Running Head: A CONSULTATIVE PROGRAM 1

A Consultative Program for Staff Working with Adults with Physical and Cognitive
Impairments:
An Adult Day Services Habilitation Program in Salt Lake County
University of Utah
Jessica Brauzer
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The purpose of this assignment is to determine how to incorporate the perspective of an

occupational therapy student into a program of an underserved population in the community. A

needs assessment was conducted and involved one-on-one informal interviews with staff, data

collection, observation of initial intake assessments completed by staff and administered to new

clients, and personal observation of group interventions among clients and staff. After further

analysis of the Neighborhood House (NH), it was concluded that there is a need for a program

that objectively evaluates and measures outcomes that will allow the staff to assess how clientele

are declining or progressing through their services. After an assessment of the setting, and a

comparison of the NH to other Adult Day Service (ADS) programs through literature reviews, a

consultative program will be developed and proposed to assist with the current needs of the

Neighborhood House.

Description of Setting
Philosophy and Mission
The NH Adult Day Center is a state licensed social rehabilitative program which provides

quality adult day services to those who are in need of daily supervision and structure due to

limited functional independence. The NH adult day program philosophy is to 1) prevent

premature placement in long term care (LTC) facilities, 2) provide respite for caregivers (CGs)

and family members, 3) provide a combined social and rehabilitation program model to clients,

4) educate the community on ADS, and the benefits to this type of rehabilitative program versus

LTC or a skilled nursing facility (SNF), and 5) provide affordable care based on a sliding fee

scale, making the services accessible to all. The mission of the NH “is to enrich, empower and

educate children and adults through quality affordable day care and support services.”

(Neighborhood House, 2018).

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Staff Disciplines

There are various staff positions at the Neighborhood House. The higher up positions

include the Board of Trustees, Executive Director, and the Program Director, who are salaried

employees. Other positions include Site Manager, Administrative Assistant, Lead Activity Aide,

and Activity Aides/ Van Drivers, all of whom receive hourly based pay. The Program Director

oversees the Adult Programs, with responsibilities including overseeing/directing staff, attending

monthly administration meetings, implementing agency policies, submitting and maintaining the

annual budget, case managing clients problems, meeting with CGs as needed, and implementing

staff in-service meetings, etc. Qualifications for this position include a minimum of 5 years’

experience in health care or relatable field.

The Site Manager manages the staff, maintains the budget, schedule, quarterly newsletter,

develops quarterly goals for the program, and addresses staff and client concerns. Qualifications

for this position include Therapeutic Recreation Specialist (TRS) and Certified Therapeutic

Recreation Specialist (CTRS) or bachelor’s degree in a related field. The Administrative

Assistant position answers phone inquiries, maintains confidentiality, prepares daily attendance

sheets for clients, etc. Some of the role qualifications include at least 18 years of age, high school

graduate or equivalent, obtains health exam and TB test, and has good customer service,

especially with the elderly and ill.

The Lead Activity Aide directs the staff activity aides in leading client interventions,

encourages client participation in all activities, assists clients with ambulation needs, as well as

assists with toileting, personal hygiene, dressing, feeding, meals and all other ADLs as needed.

The Lead Activity Aide qualifications include 18 years of age, current certificate as a Certified

Nursing Assistant (CNA) or Therapeutic Recreation Therapist (TNT), valid state of Utah
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Driver’s License, First Aid and CPR, ability to drive a 12-15 passenger van, and has the ability to

work in a standing position for an extended amount of time, etc. The Activity Aide qualifications

are very similar to the Lead Aide, however the difference is they do not require a certificate as a

CNA or TNT, nor do they lead or direct other Aides. Before beginning employment each staff

member is provided with a NH policy and procedures manual in which they need to thoroughly

review within the 30 days of being hired. The new hire manual check off requirements include:

ensuring they understand potential conditions they may encounter with their clientele, emergency

procedures, confidentiality, food handlers permit, and a 6 question multiple choice training quiz,

just to name a few (NH Policy and Procedures Manual). A new individual was recently hired to

the Neighborhood House, as a Program Coordinator. She is a CTRS and is working with the

Program Director on revamping the assessment and incorporating interventions that will help the

staff to objectively measure client’s progress.

