Care Plan 101 - An Introduction to Care Planning For Activity Professionals

Creating and implementing individualized care plans for residents in long-term care facilities is a very important responsibility of activity and recreation professionals. The activity assessment determines the content of the care plan. Not all residents will have an "activity-care plan", but most care plans should have "activity-related interventions" found in the comprehensive care plan. Care plans may be written regardless if a resident triggers on the MDS 2.0.It is important to set realistic, measurable goals, interdisciplinary interventions, and create care plans that are individualized and person-centered.

What is a Care Plan?
The RAI user manual defines care planning as, "A systematic assessment and identification of a resident's problems and strengths, the setting of goals, the establishment of interventions for accomplishing these goals."

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Why write Care Plans?
- Document strengths, problems, and needs
- Set guidelines for care delivery
- Establish resident goals
- Identify needs for services by other departments
- Promote an interdisciplinary approach to care and assign responsibilities
- Provide measurable outcomes that can be used to monitor progress
- Meet federal and state requirements
- Meet professional standards of practice
- Enhance the resident's quality of life and promote optimal level of functioning!

Care Plan 101 - An Introduction to Care Planning For Activity Professionals

What is a Care Plan Meeting?
A forum to discuss and review a resident's status including any problems, concerns, needs, and/or strengths.

Who usually attends a Care Plan Meeting?
- MDS Coordinator
- Nurse(s)
- CNA's
- Dietician
- Rehabilitation Therapist(s)
- Recreation Staff
- Social Worker
- Resident
- Family Member/Guardian

When are Care Plans written?
- A minimum of seven days after the MDS completion date
- Some care plans warrant immediate attention
- As necessary
- Must review at least quarterly

The Role of the Recreation/Activities Department
- Identify the resident's leisure/recreation needs
- Identify barriers to leisure pursuit and help minimize these barriers
- Identify the resident's leisure/recreation potential
- Provide the necessary steps to assist the resident to achieve their leisure/recreation goal/s
- Provide interdisciplinary support by entering a variety of recreation interventions on various (non-activity) care plans
- Monitor and evaluate residents response to care plan interventions

Components of a Care Plan
- Statement of the problem, need, or strength
- A realistic/measurable goal that is resident focused
- Approaches/interventions the team will use to assist the resident in achieving their goal
- Important dates and time frames
- Discipline(s) responsible for intervention
- Evaluation

Target areas for Recreation/Activities
- Cognitive Loss
- Communication
- ADLS
- Psychosocial
- Mood
- Nutrition
- Falls
- Palliative Care
- Activities
- Recreation Therapy
- Pain Behavior
- Restraints

Activity/Recreation Care Plan Samples
These are just a few samples. Remember, the most important aspect of care planning, is INDIVIDUALIZATION!

Statements (the resident's name is usually used instead of the word "resident")
- Resident has limited socialization r/t to depression
- Resident prefers to stay in room and does not pursue independent activities
- Resident is bed-bound r/t to stage 4 pressure ulcer and is at risk for social isolation
- Resident demonstrates little response to external stimuli r/t to cognitive and functional decline
- Resident enjoys resident service projects such as changing the R.O. boards
- Resident becomes fearful and agitated upon hearing loud noises in group activities r/t to dementia
- Resident has leadership abilities
- Resident prefers a change in daily routine and wishes to engage in independent craft projects

Goals
- Resident will respond to auditory stimulation AEB smiling, tapping hands, or vocalizing during small group sensory programs in 3 months
- Resident will actively participate in 2 movement activities weekly in 3 months
- Resident will remain in a group activity for 15 minutes at a time 2x weekly in 3 months
- Resident will accept in room 1:1 visits by recreation staff 2x weekly in 3 months
- Resident will socialize with peers 2x weekly during small group activities in 3 months
- Resident will respond to sensory stimulation by opening eyes during 1:1 sessions in 3 months
- Resident will actively participate in Horticultural Therapy sessions in the green house, 1x monthly in 3 months
- Resident will continue to assist other residents in writing letters on a weekly basis in 3 months
- Resident will exhibit no signs of agitation during small group activities 3x weekly in three months
- Resident will engage in self-directed arts and crafts projects 1x weekly in 3 months

