care conferences

[AlleeBooRN]

how do you all set up your care conferences. right now im not doing it social service does. its not always timely with my mds's. how do you all organize things

[Bella'sMyBaby]

The buildings I have worked in, it has been the responsibility of the Social Service Dept. to send out letters residents & their families.

[katoline]

Are you talking about Medicare or case-mix care plan meetings? With medicare, our social worker usually scheduled the care plan meeting the week after the 14 day ARD so they would fall around that 21 day requirement (7 days after the 14 day deadline for an admission). We had care planning one day a week, so it might be a few days either way. If a family wished to have a meeting prior, we included our care plans with that, had them sign the attendence record. With case-mix, I would get with the social worker for the upcoming assessments due. I would usually have them split in a managable way a few weeks or so before they were due. We often have to "capture" part B rehab, IV fluids or ABT, etc., before we had those residents scheduled, so if the letters had already gone out or the number was high, we would try to fit them in as soon as we could. We were told we could not move them up in the schedule more than a month unless they were a significant change, so they would be due for a care plan soon anyway. If something is going on, family would often like to discuss it and we could have an impromtu meeting on a day that was not a regular care plan day. Hope that helps. Everyone does things differently.

[Dellarina]

how do you all set up your care conferences. right now im not doing it social service does. its not always timely with my mds's. how do you all organize things

As the MDS Coordinator I set up the Care Conferences for my long term patients. I schedule my meeting and my ARDs so that the meeting falls within the 7 day look back period for the MDS. I send letters to the residents or family member inviting them to attend. It is expected that all disciplines (dietary, activities, etc.) complete their assessments and quarterly notes within the look back period. We review QMs as part of the meeting, and review the chart to ensure dates, consents, assessments, etc. are in compliance. Medical Records attends the meeting and they thin the chart at the same time. We complete and update care plans during the meeting too. By the time the meeting is over and the MDS has been completed, I am confident that surveyors could go through it with a fine tooth comb and be satisfied.We invite families to attend, and if they don't, I call them or sit down with the resident afterwards to ensure that they are familiar with their care plan. It takes some time, but coordinating MDSs is about a lot more than completing and transmitting MDSs.

[SuzieVN]

As the MDS Coordinator I set up the Care Conferences for my long term patients. I schedule my meeting and my ARDs so that the meeting falls within the 7 day look back period for the MDS. I send letters to the residents or family member inviting them to attend. It is expected that all disciplines (dietary, activities, etc.) complete their assessments and quarterly notes within the look back period. We review QMs as part of the meeting, and review the chart to ensure dates, consents, assessments, etc. are in compliance. Medical Records attends the meeting and they thin the chart at the same time. We complete and update care plans during the meeting too. By the time the meeting is over and the MDS has been completed, I am confident that surveyors could go through it with a fine tooth comb and be satisfied.We invite families to attend, and if they don't, I call them or sit down with the resident afterwards to ensure that they are familiar with their care plan. It takes some time, but coordinating MDSs is about a lot more than completing and transmitting MDSs.

I had a sign in sheet behind the care plan that staff and family signed after care plan meetings, to indicate all were aware of the contents of the care plan, and a space for family to add comments if they wanted to.

[melissabRN]

In our SNF, our SW does this. She calls one week ahead (prior to the ARD/CP meeting date) to invite families. By calling, we have noted a major increase of participation instead of sending out letters.

[Mauves08]

For Medicare patients, our therapy/social services department coordinates their meetings according so they have a family meeting during therapy (generally by the person's two week mark in our facility) as well as discharge planning meeting. For my long term care folks, I send out letters. I use to send out letters that had traditional time slots on our "careplan day" (it was Wednesday afternoons) and families had to arrange their schedules accordingly to attend. However, in our "culture change" attempt, I changed my letters and careplans to be more flexible with the families. Instead of time slots, I give them an entire week to choose when would be best for them & we work to make sure all staff members are present. This can be inconvenient at times, but we have had meetings before at 6pm with families that NEVER have attended before and we otherwise wouldn't get to hear from them!

Since doing it this way, our family involvement has increased quite a bit.

[MichelleRN34, ADN, RN]

We are going through culture change also. I haven't changed the scheduling of my care plan meetings yet.... Interesting concept.

[aprilyy]

In our building, our social worker schedules the care conferences. Our policy is to have them within 5-7 days of admission, which does not really make sense to us MDS Coordinators (Medicare and managed care) because we haven't had the chance to do the 5D assessment yet. Right now, MDS Coordinators and the nursing supervisor split the conferences (it used to be the nursing supervisor who does all of them).

For our LTC patients, the MDS Coordinator for LTC schedules the patient's care conferences based on when she does her assessments.