Focus on Interests, Preferences and Choices: All required by Tag F679 and all Good

Did you know, the focus is not activities?

CMS Tag F679 Activities
The facility must provide, based on the comprehensive assessment and care plan and the preferencesof each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community.

Preferences

Did you also know, CMS references preferences 232 times in the State Operations Manual? That’s a lot.

Even before CMS made this terrific change, we were preaching this idea in the culture change movement. I discovered what I called, care plan preferences, not problems.

Do you remember when everything in a dear person’s care plan was geared around a problem thereby creating a list of problems? Is that what any of us want to be known for?

When I began in this beautiful business of loving people, sadly, the most common care plan statement was framed as a problem: “Potential for social isolation.” Everyone, the same problem. So sad. It is called generic care when all are treated the same or assumed the same problem no matter if it was true for that person or not. In fact, this regulation and many others tell us we are to individualize. Guard against generic care. We are to provide individualized care.

At the same time, we are also moving away from the term care. It is overused.

Individualized life! Not generic life. No one wants generic life.

Then it changed. With the advent of the MDS, the institutional, generic problem became “Activity deficit.” Also, sad. What even is an activity deficit?

Notice in Tag F679 we are told to ensure a person’s preferences are known and care planned. That is good.

Even more, did you know CMS actually refers to the term preferences, 232 times in all the regulations? Whoa. That’s good too.

232 CMS references to preferences.

Preferences is a replacement term for refuses, as well. “She refused activities.” Refuse is strong and unfortunately infers that the person is wrong for not wanting to do something the institution says they should; a bath, the group activities scheduled, etc. Refusing is not bad and instead is a giveaway that the person has a preference that is not being met in some way. Put preferences first and you can’t go wrong.

Choices

Institutional life is notorious for lack of choice yet there are about nine regulations that focus on honoring individuals’ choices. Perhaps I will do an article showcasing them.

This requirement, F679, says we are to support the person in their choices. That is good. Look at these great words: preferences, support, and choices. Weave them into your work.

Back to the term refuses. I used to think the best replacement word was decline. The term decline does imply that the person had a choice. Although that is good, it is still focused on this one choice in the moment when in fact it is a bigger issue. What is the person’s preferences and then choices regarding what is going on here… regarding the interest in whatever they are being invited to i.e. do they have any interest in Bingo? Then preferences, if they do like Bingo, does the way it is played meet their preferences? Then their choice; no Bingo ever, or a different way to play it? Help it to go beyond a single invitation but into the person’s interests, preferences and choices in the matter. Maybe they have no interest in any groups. Maybe they have no interest in leaving their room. There is much more to one invitation that meets the eye, as you know.

Interests

Last but not least, the next amazing word right out of this federal requirement is interests.  I strongly suggest switching over to it as it changes everything. It fixes everything. It guides everything. See my past articles about putting the interests before the groups much like the horse before the cart. Flipped it would go like this. Don’t put the horse before the cart and don’t put the groups before the interests. This has opened up doors in my work. Bring the horse to the LTC home and see who lights upChances are you just started a group of horse lovers by discovering the interests of the individuals who live there. Then keep that up. Put interests first. I love to watch birds and scrapbook. Make those the focus. Maybe they turn into a group of other birders and scrapbookers, maybe not. But it doesn’t matter. What matters per the federal regulation, are my interests. Lean into and let this good requirement guide you. There is freedom in fixing your work on what this regulation requires and you meet the requirement as you do so.

I find it interesting and fabulous that we can lean on regulations to honestly guide what we do. These regulatory standards are good. Very good. Just from this one strong requirement known as Tag 679, we can glean the following:

Preferences over problems.

Prefers over refuses.

Chooses over declines.

Interests over groups.

Carmen Bowman, MHS, Regulator turned Educator of Edu-Catering: Catering Education for Compliance and Changing Institutional Culture is an activities/engagement, regulatory compliance and culture change consultant.  She offers new or not-yet-qualified activity director consultation and personalized continuing education for professionals/teams/associations. Also, a new blog and eResource GUARDIANS OF NORMAL LIFE: How Activity/ Recreation/ Engagement/Community Life Professionals can Save the World of LTC at  www.edu-catering.com.At the Edu-Catering YouTube channel see how turning rigid schedules into flexible ones creates all the outcomes everyone wants!