with a high sense of smell-put together, would cause someone to have to clean me up if I were to try to clean someone else up! I have great respect for those who can. But learning about the field of recreation, I found a way I can help the older people, with whom I love to be, without having to be medical or do personal care.
As far as the nurses, I agree with ours that they are overpaid to serve lunch trays when dining aids could be hired to dress in black and white waiters uniforms and make it feel special to the residents as fine dining; some of them even wonder why a nurse would be serving meals, or why our dept. heads are doing these things when there is business to conduct-they realize these things, too. I think the worst part is just getting around the change process, especially if you are going through a low census period. And how much paperwork must this universal worker be cross-trained in? Actually, I can see this heading the way the factories did- cross-training to do several jobs, move people around at will, in an effort to get one person to eventually do what two used to do-just not as well or in the same time as two could. Doing the cooking, laundry, cleaning, etc. will still ultimately fall upon that universal worker, not the residents. Those who can do it, will also decide IF they want to. The rest either can't or need so much cueing that the worker will be frustrated and do it themselves because there is always something else that much be done. I keep an open mind, because I do like the smaller worlds for them; but corporations must provide the resources to make it happen in a way that is beneficial to the resident, and ultimately, the workers as well. Thank you for asking us for our input.
Gracie Daniel
May 12, 2010
The universal worker sounds great in theory, but I don't think it will work in actuality. Our CNAs are trained to do activities on our Memory Care neighborhood, but activities rarely occur if an activity assistant is not present. The residents are the ones who are affected when they don't have any meaningful activities. We see increased behaviors, wandering and sundowning. If residents are engaged in meaningful activities, they experience less anxiety and more moments of joy. There is nothing more heartbreaking than seeing a resident in distress with no one even noticing or seeming to care because they are "too busy" doing their jobs.
I understand the philosophy behind the universal worker and the Culture Change Movement. If everyone was on board with the concept, it could provide awesome environments for our residents to grow and thrive in. But I do think it takes a very special person to be involved in activities. Not everyone is suited to do activities. I know many times we are not truly appreciated for the many things we bring to our residents or our facilities. So much of what we do is behind the scenes; therefore people think we have the easiest job in long term care. But who is it that takes time to sit with a dying resident when her daughter can't be there? Who is it they call upon to help a resident with disruptive behaviors? I think it is a matter of taking ownership and respecting our residents as the people who have lived rich, full lives and still have a need to give to others. I would love to be able to help others see the inner beauty of our residents-so they could truly see them as people with the same needs, wishes, and desires as younger people.
I think to make the universal worker successful, there would still need to be an activity professional to assist in planning activities, obtaining supplies, and providing the required documentation. We can bring variety and spice to our programs. When someone is responsible for ADLs, housekeeping, laundry, and meals she may not have the time needed to plan and implement a meaningful program. We have to know our residents interests and abilities. We have to adapt our activities to their needs. Can the universal worker do all this?
I apologize for this message being so long, but I think your question struck a nerve with me. I am all for Culture Change when we put our residents first. I can't imagine anything better than that!
But we know the reality of the long term care field.
I work in a 93 bed facility with rehab, skilled, and secured dementia neighborhoods.
Sandy Whelan, ADC
May 12, 2010
What would become of "professional therapist"...these words mean we have studied and learned all the intricacies needed to enhance quality of leisure life for our elders living within nursing facilities.
We are the professional "ways and means" for a more home-like atmosphere where compassion and joy filled events are therapeutically delivered for loved ones who are unable to provide for themselves and a "means" of re-gaining past interests through the intuitiveness of a trained activity enthusiast "ways" who wants the best for residents placed in his/her care.
A non-experienced, non-qualified universal worker would greatly diminish the less-abled resident to fully enjoy an event or even feel part of it.....A "universal worker" without years of proper training might only include the residents who were more abled. Where would the "individual" be without adaption of events for their joy provided by the "professional" who has engaged in depth, all aspects
of how activities provide a more meaningful life not just existence.
The years of "preparedness" that activity professionals attain not only give them knowledge of
the needs of geriatric residents but help ensure confidence in family members who have placed a loved one within a facilitiy are expecting and have a right to expect only the best for their loved one. Staff also have the right to be certain that the good judgement and experience the activity professional brings to utmost patient care in therapeutic treatment and understanding is a "given".......and of course, the love given as this is their chosen profession and aim in life.
Desline Vitto, ADC
May 12, 2010
Kim, I agree with you but... the other problem that we all face is there usually isn't enough money allocated to the staff in the activity department and there is always a need for more activities, so... cross training CNA's to do activities is usually helpful and necessary. if we are doing this are we cross training ourselves out of the fight for more capable staff? How do we lobby with Administrators and owners to get them to understand the true nature of our contribution to the overall health and quality of life for each resident and raise our importance to the level of the Medical personnel in the building? I think this is the true crux of the problem.
