“Where There’s a Way, There’s a Will” Changing The Culture For Person Directed Care Planning

1. “Where There’s a Way, There’s a Will” Changing The Culture For Person Directed Care Planning & Engagement For Therapeutic Recreation: An Overview Brad Norris, Activities Consultant, Certified Certified Cognitive Stimulation Instructor Administrator-In-Training bjn040961@gmail.com

2. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation F-Tag 675 Quality of Life • The Facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psychosocial well-being of each person • F-Tag 675 applies to the Facility and not just the Therapeutic Recreation Department

3. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation The intent of F-Tag 675: • To ensure the Home identifies each persons individual interests and needs • To ensure the Home involves each person in an ongoing program of activities that is designed to appeal to his/her interests • To enhance the person’s highest practicable level of physical, mental, and psychosocial well-being

4. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation What is Therapeutic Recreation / Therapeutic Activity / Life Enrichment? • For the purpose of Long Term Living, Therapeutic Recreation/Therapeutic Activity/Life Enrichment is defined as any endeavor, other than routine ADL’s, in which an individual participates that is intended to enhance his/her sense of well-being

5. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation Person -vs- Age Appropriate • The former refers to the notion that each person is a unique individual (ie. They are a person first and their diseases or frailties are secondary to who they are as a person) • The National Alzheimer’s Association has changed the language in their literature from “age” appropriate to “person” appropriate to better align with “Person First” and “Person Directed” approaches to service delivery

6. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation So what’s different about a Person Directed approach? • The home’s approach focuses more on community life and less on a “calendar” of events • All Care Partners are cross trained and are responsible to ensure activity pursuit/involvement • Individuals reside in clusters called “Households”, “Neighborhoods” or sometimes “Streets” • Activities offered resemble those of any private residence • Individual’s lives are centered on their schedule and usual routines instead of the home’s

7. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation Why the TR Assessment is critical… • A good assessment includes the person’s lifelong interests, spirituality, life roles, goals, strengths, needs, and activity pursuit patterns and preferences prior to relocating to the home • This facilitates development of a comprehensive care plan with relevant goals and approaches that incorporate the person’s interests, pursuit patterns, preferences, and needs for adaptation

8. LIFE HISTORY • Information that is from THE PAST – prior to entrance into your community • Includes information to give an overview of the WHOLE LIFE of the person • WHAT the PERSON HAS EXPERIENCED during their life time • Informationthat can be used in helping the PERSONMAXIMIZE SUCCESS • Becomes the basis for the initial comprehensive assessment and planning process • Facilitates positive adjustment to the community • Provides pertinent information for use LATER (especially if the person develops or has Alzheimer’s Disease or other related dementias)

9. LIFE HISTORY TOOL

10. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation Good Assessment = Good Care Planning • This enables the TR professional to match the skills, abilities, and preferences of the Person with the demands of any given group or individual activity pursuit and with the characteristics of the physical, social, and cultural environment

11. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation The Care Plan Should… • Identify the person’s interests, preferences, abilities, issues, concerns, problems, or needs affecting their ability to engage in activity pursuits they prefer • Validate the Assessment, and vice versa • Involve the person in its development • Account for continuation of life roles consistent with the person’s preferences and functional capacities

12. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation The Care Plan Should Also… • Encourage and support the development of new interests, skills and hobbies • Identify pursuit possibilities in the community, if appropriate • Incorporate necessary adaptations in order to facilitate participation of the person at their highest practicable (vs-practical) level of participation • Identify how the facility will provide activities to assist the person in meeting their goals as well as who is responsible to implement the plan • Include goals based on measurable objectives and desired outcomes (beyond how many times the person attends each week)

13. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation How Person Directed Care Planning Affects Approaches • Generic approaches don’t fit into the “Person First / Person Directed” mind set (ie. …provide diversional activities, redirect, allow to vent feelings, monitor mood, etc. are non person specific approaches) • Approaches are individualized based on what we know of the person’s history, preferences, functional abilities, and strengths • “Person Appropriate” approaches replace “Age Appropriate” approaches • Care Planned approaches are revised as the person’s functional abilities change (reflecting improvement or decline in status) • Approaches validate the Assessment and Care Plan, and vice versa

14. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation Accommodations We Will All Need To Make • Individuals get up and go to bed on their preferred time schedule • Individuals eat their preferred foods at their preferred times • Therapy, bathing, etc. “schedules” are altered to accommodate the person’s desire to participate in activities that may occur at the same time as therapy, the bath, etc. , thus providing the person with increased autonomy in daily planning and decision making • Assisting individuals as needed to get to/from preferred activities (altered rest room breaks , Nursing measures/treatments, walking to but riding from, etc.) • Providing supplies, assistance, etc. for individuals’ use at their preferred time and location when TR Staff is not available to assist (eg. playing cards in a different neighborhood on Saturday night)

15. Activity Models Representative of Transformed Programs • THERAPIES • INTERGENERATIONAL • MONTESSORI-BASED • THERAPEUTIC ENGAGEMENT PROGRAM (TEP)™ • MEMORY ENHANCEMENT PROGRAM (MEP)™ and THE CLUB™ • TECHNOLOGICALLY BASED INTERVENTIONS • SPONTANAEITY

16. Art and performance therapies are utilized in a wide array of settings to promote wellbeing, socialization, communication, and healing; ease stress, pain, and loss; improve cognitive and motor skills; and empower through transition concerns such as loss and new environments • Timeslips™ goals: Inspire people to share the gifts of their imagination; to inspire others to see beyond loss to recognize the strengths of people with dementia and to improve the quality of life for those with dementia and their caregivers • Sensory activities and Pet Therapy used to evoke lost memories and create a sense of well-being THERAPIES ART and PERFORMANCE Painting, drawing etc. Drama Dance WRITING Timeslips™ - Anne Bastings SENSORY Music Therapy Aroma Therapy Visual Therapy Tactile Therapy PET Pet therapy

17. Informal interactions with children that build relationships and provide opportunities for elders AND children to create “connections” • Formalize opportunities with the goal of shared ability levels to accomplish a common task • Ability for elders to nurture, play with, and observe children at play INTERGENERATIONAL Day Care Kindergarten Visitation

18. Montessori-Based Activities for Persons with Dementia, Volume 2 is a manual that contains all new Montessori-Based activities, including • Activities for individuals and groups, • Intergenerational activities, • Activities for men, • Subject-based activities, • Activities for restorative care practices. The manual provides step-by-step instructions and guidance for creating and conducting each activity Also provided are tips for extending activities, making them more or less difficult and addressing challenges that may occur MONTESSORI-BASED Based on principles developed by Maria Montessori and adapted by Cameron J. Camp, PhD.

19. Protocols for providing evidence-based group therapeutic engagement sessions as part of the consistent daily routine that provides meaning to all people involved and are based on their preferences and abilities • Daily offerings of social, sensory, spiritual/ethnic/patriotic, intellectual, and physical adds variety and consistency for all ability levels to insure their success • Staff empowerment through specialized training for those who would be conducting the TEP™ activities THERAPEUTIC ENGAGEMENT PROGRAM (TEP)™ Developed by GOOD NEWS CONSULTING, Inc. Part of the CULTURE of C.A.R.E. MODEL Dementia Care Model of Excellence (DCME)

20. Seven-days a week that provides a wide-range of meaningful activities that help bring pleasure to people with dementia or those who have other physical or mental impairments • Daily routine of continuous activities including physical, brain-stimulating, and socializing based on their preferences, interests and abilities • “According to research engaging in meaningful activities during their waking hours makes a positive impact on their lives” • Training provided for the techniques used in the model MEMORY ENHANCEMENT PROGRAM (MEP)™ and THE CLUB™ Developed by Joyce Simard Part of the Namaste Care Model for Dementia www.namastecare.com

21. Utilizes the skill level of each person • Can “simulate” sports and other activities of interest and preference • Interactive – brain games – to enhance skills • Relationship building with care partners, family and friends • Training is needed to use equipment • Usually held in the area where the equipment is located, with exceptions TECHNOLOGICALLY BASED Wii Skype iN2L iPad iPod

22. Decisions about what and when are made by those who live/work in the household • Coordinated by a housemate, homemaker (cross-trained) etc. who also helps with “chores” in the household • Creates a daily routine that becomes a “lifestyle” • Usually the “common” area is where the action is SPONTANEOUS Household Model Developed for small groups living together

