Plan of Care
By JIM NICHOLS
At the conclusion of a visit to a hospice patient, the outside caregiver must complete an electronic questionnaire regarding the impressions from the visit. This is a requirement of the hospice providing company as well as Medicare, the entity often paying for the service. Since there are generally three different types of service provided, there are three reports submitted. The most obvious submission is the medical one from the nurses and physicians, but there is also a report from the social worker and the chaplain. One of the questions appearing on each asks, “Was the plan of care for the patient reviewed and modified as needed?”
I have found this “plan of care” concept attractive especially from the chaplain point of view. Not only does it address the activities during a visit to a hospice patient, but it has great applicability to human relations in general.
Like it or not, each of us has a set of caring responsibilities. Those change as we move through different places in life, but there are always people around us who rightly can expect that we will exercise some degree of care over them. Examples would include the relationships between spouses, parents and children, or teachers and students in a classroom. Friends have some reasonable expectation that each will act with care in the relationship. Employment relationships fit here too. God expects the same from us in our relationships.
What the “plan of care” concept does, it seems to me, is to suggest that there should be a purposefulness to our lives as they relate to each other. Each of us is prone to just “get by” in our important relationships; I suggest that is recipe for unhappiness.
The two loaded words are “plan” and “care.” Whereas in a few circumstances, a “plan” might be something concrete, perhaps even written down, this may be emphasizing it too much in most cases. Too many of us just say things, just do things, just go places, just buy stuff . . . without considering potential negative impacts on those depending on us. Living thoughtful lives (including lives of care) requires forethought and anticipation of consequences on others. This may not be a concrete plan, but certainly a direction in which we want to live.
On the other hand, “care” is such an encompassing word that it is difficult to clarify. It is in the category of “I may not be able to define it, but I know it when I feel it.”
Whatever the relationship, care should certainly involve offering safety and security. People who care for one another trust one another. They have certain expectations of kindness and patience and, when those expectations are not met, the emotional pain can be significant. I can remember some friendships in my past that were damaged because the care I expected did not occur; I also suspect there are some instances in which I have been the instigator of such damage to a previously caring relationship.
Care is not about power or influence. It would be nice if my care for another would be reciprocated but it is not the goal. Care is a version of love and God loves and cares for us whether we reciprocate or not. Care involves my asking myself, “How will I express my love and appreciation for this person?”
Caring is not for me. It is not part of a growth plan either for me or the other person. It may result in growth, but that is not the purpose. Genuine care comes from our heart.
As the report guidelines suggest, sometimes the plan of care, after review, needs to be modified. Relationships are fluid and they need assessment and tweaking regularly. What might have been a reasonable expression of care earlier may no longer be appropriate.
Lurking in the background, of course, is self-care. This deserves fuller development, but certainly we should have a “plan of care” for ourselves as well as for others. This will have the same characteristics as caring for others, but with the added dimension of our personal intimacy. Who knows me better than I do? A plan for self-care involves a higher degree of honesty and forgiveness.
One of my current goals is working on appropriate expressions of care for others and myself. This might take a plan.
Jim Nichols is a retired Abilene Christian University biology professor and current medical chaplain