Survival Guide for The New Long Term Care Activities/Recreation Director: 10 Things You Should Know

You’ve just been hired as an Activities/Recreation Director for a long term care skilled nursing facility – Congratulations! Let me be the first to tell you how exciting that is! I might be biased but geriatrics are the BEST population for human services. As someone who has worked in long term care, and is currently a recreation director, I’ve seen and dealt with quite a few things and tackled some problems that I think are important to know and take into consideration while working in Long Term Care. From self-care to proper documentation, these are the ten things I think every Activity Director should know.

Disclaimer –documentation tips are directed towards those working as Directors in the United States LTC that are following Activities Department federal guidelines & regulations. If you are a Recreation Therapist (CTRS) working in LTC in a separate department (with PT/OT/Speech) or as a director outside of the U.S some of these might not pertain to you but some certainly will!!

KNOW YOUR WORTH
I cannot stress this enough. And that is why this is the first thing you should know from this post. Activities Directors bring the heart, the fun and the special into every single thing that goes on in a facility. With that “fun” comes a lot of paperwork, a lot of stress, and a lot of “Oh YoUuU GeT To PlAYyY AllLl DaAYyY must be nice!!!” – while yes, many times we DO get to “play” aka enhance our resident’s lives with recreational programming we also do A LOT behind the scenes that go unnoticed. So please, know and remember your worth to your facility. Keep track of all the good things (events, marketing, budget, happy clients and PRESENT THAT to your employer when yearly reviews role around!) You might be new, but it’s never too early to track those accomplishments baby!

YOU CANNOT FIX EVERYTHING
Screaming loud into the void for all the administrators, and whoever else in the back! Activities Departments get dumped with a lot of unwanted stress and anxiety because we are asked to basically pull rabbits out of our hats on the daily. Many times other departments will suggest that Activities should be done to curb behaviors, or that we aren’t doing enough to aid in some bigger issue. Trust me, this tends to happen often. Know that you cannot fix every problem, you cannot attend to every resident 24/7 and that you are doing the best you possibly can with what you have. You aren’t alone.

PERSON CENTERED PROGRAMMING IS KEY
No one is the same. We kind of already know that, right? But sometimes when we think “geriatrics” we clump all older adults into one category – the 1950s! They must LOVE Dean Martin, I bet their favorite show is Leave It to Beaver! The list goes on. But, as a director and programmer for your facility, you need (!!!) to create person-centered programming a top priority. Yes, group programs won’t be tailored to everyone’s interests. Your calendar on each and every specific day won’t be everyone’s cup of tea. (And you’ll hear about it from your more vocal residents…trust me) But, what you are aiming for is to sprinkle those ideas, and interests of ALL your resident’s into your programming as much as possible. You should also be following the OBRA guidelines for Long Term Care that state you need to include stimulation, solace, physical health, cognitive health, emotional health, self-respect, male-oriented activities, take segmentation, seasonal/special events, indoor/outdoor programming, community trips, cultural programs, religious/spiritual, adaptations and special needs, activities for all ages and lastly in-room activities. PHEW. So when you’re looking at what to add to your monthly calendars make sure you’re thinking about how they align with the OBRA guidelines! All while making sure you’re tailoring programs to your resident’s interests, and recreational histories. Are you having fun yet? This also applies to everything you chart. Did anyone tell you about the glorious world of charting and documentation!?

DOCUMENTATION IS NEVER ENDING
You’ll saw “phew” I finally got through ALL my progress notes that were due…you’ll go to lunch and BAM – it’s like a cruel little trick. The documentation in long term care is necessary for federal, and state guidelines. Especially, to ensure you are keeping up with Medicaid reimbursement standards. As an activities/recreation director, you’ll be responsible for an array of documentation. These are the pieces you’ll need to keep in mind (Please note these are for directors that are following F-tag guidelines for Activities/Recreation Departments NOT Recreation Therapists who work within the rehab departments – you have different paperwork!)
 – Initial Assessment
– Resident Assessment (RAI)
– Care Plan
– Attendance documentation
– Quarterly Progress Notes
– Change in condition progress notes
PHEW – I thought we got to play all day!? rolls eyes* You might not be the only person allowed to do these assessments, in a wonderful world you’ll have a team of recreation professionals who each have their own caseload of clients. That way, it’s easier to keep track of your own people!! But certainly keep track of what notes you’ve done, and when. In a later blog post, I will delve into the details and intricacies of LTC documentation, the does and don’ts and everything In-between.

