The Care Planning Process - A Framework for Investigating and Prosecuting Nursing Home Abuse and Neglect Cases
Barry: At bottom, what we're looking for is to find places where there is a breakdown in the delivery of care. Nursing homes use a process, a system, called the care planning process to determine how to deliver care to each particular resident, and it's something that's actually required by federal regulations.
Pam: So then what does the care planning process look like?
Barry: So the care planning process is a six step process. The first step of this is an assessment. The second is developing a care plan. The third is communicating the care plan to the staff. The fourth step is implementing the care plan. The fifth step is evaluating whether it's effective. And the sixth step is revising it if there has either been a change in the resident's condition, or if the care plan that you've put into place isn't effective in addressing the care needs of the residents.
So those six steps have to be carried out kind of end to end, day to day, throughout the whole time that somebody lives in a nursing home. The assessment gets done when the resident comes into the nursing home, and then is done every quarter, or if there's what's called a significant change in the resident's condition.
And the point of the assessment is this, it's a comprehensive look at the condition of the resident, and it's really designed to kind of suss out what the threats are to the health and well-being of the resident. Once those areas are identified during the assessment, then the next step comes into place, and that's developing the care plan.
A care plan is an actual written document, and it assigns to various members of the staff things that have to be done day in, day out, to address the various threats to the health and well-being that are identified during the course of the assessment. The whole point of having it be a written document is so that everyone is singing off the same sheet of music. It makes sure that the care that's being delivered to the resident day to day isn't something that's being left to random chance.
So, once you have this written document, that's prepared, that sets out what everyone is supposed to be doing, it has to be communicated to the people who are on the floor who are actually charged with doing these things day to day, shift to shift. There's no point in having this great written care plan if nobody knows what's in it, and nobody's actually doing it.
Once everybody knows what they're supposed to do, it has to be carried out day to day, shift to shift, which is the fourth step in the care planning process, which is the implementation of the care plan. A lot of times when you find that things aren't done and an accident results, it's a relatively clear example of how a breakdown in the delivery of care results in an accident.
That brings us to the fifth step in the care planning process, which is the evaluation stage. Basically what this asks is is the care plan that we have in place actually meeting the current needs of the resident. If it's not effective in meeting the care needs of the resident in the sense that it wasn't a sufficient care plan to begin with, or if there have been declines or changes in the resident's condition, then the sixth step comes into play, and that's the revision of the care plan. If it's not effective in meeting the care needs of the residents, then it needs to be changed.
Pam: So then how do you use the care planning process to investigate nursing home cases?
Barry: So, it really serves as a lens for how we look at cases, and what we find is when we go through this care planning process we can often identify places where there were defects or shortcomings in the care planning process where you can point to that were days, or weeks, or months in advance of the events that really bring people into my office.
So, for example, if there was an assessment that was inadequate, in other words, it didn't really properly identify the risks to the health and well-being of the resident, you're going to end up with an inadequate care plan, and inadequate care being delivered throughout the course of the resident's admission. There are other times where you have a good assessment, but the care plan itself was inadequate in the sense that it didn't put into place the steps that really needed to be taken to address the care needs of the resident.
So the third step in the care planning process is communication, and a lot of times when we're taking depositions of members of the nursing staff you'll find that they have no idea what was really in the care plan, or how the care plan would be communicated to them. There's a great plan on paper, but nobody knows what they're actually supposed to be doing.