Looking at CMS Tag 679’s Community Focus

F679 §483.24(c) Activities.

• 483.24(c)(1) The facility must provide, based on the comprehensive assessment and care plan and the preferences of 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.

It is good to take note that this portion of this requirement encouraging both independence and interaction in the community was added in 2016. Additional language from the CMS Guidance, an insider story and very encouraging true stories explores this further.

CMS Tag F679 Activities. GUIDANCE §483.24(c)

Maintaining contact and interaction with the community is an important aspect of a person’s well-being and facilitates feelings of connectedness and self- esteem. Involvement in community includes interactions such as assisting the resident to maintain his/her ability to independently shop, attend the community theater, local concerts, library, and participate in community groups. (Italicized by CMS to indicate they are new as of Nov. 2016.)

Maintaining Contact and Interaction with the Community

Notice, this is strongly worded: “The facility must provide… an ongoing program of activities … encouraging both independence and interaction in the community.” A certified Medicare and Medicaid nursing home mustprovide this per this CMS federal requirement. Does yours? State regs and assisted living regs may be just as strong on this provision.

Independently Shop, Theater, Concerts, Library, Community Groups

Hopefully these are “old hat” for you. If not, start by exploring the local options with those who live there using this great from the federal regulations:

• Independently shop
• Theater
• Concerts
• Library
• Community groups

See where discussions take you with those who live there and their families about these topics and options since they come straight out of requirements. Collect more and more ideas from everyone for everyone has differing knowledge of what your community has to offer. Collect even more personal history including places of interest for those who live in the home you represent.

Outings draw People to Live there

Speaking of concerts, on a call with Karen Tritz of CMS Central Office once, she shared a very interesting story that is very fitting here and perhaps why this was added to the regulation in 2016…. At the national Consumer Voice ombudsmen conference she attended and spoke at, there was a panel of several groups of people who lived at different nursing homes who were asked questions about where they lived. One group spoke highly of the home they lived in, highlighting the concerts they went to frequently. Another resident group started to ask them where they lived! “Concerts weren’t even in the scope of possibilities for the others” she noted, she being the Deputy Director of the CMS Division of Nursing homes at the time. I hope it is in the scope of experiences those you serve are offered. If not, make it a priority, see what you can do on their behalf. Plus, it’s in the regs!

TWO OUTINGS A DAY!

I was blessed to get to work with a home that offered two outing options a day! Wow. I’ll tell you what, I’d much rather live in a home that had outings twice a day than twice a month, how about you? To be honest, wonderful practices such as this put my heart at ease thinking that I could actually live in a LTC home that offered such a tremendous opportunity for everyone who lives there. Culture-changing teams proactively make it work for CNAs to go on outings to assist and this home’s administrator was so dedicated to this idea she hired a full-time bus driver just for the daily outings! Talk about commitment to interaction in the community.

Lean on the regs to make this your time to do things differently.

Transportation Needs – Take advantage of these Good Requirements

Lean into this regulation, talk about, print copies, bring up to improve upon your transportation offerings perhaps. Whenever something is in the regulations, it is an opportunity, and really obligation, to make a case for whatever it is that is needed to meet the requirement. A van or bus? A new van or bus? Another van or bus? While you wait, get super savvy with booking Access-A-Ride type options as a good faith effort to meet this requirement.

Get Good Use of the Bus or Van

Karen Laughlin is the retired Activity Lead at the household-model nursing home Perham Living in Perham, Minnesota. This was formerly Perham Memorial Home – notice the intentional positive language change. Karen explains that after having transformed into households and opening use of the bus to all households and those working in them translated into “we get good use of the bus now.” She admits that when it was only the institutional practice of the institutional “activity department” driving the bus, the bus sat around a lot unused. Once it became shared, the bus is on the go more than sitting idle.

Ask for Volunteers to Learn how to drive the Bus/Van

I encourage all teams, regardless of whether your home is in the household model or traditional model, to learn from Perham Living’s experience. Some culture-changing teams have opened up the possibility for any team member to get trained to drive the bus, thereby increasing the number of people available to take those who live there all sorts of places. Get creative with your team at large because we can’t do it the old way anymore. Talk with your administrative team and leadership team. Make a case for opening this up to better serve those who live there. With their support then make the ask.

I’ve done this in communities. Ask at an all-team member gathering, “Who would be willing to learn how to drive the bus in order to offer more to those who live here? And watch the hands go up. I’ve seen it. It is exciting and meaningful and wonderful.

Real Community Involvement – A Heart to Serve

Rockport Healthcare Services is a not-for profit company of 70 homes predominantly in California. On a Conversations in Culture Change with Carmen web talk show, I interviewed the team and Peggy who lived at one of the homes at the time.

Matthew Lysobey, Chief Community Integration Officer, asked himself years ago, “If we’re doing the right things, why aren’t residents happy and fulfilled?” The problem identified was that those who live in the homes are “just care receivers.”  He brought this up to those who lived there and Alma said, “Let’s feed the homeless.” In his mind, Michael brushed it off, but Alma reiterated she was serious, and the idea blossomed into what is now known as A Heart to Serve, a resident-run community project in each of the 70 Rockport homes providing approximately 6000 meals a month to hungry people in their towns and cities.

A co-founder, Peggy Fraricks, says “It makes me feel productive again” and gives her “something to look forward to —that’s important!” Have you ever realized institutionalized elders often have little, sometimes nothing, to look forward to? Nothing to put on a personal calendar. Community service projects can help to change that.

Peggy points out that it requires seeing the potential in every person. One arm?  Grate cheese. Plastic chef knives support a person with cognitive challenges or tremors to contribute. Look up the A Heart to Serve videos on YouTube.

Rockport K9 Project

The first Senior K9 Adoption began at the Rehabilitation Center of Bakersfield where some who lived there created a committee to take this on. It was not run by anyone who worked there. They fostered Bootsy, a 10-year-old terrier.  Bootsy was cared for by many who lived there including the Adoption Coordinator Valerie Miller who managed the hotline to place Bootsy in a family. Interested parties were interviewed and keenly observed interacting with Bootsy before the committee made a decision on which family got take him to his forever home. Look up the K-9 Adoption Project videos on YouTube.

Talk about interaction with the community. Wow. Hopefully you see how to lean into good regulations, use them, bring them to life. Those who live there will be glad you did and it leads to not only meeting – but likely going beyond – federal requirements which are considered only minimal. Focusing on interaction with the community and see what it does for individuals’ quality of life.

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 started a new eResource series called Using Regulations to Reject & Replace Institution with Home & Normal life, a new blog and first 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!