Resident care plans are being written in a new voice as more nursing facilities replace traditional medical-model care plans with "I" care plans.
"I" care plans, also known as resident-centered or person-directed care plans, attempt to move away from the medical model of care planning by focusing on individual residents' needs and preferences. "I" care plans are usually written in the first person, using statements like "I want to complete my rehabilitation quickly and return home as soon as possible."
Under the traditional medical-model care plan, many facilities state a diagnosis or problem, a goal, and then list numerous interventions. The problem with this model is the care plan is often not individualized for the resident, so the interventions don't work, says Bonnie G. Foster, RN, BSN, MEd, a long-term care consultant in Columbia, SC.
Proponents of "I" care plans say the new kind of care plans have the potential to transform care plans from paper compliance products to useful tools for nursing home staff members, improve quality of care, and encourage culture change.
Opponents say "I" care plans are too wordy and represent a semantic change rather than a true change in care. Person-directed care plans can seem like an exercise in semantics when nursing facilities simply replace "Mrs. Jones" with "I," says Michele Nolta, CTRS, ACC, owner of Recreation Therapy Consultants in San Diego and the author of a book about care plans.
To write a true "I" care plan, staff members must use the resident's own statements, Foster says. In other words, staff members can't invent an "I" care plan without input from the resident.
Nursing facility staff members are often concerned about how surveyors will react to "I" care plans. Foster says that while she can't predict what a surveyor will do, nursing facilities must have the proper documentation to support care plans.
"A care plan tells staff members how to take care of a resident," she says. "It doesn't matter how you write it if you don't have the documentation to back it up."