Search

Men's Activities for Senior Care by Celeste Chase AC-BC,ACC,CDP Activity Directors Network





Activities for Men . . . .
Author M. Celeste Chase, AC-BC, ACC, CDP   Activity Directors Network        ActivityDirector.org


While walking through most Long Term Care facilities you will easily take note that the ratio of female versus male residents is significantly tipped towards the female population. Women residents outnumber men at the rate of about 2 to 1 (partly due to the fact women live longer than men). Contributing factors that tip the scale further is that it is not uncommon to find that approximately 80% of the staff is also female and the majority of visitors in general are female as well. Men are simply outnumbered in Long Term Care facilities.

            “this map of America shows the male/female sex ratio for all the states and    
            counties — It's worth noting that, at a glance, the most populous counties in
            America seem to tilt towards female”. 

Upon further glance it may appear that a vast number of activity calendars have more programs geared for women than men. Activity calendars often do reflect a variety of feminine-based domestic activities such as cooking, baking or “unisex” geared activities. One might speculate that Activity Directors focus on meeting the needs of the majority (female) residents but it is more the case of how much more challenging it is to create male oriented programs than it is for the female persuasion.

Consider some of the following factors that contribute to the increased challenge in planning for men’s activities.

·         Of the less than  30% of male residents in Long Term Care facilities, approximately 1/3 of the population present with less ability to communicate than women due to their respective medical or mental status.
·         Some men suffer from strong fear of failure; particularly relating to starting a new skill in which they may appear incompetent to others.
·         Men of past generations may feel embarrassed or self consciousness relating to their particular disability and how it may cause unsuccessful outcomes.
·         Career responsibilities that have long since pasted may leave a sense of loss or void that may damage self-esteem, and instill feelings of uselessness.

All of the above are useful information when planning for men’s activities but are only a fraction of the possible scenarios that today’s Activity Director needs to consider while planning for a balanced and purposeful activity calendar.

Additionally, there are lifestyle differences that contribute to men’s personal attitudes regarding leisure pursuits between white collars versus blue collar workers. White collar workers engaged in less physical job related labor, shorter work d hours and benefited from higher paying salaries than blue collar laborers.  Thus, white collar workers were more likely to feel more energetic, have additional time in the day for leisure choices and possessed the financial means that allowed him to select from a range of interests and pursuits.

Below are some considerations that may help you to best identify how to plan for men’s activities, specific to Blue Collar Workers.

·         Men put in exhaustive long hours and often were left with little or no time for leisure pursuits thus they tend to be lacking in leisure related skills.
·        
What little available free time in any given day was spent with family members, particularly with their children.

·         Minimal earnings did not allow for financial means to spend on leisure activities.

Starting  Point – the assessment /gender reviewed

Fine tune your Assessment Forms

Most likely you already have a standardized assessment form. Take some time to review your assessment form and activity check sheet and take note of the types of activities that may be more specific to male residents.  You can create a framework of questions that will help you probe for more details regarding his preferences. As you check those areas of interest expressed by your resident make it your mission to elicit and document more information describing what makes his specific selection particularly appealing.

Example - Resident selects Sailing:

Questions to ask:
·         Can you describe what your sailboat looked like?
·         Where is your favorite sailing destination?
·         What time of day do you like go sailing?
·         Who do you like to be with when you go sailing?
·         How often did you go sailing?
·         How do you take care of your sailboat?

Your resident’s answers can be used to engage him in a conversation at a later time about this past time experience and will aide in re-affirming a particularly meaningful memory.  Men of this generation often thoroughly enjoy exchanging stories of past days of glory, sports or children and grandchildren’s accomplishments. Look within your male population to group residents with common denominators that you can foster in friendship and mutual camaraderie.

Once you incorporate your residents’ noted interest in the activity calendar and highlight care plan objectives you are well on your way  to providing for the needs and interests of your resident as a unique individual within the facility community - thereby meeting federal laws for nursing homes.

Men might be the minority in this club but given the opportunity, appropriate resources and a through comprehensive assessment, men may not only be able to participate but contribute greatly by adding to the overall program enrichment through a well balanced activity calendar schedule.
NOTE:
Although the Activity Director professional who will focus on planning these activities keep in mind that the ALL staff members are charged with ensuring that the needs and interests of each individual is met to attain or maintain the highest practical physical, mental, and psychosocial quality of life possible. Such programs are essential to the health and well being of all men and women living in Long Term Care facilities today.

