April 3, 2011

Understanding a Nursing Home Care Plan – Part 1

Toal,-DebBy Deb Toal
GolderCare Solutions

Your Advocacy Connection – Offering Comprehensive Care and Financial Advocacy

It’s quite an adjustment for anyone when their loved one needs to enter a nursing home. We might wonder how the nursing home staff will know how to provide for our loved one’s wants and needs while respecting his or her personal preferences. State-mandated care plans are developed to address these concerns. Care plans are a working tool for the nursing home to identify the resident’s potential problems, establish measurable goals and objectives for the resident, and directives for achieving those goals. Care plans should address all medical and non-medical issues and are reviewed routinely and modified to meet the resident’s changing needs.

Family members may provide input regarding the concerns they have for their loved one at any time. For example, they may provide input prior to the resident moving to the nursing home and upon admission to and during their loved one’s residence at the nursing home.

The first step to creating a care plan begins when a nursing home screens a potential resident and assesses the care needed to determine if their facility has the resources to meet those needs. Once the resident has moved to the nursing home, the assessment process continues with several of the nursing home departments meeting and reviewing the information and completing the assessment.

The state mandates that care plan meetings occur quarterly. There may be additional care plan meetings if there is a change in the resident’s condition or if requested by the resident or their family member. The resident’s medical power of attorney or the designated person listed on the admission contract should receive written notice of the date and time of the care plan meetings. Who attends the care plan meetings? Staff from nursing, dietary, activities, social services and therapy departments involved in the care should participate in each of the care plan meetings. The resident and their family members are encouraged to participate by voicing their concerns, providing information regarding the resident’s daily routine and asking questions. The care plan meeting provides family members with the opportunity to improve the quality of care their loved one receives by providing the nursing home with important background information.

It is important for all participants in the meeting to remember to focus on the reason for the care plan meeting. The top priority and bottom line is it to make sure the resident is receiving the very best care possible. Care plan meetings should be a win-win situation. The resident gets individualized care delivered by staff who has received clearly written direction. Then, the family can feel confident the process is working.

In our article next month, we will provide additional information on care plans and how you as a family member can best participate at care plan meetings and we’ll discuss how care coordinators can be a strong advocate for your loved one.

Deb Toal is a Care Coordinator at GolderCare Solutions Unlimited. She is an RN with Certifications in Geriatrics and in Dementia Assessment Care & Management. Deb loves the fact that at GolderCare the Solutions truly are Unlimited.