One of the most important factors while evaluating a nursing home for your elderly family member is the kind of care plan they present and follow. In all nursing environments, quality care is a group effort.
In the nursing home setting, your loved one’s needs will be managed by an interdisciplinary team of healthcare professionals who perform the specific tasks in which they specialize. In such environments, it is extremely crucial that the overarching care is detailed in a thorough written care plan that can be used as a roadmap.
What is a Nursing Care Plan?
A Nursing Care Plan is a detailed document that highlights the individualized needs of a nursing home resident. It contains information about the resident’s diagnosis, their medical history, the goals of the treatment, action plans, progress tracking, and evaluation. A good nursing care plan ensures continuity and consistency of care and doubles up as an accessory for evaluation and required course adjustments.
Within nursing homes, the federal and state regulations require the initiation of a care plan for every resident that is based upon a comprehensive assessment of their needs and conditions.
While there are many different frameworks to develop a comprehensive nursing care plan, below are some of the specific steps that a nursing home’s staff must take to ensure that an appropriate care plan is developed to address a nursing home resident’s needs:
The first step in developing an adequate care plan to address a nursing home resident’s needs is to perform an assessment of what his or her needs are. Some of the most important components of the care plan are those that address the resident’s risk factors for:
- skin breakdown or bedsores,
- wandering or elopement,
- urinary tract infections,
- incontinence or toileting, and
- the risk of further complications due to underlying medical conditions.
Common underlying concerns that need to be care planned for include the
- management of anticoagulation medications (such as coumadin) to prevent bleeding or stroke,
- fluid management in residents with coronary and pulmonary diseases (such as CHF and COPD) to avoid fluid overload, and
- feeding-tube management to avoid aspiration and ensure adequate parameters of nutrition are maintained.
2. Diagnosis and Goals
The second step in the care plan process is recognizing and appreciating the knowledge gained during the assessment phase. The information that the nursing home staff obtains through its assessment must be utilized to make a diagnosis of the resident’s needs and to create the care plan.
A nursing diagnosis is the actual list of conditions or health problems affecting your family member. The North American Nursing Diagnosis Association (NANDA) International has defined 4 specific categories of offering diagnosis:
- Problem-focused diagnosis
- Risk diagnosis
- Health promotion diagnosis
- Syndrome diagnosis
Elder residents are at a higher risk of developing conditions due to reduced physical strength, immobility, and decreased cognitive or mental status. A good care plan should contain interventions that may be taken to address each of these types of diagnoses. A thorough diagnosis facilitates the next step – goal setting.
A goal could be a noticeable improvement in physical or mental condition, maintenance of the status quo, or simply ensuring that your loved one is kept safe from injury or exacerbation of a pre-existing ailment. Sit with the interdisciplinary team of health professionals at the nursing home and define realistic goals, taking into consideration your family member’s history and present status.
These are the tactical actions that the resident’s healthcare team performs on a day-to-day basis to maintain or improve the resident’s condition. Some of the standard care practices followed by a good nursing home are:
- moderating medication dosages,
- ensuring that they are eating and drinking,
- monitoring vital stats,
- following basic care protocols,
- providing incontinent care,
- providing supervision,
- assisting with ambulation, and
- turning/repositioning to prevent bedsores
With older residents living away from their families, the care plan also involves creating a warm, loving space where their emotional needs are met just as well as their physiological.
Once a care plan is created, it needs to be continually evaluated and adjusted based upon the changes in the resident’s needs. This is one of the most crucial parts of a geriatric nursing care plan. A nursing home is supposed to provide your family member with the attention and care they deserve. Moreover, nursing homes within the US are bound by state and federal laws for the quality and consistency of care they offer.
While looking at nursing homes and reviewing geriatric nursing care plans, make sure they match up to state and federal standards set for nursing homes. Sending an elderly family member to a nursing home is a tough choice, but by ensuring you pick the best nursing home, you can allow yourself the peace of mind and confidence that they are being offered the best care, at all times.
When Your Nursing Care Plan Isn’t Followed
One of the trickiest parts of nursing care for elderly family members is spotting signs of bad treatment or abuse. While trained professionals can highlight patterns that historically indicate a volatile and abusive environment, as a family member, you must learn to understand warning signals.
If your family member exhibits a sudden change of behavior, this might mean that the care plan is not being followed or is inadequate. It can also be indicative of a change in the person caring for your loved one. Nursing home staff turnover is known to be a major cause of distress to elderly residents.