History

The Neighborhood House began in 1894 when Utah was still a territory. The organization

was first operating solely as a kindergarten mainly for underprivileged children who were in

need of food, clothing, care, and guidance. After various services were added, such as a milk

station, a public playground and an employment bureau for women who were seeking work, the

organization decided to provide intergenerational care, and open an adult day care center. It was

the year 1978 and the women who had formed and developed quality and affordable care for

children decided that these same services should be provided for adults with disabilities

(Neighborhood House, 2018).

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Target Population
The Neighborhood House Adult Day Center aims to help adults ages 18 and over with

physical and/or cognitive impairments age in place. Each individual is supported and respected

by the staff members, and their daily routine is based on activities centered on

emotional/spiritual, cognitive, physical, and social stimulation. Many of the clients have

dementia or Alzheimer’s disease, traumatic brain injury (TBI), stroke, developmental disabilities,

or are isolated during the day that they are in need of daily supervision. The staff to client ratio is

1:6 which enables intimate interaction, participation, and encourages independence at the

facility. This helps to delay placing the clients with disabilities in an LTC (Neighborhood House,

2018).

External Influences on Adult Day Services

Policy. According to fhwa.dot.gov, Title VI of the Civil Rights Act of 1964 prohibits

discrimination based upon race, color, and national origin. Specifically, 42 USC 2000d states

that “no person in the United States shall, on the ground of race, color, or national origin, be

excluded from participation in, be denied the benefits of, or be subjected to discrimination under

any program or activity receiving Federal financial assistance.” (U.S Department of

Transportation, 2018). The Neighborhood House is a public non-profit entity, and it is policy that

it stays in compliance with Title VI. If an individual feels that he or she has received unlawful

discriminatory practice under this Title, then he or she may file a complaint no more than 180

calendar days after the alleged incident with the NH Civil Rights Department or an affiliated

individual. The NH has 10 business days to investigate the complaint filed by the complainant

(Neighborhood House, 2018).

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The NH also acts in accordance with the American with Disabilities Act (ADA) of 1990.

This allows those individuals with disabilities to be protected and granted their rights as

indicated by the 5 Titles that the ADA consists of. These titles include: Title 1-Employment,

Title 2-Public Entities/Transportation, Title 3- Public Accommodation, Title 4-

Telecommunications, and Title 5- Miscellaneous Provisions (NH Policy and Procedure Manual,

p. 58). Lastly, the NH is held to high standards of providing quality service to their clients. In

order to ensure these services are being provided, the NH must abide by 6 quality assurance

requirements. These include 1) yearly family survey to evaluate customer satisfaction and the

impact on clients and their family members, 2) yearly audit by the state adult day services

licensure committee, 3) yearly audit by State of Utah Department of Human Services, 4) budget,

program outreach, enrollment review, etc by the Board of Trustees, 5) documentation of the

quarterly progress notes which state the type, frequency, and level of participation of activities

that the clients are involved in, and 6) yearly audit by a Private CPA Firm (NH Policy and

Procedure Manual, p. 57).

Geographic. The Neighborhood House Adult Day Center has two locations: one located

in Riverside, while the other is located in Cottonwood Heights. Since I am mainly completing

my fieldwork at the Riverside location, I will provide geographical information on this area. The

Riverside NH is located in the Poplar Grove neighborhood of Salt Lake, which lies North of

Glendale and South of Rose Park. Poplar Grove lies on the West side of Salt Lake City,

stretching from I-15 to Redwood Road and from 950 South to 2100 South. It is the second

largest neighborhood in SLC (after Glendale), is one of the most culturally diverse, and has a

population of 17,922 residents (Niche, 2018). Poplar Grove got its name from a grove of trees

that the Rushton family planted in area in the late 1800s, where it was initially named “Popular
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Grove” (Salt Lake City, n.d). The community is predominantly of Spanish influence, where the

locally owned markets and storefronts cater to the Spanish-speaking community. The area is

known for its low home prices, and delicious Mexican restaurants. With Poplar Grove being a

strong working class, it also has numerous healthy families and many great schools around the

area. The city is also continually working to connect Poplar Grove and other Westside

neighborhoods to the rest of the city. Such projects include the 9-Line Trail, the Jordan River

Parkway, and Folsom Trail (Building Salt Lake, 2017).

