Historical Background
As far back as the early writings of ancient Egypt, we can trace the history of the treatment of the ill. It began with the idea that one human being could eliminate the suffering of another through the use of supernatural powers to ward off evil. Many of these cures were centered on music and dance. This may very well be the beginning of the Activity Professional as we know them today.
Some evidence of elementary hospital care has been attributed to early Greek and Roman civilizations. It was during this period, that the use of music and recreation was used by Soranus and Galen to relieve pain and relax the body.
A community hospital, built by Justinian at Caesars in 1369, was an institution for the sick, orphans and aged. This may be thought of as a precursor of long-term care.
Up through the Middle Ages, religion was the dominant influence for the establishment of health care institutions. As a result of pressures from advocates of the Reformation, a Royal Degree in England, ordered hospitals to be destroyed or turned over for public use.
During this time, interest increased around the establishment of public facilities to alleviate the hardship and suffering of the aged poor. In 1368, the earliest example of such an establishment became known as an almshouse. Ambroise Pare’s use of music and games to relieve the suffering of the ill may have become an influencing factor of the need for services, other than medical treatment.
With the establishment of almshouses, it became evident that the care of the sick and aged, provided first by the church, would slowly become the public’s responsibility.
The first English settlers in America brought with them the indigent and aged. This was a result of the English Poor Law of 1601, based on the principles of public responsibility for the sick, poor and aged.
In 1662, the Act of Settlement was approved by Parliament, permitting the authorities to remove nonresident paupers to the parish of last legal settlement. Together with the Poor Law of 1601, the responsibility for the indigent and elderly was shifted to the community and family.
During the latter half of the 18th century, many of the newly constructed hospitals evolved from a common ancestor, the almshouse. In spite of its contributions to later health care, the almshouse was primarily regarded as a home for the indigent aged, where medical care consisted as a type of infirmary care.
Studies and records relating to the historical ancestors of long-term care institutions are largely nonexistent. The almshouses, the hospitals, and the asylums, were facilities that by today’s definitions were something between a hospital and a home.
The nursing home industry became established around 1935 with the passage of the Social Security Act. This Act provided a system of social insurance for the aged and also set up a public assistance system in which the federal government shared the cost with the states. The Social Security Act helped the states provide maintenance for the needy, aged, blind, families with dependent children, and ultimately, the permanently and totally disabled.
In 1939, 1946 and 1948, legislative amendments increased federal cost-sharing. In 1950, with further amendments to the Social Security Act, Congress broadened the definition of assistance to include vendor payments and direct payments by the state to doctors, nurses and health care institutions, rather than to the welfare recipient.
The next Congressional action culminated in the enactment of Medicare and Medicaid in 1965. President Johnson declared in his State of the Union Message that assistance for the “elderly” was a priority item in his legislative program. A new Bill was introduced in the House on March 24, 1965, which established an insurance program for persons 65 and older: Title XVIII–Medicare.
In the 1960’s, it became apparent that a staff person was needed to provide meaningful activities to fill the residents’ days. Since the federal regulations did not specify the educational requirements, some facilities employed nurse aides, housekeepers or persons from the community who demonstrated leadership abilities through scouting, a Parent Teacher Association and/or church work. It was during these early years that the Activity Professional became known as the bingo, Bible study and birthday ladies.
As the profession grew, so did the realization regarding the need for continuing education programs, conferences, workshops and seminars. The Activity Professional discovered quickly, there was more to activities than the three B’s.
In the early years of growth, the Health Care Industry was supportive and included Activity Coordinators in annual conventions, seminars and educational sessions. It was during these conventions and educational sessions that activity programs began to emerge as a meaningful part of the residents’ lives. Activities became one of the disciplines in the facility.
The Activity Coordinator’s 36-Hour Education Course evolved in the early part of the 1970’s, and was the qualifier for Activity Professionals for many years. In some states, the courses were conducted with grant monies received from the federal government
As the profession grew, the need for identification as professionals grew. The American Health Care Association (AHCA) recognized this need. During the AHCA conference in 1976, the first Council of Activity Coordinators (CAC) was established. The Council addressed the commonly asked question: What is an Activity Coordinator? They responded with an article that defined “Who We Are and What We Are.”