May 12, 2010
I really think this could do more damage than good. It takes training to be able to assess everyone's needs , there are so many residents on different levels, the activities need to vary to meet those needs and a universal worker is going to have a hard time finding a activity interests for everyone while trying to get basic household chores done etc. It is definitely going to take the focus away from the residents quality of life , probably the complete opposite of what the objective was thought to be.
Jennifer Byrom, Activity Director
May 12, 2010
I am the Certified Activity Director in Alabama; a small city by population, but a big city when it comes to tradition, and life! The key word here is life. You mentioned in your question/statement two things that I feel are very important when it comes to rationalizing the importance of our career. First and foremost is the need for provision, by an understanding professional, on giving "Quality of Life" activities to any and all individuals. I have had this fear of stepping on toes when it comes to this subject, but have found so many ways of making this an important issue, especially to the unappreciative nursing staff at many long term care facilities. Please note that I am not individualizing any certain person, but I really do want to address this certain position due to the common response by the so called higher educated staff members. The nursing body in general seems to miss the importance of meeting domains. Recreational professionals know what "domain" means, and how important it is not only to the LTC resident, but to ourselves as well. In short, laundry, food, meds have always seemed top priority, but making sure Mrs. Jones' emotional, spiritual, physical, or cognitive needs are helped, just doesn't seem as important. The funny thing is, many times they are assisting in "helping" meet those domains without really knowing or giving credit for it.
Secondly, I hear the argument of time. Life has become so fast, and professions are flying right past what the LTC resident is reaching out for, or living for each day. The concern I see regarding a "universal" worker comes down to a time management issue as well. Maybe, cost-effective as well. Time and mobey, what a combination of bumps in the road of logic when it comes to the care of loved ones. In combination of how these workers react to "activities" is also the way they are trained. Again, I am only responding in honesty by saying that in the nursing profession, new career holders are only seeing that which I mentioned earlier maybe because that is what they are taught in the first place. How many instructors know the importance of therapeutic activities or meaningful engagement in everyday life, or took the "time" to see how important it is, and how much"time" it takes to give each individual the focus, attention, or response period they truly deserve to LIVE their lives fully without the shadow of being institutionalized, whether it be by choice or not.
Having nurses is of utmost importance to me personally in the LTC setting, and seeing the way nursing has adapted some of their routine to meet the need of culture change has not gone without notice. I hope that what I have said will accomplish my goal of sharing not only my ideas, but the ideas and feelings of many of my fellow activity professionals as well. Thank You for this opportunity to have a voice.
Wendell Greenleaf, ADC
May 12, 2010
Hi Kim...GREAT QUESTION! I think the culture change movement is a fantastic concept...but if individual miss the intent of what this means, I fear we do stand to lose the benefits of Recreation in our Long Term Care Environments. For example, we encourage our CNA's to participate in activities...they report...put the supplies in front of the residents...and that's about it. Without the Recreation Staff facilitating and reinforcing the intent of the program, it becomes "busy work" and loses its meaning. I also feel the Culture Change Movement was not meant to force our elders in working as their only means of diversion. Honestly, what person likes to cook, clean, and do laundry ALL day? Recreation is a needed component of everyone's life. We are the professionals that pull the therapeutic and the FUN together. As I grow older, I want to laugh and know that there will be times when I can let loose and be silly and fun with my friends! This should be a time of active involvement in life...continue the adventure and not look upon the living arrangement as the end of the journey.
Remember the saying, Jack of all trades master of none... this is something that needs to be addressed. I personally believe that a person needs to be very well versed in his/her field. You can't be an activity professional and a part time CNA/ Nurse/ Maintenance guy etc. there has to be a distinction between us and them because how would this UW meet the needs of a resident/patient when he, himself doesn't know exactly or has no in depth knowledge of the field. I watch many people working in the nursing home trying to do an activity with some residents and guess what I saw? they are only good in the first few minutes but doesn't have the patient, stamina, creativity etc. that a trained Activity Professionals have. What quality of life can a LTC resident get from somebody, who only knows bingo and watch TV? based upon experience, we have a resident who loves bingo and will never ever miss the game but when I tap him for a role in our performing arts club, I was apprehensive then because our rehearsals happens to be in conjunction with bingo BUT he told me, that he can forgo bingo but not the drama rehearsals. He memorized his script made some improvs and he was The step mom of Cinderella. With this, what can a non trained AP do to give this man an empowerment activity? nada... unless there are some miracle somewhere... and by the way recreation doesn't only deal with activity...there is more to it than what meets the eye...we, who are in this field, trained and experience even need more education etc.so, what can a UW produce?
