Here Comes Phase II

For the first time in almost thirty years, the long-term care industry is in the midst of significant changes to the federal regulations. These changes are so significant that they are being introduced in three phases. Phase one was introduced last November and mainly set the tone for changes to come, introducing language changes. These language changes are “activity-friendly” as the push toward Person-Centered Care is getting stronger.

Activity Professionals have long embraced Person-Centered Care concepts and many of these regulatory changes validate the importance of quality of life. The wording of our federal tag was revised slightly to more clearly define the scope of programming and emphasize individual preferences.

The second phase is to be implemented November 28th, 2017 and will be introducing the most significant changes of the three-phase implementation.

The following is a summary of the planned changes:

-The regulations have been re-arranged and renumbered. Whereas activities used to be F-248 and F-249, we are now F-679 and F- 680. Same requirements but located differently.

There are references to activities in at least 52 additional regulations which strengthens the importance of quality of life as an interdisciplinary approach.

-Resident rights have been redefined and strengthened. There are more specific guidelines for responding to the exercising of individual rights, abuse, and neglect. All care communities should be sharing the current set of resident rights with their residents at the resident council as well as individually, as appropriate.

-New Behavioral Health regulations are being introduced. These regulations emphasize non-pharmacological interventions for behavioral expressions. The activity profession will play a significant role in these new requirements as individualized activity interventions, both group and 1-1 can be an effective nonpharmacological approach. We will need to be prepared with a wide spectrum of interventions for individuals with all sorts of behavioral needs.

| -Part of these Behavioral Health regulations define the need for sufficient and competent staff. The activity professional needs to ensure they have acquired the necessary training to appropriately respond to elders with cognitive loss. To assume a strong role in defining and implementing non-pharmacological alternatives, we need to acquire the necessary knowledge, skills, and competencies.

Obtaining a national certification through NCCAP or NCTRS would be one way to secure the basic knowledge of therapeutic interventions.

Acquiring a memory care specialization or at the very least, additional training on the subject, would contribute to your knowledge in understanding behaviors and developing individualized approaches that might be effective in meeting individual needs. The activity manager should be developing a training program for the staff in their department, offering regular in-services on dementia care, understanding behaviors and relevant communication strategies.

It is suggested to maintain a training binder which outlines the specific training of the staff on the special needs of your residents. The activity professional can also be a strong asset in providing in-services to the rest of the facility staff on individualized nonpharmacological interventions.

-Phase II also introduces a new survey process implemented by the state surveys.

This Quality Indicator Survey process has already been introduced in parts of the country and with this phase II, the entire country will now be surveyed under this method. This new survey process requires that the surveyor enter all findings into a tablet or PC. The software will organize the data and contribute to a more objective and consistent assessment.

-The new survey process will be using Critical Element Pathways which are investigative protocols. The activity professional should have copies of the Critical Pathways not only for activities but the resident council, dementia care, sufficient and competent staff, behavior and emotional health, communication, and sensory problems, hospice, and end of life, as well a pain management. These pathways can assist the activity professional in assuring all systems are in place and effectively meeting the need of the residents.

This brief listing is just the “tip of the iceberg” as they say. Yes, these changes are monumental and yes, they seem overwhelming. However, the goal is to provide individualized care for the individuals living in our care communities.

It will be challenging for sure but these regulations support the goal of the activity profession – which is individualized, person-centered care. We can assist our communities in meeting these new requirements with our knowledge and skills that we have been practicing all along.

eimer’s disease or another dementia does not mean it’s necessary to stop participating in meaningful activities such as travel. However, it does require planning to ensure safety, comfort, and enjoyment for everyone.

For all travel, regardless of distance or duration, it’s important to take into account the specific needs, abilities, and preferences of everyone involved. For example, if you have always gone to Florida in the winter, you can continue the tradition until the trip becomes too difficult or is no longer relaxing for the person with dementia or the caregiver.

Tips for a calm traveling experience:

• Plan ahead.

• Learn to recognize the warning signs of anxiety and agitation and identify strategies to reduce them. Discuss this plan with the person with dementia.

• Try not to overload the person with a lot of directions or too much information.

