In residential facilities there is an ongoing conflict between the self-care that these people can do and the time that nursing attendants have to take care of a caseload. The problem was intensified when self-care was the only thing that we knew about that they could still do. The paradigm shift from behaviour to information increases the scope of what they can still do during the rest of the day.
In the interest of efficiency, I recommend that we aim for nursing attendants being in charge of self-care activities and activity directors being in charge of scheduled activities during the hours after morning self-care, during the afternoon and after the evening meal. Occupational therapists should be responsible for the affirmative activities that includes the selection, design and modifications of the activity to fit the individual. If that is going to be a major part of the job description, we need to start taking pride in our spectacular ideas. I've been bragging about my metronome idea for months.