Pam: Barry, as a lawyer how do you go about deciding when a potential case has merit?
Barry: Well, you have to understand what nursing homes are really intended to do is manage a long term chronic conditions that resident or patient has, when there are problems that crop up that are really beyond the skills and abilities of the nursing home to manage, it’s the job of the nursing home to alert the doctor and have the patient’s doctor transfer them to the hospital.
Outside of that, when it comes to managing sort of the long term chronic conditions that are admitted to the nursing home to care for, there’s a process called a care planning process which really is at the heart of how care is provided in a nursing home.
Pam: What is the care planning process?
Barry: It’s a standardized process which is in use in every nursing home, it’s actually incorporated into the federal regulations. The end goal of this is to provide a standard, systemized way of delivering the care that the resident needs.
Pam: What is the care plan?
Barry: The care plan is actually a written document that is incorporated into the resident’s chart and what it does is it signs various tasks or interventions that have to be done to the various groups that work within the nursing home.
Pam: When does the care plan get completed?
Barry: It happens shortly after resident is admitted to the nursing home and then is updated every 90 days or when a resident has a significant change in condition.
Pam: Okay, so how does the care plan get completed?
Barry: Care planning is in theory an ongoing process, in practice there are really six steps to it. The first step is doing an assessment, the second is writing up the care plan, third is communicating the care plan to the staff that’s gonna be carrying it out, fourth is implementing and actually carrying it out and then the fifth would be evaluating its effectiveness and the sixth and the final step is revising if it needs revision.
Pam: And what’s involved in the assessment portion?
Barry: So, when a resident is admitted to the nursing home there is a … what’s called a comprehensive assessment that’s done on the resident and the idea behind the comprehensive assessment is that it’s supposed to really take stark of the physical and mental well-being of the resident and really identify what are the threats to the health and well-being of the resident.
Pam: What is the care planning portion of the process involved?
Barry: Once the various threats to the health and well-being of the resident are identified then there are intervention steps that are assigned to the various different disciplines that work within the nursing home to carry them out for example, some will be assigned to the nursing staff, some will be assigned to the dietary, some will be assigned to the social service, and so forth.
Pam: What is the communication portion that is involved?
Barry: There’s no point in having a good care plan if the people who are charged with carrying it out don’t know what’s actually within the care plan so the contents have to be communicated to the people who are actually charged with carrying it out and one of the things I find over and over when I’m taking depositions of nurses and aids from the nursing home is that they have no idea how they find out about what’s in the care plan, the most common answer I get from the nurses is that this happens if the shift to shift report which is the 15 minutes that one nurse meets with the other in the change of shifts where they discuss all the residents that they’re taking care of and a lot of times, a care plan is 10 or more pages and supposedly the contents of these are being communicated during shift to shift report, I think the real … reality is that the communication process leaves a lot to be desired in a lot of nursing homes.
Pam: What does implementation mean?
Barry: When you’re talking about implementation, you’re talking about carrying out the care plan day to day, shift to shift.
The things that are identified as being part of the care plan are one offs, do this once and you’re over and done with, these are the things that need to be done day and day out to address the very specific threats to health and well-being of the residents are identified during the assessment portion.
Pam: So then what is the evaluation process?
Barry: Evaluation process in theory should be an ongoing process and the really two separate components to this, the first is kind of measure up whether or not what was … set forth in the care plan is really effective in meeting the threats to the health and well-being of the resident, the other part of this is that residents in nursing homes heading for the most part are old that have multiple health problems which are subject to the client and the ongoing evaluation that has to be done is whether or not there have been changes in the resident’s condition during the 90 days in between each assessment which either makes … it already identified … threat to the health and well-being of the resident more acute or they have some new problem that crops up which also needs to be addressed in the care plan.
Pam: Alright, well what is revision?
Barry: So, if there are changes to the resident’s condition or the existing care plan proves to in a fact that the care plan needs to be changed. There’s no point in having a care plan if the care plan really doesn’t help you take care of the resident in an effective kind of way.