Guilty. I am one of those women who strategically sets my Christmas deliveries and prays her husband is not home when the holiday packages from Amazon arrive.

However, on December 11, when 14 total boxes “with a smile” arrived at our home, I, for once, was not the one asking for forgiveness.

What was in those packages you ask? Better yet, who placed those orders?

Shocked, I had NO idea.

When I logged into my Amazon account, however, I quickly learned the consequence of “one-click ordering” in a household of tech savvy children.

Much to my surprise, a little 8-year-old someone had treated himself and the rest of the family to a few gifts, including: 15 Disney figures, in duplicates; two fresh apple air fresheners; a chest of princess dress-up clothes; 30 goblets; 12 wine glasses; four Waterford crystal glasses; and a single squishy unicorn.

If there is any lesson to be learned from my young Joseph, it is that sometimes life requires we take charge and treat ourselves.

Mom is busy. Dad does not shop. Christmas is near. Someone better take care of the family.

In a similar sense, I reflect on the individuals we serve as care providers every day in our skilled nursing facilities.

Now, more than ever, culture and regulatory change calls for them to take charge and direct their care.

The cultural shift from provider-directed care to person-directed care has carried over effectively into the updated state survey processes being implemented secondary to the Phase 2 Requirements of Participation.

Therapists, tune in. You are now an integral part of the new Critical Element Pathways being used to assess care.

Take, for example, the Activities of Daily Living Critical Element Pathway that engages therapy team members, in addition to the residents themselves in understanding and directing their care needs.

The ADL pathway is designated for use when individuals require assistance with or are unable to perform ADLs (Hygiene — bathing, dressing, grooming, oral care; Elimination — toileting; Dining — eating, including meals and snacks; and Communication, including — speech, language, and other functional communication systems) to determine if facility practices are in place to identify, evaluate, and intervene, to maintain, improve or prevent an avoidable decline in ADLs.

Following state surveyor record review and care observation, we see descriptive interview questions that engage all members of the interdisciplinary team.

The resident is central.

ADL Pathway Resident, Resident Representative or Family Interview Questions include:

•  How did the facility involve you in developing the care plan? Did you talk about your preferences and choices regarding care (e.g., when care should be provided such as bathing)?

•  Are you able to actively participate in ADLs? If so, what is your involvement? How and who instructed you in the interventions? Does staff provide encouragement and revision to the interventions as necessary?

•  Are you getting PT, OT or speech therapy for any of your ADLs? If so, how often do you receive assistance?

•  What type of interventions are done? Have assistive devices been provided (e.g., reachers, mobility devices, or communication devices)? If so, were you instructed on how to use them? If not, why not?

Furthermore, therapy team members should be prepared to respond to questions related to person-centered plans of care for individual residents receiving skilled therapy interventions.

ADL Pathway PT, OT, SLP or Restorative Manager interview questions include:

•  When did therapy/restorative start working with the resident?

•  How did you identify that the interventions were suitable for this resident?

•  What are the current goals?

•  How do you involve the resident or resident representative in decisions regarding treatments?

•  If the resident is not on a therapy or restorative program: How did you decide that the resident would not benefit from a program?

Therapist. Ask yourself: Are you prepared to respond to these questions?

Are your treatment plans for therapy inclusive of patient engagement and person directed goal setting?

Or, are your “one-click” physician’s orders the typical, standard care that you have historically delivered?

Let’s help treat those we serve to a Person-Directed 2018.

Most everyone who has heard the story of Joseph’s ordering fiasco has asked me, “What did you do to him?” and even better, “How in the WORLD are you going to return all that stuff?”

Well … It’s Joseph, and he has a way with Mommy.

We opened the packages together, celebrated all the individuals he had remembered at the end of the year, wrapped the gifts, and went on to treat friends and friends and family.

And, seriously, he treated me to those Waterford glasses. Couldn’t have directed that pick better myself!

Renee Kinder, MS, CCC-SLP, RAC-CT currently serves as Director of Clinical Education for Encore! Rehabilitation www.encorerehabilitation.com and acts as Gerontology Professional Development Manager for the American Speech Language Hearing Association (ASHA).