Below are a number of ideas for your consideration but remember, that you’re objective is to find a “match” between your resident’s needs and interests to the many potential ideas you come across. 
Train Hobby Club – The collection for the train hobbyist is numerous, everything from the train itself to the landscape and surrounding villages will keep your resident busy. Look for a location in the facility where you can leave the train convoy permanently set up for residents to watch throughout the day.
Men’s Choral Group – Rehearse all time men’s favorite songs to musical accompaniment or acapella style.  Let your residents listen to past male entertainment groups (Miracles, The Four Tops, The Platters, etc.) 
Car Talk – Collect car magazines and new car brochures and solicit a discussion about new cars vs. the old cars, foreign vs. domestic, manual vs. automatic transmission, 2-door, 4-door, convertibles, etc.
Car Wash – A simple hose, bucket, soap, sponges, and towels is all that’s needed. Solicit facility staff members to volunteer their car for washing. Each resident may choose whether to wash, rinse, dry, or just watch the scrubbing and polishing busy work.
Rope Tying – Former professionals and wanna-be ship mates will enjoy trying and re-trying various rope techniques to get it right - while sharing sea worthy tales. If there is no sea captain in the crowd just purchase the many rope tying teaching books out there and dawn your sailor hat to get the ship moving.
Santas Workshop – Doll houses, airplanes, train kits, bird house, mailboxes etc., make for a super great Santa Shop assembly line. Finished product can be donated to non-profit organizations such as Toys for Tots during the holidays. Your men will love knowing how meaningful their labor of love will be to a child.
Sports Time – Watching a live or a pre-recorded horse race, ballgame, boxing match on a big-screen will get the crowd in the mood. Set out peanuts, popcorn, and pretzels. Serve non-alcoholic beer and soda.  NOTE: keep in mind any issue with potential chocking risk/consult with nursing.
Competitors Club – Horseshoes, bean bag tosses, badminton, and bocce ball, balloon toss are fun games that involve a lot of movement while encouraging interaction, socialization, and teamwork.
At the Movies – Ask the residents to select a film (a western, war movie, or mystery). Schedule a matinee or an evening showing. Supply hot-buttered popcorn, movie-style candy, and soda (if permissible- relating to potential chocking/consult with nursing). NOTE: War movies may be triggering for some residents. Be sure to vet your residents for potential behavior relating to aggression that may be triggered from viewing war movies.
Honoring Veterans – Military veterans are often eager to exchange stories about the war days as a way to bond and honor veterans and the past memories. Create a list of “military positions” held by your resident and post in an easily visible location to honor their service.
Casino Night – Organize a game of dominoes, checkers, chess, or a card game (poker or Blackjack). Be sure to decorate with all the ambiance and glitz and glamour to set the tone. Arches ranging from roulette wheel to gleaming gold circle to let the residents make an entrance.
Tool Bits – Provide a variety of different sized nuts, bolts, and washers and a few empty containers. Either direct the person to sort the items or assemble the items and start up a conversation and provide pictures about what each item might be used to make. NOTE: Be aware if there is any evidence whereas you believe that your resident may want to ingest non-consumable items.
Trade Show – Journey out to a local hardware store, such as Home Depot or Lowe’s. Make a project list and ask the men to find the supplies to complete the job. Many men enjoy discovering new tools and many will spend countless hours at a hardware or home-improvement center.
Shoe Shine – Contac a local shoe shop to enlist the tradesman to come to the facility to show off his craft to the men of the house. Your residents can wear their Sunday best shoes for this shoe renovation. Offer newspapers, magazines, books for reading while resident shoes get a new lease on life.  The smell of shoe polish may evoke memories and provide opportunities to reminisce.
Card or Coin Collection Club – Many men collected and traded baseball cards or coins when they were young. Gather a collection of baseball cards or coins and set up a sorting/organizing station. Obtain detailed information about the items to share with the residents. Encourage the men to talk about their baseball or coin favorites and share how they acquired their treasures.
Career Day – Gather a collection of photographs with a focus on jobs, occupations, and careers. (Also consider: colleges, military service, sports activities, clubs or organizations, hobbies or leisure activities.) Encourage the person to discuss the photographs and their past employment. Pass around various hats representing different careers and ask residents to talk about which occupation they think the hat belongs to. Share information about each career such as, educational requirements and potential earnings.


