Thank you for you reply and I feel support that I was feeling really alone
on this issue. I am horrified that the state team will sit down w/S.W. and
realize she hasn't a clue on what is going on, not to mentioned that the rap
for mood, behavior and psychosocial is an extremely important one and takes
soooooo much of my time, and time is something we don't have. I already have
worked est 90 hrs this past week and I still have tom to complete my 2 wks.
Thank you ago so much. Now maybe some one can help me slice off the
comprehensive time I send w/care plans.
Claudia
>From: "Holly Sox, RN, RAC-C" <[EMAIL PROTECTED]>
>Reply-To: [EMAIL PROTECTED]
>To: <[EMAIL PROTECTED]>
>Subject: Re: RNAC per facility numbers
>Date: Tue, 6 Jan 2004 19:34:54 -0500
>
>Claudia,
>I agree with you absolutely. I am currently working with the
strongest team that I have been associated with in LTC. Our social
workers do the Mood, Behavior and Psychosocial RAPs, Activities does that RAP,
and DM does Nutrition and Feeding Tubes. SS generally begins the
discussion about DNR status. I usually revisit the issue with annual care plan
meetings, just to ensure that families/residents are still comfortable with
the status. I think it becomes more and more important as the years go by to
ensure that the Full Code that was agreed on admission 10 years ago, may not
still be appropriate today.
>
>As a side note, on our recent survey, we received tags in
Activities and Social Service that could be directly traced to upper level
management budget decisions that were made almost a year ago, to cut
activities staff from 2 full time and 2 part time positions to 1 full time and
1 part time. One of our social workers does half SW, half activities. At least
management was willing to admit where the fault lies.
>
>Holly F. Sox, RN, RAC-C
>Clinical Editor, Careplans.com
>www.careplans.com
>[EMAIL PROTECTED]
>
> ----- Original Message -----
> From: claudia farrell
> To: [EMAIL PROTECTED]
> Sent: Tuesday, January 06, 2004 6:59 PM
> Subject: Re: RNAC per facility numbers
>
>
> Ok, I didn't mean to start an issue w/Delirium
rap. I agree. But the other sections are not unreasonable for a S.W. to
complete..............Who in your facility discusses w/the families about an
DNR? And for the record, having been a Hospice RN for years, I couldn't of
done my job w/o the support and strength of the social workers I had the
privelage to work with.
>
>
>
>
>
>
> Claudia
> >From: C Hannant
> >Reply-To: [EMAIL PROTECTED]
> >To: [EMAIL PROTECTED]
> >Subject: Re: RNAC per facility numbers
> >Date: Tue, 06 Jan 2004 09:57:22 -0500
> >
> >I agree since it is possibly the sign of an
acute medical condition
> >and needs thorough review...cher
> >
> >Holly Sox, RN, RAC-C wrote:
> >
> >>I think Corey's point was that the
Delirium RAP is often related to
> >>other complex medical issues that
are more likely to be in the
> >>nurse's body of knowledge than a social
worker's. I do the
> >>Delirium RAP for my residents for that
reason as well. I am fairly
> >>certain Corey wasn't slamming social
workers, or indicating that
> >>they weren't capable of completing any
RAPs. Just that in her
> >>experience (and mine), the Delirium RAP
seems more in the nursing
> >>domain.
> >> Holly
> >>Holly F. Sox, RN, RAC-C Clinical Editor,
Careplans.com
> >>www.careplans.com
> >>[EMAIL PROTECTED]
> >>
> >> ----- Original
Message -----
> >> From:
[EMAIL PROTECTED]
> >> To:
[EMAIL PROTECTED]
> >> Sent: Tuesday,
January 06, 2004 7:26 AM
> >> Subject: Re: RNAC
per facility numbers
> >>
> >> These are folks
with BSW's and/or MSW's? Gosh I think at that
> >> level they'd be
more than able to understand and do a RAP.
> >>After
> >> all the MSW had
to do a thesis and that be much more
> >>complicated. And
they have more education than I do as a
> >>diploma nurse. Every
> >> social worker
I've had the pleasure of working with did both
> >>the
> >> MDS sections as
previously indicated and their RAPs. Some
> >>needed
> >> my help, seminars
or help from their consultants but they did
> >>the
> >> RAPs and
well. I have had some resist doing the RAPs
> >>foreigning
> >> ignorance, but
once it became clear it was part of their job
> >>and
> >> needed to be done
or another social worker who could do the
> >>RAPs
> >> would be sought
the problem cleared up. Yes, we often do the
> >> nursing aspect of
the MDS, but ideally we should be
> >>coordinating
> >> the team that
deals directly with the resident to complete the
> >> assessment and
care planning process. I think we need to aim
> >>for
> >> that as much as
possible.
>
>>
In a message dated 1/5/2004 10:09:38 PM Eastern
> >>Standard Time,
> >>
[EMAIL PROTECTED] writes:
> >>
>
>> With all due respect
to the many overworked, underpaid SNF
>
>> social workers out
there (and there are many), I do not
> >>think
>
>> it reasonable to have
a non-medical person work on a
> >>delirium
>
>> RAP. There
are too many complex items in the mix:
> >>medicines,
>
>> illness, change of
psychosocial status, loss of home,
> >>pain,
>
>> and then mix in a
possibly pre-existing dementia. It's
>
>> unreasonable to
expect a BSW, or even an MSW w/o special
>
>> medical training to
work their way thru that RAP. I think
>
>> they can do cognition
(most of them), mood & behaviour,
> >>but
>
>> have often found the
Activities person to be much more
> >>capable
>
>> of doing psychosocial
than social workers, although they
> >>are
>
>> almost always the
ones assigned to it.
> >>
>
>>
Susann Irwin, RN
> >> MDS Coordinator
> >> Garner, NC
> >>
>
>
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