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care plan notices



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Jun 18, 2009 10:26 AM

care plan notices


Does anyone know of a specific reg that says the SW (or whoever does the notifications) have to send a letter out about the careplan date? Our SW does phone calls and some of the team are unhappy about that. I've read the CMS MDS 2.0 manual until I think my eyes are bleeding, lol. Any help would be great.


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5 Comments
No. 1
from edhcinc
Old Jun 18, 2009, 11:58 PM

Default Re: care plan notices
Hi--the SOM (State Operations Manual) notes LTC survey requirement/regulations and the Surveyor's Interpretive Guidelines.
http://www.cms.hhs.gov/manuals/downloads/som107c08.pdf It is a rather large file, 4.7 MB.

Attached are the few pages regarding care planning.

Page 102 of the SOM discusses medically related social services---

“Medically-related social services” means services provided by the facility’s staff to
assist residents in maintaining or improving their ability to manage their everyday
physical, mental, and psychosocial needs. These services might include, for example:
• Making arrangements for obtaining needed adaptive equipment, clothing, and
personal items;
Maintaining contact with facility (with resident’s permission) to report on
changes in health, current goals, discharge planning, and encouragement to
participate in care planning;

• Assisting staff to inform residents and those they designate about the
resident’s health status and health care choices and their ramifications;


The SOM does NOT say who must actually notify the resident/family of the care plan, or how to notify, or when to notify. There is also no reg that says that the notification must be documented.

If the method WORKS, and your residents/families/ombudsman are HAPPY with the process, ask/tell your staff/team "...don't worry...be happy..."nbch:

Attached Files
File Type: pdf CP Pages from SOM.pdf (119.3 KB, 7 views)
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No. 2
from catnip3
Old Jun 19, 2009, 01:47 PM

Default Re: care plan notices
One of the secretaries sends case conference invitations to families via mail. Also, our social worker gives the residents a cute personal invitation that looks like a party invitation. Our response is good, and I'd say in any given week, 50% or more of the people/families scheduled for case conference do attend.
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No. 3
from crissrn27
Old Jun 19, 2009, 02:05 PM

Default Re: care plan notices
Thanks guys........glad to know that there is no actual reg. I personally am just happy to have a SW that will notify families of anything and I'm not about to complain about it being on the telephone and not on paper via USPS.
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No. 4
from edhcinc
Old Jun 19, 2009, 02:26 PM

Default Re: care plan notices
WOW!!!

50% or more!! Tis good to know that your processes do work!!

Truly, that IS a GREAT response!!
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No. 5
from catnip3
Old Jun 19, 2009, 05:21 PM

Default Re: care plan notices
Originally Posted by edhcinc View Post
WOW!!!

50% or more!! Tis good to know that your processes do work!!

Truly, that IS a GREAT response!!
It is a pleasure to have residents and families come.......MOST are very pleased with the care, and their input really helps our care planning.
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