Sociocultural. Although Poplar Grove is known for its affordability, and is made up of

mostly young couples and families with young kids, the crime rate in the area is a problem.

According to FBI statistics on areavibes.com as cited in move.org, “Poplar Grove has

significantly higher rates of violent crime and property crime than the Salt Lake City average”

(Move, 2018). While it does not currently appear to have an impact on the NH, if the crime rate

continues to spike, this could hinder the clientele attendance, causing families to move away

from the area. While the area may have a higher crime rate than other neighboring areas, Poplar

Grove continues to have a strong sense of community. The Poplar Grove Community Council is

quite active, hosting events and public forums. The Neighborhood House, Chapman Library

Branch and Lied Boys and Girls Club all help families find enriching activities and child or adult

day care (Move, 2018).

According to the fall 2018 report, in the first six months at the NH, the organization

brought their clients on 33 field trips which included local gardens, museums, libraries and

various organization outings. This showed a 10 outing increase from 2017 portraying how the

NH was active with their clients in getting them outdoors and exploring SLC. Not only do the

adult clients at the NH receive great care, but the neighboring child care center allows for an
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intergenerational focus. Intergenerational care brings a sense of renewed youthfulness and joy to

the elder adults, allowing them to share stories, engage in art, and feel less isolated when sharing

a space with children. The NH also uses evidence-based outcomes to track the success of their

program. Some of the outcomes for calendar year 2018 include: 1) 4,518 days of care has been

provided for 95 elder adults and those with disabilities, 2) 11,630 meals were served at both

Riverside and Cottonwood locations, 3) 88% participation of clients in daily activities which

exceeded a goal of 80%, 4) the organization achieved 87% of their individualized client care plan

goals which exceed the goal of 75%, and 5) 6 adults received $15,490.50 in hardship assistance

in 2018, which reduced their cost of care to zero for 3-6 months. (Neighborhood House, 2018

Fall Report).

Economic. The west side of Salt Lake has a reputation of being lower socioeconomic

status. Poplar Grove is a suburban neighborhood with a fairly low cost of living. According to

niche,com, median home values average around $145,942 and a median household income of

$41,352 (Niche, 2018). The NH offers services that are provided on a sliding fee scale. By

operating on a sliding fee scale, this makes it accessible to families of all income levels. The

organization is also one of two ADS services in Salt Lake County contracted with the VA which

allows this adult day service to be provided to veterans.

According to 2018 statistical data, annual household income was collected for 76 out of

the 100 clients who attend the day care center at the NH. Data shows that the vast majority, 28

clients were making extremely low income of approximately $15,550, whereas 6 clients were

making $61,993 to $1,000,000. The average annual income reported at $29,037, showing that the

NH holds true to providing care for families of lower income levels. Data was also collected on

the breakdown of payment source for the Neighborhood House for their 100 clients. The
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breakdown shows that 26 clients are paid through the VA, 55 clients are through Private Pay

(PP), 3 are paid through Utah’s Division of Services for People with Disabilities, 9 clients are

paid through Salt Lake County, 5 are through Scholarships, and 2 are through Medicaid. With

clients attending the NH, the average daily rate was $47.24, and those with PP paid $38.85. The

number of clients who received a sliding scale fee was 38 out of the 100 enrolled (NH Statistics,

2018).

Political. The Neighborhood House does not gather data on their client’s political

affiliation. According to utahpolicy.com in Salt Lake County, 42% of the population are

affiliated with the Republican or conservative side, whereas 40% affiliate themselves as being

Democrat or liberal. As far as religious preferences in Salt Lake County, 38% of the population

are active Latter Day Saints (LDS) members, while 33% say they have no religious affiliation

(utahpolicy.com, 2018). With the Neighborhood House not gathering data on an individual’s

political or religious affiliation, this shows that the non-profit organization is welcoming of any

individual regardless of the party or religion they are associated with.

