Individualized Care Plans: The Crucial Part They Play in Senior Home Care

Without an individualized care plan, your senior is at risk.
Image source: Flickr user Derrick Tyson[/caption]

woman sits next to elderly man in bed
Without an individualized care plan, your senior is at risk.
Image source: Flickr user Derrick Tyson

When I worked in a nursing home, individualized care plans were part of supervising every patient and resident. They were created, discussed, and constantly reworked – often with the input of the senior’s family members. But what most people don’t realize is that these care plans are also a crucial part of taking care of your elderly loved one at home.

Prevent illness and injury

One of the most salient reasons to have an individualized care plan at home is to decrease the possibility of your senior suffering an illness or accident. Care plans can address issues such as infection control, fall risks, and the effects of various medications and their dosages. And these are just a few of the things care plans cover – there are many, many more. Basically, a care plan consists of identifying a problem (or potential problem), outlining the steps to solve it, and re-evaluating those steps after a certain length of time, or when circumstances change.

Help maintain patient functionality

Preventing illness and accidents aren’t the only things care plans can do – they also help seniors maintain optimal functioning within their limitations. For instance, part of a care plan may have the senior attending physical therapy on a regular basis to build up their strength. This has the potential to allow them to keep their independence for as long as possible, and perhaps even delay the need for a nursing home.
And it’s not just physical skills and abilities that can be put in a care plan. Cognitive aspects –such as playing memory games to keep the minds sharp – can also be implemented. Also, while many informal caretakers forget the importance of socializing to a senior, a home health professional will almost certainly want recreation included in the care plan as well.

Help seniors feel involved in their futures

The senior years can be very rewarding, but they can also be a time filled with stress and uncertainty. New medical problems arise, old friends may pass on, and elders find themselves becoming less independent by the day. If your senior has the wherewithal to be involved in their individualized care plan, this can improve their outlook and state of mind. Instead of feeling like they have no control over their future, participating in regular care plan meetings can help put them back in the driver’s seat.

Formulate a thoughtful care plan

To formulate a care plan, gather all members of the team together. This might consist of a home health aide, nurse, social worker, and family members. The meetings do not have to take place in person – if a family member lives across the country, for instance, a group or Skype call will suffice. It’s important that the entire team knows the risks and goals of the care plan, so one person isn’t just focusing on the part they’ll play. For instance, a nurse needs to know if the patient is at risk for depression; a visiting social worker should be aware if the senior is a fall risk.
A very simple example of a care plan for a fall risk might look something like this:
Problem: patient is a fall risk.
Reason: decreased mobility due to poor circulation in legs.
Goal: patient will have zero falls this quarter.
Intervention:

  • Address client’s poor leg circulation with physician.
  • Educate patient to ring bell or call for assistance with ambulation and transfers.
  • Remove objects in the environment that may contribute to injury (ex., frayed rugs).
  • Have physical therapist teach client appropriate use of a walker and any other necessary mobility aids.

Don’t delay in making an individualized care plan

Putting off making an individualized care plan can only mean putting your elderly loved one at risk. It’s understandable if you find the task onerous or daunting. But the sooner you get started, the sooner you can rest assured you’re doing everything possible to keep your senior safe, comfortable, and healthy.
If you are unsure of how to best help an aging loved one, the trained and compassionate staff at the Institute on Aging is here to help you make that decision and gain the best in at-home senior care. Contact us to find out more.

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Three and a half years ago, Maggie Fang started her journey as an Assessment Specialist in the Support at Home Program at IOA. Her excellent people skills enabled her to manage a caseload of older adults and individuals with disabilities, helping them receive homecare to age in place. Maggie was selected to pioneer the Temporary Respite Caregiver Support program, and we are delighted to have such a skilled and dedicated individual leading our newest program at IOA. Thank you, Maggie, for your exceptional work! 

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