Managing the Insertion of Residents Not Suited to Programs
You have created your new program, carefully selecting the appropriate expected outcomes relative to the abilities of the residents you have invited to the activity. You are vigorous in your efforts to ensure that you are “meeting the residents where they are” relative to matching residents to programs in which they have the ability to engage successfully.
Just as you are about to get underway with the group of residents, a front line staff member wheels in a resident who is not suited to this program (not suited because either they are unable to successfully demonstrate the expected outcomes, or they have little or no real interest in the program). Within 10 minutes you are faced with a resident who is either becoming agitated and disruptive within the group, or has fallen asleep.
The same kind of inappropriate inclusion of a resident in a program can also be initiated by family members. Regardless of who is doing it, as recreationists we do need to challenge such actions.
When an incident such as this occurs, it is difficult to correct the situation at that moment in time. Creating a moment of conflict in the presence of residents should be avoided. So while allowing the program to proceed, with less than ideal outcomes the likely consequence, meeting with the person who initiated the insertion later is probably the best strategy. Here again you can explain the premise behind your programming approach, and hopefully redirect this person’s efforts to more productive program options.
A positive, proactive strategy is to provide recreation education. Make the opportunity to attend a meeting with other departments, and get on the Family Council meeting agenda. Use these meetings to share information about person-centered programming, and your success model of care (the concept of meeting the resident where they are). Also explain how residents sometimes respond when they are unable to successfully engage, and the frustration it can create for other residents more suited to the program. And for sure provide examples of alternate programs and program strategies you have for those who can’t successfully engage in the “regular” programs.
Another approach is to share the outcomes (scores) of resident participation at programs not suited to them at the resident’s care conference. When sharing the resident’s performance scores with other disciplines and family members, by highlighting those programs the resident is scoring poorly in (i.e. they are having limited or no success) you are able to reinforce the negative impact this has for and on the resident, and provide alternate programming options. In ActivityPro, the Resident Multi Day Report would work well to communicate this information.
In these situations, we often hear other staff say things like “She (the resident) has a right to be here,” or a family member might say “Well coming in here is better than sitting in her room doing nothing.” For the first comment, we should reinforce that our obligation is to provide residents with programs in which they can participate and succeed, and not be frustrated. And the residents who are suited to the program have the right to participate in programs without disruptions from those not suited to the program.
For the family members, helping them understand that resident frustrations at programs they can’t do successfully often result in resident behavioral responses, which we believe is not fair for the resident. Be sure to let the family know about other programs you will provide for their loved one that are more suited to their ability.
While it might appear unreasonable to us when others bring residents to unsuitable (for them) programs, in most instances, people are doing what they think is the right and best for the resident. By taking the time to explain your responsive and person-centered approach, and the consequences of inappropriate placement in programs, most will understand and appreciate your programming strategy. Backing up your position with data (such as low performance scores) and, where applicable, evidence of behavioral responses, further reinforces the significance and importance of what you are promoting.
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