M. Celeste Chase, AC-BC, ACC, CDP

How do you Avoid Job Burnout? Internal Validation ... have a look



How do you Avoid Job Burnout?

Many of us, admittedly most of us, look for some level of external feedback in the form of recognition to measure the importance of what we do. Feedback from our family, friends, business associates or coworkers helps us to develop a sense of personal and professional contribution. But all too frequently we give away our power to others to rate how successful we are while working to achieve our goals. The success of our own internal ability to self-motivate will increase or decrease greatly when those external sources say yah or nah to what we do often leading to a maker or breaker attitude.
 We can always count on our loved ones to give us what we need to succeed but that is not the expected scenario out there in the working world. It is neither rewarding nor any fun to toil away at a job where your efforts go unnoticed. You are especially prone to those influences when the elements of your work are demanding both physically and emotionally.

GIVE YOURSELF PERMISSION
Give yourself permission to find reward and value in what you do. When we are waiting for those external sources to find time during that busy work day to give us praise for work well done, we stand in pause, a momentary state of waiting for validation and responses to unanswered questions. Are we valued, are we not valued for our work? Did we do as well as we thought we did – did we do as well as we wanted to?
Permit yourself to self-reflect and self-rate what you do first and then proceed to include the input from those outside sources. Establishing a sense of a job well done is the best way to prevent burnout. Ask yourself if your still leaving work at the end of the day feeling satisfaction and excitement upon the thought of returning back to work the next day.

SEEK DIRECTION
Before evaluation date, pursue a dialogue with your work supervisor to ask how you are doing. Your approach should not be defensive but rather should be to seek better understanding of what is expected and whether you are on the right track. Ask for clarification if need be so you can make clear plan of action to meet your job requirements. You will ensure that you remain on target to be in line to move into another position of more responsibility if you have aspirations to do so. You are looking to partner with your supervisor in a way that supports the overall mission & goals of your department. Your supervisor will remember & appreciate this meeting when your actual performance rating is scheduled.

EDUCATION
There is never a time when we have learned it all; regardless of what position of professional status one may achieved. Continued education is not only consistently required to maintain certifications but continues to provide one of the largely single greatest source of renewed interest in any given career path. Learning sparks introspective thought that provokes one to look for better and more current strategies to improve delivery and discover more effective ways to offer the services provided.
Job burnout is often seen to take hold when work tasks become mundane in nature or otherwise automatic and lack the need for individualized thought process, thus, mind stimulation through continued education provides a pathway that may prevent that “same old same old” mind set.

YOU ARE NOT ALONE JOIN THE TEAM
Protect yourself from that it’s me and me alone feeling. No one success story in any profession, business or leadership role, was ever accomplished by just one individual alone. Plans are devised policies & procedures are written but it takes the entire team to create a synergy – whereas; combined effect of the sum of all is greater than individual efforts. Remember … “IT TAKES A VILLAGE”

Here are a few qualities that a successful team possess.

  • Group focus on goals and mutual support of each other’s achievements
  • Everyone contributes their fair share – jointly collaborating towards a common action plan
  • The team offers each other support & develops natural synergy amongst the group
  • Unity of individualized members creates a collaboration of diversity that creates success
  • Good leadership is balanced by each individuals unique leadership style

Look around for Validation
Look for those rewards that which is not spoken; those quiet subtle nuances that speak volumes. You will see that in the smiles, it will present in the body language, it will be reflected in the positive behaviors and in the active engagement of those you serve. Take time at the end of each day or week to reflect on what went well and what didn’t go as well. This task helps you to recall both what you’re good at and why you do what you do. Concentrate on the positive to nourish your self esteem and self-validate your achievements. Those external sources charged with rating you in the work world will also see that you have that special quality – that capacity to improve the quality of life of others in a meaningful way.

Look to move away from the desire to obtain external validation; fulfillment, job burnout prevention and real validation will come from within and will always lead to a proven success story.”

Internal Validation to Prevent Job Burnout …. 
Author : M. Celeste Chase AC-BC, ACC, CDP
Activity Directors Network - ActivityDirector.org
10/24/2018



What’s The Difference . . . between Adult Day Centers?

