Published Apr 18, 2003
MDS Coordinators Post #1
Hi, I am not new to the site, but been away for awhile. Just wanted to start a discussion about Care plans, if anyone is interested.
We recently had our state survey, and the came down hard on our activities department. Our AD is 20 yrs old, and has no prior experience. Her activities are somewhat dead, and everyone sees this, except our Administrator
Well, we were sited w/ 3 F tags on activities, and I got an F tag for careplanning activities. Her charting is lacking in detail and there are only 3 big events that residents w/ cognitive impairment can attend, well actually 2....Music 1 time a week, and b-day parties once a month. Then we have Bingo 2 times a week and cooking for the oriented residents. Well, how do I individualize careplans for the cognitively impaired residents, or the oriented ones for that matter, when there really aren't any activities going on? In her notes she rights that she does one on ones w/ the residents that don't come to activities, but then she doesn't say what the one on ones are. Our administrator, took her side in the matter, and says that she does the activities, but said my careplans are generic. I showed the administrator where her note for one resident said that the resident enjoyed laying in bed and sleeping....wtf? Does anyone have any suggestions as to what I can do, before the state revisits, what to write in my plan of correction and how I can individualize a careplan on activities that really aren't getting done? Letting her do her own careplan is out of the question, we only have one computer.......
Please give me some feedback.............
Hi Nursie....fun and a tough job for you. I noticed on our last annual they zeroed in on activites too.
A few suggestions that they were looking for in our facility:
1...the careplans for the cog impaired were individualized and listed some of their past activity preferences prior to dementia. The intervention on the 1:1's were to talk about that etc.
The care plan also listed the extent to which they could participate (became distracted, annoyed, wandered away etc)
2. Increase variety of activities per functioning level. Cognitively impaired were involved in activities for their level...rather music, food activity, bounce the beach ball sort of thing.
3. The alert and oriented more challenging activities, actual sing alongs, bingo, cards, outings, current event discussions, etc.
Hope this helps some.
'am only responding to the Care planning scenario... but, shame on your Admin tho' -
Care planning is the primary responsibility of a discipline who has expertise in the field. MDS coordinators simply oversee that these care plans meet the RAP guidelines and coordinate services from other disciplines. Well afterall, most disciplines are just learning how to care plan. Nurses are grilled to it during student days.
Our Activities Leader (AL) perform a type of Activities pursuit assessment on each resident during initial admission, annual assessment, or during a significant change in condition.
In this assessment, the resident's pysical and mental state is addressed, including his/her previous and present activity pursuit patterns. The AL identifies the activity programs available in the facility appropos to the resident's need (whether 1:1, small or large group, time awake, etc.), and writes a rationale why not. The AL writes a goal and her interventions. In this same form, she writes her progress notes.
Should a formal care plan be created, as in your case, the approaches indicated in this assessment will then be reflected in the care plan. Although you would have created the care plan, the approaches or interventions were that of the AL.
BTW, lying in bed and napping, can be a form of activity with which a resident prefers (ruling out other factors). However, I would document that despite the resident's choice, you continually offer other forms of activity program.
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