Tag F741 Non-pharmacological Approaches – Exercise and Increased Individualized Movement

CMS Tag 741 includes a long list of examples of individualized, non-pharmacological approaches to help meet behavioral health needs. We will be reviewing all of them. We now highlight:

• Ensuring adequate hydration and nutrition (e.g., enhancing taste and presentation of food, addressing food preferences to improve appetite and reduce the need for medications intended to stimulate appetite); exercise; and pain relief;

Wouldn’t you love to ensure adequate exercise for the people who live where you work? I would.

Sadly, institutional culture is more known for promoting immobility than mobility. We can change that too. Let’s be pro-mobility.  Notice institutional culture is also more known for being reactive than proactive. But we can change that. Let’s be proactive.
Institutional culture promotes a “prevent falls via immobility” unfortunately. Watch when a person stands up. What do many well-meaning team members say to the person? “Sit down.” That tends to show the common focus of immobility.

What pro-mobility teams say instead is “Do you need to walk, stretch, just stand for a minute? I would too. We all need to move more.” Teams make a switch and regard the standing as a cue that this person needs to move, and they are charged with helping to make it happen.

I have developed a 12-part teaching series called Proactive Practices to Prevent Falls and one of the 12 parts is what I call increased individualized movement. We all know if we don’t move it, we’ll lose it. Are ability to move is linked to whether one ages successfully or not and makes complete sense. So, I ask teams to answer honestly as a quality assurance question, are therapies doing their work as best as they possibly can be? Similarly, I ask if restorative nursing is taking place as best as it possibly can. And then we move into what I see as a gap that we can close namely defining and providing movement for each individual outside of therapy and restorative services. This is a gap we can all help to close. This is where we all can help people move more.

Then I have such fun asking, “What if you had a new job and your new title was the Increased Movement Coordinator? Ponder how you would describe this job and all the ideas you might have to help people to move more.

I recommend thinking about this topic in three ways.

• Identify how each person can and wants to move, and what assistance is needed and who can provide it. For instance, if Mr. Smith needs passive range of motion, who can give it? If a person can walk, can anyone walk with them or must it be a CNA/nurse/therapist? Then identify who will, how often and care plan it.
• Invite, or even better give an expectation to each team member to commit to helping people move more. For instance, the above example of helping Mr. Smith with the passive range of motion. I could commit to dancing with Mrs. Smith who loves to dance as I do and I make a commitment to do this say weekly or more and we care plan it.
• Commit to increasing the opportunities for increased movement.

Chautaugua Rehab in Florida decided to offer some sort of physical activity every afternoon for all but strategically for those who were experiencing falls. The administrator as a sports fan really got into it. He helped people to walk to “the game” every afternoon as did the restorative team and called it the pre-game workout. They offered lots of physical games such as Hungry Hippo, noodle basketball, balloon with fly swatters, bowling. One of their observations was, “The games knock them out!” Also good for sleeping and being well rested helps to prevent people from falling.

The Courtyard in Florida offered more sports games as well such as corn hole, soccer, volleyball, and practicing sports for Senior Olympics with sister SignatureHealth homes. They also held the Courtyard Boogie where music was played every day at the same time for all team members to dance with those who live there. Also the restorative and quality of life team committed to encouraging movement in each encounter.  A team could take their idea further inspiring and expecting this of all team members.

What else could you do to help increase movement for individuals? Does just having “exercise” motivate people? How about yoga, chair yoga, strength training, Jazzercise, Zumba, fitness class, dancing, tossing the football, weight lifting, etc. How about the guys, what do they want? Speaking of Jazzercise, jazz it up. Have fun while also making it meaningful. Talk to everyone. Try new things. Experiment with everything to explore what appeals to people.

Also consider creative ways to move more. Pantomime. Sign language. Fist bumps. High fives. Blowing kisses. Purposefully holding something further away for someone to have to reach. Suggest families also take part in helping to increase movement.

And, you don’t have to call it a program. Program is the mark of an institution. You and I don’t have so many programs in our daily lives. You are simply helping people move more.  It is desperately needed. You will help to increase strength, prevent falls, prevent injury from falls, prevent the use of psychotropics and help be more compliant with this list of good examples listed in CMS Tag F741 for behavioral health.

Carmen Bowman, MHS, Regulator turned Educator of Edu-Catering: Catering Education for Compliance and Changing Institutional Culture is an activities/engagement/community life, regulatory compliance and culture change consultant.  She is a co-developer of the Artifacts of Culture Change original/2.0 Nursing Home and first-ever Assisted Living version. She offers new or not-yet-qualified activity director consultation and personalized continuing education for professionals/teams/associations. At www.edu-catering.com join The Be Encouraged Blog, Become a Leader of Normal Life with the eResource GUARDIANS OF NORMAL LIFE: How Activity/ Recreation/ Engagement/Community Life Professionals can Save the World of LTC and share with your team the eBook Individualizing Medication Administration using Regulations. At the Edu-Catering YouTube channel, see the documentary that highlights changing institutional culture.