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by
Debbie Hommel, ACC, CTRS
See
DH Special Services Independent Study
Documentation
Techniques for the Activity and Recreation Professional
NCCAP
approved 8 contact hours
 There has been much debate on some of the
activity based bulletin boards about the need to write an "activity"
care plan for "every" resident in the facility. Some facilities
have made it a policy to mandate an activity specific care plan
(meaning an activity based problem, activity specific goal and
activity interventions) for every resident - regardless of their
functional or cognitive status. Maybe this is in response to
the specific references to care planning within the revised
guidance for F-248.
Before putting in all the time and effort
to create individualized activity care plans for every resident
who resides in the facility, the activity professional should
consider the following points:
-If the decision to add an activity care plan
for every resident is based on the revised guidance, it should
be noted that nowhere in the guidance does it say we have to
have such a care plan. All references to care planning within
the guidance support the interdisciplinary model of care planning.
Most references in the guidance refer to the care plan as the
"comprehensive care plan" and refer to activities involvement
as the "activities component" of the care plan. It does not
say anywhere there needs to be a separate activity specific
problem, goal or interventions.
-The act of separating the activity component
from the comprehensive care plan (through a separate activity
based care plan) does not support the integrated, interdisciplinary
intent of the revised guidance. If the activity department separates
the activity based interventions from the main comprehensive
care plan, symbolically -it minimizes the responsibility and
involvement of the team in implementing quality of life interventions.
-If we use the comprehensive care plan as
the activity care plan and integrate activity based interventions
throughout interdisciplinary issues, the team can be more readily
involved. An integrated approach to quality of life and activity
participation is a team responsibility, as is stated throughout
the new guidance. Some activity professionals make the mistake
of thinking "if the resident has not triggered I do not need
to care plan anything". Nothing could be further from the truth.
Many of our residents do not trigger (which is another discussion)
and if we used that as criteria to care plan, very few residents
would have any care plan interventions at all. The guidance
states that many residents would most likely benefit from some
sort of activity care plan intervention. In order to achieve
this, the activity professional needs to review the entire care
plan to see where we can assist or integrate. The guidance has
over five pages of suggested care plan interventions to be considered
for a variety of interdisciplinary issues. The goal of the activity
professional is to imbed quality of life and activity based
interventions into as many interdisciplinary care plan needs
or concerns as relevant.
What does one do if the comprehensive care
plan offer minimal means to integrate quality of life or activity
based approaches? Some facilities have simplified their care
plans a great deal and have adopted the philosophy that if it
is a "standard of care or standard of practice" it should not
be on the care plan. The activity professional would need to
evaluate if the individual resident had some special needs regarding
activity involvement or quality of life that went beyond standard
of care, even if the resident did not trigger. In that case,
the activity professional should introduce the need to the care
plan team and within the care plan, actively involving the care
plan team into the new concern or need. Care plans can address
needs as well as problems. If a resident is in a special program
or has specialized interventions developed to meet a specific
need, it should be noted with the care plan. More importantly,
the team should be a part of that care plan as they should be
ensuring the resident is assisted to the special group or the
specialized interventions are implemented consistently.
Care planning trends come and go. We must
also keep in mind the regional differences and requirements
from State to State. But as activity professionals, we need
to rely on our knowledge of therapeutic care planning and the
regulations to guide us. Our ultimate goal is to address the
needs and problems of our residents and clients through an integrated
team approach. The new guidance encourages collaboration, communication
and a team approach to quality of life.
Recommended
Reading:
Care Planning
Cookbook
Edition 5 by Michele Nolta & Beth Hall
Dementia
Care Plan Dictionary
By Michelle Nolta & Beth Hall
RAP Handbook for
Activities
by Michelle Nolta, CTRS, ACC
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