23. Get to know about the person through assessment • Get to know the person through relationship building to determine how the elder wants to be involved in the life of the community or organization • Through planning with all of the elders, re-create a daily routine of activities that offers opportunities for success based on their abilities, interests and preferences • Trained professionals provide consistent daily opportunities for elders to engage in activities that are designed to enhance cognitive, physical, social, emotional and spiritual well-being • By monitoring the responses of the elders, a determination can be made as to the effectiveness of the approach with adaptations made accordingly COMMON THEMES THERAPIES INTERGENERATIONAL MONTESSORI-BASED THERAPEUTIC ENGAGEMENT PROGRAM (TEP)™ MEMORY ENHANCEMENT PROGRAM (MEP)™ and THE CLUB™ TECHNOLOGIC SPONTANEOUS

24. The Rothschild Person-Centered Care Planning Task Force • (October 2013) • First, the focus has been on doing what is “in the best interest of the person” • as defined by the healthcare professional staff, rather than as defined by the person. • Second, when is it appropriate NOT to honor a resident’s preferences? • Third, we recognize that the vast majority of the time, residents’ preferences are • not hazardous. However, they might not be in, what some staff members • would consider, the best interest of the resident. • The regulatory guidance refers to both education and offering the resident (presumably safer) alternatives. It also refers to not assuming a decision once made holds true forever, so that ongoing efforts at education and the offering of (safer) alternatives are expected. • Fourth, because each care community develops its own care plan format, • along with its own policies, procedures and forms, it is even more difficult for • surveyors to evaluate whether, in accommodating resident preferences for risk related • activities, the care community has fully met the requirements (which • are largely unspecified) for education and lower risk alternatives.

25. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation The Rothschild Person-Centered Care Planning process involves: I Identifying and clarifying the resident’s choice II Discussing the choice and options with the resident III Determining how to honor the choice (and which choices are not possible to honor) IV Communicating the choice through the care plan V Monitoring and making revisions to the plan VI Quality Assurance and Performance Improvement

26. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation Sample Situation #1 The Person With Terminal Illness • Life Review • Time with chosen relatives, care partners, friends, other individuals • Spiritual Support • Massage/Touch • Music (based on individual preference) • Reading to the person (based on their preference) • Silent time with the person (Note that individuals who choose to spend time alone introspectively are not “noncompliant” with treatment goals/objectives)

27. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation Sample Situation #2 The Person with A Diverse Cultural or Ethnic Background • Special events that include meals, decorations, celebrations, rituals, music • Visits from Spiritual leaders or other individuals from the same ethnic background • Printed materials about the person’s culture • Opportunities for the person to share information about their culture, background or ethnic diversity, with other participants, families, or care partners

28. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation Sample Situation #3 The Person With A Varied Sleep Pattern • Activity pursuit options/preferences must be made available for the person during their “times awake” • TR Care Partners will ensure that implements are available based on assessed individual preference • Nursing Care Partners could read a newspaper to the person • Dietary Care Partners could make finger foods available • CNA Care Partners could work crossword puzzles with the person • Night Nursing Supervisor could take him/her on rounds with them • Individuals could have “early morning” delivery of coffee or juice

29. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation Sample Situation #4 The Individual On A “Short Stay” Basis (aka “The Rehab Resident”) • “A La Carte” activity pursuit options are made available for use at the convenience of the person (eg videos, video games, magazines, electronic devices, etc.) • Accommodations are made for younger visitors • Interesting or Contemporary group activity options are made available geared specifically towards the person on a “short-stay” basis (eg. supper club, card club, community reintegration opportunities, etc.) • Individual activity pursuit options are designed to enhance therapy goals (eg. jigsaw puzzle for improving fine motor skills, walking group for improved ambulation, etc.) • Discharge planning includes aftercare recommendations and connectedness to community resources to maintain treatment gains

30. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation Sample Situation #5 DOH Investigation results from a PA facility (based on a complaint) The Problem The Findings The Fix

31. "Where There's A Way, There's A Will"Changing the Culture For Person Directed Care Planning and Engagement For Therapeutic Recreation THE ONLY THING THAT IS CONSTANT IS CHANGE “CULTURE CHANGE!!!” Brad Norris, Activities Consultant, Certified Certified Cognitive Stimulation Instructor Administrator-In-Training bjn040961@gmail.com