Care Plans in Georgia Nursing Homes
Care plan meetings are conducted to assist nursing home staff in the care of a resident. It is not always assumed that family should be present at these meetings, even though it can be beneficial for resident care. In today’s episode, nursing home abuse attorneys Rob Schenk and Will Smith discuss care plan meetings and why family members should be involved with guest Sarah Curatella, a Legal Nurse Consultant with SarahC & Associates.
TRANSCRIPTION OF EPISODE
Schenk: This is the Nursing Home Abuse Podcast: Episode 81 – What to know about plan of care meetings in Georgia Nursing Homes.
The Nursing Home Abuse Podcast is dedicated to providing news and information for families whose loved ones have been injured in a nursing home. Here are your hosts, Georgia attorneys Rob Schenk and Will Smith.
Schenk: Hello out there and welcome back to the Nursing Home Abuse Podcast. My name is Rob Schenk.
Smith: And I’m Will Smith.
Schenk: Very interesting episode today. We are going to be talking all about meetings that take place between a nursing home resident and the families of the nursing home resident, as well as the various staff members, administrators and so on and so forth that are geared towards executing the necessary steps to take care of the residents.
Smith: Or more simply known as care plan meetings.
Schenk: That’s right – plan of care meetings is what we’re going to be diving into today, and we are not doing this alone. So Will, who do we have joining us here today?
Smith: Today we have Sarah Curatella, who is a registered nurse and a legal nurse consultant. She’s been a nurse since 1994 when she started out as a nurse manager, a restorative nurse and a wound care nurse in long-term care in rehabilitation areas in Alabama, actually.
And currently, she is the principal owner of Sarah Curatella and Associates, which are legal nurse consultants, and she’s basically dedicated her nursing career to assisting and guiding seniors through many transitions of aging. Her experience spans across settings such as long-term care, short-term rehabilitation as well as assisted living and specialty care assisted living.
Sarah is an ambitious nurse manager who in practice combines and applies her over 20 years of clinical experience with her extensive knowledge in geriatric care management, administration and wound care. So we are very excited to discuss care plan meetings with somebody who has had an extensive history with those types of meetings.
Schenk: And Sarah, welcome to the show.
Sarah: Thank you.
Schenk: All right. Well Sarah, as I was mentioning to you before we went to recording was that oftentimes our clients, they have loved ones that are in nursing homes and they are perceiving difficulties with staff or difficulties with administration about how their loved one is being looked after, and they’re going to have a lot of times questions or suggestions about how that care should be administered or things of that nature. Now we wanted to have you on to talk about what are some things that they can do to move forward and be involved in how their loved one is being taken care of?
Are care plans required in nursing homes?
Sarah: Okay, yeah, that’s a great question. So nursing homes are required to have care plan meetings regularly, and this is a perfect opportunity for family members to be able to attend and listen to what care that the nursing home staff does have documented for everyone to be able to do for their loved one. So when they come to the care plan meetings, there’s going to be nursing that’s present. There should be therapy disciplines that are present if they’re receiving any kind of therapy services. There’s going to be representatives from dietary to talk about their diets and their meals and what they have been providing for them, the nutritional status. There’s also going to be even care staff that work with them, such and such days when they’re on the floor. Usually residents stay on one certain hall and you might have regular staff that have been working with them, so having some of the people that are hands on is really important.
Schenk: That makes a lot of sense. How about this? If the loved one is wanting just to start from scratch, how would they approach being in that plan of care meeting? Is that different from just any other type of meeting? Like how would you initiate that?
Sarah: They would just need to go to their nurse manager for the unit and let them know that they would like to have a care plan meeting. There are MDS coordinators that usually oversee the care plan meetings that coordinate those times, so then they would then get with them to coordinate the meeting.
Schenk: I see. And from a logistical standpoint, is this something that happens in like the resident’s room? Is there a conference room? Can you lay out where the people sit, just the basics of how that works?
