- 1.Care PlanningMoving From Paper to Person Presented byDebbie
Ohl RN, M.Msc., PhD.Ohl and AssociatesCommitted to Quality Care
& Professional Excellence 613 Compton Road Cincinnati, Ohio
45231MDSCarePlanBuilder.com December 2011
2. Evolution of Care PlanningLook back to see aheadEvolving
regulationsProgression of care plans Debbie Ohl & Associates
LTC Consultants & Educators MDSCarePlanBuilder.com
ThinkTheThoughts.com 3. 19351965 Poor houses Federal funding
forMedicare/Medicaid SSA established public Standards put in
placeassistance For profit homes proliferate19701950 NH atrocities
headlinenewspapers States required to licenseNH1972 Enforcement
Standards not Welfare Reform Act fundsspecify state survey and
certificationto establish uniform1956standards and conditions.Feds
find NH substandard Emphasis on institutionalframework: CAPACITY
toDebbie Ohl & Associates LTC Consultants &deliver
care.Educators MDSCarePlanBuilder.comThinkTheThoughts.com 4. Mid
70s-early 80sOutcome Patient Care & Services Survey born
Mechanicalto correct emphasis on CAPACITY to process withdeliver to
ACTUAL delivery of care. conflicts,omissions, Controversy over
legitimacy.contradictions Paper compliance in the form ofand
animositypolicies was nearing its end. among teammembers. 1975-76
Use of paper in the form of care plan takes center stage to insure
care delivery....or at least begins the process. Debbie Ohl &
Associates LTC Consultants & Educators MDSCarePlanBuilder.com
ThinkTheThoughts.com 5. Phase 1Paper to Person 1976-1987 EVERY
resident must Result:have a plan. Multi-disciplinary conflict EACH
discipline must Plan fragmentationhave a plan. Mass confusion Every
diagnosis must Mega citationsbe on plan. Care plan content All
medications mustexpectations havebe on the plan. increasing
demands. Total Confusion i.e. goal measurability.Debbie Ohl &
Associates LTC Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 6. Phase II
Interdisciplinary Team Building Quality of Care 19871995 MDS 2.0
OBRA creates Assessment processframework forformalized.continuity
of care. Multi-disciplinary POC goals, conflictinterventions,
target Increaseddates used to site expectations
fordeficiencies.documentation and Emphasis on Qualitycare
delivery.of Care. RAPS about paper Debbie Ohl & Associates LTC
Consultants & Educators MDSCarePlanBuilder.com not process.
ThinkTheThoughts.com 7. 1987 to September 30, 2010 MDS 2.0 promoted
inter-disciplinary careplanning. Quality Indicators and Measures
createdbenchmarks. RAPs provided insurance that at least theobvious
was care planned. Clinical assessment skills were maturing. Quality
of care the expected norm. Care plans became more resident
specific.Debbie Ohl & Associates LTC Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 8. 2010Quality of Care
ActualizedQuality of life comes toforefrontPerson Centered
Careemerging as Standard ofPractice.Debbie Ohl & Associates LTC
Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 9. Phase
IIIIntradisciplinary Team BuildingQuality of Care Meets Quality of
LifeOctober 1, 2010 MDS 3.0 promotes resident driven care planning.
CAAs demand looking beyond the obvious. CAAs demand staying current
with best practices. Quality of care is the norm. Quality of Life
comes to the forefront. HUGE paradigm and culture change shifts
further advances the human condition.Debbie Ohl & Associates
LTC Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 10. 1st Program
ObjectiveDiscuss expectations of person centered
careplanning.Discipline SpecificPerson and theirProfessionals
Significant Others The ResidentA Unique BeingAdministration
Regulatorsand Staff Debbie Ohl & Associates LTC Consultants
& Educators MDSCarePlanBuilder.com ThinkTheThoughts.com 11.
Discipline Specific Professionals 1. Who will do what, when, how
Person and theirandSignificant Otherswhere regarding the MDS
andCAAs? Wishes: desire, hopes, wants 2. Have you considered the
Preference :choice, preferredsetting for obtaining
dataactioncollection? Maintain Individuality 3. How will the
professional teamcoordinate the information? Administration and
StaffRegulators Culture change A shift in emphasis: Change
existingFace the same dilemma as themission and vision statement?
facility. Black and white maynow often be gray.Listen, Learn,
Connect.Debbie Ohl & Associates LTC Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 12. Care Planning
TeamsTeamA group of people with a commonpurposeDisciplineRelating
to a particular field of study Multidisciplinary Many (Isolated,
all mine) Interdisciplinary Between and among (mine,
yours.Sometimes ours) TransdisciplinaryStrategy that crosses
manydisciplinary boundaries to create aholistic approach Debbie Ohl
& Associates LTC Consultants & Educators ours)(Integrated,
MDSCarePlanBuilder.com ThinkTheThoughts.com 13. Person-centered
planningbegins when people decide to listen carefully and inways
that can strengthen thevoice of people who have been or are at risk
of being silenced. John OBrienA Little Book about Person Centered
Planning 14. Person-centered planning wasinvented in an effort to
offer peoplewho request and receive humanservices the opportunity
to describe anddefine the characteristics and conditionsof life
that represent for them a desirablepresent and future. It was
invented in an effort to offerpeople who deliver those services
anopportunity to learn and to growalongside the person who is at
the coreof the planning process. 15. The FactsPerson-centered care
is an idealistic approachto resident care that became common
around1985.It was designed to allow people withdevelopmental
disabilities to have a voice intheir lives and to facilitate self
determination.By the late 1990s the concept had filtered intoother
areas of health care.Debbie Ohl & Associates LTC Consultants
& Educators MDSCarePlanBuilder.comThinkTheThoughts.com 16.
