OBRA 1987 Regulations

F 248 Activity Program

(f) Activities
(1) The facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psychosocial well-being of each resident.

(2) The activities program must be directed by a qualified professional who:
(i) Is a qualified therapeutic recreation specialist or an activities professional who:
(A) Is licensed or registered, if applicable, by the State in which practicing; and
(B) Is eligible for certification as a therapeutic recreation specialist or as an activities professional by a recognized accrediting body on or after October 1, 1990;
(ii) Has 2 years of experience in a social or recreational program within the last 5 years, 1 of which was full-time in a patient activities program in a health care setting; or
(iii) Is a qualified occupational therapist or occupational therapy assistant; or
(iv) Has completed a training course approved by the State.

Guidelines ' 483.15(f)(1)
Because the activities program should occur within the context of each resident's comprehensive assessment and care plan, it should be multi-faceted and reflect each individual resident's needs. Therefore, the activities program should provide stimulation or solace; promote physical, cognitive, and/or emotional health; enhance, to resident's self-respect by providing, for example, activities that support self-expression and choice. Activities can occur at anytime and are not limited to formal activities being provided by activity staff. Others involved may be any facility staff, volunteers and visitors.

Probes: ' 483.15(f)(1)
Observe individual, group, and bedside activities.
1. Are residents who are confined or choose to remain in their rooms provided with in room activities in keeping with life-long interests (e.g., music, reading, visits with individuals who share their interests or reasonable attempts to connect the resident with such individuals) and in-room
projects they can work on independently? Do any facility staff members assist the resident with activities he or she can pursue independently.
2. If residents sit for long periods of time with no apparently meaningful activities, is the cause:
a) resident choice;
b) failure of any staff or volunteers either to inform residents when activities are occurring or to
encourage resident involvement in activities;
c) lack of assistance with ambulation;
d) lack of sufficient supplies and/or staff to facilitate attendance and participation in the activity
programs.
e) program design that fails to reflect the interests or ability levels of residents, such as activities that are too complex?
For residents selected for a comprehensive review, or a focused review, as appropriate, determine to what extent the activities reflect the individual resident's assessment. (See
especially MDS III.1 and Sections B, C, D, and I; MDS
version 2.0 sections AC, B, C, D and N.)
Review the activity calendar for the month prior to the survey to determine if the formal activity program:
$ reflects the schedules, choices and rights of the residents;
$ offers activities at hours convenient to the residents (e.g., morning, afternoon, some evenings and weekends);
$ reflects the cultural and religious interests of the resident population;
$ would appeal to both men and women and all age groups living in the facility.
Review clinical records and activity attendance records of residents receiving a comprehensive review, or a focused review, as appropriate, to determine if:
$ activities reflect individual resident history indicated by the comprehensive assessment;
$ care plans address activities that are appropriate for each resident based on the comprehensive
assessment;
$ activities occur as planned; and
$ outcomes/responses to activities interventions are identified in the progress notes of each resident.

Guidelines '483.15(f)(2)
A A recognized accrediting body@ refers to those organizations or associations recognized as such by certified therapeutic recreation specialists or certified activity professionals or registered occupational therapists.

Procedures: '483.15(f)(2)
If there are problems with provisions of activities, determine if these services are provided by qualified staff.