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Brandy

"I" Careplans

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Who has heard of the "I" careplans? They are careplans wriiten in the first person. We are currently using them in our facility. There are web sites that talk on the subject and powerpoint presentations. Just when you get careplans down pat, they change them AAAAHHHHHH!

Brandy

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Hey Brandi,

I have not heard of this before. I went to Google & did a search but didn't come up with anything. Can you tell me where to go to read more about this? Also is this a P & P for your facility or state? Is this acceptable for state/survey time? The "I" is it for the res or staff (person writting the CP? (I assume res) Please tell us more. Thanks Pennie

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Hello Brandi , I could not come up with anything on this subject either , and I have spoken to two other AD's about this and they have not heard anything as well. But I would love to hear more about it when you get time , thanks , BartMan :o)

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Here is the sample of an "I" Care plan that was available on the CMS webcast for the "New" guidelines:

 

RIVERVIEW CARE CENTER

RESIDENT CARE PLAN

 

NAME: Jane Doe ROOM#: 344 DATE: 11/20/04

ADDRESS ME AS: Jane or Mrs. Doe BIRTHDATE: 5/15/1915 ADMIT DATE:11/01/03

 

SOCIAL HISTORY : I was born in Minnesota in 1915. At a young age I moved west with my family. We settled in Tekoa, Washington where we lived on a large farm. My mother and father managed the farm while my brother and I attended school. My parents always valued a good education. I graduated from high school in Tekoa during the Great Depression. To attend school I moved to the “big city” of Seattle. In the city I attended Washington State College. To pay my way, I went to work as a model. My Seattle modeling career only lasted for 5 years but I had a very enjoyable time at it. “The things I learned in that job lasted me a lifetime.” After moving to Spokane to be closer to my family, I worked as a model for “Bernard’s” which was a big department store back then. In 1940 I married my first husband. He was an established dentist in the Spokane community. We raised two children, a boy and a girl. After my husband’s death in 1955, I remarried. My second spouse was a land developer. We enjoyed our life together until his death two years ago. My 2 children, 3 grandchildren and seven great grandchildren all live nearby. They visit often and I enjoy their companionship.

 

COMMUNICATION/MEMORY: I have a little bit of trouble with my memory. I have been diagnosed with early Alzheimer’s dementia. I am aware of my situation, my caregivers and my family. Occasionally I am a little forgetful and confused. Be sure to orient me as part of our conversation while you are providing care. Remind me what is going to happen next. Introduce yourself every time you meet me until I am able to remember you. If I should be more confused than you normally see me, or I don’t remember details about my day, notify the nurse. Often times this means that I am having health complications, which my nurse will be able to assess. I enjoy conversation about your family and your children. I have had a lot of experience raising kids. If you would like some advice on beauty or fashion, I would love to share my opinion. I especially like to comment on how you should do your hair or what clothes look good on you. Being a model all those years has paid off.

GOAL: I want to remain oriented to my family and my caregivers. I want to be able to remember special events and holidays with your reminders.

 

WELL-BEING: Most of the time my mood is very pleasant. I enjoy people, I enjoy talking, and I look forward to the daily visits from my daughter. She brings in the grandkids and her little dog most of the time. Looking forward to her visits gives me hope and keeps me from being lonely. She comes in the early afternoon. Sometimes in the morning around 10:00 I start to miss her. Take a few moments to talk with me

And remind me of her schedule. I especially like to spend the morning on Thursday with the daycare kids to pass the time while I wait for her.

I am not helpless. The thing that makes me happiest is when I am in control of the things going on around me. You can help by offering me choices in my care. Encourage me to get out and be with others. It is important that I get to all three meals in the dining room because my table companions count on me to be there. If I appear grouchy, really listen to me. I like to have things done my way so follow my directions. I also get grouchy if I am hurting in my back, hip or shoulder. I take medication that helps me with pain and with depression. Let my nurse know if I am feeling irritable, if I don’t want to get out of bed, if don’t feel like eating, or I don’t bother to put on my make-up. These are signs that I am not quite myself.

Looking good is critical in enhancing my mood. Don’t let me leave my room unless I am very well dresses and groomed. My daughter irons all my clothes and hangs them in coordinating sets in my closet to help you. My favorite color is red. For any parties or special events offer me a red outfit first.

GOAL: I want to make decisions in my life and daily care. I want my mood to improve with your helping interventions. (Measured by mood monitor).

