The aged care industry is developing ways in which elderly people can have personalised care that describes an individual’s values, preferences and future medical treatment decisions. An aged care plan, which is a person-led document completed and signed by a willing person, includes instructions on their care, their goals and their medical treatment.
This form of care allows elderly individuals to achieve their own form of independence when it comes to transitioning into their later years and achieving the goals of their needs, while supported by aged care professionals.
What is a Care Plan?
A care plan is a collection of information that clearly outlines and describes the support and services that are needed by a person and how you will meet the needs of said person. These care plans should be collaborative documents where the person being cared for has equal input into the plan which is then agreed upon by both parties.
The overall plan of care is made up of individual records including experiences between the carer and the person needing care along with future expectations and needs. This means that once care services start, it is optimal to continuously review the plan at least once every 12 months with the person being cared for. It ensures that clients are looked after in accordance with their particular, individual requirements and that the carers efforts are effective and tailored.
Care plans determine the care and improvements needed in daily life and should consider what is important to the person’s preferences for the present and future.
Understanding Care Plans Within an Aged Care Context
Care plans in aged care require extremely involved ongoing assessments, diagnosis, interventions and evaluations of client outcomes. This will inform family members and future carers to keep clear records of interventions, outcomes and progress or deterioration, especially if the person cannot communicate themselves.
By creating an aged care plan, a client’s preferences and needs, as they transition into a new stage in their life, are known medically, physically and socially. Consequently, care plans also assist in ensuring the continuity of the services of a carer and can offer valuable feedback for a carers improvement in their profession.
An aged care plan is of the utmost importance, especially for elderly individuals who are impaired or are unable to communicate effectively to align the care that is being received to their own personal preferences and health outcomes.
In summary, a care plan facilitates:
- The direct needs of a participant,
- The view, preferences, and choices a participant has requested,
- The resources, that are available to a care team, to meet their requirements,
- The emergency and risk easing measures pertaining to the participants care situation.
A care plan is a key to the services you get, and getting a care plan includes some steps which are explained below.
What Does a Care Plan Include?
A care plan in aged care services consists of the pre-preparation and the future expectation of a client and a carer. An individuals care plan is determined and written simply with an effective approach and ideas, in addition to the strategy that will be used to improve the condition of the individual person.
A care plan should include:
- Exploring, finding and discussing the best way to assist the person in need.
- Planned conversations, open communication and sharing thoughts between a client and a carer.
- Clear methods and plans that will be used to measure progress.
- Goal setting to ensure that a client is achieving their ideal care.
- Update the information of the client while in care.
- Review care plans if necessary.
- List of treatment preferences and where a client wishes to receive care specifically.
- Strict confidentiality between the client and the carer with the plan belonging to the client, keeping them in control.
- Clear roles of who will provide services, when they will be provided and how a client’s daily life will be managed.
- Scheduling formal reassessments.
- The desired outcome of the relationship between a client and carer.
- How the care providers will make the aged care experience as safe and joyous as they can.
A care plan could include anything, from personal assistants assessing a client each week to home modifications with a domestic assistance plan to make non-residential aged care a reality. The inclusions of an aged care plan are made clear to effectively manage and support a client depending their needs.
For an effective result, a care plan should be made with the consultation of an elderly patient, their doctor, and their family members.
Why Care Planning is Important Within Aged Care
A care plan assists not only in making sure that a client achieves the right level of personalised long-term care but also in ensuring that a client’s needs are known by care workers and other loved ones. An aged care will outline what a client’s goals are, how they want to live their day-to-day life and how they will transition into their elderly years.
The best part about an aged care plan is that it helps an elderly person understand their condition in more clarity and enables them to live as independently as possible while getting assistance that they may need.
The Benefits of Care Plans
There are many benefits to creating an individual care plan with a service provider. Some of the major benefits include:
- A care worker is given a guide of a client’s individual needs – a comprehensive document of information prepares everyone involved and maintains a high quality of care long term.
- A care plan outlines how both parties navigate situations – this can be mundane like daily plans but can also include emergency procedures and medical issues. This also prepares a carer, before beginning their care, for challenging situations before they arise.
- A care plan helps to identify potential upcoming risks – having a clear assessment of risks ensures decreasing their probability of occurring and alerts staff and other care home residents.
- A client’s care plan is personalised – no matter the situation, the goal of creating a plan is to ensure that a client’s needs are met to their standards and no one else’s.
- A care plan schedules health services for the client.
How Often Should a Care Plan Be Updated?
Two care plans are never alike and one should never remain the same as the carer and client continuously update it as their relationship develops. Updating and developing a care plan depends on the nature of the clients cognitive and physical health and the degree of assistance that they may require. A person’s care will most likely never remain the same as their daily challenges may become different and evolve over time.
An updated care plan is also essential for someone with an unstable condition like chronic obstructive pulmonary disease (COPD) or dementia as they will require more frequent health assessments. Concentrating on patients with complicated health conditions and care needs can be extremely difficult without these care plans as attention to detail becomes the most important aspect of caring.
Updating care plans for elderly individuals who are still fairly healthy and independent is important as their needs and wants still require the right care and focus.
Involving Yourself Within the Care Planning Process
It is extremely important to discuss your care plan with yourself and your family. The more information that is shared between family members becomes extremely hard to know who knows what but a clear set of documentation can change that. Managing one set of documents becomes key as everyone involved becomes a team working towards the development of a healthier lifestyle for the client.
If you are a family member who is the primary carer for your loved one it may be optimal to engage some other service providers or health care professionals to assist in your care planning. Different care pathways can provide you and your loved one who needs care with valuable information, services and even a home care package to ensure that the best support is provided.
How Health Professionals and Aged Care Workers Should Approach Care Planning
Care planning is not a means to an end. Health professionals and aged care workers should be both empathetic and patient when it comes to creating a comfortable, satisfying and effective care plan for clients.
Creating a care plan should be consistently built upon and updated depending on the situation of the person needing care. This means reviewing plans every few months, a transparent line of communication between every party involved and clear goals that satisfy the needs of the client.