Author:  M. Celeste Chase, ACC, CDP
               Activity Directors Network
                http://www.activitydirector.org
10/17/2018

 
-Medical, therapy and socialization centers
-Socialization and safety centers
-Alzheimer’s and dementia care facilities

Adult Day Centers are either social or medical in nature with specifically trained and compassionate staff that creates programs to meet the needs, preferences and cultural differences of those they serve. These facilities offer supportive assistance by way of physical activities and cognitive stimulation and/ or medical care during the day-time hours (no overnight stays).

 Family members can plan for daily “predictable respite” for which they might use to relax or go to work or run necessary errands (without the added burden taking their senior loved ones with them). When participants go home to be with their families after a day at the center, families will find their loved ones happy, stimulated, alert and often more ready to sleep soundly through the night. Giving the entire family a most welcomed nighttime benefit which is often desperately needed. Without a doubt adult day health programming leads to improved well-being and increased socialization within a safe, nurturing and comfortable community setting.

Medical vs. Social  - There are two types of adult day care:
Both provide a comfortable, secure place for a senior to reside during the day, enabling them to socialize, stay active, remain productive and enjoy an improved quality of life, Typically, the center provides one or two meals a day. Some centers provide transportation for pick up and/or drop off, which may or may not be included in the cost.
The main difference between medical and social day care is that the medical model also provides an array of medical professionals, which may include on-site registered nurses, speech therapists, occupational therapists, physical therapists, social workers and registered dietitians.
Keeping it simple; the easiest way to identify the difference between these two centers is to take a look at the name. An “adult day care” facility, without the word - “health” in the title are not required to adhere to the same standards and regulations and do not offer the availability of on-site health care professionals from a range of disciplines to provide clinical oversight.

Adult Day Centers and Offerings
Socialization and safety centers – Adult Day Care

Adult Day Care Many centers have well-trained activity specialists who lead dynamic activities programs.  These programs might include arts and crafts, intergenerational programs, music, cooking classes, exercise sessions, movies, discussion groups, live entertainment and trips into the community.  Some care centers offer programs that are especially designed for physically frail individuals with special medical needs such as diabetes, hypertension and post-stroke disabilities, and those with mental health challenges such as dementia, confusion and Alzheimer's disease.  The goal is to be an extension of the home environment with caring, personalized service. These centers rely on private pay reimbursement for services provided.
Medical, therapy and socialization centers – Adult Day Health

Adult Day Health centers offer all of the same services you would find in Adult Day Care centers mentioned above, in addition; they provide ” certified” amenities via trained health care professionals such as physical, occupational and speech therapies, nursing services, personal care, social services and much more depending on the individuals acuity level assessment. These centers are prepared and well equipped to enroll not only very independent individuals but also those with chronic physical illness and/or cognitively challenging needs.
Most states have specific governing bodies that work to establish procedures for licensing and regulation standards to oversee the business of Adult Day Health “medical” care centers. These regulations are mandated and centers are required to adhere to guidelines and protocols to be given licensing privileges. These standards are not only specific to medical record guidelines but are also required for the centers to qualify to submit billing to Medicaid and/or Medicare for reimbursement of services on behalf of those participants pre-approved to receive these benefits.

Alzheimer’s and Dementia Care centers – may be found in either social or medical model centers (medical facilities usually provide for more advanced stages of the disease).
Many dementia patients are at risk for safety and cannot be left unsupervised. Progressive memory and cognitive decline may lead to potential for wandering, risk for self harm from misuse of everyday regular household items. This puts family caregivers in a difficult position, especially if outside help is scarce and/or family members are still working. Dementia programs at adult day centers typically utilize security features to prevent wandering as well as improved staffing ratios to ensure seniors are safe and their needs are met in a timely manner. This provides invaluable free time and peace of mind for the dementia caregivers. Skilled Adult day centers that specialize in the care of those with dementia are becoming more and more in demand in light of the increased numbers of seniors diagnosed with this disease over the past few years. Many states require centers to have staff members obtain specific dementia  training to care for this population.  Trained professionals are able to recognize those seniors that prefer quiet, solitude like environment while others are in desperate need of more stimulation. This expertise proactively minimizes potential disruptive behavior by addressing each     individual’s unique needs. State regulations have been written to target this topic requiring medication management to modify behavior to be used only as the last option after it is documented that all non-pharmaceutical interventions have been implemented without success through the individualized care plan.

