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Quality of Life - Activities

 

Description of Federal Requirements
Comparison of State Requirements
Table Comparing States

Complete Transcript of State Requirements on Quality of LIfe - Activities (PDF)

Federal Regulations & Related F-tags for 483.15 Applicable Federal Regulation
(c) Space & Equipment - Facility must provide one or more rooms designated for resident dining and activities.
These rooms must -
(1) Be well lighted;
(2) Be well ventilated, with nonsmoking areas identified;
(3) Be adequately furnished; and
have sufficient space to acommodate all activites. | F464
(d) Participation in other activities | F245
(e) Accomodation of needs | F246
 
483.15 Quality of Life
483.70 Physical Environment

Description of Federal Requirements    (TOP)    (NEXT)

The federal requirements for activities are contained in a brief section of the Quality of Life regulation, (483.15 (f).  First, this regulation requires that the facility have an ongoing activity program designed to meet the interests, physical, and psychosocial well-being of each resident, in keeping with the comprehensive care plan.  Second, the activity program must be directed by a qualified individual.  Several alternatives for qualifications are laid out:  a recreational therapist or activities professional licensed in the State (or eligible for such licensure); an occupational therapist or occupational therapist assistant; a person who has 2 years of recreation experience in the last 5 years, one of which was in a health setting; or who has taken a course for activity directors approved by the State. Under 483.70 Physical Environment (c), Space and equipment, the facility must provide sufficient space and equipment in dining, health services, recreation, and program areas to enable staff to provide residents with needed services as required by these standards and as identified in each resident's plan of care.

Comparison of State Requirements    (TOP)    (NEXT)

Most state statutes regarding activities in nursing facilities provide mandates above and beyond the federal laws.  The activities regulations of six states (Arizona, Florida, Kentucky, Louisiana, Montana, and Wyoming) are reflective of the federal statue or do not address activities.  

Ten states differentiate from the federal regulations in the area of qualified activities professionals.  Seven of them include higher standards than the federal regulations.  California regulations include training in various forms of activities such as recreational, art, and music therapy.  Colorado statutes include the qualifications of a bachelor’s or master’s degree in social or behavioral sciences.  Illinois includes licensed social workers as qualified activities professionals.  Kansas regulations include a bachelor’s degree in therapeutic recreation to its qualifications.  Nebraska statutes include one year of long-term care experience and a bachelor’s degree in social or behavioral sciences.  Oklahoma regulations contain the provision of an associate’s degree or bachelor’s degree.  New Jersey includes provisions for a bachelor’s degree.

Two states include provisions for qualified activities professionals that are less than the federal standard.  Maryland regulations indicate vaguely that “a staff member qualified by experience or training shall be appointed to be responsible for the activities program”.  If the designee does not meet these unstated qualifications, the state must approve the designee.  Virginia regulations only require one year of full time experience versus two years in last five years designated by the federal regulations.

Massachusetts standards for qualified activities professional are below the federal standard.  These regulations require an activity director to have a high school diploma, 1 year of experience, and an interest/ability to work with older adults.

Alabama, Arkansas, Colorado, Georgia, Illinois, Indiana, Maryland, Mississippi, Nebraska, New Mexico, North Dakota, West Virginia, and Wisconsin require consultation by qualified activities professionals if one is not employed by the facility.

The regulations of nineteen states (Alabama, California, Colorado, Connecticut, Delaware, Hawaii, Idaho, Illinois, Iowa, Maine, Minnesota, New Jersey, New Mexico, New York, Oregon, Rhode Island, South Carolina, South Dakota, and Tennessee) require documentation of the services provided with regarding to activities.

Alabama, Arkansas, California, Colorado, Connecticut, District of Columbia, Idaho, Indiana, Maine, Minnesota, New Mexico, New York, Nevada, South Carolina, and Tennessee mandate posting a calendar with the activities programming in a visible place in the facility.

Arkansas, Colorado, District of Columbia, Georgia, Iowa, and South Carolina statutes provide lists of suggested activities supplies and equipment such as newspapers and televisions. 

Wisconsin regulations require activities specifically for people with developmental disabilities.

Four states (Arkansas, Idaho, New Jersey, and Oklahoma) require nursing facilities to maintain policies and procedures for activities departments.

