How Activity Professionals can save the world of LTC – Making Work Work

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Can a person who lives in a nursing home work? Yes. The CMS regulation used to be titled Work which was great really. Now Tag 566 doesn’t really have a title but if you take the beginning of the long regulatory sentence it reads… The right to perform or refuse to perform services. Here it is and please note how self-explanatory it is…

CMS Tag 566 The resident has a right to choose or refuse to perform services for the facility and the facility must not require a resident to perform services for the facility. The resident may perform services for the facility, if he or she chooses, when—

(i) The facility has documented the resident’s need or desire for work in the plan of care;

(ii) The plan specifies the nature of the services performed and whether the services are voluntary or paid;

(iii) Compensation for paid services is at or above prevailing rates; and

(iv) The resident agrees to the work arrangement described in the plan of care.

DEFINITIONS §483.10(f)(9) “Prevailing rate” is the wage paid to the majority of workers in the community surrounding the facility for the same type, quality, and quantity of work requiring comparable skills.

GUIDANCE §483.10(f)(9)
All work or services provided by a resident, whether voluntary or paid, must be part of his/her care plan. Any work assignment must be agreed to and negotiated by the resident or the resident’s representative. The resident also has the right to refuse to participate in these services or assignments at any time. A resident’s request to work or perform services should be discussed by the interdisciplinary team and be clinically and psychologically appropriate for the resident.

PROCEDURES §483.10(f)(9)
Through interviews with residents, resident representatives, and staff, determine if residents were given a choice as to whether or not they were willing to perform services.

During observations, note whether residents are engaged in performing these services (such as housekeeping, laundry, meal set up, etc.).

Review the resident’s care plan to ensure it includes; o The nature of the services to be provided, including the resident’s desire to do so, and the objectives for this arrangement; and, o Whether they are provided voluntarily or paid.

Examples of noncompliance may include, but are not limited to:

The resident or his or her representative did not agree to the work arrangements;
The resident’s care plan does not specify the nature of the services provided by the resident or whether or not they are voluntary or paid; or
Compensation for paid services is not at or above prevailing rates

Can a person who lives in a nursing home set tables? Yes. Clear tables? Yes. Vacuum? Yes. Prepare food? Yes. Whoa. Doesn’t there need to be good infection control? Yes. Of course there needs to be good infection control. If someone doesn’t have great infection prevention practice, say I pick my nose… just don’t invite me to set the table or work with food. But I could clear tables and lots of other things. Invite me to do things that are meaningful and infection control is less of an issue. Water plants? Tend to the garden?

I worked with Life Care Center of Casper WY in a one-year culture change project and they opened the pathway for many opportunities to work. Residents chose to do them voluntarily. Some set tables, some set up Bingo and then set the dining room tables afterwards. It is so powerful to see how precise they work to get the tablecloths just right. And what is striking, they have time to get the tablecloths just right. They feed the birds. They fill salt and pepper shakers. And yes they even moved into making it work for people who live there, in other words their home, to put sandwiches into baggies using tongs, and other simple jobs with built in infection control practice. Another who lives there leads exercise. One can sign up to work in the ice cream parlor. They have so many jobs that they even have a class explaining them all to any interested persons who live there.

This is real life, not activities. Not “little jobs” no, real jobs that either pay prevailing rates, as some people might actually need, or are agreed upon as a volunteer. And keep in mind, people who live there, in their home, are not helping us/helping staff, they are contributing to the life of their home. They are living real life. Go for it my colleagues, join me in becoming a guardian of real life. More real life; less fake, less contrived groups. Talk to those who live where you work, see what they think.

To learn more, see the WY Culture Change Nursing Home Video – Life Care of Casper on YouTube. See the sweet dietitian talk about the opportunities to actually prepare food. Link: https://www.youtube.com/watch?v=JOp5XbwYuwE.

Consider learning more by watching the other four other beautiful changing homes and their stories. And then please pass them on. Help change the world of living in LTC!

Carmen Bowman, MHS, of Edu-Catering: Catering Education for Compliance and Culture Change is an activities/engagement and culture change coach. New or not-yet-qualified activity director consultation, personalized continuing education, meaningful engagement/real life consulting for the whole team. As a regulator turned educator, Carmen also provides “be your own surveyor” training. Training videos available at https://www.patreon.com/educatering. Contact: carmen@edu-catering.com,
303-981-7228 www.edu-catering.com Also, www.facebook.com/edu-catering.