It’s one of the most delicate issues in long term care. In most facilities, there are residents who just don’t have the capacity to make their own personal care decisions.
In these cases, a substitute decision maker must be appointed. This person—whether she’s a family member or some other individual with power of attorney—needs to sign off on all care plan changes.
Of course, there’s good reason for these rules. The goal should always be to get as close as possible to acting in accordance with resident wishes. And when they can’t decide for themselves, residents are best served by the people who have been entrusted with their care.
But reaching a given substitute decision maker isn’t always an easy process. This crucial step in care delivery can eat up a whole lot of time—and resources.
At Aetonix, we’ve spoken to a lot of professionals who work in long term care. And this is one of those issues that keeps coming up, again and again. In this post, we’ll look at what’s wrong with the care plan approval process—and how it can be fixed.
Ontario’s Health Care Consent Act is clear. When a patient is incapable of making a crucial care decision, a substitute decision maker must be brought in.
An individual tasked with making health care decisions for another person carries an enormous amount of responsibility. It’s a difficult role to take on, which is why health care professionals should treat those who fill it with sensitivity and respect.
That said, acquiring consent can be difficult for those working on the frontlines. In long term care, problems often occur when a resident’s care plan needs to be changed. A prescription update or treatment modification can lead to countless voice messages. Often, there are rounds of phone tag, numerous faxes, and extended periods of waiting.
For the practitioner or caregiver hoping to take action, this process can be extremely frustrating. These feelings may be compounded by confusion when many care professionals are involved. All too often, an on-duty nurse will find himself waiting to get the go-ahead from a resident’s loved one. When a shift change occurs, the situation may be even more unclear to the worker who takes over. Questions can arise, leading to uncertainty.
Was the right person contacted for consent? What’s the status of the request? Was the most up-to-date information entered into the care plan, or did the nurse from the earlier shift get delayed? If you work in long term care, you know how frequently urgent situations can pull staff away from administrative tasks.
Between even the most dedicated physicians, nurses, and personal support workers (PSWs), miscommunications can occur. Information can get lost in the shuffle. And the care plan approval process can get held up.
This is a fundamental problem with many circles of care. The people who care for a resident aren’t always in sync. And when they don’t have the latest information, t’s difficult for health care practitioners and family members to provide full support.
Consider this: 90% of Ontario’s long term care residents have some form of cognitive impairment. One in three are severely impaired.
If you manage a home for people who belong to this population, you’re aware of the challenges involved. Caring for those with cognitive impairments can mean struggling to to obtain consent from substitute decision makers. This difficulty isn’t a well known to those outside of the health care field. But that doesn’t mean it’s easy to tackle.
When care plan approval doesn’t come, team members can’t implement crucial changes. As a result, residents must wait to receive beneficial treatments. Unfortunately, the impact of waiting can be significant.
For someone who needs it, consider the difference that switching a pain medication can make.
Of course, it’s not just about individual patients. Delays can hold up care across facilities, slowing down operations. Managers: how much time do you think your staff spends, in total, trying to get hold of substitute decision makers? How often does treatment get held up because caregivers haven’t received care plan approval?
The truth is, you might not even be aware of the extent of the problem.
In order to provide residents with the best care possible, it’s important to allocate resources in the right way. This includes human resources. For workers and practitioners, the extra effort required to communicate with people outside of their work environments can take its toll. It can even contribute to mental and physical burnout—conditions that have serious consequences.
Every long term care professional (including those in management) should care about this issue. Solving it will lead to better resident health outcomes—and make life far less stressful for entire circles of care.
How can long term care homes avoid spending massive amounts of time on the care plan approval process? The answer: strengthen resident circles of care. This goal may seem massive in scope and difficult to reach. But it’s far from unachievable.
In long term care, a resident who’s capable of making her own decisions is at the centre of her circle. Her goals and preferences come first during the care planning process. Every time there’s uncertainty about making a change to her plan, she’s the one who has the final say.
When she can’t make these decisions, her circle of care is just as important it otherwise would be—if not more so. But how can the individuals who comprise her circle work together? More often than not, they’re in different locations. And their schedules are bound to be different.
Communication technology holds the key. By bringing everybody together, the right digital platform can streamline the care plan approval process. The result is instant actions that truly benefit the resident.
What does this type of solution look like in practice? Let’s say all of the members of a circle of care are connected through the same electronic system. This system would allow everybody—including relevant nurses, physicians, and specialists—to relay real-time information to the resident’s family members (and, importantly her substitute decision maker).
Using their mobile devices, facility caregivers and attendant practitioners could submit requests as they arose. With the tap of a cell phone or tablet screen, the resident’s substitute decision maker could approve requests quickly.
After shift change, new workers could log in to see the status of requests on an as-needed basis. Care would be delivered quickly, and everyone would win—especially residents.
Fortunately, the technology we’re talking about already exists. In facilities that have trouble with care plan approval, it’s time to incorporate an easy communication and information-sharing app.
Operating a long term care home comes with many challenges. With advancements in digital technology, some are easier to overcome than others.
Streamlining the care plan approval process is an efficiency-enhancing measure that benefits all involved. When communication is quick and easy, physicians, nurses and PSWs can focus on what they’re best at—caring for residents.
Feature image courtesy of NEC Corporation of America