bigchris

Ok Gang, This week I will try one for a resident that I just call a safety. They are usually dementia/memory impaired with some type of safety device (AKA- chair alarm or possibly a lap/chair buddy) Problem- I have safety concerns from past falls and a history of ________, I will need small group and one to one activities such as __________ to make sure I am safe around others. Goal- I will continue to participate in _________ activities that I prefer in a safe manner for the next _____. Give some examples of your activities..... Approach- You have some leeway here depending on what activities you provide. I will use a few.....but please remember that memory residents have TONS of different approaches, especially on keeping them safe. For this example, I will use a resident who was a secretary.....worked during the day..... 1) I enjoy staying busy and putting things in thier place, please provide me with activities that keep my fingers busy. ( Filing, folding, general fiddling) 2) I am an early riser and am busy all day, transport and provide 1/1 with _______ to help me get through the day. 3) I sometimes forget that I can fall, seat me near a desk or table and I will do well. ( I actually sit her with me when I chart and give her a file folder with blank forms, articles, etc.) Ok, my friends.....the floor is open..... Bigchris

So many of you have told me that one of the "tough" residents to CarePlan for is the highly active/independent resident. There are several scenarios that we could look at and I invite you to send them to me. But for now, I will give you my CP that I did for a highly active resident that I can't get to come to many activities. Here goes: Problem Statement- " I prefer independent activities to those provided at the facility, I will attend occaisionally so make sure to provide a calendar and remind me of (Food Related) activities. Goal- I will continue to have access to structured activities that I enjoy ( Armchair Travel, Cookouts, Cookie Social) in addition to my independent pursuits ( reading, computers, .....) during the next 90 days. Approach- Please remind me of food related activities when they arise. Ask me about my family and e mails that I receive from them. Please remind me when new books arrive in the library. ETC....... Any questions? Chris

I am doing my Egg Hunt with the Bunny on the 9th as well, just because there is soooo much other stuff going on. I think with certain holidays it is perfectly fine to do the celebrations on another date other than the actual holiday, especially if it is a "family" holiday suchas Easter, Christmas, Hannukah or Thanksgiving. Just my opinion. Chris

We all have Care Plans that we put off until the end of the day, those that will literally keep us up at night. I wanted to hear from you. What care plans keep you up at night. I will give you my top 5: Number 5 Frequent Fallers- those resident who cannot be left alone for 5 seconds or they are on the floor Number 4 Very picky eaters! (yes I know, why not dietary??) The reason this is not in dietary is that I love to cook, so I have a food related activity at least every week, usually more. I actually have a resident that will not go on a trip to an eatery if they do not have printed menus, and /or serve southern food!!!!! Hellooooo, we are in Georgia!!!! (just a little vent there : ) ))) Number 3 My independent resident with memory issues...... Real story- I had a resident, highly independent, with STM deficit. She reported a "stolen" item from her room that we used in activities that was D/C 'd 8 months earlier! Thank GOD I care planned it, no Tag! Number 2- My fakers..... You ever had a resident that could hold a conversation with most everyone, but was a HUGE wander risk???? Yeah..... And Number 1 Anyone who acts like my gramma!!!!! Let me explain. Both of my gramma's have been in my nursing home and they both passed there. And they both had thier own "quirks". I have to reel myself in on a daily basis with residents who share those quirks or I revert to care giver mode ( I had both in my house as well). My predisposition to my gramma couldl cause a bias with those residents. Those are my top 5, What about you??? Chris

Some clarification..... It is a fully operational shop in the facility, staffed by contracted/liscensed cosmetologists(sp??) I am now in charge of all transport, payment, scheduling. Chris

We were just given the job of running the beauty shop....does anyone else do this? Any tips? Chris

I do special events for the whole week. We usually don't incorporate the theme in everything, but we have special days for each department and especially for Mother's Day. Chris