Person-centeredness is about intentionally beingwith people. It
demands a personal commitment to engagingconscious awareness and
self-reflection about therelationship between what we are thinking,
feelingand actually doing Not everyone needs or benefits from a
person-centered planning process Essential lifestyles plans are
developed through aprocess of asking and listening. The
bestessential lifestyle plans reflect the balancebetween competing
desires, needs, choice andsafety It is critically important to
remember that a plan isnot an outcome. 17. How does personcentered
care differ from residentcentered care?Debbie Ohl & Associates
LTC Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 18. Person Centered v.
ResidentCenteredPerson Centered Resident CenteredStandard of
PracticeObsolete Resident driven Professionally driven Addresses
resident Addresses what thepreferences related toresident
needs.their needs. Individualized, but not Individualized
andpersonalizedpersonalized. Facility routine Resident routine
About doing things for About being withor to residentresidentDebbie
Ohl & Associates LTC Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 19. Quality of
LifeQuality Degree of excellence or worth Life A manner or way of
existingAutonomy Self-governance, self- sufficiencyRAI The path to
improvement. 20. Our New Mission isPERSON FIRST care
planningKeeping this in mind may lessen thefrustrations, anxieties,
and regulatoryfears we will surely face as we transitioninto the
next generation of care planning.Debbie Ohl & Associates LTC
Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 21. Care Plan Formats1.
Common Plan: Problem Goal Intervention The format most of us our
familiar with2. I Plan Typically reads like a book or changes
language content of PGI plan Often written in 1st person even when
person cannot speak for self.3. Suggested format: PNS R/T R/I R/C
PCP which means? Debbie Ohl & Associates LTC Consultants &
Educators MDSCarePlanBuilder.com ThinkTheThoughts.com 22. Which
means?PNS : Problem Need StrengthsR/T : Related toR/I : Resulting
InR/C: Risk / ComplicationsDebbie Ohl & Associates LTC
Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 23. 2nd Program
ObjectiveIdentify the seven components of the care plan and onekey
factor of each as it relates to RAI expectations.7 53Debbie Ohl
& Associates LTC Consultants &4Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 24. 1st Components of
the Care PlanIncorporate PNS R/T R/I R/C PCPPNS Problem, Need,
Strengths (&preferences)R/T Related toR/I Resulting inR/C Risk,
ComplicationsPCP Physical, Cognitive, PsychosocialDebbie Ohl &
Associates LTC Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 25. Care Plan with Pain
as the Root ProblemComponents of Pain Care Plan: Analgesia, Quality
of Life, Ability to Function PROBLEM/NEEDGOAL(S)
TargetAPPROACHES/ResWhat does theDate INTERVENTIONS Disc
/STRENGTHresident want?Problem: Description of1. Resolve and
Medication planpain: type, source, eliminate thelocation, intensity
issue if possible Who can doWhat 2. Pain Relief / WhenRelated to:
why painControl WhereHow often.Resulting in/ creating 3. Quality of
Life -/impacting: affect on What can youfunctional status PCP make
better?- What is the bestyou can expect?Risks / complication(from
pain and med used)Strengths/Wishes: 26. Care Plan ContentSpecific
General Person centered Functional status maintaining and Rehab and
restorative improving quality Health maintenance of life.
Medication Daily care needs Discharge potential Debbie Ohl &
Associates LTC Consultants & Educators MDSCarePlanBuilder.com
ThinkTheThoughts.com 27. Priority Plans1. Unstable health6. Wounds,
pressure conditions. ulcers.2. Pain management. 7.Medicare RUGs3.
New areas of risk: falls,(reason for coverage) skin, dehydration,
etc.skilling services.4. New problems requiring8. Acute problems
use of psychoactive * Falls medication to correct or* New pressure
sores control.* Unplanned weight loss5. Medications with high *
Unplanned weight risk for side effects, or gain adverse Associates
LTC Consultants &drug reactions.* Elopement Debbie Ohl &
Educators MDSCarePlanBuilder.com* Resident to resident
ThinkTheThoughts.comabuse, 28. 2nd Component of the Care
PlanResident Voice Preferences Wants Wishes AccommodationsDebbie
Ohl & Associates LTC Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 29. 3rd Component of the
Care PlanGoals What influences selection of goal dates ?Debbie Ohl
& Associates LTC Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 30. 4th Component of the
Care PlanTarget Dates MEET GOALS CHECK PROGRESSTarget Dates Outside
of Scheduled Reviews. Who does it? Where will it be documented?