MOBILITY:

AMBULATION: I have a deep bruise on my hip. My legs are too weak for me to take steps for walking. I have a rehabilitation program to regain my walking abilities. If you perch a cockatiel on my walker when we are going down the hall I enjoy the exercises more. This way I am taking the bird for a walk too.

TRANSFERS: I am not standing very well. I need a full mechanical lift for my transfers. Use a medium sling with the blue loops on top and the black loops on the bottom. My legs give out easily. I have a lot of leg pain. Use special care during transfers to guard my left arm and protect it from bumping hard surfaces. I have a special rehab program in which I pivot transfer only with the trained rehab staff. We also work on a stretching program to prevent my joints from becoming stiff and contracted.

POSITIONING: I can roll and position myself in bed. I need extensive assist to pull into a sitting position because of back pain. I don’t use side rails for assistance with my bed mobility. Please assist to turn and reposition me in bed every two hours if I am not moving on my own.

ASSISTIVE DEVICES: I use a wheel chair to get around in. I need your help to get where I need to be. I have a custom cushion with lateral support to help me sit upright in my chair. Assist me to sit correctly with proper alignment of my spine. This helps decrease back fatigue and pain. Encourage me to hold myself in an upright position when I am able or offer to lay me down for a rest if I am too fatigued.

MOBILITY GOAL: I want to maintain my ability to bear weight sufficient for a stand/pivot transfer with the rehabilitation staff. I want to work toward a stand/pivot transfer with all my care. I want to be free of contractures with no further muscle loss. I want to maintain comfortable positioning in my wheelchair.

 

PERSONAL CARE:

VISION: My vision is not as good as it used to be. I wear glasses and have a magnifying glass to help when reading. Please make sure my glasses are clean and stored safely at night. Put my magnifying glass in my top drawer for me so I can find it every time I look for it.

HEARING: My hearing is very sharp. I don’t wear hearing aides.

ORAL CARE: I have my natural teeth. Please assist me to sit up at the sink. I need help to load the toothpaste. I prefer to brush my teeth on my own.

A.M. / P.M. CARE: I need extensive assist with my lower body hygiene. I can take care of my upper body on my own if you set me up with warm water and a wet washcloth. I like to be near the sink and mirror to take my “sponge bathe”. I get my hair done in the beauty shop every week. I don’t like it to get wet in between times. If my makeup is a little messy, please offer to assist me.

DRESSING: I am able to dress myself sitting at the edge of the bed or in my chair. Please ask me which clothes I would like to wear. Be available to provide assistance if I ask. I sometimes need help getting my pants pulled up or getting my dress under my bottom.

TOILETING:(Transfer/Assist) I use the bedside comode or the toilet in my bathroom. In bed I prefer the bedpan to getting up. Offer me the choice of which I prefer.

BATHING: I am dependent on you for my bathing needs. I prefer a whirlpool twice a week. I have never liked showers. I want to try to remain independent so allow me to do as much washing on my own as possible. Ask me if it is okay for you to finish up the hard to reach places.

ADL GOAL: I want to be able to complete my daily care with set up and no assistance. I want to regain my mobility to a level in which I can stand and /pivot transfer in the bathroom safely.

 

BLADDER FUNCTION:. I am mostly able to hold my bladder. Assist me to toilet when I feel the need. Offer to assist every two hours if I don’t ask. Help me wipe if I need help. I am prone to infections so let the nurse know if my urine is strong smelling or dark in color. Encourage me to drink a lot of fluids between meals.

GOAL: I want to become 100% continent of my bladder. I want to be free of urinary tract infections.

 

NAME: Jane Doe ROOM#: 409 DATE: 11/20/2004

 

BOWEL FUNCTION: My usual bowel pattern is every morning after breakfast. I have trouble with constipation so I drink warm prune juice every morning for breakfast. I also use a stool softener every day. I prefer using the high fiber drink when I take my medications. Please notify my nurse if I haven’t had a bowel movement by the second day. She can assess for further interventions, which the doctor has ordered.

GOAL: I want resume my normal bowel pattern of having a bowel movement every a.m.

 

SAFETY NOTES: I had a fall a month ago which left me with a fractured shoulder. I am working with the restorative caregivers to maintain mobility in my shoulder as it heals. I will be sure to ask you for help when I need it. I know my limitations and will ask you for help. I do not attempt unsafe movements or transfers.

GOAL: I want no further falls, which result in fractures.

