Treating Trees as Medicine in a World of Lockdowns<p><img src="/Topics/Guest-Columns/PublishingImages/2021/Masonic-Campus-Photos-90.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;300px;height&#58;194px;" />​March 2020 is a time that no one will soon forget. The fundamental way people lived their lives changed overnight, as all across the world people collectively went into lockdown to prevent the spread of COVID-19. As people were urged to stay home, particular caution and care were afforded to those who were deemed especially susceptible to the virus&#58; the immunocompromised, frontline workers, and, of course, the elderly. <br></p><p>Health care facilities reacted swiftly to lockdown and secure their campuses in a conscious effort to protect their vulnerable populations. Nursing homes and assisted living communities have had a challenging time during the pandemic, as these facilities rely on a consistent flow of volunteers and family members visiting the residents.</p><p>Suddenly the residents found themselves cut off from the rest of the world, and these facilities had to find ways to help them adapt. They had to work to find new ways to keep their residents’ minds engaged and uplifted throughout the lockdown. </p><p>Masonic Homes Kentucky’s Louisville Campus turned to an unexpected outlet of healing and comfort during this time&#58; Trees.</p><h3 class="ms-rteElement-H3B">About Masonic Homes’ 82-Acre Arboretum</h3><p><span><img src="/Topics/Guest-Columns/PublishingImages/2021/Masonic-Campus-Photos-311.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;150px;height&#58;225px;" /></span>Trees and the green spaces the trees create play a massive role in the landscape for Masonic Homes Kentucky. In particular, the Louisville Campus was designed in 1927 by renowned landscape architectural firm, The Olmsted Brothers.</p><p>It was established by the sons of the landscape architect Frederick Law Olmsted who is best known for his work in designing the grounds of New York City’s Central Park, the U.S. Capitol in Washington, D.C., and the Biltmore Estate in North Carolina. </p><p>“Masonic has taken great care and consideration to preserve elements of the original design and to replicate it whenever possible,” says J Scott Judy, chief executive officer, Masonic Homes Kentucky.</p><p>“One of the many beauties of Kentucky is the changing of its seasons. Masonic’s parklike setting offers four miles of paved walking paths that intertwine the historic and the contemporary community buildings.”</p><p>The Masonic Homes Kentucky community hires certified professional grounds staff who are responsible for all of its three campuses, each with its own unique landscape. These professionals understand trees and green landscapes as an investment in the well-being of the residents and staff of the communities. </p><p>In addition, the Louisville Campus will soon add walking paths that will line the campus to help encourage employees and residents alike to spend more time outside.</p><h3 class="ms-rteElement-H3B">Recognized By Arbor Day</h3><p>Masonic Home Louisville is recognized as a Tree Campus Healthcare facility to highlight its dedication to trees and nature. Tree Campus Healthcare is a program of the Arbor Day Foundation, the world’s largest membership nonprofit dedicated to planting trees.</p><p><img src="/Topics/Guest-Columns/PublishingImages/2021/Masonic-Campus-Photos-99.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;199px;height&#58;299px;" />Launched in 2019, Tree Campus Healthcare is one of the newest recognition programs from the Arbor Day Foundation that aims to recognize any health care facility purposefully using trees and green spaces to promote good health and well-being for its employees and occupants.</p><p>For Masonic Home Louisville, its designation as a Tree Campus Healthcare facility serves as an opportunity to remind its leadership to continue investing in these types of greening projects and as a general reminder for everyone of the close relationship nature can have for the care and healing of residents. <br></p><h3 class="ms-rteElement-H3B">The Healing Benefits of Trees</h3><p>Trees can help more than just the environment; they help with human health. Research shows that patient recovery improves when there is interaction and incorporation of green spaces, gardens, and parks. Natural areas help patients reduce stress, help restore physical health, and shorten the overall recovery process, according to R.S. Ulrich, reporting in Science magazine. <br></p><p>Spending time outside in hospital gardens is highly beneficial for the patient and additionally, hospital window views of natural scenes have been shown to reduce post-operative hospital stays. Having trees on a health care campus is a natural partnership. </p><p>“Outdoors is a respite for so many residents during the pandemic,” says Judy. “The vast grounds offered residents a safe sanctuary to enjoy fresh air, exercise, and beautiful scenery while allowing social distancing.”