The F-248 tag requires that CNAs get more involved in activity programming.

By Sandra Stimson, CALA, ADC, CDP, & Fred S. Sganga, FACHE, LNHA

Many dementia units have only one activity assistant. When that person leaves the floor, the residents often sit idle with no other form of stimulation. Typically, nursing assistants are not involved in daily activity programs for several reasons. (See box 1.)

But the new interpretive guidelines regarding F-248 are going to change all that. Under these regulations, CNAs should help transport residents to programs, implement care plans and activity interventions in resident rooms, and participate in day-room activities.

Together with the activity director, the director of nursing and the administrator must recognize this new role for CNAs. They should provide communication and training opportunities to help CNAs fulfill this requirement.

INVOLVING CNAs

The first step is to provide various in-service training sessions on the following topics:

• the scope of your activities program

• types of activities offered

• times and location of programs

• location of activities supplies

• activity resources (downloads, Web sites and magazines)

• quick activities

• policies and procedures for all programs

• guidelines for implementing a program.

Once you've educated the CNAs on your activities program, identify those who would like to participate in or lead activity groups. Then conduct individual meetings with the CNAs to find out their strengths. For example, one aide might like to sing, while others may enjoy spiritual programs or discussions on their cultures. Incorporate these types of programs into the activity calendar during times when you need CNAs to cover the day rooms and assist with programs.

In addition, involve the nursing assistants with planning activities. Ask the activities director to solicit input from CNAs when planning the next month's activity calendar. Since CNAs know residents so well, they usually have great ideas. Challenge them, as a group, to come up with 25 ideas for these activities and post those ideas prominently in a frame.

ON THE DEMENTIA UNIT

Planning activities on the dementia unit may require a special selection process. Not every CNA wants to work on the dementia unit. To find the best fits, select CNAs who have taken on leadership roles (as lead CNAs) or who have previously expressed interest in working on the dementia unit. The ideal CNA for the dementia unit would be someone with experience, compassion, creativity, good verbal skills and motivation to be a team player.

Assign a lead CNA to target daily ADLs and schedule the other CNAs to work with the dementia activity program. Since activity rooms can't be left unsupervised or understaffed, nurse managers or dementia unit directors should provide a daily activity room schedule so the nursing assistants know when they can help with activities.

STAFFING REQUIREMENTS

Nursing assistants have a lot of important work to do daily. To avoid over-burdening your CNAs, recruit volunteers to be bed-makers or hire someone from one of the many organizations that work with disabled clients who would be interested in a minimum wage, part-time job.

You can improve the daily quality of life for your residents if everyone works together. The administration, nursing and activities staff should take the time to develop a quality program. Great things will occur when we motivate our CNAs to step up their involvement with activities. n

Sandra Stimson is executive director of the National Council of Certified Dementia Practitioners, Sparta, N.J., and Alternative Solutions in Long Term Care, also in Sparta. Fred S. Sganga is executive director of the Long Island State Veterans Home, Stony Brook, N.Y.

BOX 1: Reasons CNAs cite for lack of involvement with activity programs

• Lack of activity training

• Don't understand activity terminology

• Activity supplies not available

• Don't want to get involved

• Not comfortable leading an activity

• Not in my job description

• I'm not paid enough to do activities

• Not enough help in the day room

• Not on my assignment list

• Not aware of care plan interventions

• Not invited to care plan meetings

• Unit manager or dementia director gives no direction

• Activity assistant gives no direction during a program

• Don't have time to transport to day room

• Too many residents to care for on this shift.

—Sandra Stimson & Fred S. Sganga

BOX 2: Activity Incentives to Motivate CNAs

• Provide certificates for the most creative activity.

• Provide recognition for bringing in a volunteer or group.

• Hold a monthly luncheon to exchange activity ideas.

• Send staff to activities courses and seminars.

• Promote CNAs to working in the activity department as positions open.

• Provide incentives for higher learning.

• Provide competitive salaries for dementia unit workers.

• Have daily stand-up meetings with an uplifting quote.

• Have CNAs present at corporate functions.

• Allow CNAs to give facility tours.

• Make training fun (role playing, word searches, games and personal -stories).

• Honor CNA birthdays with residents.

• Celebrate Nursing Assistant Day.

• Provide positive feedback about activity program or involvement.

• Replace torn uniforms if caused by residents.

• Distribute logo pins to acknowledge trained staff.

• Always remember to say thank you.

—Sandra Stimson & Fred S. Sganga