In 1977, a registration process was implemented and Activity Professionals were registered with the American Health Care Association Council of Activity Coordinators as a qualified Activity Coordinator and/or Activity Consultant. This registration was accepted through the early 1980s and then discontinued.
The activity leaders continued their quest for professionalism. In 1981, local and state associations sent representatives to Chicago to explore the possibility of forming an association to represent the needs of all Activity Professionals employed in the delivery of activity services in long term care institutions. The National Association of Activity Professionals (NAAP) was formed.
By 1982, NAAP began its first political action campaign against threatened federal de-regulation of activities in long term care. That same month, the national membership was established and the first Board of Trustees officially began their duties. The Board of Trustees held its first meeting on July 9, 1982 in Des Plains, Illinois. The first annual convention was held April 29 and 30, 1983 in Cincinnati, Ohio. In March, bylaws and policies and procedures were ratified by a charter membership of 254 individuals. The first meeting of the NAAP Board of Trustees was held July 1982.
After that first convention in 1983, the Activity Profession was off and running. NAAP began to grow and develop relationships with other organizations. The State Contact program began and in September 1983, the first professional association – the National Association of Activity Professionals (NAAP) – was chartered as a nonprofit corporation in Illinois.
To honor Activity Professionals across the country, the very first National Activity Professionals Day was celebrated on January 27, 1984. Each year, the fourth Friday in January was designated as the day to celebrate and recognize Activity Professionals. Now it is celebrated for an entire week.
In October 1986, the NAAP Board of Trustees held its first mid-year Board meeting. At this meeting, seeing the need for a certification body, the National Certification Council for Activity Professionals (NCCAP) was incorporated, with three levels of certification:
- AAC, Activity Assistant Certified;
- ADC, Activity director Certified; and
- ACC, Activity Consultant Certified.
A criterion for certification was outlined to include academic education, activity experience and continuing education. From October 1986 through December 31, 1989 a grandfathering track was available to all Activity Professionals. In April 1988 grandfathering was extended to December 31, 1990. Since January 1, 1991, some education has been required for all levels and tracks of certification.
In 1988, thanks in part to the legislative efforts of NAAP, Congress passed legislation requiring all nursing homes that receive federal funds to have an ongoing activity program, directed by a qualified professional.
In February 1989, the Health Care Financing Administration (HCFA), now known as the Centers for Medicare and Medicaid Services (CMS), issued new federal regulations for long term care facilities. NAAP began lobbying to improve the regulations and the interpretive guidelines for implementing them. As a result, NAAP was acknowledged by HCFA as a recognized accrediting body for Activity Professionals. In November and December 1989, NAAP was invited by HCFA, to participate in its national surveyor training.
In November 1990, both NAAP and NCCAP approved a Modular Education Program for Activity Professionals. In April 1992, the instructor manual for NAAP’s/NCCAP’s Basic Education course was taught in a 6-hour workshop referred to as “Train-the-Trainer.”
During 1996, NAAP was invited to participate in HCFA’s Quality of Life Symposium. Surveyors, educators, research analysts and provider representatives gathered to discuss the survey process and surveyor assessment of a resident’s quality of life in long term care facilities. This conference was “by invitation only” for the first day and included several hundred participants. The second day was a much more exclusive session, with approximately 30 participants. Once again, NAAP was included in this session.
NAAP was one of thirteen invited guests to participate in the Surveyor Training for the new interpretive guidelines and enforcement regulations. NAAP continues to play an important part in regulations affecting Activity Professionals.
The Activity Profession
Quality of life is something that we all seek at every age and stage of life. Residents in long term care facilities come with their personal history, talents, potential needs and dreams. The Activity Professional is the one who treasures each resident’s history, respects their needs, and enables their potential and dreams to be recognized. Thus the Activity Professional is the key to providing quality of life experiences for long term care residents. The interests, strengths and needs of the residents are constantly changing. Therefore, activity programming cannot remain static; it must be dynamic and ever changing. A dynamic activity program, which promote quality of life for long term care residents, demand quality activity education courses.