Demographic. At the Neighborhood House, the majority of clients (84%) are Caucasian

with a total of 83 out of the 99 clients who reported. The gender breakdown shows that males are

a bit more predominant at the NH with 59 clients being male, and 41 are female. As for the 99

clients who reported marital status, the breakdown shows: 21% are single, 40% are married, 8%

are divorced, and 30% are widowed. Lastly, the average client age is 79. The youngest age range

is 25-30 years old, whereas majority of clients range in age from 85-90 years old. With the

majority being elderly, this shows how much more valuable and important it is for interventions

to be focusing on cognitive, emotional, physical and social stimulation.

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Services Provided for Adult Day Services

Related Services for Clients. Clients have the opportunity to attend the Neighborhood

House’s recreational day program from Monday through Friday, between 7:30am until 5pm.

Majority of clients typically arrive around 9am and leave around 4pm. The day is structured with

8-10 therapeutic activities that match one of 4 domains such as cognitive, physical, emotional

and social (Neighborhood House Adult Care, 2018). These 4 domains are structured in the

morning and afternoon, with a lunch break dividing the day’s activity schedule in half. Here is an

example of how the day is planned: 10am-emotional activity, 11am-physical activity, 11:30am-

social activity, 12pm-cognitive activity, 12:30pm-lunch, 1:30pm-physical activity, 2:00pm-

cognitive activity, 2:30pm-emotional activity, and 3:30pm-social activity. An example of a

monthly calendar of activities is provided in Appendix B.

Staff: The Director and Site Manager administer an assessment to clients when they

initially join the NH. The assessment is the Adult Activity Measurement Tool (AAMT), which is

based off of the Saint Louis University Mental Status (SLUMS) examination which helps detect

mild cognitive impairment to dementia. A sample page of the assessment is provided in

Appendix C. The assessment was developed by the NH in 2014 by Recreation Therapists as a

way to measure progress and baseline data in an adult day center setting. The assessment is made

up of a physical, social, leisure, spiritual, emotional observed affect, and cognitive aspects. After

clients are assessed, an individualized care plan must be written up within 30 days. The plan

includes 2-3 objectives revolving around a physical, cognitive, social, emotional, and spiritual

goal. Lastly, client’s participation is charted daily by the Lead or Activity Aides who are also

leading the activities. The Aides will typically chart early in the morning, or at the end of the
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day. The information is put on a spreadsheet that is divided into the 4 domains and each client is

listed alphabetically. The Aides will then subjectively rate the client’s participation (for each

domain) for that day based off a 4 point scale, with 1 being 25% and 4 being100%.

Community Partners. The NH acts in partnership with various organizations in the

community, and these partners help to support the NH program. Some of these partners include

Salt Lake County Aging and Adult Services, University of Utah College of Nursing and Health,

Westminster, Seniors Blue Book, and Silverado Hospice (Neighborhood House, 2018).

Funding Sources. The Neighborhood House is a non-profit organization that relies on

donations from corporate and individual sponsors, such as United Way of Salt Lake, Zions Bank,

and Google Fiber, etc. (Neighborhood House, 2018). Not only does the organization receive

assistance through donations, but from trust money and federal and state grants. The NH has a

contract with the Veterans Administration (VA) which enables veterans to receive affordable and

quality care.

Future Plans. In 2016 the Neighborhood House spent time deciding whether to remodel

or build a new facility. After almost 60 years in their current building which is 5,650 square feet,

it was decided it would be cost effective to build and expand, rather than remodel. This is how

the Open More Doors Campaign started. By 2019, a new 57,000 square foot facility will be built

on 5.5 acres (adjacent to the current Riverside Adult and Child Center Buildings), and it will not

only combine both Adult Day Centers, but the children’s center as well. This facility will be

much bigger than the original building and will be able to serve 100 additional families. It will

help to strengthen the NH’s focus on intergenerational activities. Plans for the Adult Day Center

in the new building include a Library, Kitchen, Adult Foyer, Transportation Hub, Art Studio,
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Adult Kitchen, Adult Dining Room, Adult Craft Room, Adult Gardens/Walking Paths, and

separate Adult Living Rooms for low and high functioning clients (Neighborhood House, 2018).

