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Federal Regulations - OBRA
*Regulations summarized, as they pertain to Activities.
F151 Exercise of Rights
F156 Rights and Services Residents must be informed of their rights. Resident Rights should be posted in the facility and reviewed during each resident council meeting. F169 Work All resident work, whether of a voluntary or paid nature, must be part of the care plan and be approved by the resident's attending physician to determine medical appropriateness. A resident can refuse to perform services for the facility at any time. Compensation must be paid for services rendered by residents at or above prevailing rates if this is a position that would otherwise be filled by a paid employee. F170 Mail Mail should be distributed unopened within 24 hours of delivery. Staff should provide assistance in opening and reading mail upon request. Residents should also have the accessibility to writing materials and stamps, as assistance with correspondence, when necessary. F174 Telephone Residents must be able to speak on a telephone privately. Resident public telephone needs to be equipped with amplifying device and large print numbers. Residents should be able to access the telephone independently. F221 Restraints Activities should be actively involved in the restraint reduction program. Restraints can be released during group and 1-1's. Adequate supervision is a must. Include Activities in the restraint reduction program and care plan for accordingly. F241 Dignity Residents should be treated with dignity and respect. This is done through assisting residents to and from activities of choice, talking with and listening to residents respectfully, addressing the resident by the preferred name of choice, knocking on resident doors, ensuring that residents are dressed and groomed appropriately for groups and outing, not interrupting residents while they are participating in an activity, etc. All staff members must recognize each and every residents individuality. F243 Participation in Resident Groups Residents have the right to organize and participate in a resident group, such as a resident council. It is up to the residents to determine who will and will not be invited to their meetings. Staff has the obligation to act upon the suggestions, complaints or grievances voiced by residents. Follow-up must be documented. (It is helpful to utilize Resident Council Action Forms). F246 Accommodation of Needs Resident rooms should be arranged so that residents are able to enjoy their leisure. A resident lying in bed should be able to see his or her TV and/or personal photographs or pictures hanging on the wall and/or out the window. Make necessary adjustments and adaptations to accommodate resident's personal preferences and needs. If a resident is unable to program their own television or radio, staff must assist resident in doing so to their station of interest. Assist residents with putting on and wearing (clean) glasses, contacts and hearing aides (F313). Other adaptive devices should also be accessible to maintain optimum functioning and psychosocial well-being. F248 Activities 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. Residents should not sit idle for long periods of time without being invited to an activity or offered individual activity supplies. This is the responsibility of all staff. MDS N2 addresses "Time involved in activities." All staff must take an active role in inviting and assisting residents to activities on choice and interest. (F150…Dignified Existence and F242 Self-Determination and Participation). Activity staff must make an effort to actively engage residents into a group, especially if each resident will be recorded in the participation record as attending. Attempt to wake up residents who tend to nod off during groups. If a resident is not able to be aroused, consideration must be made to lay the resident down. The Activity Calendar needs to reflect the interests and needs of all resident. Special groups should be designed for the lower functioning residents, men, residents with similar issues, younger residents, residents with similar cultural backgrounds, etc. In addition, if a resident has an expressed interest, it is imperative that the resident is invited, encouraged and assisted, if necessary to those particular groups. Documentation must be timely, complete, accurate and organized. (F514) Overall care plans must be interdisciplinary in nature, specific, measurable and individualized. (F279) The care plan should reflect services provided to attain or maintain the resident's highest practicable physical, mental and psychosocial well-being. If a resident expresses an interest, it is the activities responsibility to provide the resident with the opportunity to enjoy that life long interest. Interests are identified on the MDS, Activity History and Interest Survey, planned for in the care plan and/or Overall Activity Plan, and followed through with, as evidenced in the participation records, 1-1 documentation forms and progress note. If you say you are going to do it, do it! Outcomes/responses to activities interventions (written in the care plan) are to be identified in the progress notes of each resident. Participation records and 1-1 documentation must be accurate and current. Falsification of records is not permissible! Spiritual activities should be offered each Sunday (the most normal time services are offered in the community) and as needed. Every resident must be given the opportunity to practice his or her religion. Facilitate special needs when necessary. Activities must be offered throughout the day, evenings, weekends and holidays. Residents at risk for isolation must be on a 1-1 program or visitation schedule. Documentation of 1-1 programs must reflect the type of program offered, approaches, length of program, response of resident. Sufficient funds must be available to the Activity department. Transportation must be available for taking residents out of the facility. Supplies need to be appropriate and as adult-like as possible. A change of condition may warrant a change in the activity plan. Activities should occur as planned. Avoid canceling groups. In the event of a cancellation, revise the activity calendar. Maintain a master calendar. Volunteers require proper training to perform required duties. Volunteer files must be current and include an application, orientation checklist and job description. Volunteers must sign in. F249 Qualifications Activity program must be directed by a qualified:
If a consultant is contracted facilities may consider putting the consultant name and certification number on the staffing record. F252 Homelike Environment Resident rooms should be homelike in appearance and link the resident's past. F258 Comfortable Sound Levels Intercoms, buzzers, loud conversations, ice machines, cleaning equipment should not interfere with a resident's ability to socialize and/or participate in groups. F272 Comprehensive Assessment The comprehensive assessment must include "Activities Potential." Activities Potential is defined as the resident's ability and desire to take part in activities which maintains or improves physical, mental and psychosocial well being. Activities should also provide benefits in self-esteem, pleasure, comfort, health education, creativity, success and financial or emotional independence. The assessment should take into consideration the resident's normal everyday routines and lifetime preferences. F284 Post-Discharge Plan of Care A post discharge plan of care is developed to assist the resident in adjusting in his or her new living environment. Prior to discharge, describe how the resident's activity preferences, needs, and services can be accessed following discharge. F371 Store, Prepare, Distribute and Serve Food Activity and resident refrigerators should have a thermometer in the refrigerator and in the freezer. The temperature of the refrigerator should be maintained at 41 degrees or lower, without freezing. The temperature of the freezer should be at 0 degrees. Stored food should be covered, wrapped or sealed, labeled and dated. Expired or spoiled food should be disposed of. F386 Physician Services The physician must review the resident's total program of care including activity services. Activity related physician orders generally include approval of the residents overall activity plan, participation in facility sponsored outings, work therapy/volunteer services by resident, therapeutic type activities and alcohol use. F441- F 444 Infection Control The facility must establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment. Activity staff should practice good hand washing techniques when cross contamination can occur. Support facility policies when practicing good infection control procedure. Protect residents from cross contaminating each other. Sanitize equipment and supplies often. Follow facility isolation procedures when working with residents in isolation. F456 Space and Equipment The facility must provide sufficient space and equipment to comfortably accommodate the needs of the residents. Facility must also provide for sufficient storage of supplies. F464 Dining and resident activities The facility must provide adequate and comfortable lighting levels (F256) and be well ventilated with acceptable temperatures (F257). Smoking areas are to be well ventilated and have adequate smoke exhaust removal. F497 Regular In-service Education In-services are recommended to address special needs of residents, needs of residents with cognitive impairments and resident rights. Recommend that the Activity Department present an annual in-service to all staff. Activities could be involved in new staff orientation to relate the needs of residents, including their rights. The Activity Department should take good advantage of this time to share with staff the importance of activities in the lives of the residents and how staff can be supportive of that concept. F514 Clinical Records Clinical records must be complete, accurately documented, readily accessible, and systematically organized. The clinical record must contain sufficient information to identify the resident. (Common practice is to not purge admission documentation. Generally, other documentation can be purged, leaving 6 months to a year on the chart.) Colorado, Chapter V Regulations
Long Term Care Facilities *Chapter V regulations summarized, as they pertain to Activities
These regulations were summarized by "Innovation in Recreation". The intent is to help Activity Staff focus on the regulations that are pertinent to the Activity Department. This is not a complete set of OBRA Regulations, nor are the regulations summarized here verbatim from the complete set of regulations. See the actual set of OBRA Regulations for specifics. Innovation in Recreation, 5/02 "Resident Rights" and "Quality of Life" Questions
In order to provide residents with the highest quality of life in your facility, it is suggested that you address the following questions with residents on an individual basis and/or during Resident Council Meetings. If utilized during Resident Council Meetings, you may focus on several questions at each meeting. Any negative comments made by residents should be followed up with and addressed at the subsequent meeting. General Questions
Environmental
Dietary
Activities
Social Services
Nursing
Special Note: These questions were generated from the set of OBRA Regulations and summarized by the staff of "Innovation in Recreation."
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Residents have autonomy and choice of how they live their everyday lives and receive care. Additionally, resident continue to have rights as a United States citizen or resident. Residents must be given an opportunity to vote.