The person-centered care plan has always been the guide with which successful facilities provide quality care to their residents. Updates to the Quality Reporting Program, implementation of the Patient-Driven Payment Model (PDPM) in October, and phase three of the Requirements of Participation (RoP) scheduled for implementation November 28th, ensure the person-centered care plan will continue its prevalence in the spotlight.
Care planning involves assessing the resident’s needs, health status, personal preferences, religious and cultural beliefs and discharge destination in order provide the best possible individualized care. Trauma-informed care focuses on reducing triggers and re-traumatization. The goal of care planning is to develop a comprehensive plan that the interdisciplinary team (IDT) can then implement. Ensuring receipt of all relevant medical records is vital in determining how to best care for the individual. Additionally, the IDT members must be involved early in the process to identify areas of risk and interventions that are specific to their discipline or department and enhance quality of care for the individual. The goal is for each team member to bring those elements to the table for the IDT meeting in order to determine service provision under the PDPM and to accurately care plan person-centered, trauma-informed services for seamless implementation.
Therapists are uniquely qualified to assess the needs of the resident and identify individualized intervention strategies specific to their discipline; therefore, in most cases, therapy should highly influence the care planning process so that patients and facilities experience successful outcomes. Notification of admission, staff scheduling, and medical record availability is imperative to gathering accurate information for the MDS, baseline care plans and IDT education. Providing trauma-informed care is yet another aspect of care planning that is vital to patient success. Ensure processes are in place to promote IDT collaboration to determine the best approaches for each individual.
This month take opportunities to assess and refine these processes. Ensure all team members have influence at the IDT table as each person’s input is invaluable to identification of service provision under the PDPM and person-centered treatment strategies for the care planning process in order to safeguard positive patient outcomes and satisfaction.
Click here to access the final rule regarding the Requirements of Participation.