Staff, Client and Caregiver Perspectives on the ADS Program, and Strengths and Areas for

Growth

Program Director Perspective. A one-on-one informal interview was conducted with

the Program Director at the Riverside location. While she is proud of the work they do, she is

energized and prepared to revamp the program. She was asked clients regarding the strengths,

areas for improvement, relevant needs, the comparison of NH to other programs, and if the

program had unlimited funds. The strengths of the organization include 1) intergenerational

opportunities, 2) partnerships with institutes of higher learning such as the U and Westminster, 3)

the community partnerships are tremendous, 4) the organization gets good referrals from the VA,

as the VA recognizes the organization as a program of distinction, 5) and it has been a sustained

program for 40 years. As for the program strengths, she feels there is great support by the Board

and Executive Director to improve quality care for the clients and staff development where

possible.

She also shared her top priorities for the program. These include 1) identification of

measurable outcomes for the client, 2) identification of measurable outcomes for the caregiver,

3) identification of current evidence based assessments for client evaluation and re-evaluations,

4) clearly defined and individualized written client goals, 5) staff training (in particularly,

trainings on how to engage clients, how to re-direct agitated clients, how to have resilience in a

tiring job, and literacy services) and 6) caregiver communication. Based on the NASA Research

Committee ADS Outcomes 2015 Survey, the measurable outcomes she felt would be pertinent to

the client’s success included Falls Rate, Depression, Loneliness and Social Isolation, Cognition,
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and Quality of Life (for both clients and CGs). Some areas for improvement in the organization

include 1) staff recruitment and retention as it relates directly to wage competition in the local

market.

As for the most relevant needs for the clients at the NH, these would include 1)

incorporating the kids more in adult day care activities, 2) breaking the adult clients into smaller

groups in order to get them engaged and to stay in engaged, and 3) differentiating the curriculum

so the clients’ needs are met individually. The NH program is a social and recreation program,

and is not medically based. She feels that if the program was compared to other similar

programs, or the private sector, what is lacking would be their budget. As for unlimited funds,

both she and the new program coordinator believe additional programming ideas may include

Horticultural Therapy, a Sensory Room through “Sensory Works”, Smart Technology such as

Alexa or “Hey Google”, an Interactive White Board or Touch Screen TV, Virtual Reality, a Dark

Room, Photo Printer, a Frisbee Disc Golf Course, additional Staff, and more Trained Therapists.

Program Coordinator Perspective. A one-on-one informal interview was conducted

with the new Program Coordinator at the Riverside location. Although she has only been with

the program for approximately two weeks, she recognizes the current strengths of the program

and organization include 1) staff members who care and have enthusiasm for the clients, 2) the

organization has good access to community supports and funding opportunities, 3) the

administrative team is passionate about what they do, and they have a desire to make things

better, as she is able to feel that, and 4) the community involvement with the NH. As for NH

program needs, she believes there should be more staff training on the floor, as well as a better

assessment. She feels that the staff does not involve everyone on the floor, as she will see many

clients sleeping. She wants the staff to get everyone engaged, such as having 1 staff member
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form a mini group for the clients who do not appear to participate as much. As for activities, staff

should be cognizant of the resources available to them. There is an art room that should be used

for activities such as chalk or a painting project. The staff also play Bingo a lot. They should

grade the activity up or down to make it a just right challenge for the client. Overall, the biggest

need she feels is the implementation and functionality of the current program by the staff

members.

