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個案照顧服務計畫的 擬訂與執行 財團法人私立廣恩老人養中心 財團法人私立廣恩老人養中心 社工督導 周慧敏

個案照顧服務計畫的 擬訂與執行 - 大贏家外 ...agency.twinner.com.tw/files/tlcda/0328b.pdf · 照顧計畫(Care Plan)的功能 提供明確的照顧目標與方式

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  • (Care Plan)

  • (Care Plan) ()

    /

    /

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  • 243(21)( )

  • /

    RAI

  • A RAI 1RAIRAI

    (1)Minimum Data Set (MDS)

    (2)Residential Assessment Protocols (RAPs)(RAPs)MDS

  • A RAI 2RAIRAI

    Assessment (MDS)

    Decision Making (RAPs)

    Care Plan Development

    Care Plan Implementation

    Evaluation

  • A RAI 3Residential Assessment Instrument (Multi-Dimensional) (Multi Dimensional)

    (f ti l) ( di l) (functional) (medical) (psychosocial) (cognitive status)

  • RAI 3 Minimum Data Set (MDS)

    1. ()

    10. 11.

    2. 3.

    12. /13. /

    4. /5.

    /14. 15.

    6. /7.

    16. 17.

    8. 9. 14

    18. 9. 14

  • RAI 4Residential Assessment Protocols (RAPs)

    10 1.2./

    10.11.

    3.4

    12.13 4.

    5./(ADL)

    13.14./15 6.

    7.

    15.16.

    8.9

    17. 18. 9. 18.

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  • (Be better)

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    ()

  • A Better LifeWhat old people with high support need value needs (2011, www.jrf.org.uk)

    Aspects of Theme headings Barriers &Aspects of well-being

    Theme headings Barriers &Enablers

    Social Meaningful relationships (personal and with paid carers) InformationSocial well-being

    g p (p p )Social interactionMaking a contribution (including roles)Cultural activities (including religious activities)

    Financial resources( g g )

    SupportPsychological well-being

    Self-determination (including involvement in decision-making,control, independence, autonomy)Continuity and adjusting to change

    Other peoples Time

    Continuity and adjusting to changeSense of self (including self-esteem)Humour and pleasureMental health (including existential balance, sense of purpose

    Technology

    Equipment

    ( g , f p pin life)

    Physical ll b i

    Safety and securityGood environment (including contact with nature)

    Transportwell-being ( g )Getting out and about

    Physical health (including living in an ageing body)Physical activities

  • A Better LifeWhat old people with high support need value needs (2011, www.jrf.org.uk)

    (Social Well-being)()()

    () () ()

  • A Better LifeWhat old people with high support need value needs (2011, www.jrf.org.uk)

    (Psychological well-being)((

    )

    ()

    ( ( )

  • A Better LifeWhat old people with high support need value needs (2011, www.jrf.org.uk)

    (Physical well-being)

    ()

    () ()

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    /1555

  • Doing Trying Trying WaitingKeeping positiveCaringCaring Growing