|(a) A facility must encourage socialization, cognitive
awareness, self-expression, and physical activity in a planned and
structured activities program. Activities must be individualized,
based upon the resident assessment, and appropriate for each resident's
(b) The activity program must contain a balanced mixture
of activities addressing cognitive, recreational, and activity of
daily living (ADL) needs.
(1) Cognitive activities include arts, crafts, storytelling,
poetry readings, writing, music, reading, discussion, reminiscences,
and reviews of current events.
(2) Recreational activities include all socially interactive
activities, such as board games and cards, and physical exercise.
Care of pets is encouraged.
(3) Self-care ADLs include grooming, bathing, dressing,
oral care, and eating. Occupational ADLs include cleaning, dusting,
cooking, gardening, and yard work. Residents must be allowed to perform
self-care ADLs as long as they are able, to promote independence and
(c) Residents must be encouraged, but never forced,
to participate in activities. Residents who choose not to participate
in a large group activity must be offered at least one small group
or one-on-one activity per day.
(d) Facilities must have an employee responsible for
(1) Facilities with 16 or fewer residents must designate
an employee to plan, supply, implement, and record activities.
(2) Facilities with 17 or more residents must employ,
at a minimum, an activity director for 20 hours weekly. The activity
director must be a qualified professional who:
(A) is a qualified therapeutic recreation specialist
or an activities professional who is eligible for certification as
a therapeutic recreation specialist, a therapeutic recreation assistant,
or an activities professional by a recognized accrediting body, such
as the National Council for Therapeutic Recreation Certification,
the National Certification Council for Activity Professionals, or
the Consortium for Therapeutic Recreation/Activities Certification,
(B) has two years of experience in a social or recreational
program within the last five years, one year of which was full-time
in an activities program in a health care setting; or
(C) has completed an activity director training course
approved by the National Association for Activity Professionals or
the National Therapeutic Recreation Society.
(e) The activity director or designee must review each
resident's medical and social history, preferences, and dislikes,
in determining appropriate activities for the resident. Activities
must be tailored to each resident's unique requirements and skills.
(f) The activities program must provide opportunities
for group and individual settings. On weekdays, each resident must
be offered at least one cognitive activity, two recreational activities,
and three ADL activities each day. The cognitive and recreational
activities (structured activities) must be at least 30 minutes in
duration, with a minimum of six and a half hours of structured activity
for the entire week. At least an hour and a half of structured activities
must be provided during the weekend and must include at least one
cognitive activity and one physical activity.
(g) The activity director or designee must create a
monthly activities schedule. Structured activities should occur at
the same time and place each week to ensure a consistent routine within
(h) The activity director or designee must annually
attend at least six hours of continuing education regarding Alzheimer's
disease or related disorders.
(i) Special equipment and supplies necessary to accommodate
persons with a physical disability or other persons with special needs
must be provided as appropriate.