CARE PLANNING for ACTIVITY and RECREATION PROFESSIONALS

*Please check with your Care Planning Director for any potential updates in required documention.

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 resident’s status including any problems, concerns, needs, and/or strengths

Who usually attends a Care Plan Meeting?

• MDS Coordinator
• Nurse(s)
• CNA’s
• 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 resident’s 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.

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