What if the plan is off track?Debbie Ohl & Associates LTC
Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 31. 5th Component of the
Care PlanApproaches.Debbie Ohl & Associates LTC Consultants
&Educators MDSCarePlanBuilder.comThinkTheThoughts.com 32. 6th
Component of the Care PlanMonitoringa. Accountability b.
ImplementationDebbie Ohl & Associates LTC Consultants
&Educators MDSCarePlanBuilder.comThinkTheThoughts.com 33. 7th
Component of the Care PlanReview and Revision Care conference
scheduled reviews. Overview Status of goals Met Unmet Rationale New
areas of concernDebbie Ohl & Associates LTC Consultants
&Educators MDSCarePlanBuilder.comThinkTheThoughts.com 34. 3rd
Program ObjectivesList the 10 Care Plan Must Haves to Meet
Standards ofPractice A standard of practice is a diagnostic and/or
treatment process that a clinician should follow for a certain type
of patient, illness, or clinical circumstance. That standard will
follow guidelines and protocols that experts would agree with as
most appropriate, also called "best practice."Debbie Ohl &
Associates LTC Consultants &Educators
MDSCarePlanBuilder.comThinkTheThoughts.com 35. 1. Prevent avoidable
declines 10 Care Plan MustHaves to Meet2. Manage risk Standards of
Practice3. Address resident strengths4. Utilize standards of
practice in care planningprocess5. Evaluate treatment objectives
and outcomes6. Respect right to refuse treatment,
offeralternatives, adapt.7. Use an inter/trans disciplinary
approach8. Involve family and resident representatives9. Assess and
plan to meet needs of newadmissions Debbie Ohl & Associates LTC
Consultants & Educators
MDSCarePlanBuilder.com10.ThinkTheThoughts.com direct care staff in
planningInvolve the 36. Which of the followingCare Plan Format
ExamplesDo You Think Best Serve the Residentand Comply with
RegulatoryRequirements?Debbie Ohl & Associates LTC Consultants
&Educators MDSCarePlanBuilder.comThinkTheThoughts.com 37. Taken
from web site on I careplansSleep medication prn.Discourage napping
during the day.Side rails up.IF unable to sleep place in
Geri-chair.I softer PlanI like to walkIF I am walking at night
please offerduring the night. to walk with me.Place sashes in
doorways ofresident rooms who are disturbed bymy presence at
nite.Offer me snacks.I like to read the sports section of thepaper
and play solitaire. Debbie Ohl & Associates LTC Consultants
& Educators MDSCarePlanBuilder.com ThinkTheThoughts.com 38.
I-Format Care Plans from http://I care plan sample
SKINpaculturechangecoalition.org I am at risk for skin breakdown
because of mydecreased mobility. I had an open area on mycoccyx,
which I obtained while in the hospital. Ithas improved to just a
reddened area. I want tokeep healing. Assist me to reposition every
twohours if I have not done so on my own. Remind meto keep off my
back as much as possible when I amin bed. I have a special
pressure-reducing cushionon my chair, which needs to be
straightened, beforeI sit in it every morning. My bed has a
pressure-reducing mattress. I take a multivitamin to help withskin
healing. I concentrate on making sure I eatproteins at every meal.
Remind me that protein willhelp Ohl &healing. Consultants
&Debbie in Associates LTCEducators MDSCarePlanBuilder.com GOAL:
I wish to remain free of skin breakdown.ThinkTheThoughts.com 39.
Care Plan with Pain as the Root ProblemComponents of Pain Care
Plan: Analgesia, Quality of Life, Ability to Function
PROBLEM/NEEDGOAL(S)TargetAPPROACHES/Res What does the resident Date
INTERVENTIONS Disc /STRENGTHwant?Problem: Description of1. Resolve
andMedication planpain: type, source, eliminate thelocation,
intensity issue if possibleWho can do What 2. Pain Relief
/WhenRelated to: why painControlWhere How often.Resulting in/
creating 3. Quality of Life -/impacting: affect on What can
youfunctional status PCP make better?- What is the bestyou can
expect?Risks / complication(from pain and med
used)Strengths/Wishes: 40. Person Centered Care PlanningWhat do we
live for, if itis not to make life lessdifficult for each
other?George Eliot 41. Debbie Ohl RN, M.Msc., PhDOhl and
AssociatesLong Term Care
[email protected] 30 year consulting
practice is an outcome of learning lessons the hard way as a
nursing director, sometime nurses aide and behind the scenes
administrator. She is a regulatory compliance and interdisciplinary
care planning specialist, authoring more than a dozen manuals
including HcPros, MDS 3.0 Care Plans Made Easy and Care Area
Assessments.As a nationally recognized expert, Debbie has presented
for many prestigious organizations including the National Institute
for Health , the American College of Nursing Home Administrators,
the National Health Care Lawyers Association, and numerous Health
Care Organizations, and Nursing Facilities throughout the
country.Recently completing her Ph.D in Holistic Life Coaching,
Debbie brings a unique perspective on the impact thatDebbie Ohl
& Associates LTC Consultants &Educators
MDSCarePlanBuilder.com actions have on ourselves and thoughts,
feelings, and those we serve.ThinkTheThoughts.com
