Forms & Templates

My Life Timeline

This activity is excellent for reminiscing and it is suitable for residents with Dementia and Alzheimer's where the long term memory is preserved. It is most suitable for one-to-one sessions but it can be done as a group activity as well if the residents can fill the document by themselves or if you have support from volunteers.

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Thank You Speech for Nurses & Staff

Here is a sample message you can adapt to thank nurses and staff at your facility!

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Free Activity Calendar for Seniors

You can now add Daily Schedules, Icons, and Print at a variety of sizes! This easy to edit activity calendar can be pre-filled with upcoming events and celebration ideas for nursing homes and assisted living facilities. A perfect resource for activity coordinators working with the elderly.

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Cue Cards for Dementia Care

Cue Cards or Communication Cards are visual tools that can be used to overcome communication difficulties with clients living with dementia. They assist and support caregivers, staff and volunteers to engage with the person in their care.

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Social & Cultural Profile Form

The Social & Cultural Profile Form is an important part of the overall assessment of each individual entering long term care.

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Dementia Program - Weekly

This sample program is for acute Dementia care. Some people like to do it weekly, others monthly. Download the form and adjust it to suit you.

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Work Instructions and Procedures

A 'Work Instructions and Procedures Manual' is important because it assists all recreation and volunteer staff to conduct activities in the same manner. Routine, as we all know, in an aged care facility is conducive to harmony and contentment.

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Risk Assessment Form for Activities

Risk Assessment form for There seem to be  plenty of risk assessments for external activities and bus outings but I couldn't source one for internally run activities so have formulated a Base template for internal activities risk assessments.activities

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Glossary of Terms for Activity Professionals in Senior Care

The following glossary contains many common terms used by Activity Professionals working in senior care. It is not a complete list but may be used as a reference point for newcomers to the industry.

Diversional Therapy Information Sheet

When a Resident transfers to another facility for any such reason, it is, I'm sure, very helpful to the next DT/Activities person, to know a little about the 'new' Resident immediately on transfer/arrival.

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Activity Evaluation Form

Here is an activity evaluation form that I used in the past. Each facility will have their own version. It is called a Monthly Program Evaluation and it consists of one sheet for each week of the month;

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What to Include in a Staff Meeting

It is necessary to communicate regularly with your staff. You should have a formal meeting at least once per quarter.

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Sample Activities Calendars

Sample monthly and weekly activity calendars for activity coordinators working in nursing homes. I know from experience that when i first started at a rest home I was thrown in the deep end, and I just thought by sharing this it may help out a newbie to develop their activities program. This is a wonderful resource to help you plan ahead. Thanks to everyone who has shared their calendar.

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How to Conduct an Activities Survey

A Guide for Activity Coordinators working in Senior Care. Ask your clients for feedback regarding your Program and how to improve it. Survey template included.

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The Benefits of Mindfulness Meditation for the Elderly

In nursing homes and other long-term care facilities, loneliness, depression, and anxiety are considerable risk factors for residents. Mindfulness may help elders to find peace within themselves with daily practice.

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How to Plan & Implement an Induction & Orientation Program

This article provides a general guide Activity Coordinators can use to plan and implement an Induction & Orientation Program; the specific requirements for each facility will differ.

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Activity Goals Presentation

Power point presentation on activity goals.

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Leisure & Health: Policies & Procedures Handbook

The step by step instructions of this handbook allow Activity staff to clearly understand their roles and responsibilities as well as the routine and practices expected by residents.

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Mealtime Placemats

We have created mealtime placemats to assist with mealtimes, highlighting individual client needs.

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Daily Attendance Forms

Most residential facilities have their own attendance form however for those of you looking for something different, or if you find the template you are currently using is inadequate, here is a sample and template attendance form.

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How to write Progress Notes

How to write objective, concise and professional Progress Notes. 11 Examples of progress notes, both good and bad versions, included.

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My Story - Short Biography Template

Here is a sample of a Life Story Template for you to use.
These are only ideas, you may have questions of your own relevant to the person you are talking to.

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Newsletter Template 1

A newsletter is an asset to your facility and an effective way of letting all concerned know what's going on. Remember that you are writing about the residents and for the residents.

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Monthly Activity Attendance

There are a few ways to record programmed actitives attendance. This is an individual one. The advantage of this one is that you can see at a glance how the resident is doing.

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Health & Lifestyle Survey

The 'Health & Lifestyle Survey' is a tool used to determine whether the respondents have a positive view of the facility and the care being provided.

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Social Outing Evaluation Form

The evaluation of social outings can be done in various ways. Keep in mind your objectives for the outing and write about your observations.

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Annual Report

The Diversional Therapists Annual Report is a wonderful forum by which to communicate effectively to your manager and peers without letting your emotions get in the way.

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Annual Events Calendar

The attached sample calendar is for the sole use of the Leisure Coordinator or Recreation Therapist, so she/he can swop and change dates as they see fit. If dates fall on the weekend you may change it for a weekday.

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Social Outing Information Sheet

Social Outings should be carefully planned, with safety always being the utmost priority. The ratio of carers per resident depends on the capabilities of each resident.

Checklist for Social Outings

A checklist is the best preparation for social outings. It's also great for piece of mind!

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Volunteer Work Record

All volunteers need to keep record of their hours. Here is a form that facilitates the process.

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Volunteer Application for Employment 1

This is a sample application form for someone applying for a volunteers position.

Volunteer Application for Employment 2

Another sample application form for someone applying for a volunteers position.

One-on-One Visits

One-on-One forms are useful for recording individual visits. Individual visits are interventions used to support residents who are ill, unable to attend programmed recreation or simply refuse to leave their rooms.

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