Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Sun Aug 17, 2003 6:00 am Post subject: Care Plans
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The one thing that upsets me about care plans is........In the care plan you are to acknowledge that you have been offered all the dialysis options, in-center, transplant, PD and home hemo and you and the staff have decided on what is your best option. Needless to say without most centers offering home hemo patients have not been given all the options nor will they be given all the options. The care plans further state if the center in which you go does not offer a home hemo program they are to help you get into a program. Obviously this is never enforced by the networks or CMS.
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patientwife
Joined: 18 Jul 2003
Posts: 47
Posted: Sun Aug 17, 2003 7:49 am Post subject: Care Plans
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Marty, this is reason that I am of strong position that "care plans", as they are developed with expectation that patients sign off on such, make a mockery out of patient participation in healthcare decisions and the planning process. Not only are patients not given info about all options for treatment nor helped to facilitate option(s) chosen by patients, they, patients, are completely ignored in development of short and/or long-term treatment planning. CMS and the Networks have failed miserably in ensuring the basic right of a patient to involve him/herself in determining their course of treatment.<
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>Interestingly, there are many declarations of patient involvement in treatment planning, which we know do not occur. We are not offbeat in our understanding that there is something seriously wrong about "treatment care planning" in dialysis units. Consider the following:<
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>Medicare defines care plan as "A written plan for your care. It tells what services you will get to reach and keep your best physical, mental, and social well being".<
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>There is statement in Communicator, April 2003 Edition, Network 6, "Dialysis facilities are required by the Conditions of Coverage to maintain a written long-term care plan for each patient to ensure that each patient receives the most appropriate modality of care and the most appropriate care within that modality. The facility healthcare team must involve the patient...in care planning"<
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>From the Food & Drug Administration, Patient Representative Program, March 30, 1998, "When the Patient Speaks.... "Patient participation is important to medical decision-making, whether the setting is a doctor's office or a government agency".<
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>From Duke University Hospital, May 23, 2003, following the tragic transplant mistake and subsequent investigation of the hospital, "Additonal concerns related to outpatient long-term plans of care (i.e., patient involvement in planning and...the sharing of plans with hospital staff upon admission). We have taken steps to ensure that patients are more closely involved with long-term care planning...."<
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>And , lastly, there is something I read about which I have question re intent. In the Forum of ESRD Networks Medical Records Model there is, among other things, outline of requirements to satisfy the model. One is "Patient's Signature (or responsible party)" with notation that such "reflects participation". Apparently, dialysis units are of opinion that the patient's signature reflects participation. I believe otherwise -- that there is no participation unless there is dialogue and understanding between the patient and the healthcare team.<
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>We've got a long way to go when it comes to the care plans. <
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Chipper
Joined: 30 Jun 2003
Posts: 2
Posted: Sun Aug 17, 2003 8:43 am Post subject: patient care plans
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How can you participate in your care plan if you are just supposed to sign it and give it back? The staff has a screaming deamon seizure if you make a mark anyplace on any paperwork other than where you are supposed to sign!
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Aug 18, 2003 8:33 am Post subject: Whatever do you mean?
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Well gee Marty, they offered me home hemo when I asked for it. Problem is the FMC unit I go to (in Morris County NJ) wanted to charge extra for the water tx. equipment, over and above the over 12k they alread get paid, but in their defense the opportunity was offered :"> <
>Looking back I'm not sure if they wanted to take me on. Then again since the money is paid to FMC directly and not the units, I have to wonder if they want to sign on home hemo pts.. I no longer see posters or phamplets about home hemo in the unit. They used to be on the wall, and in the pts. waiting area. Poof, they're gone!<
>In light of the newest figures about cost savings in regards to home hemo (newest Canadian study) units that now aren't serious about taking on pts. might be changing their tune! A new Gam
o unit is opening up soon and is no farther from my home; I'm checking them out to see what they offer.<
>The care plans are a joke. Most of the time the writing is so sloppy I can't understand it, like it was written really fast on the run, with no forethought. No concern that I wouldn't be able to read it before signing. Next time it's going the same place their survey goes; filed under g for garbage! Signing benefits them, not us. It's a requirement or they wouldn't even bother doing it. It's certainly not out of concern for pts. and neither is the survey. Lin.<
>
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Wed Aug 20, 2003 2:35 am Post subject: Junk Care Plans
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Lin, We will never know the answer unless we get the "law" involved but I really have my doubts rather or not FMC could even charge you for the DI tanks unless it's because your on insurance. I "think" under the medicare payment terms the water treatment is covered. I also don't understand how these careplans get so abused; I guess it's just because it cost to much to get an attorney involved to make the companies follow them.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Wed Aug 20, 2003 8:55 am Post subject: I think
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they just didn't want ANY pts. doing home hemo, even though they alledgedly offer it. I'm a very good candidate so the only excuse they could come up with was water tx.. No one tested; no one even visited. I'm convinced they don't want anyone to sign up! <
>The care plans are insulting to say the least. They even copy what they put on them the time before, word for word. Other pts. sign them without even reading them just because someone tells them to. Lin.