Sarah: Yeah, usually there’s a conference room that everybody joins into that the family member and even the resident sometimes if it’s appropriate can meet and talk with everybody and hear what everybody has to say. And then they have an opportunity to be able to ask questions or even say, “I don’t think this is going to work for them. This is how things were when we were at home,” and be able to share some insight that maybe the nursing staff does not have already.
When should care plans be made?
Smith: So Sarah, generally speaking, how soon after a resident is admitted do they have care plan meetings?
Sarah: Typically it’s within the first three months that they should have one. Sometimes it might be sooner, and then it is every six months, and if there are any significant changes, they can also call a separate meeting if someone is having any problems. But the families can go to the nurse managers any time they want and they need to sit down and have a conversation – it doesn’t have to be when the care plan is due necessarily.
Smith: Sure. And just to expound upon what you were describing, it sounds like the care plan meeting if where they can go and they can talk about anything from, “Hey, Mom doesn’t like mashed potatoes,” or “We want her to have a certain kind of roommate,” or “What are the doctor’s orders regarding her rehabilitation?” Is that right?
Sarah: That’s correct. So they’ll review their medication list, the reason why they’re on medication, any kind of treatments they’re receiving, if they were to have wounds or rashes or anything like that. Again, therapy is present, so if they’re receiving any therapy services to reach a goal, then they would go over that. And that’s just an opportunity for families to say whether they like it or don’t like it or wanted to add something.
Smith: Sure, and with regards to families, generally speaking, are there requirements from HIPAA that they have authorization, that they have durable healthcare powers of attorney? I mean I worked in nursing homes for a long time like you have – I was a CNA – and it seemed to me that most family members, and as an attorney now, most family members didn’t actually go through the steps to become healthcare proxies or guardians, and they seem to have a lot of interaction. But when the family member passes away and we try to get medical records, they quickly learn, “Hey, I don’t have HIPAA authorizations.” How does it work for family members to be able to be a part of that care plan meeting?
Are families allowed to help create nursing home care plans?
Sarah: If the residents are able to say that they want that person to be part of that care plan meeting, if they’re alert and oriented enough to say that, then they would be allowed to enter the care plan meeting, but typically if the resident is not able to and there is a power of attorney in place or guardian or whatever, then they can appoint and say and give permission for specific people to be involved in and have access to certain information.
Smith: I got you. And could you tell us again how often these happen, because these are not a weekly thing, clearly, because a nursing home has 100 different residents depending on the size of the nursing home, several different halls. So is it important how often these happen?
Sarah: It is important how often it happens. They are required to do them at least quarterly, well they have to do them quarterly, and then they have an annual review, so each one of the MDS is different, but the care plan meetings are typically every quarter.
Smith: I got you. And how are they communicated to the staff? In other words, they have a care plan meeting and they’ve decided, “For Ms. Johnson, we’re going to do X, Y, Z from now on after discussing it with her family.” So at the beginning of her shift, does a floor nurse, does a charge nurse disseminate that information? How does it get out to everyone including CNAs, dietaries, etc.?
Sarah: Yeah, that’s a really good question. So the care plans would be updated and then they would be sent out on the floor. They do shift reports at the beginning of the shift to update the CNAs and the nurses and let them know what things have changed and have been added and taken away from the care plans. The nurse supervisors that are on the floors throughout the rest of the shift, so day shift, evening shift, night shift – the ones that are difficult for your administrative nurses to get to, it goes from your nurse manager down to your licensed nurses, and then the licensed nurses discuss it with the CNAs. Dietary, therapy, they are in those meetings. If they miss those meetings, then a report is given to them so they’re aware.
Schenk: And so just so I’m understanding you correctly, not only is this to be done at least quarterly, but also upon the request of the family. Is that…
Sarah: That’s correct. They do not have to wait until a specific date to have a care plan meeting. Families have the right to be able to request a meeting any time they want to discuss the care of their loved ones.
