05/08/2025

Survey Tip of the Week: Activities-Related Interventions

In the State Operations Manual Appendix PP, CMS emphasizes that for residents with dementia, a lack of meaningful, engaging activities can lead to boredom, loneliness, and frustration, resulting in distress and agitation. Surveyors are looking closely at whether activities are individualized and tailored to each resident’s previous lifestyle, preferences, and comforts. Facilities should identify patterns of behavioral symptoms and proactively provide activity interventions before distressing behaviors escalate. Once a behavior intensifies, an activity intervention may be less effective or could even increase stress for the resident.

A recent F679 citation highlighted the consequences of missing this proactive approach. A surveyor observed a resident who was tearful and attempting to exit the facility. While staff tried to redirect her, the resident became more verbally agitated. Upon record review, the surveyor found no documented interventions or individualized activities designed to address the resident’s exit-seeking behavior.

CMS provides examples of interventions that may help residents exhibiting increased energy or walking without purpose:

• Providing a space and environmental cues that encourages physical exercise, decreases exit-seeking behavior and reduces extraneous stimulation (such as seating areas spaced along a walking path or garden; a setting in which the resident may manipulate objects; or a room with a calming atmosphere, for example, using music, light, and rocking chairs);
• Providing aroma(s)/aromatherapy that is/are pleasing and calming to the resident; and
• Validating the resident’s feelings and words; engaging the resident in conversation about who or what they are seeking; and using one-to-one activities, such as reading to the resident or looking at familiar pictures and photo albums.

Ultimately, the goal of individualized activities is to help reduce or eliminate distressing behaviors. If the activity is effective, it validates the intervention; if not, it signals the need for a different approach.

CMS has updated the survey resources on the CMS Nursing Home webpage in accordance with the revised QSO-25-14- NH memo. LeadingAge Ohio encourages facilities to monitor compliance using the surveyor guidance found in the State Operations Manual Appendix PP . Additionally, the survey pathways can be found in the Survey Resources zip file on the CMS Nursing Home webpage and under the downloads section on this CMS webpage. LeadingAge has developed webinars and resources on the requirements of participation which are located on the LeadingAge learning hub. LeadingAge continues to add QuickCasts on the regulatory groups. Updated resources have also been added on the Nursing Home RoP Tools and Resources webpage.  

 

For more information about the requirements of participation and citations occurring in Ohio, please join us on the monthly STAT: Survey Tips and Tactics call. Register now for the May 14 call at 11:00AM. LeadingAge Ohio is sharing tips to assist members during the survey process. Send questions you would like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org.