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patientwife
Joined: 18 Jul 2003
Posts: 47
Posted: Thu Aug 21, 2003 8:24 pm Post subject: Care Plans
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Check out Network 5 Staff CEU Opportunities. There's a training/education curriculum, "Patient Centeredness In the Dialysis Unit" with goal "to improve patient care by educating dialysis facility staff on the benefits of Patient Centeredness". There's a slide, p. 29, entitled "Care Planning". Three educational statements are included: (1) The healthcare team should NOT make a treatment plan without involving patients (2) Tailor the care plan to their concerns and needs, and (3) What are patients' fears, feelings, and expectations about dialysis. <
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>In my opinion, the training needs to be MANDATORY for all dialysis staff, including techs. It is a solid program and emphasizes what dialysis treatments should
be about -- centered on the patient.<
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>We have CMS including "patient involvement" in their Conditions of Coverage (with some staff person in Baltimore responsible for ensuring that conditions are met); we have the Networks responsibile for quality assurance of dialysis units (and at least one has used money to develop a training program which specifically states what some, if not most, of us know: that THE HEALTHCARE TEAM SHOULD NOT MAKE A TREATMENT CARE PLAN WITHOUT INVOLVING PATIENTS. Where is the accountability -- What does CMS do to ensure that such is taking place. -- What do the Networks do to ensure same? ABSOLUTELY NOTHING!<
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>It is no wonder that there is so much disgust and distrust. I guess THEY think we are all ignorant. <
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Aug 22, 2003 1:12 am Post subject: Care plans
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are made without the pts. input. Gee, prior to dialysis I was the one in charge of my life, now suddenly EVERYONE but me gets to sit around and plan my life and my goals; there is something seriously wrong with that picture! Dialysis pts. are treated like suddenly they've become senile and everyone else knows what's best for them. I know some pts. can't make rational decisions, but most of us can. I know I still can!<
>Every month the unit I go to holds a meeting and staff and the neph. sit around and discuss the pts. but the pts. aren't invited, or told what is said. Sometimes I feel like I'm in an experiment that I didn't sign up for. The other day when I went in for dialysis I just looked continually at the floor. When asked if I had lost something said "yes, control". Lin.
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patient
Joined: 29 Oct 2002
Posts: 137
Posted: Fri Aug 22, 2003 4:44 am Post subject: loss of control
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So true, lin! The disrespect with which we are treated is appalling. The medical staff headed by my arrogant doctor act like ants swarming over a crumb. I just let them think they are making the decisions for me, but I never relincquish that right. They have alot of audacity and it will come back on them when they are on the recieiving end of the same type treatment one day. There are also staff that act like we are stupid if we ask a question. My favorite are the ones who insist something they say is true when I know they are incorrect. I just laugh to myself, because they are too vain to face that they don't know what they're talking about.
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RedheadedReptile
Joined: 09 Mar 2003
Posts: 69
Posted: Fri Aug 22, 2003 11:46 am Post subject: Combining 'mandatory' video with care plan question
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The other day we had to watch the 'mandatory' modality choice video at dialysis. A paper was handed out to all the patients asking if we'd seen the video, but there was also a question thrown in there asking if we'd had input on our long-term care plans. I checked "No"-- and I'm sure I'm the only patient who had the guts to do it, even though no other patient had talked to their doctor or staff about their long-term care plan, either. Our 'participation' seems to be limited to signing the paper.
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ridgerunner
Joined: 11 Jan 2003
Posts: 101
Posted: Fri Aug 22, 2003 12:34 pm Post subject: care plan
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i am a retired health care provider who never learned to type. the fact that a dialysis patient has no part in deciding their treatment plan is totally foreign to me. the fact that patients are very seldom told the truth and the quality of treatment the use of untrained personel would have had them reported to the state board with loss of the right to practice. the right to practice is not a right. it is something to be taken serious.
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patientwife
Joined: 18 Jul 2003
Posts: 47
Posted: Fri Aug 22, 2003 4:00 pm Post subject: Care Plans
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Are you serious, RedheadedReptile? How deceitful and manipulative can professional staff be!!??!!