The Activity Education Program
The National Association of Activity Professionals (NAAP) and the National Certification Council for Activity Professionals (NCCAP) collaborated and produced two activity education programs. The programs include a beginning level Basic Education Course (BEC), and a second level Advanced Management Course (AMC). These courses were designed to prepare participants to function ethically and effectively in the prevailing health care climate. The courses introduce the participants to the profession’s educational and professional standards.
In 1981, practitioners (under the auspices of the NAAP Education Committee) worked steadily to study the education course curricula for Iowa, Michigan, Oregon, Indiana, New Mexico and South Carolina, and contributed to a preliminary outline for the training of Activity Professionals in these states.
In 1987, a case between a resident in a Colorado nursing facility, Smith vs. Heckler, brought about the OBRA regulations.
In 1988, development of the original ideas and outline were refined and adapted. The resulting document provided the essential knowledge needed for practice. The Modular Education Program for Activity Professionals proceeded directly from the work under the direction of NCCAP.
In 1989, writers of the MEPAP Teachers’ Manuals were a cross-section of practicing certified Activity Professionals, administrators and experienced educators from all parts of the United States. The entire project took three years to complete. Each section of the MEPAP curriculum was piloted before the manuals were released.
Many educators have taught the MEPAP curriculum since 1992. They have joined the pioneers of the education movement with enthusiasm and commitment. The results they have achieved through their efforts are impressive, as shown by the increasing number of applications for certification. MEPAP instructors, so vital to raising the educational level of practitioners, have ensured that better activity care and services are being provided across the country.
In 1999, NCCAP developed, and continues to implement, a comprehensive plan to revise, update and clarify the system of Activity Professional education. The re-engineering committee included educators who have taught the MEPAP curriculum since its inception. The most important action taken was the NCCAP Board’s officially adopting Standards for Professional Preparation in Activity Services. The MEPAP 2nd edition is constructed in accordance with these standards.
In November 2010, at the request of its members, NAAP created another credentialing body. NAAP’s goal is to continue to provide Activity Professionals with another option for obtaining board certification. Members of NAAP requested another certification option, as other certifications were not meeting their needs. A stakeholder committee was appointed and the research and development of the National Association of Activity Professionals Credentialing Center (NAAPCC) was established. An NAAPCC Board was established and criteria were written.
In June of 2017, NAAP of NCCAP began discussion pertaining to the betterment of the activity profession. This discussion continued for another year in working and developing a partnership of one membership and one education. At the annual conference in 2018, the NAAP, NCCAP and NAAPCC held a joint meeting driven by new regulatory requirements and the need to meet increasing demands in the long-term care sector. After that meeting, the NAAP Board of Directors presented to the membership that the National Association of Activity Professionals (NAAP) made the decision to support the National Certification Council for Activity Professionals (NCCAP) as the certification body for the professioneffective January 1, 2019. The move to a single credentialing body is designed to ensure the quality of certification and enhance the value of the Activity Profession.
In 1986, NAAP created NCCAP as the credentialing body of the Activity Profession to fulfill the requirements of the Federal Omnibus Budget Reconciliation Act (OBRA) for the delivery of activities in long-term care. Accordingly, NCCAP is the only certification endorsed by NAAP for Activity Professional Certification.
It is the position of NAAP that Board Certification claims primarily apply to clinical healthcare professions. Nursing and Medical Schools are two examples where Board Certification is utilized after mandatory institutional academic education is completed that ensures the required competencies of the respective healthcare professional.
By comparison, there is no mandatory institutional academic education required for the Activity Profession. Accordingly, NAAP maintains that the Modular Education Program for Activity Professionals (MEPAP) provides the highest level of education and practice necessary to ensure the required competencies of a certified Activity Professional.
