As we look at Person Directed Care and individualizing our care plans and services, we need to review the coding of the MDS to ensure we are truly capturing the unique wishes and needs of each resident. There is no place where this is more important than with Section N related to activities. The emphasis here usually lies in the “general activity preferences” section that specifies the kind of activities (cards, crafts, T.V….) the resident enjoys. However we must not overlook the significance of “Preferred Activity Setting” of MDS Section N3.

The intent of this section is to identify settings that the resident prefers AND is at ease in. The setting itself may be a physical destination, but also includes differing circumstances that the resident will find him/herself in, prefers and is most comfortable in. For example, a preference for “own room” may indicate a preference for solitude and/or being ill at ease in crowds…

And while at one time, a preference to remain in one’s own room may not have been considered in the best interest of the resident (under the old Medical Model), we now understand that not only is this a Resident Right, but often a continuation of a lifestyle pattern that we are responsible to accommodate (and not just with activities; this means meals too).

Under the enlightenment of Person Directed Care we no longer assume a resident who wants to remain in their room must be depressed or is self-isolating. It is only when the preference to remain in their room is out of character, is new and in contrast to usual social patterns that we need to further assess.

Also remaining in one’s room does not imply “inactive” nor does it release us from the responsibility of providing in-room activities of the resident’s choice. For residents who can not state a preference, it is very important to get family’s input into usual patterns/ preferences. It is equally important for staff to observe reactions in group settings to assess comfort level. Residents with dementia and/or anxiety may become over-stimulated in large group settings and therefore in-room activities may be the preferred setting.

Getting input into the resident’s preferences implies an awareness of the options AND the possibilities. The MDS choices in N3 are very general and in working with the resident, we need to expound on what “off the unit" (how Medical Model is that!)” and “outside the facility” means. Remember the possibilities for activity settings are endless!

By Janice McCoy L.B.S.W., M.Ed.