Re: Care Plan Conferences

[John and Michelle Tracy]

I am a nurse manager of a sub acute short-term rehab unit.  We conduct our careplan on the 5 day MDS rather than the 14 day.When a resident is admitted the SW touches base with the resident and the family regarding the D/C process and the care plan.  Thursdays are our care plan meeting days.  We contact the resident's families on Tuesday and let them know that we will be meeting on Thursday and set up an appointment.  I always have families at my care plan meetings.  We meet as a rehab team on Wednesdays and discuss all of our residents, their progress, their discharge plans, services and equipment needed, and tentative dates.  We fill out a form with this info on it for each resident and the form goes to the resident after the meeting.  The SW goes over it with the resident.  Then the resident has the info and can share it with their families.  Wednesdays also give us an opportunity to discuss these resident's prior to our meeting on Thursdays.   The only time we do not care plan for these people is if they go home prior to the care plan day or on it.  But we have a discharge meeting with the resident and family.  So these can count as a care plan meeting.   The only way to get your staff to do it is arrange a preset schedule. We also utilize a discharge planning record so that we have documentation to support us.  Each discipline documents and signs  regarding anything to do wit discharge planning.  At our weekly meetings we review the info and sign off.   The regs have to be met regardless of their short-term stay.  This seems to be the easiest way.   Hope this helps.   Michelle Tracy, RN, MA Nurse Unit Manager Transitional Living Center Genesee County Nursing Home Batavia, NY ----- Original Message ----- From: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, January 06, 2004 7:45 PM Subject: Care Plan Conferences I am having a real delimma getting my team to conduct care plan conferences on our sub-acute unit-ultimate excuse is they are only in the facility 10-20days.  Out of curiosity how are the rest of you arranging care plan conferences for sub-acute? Currently our Social worker calls the family within 72 of admission, introduces themselves and states that if at anytime they want a family conference one can be scheduled.  I am uncomfortable with this as this is no documentation to support that we offered the family a care plan conference and whether or not the accepted or declines.  Who notifies the families on conferences and how?  Do to our turn over 120 admissions/discharges a month we do not have care conferences unless the family requests one.  Is this acceptable?  Any recommendations on care conferences how to get them going, content of conference with or without family etc would be greatly appreciated.  Thanks Lisa Aurora, CO