COLLABORATION IS NECESSARY
Remember that you are not an island. There are many departments within LTC that aim to make the lives of those living in your community better. Utilize them. And NOT just for care plan meetings!! The more you reach out and collaborate, the more interpersonal your work will become. Work with the rehab department to create more person-centered programming for their residents. Work in social work to ensure you are creating psychosocial well being. And ALWAYS get in good with your nurses. They will be a huge ally when it comes time to needed CNAs to transport and aid in programming. And of course your CNAs – you need them. Show them they are appreciated and you are thankful for their time and effort in aiding you with recreational programming. Without them, many of the programs go to the wayside. It gets REALLY stressful when you feel like it’s you against everyone else! So collaborate, give thanks, and keep other departments in the loop of what you’re up to! Create programs where other departments are involved. The ideas are endless!

TAKE TIME TO BUILD A VOLUNTEER BASE
Many directors let volunteer programming fall the wayside, seeing it as extra work and instead put in the most effort to create strong programming. While that is good – I think it is just as important to ensure you have a strong community base of supporters. Volunteers can aid in an array of things from small group programs, 1:1 visits, party set up, etc. Having extra hands is NEVER a bad thing. Being able to utilize volunteers enhances your programming abilities and showcases the amazing things you’re doing throughout your community!! For more information on volunteer programming check out my blog on the subject HERE.

NOT EVERY PROGRAM WILL GO WELL
This is something many directors hate to come to terms with. We work REALLY hard on our programming, on our calendars, on picking out materials, etc. And sometimes no matter how much we plan and create and do….a program just goes over like a lead balloon. Maybe only 5 people show up. Maybe your residents complain the whole time. Maybe something just goes wrong. Guess what, IT’LL HAPPEN. Not everything is going to go perfectly all the time. And not everyone is going to LOVE every program you implement. What matters is that you tried and now you can tailor your next calendar a little differently. & use that information accordingly. Maybe you put a movie day on at 10:00 am and didn’t realize most people are in rehab on your unit – so you move it to 10:30 and BAM – the room is packed the following month! Don’t get discouraged and keep tinkering with your calendar so it’s the most beneficial to your residents.

STATE INSPECTIONS ARE ALWAYS STRESSFUL
There’s no way around this one. State inspection time is ALWAYS stressful. I honestly wonder if state inspectors enjoy their jobs – not that I would ever ask while they’re visiting…YIKES. As far as your job is concerned you just need to remember the following – you will be FINE. If you are keeping up to date with your paperwork throughout the year, following your calendar programming times and scheduled activities, and have person-centered care plans in place, then you’re good to go. Do your job, be out on the floor. Do NOT hide in your office, even if there is paperwork or things you could be doing. During inspection it is always best to seen and heard with your residents, engaging and showcasing your amazing programming!

LEARN TO SAY NO
As recreation professionals were known as the “fun ones”. Our jobs are just filled with fun, fun, fun. We couldn’t possibly EVER be stressed. Because well…aren’t we just always having FUN!? (I say with a manic smile and a twitching eye) Many people will ask you to do certain programs, join various meetings, be on an array of QAPI’s and are ALWAYS the “go-to” for a resident that is “causing a disruption”. It takes some time, but eventually, you need to say NO. Not everything should or can fall onto the recreation director’s lap, and we cannot solve everything. You need to learn to let things go, to feel comfortable saying “I cannot do that at this time”. You’ll feel A LOT better focusing on a few projects to tackle head-on, than dipping your toe into 50 different problems at once because you overextended yourself.

IT IS OKAY AND NORMAL TO GRIEVE
You work in geriatrics. You are human. You work in human services. You will become close to the residents you work with. You’ll most likely see these residents every single day, for months or even years. When a resident passes away, many try to push that grief down – this is our job, this is what we signed up for. There is no time to be sad. FALSE. You are allowed to grieve. You are ALLOWED TO BE SAD. YOU ARE ALLOWED TO CRY. Empathy and human understanding, is WHY we are in human services in the first place, isn’t it?? Death is simply a part of life, but that doesn’t mean we aren’t allowed to feel that grief. It doesn’t get easier, but allowing yourself grace in those moments, and remembering your residents and sharing that grief and sadness with your other residents and coworkers is crucial. Again – you are not an island. Doing small things like holding ceremonies for those who pass, going to their memorial services if you can, telling stories about them with other residents is a good way to ease that grief and heal.

BONUS: YOU ARE DOING GREAT!
Did anyone tell you this already? No? Well, here I am telling you – you are doing GREAT! Take a breath. Then take another one. Have you drunk enough water? Did you eat lunch? You are doing all you can to provide for your residents. And they are thankful. Trust me. They are. You are doing AMAZING. And guess what? You have an entire network of support right here at What The Rec to help you if you need it. Remember you are not alone. You are KILLIN IT!!!

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