How many care plans are created at a time?
Schenk: And how far in advance in your understanding does a nursing home schedule a plan of care meeting? So for example, it’s like, “Okay, we’re going to knock out all our plan of care meetings for this particular wing on this such and such a week?” Is that kind of how it works?
Sarah: No, actually how to works is depending on their admission date, they developed the schedule for quarterly and then when they get closer to that time, they send out notifications to the families at least a week in advance so that they know that their care plan meeting is scheduled for this day and at this time so that they have an opportunity to say if they’re going to be able to attend or not attend. If they physically can’t attend, then most nursing homes will coordinate a phone conference so that at least they can hear what options or what things are going on, so they have different options to communicate other than physically coming in and being at the meeting, because you know nowadays, a lot of family members do not live in the same area that their loved one is in the nursing home. It makes it really challenging, so having phone conferences, ability to skype, things like that help with that communication.
How can families prepare for care plan meetings?
Schenk: Is there anything in particular that would be helpful for the family member to bring with them or have available to them during the meeting? In other words, how would a family member prepare for a plan of care meeting in order to get the most out of it for a loved one?
Sarah: Well we usually tell them they should make a list of their own questions. What questions do they have of things that they like that are going on, that they know that their loved ones enjoy, or things that we can work better on, improve on? Any complaints that they might have about things that they’ve seen in interactions they’ve had with anybody or meals, if they’re not enjoying their meals? Any suggestions that they might have?
Sometimes if it’s a brand new resident, they come in and they have all these orders from the physicians that maybe has not been their medication regiment for years and they have some concerns about that, so if there are specific medication regiments that they’ve had for a long time and they’d like to see them get back to that because it works best for them, that’s the time to really go through and talk about that as well.
And any quirks for therapy or how we work with someone makes it helpful for us to know that. Maybe they have favorite pajamas they want to wear at night or maybe they never took medicine in the morning and they’ve been refusing their medicine every morning and we don’t understand why because they can’t communicate that, but the family member knows that little quirk about them. So that helps us be able to adjust our care to get them what they need.
Smith: Yeah, and it sounds like part of what you’re saying, Sarah, is the family members are going to be advocates for the residents, so it’s very helpful that the family has spent time with the resident at the facility so that they know what the resident’s complaints are, whether it’s, “Hey, I don’t want to go to activities at this time,” “My roommate listens to the television too loud,” or “I’d like to go to a later church service,” or anything like that. I feel like knowing your resident and visiting your family member is always, always important.
Sarah: That’s correct, or “My loved one has always worked a 3 to 11 shift. She never gets up out of bed before 10 o’clock.”
Smith: Right, yeah. And are these types of meetings unique to nursing homes, these care plan meetings?
Sarah: Actually not necessarily. So assisted living settings also do care plan meetings. They don’t have the requirements that nursing homes do as far as significant details in their care plans, but in general, they are required to have a plan of care that goes over the needs that the resident has for the care associate to know how to work with them. And it’s the same principle. The families are asked to be involved and help develop that plan of care so that we can provide them with the services.
How are care plans implemented?
Smith: Now Sarah, you’re also a legal nurse consultant, so you work with attorneys. You understand negligence, review cases for negligence, and help attorneys determine where a breakdown in communication happened and why there’s negligence or where there’s negligence. Do you have a sense of what the main factor is in a breakdown of a care plan? I mean if they’ve got a care plan in place and it says that X, Y and Z should happen, what’s generally the problem in executing that?
Sarah: Communication is a big one or not care planning the needs appropriately so that the care staff do know what they need to do. So for example, if you have someone who has a urinary tract infection and they’re supposed to have antibiotics that are given, monitor for signs and symptoms of fever or increased confusion, things like that. If that’s not been documented, it’s not in the care plan, then maybe your staff doesn’t know that and they’ve missed something and that person ends up septic and out to the hospital. If someone is non-weight bearing because they’ve had surgery on their leg or for whatever reason and it’s not care planned and the care associates are not adhering to that non-weight bearing status and the person falls and gets significantly injured and ends up in the hospital, that’s a problem. So it’s really important that they are care planning everything to meet the needs because that’s the direction that the staff is using to make sure that they’re safe and that we’re observing for anything that could possibly cause them harm.
