To Care Plan or Not to Care plan
By Debbie Hommel, ACC/MC/EDU, CTRS
The requirement or need to write an “activity” care plan for “every” resident in the facility has been debated for years. Some communities have made it a policy to mandate an activity specific care plan (meaning an activity based problem, activity specific goal and activity interventions) for every resident – regardless of their functional or cognitive status. Sometimes this is in response to a deficiency or some communities still practice traditional care planning.
Before putting in all the time and effort to create individualized activity care plans for every resident who resides in the facility, the activity professional should consider the following points:
-If the decision to add an activity care plan for every resident is based regulation, it should be noted that nowhere in the regulations does it say we have to have such a care plan. All references to care planning within most regulations support the interdisciplinary model of care planning. Most references in the federal regulations refer to the care plan as the “comprehensive care plan” and refer to activities involvement as the “activities component” of the care plan. It does not say anywhere there needs to be a separate activity specific problem, goal or interventions.
-The act of separating the activity component from the comprehensive care plan (through a separate activity based care plan) does not support the integrated, interdisciplinary intent of person centered care. If the activity department separates the activity based interventions from the main comprehensive care plan, symbolically –it minimizes the responsibility and involvement of the team in implementing quality of life interventions.
-If we use the comprehensive care plan as the activity care plan and integrate activity based interventions throughout interdisciplinary issues, the team can be more readily involved. An integrated approach to quality of life and activity participation is a team responsibility.
Some activity professionals make the mistake of thinking “if the resident has not triggered I do not need to care plan anything”. Nothing could be further from the truth. Many of our residents do not trigger (which is another discussion) and if we used that as criteria to care plan, very few residents would have any care plan interventions at all. Regulation interpretive guidelines infer many residents would most likely benefit from some sort of activity care plan intervention. In order to achieve this, the activity professional needs to review the entire care plan to see where we can assist or integrate. The goal of the activity professional is to imbed quality of life and activity based interventions into as many interdisciplinary care plan needs or concerns as relevant.
What does one do if the comprehensive care plan offer minimal means to integrate quality of life or activity based approaches? Some facilities have simplified their care plans a great deal and have adopted the philosophy that if it is a “standard of care or standard of practice” it should not be on the care plan. The activity professional would need to evaluate if the individual resident had some special needs or specific preferences regarding activity involvement or quality of life that go beyond standard of care, even if the resident does not trigger. In that case, the activity professional should introduce the need to the care plan team and within the care plan, actively involving the care plan team into the new concern or need. Care plans can address needs as well as problems. If a resident is in a special program or has specialized interventions developed to meet a specific need, it should be noted with the care plan. More importantly, the team should be a part of that care plan as they should be ensuring the resident is assisted to the special group or the specialized interventions are implemented consistently.
Care planning trends come and go. We must also keep in mind the regional differences and requirements from State to State. But as activity professionals, we need to rely on our knowledge of therapeutic care planning and need to define individualized preferences to guide us. Our ultimate goal is to address the needs and problems of our residents and clients through an integrated team approach. Regulations encourage collaboration, communication and a team approach to quality of life.
Check out NCCAP 10 Hour Pre-Approved Distance Learning Program
Documentation Skills for the Activity and Recreation Professional
*Note – this ten hour documentation program would meet the additional ten hour continuing education requirement for NCCAP Track Six.
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Also NCCAP 3 Hour Pre-Approved Distance Learning Program – Emailed to Participant
Documentation Skills Mini Lesson