Quality of Care demands that people receiving long-term care should be treated with dignity. True quality of care speaks to the way a long-term care recipient is treated every day by everyone with whom they come in contact, and by the provider organization itself. Specific examples are the way the nurse approaches the consumer about taking medications and the manner in which an aide provides help with personal and private care.
Quality of Care means something different to each person and considers their unique needs and experiences. Quality of Care establishes approaches which make sense for each individual and their unique circumstances.
That being said, the family representative of a long-term care recipient is considered a member of the care plan team, not a visitor. If the consumer cannot speak for oneself, the representative’s role is critical. The care plan should address medical, physical, mental, and social aspects of the consumer’s life. It should be goal directed to maintain or enhance the consumer’s experiences at the highest practicable level of the person receiving care, not the provider.
The Consumer’s Care Plan
Each consumer is assigned a number of professional and paraprofessional staff to develop a plan by which the long-term care provider will identify and work to meet the consumer’s needs. The family members of the person receiving care are considered members of the care plan team (unless the consumer does not consent to this practice). In cases where the consumer is incapacitated, often there is a family member with power of attorney or designated as a legal representative who fills this role.
Families must often take the initiative to assume this role. It is this representative’s responsibility to ensure that all their loved one’s needs — medical, nutritional, communication, social, mental, psychological, recreational, religious, and personal preferences — are addressed in the care plan, which serves as the guide for all staff working with the consumer.
Properly organized providers have a social worker, case manager, or care coordinator on staff to assist in the process of developing and participating in the care plan. The care plan should have stated goals for maintaining the consumer’s well-being in all the areas of the their life. The family should gain a clear understanding of these goals and how staff will work toward them. Regularly scheduled updates should keep the family updated on progress; issues should be discussed as they arise. Natural aging-related decreases in the consumer’s functioning will occur and the care plan should be modified as needed.
What -- and Who -- Is Involved In Developing a Comprehensive Care Plan? See the drop-down box below.
NOTE: A comprehensive care plan is needed whether or not the provider will be responsible for all aspects of the consumer's life. For example, it is important for a home care provider to know that attending religious services is important to the person receiving care. Without this knowledge, the provider will not make an effort to schedule home care services to assist the consumer in the tasks to get ready or to attend religious services. Weekends are not always a routine service day for some providers.
Practicalities in Quality of Care
Quality of Care requires that consumers receive medication only as necessary, and only when a proper diagnosis indicates that the medication is appropriate for that condition. Our Mother’s Voice empowers families and advocates to speak out for consumers when they can only communicate feeling sick by acting agitated, and so receive medication to calm their behavior instead of treat the illness. Thus empowered, the advocate can say on behalf of the consumer, “I do not need medicine to calm me down! I am sick! I need to have the doctor check me out!” The family must speak out when their loved one cannot. Certainly, there are cases when medications are appropriate and necessary. Quality of Care distinguishes these cases and responds correctly.
Accidents will happen. Quality of Care is evident in how the care environment is organized to prevent accidents and respond to accidents that do occur. Consumers should be supervised adequately. Investigation, follow-up, and systems changes to prevent recurrence of accidents are all components of Quality of Care. Quality of Care minimizes staff distractions, establishes safe environments and practices, and ensures that staff members are actively engaged with consumers, not involved in nonwork-related pursuits.
Quality of Care ensures consumers are free from physical or chemical restraints used for purposes of discipline or convenience, and which are not required to treat the consumer’s medical symptoms. Recipients of care must not be exposed or vulnerable to verbal, sexual, physical, or other forms of abuse, neglect, or exploitation. How any allegations or acts of such treatment are handled can determine the presence or absence of Quality of Care. All alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown sources and misappropriation of the consumer’s property are to be reported immediately to the administration of the service provider and to other officials as established by state law.
The provider must complete an internal investigation of all violation reports and complaints, and submit the findings to those officials within a specific timeframe. In cases where violations of law or crimes may have occurred, law enforcement may be required to conduct an independent investigation. Certain actions, as each situation requires, must be taken when any violation is verified. The laws governing abuse and reporting must be posted in every facility.
The terms abuse, neglect, exploitation, and misappropriation of property are defined on our “What You Can Do” page
Source: Code of Federal Regulations, 42CFR483.25, 42CFR483.12, 42CFR483.20, 42CFR483.24, 42CFR483.40, 42CFR483.45, 42CFR483.70, 42CFR483.75, and 42CFR483.85, and the Center for Medicare & Medicaid Services.
The information in this document is largely extracted from federal nursing home regulations, which serve as the basis for other care settings and for state regulations as well. Only those provisions that are applicable across care settings are included. Please refer to the regulations for a specific care setting under the “Foundation of Quality” tab of our website for more information specific to that particular care setting.
The provider must develop and implement a comprehensive person-centered care plan for each consumer, consistent with the consumer’s rights (including the right to refuse treatment), and which includes measurable objectives and timeframes to meet a consumer’s medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment – for which the family representative or POA should serve as an informant.
Services are to be furnished to attain or maintain the consumer's highest practicable physical, mental, and psychosocial well-being, including any specialized services or specialized rehabilitative services that are identified in the assessment and related documents.
The plan must be developed in consultation with the consumer and the consumer's representative and should include the consumer's goals, preferences, and desired outcomes.
A comprehensive care plan must be developed within 7 days after completion of the comprehensive assessment. The entire interdisciplinary team should be involved, including but not limited to the attending physician, a registered nurse with responsibility for the consumer, a nurse aide or other paraprofessional staff with responsibility for the consumer, other appropriate staff or professionals in disciplines as determined by the consumer's needs or as requested by the consumer, and for residential settings, a member of food and nutrition services staff.
To the extent practicable, the consumer as well as the consumer's representative(s) should also be involved in plan development. An explanation must be included in a consumer's medical record if the participation of the consumer and their representative is determined not practicable for the development of the care plan. (NOTE: In this age of communications technology, it is difficult to imagine any scenario in which the consumer’s representative cannot be involved in the development of the care plan. Advocates should be ready to challenge this conclusion if it is presented by the provider without consultation with the consumer’s representative in making this determination.)
The plan must be reviewed and revised by the interdisciplinary team after each assessment (at least annually, updated at regular intervals as provided in regulations for the specific care setting).
The services provided or arranged by the provider, as outlined by the comprehensive care plan, must meet professional standards of quality, be provided by qualified persons in accordance with each consumer's written plan of care, and be culturally-competent and trauma–informed.