</p><p>To curb the risk of exposure during the pandemic, the facility decided to close its campus to all nonessential visitors. However, Masonic Home Louisville took a creative approach to share the beauty of its facility campus. It created a virtual landscape tour, which highlighted unique trees and interesting landscaping. The trees and green spaces served an essential purpose for the residents and staff&#58; They provided hope during the lockdown.</p><p><img src="/Topics/Guest-Columns/PublishingImages/2021/Masonic-Campus-Photos-July-2019-68.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;288px;height&#58;197px;" />It is evident that trees are a priority for the Louisville Campus, but the community ultimately prides itself on its commitment to caring for its residents. Masonic Home Louisville is not only a Tree Campus Healthcare facility, but it is also part of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).</p><p>The facility enjoys being a member of the association because of the relationships cultivated and the resources provided. AHCA/NCAL’s values encouraged Masonic Homes Kentucky to rise above and beyond the regular standard of care for its residents, even if it means extra care routinely given to maintaining and cultivating the landscaping and greenery of the grounds. <br></p><p>Little did Masonic Home Lousiville know that this dedication and love of nature would provide a safe space, six feet apart.</p><h3 class="ms-rteElement-H3B">Make Trees a Priority </h3><p><img src="/Topics/Guest-Columns/PublishingImages/2021/Village_Adams-Hall.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;277px;height&#58;190px;" />More trees mean more benefits for everyone. Trees take care of the air, water, and wildlife everywhere they exist. Trees are considered the lungs of the earth because they take in carbon dioxide and release fresh oxygen. Trees help reduce urban runoff and the amount of sediment, pollutants, and organic matter that reach streams.</p><p>Planting trees is also a great way to encourage local biodiversity in urban communities. The list of good things trees accomplish can go on and on, but the message is the same&#58; Trees deserve to be a higher priority on everyone’s list.</p><p>To learn more about the Arbor Day Foundation’s Tree Campus Healthcare program, go to <a href="https&#58;//www.arborday.org/programs/tree-campus-healthcare/" target="_blank">arborday.org/programs/tree-campus-healthcare/</a>. </p><p><img src="/Topics/Guest-Columns/PublishingImages/2021/LoganDonahoo.jpg" class="ms-rtePosition-2" alt="Logan Donahoo" style="margin&#58;5px;width&#58;140px;height&#58;140px;" />As program manager, Logan Donahoo leads the Tree Campus “family” of recognition programs at the Arbor Day Foundation, which includes Tree Campus Healthcare. In her role, she focuses on growing participation in each program, creation of resources for program participants, and cultivation of relationships with collaborating organizations and networks. Donahoo can be reached at <a href="mailto&#58;ldonahoo@arborday.org" target="_blank">ldonahoo@arborday.org</a>.</p><p><br></p>2021-11-30T05:00:00Z<img alt="" src="/Topics/Guest-Columns/PublishingImages/2021/700_3576.jpg" style="BORDER&#58;0px solid;" />COVID-19;CaregivingLogan DonahooMarch 2020 is a time that no one will soon forget. The fundamental way people lived their lives changed overnight.
Common PDPM Missteps and How to Avoid Them<p><img src="/Monthly-Issue/2021/October/PublishingImages/JenniferLaBay.jpg" alt="Jennifer LaBay" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;145px;height&#58;186px;" />In October 2019, the Patient-Driven Payment Model (PDPM) became the new payment methodology for Medicare Part A residents in skilled nursing facilities (SNFs). Although PDPM has been in effect for two years, the public health emergency may have temporarily shifted priorities for some facilities.<br></p><p>This temporary shift, combined with PDPM’s relative newness and recent staff turnover, may have significantly affected Medicare revenue over the past 18 months.<br></p><p>Here are three common missteps that may be impacting a facility’s Medicare reimbursement.<br><br><em>1. Managing the Assessment Reference Date (ARD)</em><br>The Medicare 5-Day assessment has an ARD range of Days 1-8 of the SNF Part A-covered stay. Nurse assessment coordinators (NACs) who insist on using Day 8 as the ARD for all 5-Day assessments may not capture all the services or conditions that impact Medicare revenue.<br></p><p>Since payment is no longer based on therapy minutes, facilities may benefit from finessing their ARDs to ensure documentation is in place to capture key services and diagnoses. The ARD for the 5-Day assessment must be set on a Minimum Data Set (MDS) form or in the MDS software no later than 11&#58;59 p.m. on Day 8 of the Medicare stay. Once that time and date passes, the ARD cannot be changed, but until that point, it can be adjusted.