Programming Interruptions- CMS Regs 📋

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Programming Interruptions- CMS Regs

How to establish boundaries with co-workers who take residents in the middle of an activity?

Facilities are required to promote and support meaningful residential programs. This applies to Administrators down through all facility team members.

When individualized staff duties lack well defined job expectations and/or shared job duties merge the lines of accountability, it is imperative that the entire staff understands regulatory guidelines and what actions need to be implemented to ensure facility compliance with established standards. This creates a unified objective and instills collaborative team efforts regardless of job title or job duties.

Best Professional Practices

In the event that programming interruptions involve a staff member that you do not directly manage it is always best professional practice to help bring about regulation awareness which will make the dispute a whole lot less about personal boundaries or job duties disputes and more about meeting facility regulatory standards and compliance.

Be mindful that programming interruptions may be unavoidable under specific circumstances. During these moments, you will need to ensure that the planned program continue to focus on the resident’s experience and coordinate the resident’s departure as quietly and smoothly as possible.

Critical Element Pathways for Activities

Surveyors will observe and interview staff members to find concrete evidence that demonstrate facility wide support and compliance. When co-workers intentionally disregard or perhaps fail to understand required actions to support meaningful programs it may likely and inadvertently put the facility at risk to be cited for state survey deficiency.

Let’s take a look at CMS “Critical Elements Pathways for Activities” to understand what surveyors will ask during staff interviews to evaluate (IDT) Interdisciplinary Team collaborative support and facility wide efforts when it comes to programming interruptions and distractions.

NOTE: If the state survey is taking place in your facility and the surveyor noticed that you “allowed” or did nothing to prevent program interruptions; the facility could be at risk for a deficiency.

The sample questions below have been taken from the “Critical Element Pathways for Activities” guidance. Surveyors will use these questions to make the determination that staff is adequately supporting facility programming.

Pay particular attention to the underlined questions:

Activity Staff Interviews:

What is the resident’s program of activities and what are the goals?
What assistance do you provide in the activities that are part of the resident’s care plan?
How regularly does the resident participate?

Nurse Interviews:

How do you assist the resident in participating in activities of choice?
How do you coordinate schedules for ADLs, medications, and therapies, to the extent possible, to maximize the resident’s ability to participate?
How do you make nursing staff available to assist with activities in and out of the facility?
How has the facility made efforts to provide scheduled care, such as bathing and therapy services, so they don’t conflict with the activities you want to do?
How do you make sure the resident is informed and transported to group activities of choice?
How are special dietary needs and restrictions handled during activities involving food?
How do you make sure the resident has sufficient supplies, proper lighting, and sufficient space for individual activities?
If the resident is refusing to participate in activities, how do you try to identify and address the reasons?
What role, if any, does nursing play when activity staff are not available to provide care-planned activities?

Social Service Interviews:

How do you facilitate resident participation in activities of choice?
What role do you play in obtaining equipment or supplies needed by the resident in order to participate in activities of choice (obtaining audio books; assisting the resident to obtain new glasses or hearing aids, if needed; providing needed assistance to the resident for the purchase of music, crafts, and other supplies)?

It Takes a Village

In nursing homes where culture change philosophy has been adopted, all staff may be trained as nurse aides or “universal workers,” (workers with a primary role, but multiple duties outside of the primary role) and may be responsible to provide activities, which may resemble those of a private home. The provision of activities should not be confined to a department, but rather may involve all staff interacting with residents. Source: CMS Investigative Protocols - F679 Activities Meet Interest/ Needs of Each Resident

Clearly, the expectation for ALL interdisciplinary efforts is to support a successful resident program experience. Make it your goal to copy the CMS “Critical Element Pathways for Activities” to your facility Administrator who will set management expectations for the entire staff to prevent coworker interruptions and distractions during facility programming.

https://cmscompliancegroup.com/2021/04/07/current-ltcsp-forms-materials-02052021-are-you-using-the-right-version/

Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org

Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network.

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