Arkansas, Colorado, Illinois, Nebraska, and Rhode Island statutes include activities provisions specifically for Alzheimer’s special care units.

Ten state statutes mandate weekend and/or evening activities programming Arkansas requires weekend activities.  Oregon regulations stipulate the need for activities programming six days per week.  Whereas Colorado, Illinois, Indiana, Iowa, Maine, Minnesota, Ohio, and Washington require activities on both the evenings and weekends.

Arkansas regulations indicate a minimal number and type of activities and type per day.  The statutes in
Oklahoma mandate a minimal number of activities per week. 

A ratio of activities staff per number of residents is mandated by regulations in ten states ( District of Columbia, Illinois, Indiana, Iowa, Kansas, Maine, New Jersey, Nevada, Oklahoma, and Wisconsin).

The integration of volunteers into activities programming is included in statutes in Arkansas, Colorado, Idaho, Illinois, Maine, New Jersey, and New York.

The states of Arkansas, California, Illinois, Iowa, and Texas mandate minimal hours of in-service training for activity staff.

Under 483.70 Physical Environment, the regulations specify that the facility must provide sufficient space and equipment in dining, health services, recreation, and program areas to enable staff to provide residents with needed services as required by these standards and as identified in each resident's plan of care. Some states specify the required square footage per resident to be devoted to activities. Arkansas, District of Columbia, Indiana require a minimum of 20 square feet per bed. Georgia requires a minimum of 20 sq. ft per bed with 50% of the required space for dining. Illinois and New Mexico, North Carolina and Ohio require 25 sq. ft per bed with 40 sq. ft required in new construction special care units.  Delaware, Oregon and Rhode Island require at least 30 square feet per bed for the first 100 beds. In Connecticut, recreation area is to be a minimum of 12 square feet per bed of which 50 % must be located within one space with an additional 100 square feet for storage of supplies and equipment.

Table Comparing States    (TOP)

Note: If the States in this table are not hyper-linked, their provisions do not appear to address the topic, and therefore, do not alter the Federal Regulatory scope.  The Table summarizes content on Quality of Life - Activities by State (with a link to each State's specific language).  Link to a downloadable PDF document containing all State requirements on Quality of Life - Activities.

