Are care plans mandatory?

  1. When you have a resident in your SNF and they are on medicare/PPS, besides completion of the MDS/raps (14day)(full admission), if they leave on the 21st day, and do not spend the 21st night in the building, do you have to complete a care plan, espically since they have completed their 20th day and are ready to go home? Will a care plan jacket with basic adl's do? thanks tex
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  2. 11 Comments

  3. by   kids
    Not in Washington...here we are required to adhear to both state and federal regs-ie: under WA regs we have to have a 'real' care plan sooner than federal requirements.
  4. by   Talino
    Are you familiar with Federal Register 42CFR483.20. I don't what know what provisions other states have regarding care planning, but in New York, we abide by these guidelines.

    In this guideline, it specifically says that a care plan must be developed 7 days after completing a comprehensive MDS assessment. Hence, if you chose the 5-day as your admission assessment, you will be compelled to develop a care plan by day 15th (assuming you completed the assm't on the 8th day). But if you chose the 14-day as the Admission assm't, you can get away w/o a comprehensive care plan up to the 20th day.

    There is no regulation as to how a facility 's care plan should look or where it should be located.

    This is just an excerpt of that regulation...

    [Code of Federal Regulations] [Title 42, Volume 3] [Revised as of October 1, 2001] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR483.20] [Page 521-524] TITLE 42--PUBLIC HEALTH CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES--(Continued) PART 483--REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES--Table of Contents Subpart B--Requirements for Long Term Care Facilities Sec. 483.20 Resident assessment.

    (2) A comprehensive care plan must be-- (i) Developed within 7 days after completion of the comprehensive assessment; (ii) Prepared by an interdisciplinary team, that includes the attending physician, a registered nurse with responsibility for the resident, and other appropriate staff in disciplines as determined by the resident's needs, and, to the extent practicable, the participation of the resident, the resident's family or the resident's legal representative; and (iii) Periodically reviewed and revised by a team of qualified persons after each assessment. (3) The services provided or arranged by the facility must-- (i) Meet professional standards of quality; and (ii) Be provided by qualified persons in accordance with each resident's written plan of care.

    This is the link to the entire document. I usually have problem opening it... takes a long time, too even w/ DSL.
    http://frwebgate5.access.gpo.gov/cgi...ction=retrieve

    I noticed too you posted a lot about MDS. Add these links to you favorites. They are a treasure in your type of job.

    MDS Q&A link ...
    http://www.hcfa.gov/medicaid/mds20/res_man.htm

    Medicare Professional and Technical info...
    http://www.hcfa.gov/medicare/mcarpti.htm

    MDS Information site...
    http://www.hcfa.gov/medicaid/mds20/default.htm

    Good luck!
  5. by   tex
    I am sorry you spent so much time typing out the federal reg/MDS/ sites............I too have read these, but much discussion has transpired d/t our experienced mds cord., who just left. She always said you didn't have to if the patient left before spending their 21st night, I understand that c/p need to be done, maybe my ? wasn't simple enough...........if the patient leaves the facility before spending their 21st night based on the full assessment that was done on the 14 day of their stay not the 5th day, in which almost all the time the therapy dept gives us the very last day of this reference /assessment period, if you count 7 days from that date, they are almost always d/c to home. Tex
  6. by   km rn
    Our state's expectation is that some areas need to be care planned immediately if the resident is admitted with that problem or if there is high potential for the problem to occur. For example, if a resident is admitted with a history of falls - they would expect a fall care plan or at a minimum falls to be addressed in another area within hours of the admission. If a resident enters with a pressure ulcer - they would expect a care plan to be completed within that first shift for pressure ulcers.

    Part of this issue is dependent on what you consider you care plan - at our facility, we feel the MAR, Physian Orders, Treatment Sheets, etc. are all part of our plan of care for the resident.

    One surveyor stated that you needed to prove that the staff had the necessary information to provide quality care to the residents.
  7. by   tex
    thank you km any more info is always appreciated tex
  8. by   Fran-RN
    hi tex, I think you are probably OK, but remember that you have to have enough of a care plan to meet the residents needs, the facilities I worked at have form care careplans that are instituted at admission, we screen the resident for risk factors at admission, (falls, elopement, pressure sore development, etc) then individulize the forms based on the screens. you wouldn't want to wait 21 days to address these trouble spots. just make sure your state requirements are not stricter, as kids-r-fun said. you have to meet which ever are stricter.
  9. by   tex
    thanks,, the form care plans are they a tool that your facility developed? tex
  10. by   km rn
    Our facility has developed some "standardized" care plan for Falls, Pressure Ulcers, UTI, etc. We try to individualize them as soon as possible.

    Frankly right now our care plans are out of contol - some are 20 pages long - which seems very excessive. We are going to work on streamlining care plans during this next year.

    Unfortunately, we still struggle with making the "Interdisciplinary" care plan a working tool for our residents.

    We constantly struggle with the regulatory reality and reality in the trenches. Our surveyors state that you should be able to erase the resident's name from the care plan and have staff be able to recognize the resident based on how individualized the plan is. YIKES - that is a extremely high standard espicially for short-term admits like you described.

    We try to focus on "what do we need to know to take care of the resident" - meds, treatments, fall/pressure ulcer risk, urinary incontinence, discharge plans and mood/behavior issues. Our dietitian handles the dietary assessment/care planning for us.

    One of my frustrations is some staff are scared to care plan. I emphasize that any problem statement is okay as long as people can understand what the problem is. For example - they can write "***** on the floor" - at least everyone will know what the problem is. We can always go back later and refine the language - "defecates on the floor". We try to not get hung up on NANDA versus collaberative problems versus medical diagnosis, etc. Lets just get a problem on the chart.

    I also hate having 20 interventions for each problem. Lets narrow the list down to the interventions that actually mean something to that resident - sometimes that is only 1 or 2 interventions BUT that is okay.

    Good luck
  11. by   Fran-RN
    tex, do you work for a private company? the facility I worked for was part of a large chain and the company developed these care plans. but it wouldn't be hard to develop your own as once you write the basic plan, the interventions are general. you can do this in your "spare time" lol
  12. by   Catsrule16
    In SC you don't have to have it in this case. You can bet the surveyors will look for an interim care plan if that record is chosen as a closed record for review.
  13. by   tex
    thank you for all the good responses, I would love to hear also from the nurses that are now on the other side of the fence as surveyors. tex

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