<br></p><p>Ideally, on Day 8, the NAC should be completing a full chart review, including preadmission records, to determine the care and services that were provided. Using the calculation worksheets in chapter 6 of the “Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User’s Manual,” the NAC can determine the optimal ARD to capture the care and services, which will result in the best PDPM case-mix groups (CMGs).<br></p><p>Choosing Day 8 as the ARD instead of Day 2 could make a difference of hundreds of dollars per day, depending on what services were delivered and diagnoses assigned during the observation period.<br></p><p>Some examples of missed opportunities related to improper ARD selection include&#58;<br></p><ul><li>Not capturing cognitive impairment under the Speech-Language Pathology (SLP) component can occur when the Brief Interview for Mental Status (BIMS) is not conducted during the look-back period. If BIMS was completed on Day 1 of the stay and the ARD selected is Day 8, the BIMS is outside of the range for inclusion on the MDS.</li></ul><p>Per RAI manual instructions, page C-2, “Item C0100 must be coded 1, Yes, and the standard ‘no information’ code (a dash ‘-’) entered in the resident interview items. Do not complete the Staff Assessment for Mental Status items (C0700-C1000) if the resident interview should have been conducted but was not done.”<br></p><p>Preferably, the BIMS should be completed on the day of or the day before the ARD. Staff must be aware of all services that have been provided each day so that an ARD can be selected for a timely completion of the interview.<br></p><ul><li>Not capturing IV fluids or parenteral feeding from the hospital will impact the Nursing component of PDPM. Calculation for the Special Care High CMG comes from a 7-day look-back for both while a resident and while not a resident. If these services were received in the hospital, it may be beneficial to choose an earlier ARD to capture the IV or parenteral feeding.<br></li></ul><p><em>2. Assigning Primary Diagnosis Codes</em><br>Part of PDPM accuracy is ensuring the appropriate primary diagnosis is selected in section I0020B of the MDS. Some common diagnoses that have historically been used as a primary reason for admission to a SNF that, per the Centers for Medicare and Medicaid Services, will not map to a billable clinical category include weakness, failure to thrive, falls, and altered mental status. All of these calculate as return to provider (RTP) diagnoses in the PDPM ICD-10-CM mapping tool.<br></p><p>RTP diagnoses do not reflect care and services that would meet the skilled coverage criteria outlined in chapter 8 of the “Medicare Benefit Policy Manual” and will not generate a CMG. This may lead to payment at the default rate or, worse, provider liability. When this occurs, facilities need to dig deeper and query the physician or non-physician providers (NPP) about the cause of these conditions. <br></p><p>The better clinicians understand the nature of the problem, the better resident care will be, and the more accurate the payment category. It is important for the SNF team to discuss as a group before and after admission to ensure the medical record and MDS reflect the true reason for all skilled care. If there is no underlying cause found, the resident may not meet Medicare skilled coverage criteria. <br><br><em>3. Assigning Additional Diagnosis Codes</em><br>In addition to the Primary Diagnosis at I0020B, which affects the Physical Therapy (PT), Occupational Therapy (OT), and SLP components, the additional diagnoses in section I of the MDS may impact the SLP, Nursing, and Non-Therapy Ancillary (NTA) components as well. Unlike I0020B, diagnoses coded in sections I0100 – I8000 do not have to follow the clinical category map with the RTP restriction.<br></p><p>However, facilities do still need to use the ICD-10-CM map. SLP and NTA comorbidities captured in I8000 must be cross-referenced with the corresponding tabs in the ICD-10-CM mapping tool to determine if the criteria have been met for capturing the comorbidity in the PDPM CMG.<br></p><p>Another requirement for capturing the diagnosis in section I of the MDS is that the diagnosis must be documented in the medical record by the physician or NPP within 60 days of the ARD and must be active in the 7-day look-back period (excluding UTI, which must be active in the last 30 days).<br></p><p>If the medical record suggests a historical diagnosis, but there is not proper documentation from the provider during the look-back period, it is beneficial to use a later ARD to allow time for the provider to include this documentation in the medical record. <br></p><p>Some common PDPM missteps related to ICD-10-CM coding include&#58;<br></p><ul><li>Assigning a primary diagnosis that affects only one discipline instead of the overall skilled needs of the resident. For example, PT, OT, and nursing are treating removal (explantation) of hip joint, which maps to Orthopedic Surgery, while nursing is treating complication of infected hip joint, which maps to Acute Infections. Because most of the skilled care is provided to treat the explantation of the hip, that should be captured as the primary diagnosis.