Interventions/Approaches
- Provide a variety of music i.e. Big Band and Irish
- Utilize maracas and egg shakers to elicit movement
- Provide PROM to the U/E during exercise program
- Involve resident in activities of interest i.e. singalongs, adapted blowing and trivia
- Offer 1:1 visits in the late afternoon to discuss recent Oprah episode
- Seat resident next to other Korean speaking resident during groups
- Provide tactile stimulation i.e. hand massages and textured object i.e. soft baseball
- Provide olfactory stimulation i.e. vanilla extract and cinnamon for reminiscing
- Utilize adapted shovel and watering can during HT sessions
- Provide easy grip writing utensils and a variety of greeting cards/stationary
- Involve resident in small sensory groups i.e. SNOEZELEN and Five Alive
- Sear resident near a window
- Provide a variety of independent arts and craft projects
- Provide adapted scissors and paint brush

Exercise
Imagine that you are a resident in a long-term care facility and you are bed-bound for a health-related condition and are at risk for social isolation and inactivity. Write a goal and at least seven interventions/approaches that are relevant to you.

Care Plan 101 - An Introduction to Care Planning For Activity Professionals

Kimberly Grandal, Founder and Executive Director of Re-Creative Resources, Inc., is a strong advocate for the field of Therapeutic Recreation and Activities, with over fifteen years of experience working with the elderly in numerous management and consultant positions. She is an Activity Consultant Certified and a Certified Therapeutic Recreation Specialist. She is a recipient of the Kessler Institute of Rehabilitation 1997 Triumph of the Human Spirit Award.

Kim is a member of NJAPA, NJ/EPA-TRA and NAAP and serves on the NJAPA board as the Chairperson for the Legislation Committee. She is an NCCAP reviewer and is an active member of the NCCAP and NAAP Government Relation Committees.

Kim is a speaker for various national, state and local activity associations, the Society of Licensed Nursing Home Administrators of NJ, colleges, and community groups. She also provides consultation and support to numerous facilities in the state.

Kim is the editor and writer for the "The Rec-Room", a monthly newsletter published by her company. In addition, she writes monthly articles for Activity Directors Today newsletter, and has contributed articles to Creative Forecasting Magazine, Current Activities in Long Term Care Magazine and The Continuing Care Insite newsletter. For more information visit http://recreativeresources.com

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Heat Transfers 101 - Introductory Tutorial to Using a Heat Transfer Machine With Great Results!

A heat transfer press or heat transfer machine is a machine that utilizes heat to press a transfer onto an imprintable object, and this could be a t-shirt, cap, handbag, plates, mouse pads and many other items (with some exceptions and fabrics working better than others).

In prior days, hand irons could be used for simply application of small ones, but the cost of heat transfer machines have dropped and certain provide a more professional look and can apply transfers to a wider variety of materials.

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In addition, a more professional look is obtained using a heat press because it's a combination of heat and pressure that make a great looking transfer and pressure required can be up to 70-80 psi which is harder to obtain using an iron.

Heat Transfers 101 - Introductory Tutorial to Using a Heat Transfer Machine With Great Results!

What's the difference between sublimation and a this press method? The technical answer here is that sublimation permeates the surface coating of the particular medium whereas a heat transfer applies some but not all of the ink to the material while leaving some of the paper. Thus, we see sublimation used on harder materials as well as synthetic fabrics such as imprinting on coffee mugs, license plates or printing on 100% polyester t-shirts.
What types are easiest to work with for beginners?

There are three key types of heat transfers:

(1) Plastisol transfers;

(2) Transfers made with color copiers;

(3) Transfers made with Ink-Jet transfer paper.

For starters and beginners just getting into applying heat transfers to t-shirts and other products, we suggest starting with plastisol transfers or color copier produced transfers as are typical when you purchase pre-printed transfers from suppliers. You can also have the supplier make custom transfers for you with your own design. In either case, having an experienced heat transfer manufacturer supply you with your transfers is much easier to get your business started without learning an entirely new area.

