09/18/2025

Survey Tip of the Week: Activities for Behaviors

CMS notes that a lack of engaging activities can contribute to behaviors for residents with dementia. According to the State Operations Manual Appendix PP, F679, facilities must provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities. These activities may be facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community. 

For residents with dementia, the lack of engaging activities can cause boredom, loneliness and frustration, resulting in distress and agitation. Activities must be individualized and customized based on the resident’s previous lifestyle (occupation, family, hobbies), preferences and comforts. The SOM Appendix PP notes that activities should be considered as an intervention for residents who:  

• Exhibit unusual amounts of energy or walking without purpose 
• Engage in behaviors not conducive with a therapeutic home like environment: 
• Exhibit behavior that require a less stimulating environment to discontinue behaviors not welcomed by others sharing their social space 
• Go through others’ belongings 
• Withdraw from previous activity interests/customary routines and isolate in room/bed most of the day 
• Excessively seek attention from staff and/or peers: including in social programs, small group activities, service projects, with opportunities for leadership.  
• Lack awareness of personal safety, such as putting foreign objects in her/his mouth or who is self-destructive and tries to harm self by cutting or hitting self, head banging, or causing other injuries to self 
• Have delusional and hallucinatory behavior that is stressful to her/him 

The outcome for the resident, the decrease or elimination of the behavior, either validates the activity intervention or suggests the need for a new approach. CMS also references the resource Palliative Care for People with Dementia: Why Comfort Matters in Long-Term Care. Facilities should also routinely monitor compliance using the surveyor guidance outlined in the State Operations Manual Appendix PP.