483.15 Quality of Life

Activities
State Goes beyond Federal Regulations? Subjects Addressed: How State Differs From or Expands On Federal Regulations
Alabama Yes Allows for the provision of consultation if activities coordinator does not meet qualifications. Pre-planning of activities. Posting of activity calendar. Documentation of activities assessment and participation.
Alaska Yes Plan of care must reflect recommended activities. Provides definition of recreational therapy. Must provide activity program to all residents and encourage resident to attain and maintain function at the highest level possible.
Arizona No Arizona regulations on Activities mirror Federal regulations.
Arkansas Yes Allows for the provision of consultation if activities coordinator does not meet qualifications. Mandates policies and procedures specific to activities, minimal activities per day, weekend programming, minimal activities supplies, and posing of an activity calendar. Encourages utilization of volunteers. Alzheimer's special care units are required to plan, implement, and document type and frequency of activities. Minimal in-service training. Requires specific types of activities daily. Minimum of 20 square feet per bed.
California Yes Allows for training as art, music, dance, and recreation therapy in the credentials for program leader. Documentation of activities in plan of care and progress notes. Activity plan to be reviewed and approved by physician quarterly. Suggests types of activities. Minimal in-service requirements. Requires posting of activity calendar. Special treatment program service unit staff.
Colorado Yes Mandates assessment and development of activities care plan upon admission, daily activities and minimal evening and weekend activities, posting of activity calendar, maintenance of activity attendance records other than in medical record, and minimal supplies. Suggests categories of activities. Encourages utilization of volunteers. Allows for provisions of consultation for activities staff without credentials. Includes master's or bachelor's degree in credentials. Requires documentation of activity assessment and progress notes. Provisions for activities in secure Alzheimer's units.
Connecticut Yes Mandate monthly activity calendars and documentation of resident participation. Required therapeutic recreation program and director qualifications and ratio of hours. Requirements for recreation and social areas of 20 sq. ft. per average number of residents. Recreation area be a minimum of 12 square feet per bed of which 50 % be located within one space with an additional 100 square feet for storage of supplies and equipment.
Delaware Yes Require documentation of activities notes and activities policies. Resident common areas at least 30 sq. ft per bed for the first 100 beds and 27 sq. ft for beds in excess of 100.
District of Columbia Yes Require credentialed activities staff ratio per number of beds, minimal supplies, responsibility of activities director, posting of monthly activity calendar, and assessment and reassessment deadlines. Requirements for recreation and social areas of 20 sq. ft. per average number of residents.
Florida No Florida regulations do no contain specific content for quality of life activities
Georgia Yes Allows for the provision of consultation if activities coordinator does not meet qualifications. Suggested activity supplies. Minimum of 20 sq. ft per bed with 50% required space for dining.
Hawaii Yes Documentation of activities in plan of care and resident participation.
Idaho Yes Mandate activities policies and procedures, job requirements of the activities program coordinator, and post activities calendar. Encourages utilization of volunteers. Documentation of activities assessment and plan of care, and progress notes. Activities funding is to be provided by the facility. New construction requires minimum of 30 sq. ft per bed for total area of at least 225 sq. ft for under 100 beds.
Illinois Yes Requires disclosure of activities available to Alzheimer's special care units, minimal weekly staff time per resident, minimal number of annual in-service training for activity staff, and activity director to be on-site 4 days per week, Statutes define activities program. Activity director credentials include licensed social workers, Allows for the provision of quarterly consultation if activities coordinator does not meet qualifications and a minimum number of years of experience per educational status. Mandates documentation of activity assessment/plan of care/quarterly progress notes, types of activities, and activities 7 days a week for an average of 8 hours per day, Encourages use of volunteers. 25 sq. ft per resident bed. SCU's new construction require 40 sq. ft.
Indiana Yes Require categories of activities, programming 7 days a week including evenings, minimum activities time per resident, and posting of a monthly activity calendar. Allows for the provision of consultation if activities coordinator does not meet qualifications. 20 sq. ft per bed.
Iowa Yes Mandates the provision of weekend and evening programming, minimal activities staffing time per resident, minimum number of in-service hours for activity coordinator, written coverage plan for absence of activity coordinator, documentation of attendance and quarterly activity progress notes, and types of supplies. Credentials for activity coordinator only include the state training course within 6 months of hire.
Kansas Yes Activities director credentials include a bachelor's degree. Mandates minimal activity staff coverage per day per resident. Facility with 60 or fewer beds shall provide a room with a minimum of 200 square feet. Each facility with more than 60 beds shall provide 200 square feet plus two square feet for each additional bed over 60.
Kentucky No Kentucky regulations on activities mirror federal regulations.
Louisiana No Louisiana regulations on activities mirror federal regulations.
Maine Yes Requires minimal number of activity staff hours per bed, documentation of assessment/plan of care/ quarterly progress notes, day and evening activities programming, and posting of a monthly activity calendar. Encourages utilization of volunteers. Therapeutic activities.
Maryland Yes The state may approve a designee in cases where the activities coordinators does not meet the qualifications A consultation may be required for facilities not maintaining an effective activities program.
Massachusetts Yes Only credentials for activity director are high school diploma, one year of experience/training in directing group activity, and ability/interest in working with older adults. Requires an individual service plan regarding activities, post monthly activity calendars, and types of activity supplies/ equipment. At least eight square feet per bed.
