Details
Course Description
This course is designed to explain the purpose of a Service Plan, along with discussing who is involved in the process and when it is established and modified. You will also learn the important role Direct Care Staff play in this process and incorporate tips to using the Service Plan in your Community to achieve the goals to provide independence, self-esteem and choice for each resident.
Course Objectives
By the end of this course participants will be able to:
- 1. Define the purpose of a service plan.
- 2. Describe what is included in a service plan.
- 3. Identify who is involved in the process of developing a service plan.
- 4. Explain the Direct Care Staff’s role in the service planning process.
- 5. Specify when the service plan is created and how often it must be updated.
- 6. Discuss how the service plan can be used as a valuable tool to best assist each individual resident.
- 7. Incorporate the tips to ensure a successful service plan provides the best service for your Community.
Course Outcomes
Hour One
- 1. Introduction
- A. What is a service plan
- a. A Tool Used In Assisted Living Communities To Plan Quality Care For Residents
- b. A Written Plan Of Care Developed To Coordinate Care and Services
- B. Not All Service Plans Are the Same
- 2. Purpose of A Service Plan
- A. Plan and Coordinate Resident Care and Services
- B. Fulfill Regulatory Compliance
- C. Have a Written Tool To Improve Communication Between Facility Staff, Residents, Responsible Parties, and Other Stakeholders
- D. Provide Documentation for Risk Management Purposes
- E. Resident Centered Care
- 3. The Core Components
- A. All States Have Different Regulations Regarding Service Plans
- B. Service Plans Should Include:
- a. A plan to meet the needs and preference of the resident, including the level of service required
- b. The amount, type, and frequency of health-related services needed by the resident
- i. Activities of daily living
- ii. Assistive devices
- iii. Psychosocial needs
- iv. Activity preferences
- v. Cognitive needs
- vi. Medications
- vii. Medical/Health-related needs
- c. Each individual responsible for the provisions of the service plan
- i. Include Information that Describes Who is Responsible for Each Activity
- 4. The Stakeholders Involved
- A. Many People Are Involved In Process
- a. The Resident
- b. Family
- c. Primary Caregiver
- d. Physician/Physician’s Report
- e. Social Workers, Case Managers
- f. Physical Therapist/Occupational Therapist/Respiratory Therapist
- g. Spiritual Leader
- B. Keep Interview Positive
- a. Focus on the positive things the resident is capable of doing, not what he/she no longer can do himself/herself
- C. Always Listen
- a. Listen to What the Resident Desires/Prefers
- 5. Service Planning Process
- A. Process Includes
- a. Appraisal/Assessment of Resident’s Needs
- b. Establishing Goals
- c. Performing Interventions
- d. Receiving Feedback/Evaluating Results
- B. This Cycle Continues Over Again
- C. Keep Service Plans Up-To Date
- D. Service Plan Format
- a. Needs of Individual Resident
- b. Goals of What We Hope To Achieve
- c. Interventions, The Specific Involvement Used To Achieve Goals
- d. Evaluations, How Resident is Progressing, What Changes To Make
- E. Case Study
- a. Resident Needs Assistive Device
- F. Must Gather As Much Information As Possible
- a. How To See and Meet As Many Needs As Possible
- b. Maintain the Dignity of Resident (Keep Information Confidential)
- G. Role of Direct Care Staff
- a. Service Plan is Typically Created By Nurse
- b. Direct Care Staff Must Be Involved
- i. Have More Interaction With Resident
- c. Communication Is The Key
- i. Discuss Updates With Direct Staff
- H. Service Plans Need To Be Signed and Dated
- a. Always Follow State Regulations
- I. Keep Service Plans In A Safe Place
- a. Some Communities Keep Service Plans Separate From Resident Records
- b. Make Accessible
- 6. The Clock
- A. When the service plan is created
- a. Must Be Created Prior To Resident Moving Into Community
- B. Why is it important to keep the service plan up to date
- a. Residents Needs Change
- b. Need To Continually Provide Quality Care Needed
- C. Objective To Create A Plan That Enables The Resident To Feel Important And Have Purpose:
- a. Positive
- b. Proactive
- c. Measurable
- 7. Service Plan Tips
- A. Think of Ways To Use The Service Plan To Connect Residents With Other Residents
- B. File Old Service Plans In An Organized Place
- C. Remember To Respect The Resident’s Privacy
- D. Speak To Your Supervisor If You Feel Anything Is Inaccurate In The Service Plan
Instructor: Laura Gumban, LVN
Laura Gumban, LVN is currently the Resident Care Coordinator at the Eskaton Lodge Brentwood in Brentwood California. There, she is responsible or budget maintenance; she is a liaison with the medical community; she interviews, hires, schedules, and supervises clinical staff; she completes resident assessments and quarterly evaluations; and is the director of nursing duties.Laura has been with Eskaton Lodge Brentwood since 2006. Previously she was an MDS Nurse for the Elmhaven Care Center in Stockton, California and was a MDS/TILES Nurse at Heritage Oakes Estates in Balliger Texas.