So when should the careplan be updated to stay within reason(of your time) and within compliance (with the surveyors)???? Well, here is my answer....I dunno. Let me tell you this, I am in the process of redoing ALL of the careplans in the facility, so I am compliant and without reason!!!! Care plans take time and are a necessary evil in this business. I can tell you a few things though..... I have worked in Nursing Homes for 12 years and have been through about three times as many surveys both in my capacity and as a consultant and 10 times out of 10, the surveyors have looked and actively referenced the Care Plan. So here is the rub..... Some companies have guidelines that will set a standard for the frequency of your documentation. Some states have the same..... Some administrators Some consultants Some D.o.N 's as well.. Chris's consultation- I use the quarterly note as a STOP sign for the last care plan. this means I review the Care Plan and update it with the most current information that I have for that Resident. I will also update the GOALS and APPROACHES if needed. I have also been known to update for NO REASON WHATSOEVER. Also for significant improvements or changes. I find it helpful to use the Quarterly Calendar as a reference and check off list for the residents. If I look in my folder, I can tell you pretty quickly who is done and who is still incomplete for me. You see, my A.D.D keeps me from being very well organized so my method helps me....find your own, or use mine!!!! Does that help? Until next time, Chris

Still waiting on those pen pal groups!!!! Send me a message at: christopher.loga@goldenliving.com We have Computer Class tomorrow!!!!!!! BC

I like what Jules had to say..... I was in charge of this at another facility and I can tell you that it actually makes everything easier in my opinion. 1) Restorative is a nursing based program that incorporates many of the aspects that we do already (ROM, Exercise, ETC.) so it always helps to have someone helping in a groups situation. 2) Remember that each Restorative "aide" (Which can be almost everyone in the facility.) can engage 4 residents each. Once again, they can help you plus 4 of thier residents. 3) Since restorative is a "fairly" young methodology, you can get creative with what you do. For instance, I use part of my Morning Stretch to address restorative needs. Then the other residents follow suit, because it is Therapy not Exercise. Hope this helps, Chris

Juri, I wanted to answer this because I have been involved with the ALF system, until about 2 years ago. When I participated with ALFA and AASHA. There was talk of creating a module that served the same purpose of a Care Plan. I don't know where that went since then, but it may be something to look into. Let me know if you have any questions. Chris

So in my last post I said that I was going to write a sample Careplan for the board. Penkay gave me a scenario- High Function resident with very few issues. So here we go, Remember the 3 parts- Problem, Goal and Approach. I will still call it a problem with the "I" format P-I am a highly independent resident with several unstructured activity pursuits and activities. (It wouldn't hurt to list a few) Goal-I will remain active and participate in "structured" activities for the next (quarter/90days/observation period-all work) Approach- (Here is where we can get creative-using volunteers/family/friends and even the resident) 1) (If the resident is alert and oriented) I will let the AD know when I am not feeling well so he can take me to Name that Tune each day, I enjoy that. 2) My favorite event each week is the Sing a long, please remind me before it occurs. (You can even put a specific time) 3) I look forward to seeing Bob and Neal from the VFW. Please remind them that I want them to stop by. So there you go, not your average careplan; huh????? Questions??? Chris

OK, so I got busted for missing the deadline!!!! Not a problem, it shows you are paying attention! Here is the answer for your non englisk speaking resident..... the first thing that I would say is to create several different methods to eliminate any of the issues before you careplan any of the other stuff..... So what does that mean Chris?!?!?! I am glad that you asked.... If you have a resident where English is a second language, the first thing a surveyor will ask you is what "ADAPTATIONS" have you made for this resident???? Did you see the big word? It means learn it!!! I will ask some typical surveyor questions then give you a reason, I would like a response from you as I have had this happen to me and I was able to avoid a tag from what my assistant (who is from Africa) had told me.... 1) How do you know the resident refuses activities and eating if he is Spanish speaking? They will want to see extensive documentation from you and every other department on how YOU KNOW he refuses if he doesn't speak English. 2) What have you done to ADAPT to his CULTURE/PREFERENCES/upbringing/religion???/Etc. How did you know how to adapt if he doesn't speak English??? Notice a pattern?? 3) How do you and the other departments communicate with him IF HE DOESN'T speak ENGLISH??? Definite pattern here folks..... I am trying to drive home a valid point....This is not a Care Planning issue as it stands, with the information that I was given, which is exactly what the surveyor will use by the way.... WE HAVE AN Issue that needs to be addressed first. This is, what have WE DONE for the resident, that helps him understand what we are trying to do for him? Does he refuse because he cannot understand? Because we don't communicate well for him? Will he benefit from using pictures versus words?? We don't really know.... So we go back to the beginning and put some ADAPTATIONS in place that we hope will help the resident participate in daily life. We tweak those interventions as needed and THEN we care plan about the interventions! Does that make sense? Sometimes we need to look at the main obstacle and the other obstacles will fall down. Until we chat again.... Chris