Once you get going, then you can move on to designing and printing your own transfers using software and a good printer. This method is certainly gaining in popularity and with some training you can quickly create great looking graphics, and more importantly get them onto your t-shirts or products quickly and inexpensively.

We do suggest avoiding bubble-jet printers that use water-soluble inks as these are more difficult to apply and can wash out after a few washes (which won't make your customers very happy). Instead, a decent ink-jet printer will do the job and can produce some great looking transfers. You'll need the proper heat transfer paper as well for your printer; alternatively, you could design the graphics yourself, and still have a commercial printer actually print your heat transfers using much a much higher end printer. There are many such printers that can create custom ones for you and many have fairly low minimum orders (i.e., 12 or less sheets but of course your price will go down the more you order).

As to your heat press options, there are many on the market and several have outstanding track records with years of great customer reviews, such as Hix presses made in our hometown of Pittsburgh, Kansas and Geo Knight of Brockton, Mass. The two typical options here are the clamshell type press which closes down and releases up, or the swing-away type which does the same thing then you can swing the upper arm up and out of the way once you're finished pressing. Sizes vary as well from a portable press of about 11 inches to larger 16" by 20" presses. Be sure to review the sizes of your transfers and go with the larger presses if you can to give you more flexibility in the types and sizes of them that you may run into, either in purchasing transfers or in customizing your own heat transfers.

Samples - you'll also want to test out some samples when using either a new machine, new transfer or new material such as a t-shirt or fabric type to ensure you can reproduce the correct temperature and pressure consistently. Typically you want the machine set at 375-395° F for 10-14 seconds for 100% cotton or cotton blend shirts and typically that same general guide for baseball caps.

With these guidelines, you'll be off to a great start in producing some terrific looking products whatever your line consists of, whether you're selling t-shirts, mugs, caps or other items, and best of luck with your new heat press!

Heat Transfers 101 - Introductory Tutorial to Using a Heat Transfer Machine With Great Results!

Bryan Johnson is the President and Co-Owner of BlueHeavenTees.com

Blue Heaven Tees offers innovative and unique Christian Tee Shirts, Christian Hoodies and Sweatshirts and other great Christian gift ideas. Check out our new fall line now in stock!!

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Managing Time As an Adult Learner

Time - do you ever feel you don't have enough time to fit everything into your day? Do you ever wonder how others manage to fit everything into their day - school, work, family, and friends? Maybe you're not alone... Life is hard and becomes even harder as people develop into adults. This is why excellent time management skills are a must - especially for the adult learner!

The adult learner has many challenges they face every day from schooling, to work, to making sure they have enough time available in their day for friends and most importantly their family. Often times, the adult learner will give up and drop out of college because they cannot keep up with working long hours as well as the massive amount of school work from day to day - the average worker in America is working more hours than ever before. They often feel in order to support their family they have to let college go. A college degree is extremely important in this day and age; however, while attending college many adults realize that it does not pay the bills. This is unfortunate as many adults will fail to excel in their careers without the degree behind them. Life is hard - especially for the adult learner.

For those that push through and continue to work and attend school, they often find it is a daily struggle to keep their grades up so they can make the required satisfaction of progress. The adult learner in most cases does not have the advantage of staying at home as the younger learner may have so they can focus only on their education. This makes learning even more complicated for the adult learner.

Managing Time As an Adult Learner

It is especially hard when they have a family to care for and household responsibilities too. Many adult learners will feel they are neglecting their family and other obligations so they may choose to put their education on hold while their children are growing up. Their friends may not understand why they are unable to do the things they did before and their social life may struggle because of their schooling as well. All of these situations make it incredibly difficult for the adult learner. It becomes a balancing act to make sure they do not become overstressed, overworked, or overloaded - so how do they manage it all?

There are many things that contribute to the success of an adult learner. These ideas also help any person currently in any learning environment. Many adults find mastering these skills tremendously improve academic success. If the adult learner feels they have no time available as it is - time management skills are a must. It is critical that adults who are in a learning environment focus on every minute in their day and find ways to improve the free time they have available even if the time is limited.