 

SKIN: I am at risk for skin breakdown because of my decreased mobility. I had an open area on my coccyx, which I obtained while in the hospital. It has improved to just a reddened area. I want to keep healing. Assist me to reposition every two hours if I have not done so on my own. Remind me to keep off my back as much as possible when I am in bed. I have a special pressure-reducing cushion on my chair, which needs to be straightened, before I sit in it every morning. My bed has a pressure-reducing mattress. I take a multi-vitamin to help with skin healing. I concentrate on making sure I eat proteins at every meal. This will also help in healing.

GOAL: I wish to remain free of skin breakdown.

 

NUTRITION:

DIET: I am on a general diet with mechanical soft textures. I like the variety this offers me. My weight is monitored for any change, which may occur.

DINING ROOM: I like to eat in the Melody Meadows dining room for all my meals. I sit with my friends every day and we watch out for each other.

EATING HABITS: My appetite has not been as good as usual lately. I prefer to make choices with every meal. In the morning the dietary aide comes and takes my order. I like knowing I can have whatever sounds good. My daughter brings me burgers from McDonalds once a week on Tuesdays. I enjoy this afternoon splurge.

NOURISHMENTS: I want to be offered high protein drinks for snacks. I enjoy the Ensure Brand.

I also enjoy having a late afternoon sandwich. I want something different every day so is sure to ask me before you deliver it.

GOAL: I want to maintain my weight of 120# and not gain or loose more than five pounds.

 

PHYSICIAL NEEDS:

PAIN MANAGEMENT: I have pain in my left shoulder and arm at times. If I appear uncomfortable let my nurse know. She will bring me pain medications. I will give you directions on how to place pillows so I can be more comfortable in my chair and in bed.

FLUID MAINTENANCE: I take a diuretic daily. This puts me at risk for dehydration. Offer me fluids throughout the day. I prefer fresh water without ice.

GOAL: I want my pain to be relieved with helping interventions. I want to be hydrated and show no signs of dehydration.

 

NAME: Jane Doe ROOM#: 409 DATE: 11/20/2004

 

 

 

 

 

ACTIVITIES: My activity level is improving each day. I want to stay active in the things I love. I enjoy getting out to social events and parties. I like to check the activity board in the morning on my way to breakfast. When I was younger I used to show dogs. Roly the facility dog has his dish in my room so I am sure to see him several times a day. You can help me fill his dish every morning. Outdoor gardening is also a favorite hobby. If I don’t feel like getting in the dirt I will talk my daughter into planting outside my window in the early spring. It always helps if you remind me to attend the activities I like. Sometimes I forget the times of day to go to them. I also enjoy getting involved in neighborhood fundraisers and weekly meetings.

GOAL: I want to attend at least one social activity every day. I want to stay involved in the Melody Meadows neighborhood meetings. I want to continue to care for Roly by making sure he has food and water daily.

 

PASTORAL: I am of Lutheran faith. I want to attend Bible Study on Wednesday morning and Vesper’s in the chapel every Friday. I enjoy visits from the pastor in my room twice a week. Offer us privacy during our visits so we can pray together. My faith is very important to me. I find comfort through daily prayer. I also find meaning in sharing my spiritual faith with others. Please be comfortable asking me faith-based questions.

 

DISCHARGE PLAN: I was living in my home in Spokane up until about a month ago. I was on my own without any in home help. My kids kept hinting that I should look at retirement places but I was stubborn. One day I was working in my kitchen and tripped on a grocery bag. I fell to the floor fracturing my shoulder and deeply bruising my hip. After a trip to the emergency room and a stay in the hospital, I arrived at Riverview Care Center. I need to be here now until I regain my independence in getting around by myself. I have been considering moving into Riverview Assisted Living. In order to do so I must be able to get to the bathroom on my own and manage my incontinence. I am hoping I will be back on my feet and walking before I consider this option but I could got to Assisted Living with a wheelchair. They provide my meals, housekeeping and laundry. All I need to provide is furniture, clothing and personal things. My children are supportive of my choices and are looking into the sale of my home. When I make a final decision I will let you know. For now I would like to remain in the care center and work toward my goals.

 

 

 

 

 

REVIEWED BY: DATE:

 

 

NAME: Jane Doe ROOM#: 409 DATE: 11/20/2004

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Wow !!!! Thanks KateAA , very interesting ! Thanks a lot ! I shall speak to my team about this , and maybe implement it into my program. Thanks again ! BartMan

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Guest Guest

I worked for a facility 8 years ago that was implementing the "I" CPs. I, for one thought they were fantastic. One way to "humanize" the "de-humanized". You got me thinking. I may call the facility to try and find out how they have been doing with it/if they are still doing it

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