Penkay, It is interesting that you mentioned that as I am writing several for the CarePlan area of this site. I will write a Culture change/ "I" care plan for a resident, but I would like to do one that would help someone on the site. Any takers?? I will recheck and whomever submits a problem before noon on March 6th will be the winner! If there are more than 1 I will continue.... Chris

Hello all, I have been spending some time on the CMS website and I wanted to address a common question that I hear.... Are careplans required for every resident in the facility???? As all of my information has exceptions to your particular facility,corporation, administrator, etc. The answer is yes. Straight from CMS- I am going to paraphrase here.... F248 will be cited if the facility(you) does not provide an ongoing program of activities designed to meet the needs of each resident with a comprehensive assesment....... Remember the Careplan is part of the ASSESMENT and needs to be present for every resident.... Now, does that happen? Nope, not every day. Do you have admissions? Discharges? Sig.changes? But our ultimate goal, is to have a working "living" careplan for every resident. Questions? BC

One thing that I would like to find is a simple filter for content. I am looking at all of them now and just playing with them. Computer class update!!!!! If anyone is interested in saetting up a "pen pal" program with my facility in Atlanta let me know! We have 11 residents with thier own e mail accounts and 6 have been active! Chris

Thank you for your reply..... I think that it is important to remember too, that it is very important to practice each day. For instance, I take time to read for at least an hour on topics that I want to get better with.... Positive speaking and outlook is one of them!!! I am not quite there yet, but I try to practice each day. Chris

It is very weird that I noticed this topic.... My boss and I were talking about this very subject yesterday. I have found that obtaining volunteers is tough! They are not paid, they are usually just there because they want to be, they are surrounded by people who are percieved as dying.... Those are tough elements to overcome, heck, many of the staff can't get over em! I have found that if you take time to recruit good people that want to help(versus trying to fill a position) them you will get a better result. After a volunteer fills out all of the necessary paperwork, I try to sit down with them for a talk about what they want to do. What is their background? Why do they want to volunteer? Have they had experience with seniors? What are they afraid of seeing or experiencing? I will then have them joing me in an activity. This is just to "feel" them out for thier level of comfort with my folks. This is especially true for the following types of resident: the screamer, the wanderer, the mumbler, the silent type, the grumpy male/female, the young resident I like to know what they expect in the nursing home. Now....where do you find them? Churches, civic groups, friends//family of the residents, friends and family of yours, peers of your that work in the nursing homem or somewhere else, schools, just to name a few. Hope this helps, Chris

Hello folks, This week I wanted to start a "New way" of thinking. For those of us who have been in the biz for a while, I think that it is safe to say that we sometimes get into a pattern. For instance, I was in a care plan meeting yesterday and I realized that we used to define our residents with a Problem, Goal and Approach. Now, these are not necessarily (sp) "bad" words. However, I was a problem child to my grandparents and that was not a good thing! What I am trying to point out is this... We create an unspoken "feeling" when we use certain terms. You will notice in future posts and the classes; that I am going to use different terms for careplans. We are moving away from terms that shape our residents as burdens to the staff at the nursing home and recognizing thier STRENGHTS as human beings. You may also notice that Goals and Approaches are still used in the careplans. Some people use other terms like intervention, plan, objective, purpose,ability, etc. We will also become more resident specific in the way that we think versus using blanket terms that cover a huge variety of people. This means eliminating phrases such as "resident will attned Bingo 5 times a week". Does the resident enjoy Bingo? How do you know? Why are are they going? What benefit will it have for him/her? Who wants them to attend? We will utilize words for what the resident enjoys doing and what they tell us, either in person or by an extensive information gathering by us. Example: I am a gardener who takes great pride in my vegetable garden. I will maintain the container garden(weather permitting) on the patio each day with assistance from Sally the activity assistant. Doesn't that seem better to you? Think about the picture that we paint with our language. Remember that our written words are in black and white, they have no voice. We need to paint them as positively as we can! Until next time, Chris

Mornin, When I first saw this post I had to read it a few times. First of all, I have worked in a Alzheimers specific facility and the main thing that I learned about my supplies and the things that I set out for the residents was.....don't get attached to them! Your administrator needs a little insight on the disease process. Books, Magazines, supplies, etc. Are made to be carried, looked at and used. I have never seen a news story about a book related death. Chris

