Five Steps to an Effective 1-1 Program
By Debbie Hommel, ACC/MC/EDU, CTRS
Not all residents attend group functions, either by choice or by limited function or cognitive ability. Providing non group participants with 1-1 visits is a requirement that is sometimes hard for the activity department to meet. Many activity departments conduct 1- 1 visits when they have “extra time” which does not happen too often. The 1-1 visit program should be as organized and as structured as the group programs that are offered. This will ensure those needing visits will receive them and time is more effectively managed. Here are five steps to an effective 1-1 visit program which will assist you in organizing or streamlining your 1-1 visit program.
Step 1 – Identify those elders needing visits. The activity professional should review the 1-1 visit list monthly, to ensure it remains current and complete. Residents who refuse group participation as well as those who are limited in their attendance for a variety of physical or cognitive reasons are first on the list. Very often the short term resident is a good candidate for 1-1 visits as their schedule is limited due to therapy. Finally, it is good practice to place newly admitted residents onto the 1-1 visit list. Even though the newly admitted resident may adjust quickly and participate in groups, there is the potential that this resident may need additional support during the admission adjustment period. If the newly admitted resident adjusts quickly, they are not included in the next month’s updated list but they have received consistent attention and monitoring during their initial days in the community.
Step II – Organize the program. Based on the type of residents who are on your targeted 1-1 list, the scope and method of 1-1 visits can be determined. Creating a 1-1 visit cart or mobile way to transport supplies is good practice. The cart can be organized with a variety of supplies, appropriate for those needing the visits. The cart also contributes to the visibility of the program. Creating theme carts such as a garden cart or sensory cart is a popular approach. If the department lacks space for a cart, a large basket can be substituted. There will be greater success with an elder agreeing to participate in an in-room program if the materials are readily there. The equipped cart or basket can be a source of discussion and selecting the 1-1 activity can be part of the process.
Step III – Conduct the visits consistently. Scheduling room visit times into the posted activity calendar strengthens commitment to conducting the visits routinely. If the visits are not noted on the calendar and staff conducts visits when they have extra time, it is not uncommon for the department to “run out of time”. If the visits are scheduled daily at a particular time, we are as committed to conduct the visits as we are to conduct the structured group programs. There are various ways to assign responsibility to the activity staff as well. Some departments do well when each assistant has a defined caseload of residents to visit or the departmental staff may work collaboratively from a master list of residents needing visits. In either case, the responsibility is clearly defined and staff is held accountable for conducting visits as assigned.
Step IV – Involve the team and ensure on-going stimulation is available. In addition to structured activity staff visits, the federal regulations suggest 1-1 and in room programming is a team responsibility. On-going stimulation such as music, mobiles, specifically defined television or videos, independent pursuits and additional items can be left in the elder’s room. If the resident is unable to utilize the materials independently, the activity department can in-service the IDC staff on implementation and information should be included in the care plan. Volunteers can also be a great source for 1-1 visit interventions. The clergy and spiritual volunteers, pet therapy volunteers, traveling musicians and more can supplement the 1-1 visit program.
Step V – Monitor. Since there may be various individuals (volunteers, IDC staff and activity staff) offering visits, an organized monitoring system should be introduced. Many of the electronic documentation systems include the IDC staff in documenting their 1-1 visits. The volunteer visits can be accounted for through simple lists which they would return to the activity office with their comments. If still using paper monitoring systems, keep it simple and focused on key points such as date, timing, intervention offered and resident response.
With organization and clear systems in place, the 1-1 visit program can easily be a part of our day to day programming. With appropriate and varied supplies available to staff, the visits can be individualized to interest and need.
7 hour NCCAP pre-approved continuing ed program
“Developing an Individualized Visit Program”