</li><li>Not capturing a diagnosis such as septicemia that is active at the beginning of the Medicare stay. An earlier ARD could allow capture of an active diagnosis from the hospital.</li><li>Not querying the physician or NPP for diagnosis clarification when the diagnosis is only listed in past medical history. For example, a history of cerebrovascular accident (CVA) with no residual deficits identified may miss clinically present sequelae (neurologic deficits).</li><li>Not capturing section I diagnoses correctly. Some NTA comorbidity points are assigned by section I0100 - I7900 checkboxes and others by I8000 ICD-10-CM codes. For example, coding Diabetes Type 2, E11.9, in I8000, will not accrue NTA points. MDS item I2900 for diabetes must be checked.</li></ul><p>NACs must diligently apply all the rules of PDPM, MDS, and ICD-10-CM coding. Understanding the “RAI User’s Manual” instructions and ICD-10-CM coding guidelines is essential to PDPM accuracy and success. <br><br><em><a href="mailto&#58;jlabay@AAPACN.org" target="_blank">Jennifer LaBay,</a> RN, RAC-MT, RAC-MTA, CRC, is curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN). </em><br>​</p>2021-10-01T04:00:00Z<img alt="" src="/Monthly-Issue/2021/October/PublishingImages/1021_mgmt.jpg" style="BORDER&#58;0px solid;" />ManagementJennifer LaBayNurse assessment coordinators must assign each patient’s assessment reference date to capture key diagnoses that impact Medicare revenue.
High-intensity Resistance Training in Post-Acute Care Produces Better Outcomes<p></p><p>Results of a study by researchers from the University of Colorado Anschutz Medical Campus show that high-intensity rehabilitation training for older patients in skilled nursing facilities can safely and effectively accelerate improvements in their function, enabling them to return home sooner. The study was published in <em>Physical Therapy</em>, October 2020.<br></p><p>Skilled nursing facilities provide medical and rehabilitation services to individuals post-hospitalization to help facilitate the transition to home or the next level of care. However, research has shown the trajectory of functional recovery following hospitalization and skilled nursing stay care is generally poor, with fewer than 25 percent of patients returning to pre-hospitalization levels of function. </p><h2>How the Study Worked</h2><p>“Our study identified an impactful opportunity to improve the way we care for patients in skilled nursing facilities,” said lead author Allison Gustavson, PT, DPT, PhD, at the CU Anschutz Medical Campus. “Our findings demonstrate that high-intensity resistance training is safe, effective, and preferable in caring for medically complex older adults in skilled nursing facilities.”<br></p><p>The study split 103 participants into two nonrandomized independent groups—usual care and high-intensity care—within a single skilled nursing facility. For both groups, physical therapists administered the Short Physical Performance Battery and gait speed at evaluation and discharge.</p><h2>Results of the Study</h2><p>For the high-intensity training group, the physical therapists used the i-STRONGER program (Intensive Therapeutic Rehabilitation for Older Skilled Nursing Home Residents).<br></p><p>The patients participating in the high-intensity program benefited by increasing their functional independence, as evidenced by a significant and clinically meaningful increase in their walking speed from evaluation to discharge by&#160;0.13 meters/second&#160;more than the usual care group. This is a critical outcome for this patient population, as improvements in walking speed greater than 0.1 meters/second are associated with reduced mortality.<br></p><p>Also, the patients’ stay at the skilled nursing facility was reduced by 3.5 days.</p><h2>Implications for Future Rehab Approaches</h2><p>Based on their findings, the researchers advocate the need to increase the intensity of rehabilitation provided to patients with medically complex conditions to promote greater value and patient experience within post-acute care. <br></p><p>“Our study shows that the quality of rehabilitation compared to the quantity drives better outcomes,” said Principal Investigator Jennifer Stevens-Lapsley, MPT, PhD, FAPTA. “These findings provide a timely solution to address rehabilitation value in the context of recent post-acute care changes by policymakers who are looking to raise the bar on the quality and efficiency of post-acute care services,” she said.<br></p><p>“We are eager to support the transition to this safer and more effective high-intensity care approach,” said Stevens-Lapsley, a professor and director of the Rehabilitation Science PhD Program at the CU Anschutz Medical Campus.