What is a care plan you might ask? It's a plan of care. That sounds so simple, doesn't it? The intentions of a care plan are sound and they are that each discipline identifies a problem that the resident has, or a need that he/she has. Then you must set a goal for the resident and give them a time span of three months to meet the goal. With each goal you must write at least three approaches that your discipline will take to help the resident meet their goal, and weekly you must write up progress notes detailing how the resident is doing toward their goal.

Meetings with the residents and families should take place once every three months so that they can have a say in the care planning. It all sounds so simple and straight forward, doesn't it?

For the most part it is, if you know what you are doing, sometimes it takes a bit of practise. Now my discipline was activities so you can imagine the problem I had when one of my residents was a man in a coma on a ventilator. I had never seen anyone in this condition before and although I hate to admit it, it really upset me to be in the room and have to talk to this man as if nothing at all was wrong, and hearing that haunting hiss click hiss click hiss click. The doctors held out no hope for him coming out of his coma, but his wife insisted on sustaining him.

Now the state takes care plans very seriously. All the paperwork must be kept in the residents charts and once entered are considered state documents and cannot be fooled with. They check them periodically with a fine tooth comb. Each document must have a six digit date and be signed by the person entering the document, citing also their position.

As I mentioned before when the person first enters the home as a resident you have three days to fill out your departments assessment form. The federal government also came up with their own form called an MDS, which also had to be filled out by each discipline within I believe it was 24 hours, I could be wrong but it was almost asap. For my department the assessments listed every possible hobby, sport, craft or activity, and the resident had to have either done it in the past, has or had an interest in it, or express they would like to do it. Heaven help you if you made a goal for the resident and that activity was not checked off on the assessment. If that happened the state and the feds considered you were taking away the residents rights and forcing them to do something they did not want to do. Here's the funny part about that. There were a few residents who just wanted to be left alone and did not want to participate in group activities. They were very content to watch their TVs in their rooms and nap. Even though that's what they wanted and we were only supposed to do what they wanted, this was a no no. So we would have to manipulate them into saying they used to play bingo for example and then make their goal that they would come to a game and make realistic approaches as to how we would get them to come to a bingo game. Or we could ask them if they ever went to a baseball game and then do one to one visits with them to read the sports section and discuss baseball. My coma resident was a definite one to one visit and his goal was looking for some kind of physical response to reading or talking to him about some interest he had in his past which we had to get from his wife.

I always thought it was a joke that we were supposed to provide individual goals for all the residents based on their likes and dislikes, yet at the same time engage them all at once in the same group activity. Don't forget, when the home is filled with residents they make more money, and a good way to get families to place their loved ones in your home besides being clean and friendly is to have all the residents all together having a great time. To make it even more challenging the state and the feds could walk in at any time for inspections while you are the only one leading a group activity and you have one resident who is sitting outside the room doing nothing, the inspectors will target that individual and demand to know why you don't have them involved. Homes never give you enough staff and you have to rely sometimes on volunteers if you can get them.

Goals are due to be met in three months, if they are not you can renew them for another three months with a new set of approaches, after that time they must be changed if they are not met. All this paperwork must be done in the time allotted and backdating in considered tampering with state and federal documents which is a crime, not to mention cause for termination.

I kept a master chart which was updated daily with all my residents and the dates that all progress notes and such were due, so in that respect I was very organized and complete with my paperwork. I had a large chalk board that I would write daily assignments for my staff and would verify that they were done and on time.

Just as you could not make a goal for a resident unless that was listed on his/her initial assessment, you could get in the same trouble if that resident happened by a group activity and decided to join in without that being on their chart. You would have to go to the chart after the activity and enter that as an interest on the assessment.

Like I said the original intent was good, but with a limited staff, you could very well find yourself so buried in the paperwork you actually didn't have enough time for the activity itself.

Couple that with the fact that the homes I worked at used the dining rooms for the activities, so their were time constraints. The morning activity had to occur between breakfast and lunch times, and most of the time you were on your own in having to move the tables and chairs and transport many of the residents who would or could not get there on their own. Afterwards the furniture had to be put back in the exact places you found them in. At the first home I worked for, I was lucky in that I had a couple of CNA's that were absolute angels and would convince residents to go and transport them to the dining room for group activities. Most other CNA's were just too busy with their own work. I don't blame them. In Illinois their is a quota of, I believe 11 residents to one CNA, that's what the law says. A nursing home who really cares about it's residents will reduce that number for better care. The two homes I worked at did not.