Creation and implementation of a service plan
It’s funny how the real world relates to the world we operate inside of with our communities. Just as every person in the ‘natural’ world has specific likes, dislikes, and needs, our residents do just the same! Each person living in your facility has certain needs related to their personal care and must attended to as such. This is the reason behind why a ‘service plan’ is needed for each resident. We must assess each person and develop a plan for maintaining their care in order to provide the best possible experience for them. See the following regulation regarding service plans by the Hawaii OHCA:
- 11-90-8 Range of services.
(a) Service plan.
(1) The assisted living facility staff shall conduct a comprehensive assessment of each resident’s needs, plan and implement responsive services, maintain and update resident records as needed, and periodically evaluate results of the plan. The plan shall reflect the assessed needs of the resident and resident choices, including resident’s level of involvement; support principles of dignity, privacy, choice, individuality, independence, and home-like environment; and shall include significant others who participate in the delivery of services;
(2) A service plan shall be developed and followed for each resident consistent with the resident’s unique physical, psychological, and social needs, along with recognition of that resident’s capabilities and preferences. The plan shall include a written description of what services will be provided, who will provide the services, when the services will be provided, how often services will be provided, and the expected outcome. Each resident shall actively participate in the development of the service plan to the extent possible;
(3) The initial service plan shall be developed prior to the time the resident moves into the facility and shall be revised if needed within 30 days. The service plan shall be reviewed and updated by the facility, the resident, and others as designated by the resident at least annually or more often as needed; and
(4) The facility shall designate a staff member to review, monitor, implement, and make appropriate modifications to the service plan §11-90-8 for each resident.
(b) Services.
(1) The assisted living facility shall provide the following:
(A) Twenty-four hour on-site direct staff to meet the needs of the residents;
(B) Three meals daily, seven days a week, including modified diets and snacks which have been evaluated and approved by a dietitian on a semi-annual basis and are appropriate to residents’ needs and choices;
(C) Laundry services to the extent that the resident is unable to perform these tasks for himself or herself;
(D) Opportunities for individual and group socialization;
(E) Services to assist the resident in performing all activities of daily living, including bathing, eating, dressing, personal hygiene, grooming, toileting, and ambulation;
(F) Nursing assessment, health monitoring, and routine nursing tasks, including those 90-15 which may be delegated to unlicensed assistive personnel by a currently licensed registered nurse under the provisions of the state Board of Nursing; and
(G) Household services essential for the health and comfort of the resident (e.g. floor cleaning, dusting, bed making, etc.).
(2) The assisted living facility shall also have the capability to provide or arrange access to the following services:
(A) Transportation for medical and social appointments;
(B) Ancillary services for medically related care (e.g. physician, pharmacist, therapy, podiatry, etc.), barber or beauty care services, social or recreational opportunities, and other services necessary to support the resident;
(C) Services for residents who have behavior §11-90-8 problems requiring ongoing staff support, intervention, and supervision;
(D) Social work services; and
(E) Maintenance of a personal fund account for residents showing deposits and withdrawals.
(3) The assisted living facility shall have policies and procedures relating to medications to include but not be limited to:
(A) Self-medication:
(i) Residents must have physician or prescribing advanced practice registered nurse’s written order of approval for self-medication of prescription medications;
(ii) Residents able to handle their own medication regimen may keep prescription medications in their unit;
(iii) Residents may keep and use over the-counter medications in their unit without a written order unless otherwise indicated by a physician or prescribing advanced practice registered nurse’s written orders;
(iv) If more than one resident resides in the unit, an assessment shall be made of each person’s ability to safely have medications in the unit. If safety is a factor, the medication shall be kept in a locked container in the unit; and
(v) Residents who self-medicate with prescription drugs or maintain over the-counter drugs in their units shall have all their medications reviewed by either a registered pharmacist, registered nurse, or physician at least every 90 days.
(B) Administration of medication:
(i) Prescription and non-prescription medications which the facility has responsibility for administering to a resident must be identified in the resident’s record and must be prescribed in writing for the resident by a physician or prescribing advanced practice registered nurse; and
(ii) The facility shall provide and implement policies and procedures which assure that all medications administered by the facility are reviewed at least once every 90 days by a registered nurse or physician, and is in compliance with applicable state laws and administrative rules.
(4) Recreational or social activities are to be made available to residents on a daily basis.
(c) Licensed nursing staff shall be available seven days a week to meet the care management and monitoring needs of the residents.
Top Takeaways:
- The assisted living facility staff shall conduct a comprehensive assessment of each resident’s needs, plan and implement responsive services, maintain and update resident records as needed, and periodically evaluate results of the plan. The plan shall reflect the assessed needs of the resident and resident choices, including resident’s level of involvement; support principles of dignity, privacy, choice, individuality, independence, and home-like environment; and shall include significant others who participate in the delivery of services.
The preadmission assessment is key to building an effective service plan that meets the needs of each resident. This assessment is also where you will be able to determine whether you will be able to accept the individual as a resident into your facility. The service plan should promote autonomy and independence with decision making and the activities of daily living.
- (3) The assisted living facility shall have policies and procedures relating to medications to include but not be limited to:
(A) Self-medication:
(i) Residents must have physician or prescribing advanced practice registered nurse’s written order of approval for self-medication of prescription medications;
(ii) Residents able to handle their own medication regimen may keep prescription medications in their unit;
(iii) Residents may keep and use over the-counter medications in their unit without a written order unless otherwise indicated by a physician or prescribing advanced practice registered nurse’s written orders;
(iv) If more than one resident resides in the unit, an assessment shall be made of each person’s ability to safely have medications in the unit. If safety is a factor, the medication shall be kept in a locked container in the unit; and
(v) Residents who self-medicate with prescription drugs or maintain over the-counter drugs in their units shall have all their medications reviewed by either a registered pharmacist, registered nurse, or physician at least every 90 days.
(B) Administration of medication:
(i) Prescription and non-prescription medications which the facility has responsibility for administering to a resident must be identified in the resident’s record and must be prescribed in writing for the resident by a physician or prescribing advanced practice registered nurse; and
(ii) The facility shall provide and implement policies and procedures which assure that all medications administered by the facility are reviewed at least once every 90 days by a registered nurse or physician, and is in compliance with applicable state laws and administrative rules.
Perhaps one of the most important elements of a resident’s care is the proper distribution of their medication. Think about it- these people are entrusting us with their life. The medication that often keeps them functioning and at times even alive rests in our care. It is necessary for your entire clinical team to be well versed in the regulation that is applicable to their position. The Nursing Director or their designee should hold frequent refresher trainings and have processes put into place for all matters related to the medication management process.