Site Manager Perspective. A one-on-one informal interview was conducted with the

Site Manager of the Cottonwood location. When asked about her role, and the various

responsibilities it entails, she stated “to be honest, I got into this position (Site Manager) 5 years

ago, where I shadowed the previous manager, and I did not receive any formal training. As for

the initial assessment that is administered to clients (she administers to clients in Cottonwood),

she stated that there are various areas on the assessment that she would like to change. This is

what she would like changed, added, or to pose a question about: 1) add a current president

question, 2) change the day of the week question, (she asked, “How do we score the client if they

look at their watch?), 3) there should be different levels for the questions based on the clients

functional abilities (for example low versus high functioning, or certain disabilities), 4) How do

we assess a client who is non-verbal, blind or deaf?, 5) We have clients who are different kinds

of learners (visual, auditory, tactile), can they write out the math problem question? 6) I would

like to ask them a reminiscing question (this may help to jog their memory). As for the general

physical assessment she administers, she stated, I would like to change the finger opposition

question, or it would be nice to come up with a physical assessment that caters to all varying

physical conditions.
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When I asked her about how often the clients are re-evaluated she stated that they are

initially evaluated at their baseline level within 3 days of intake. Then they are reviewed after 30

days to review their care plan. After this, they are re-evaluated quarterly, or every 90 days. When

I asked her about the care plan objectives, activities for the clients, and information for the CGs,

she responded, “As for the care plan objectives, the majority of clients have the same domain

objectives written out, which doesn’t necessarily individualize it to each client.” She stated that

for the activities, some of her clients have issues with sensory stimulation, making it challenging

for them to participate in an activity. She recognized that a sensory room or activities for sensory

stimulation could be helpful. As for CGs, she believes they should receive educational handouts

when their loved one is initially accepted into the program.

Lead Activity Aide Perspective. A one-on-one informal interview was conducted with

the Lead Activity Aide at the Riverside location to gain a better understanding of her thoughts

and beliefs on the current ADS program. She was asked questions regarding the assessment,

client’s objectives, measurable outcomes, staff training, CG interactions, and client activities.

She was asked about the strengths of the facility and the areas for improvement. Regarding the

strengths, she stated that the staff members are great to work with, and the clients bring a lot of

joy to her day. After observing some sessions that she led, I came to a similar conclusion. She

has a fun and witty personality, randomly gets up and dances with the clients, and is flexible and

willing to change on the fly if it appears that the clients may be disinterested in the current

activity.

During our interview, I asked her about the assessment and if there was anything she

would change. She feels that it is an unfair assessment for those clients who do not know how to

read or spell, or are highly cognitively impaired, especially when asking them to do math. As for
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the individualized objectives that are written for each client, she feels they should be

individualized to suit the client’s needs or abilities, and not generalized by each domain. When

asked about measurable outcomes to look at, she stated that she is about the whole spectrum

rather than just one area. She would like to measure the individual’s quality of life, or

participation capabilities based on their low or high functioning abilities. As for tracking client’s

progress on a daily basis, she said she would like to get rid of the 4 point system because she and

her staff subjectively measure the client’s participation. She feels that not all of the staff

members are on the same page, and the whole process needs to be more objective. She would

like to have an assessment or measurable sheet to refer to for scoring their clients.

Regarding the CG interaction, she says that she interacts with them enough. She stated

that sometimes the CGs have a huge standard that the staff cannot follow through on. She stated

“for instance, they want us to change their loved one’s briefs, however, we operate on a

donations only basis, so we work within our means.” When asked about staff training, she stated

that she would like more training on emergency procedures and what to do.

Lastly, she was asked about the client activities. She feels that they are often a bit

disorganized with their daily schedule, and finds herself scrambling to look up an activity to do

and then implement it on the spot with the clients. She would like more structure to the activities,

and to know which activities are going to be implemented way ahead of time, rather than the

night before or day of, which has frequently been the case. After spending time at the NH, I

know that the monthly calendar of activities is posted around the facility, which allows clients

and staff to see the various activities and the domains that will be focused on. However, the Lead

Aide feels that the activities often change, or are unavailable to the clients. When I asked her

about potentially incorporating OT related interventions, she agreed that this would be helpful.
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Interventions such as Balance and Fall Prevention, Physical Endurance, Social Skills (she stated

they do Emotional Bingo where they talk about their emotions), Safety Awareness, and Sensory

activities were all ideas that sparked her interest with the clientele.