May 12, 2010
The universal worker shouldn't be allowed to do the therapeutic recreation aspect because it takes away from our credibility, name and profession. As trained professionals, we are the ones that took the time to go to school and learn the field of Recreation and Leisure. Therapeutic Recreation in Canada, alone has a difficult time achieving its recognition it deserves never mind having some other worker do our job!!!! Qualified professionals should be the only ones performing activities for geriatrics and/or any given population. The universal worker should not.
This makes me angry from a professional stand point, that this nonsense is actually going on. As professionals, I believe we have to make a point and stick up for our profession just like any other allied health discipline, TR is a profession that is taught by trained professionals in an environment that promotes and enhances quality of life in residents and other populations.
Pamela Higginbotham
Recreation Therapist Assistant
May 12, 2010
My first response is..remember the old adage "All work and no play makes Jack a dull boy".. Think about us at home..if all we did was clean house and do household tasks all the time, we would be pretty bored, have no energy and quite possibly depressed. This is the same for persons living in nursing homes as well. Part of resident rights is to be able to be contributing members of a larger community. Is a universal worker going to be able to help a resident to go to a town meeting, help someone to vote, go to church, go out to eat, etc, etc....Even the therapeutic activities at the nursing home.. getting together to sing, pray, eat, celebrate birthdays and holidays.. Those are all parts of being normal adult citizens and our residents have the right to do all that. Having residents live in smaller neighborhood communities, with staff participating in all levels of care can be a normal routine. When the elders were at home they did chores and they can relate to all that, but they need to play too, to be balanced. At our home, we talked about the future and the fact that there would not be department heads as such, that we would take on crossing roles. I've yet to figure out that one, but I know what they are talking about. I've been in a small community home before, and they've had the day to day living at home experience, the celebrations are family oriented, but they have to leave to get any other stimulation.
May 12, 2010
Interesting - our Meijers store (similar to Walmart) has utility workers. That is, they aren't particularly skilled in anything but are supposed to do everything. Caring for a resident's needs and carrying out groceries are two different things.
My Dad used to say: "Jack of all trades, master of none."
This doesn't sound like a good approach to quality care. It sounds like an approach to hiring that negates the concept of job credentials or qualifications.
Sad state of affairs, in my opinion.
Norma Stumbo
July, 2010
The universal worker is one more way to diminish and degrade the recreation professional who spends the time and the money to receive the necessary education for this profession. The level of ignorance is all pervasive and anyone who has worked in the field knows it. So here is yet another situation where “hey anyone can do this work because it’s recreation, right”. How about NOT! How about people with professional training in any field, including recreation, have a strong heads up and understanding of what the field is about.
July, 2009
The universal worker concept has been tried in Canada and never successfully
taken off.
While it is good to be able to address specific needs in the moment to
enable a resident to move forward in their pursuit of activity rather than
waiting for a care aid to come to their assistance for toileting or other
issues, as specialists (regardless of profession) we are able to target
relevant needs expertly and thoroughly.
As they say: 'jack of all trades, master of none.' And who would hire a
carpenter to do plumbing anyway
July, 2009
The concept of cultural change is challenging. I believe that residents should live in an environment which promotes individuality and allows for diversity. The challenge arises in the amount of staff to provide this type of individualized almost "private duty" type care in a facility setting. Although cross training staff to provide multiple services will help with providing this individualized care & services I feel there is still a value and need for job/role delineation. My concern is that many LTC staff do not understand the value and importance of activity professionals regardless of the amount of inservicing & engagement. And that the quality of recreational programs & services will be diminished. Re-training the "universal worker" to see beyond the job they've always done & incorporating new roles & responsibilities will be challenge. I'm sure they're will be many road bumps along the way------but I value this profession------I'm ready for the ride.
July, 2009
I am afraid that the universal worker model will be used as a way to do an end-run around having activity professionals lead activities and to cut staff, especially in assisted living settings. So far my experience has been that administrators will have 1 activity professional and then say the rest of the staff are 'universal workers' and can do activities on weekends, etc. rather than having activity staff coverage or adding caregiver hours. The caregivers are often so busy doing care that they can't do the activities in any meaningful way, if at all. So the losers are the residents, especially those that are really dependent on others for assistance. I would like to see the Pioneer Network get behind the activity profession and the need for certified activity professionals in all elder settings.
July, 2009
No change. Culture change is about making adjustment on who we are and our lifestyles Where I come from I am the Director and I also preform the activities we have staff who asst when we need them.... We have a regulations on staffing in the activity department all ready that activity director has to be State certified. Culture change is a good thing this pertains to WHAT THE RESIDENTS WANT their lifestyles, their wants and things that are important to them... Just as if you enter into a LTC facility and you are Baptist activity has to Include Baptist on the calendar. If they are Cof Christ the same so on and so forth. There is no change If you have someone Spanish you have something for her or him. The same with any ethnic There is no change we have always given the resident activities based on their lifestyles and culture. The reason they are looking at activities is in order to get more staffing in activities.
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