<br></p><p>“We are encouraged by the results that accelerated the improvement in patient function, created positive patient and clinician experience, and resulted in less time needed for care in the skilled nursing facility,” she said.<br></p><p><img src="/Topics/Special-Features/PublishingImages/2021/1021/LaurenHinrichs.jpg" alt="Lauren Hinrichs" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;170px;height&#58;216px;" />The University of Colorado has partnered with the American Health Care Association to offer a CEU-credited High-intensity Resistance training program. For those interested in learning more about the research or training or for implementation support, contact Lauren Hinrichs or visit <a href="http&#58;//www.movement4everyone.org/" target="_blank">www.movement4everyone.org</a> for more information. <br><br><em>Lauren Hinrichs, PT, DPT, OCS, board-certified in orthopedics, is a Rehabilitation Science PhD student with the Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine. She can be reached at </em><a href="mailto&#58;lauren.hinrichs@CUAnschutz.edu" target="_blank"><em>lauren.hinrichs@CUAnschutz.edu</em></a><em>.</em><br></p>2021-10-01T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2021/1021/SF_intensity.jpg" style="BORDER&#58;0px solid;" />Clinical;DietLauren HinrichsResearchers advocate the need to increase the intensity of rehabilitation provided to post-acute patients to promote greater value and patient satisfaction.
Putting the Care Back in Care Planning<p>​F-tag 656, failure to develop and implement a comprehensive care plan, has been on the top 10 deficiencies list for years. Although this is not a new regulatory requirement, facility staff still struggle to achieve compliance with care planning during annual and complaint surveys. <br></p><p>Negative and siloed views such as, “No one looks at the care plan anyway” or “Only the nurse assessment coordinator is allowed to update the care plan,” serve only to further distance the care plan from its actual intent. While some may mistakenly view it as useless paper compliance, care plans should be viewed as a valuable tool for all staff.<br></p><p>The overall intent of the care plan is to articulate an approach to meet the resident’s goals and preferences and address medical, physical, mental, and psychosocial needs. However, care plans often look instead like lists of general interventions for nonspecific problems, which cannot actually drive resident care.<br></p><p>Refocusing the development and use of the care plan as a valuable tool for the interdisciplinary team (IDT) may help to provide more resident-centered care, improve outcomes, and reduce the risk of receiving an F656 citation during survey.</p><h2>Redefine the Care Plan as an Invaluable IDT Tool </h2><p>The guidance provided in the “State Operations Manual (SOM)” for §483.21(b) requires that “facility staff must work with the resident and his/her representative, if applicable, to understand and meet the resident’s preferences, choices, and goals during their stay at the facility.” However, the regulation allows the facility to determine how this process will be completed and to delegate to appropriate staff members.<br></p><p>The guidance continues that, “the facility must establish, document, and implement the care and services to be provided to each resident to assist in attaining or maintaining his or her highest practicable quality of life.”<br></p><p>While this regulation is well-known to most facility staff and is used to develop the comprehensive care plan, the final product often falls short of becoming an ongoing IDT tool to drive the care and services that the resident receives daily. The focus must be on developing the care plan to meet the needs and preferences of the resident, which will meet the regulatory requirements. However, if the focus is on checking a box for regulation, the team will miss critical elements or interventions. <br></p><p>If a physician asks, “What are we doing for Mr. Jones’ chronic obstructive pulmonary disease [COPD]?” The answer, from medication to diet, should be articulated in the care plan, providing the full holistic approach from the IDT. If Mrs. Johnson’s daughter asks what the facility is doing to prevent her mother from falling, all current interventions, from activities to rehabilitation, should be present in the care plan. <br></p><p>Using the care plan as a collaborative tool among all departments helps align the care and services the resident receives to assist them toward their goals. However, to achieve this, facilities must establish clear expectations regarding the level of detail and enforce and monitor timely updating.<br></p><p>If the team shifts its focus from meeting the minimums of regulatory requirements to instead elevate the purpose of the care plan, they can accomplish both by more effectively driving the care and services for the resident.