Client Perspective. Two informal one-on-one interviews were conducted with clients at

the Neighborhood House. The first client, who is 27 and has Williams Syndrome, shared what

she enjoys about the NH and what she feels needs to be implemented there. She enjoys the music

activity they have. She loves to dance and sing, and finds that this is a great way for her to

combat her anxiety and depression. However, with her anxiety and depression, she stated that

she has many overwhelming moments and the only places to escape to are the sun room and the

back room. She believes a Therapist should work at the NH so she has someone to talk to. She

then went into explicit detail on what may have triggered her anxiety and depression. She stated

she was bullied as a child, she has been verbally abused by her step father, and 3 years ago her

mother was diagnosed with ALS. She feels that an activity that is easy on her bones should be

implemented at the NH. When I asked her about yoga or stretching, she responded, “yeah,

stretching would be really nice.” As I observe her engaging in activities at the NH, I can see she

is quite the life of the party. While she is the youngest attending the NH, she is extremely

sociable, and appears to be a great leader to all of the other clients surrounding her. In fact, when

I first arrived to the NH, she pulled me aside to the back room and gave me the low down on all

of the clients there.

I then spoke with a 75 year old male client at the NH to get his perspective. This client

has mild dementia, and suffered a brain injury from a car accident where he lost majority of his

vision. While he may be blind and have a mild cognitive impairment, this man has the most

positive outlook on life. He shared so many vivid memories and experiences with me as a
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climbing guide and how being outside in nature is his meditation of choice. When I asked him

about what he enjoys about the program, he responded, “The people here are just great. They are

kind, loving and helpful. They are angels to me.” This man really put life into perspective for

me. He shared with me the connections he has made with people, and how it is important not to

whine, as you only have so much time in life.

Caregiver Perspective. I did not interview any caregivers, however, I did receive the

2017 annual caregiver survey to see what their feedback was on the program. There were 36

caregivers who participated in the survey. The results of the survey were quite lengthy, thus I am

going to provide the entire 2017 report in appendix D, at the end of this paper. However, I will

provide two areas of importance for CGs. One such area was the reported effect that the NH

ADS has on caregivers. Fifty percent of respondents reported that they were able to seek or

maintain employment with their loved one attending an ADS. Fifty percent reported that their

health has improved with their loved one attending the NH. Ninety seven percent reported they

experienced a decrease in their stress level and could perform better (with fewer distractions at

work) with their loved one attending the NH. Sixty seven reported that they were better able to

meet other household expenses. Secondly, CGs reported future uses of NH facilities. Results

showed that 58% would use it for caregiver support groups, 28% for community classes, and

28% for access to other service providers. There was less interest in using the NH for social

events (11%), and a community meeting space (8%) (ADS Client and Caregiver Survey 2017

Report).

Graduate Student Perspective. Through a combination of data collection, one-on-one

informal interviews, continual open conversation, and observation of group activities and staff
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charting, I was able to gain a better understanding of the strengths and areas for improvement for

the current NH adult day services program.

Strengths. The current program is supported by caring staff members who show a great

interest in the well-being of their clients. They integrate many of the clients in a variety of

activities, help those with feeding difficulties, and provide helpful feedback to caregivers as

needed. The administrative team and staff aides work hard at gathering data and have begun

brainstorming program interventions for the new facility. It is also readily apparent on how

connected the NH is with the community. They receive great support and funding from local

partnerships. Another strength is the high client attendance. Although I am at the NH 1-2 x/week,

I see the same faces every time. This to me shows that the clients enjoy attending the program

and look forward to a structured routine each day. Another strength is the high percentage of

caregiver’s who receive respite and the ability to maintain employment with their loved one

attending the program, based off of the 2017 report.

Weaknesses/Areas for Improvement. Although the clients have a supportive team at

the NH, there are some areas for improvement. One area is client documentation. After

reviewing the client assessment, it does not appear that what is initially measured or assessed,

matches up to the interventions that are implemented. It is important to implement a holistic

evidence-based assessment that will provide the assessment administrator with a clear

breakdown of the various domains that can be individualized to the client and may help them to

progress. It is also important to re-evaluate a client’s progress, more frequently, as opposed to

quarterly.