Adult Day centers provide an array of activities for attendees to participate in; adapted to each person’s unique abilities to maximize enjoyment and minimize frustration.  Many centers also offer flexible scheduling choices from attending just a few hours each day to attending the entire day for one or more days per week.  The affordable cost of care for Adult Day allows these centers to be more accessible to a wide range of families for senior care options. Clearly, Adult Day Centers are the go to choice for those looking find support that fits into their family values and needs while allowing them to keep their loved one at home.

Author : M. Celeste Chase, ACC, CDP
All Rights Reserved
 


Activity Directors Network is the premiere Online provider of the MEPAP classes with almost all of our students passing the NCCAP national exam. We have taught students from all 50 states, Canada and England.

Our Online MEPAP Classes start the first Tuesday of every month.  

We are always enrolling!    
Visit ActivityDirector.org or call us at 1.888.238.0444



Activity Directors in Long Term Care, Nursing Homes, Assisted Living Facilities, Adult Daycare, Swing-Bed Hospital Care and Recreational Care.
Our MEPAP 1 is the most widely accepted Activity Director Training course in the US.

Make sure your Activity Staff is qualified before your next Survey, The Centers for Medicaid and Medicare (cms.gov) State Survey of Senior Care Facilities follow Federal Regulation F680-F679, Surveyors Guidelines.
------------

Taking a course Online is a very interactive way to learn.
Not only do you benefit from a professional Activity Director Instructor, you also share the knowledge and networking with your entire class.

Our Classrooms Lead Instructor, Kathy Hughes ADC, has over 35yrs of teaching the NCCAP Certification course experience, as one of the original MEPAP Certification Training Course Authors, Kathy has the "know how", the experience and the resources to train you and your staff to provide innovative activities to your residents as well as learn about the regulations that effect the delivery of activities.

Our Guest Instructors  - Swing-Bed Specialist, Ruth Martanis, ADC - Adult-Day Health Specialist, Celeste Chase, ACC CDP

 Once you experience the Online Classroom setting you'll wonder why you didn't try this sooner.

The 24/7 Chatroom and the Class Forum are just two of the ways each and every Student can reach out to the entire class to either ask for help, offer some advice or share their particular journey with the class. You will enjoy networking with activity professionals who share their ideas and knowledge throughout the course.

Our online class lasts 4 months, a 180hr course, 90hrs Class Study/90hrs of Practicum (Fieldwork). Cost is $600 - Payment Plans are available. If your facility is paying, simply sign our Purchase Order Agreement and begin immediately.

Ask about our "Self Paced Course" format that will allow you to expedite the training or extend it out for a year to help accommodate a busy life.....

To Get Started . visit ActivityDirector.org and download the MEPAP 1 Enrollment Packet . fill out the enrollment forms, fax them in and you're ready to go. (fax 1.866.405.5724).


Be sure and use our "Military Family Discount"  $100 off any Military family

Download a Enrollment Packet, fill out the forms, fax it to us. 855-405-5724
Pass it along to your employer to assure them they are making the Right Choice with NCCAP Certification .

Click HERE for the MEPAP1 Enrollment Packet
or

Be sure and use our "Military Family Discount"  $100 off any Military family
Payment Plans Available  - Call or email us to set up a plan that will work for you!

New Classes Start the 1st Tuesday of Every Month

Activity Directors! Mark you Calendars. Reserve the Bus, Mothers Day Comedy Show - MAY 13th Southern CA

California here they come... it's the craziness from SeniorComedyAfternoons.com

     Bonnie and her bunch have put together a Mothers Day Event like no other.. 
Mark your Calendars for May 13th 2018  .  Get the Bus reserved and make your way to the Palos Verdes Golf Course
Vista Ballroom for an afternoon of Funny!

   Here's a little Sample    https://youtu.be/qz0W1HVWU18


MothersDayPostcard%20flyer.jpg





Download this Flyer for the Details.
Hats On For Momma.jpg


Download this Flyer for a Pass Around Flyer to Share.
MothersDayPostcard flyer.jpg

Home Care Certification Course offered by ActivityDirector.org

Caregiver Training Requirements By State  

Caregiver training requirements for each state are shown below. 