</p><h2>Self-Identify Problems with Care Planning </h2><p>Care plans can come in various shapes and sizes; they may be handwritten on paper, completed electronically and printed, or maintained in electronic medical records (EMRs). Although EMRs have many benefits, they can also leave some gaps. Often, EMR users add interventions by simply checking an electronic box, which can lead to generic care plans that are not resident-centered.<br></p><p>Ready-to-go interventions often require individualization once added to the care plan. Failing to individualize results in confusing and incomplete care plans. <br></p><p>While direct care staff should frequently be accessing and updating the care plans, clinical leaders should also monitor for compliance and the quality of these updates. If a resident’s care or interventions have changed, did the team member responsible for the change update the appropriate care plan? Have resolved interventions been appropriately archived? Are the care plans easy to read for non-medical individuals? <br></p><p>Each time clinical leaders identify an incomplete or generalized intervention, or failure to timely update, they also identify a potential survey tag. While the process of monitoring and identifying these problems may be labor-intensive initially, as the facility’s culture adopts the care plan as a tool, the task becomes easier. </p><h2>Remove the Siloes </h2><p>Often, staff develop multidisciplinary care plans and believe they are creating interdisciplinary care plans. The key difference is that multidisciplinary care plans focus on the discipline, not the resident. One way to move toward a successful interdisciplinary care plan is to focus on the resident and their actual or potential needs. <br></p><p>For example, often the dietary department is responsible for completing section K of the Minimum Data Set, Swallowing and Nutritional Status. If a resident is coded as having a therapeutic diet, such as a diabetic diet, it will trigger the nutritional status care area assessment (CAA). This may result in the dietary manager or dietitian creating a care plan by focusing on the triggering reason. <br></p><p>The problem statement may read, “Mr. Jones receives a therapeutic diabetic diet due to having a diagnosis of diabetes.” This type of siloed care planning does not allow for an interdisciplinary approach because it does not focus on the resident’s needs. The resident’s need is not for a therapeutic diet, but rather, the management of his diabetes; the therapeutic diet is just one intervention the IDT provides the resident.<br></p><p>When the team shifts the focus to the resident’s needs and the resident’s goal is established with the team, the care plan becomes the IDT’s holistic approach to addressing these needs. As the road map to care, it is used to measure progress toward goals and ensure the resident’s preferences are being met.<br></p><p>The SOM, §483.21(b), states, “Care planning drives the type of care and services that a resident receives. If care planning is not complete, or is inadequate, the consequences may negatively impact the resident’s quality of life, as well as the quality of care and services received.” </p><h2>Include the Resident</h2><p>Among the tools available to surveyors are the Long-Term Care (LTC) Critical Element Pathways (CEPs). While there are over 40 tools, there is not one specifically for care planning. However, there are numerous pathways, from activities to behavior, and emotional status to nutrition.<br></p><p>All ask the same question&#58; Did the facility develop and implement a comprehensive person-centered care plan that includes measurable objectives and time frames to meet the resident’s medical, nursing, mental, and psychosocial needs and includes the resident’s goals, desired outcomes, and preferences? <br>If this was not achieved, the facility will receive a F656 citation.<br></p><p>It is not enough to address what the IDT is doing for the resident’s needs—the resident must play an active part in developing the goals, expressing to staff what his or her desired outcome is, and the staff must understand his or her preferences for care. And just like updating the care plan when changes occur, the resident’s goals and preferences must be frequently reviewed with the resident to ensure it continues to reflect those goals and preferences. <br><br><em>Jessie McGill, RN, RAC-MT, RAC-MTA, is a curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN). She can be reached at <a href="mailto&#58;jmcgill@AAPACN.org" target="_blank">jmcgill@AAPACN.org</a>.</em></p>2021-09-01T04:00:00Z<img alt="" src="/Monthly-Issue/2021/September/PublishingImages/0921_cgiving.jpg" style="BORDER&#58;0px solid;" />CaregivingJessie McGill, RNThe overall intent of the care plan is to articulate an approach to meet the resident’s goals and preferences and address medical, physical, mental, and psychosocial needs.