Social Service  Care Plans for Long Term Care 

Psychosocial Care Plans ~ Cognitive ~ Mood ~ Behavior ~ Medications ~ 

2023 Book and Flash Drive for MDS v1.18.11

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11 monitoring and tracking forms, 7 CAAs, Psychosocial Outcome Severity Guide, F-tags, Resident Rights, MDS Coding, Psychotropic Guidance, Quality Measures, Modified Abnormal Involuntary Movement Scale AIMs, Skilled Charting Guidelines, Alternatives to Restraint Use, Dementia Inservice

Current with all RAI Manual Updates, PDPM, Trauma Informed Care, Surveyor Guidelines, and Federal Regulatory Changes

Table of Contents 

Anger Care Plan

Mood State Care Area Assessment CAA

  39 Psychosocial Care Plans

Abusive

Anger

Antidepressant

Anxiety

Conflict with Family

Decision-making

Depression

Disordered Thinking

Family Coping

Fear

Grief Over Lost Status

Hypnotic

Lithium

Manipulative Behaviors

MAO Inhibitor

Memory Problem

Non-compliance

Paranoia

Prefers Own Routine

Psychotropic Drug Use

Refuses to Eat

Rejects Care

Restraint

Room Change

Sensory Deprivation

Sensory Perception

Sleep Pattern Disturbance

Smoking

Social Isolation

Socially Inappropriate

Strengths

Terminal Prognosis

Trauma

Tricyclic

Unhappy with Roommate

Wandering

Withdrawal from Care 

This manual provides information and tools to improve Social Service  assessments and interventions for meeting psychosocial needs. Regulations, survey protocols, and excerpts from the RAI User’s Manual give the basis of long term care industry standards and quality of care. Social Service care plans are provided for every possible problem generated from the MDS  entries.

Assessment forms and Quality Assurance audits are included, as well as a complete copy of the Psychosocial Outcome Severity Guide.

Social Service care plans and forms have been updated to ensure compliance with the change to MDS version 3.0 and with all of the federal regulations and guidelines updated during the past year.

When the Psychosocial Outcome Severity Guide became effective in 2006, it became apparent that CMS expected Social Services to be much more involved in the care planning process. The Social Service care plans in this manual cover the possible psychosocial needs residents may have in response to issues, illnesses, medications, and/or other factors.

Text, care plans, and forms specific to certain medications in the Psychotropic Medication section reflect changes to the State Operations Manual, Appendix P, Medication Pass and Pharmacy Services.

The Flash Drive contains all of the forms and care plans from the book, and these can easily be made resident and facility specific using a word processor.

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