Schenk: Speaking of communication, taking it back to the actual meeting as it takes place, what’s the format and how prepared are the staff generally supposed to be? So in other words, if it’s the dietician, does the dietician go in there and say, “Mrs. Johnson is eating everything pretty good. I’m out of here,” or does the dietician need to bring in, “Well the records indicate what her blood sugar level was for a particular shift?”
Sarah: Yeah, now the dieticians do review the resident’s records and all of that and make notes and make recommendations throughout their stay, and so they will have their weights over several months, depending on how long they’ve been there, to review their weight fluctuation and, yes, their eating habits, if they’ve been eating 50 percent, 100 percent, or if they’ve had a decline in that, if they’ve not been eating well to begin with and now they’re improving. They do review their labs as far as their units and anything related to their nutrition.
If they have wounds, then they’ll also review needs for increase in protein to help with wound healing. If someone needs supplements, whether it’s because they have wounds or it’s because they’re not eating well, so they do a pretty well-rounded conversation. Yes, they have to be prepared for that before they go into the meeting to be able to address the issues and talk about the plans.
Schenk: Got you, so this is not something that if you’re the loved one of a resident in a nursing home, this is not something that the staff should be going through the motions. This should be something that is informative and they should be able to respond to questions in an informative way.
Sarah: That’s correct.
Schenk: And so in terms of format – well actually let me ask this then – when the individuals disperse from the meeting, is there like – does anybody take notes? Does the family member get a copy of who was there? In terms of documentation, how does that go down?
Smith: Yeah, I think that might be helpful for people who have not worked in nursing homes, them trying to imagine what this looks like – so are they going in there and there’s all this staff – how is it recorded? How is it implemented?
Sarah: So there is a sign-in sheet to show who has attended the meeting and each person has to sign their name, what their title is, and that goes around the table. The MDS coordinator is the one that takes the notes to talk about the entire meeting about what was discussed and what the solution was too, so any problem, what the solution is, or any improvement.
What does the care plan look like? Can families see it?
Schenk: And where does that document go? Does that go into the nursing records of that resident? Does it get handed to the family member?
Sarah: It goes into the nursing home records.
Smith: And it’s largely the MDS coordinator because at the end of the day, the care plan is going to decide what level of care this person gets, correct? And that’s what they’re going to use to decide how Medicare and CMS pays them.
Sarah: That’s absolutely right.
Schenk: Well let me ask this, Sarah, are there any tips that you would give to a family member who is a) wanting to meeting with the staff to go over the care plan, and b) once that meeting is established and it’s in their schedule, tips to improve the experience.
Smith: And make the most out of it. How do they make the most out of this chance to sit with the staff and say, “This is the level of care and quality of care that I want for my loved one?”
Sarah: The tips that I always give is make a list. Make a list and do not leave there until everything on your list is addressed. It’s kind of like going to the doctor’s office. You forget when you get there. So make a very good list. While you’re coming for your visits to see your loved one, jot down some things that you think of while you’re there, and kind of put it to the side if it’s not things that have to be address immediately, and they’re things you want to talk about when you have your meeting. So be observant, listen, watch, and the biggest thing is don’t be afraid to share things because that’s the only way they’re going to know where they need to improve. A lot of times people are afraid to say the things they’re concerned about or not happy with because they’re afraid that something bad might happen to them, and we don’t want them to feel that way. This is a time to be able to talk about both good things and things that need improvement.