Most people now would be thinking to themselves, "There is nothing in my life I can cut - I'm maxed out!" How many adults spend hours sitting in front of the television - people are surprised when they truly evaluate the time spent mindlessly watching movies, ESPN, etc. It is important to have time to unwind and relax; but when the adult learner is trying to fit an education in with an already busy lifestyle, they must evaluate which areas they can adjust. If they don't find a lot of time is wasted watching television, perhaps they spend a lot of time playing video games or doing other activities - if their education is important they may want to cut these things for the time being.

The question is - is the adult learner willing to make these sacrifices? If so, they will need to sit back and decide what is important in their life and which activities they can let go - for now. It helps if they can make a list of how much time they spend doing these different activities and then figure out where they can manage their time more efficiently. No two adult learners are exactly alike. Only they will know the schedule they are currently keeping and which areas they are willing to adjust so they will be able to finish their degree. If an education is truly important to them - the adult learner will find a way.

While getting rid of events in their life that are hoarding precious time, there are other things the adult learner can do in order to get the most out of the time they have available. The adult learner must improve their study skills. By improving study skills they can spend more time with their family and friends. Most would prefer reading a book one time while increasing their comprehension of the content instead of reading it several times because they do not remember what it is they read. Most people would like to read it only once or maybe a few times -in order to do that you have to maximize your study skills. By doing this, they will improve the time they have available to enjoy other things in their lives.

One of the most important ways the adult learner can improve their skills is to make sure they always take exceptional notes of the material studied; it often helps to use different colors while highlighting to separate key points, make index cards with questions on the front and answers placed on the back. This way the adult learner can practice them while on the go. They can then study while at a baseball game, waiting in line to see the doctor, etc. This will take full advantage of the time they have available in a day. It is little things like this that will have a huge impact on time management.

It is also critical the adult learner always engages in their learning environment whether online or not. They may view the discussions pointless or forum posts as only taking away more time from their already busy schedule, but this will increase their comprehension on the topic they are studying. So it is important they take full advantage of them! They are there and available for a reason.

When the adult learner is feeling overloaded, stressed and wanting to just throw in the towel - it is imperative they stop and take a break. It is very important to take time to reenergize your mind and body while seeking an education. When taking a break it often helps to enhance memory because you can concentrate more effectively. This will also allow you to spend less time studying. If people study when they are exhausted their mind will not function appropriately in order to retain the information - having to read it again is not helping the adult learner manage their time more efficiently. So, they must make the most out of every study session scheduled. It is also essential to only study when alert and there are no distractions around so they can fully focus on the information in front of them.

Schooling can be incredibly taxing for the adult learner - but is the end result worth it? The adult learner must always keep their mind set on the goal. They must stay positive and believe that anything is possible if they set their mind to it. Adults graduate all the time - so it is conceivable and if they believe they can finish, they will. Many attending college these days are older adults; it helps to remember that you're not alone.

A support chain is particularly important. The adult learner should seek the help and support of their husband/wife, family members, and even their employer. They need to ask for help when necessary. Perhaps their husband/wife can help with chores around the house, run errands, or help with the kids so the college student can spend a set amount of time each week studying. Maybe a family member could even pick up their kids from practice/school a few times a week.

The adult learners who are employed while attending school could communicate with their superior the desire to work out a more appealing schedule that works for the business as well as for the student. This way they could focus their schooling more appropriately around the new schedule - this may help them manage their time more efficiently as well. Many employers will even help pay for an employee's academic studies, so they need to make sure to utilize all the help available. Employers want educated employees and in most cases will work with the student so all involved are happy.

The truth is every day people adjust their time in order to do things they love. When somebody really wants something - they make it work. If they don't - they will probably give up. When the adult learner wants it bad enough, they will find ways to make the most out of every situation. It is obvious the adult learner struggles to balance everything in their life; this is why time management for the adult learner is a critical skill to have. It is extremely important the adult learner utilizes ways to enhance their learning strategies - so they can maximize the time they spend on their education, and also have a strong support chain that will encourage them continuously. In doing this, they will have more time available for the things they love to do the most and be a lot happier in the process while achieving academic success.

Managing Time As an Adult Learner
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