Michigan Yes A written description of types and frequency of activities must be provided to prospective resident or proxy. Diversion activities.
Minnesota Yes Mandates daily activities with exception of holidays and other days per facility policy, posting of activity calendar at least one week in advance, and documentation of activities in the medical record.
Mississippi Yes Allows for the provision of consultation if activities coordinator does not meet qualifications. 18 sq. ft. per bed. Therapeutic activities for special care units. Forty square feet per resident, but in no case shall be smaller than three hundred-twenty (320) square feet for special care units.
Missouri Yes Suggests types of activities. Facility with an adult day service may include those clients in facility activities. Facilities with more than 12 beds must utilize a method of informing residents of upcoming activities. Alzheimer's demonstration projects.
Montana No Montana regulations do not contain specific c ontent for Quality of Life, activities
Nebraska Yes Require one-year of long-term care experience in addition to credentials and includes a bachelor's degree in a social/behavioral science as a credential. Allows for the provision of consultation if activities coordinator does not meet qualifications. Mandates a written statement of type and frequency of activities in Alzheimer's special care units.
Nevada Yes Mandates a posted program of activities at least one month in advance, Administrators of facilities with more than 20 beds will appoint a staff person responsible for the activities program. If more than 50 beds, more than one person will be appointed.
New Hampshire Yes Recreational activities program to be directed by a therapeutic recreation specialist.
New Jersey Yes Requires assessment of resident initiative of activities within 14 days of admission, minimum staff time per resident, categories of activities, posting of weekly activity calendar, advisory activities policies and procedures, minimum number of evening activities per week, and integration of children into programming. Credential options include a bachelor's degree or high school diploma plus three years of activities experience and state training course. Encourages the use of volunteers. Advisory activity programming.
New Mexico Yes Allows for the provision of consultation if activities coordinator does not meet qualifications. Requires documentation of activities assessment, programming, attendance, and quarterly progress notes. Credentials for intermediate care activities staff member is experience or training in directing group activities. Not less than 25 sq. ft per bed.
New York Yes Information regarding the activities program must be provided to residents or their designee upon admission, activity plan reviewed at least quarterly, and approval of resident activity plan of care from physician. Requires documentation of activities, attendance and plan of care. Encourage the use of volunteers. Mandates posting of activities calendar.
North Carolina Yes Required space not less than 25 sq. ft per bed.
North Dakota Yes Allows for the provision of consultation if activities coordinator does not meet qualifications. Mandates activities policies and procedures and documentation of activities assessment/plan of care/ progress notes.
Ohio Yes Mandates a full time director, and day/evening/weekend activities, qualification, 25 square feet per resident for seventy-five per cent of the total number of residents
Oklahoma Yes Requires activities policies and procedures, minimum numbers of activities staff per week, at least monthly activity progress notes in the medical record, and minimum number of activities per week/weekend day. Credential options for activity directors include an associate's or bachelor's degree. Another credential option allows for 1 year of long-term care experience and enrollment in an appropriate training program within 180 days of employment, department approval of activities director course
Oregon Yes Mandates activities six days a week, types of activities. Documentation of the activities plan of care, physician orders regarding level of activity and activity restrictions, and at least quarterly progress notes, not less than 30 square feet per bed with a minimum size of 225 square feet
Pennsylvania Yes Activities coordinator qualifications, adequate lighting
Rhode Island Yes Mandate therapeutic activities for Alzheimer's special care unit and documentation of activities in the medical record, 30 square feet per bed for the first 100 beds and 27 square feet per bed for all beds in excess of 100, recreation requirements including director
South Carolina Yes Requires documentation of activities assessment, care plan and progress notes in medical record, and posting of the monthly activity calendar. Provides examples of types of supplies and equipment.
South Dakota Yes Requires integration of activity assessment in plan of care. Defines therapeutic activity.
Tennessee Yes Mandates activity calendar and documentation of resident attendance, direct access to secured outdoor area in Alzheimer's units.
Texas yes Requires minimal amount of continuing education and appropriate toys and recreational equipment for pediatric residents, outdoor space as space permits
Utah Yes Recreation therapy
Vermont Yes Secured outdoor space and walkways
Virginia Yes Credentials for activities coordinator are less than federal regulations (1 year of full time experience in the last five years versus two years). Encourages utilization of volunteers. Mandate activity assessment, implementation of plan of care, and documentation in clinical record, 10 square feet per bed with a minimum of not less than 225 square feet shall be provided. In multi-story buildings, a minimum of 225 square feet shall be provided on each floor.
Washington Yes Requires daily activities including evenings, activities program, outdoor recreation space in new construction
West Virginia Yes Allows for the provision of consultation if activities director does not meet qualifications for 12 months and outlines minimal time expectations for consultant. Job requirements of activities director include planning, implementation, assessment, care planning, documentation, and maintenance of resources, activities for special care unit
Wisconsin Yes Allows for the provision of consultation if activities coordinator does not meet qualifications. Establishes activity staff time per resident, and requirements for activities for persons with developmental disability.
Wyoming No Wyoming regulations for activities mirror Federal regulations

Complete Transcript of State Requirements on Quality of Life - Activities    (TOP)