Individualized vs. Non-Individualized vs. I Care Plans
by Debbie Hommel, ACC/MC/EDU, CTRS
There has been a lot of discussion on social media about individualized and person centered care plans of late. Is it new? What do I have to do differently? Can I see an example? Is there a new book? As an instructor for the Modular Education Program for Activity Professionals (MEPAP) for many years, we have been teaching individualized care plans for as long as I have been teaching the class. So, individualized care plans are not new. Individualization simply means that we see each person as the individual they are and that activities and approaches should be designed for that person, based on their preferences and needs. “Cookie cutter” and standard of practice interventions are not part of individualized care plans.
The first step in individualized care plans is a conducting a good assessment. Gathering pertinent and individualized information about a person’s leisure needs, interests and preferences is crucial. It is not enough to state the person likes music, crafts or television. We must assess further and define the specific preferences. Without this specific information, one cannot create individualized care plans. In addition to identifying the specific preferences, efforts should be directed toward understanding how important these preferences are; can they pursue their preferences independently; what adaptations are needed to enable preferences; and what impact would not being able to pursue these preferences have on the person. Some activity assessment forms do not allow for such detailed information, specifically some of the digital assessment tools. The activity professional needs to find a way to adapt their assessment form or add individualized preferences somewhere on the assessment. Without this information, it is difficult to create individualized care plans.
In the MEPAP class, we discuss creating individualized care plans. It is within the intervention/approach section of the care plan where we can individualize the most. Relying on the pre-made and standardized care plans, without adding individualized notations is not individualized care planning. Here are some examples of non-individualized interventions vs individualized interventions vs. I care plans. I care plans are simply a writing format. The care plan is written in the first person using “I” as the subject of the care plan.
For a person who needs encouragement to attend daily programs of interest:
Non-individualized: Encourage participation in group activities.
Individualized: Provide person with monthly calendar of preferred (socials, religious services, musical events, pet therapy) programs highlighted. All staff should remind and assist to religious services and musical programs as she often asks when they are scheduled. Remind person to attend weekly rosary group and hymn sing. Assist to morning socials and seat near friend (RH) from the other neighborhood as this friend makes her feel safe. Position with her with back to the sunny window as the glare makes it hard for her to see. Do not pressure her for participation as she gets nervous when questions are directed at her personally. When not in group activities, she likes to sit near the birds in the lobby with her friend.
I Care Plans: I like receiving the monthly calendar with my favorite activities noted – socials, religions programs, and musical activities. I need to be reminded a few times to attend my favorites – rosary and musical programs. I like sitting near my friend from the other neighborhood as she makes me feel safe. I don’t like bright windows so sit me with my back to the window. Don’t direct attention to me or “put me on the spot” in groups. I will participate when I want. I like sitting near the birds with my friend in the afternoon.
For person who needs room visits:
Non-individualized: Provide room visits 3 X weekly.
Individualized: Visit person in room during morning hours, before lunch. She likes to watch her shows in the afternoon. When visiting, bring reminiscing magazine and simple trivia. Conversation is easily generated with some large images of older households and some questions. She likes talking about her early days living in the south and recipes her mother made. Utilize IPad to bring up photos of towns she has lived in and also some of the recipes on Pinterest. Weekly visits from the rosary volunteers are scheduled. Weekly visit with Piper, the pet therapy dog, are scheduled. During morning care IDC staff can discuss their weekly shopping trip to the grocery store and current prices of items as she loved food shopping when living at home and enjoys talking about bargains.
I Care Plans: Visits are welcome before lunch. I have lots of shows I like to watch in the afternoon and do not like to be disturbed. I like talking about my childhood in the south and looking at old photos in magazines or on the I pad. I like talking about my mother and her recipes. I love a good bargain and enjoy talking about the sales at the food market. I like visits from the pet therapy dog and also the rosary volunteers weekly but only in the morning.
Person who has cognitive loss and short attention span:
Non-individualized: Escort to morning diversional group.
Individualized: Escort to morning diversional group. Offer folding towels first thing upon arrival and as she needs to get her “work done”. After folding, offer cup of coffee. When getting restless, ask her for her help cleaning up the coffee cups and napkins. She enjoys music and responds well to early 60’s music and will do “the twist”. Do not pressure her to sit with the group as this will irritate her. She likes to “organize” and can be diverted with the yarn bin or other craft bins needing straightening.
I Care Plan: I kept a beautiful home and housework is important to me. I start my day with laundry and need to fold before I can do anything else. Only after my chores can I have coffee. I don’t like sitting with those other people as I am too busy. I like to help others and also clean up. I like organizing, sorting and straightening out messy drawers. I also like a “thank you” when I am done. I like Chubby Checker music and anything from the 60’s. I can’t help but dance when I hear that music.
Person with severe cognitive loss, needing sensory:
Non-individualized: Escort to sensory program 3X a week.
Individualized: Escort to afternoon sensory program daily. Evaluate response level upon arrival. When restless, position near soothing music and present with heated pillow to hold, for comfort. When more responsive, involve in thematic sensory approach. Present cues in visual field and give her something to hold. She is very responsive to baby sensory as well as holiday sensory approaches. Signs of over stimulation include fidgeting and biting of hands. During non-group time, staff will play the classical music channel or religious channel on television in her room. She has a soft pillow with her name on it that she likes to hold while in her room.
I Care Plan: I am comfortable in my bed throughout the morning and will get up after lunch. Do not rush me and if I am restless, I do calm down with the soothing New Age music and my heated pillow. I do like looking at the bright items in the seasonal sensory boxes and I love the babies. I do get fidgety when I have had enough. At these times, I am most calmed by religious or classical music. I have a pillow in my room, made by my daughter, that has my name on it. I like to hold that as it is soft.
Does it look like we are writing more with individualized care plans? Yes, but if we are to provide person centered, individualized care – it needs to be defined in the care plan. If we are to involve the interdisciplinary staff in offering these individualized approaches, it needs to be outlined in the care plan for all staff to see. Knowing our elders, as most of us do, defining these interventions should be common sense. We are implementing these approaches in our programs and 1-1 encounters – it is just a matter of documenting them on the formal plan of care. Quality of life is a team responsibility, as is person centered care. The activity professional is an expert in both of these areas. We play a crucial role in individualized care planning by defining personalized and individualized interventions.
Documentation for the Activity and Recreation Professional in Long Term Care
Ten CE Hours NCCAP Approved
Documentation Mini Lesson
Three CE Hours NCCAP Approved
Person Centered Mini Lesson
Three CE Hours NCCAP Approved