OK, so we recapped the old style of a care plan, we had an intro to the I Care Plan. Let's look at the basics of a care plan. Remember, a care plan needs to focus on a resident and thier strenghts. Not what obstacles that they pose to you or other staff member. Some of you have been doing it this way for years, but now; the shift will be in strengths not weaknesses. With that being said, there is talk that the wording of Careplans is going to shift. But for now, I will give you the 3 elements and some options to make your careplan sound strength based. The purpose of a careplan is to identify strengths of the resident and make it easier for the entire team to care for the resident. As we all know, there is a Problem/ Goal and Approach. There have been many different ways to word these, I will give you the ones that I use. Problem (Issue/ Action Item) Goal (Intervention/ Goal is still good) Approach (Method) The Problem- Needs to be concise and to the point. Try to avoid any wording that confuses. E.G- (I Format) I have a decrease in my favorite activities (List them) due to a recent __________ I say be specific. I just had survey and I was not in some of mine. When the surveyor sat down with me to ask about the favorite activities, I was able to elaborate. I learned that my mistake was assuming that only the team would see the actual care plan. Goal (I)- the most important thing about the goal is a realistic and measurable format. We want something that is definitive in the numbers and that we can show an increase/decline in our efforts and reevaluate later. Also, this is where I use my journalism background to add more to the goal. Remember we are going to speak for the resident with the "I" careplan. I enjoy going to _____every ______ and I will make an effort to attend when I feel better. I will ask for help and transport to this activity. See how I was a little "wordy" here. I do this because I had a careplan this week. In the meeting the resident said that he was not taken to activities. He is able to take himself and is too proud to ask for any assistance, so he would rather sit around than ask me for a push. With this CP, I made a deal with him and his DTR. And we came to a happy medium. I then have backup, just incase the state ombudsman comes and talks to him and he states he is not taken to activities. The approach- this is what your team is doing to make the goal(s) successful. I suggest having several approaches, because you will problably need to change your method depending on how the resident feels. PLEASE NOTE: THE APPROACHES MUST BE DONE!!!! Is okay if you have 5 and rotate through as you need. But you should not have 5 approaches and do none!!!!! OK, so there it is. We will next look at some sample "I" careplans. I have not heard from you, so get busy!!! You help my brain work. Give me some of your issues and we will work them out. Until next time, BC

Maybe your "authority figure" needs to be reminded that interuppting activities for any reason is a regulatory issue, and if any of the aides mention that the resident is being ( medicated, toileted, dressing change, etc.) that the surveyors will nail you on several tags. Including HIPPA, dignity and privacy. bigCHRIS

Ok Folks, lets do a short recap of what a CarePlan is supposed to be. Also, let's forget about the "I" careplan for a minute. remember, this is audience participation!!! The Careplan was created to be a 1 stop tool for EVERY team member in the Nursing Home Care Spectrum to utilize and participate in....yes thats right, even Maintenance and Housekeeping. It needs to be a "place" where I can look and get a full view of the Strengths/Needs and issues that every resident has, in regard to not only thier health, but every aspect of thier life. SELF REFLECTION- Take a look at 5 random careplans at your "facility" does everyone have this format??? Let me know. The care plan is to be set up as follows- Remember we forgot about the "I" format for the time being.These sound cynical for a reason : ) Problem - What does the resident have that impedes our job? I.E for activity Directors...why doesn't Ms. Johnson come to Bingo/Crafts/Etc.??? SO: Resident at risk for isolation due to>>> Goal: What do we want the resident to accomplish? In this format it is what WE want. Not the resident. Yes folks, I'm sorry, it's' true. Res. will participate in small group activity 3x per week as evidenced by________ Sound familiar?? I am guilty too! Interventions- this is what the staff is going to do, to be successful in the goals. Res will be transported to _______ each week by______ Provide Encouragement x 3 each week at end of act. Etc. I know these are rough, but I do it for a reason.... How many of you have these? Have you seen them before???? Let me know.. bigCHRIS

Sorry for the delay folks, I haven't forgotten about you. I am at the GNHA ( GA. Nursing Home Association) Conference until Friday. I will post several messages over the weekend and I am looking forward to your comments!

Other facilities are asking for my help with this. I can tell you one thing that I am learning while doing this.....don't be afraid to change your plan. I actually make a "lesson plan" with handouts but I have found that using analogies and asking a ton of questions to my folks is key. I will add to this string, but I enjoy hearing from others. keep going!