While measuring a client’s participation is a valid outcome, it may be vital to objectively

measure other evidence-based outcomes (such as QOL, depression, cognition) in order to

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pinpoint various areas where a client is declining or progressing. Through observation, I

witnessed numerous clients sleeping during activities. By implementing meaningful, occupation-

based interventions, the staff may be able to counter sleepiness or boredom. It will be helpful to

individualize the client’s care plan objectives (such as creating a SMART goal) to see how they

are doing, or where they need to improve. Evidence-based interventions are well supported in

research and may help the program to objectively measure the client’s outcomes, better assisting

the staff to understand what factors a client may need to be initially assessed on. Administering a

CG survey quarterly as opposed to annually, may help to continually give staff ideas on how to

better serve caregivers. It appears that staff members have huge responsibilities, many of which

require ongoing training. Perhaps reducing some of these responsibilities for the staff members

and /or contracting a licensed Occupational Therapist to assist in these areas.

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References

Bernick, B. (n.d.). Analysis: Just how liberal is Salt Lake County? Retrieved from

https://utahpolicy.com/index.php/features/today-at-utah-policy/13947-analysis-just-how-

liberal-is-salt-lake-county

City finds new life for dead space with 9-Line Park. (2017). Retrieved from

https://www.buildingsaltlake.com/city-finds-new-life-dead-space-9-line-park/

Living in Poplar Grove, Salt Lake City. (2018). Retrieved from

https://www.move.org/living-poplar-grove-salt-lake-city/

Neighborhood House. (2018). Retrieved from https://www.nhutah.org/

Neighborhood House Policy and Procedure Manual. (2018). 1-140.

Poplar Grove Neighborhood. (n.d.). Retrieved from https://www.slc.gov/district2/poplar-grove/

There’s Something Great Happening on the Westside. (n.d). Retrieved from

http://www.slccouncil.com/wp-content/uploads/2015/06/WC_Map_Pages.pdf

Title VI - Civil Rights | Federal Highway Administration. (n.d.). Retrieved from

https://www.fhwa.dot.gov/civilrights/programs/tvi.cfm

User, N., & Resident, C. (2016). Living in Poplar Grove. Retrieved from

https://www.niche.com/places-to-live/n/poplar-grove-salt-lake-city-ut/
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Appendix A: Interview Questions

Staff Questions
Director/Program Coordinator
1. What is the purpose of your organization? (Mission statement, philosophy, etc.)
2. What group of individuals do you serve?
3. What are some of the characteristics of this group? Diagnoses, LOS, what other services
do they usually get?
4. What are your funding sources?
5. What kinds of programming/services do you currently offer?
6. What plans for different or additional services, etc.in the future?
7. Based upon your knowledge of your clients (e.g., participants, members, patients, etc.) and
how they function in your program or after they leave, what gaps do you see in their
functioning or skill levels?
8. How often do you get feedback from the CGs?
9. Which measurable outcomes do you feel are the most important, when it comes to your
client’s success/progress?
10. What are some of the strengths of the current program at the NH?
11. What are some of the weaknesses/ top priorities/needs?
12. What do you think the NH is lacking, that other similar programs have?
13. If you had unlimited funds, what would you buy for the NH?

Site Manager/Lead Activity Aide

1. How often do you document/chart the client’s progress?
2. How often are clients re-evaluated?
3. Tell me about the initial assessment that is used with the clients.
4. Tell me about the client’s care plan objectives.
5. Tell me about the system you use to track a client’s participation on a daily basis.
6. Are there other outcomes you would like to look at with the clients besides participation?
7. Is there anything you need more clarity on regarding staff training?
8. Do you interact with the caregivers?
9. Is there anything you would change about the activities you implement with the clients?
How do you feel about OT-based activities?

Client Questions
1. What activities do you enjoy?
2. Are there any additional activities you would like implemented at the NH?
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Appendix B: ADS October 2018 Activity Schedule Sample

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Appendix C: Sample Page of the Adult Activity Measurement Tool (AAMT)

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Appendix D: ADS Client and Caregiver Survey 2017 Report and Results
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