General travel considerations:

• Environmental changes can trigger wandering or confusion. Enroll in MedicAlert® + Alzheimer’s Association Safe Return®, a 24-hour nationwide emergency response service for individuals with dementia who wander or have a medical emergency. Call 888.572.8566 or visit alz.org/safety to enroll.

Those already enrolled should notify MedicAlert + Safe Return of travel plans.

• It may be helpful to stick with the familiar. Travel to known destinations that involve as few changes in daily routine as possible.

• Evaluate options for the best mode of travel. Based on needs, abilities, safety and preferences, decide what would provide the most comfort and the least anxiety.

• When selecting destinations, consider those that have easy access to emergency health services and pharmacies. 

• Consider everyone’s needs and desires as you plan your trip; elaborate sightseeing trips or complicated tours may cause anxiety and confusion.

• If you will be staying in a hotel, consider informing the staff ahead of time of your specific needs so they can be prepared to assist you.

• Have a backup plan in case your trip needs to change unexpectedly. This may mean purchasing travel insurance if you have booked flights or hotels.

• Carry with you an itinerary that includes details about each destination. Give copies to family members or friends you will be visiting or to emergency contacts at home.

Travel during the time of day that is best for the person. For example, if he or she becomes tired or more agitated in the late afternoon, avoid traveling at this time.

• Have a bag of essentials with you at all times that includes medications, your travel itinerary, a comfortable change of clothes, water, snacks and activities.

• Remember to pack necessary medications, up-to-date medical information, a list of emergency contacts and photocopies of important legal documents.

• Allow plenty of time for rest. Don’t over-schedule.

• Contact the Alzheimer’s Association to learn if services are available at your destination.

What to keep in mind for visits to family and friends:

Prepare friends or family members for the visit by explaining dementia and any changes it has caused. Go over any special needs and explain that the visit could be short or that you may need to change activities on short notice.

Some additional considerations:

• It may be helpful to stay as close to your normal routine as possible. For example, keep meal and bed times on a similar schedule to that followed at home. Eating in may be a better choice than at a crowded restaurant.

• Be realistic about abilities and limitations. Allow extra time when scheduling activities.

Suggestions for air travel:

Moving through an airport requires focus and attention, as the level of activity can be distracting, overwhelming and difficult to understand.

Consider the following for air travel:

• Make your reservation through a travel agency or by calling the airline directly. Doing so allows you to add notes or instructions to the reservation for special needs such as wheelchair assistance or in-flight meals.

• Avoid scheduling flights that require tight connections.

• If traveling through an unfamiliar airport, review a map of the facility to plan for the distance between connecting flights, locations where security re-entry may be required and locate convenient locations such as restrooms.

• If walking is difficult, consider requesting a wheelchair or motorized cart so that an airport employee is assigned to help you get from place to place. Most airlines ask for at least 48 hours of notice.

• Even if the passenger does not require support for mobility, consider requesting wheelchair assistance to help with navigation through security checkpoints. This support may help expedite the process and reduce stress.

• Contact the Transportation Security Administration (TSA) at least 72 hours prior to travel for information about what to expect during the security screening. While at the airport, ask what to expect and inform the TSA agent at the security checkpoint about the dementia diagnosis.

Do not hesitate to ask for assistance from airport employees and in-flight crew.

• If the person needs help using the restroom, look for companion care bathrooms so you can more easily assist.

• Stay with your travel companion at all times.

Traveling alone with dementia.

Some individuals in the early stage of Alzheimer’s who remain independent may be able to travel alone, but planning ahead is necessary.

Consider the following:

• When booking flights, inquire if the airline offers a “meet-and-greet” service to escort passengers through security and to their gate terminal. This service may also be used to help passengers transfer between connecting flights.

• Inquire about any other services that would offer companion support to meet the safety needs of the passenger.

• Include all emergency contacts on the airline reservation.

• Contact TSA to determine if a pass can be issued to family members or friends to escort the passenger through security to their gate terminal.

• Make sure that all travel documents and identification are readily accessible. It may be helpful for the person to wear a document holder.

Source: Alzheimer’s Association

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