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Care Plan Conferences

December 6, 2016

This message was sent by Linda Handy RDN

Hi Liz, It is interesting how the surveyor (who presented at your seminar)
answered your question. Ultimately, it is each facility's decision on
compliance. The new intent I believe is to ensure that key IDT members
(including APPROPRIATE STAFF LIKE DIETARY) PARTICIPATE and are aware of
resident desires/care needs. One of the purposes of a quarterly face to face
 Care Conf, is to invite the resident to meet with IDT. Can you accomplish
this by paper compliance-filling out MDS, CAA or maybe interviewing the
resident? Maybe. But truly, I think this revision intents to have a stronger
 IDT that meets and discusses WITH THE RESIDENT for a more comprehensive CP.
 And when all is said and done, the deficiency potential is whether those
needs were met (whether dietary folks: RD and CDM were aware and ensured the
 resident's needs AS DEFINED BY THE RESIDENT (with goals and approaches)
were met. If the surveyor found some dietary issues/resident not having
choices/desires met with care planning/decline, etc and  that no dietary
member attended the CP meeting,( esp with these specific revisions identifying
this participation) then you are at risk for a deficiency. Just my take on
it. Best wishes

Here's the wording of the revision:

(2) A comprehensive care plan must be—

(i) Developed within 7 days after completion of the comprehensive assessment.


(ii) Prepared by an interdisciplinary team, that includes but is not limited
 to—

(A) The attending physician.

(B) A registered nurse with responsibility for the resident.

(C) A nurse aide with responsibility for the resident.

(D) A member of food and nutrition services staff.

(E) A social worker.

(F) To the extent practicable, the participation of the resident and the
resident's representative(s). An explanation must be included in a resident's
 medical record if the participation of the resident and their resident
representative is determined not practicable for the development of the
resident's care plan.

(G) Other appropriate staff or professionals in disciplines as determined
by the resident's needs or as requested by the resident.

(iii) Reviewed and revised by the interdisciplinary team after each assessment,
 including both the comprehensive and quarterly review assessments.

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