Schenk: And with that being said, Sarah, what are some recommendations that you’d give if after a few days, maybe a few weeks after that plan of care meeting, the loved one or the resident is not seeing the changes that were supposed to be implemented in that meeting? What’s the next course of action? Schedule another meeting? What would you recommend?
Sarah: I recommend that they ask to speak with them again, and if they are not getting what they need from the nurse manager, there is a director of nursing they can speak with and then there is also the administrator of the community.
Schenk: Okay, very good.
Smith: Excellent. All right, Sarah, we really appreciate having you on. It’s always helpful to have somebody who has been there, who has worked there, because I know this can be a frightening experience for loved ones who have never put their family members in nursing homes. They don’t know what to do. They don’t know what to say and it couldn’t be more important at the end of the day. It really couldn’t.
Sarah: That’s correct. I agree.
Schenk: Again, Sarah, thank you so much for being on this show.
Smith: Yeah, absolutely.
Schenk: This has been a tremendous value for our audience. And actually Sarah, if you could, how can people get in touch with you and phone numbers and all that kind of stuff?
Sarah: Yeah, anybody can get in touch with me at 205-379-8958 and my email is sarah@sarahc/associates/llc.com.
Smith: And what services do you provide?
Sarah: So as a legal nurse consultant, I choose to be a behind the scenes nurse where I work with attorneys and help them to identify failures in standards of care, and that can be for plaintiff attorneys or for defense attorneys in helping them with doing some – I’m sorry – doing some documentation to show them throughout the time things that have happened, chronological time reports, and giving them an education on what things mean, how that affects the residents, what the nursing home or facilities should have done to prevent this failure from happening.
Smith: Excellent. Excellent.
Schenk: Well great, Sarah. Again, thank you so much, and if your schedule permits, we’d love to have you back on in a future episode.
Sarah: Great, thank you.
Schenk: Great, Sarah. Thank you. Plan of care, care plan, tomato tomato – not necessarily tomato tomato. Maybe I’m out of sorts today because what is today?
Smith: Today is National Left-Handed Day?
Schenk: International Left-Handedness Day – although I’m not left-handed, somehow that’s still throwing me off, I guess. Wait, no, that’s not it. It’s left feet – having two left feet.
Smith: Having two left feet.
Schenk: That’s when you’re off. That’s when you say you’re off, not that you’re left-handed.
Smith: Yeah, like you’re stumbling along, you don’t have any coordination.
Schenk: Yeah, that’s two left feet.
Smith: If you have two left hands, I don’t think that’s the same thing. And what’s that movie with Daniel Day Lewis?
Schenk: “Last of the Mohicans?”
Smith: No, I think it’s “My Left Foot?”
Schenk: No, absolutely not. I think it’s something about having a red shoe. “The Man With One Red Shoe?”
Smith: No, I think it’s “My Left Foot.”
Schenk: Are you sure? That’s the one where he’s so method in his acting that he demanded that the crew pick his wheelchair up over cords and stuff. He wouldn’t just get out of a chair and walk because he wanted to stay, in between takes, he wanted to stay in character.
Smith: That had to be annoying.
Schenk: Yeah. Anyways, I guess with that – I don’t even know why I brought that up – oh, because I’m out of sorts.
Smith: Yeah, clearly.
Schenk: Sometimes I lose myself in my segues.
Schenk: Will actually is saving up to buy a Segway.
Smith: I still think those are amazing machines.
Schenk: So anyways, that’s going to conclude this episode of the Nursing Home Abuse Podcast Episode 81. There are two ways to consume every episode. One is by the audio – you can download the MP3 at our website, NursingHomeAbusePodcast.com, or wherever you get your apps. I don’t know – it’s like the first time I’ve ever done this. You can go to Spotify, iTunes, Stitcher, Google Play, Pound Podcast Puppies, anywhere where you get your podcasts, you can get the Nursing Home Abuse Podcast, or you can watch us on our YouTube Channel or on our website, NursingHomeAbusePodcast.com. And with that, we will see you next time.
Smith: See you next time.