 8-hour  Home Care Certification course meeting the standards developed by the NCCAP.org

   

 

 










  1. Alabama 8-hour Caregiver Course, No licensing requirements 
  2. Alaska 8-hour Caregiver Course,No licensing requirements (only business license required) CPR, First Aid Training, TB test are required.
  3. Arizona 8-hour Caregiver Course, Licensure for Home Care Agencies Requires Basic Caregiver Training. DCW Caregivers for Medicaid (ALTECS) Must Have 6 Hours of Training 
  4. Arkansas 8-hour Caregiver Course,
  5. California 10-hours total : 5-hours Training Prior to Presence with a Client + 5 Hours Annual Training 
  6. Colorado 8-hour Caregiver Course, Personal Care 
  7.  Connecticut 8-hour Caregiver Course, Personal Care - Home care agencies not licensed under Dept. of Health but "registered" under Dept. of Consumer Protection, which requires background checks, basic training. Background check required. 
  8. Delaware 8-hour Caregiver Course, Personal Care 
  9. District of Columbia  8-hour Caregiver Course, Personal Care 
  10. Florida 8-hour Caregiver Course, Personal Care 
  11. Georgia 8-hour Caregiver Course, Companion/Homemaker, Personal Care 
  12. Hawaii 8-hour Caregiver Course,
  13.  Idaho 8-hour Caregiver Course,
  14. Illinois 8-hour Caregiver Course, Home Services 
  15. Indiana 8-hour Caregiver Course, Companion/Homemaker, Personal Care 
  16. Iowa 8-hour Caregiver Course, No license required Home care agency provides training.
  17. Kansas 8-hour Caregiver Course, Home care agency provides training.
  18. Kentucky 8-hour Caregiver Course,
  19. Louisiana 8-hour Caregiver Course, Home care agency provides training. training details
  20. Maine 8-hour Caregiver Course, Home care agency provides training. 
  21. Maryland 8-hour Caregiver Course, Personal Care 
  22. Massachusetts 8-hour Caregiver Course, Special Business License 
  23. Michigan 8-hour Caregiver Course, No licensing required 
  24. Minnesota 8-hour Caregiver Course, Special Business License, Personal Care 
  25. Mississippi 8-hour Caregiver Course,
  26. Missouri 8-hour Caregiver Course,
  27. Montana 8-hour Caregiver Course,
  28. Nebraska 8-hour Caregiver Course, Personal Care 16 of the 75 hours must be supervised training
  29. Nevada 8-hour Caregiver Course, Companion/Homemaker, Personal Care No specified number of required training hours, but training in 16 subjects is required by the state. 
  30. New Hampshire 8-hour Caregiver Course, Companion/Homemaker, Personal Care Home care agency provides training.
  31. New Jersey 76-hour Caregiver Course, CNA, Companion/Homemaker, Personal Care 
  32. New Mexico 8-hour Caregiver Course,
  33. New York 8-hour Caregiver Course, Personal Care 
  34. North Carolina 8-hour Caregiver Course, Personal Care 
  35. North Dakota 8-hour Caregiver Course,
  36. Ohio 8-hour Caregiver Course,
  37. Oklahoma 8-hour Caregiver Course, Personal Care 
  38. Oregon 8-hour Caregiver Course, Personal Care
  39. Pennsylvania 8-hour Caregiver Course, Personal Care Must be completed within first 3 months of employment
  40. Rhode Island 8-hour Caregiver Course, Personal Care 20 hours in classroom; 5 hours practical
  41. South Carolina 8-hour Caregiver Course, Established - postponed drafting specifics until October 
  42. South Dakota 8-hour Caregiver Course,
  43. Tennessee 8-hour Caregiver Course, Personal Care 
  44. Texas 8-hour Caregiver Course, Personal Care 
  45. Utah 8-hour Caregiver Course, Companion/Homemaker, Personal Care 
  46. Vermont 8-hour Caregiver Course, Caregivers must pass a state test as well as a background check and drug test. 
  47. Virginia 8-hour Caregiver Course, Personal Care 
  48. Washington 75-hours Companion/Homemaker, Personal Care 85-hours to become a CNA 
  49. West Virginia 8-hour Caregiver Course, No licensing requirements 
  50. Wisconsin 8-hour Caregiver Course, No licensing requirements for personal care 
  51. Wyoming 8-hour Caregiver Course,                                                                                                          list provided by Cargiverlist.com