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Description: In this topic, the user will learn how to set up Care Management for a client. Complete all steps in all sections below to finish the set-up which includes enabling care management for the client, creating the plan of care, adding goals, adding tasks, and linking goals to the funding account.
Enable Care Management for a Client
- Log in with the appropriate profile
- Click Home on the main menu
- Click Clients on the submenu
- Enter the client name into the search filter and click Search
- Click anywhere on the client’s row in the results table to open the Client Details page
- Click Actions
- Select Edit Client from the drop-down menu
- Click the Client Information tab on the Edit Client Details page
- Click the Enable Care Management checkbox at the bottom of the page
- Click Save and Yes to confirm
Add a Plan of Care for a Client
- Log in with the appropriate profile
- Click Care Management on the main menu
- Click Plan of Care on the submenu
- Click Actions
- Select New Plan of Care from the drop-down menu
- Complete the Add Plan of Care form wizard
- Client - Type the client's name and select it from the list generated
- Please note: If the client’s name does not appear in the list, Care Management is not enabled on the client profile.
- Assessment - Enter the assessment, a summary plan of care, progress, and status of goals.
- Assessment field is free text, data-based, or narrative, and can be edited throughout the life of a Plan of Care.
- Effective Date – Enter the date the Plan of Care starts
- End Date – Enter the date the Plan of Care ends
- Status – Select Active or Inactive from the drop-down
- Client - Type the client's name and select it from the list generated
- Click Save andYes to confirm
Add Goals to the Plan of Care
- Log in with the appropriate profile
- Click Care Management on the main menu
- Click Plan of Care on the submenu
- Enter the client name into the search filter and click Search
- Click anywhere on the client’s Plan of Care in the results table to open the Plan of Care Details page
- Click Actions
- Select Add Goal from the drop-down menu
- Complete the Add Goal form wizard
- Goal Name - Enter a general name for the goal
- Summary - Enter information specific to the individual and goals
- Target Outcome - Represents the target percentage of met outcomes for all completed tasks under this goal
- Effective date - Select a start date. Goals can start on any date within the plan of care dates and will display for the caregiver.
- End date - Select an end date. After this date, the caregiver will no longer see the goal.
- Status - Select Active or Inactive from the drop-down
- Click Save andYes to confirm
- Repeat steps 6-9 to add additional goals for the client
Add Tasks to Goals
- Log in with the appropriate profile
- Click Care Management on the main menu
- Click Plan of Care on the submenu
- Enter the client name into the search filter and click Search
- Click anywhere on the client’s Plan of Care in the results table to open the Plan of Care Details page
- Select the Goals tab on the Plan of Care details page
- The goal(s) for the client will be listed
- Optionally search for a specific goal or scroll down to view all goals for the client
- Click anywhere on the goal row in the results table to open the Goal Details page
- Click Actions
- Click Add Task from the drop-down menu
- Complete the Add New Task form wizard
- Task Details tab:
- Task Name - Tasks are a component of the overall goal
- Summary - Enter the actions the caregiver must take for the task
- Met Condition - Enter the condition(s) acceptable for the task to be marked as Met
- Not Met Condition - Enter the condition(s) in which the caregiver should mark Not Met
- Additional information - Optional text field available to provide additional information to the caregiver about the task
- Required - Click Yes or No
- If Yes, the task must be resulted before a care note can be published.
- If No, the task is not required for the care note to be published.
- Target Outcome - The target percentage of met outcomes of completed tasks
- Effective date - The date the task starts. Can be any date within the goal dates. The task will be visible to the caregiver.
- End date - After this date, the caregiver will no longer see the task.
- Status - Select Active or Inactive from the drop-down
- Click Next
- Tracking Option tab:
- Allow Refusal - Select Yes to allow the caregiver to select that the client refused to participate
- If yes is selected, it will count towards the target outcome goal.
- If no is selected, it does not count towards the target outcome goal.
- Allow Barrier - Select Yes to allow the caregiver to select Barrier as a task outcome
- Examples of barriers might include Client was sleeping, client was having a medical issue, etc.
- Click Next
- Allow Refusal - Select Yes to allow the caregiver to select that the client refused to participate
- Additional Questions tab:
- Additional Questions are questions the employee will document with their care note and can be either Canned or Custom question types
- Question type - Click Canned or Custom
- Canned – This question type applies to more than one client. To add canned task questions, see the step-by-step instructions below for Create a Canned Task Question.
- Select Question - Click the Select Question drop-down and make a selection
- Required - Click Yes or No
- Status - Select Active or Inactive from the drop-down
- Click the plus sign (+) button to add a canned question
- Repeat as necessary
- Click Save
- Custom – This question type is specific to a client and the documented task
- Question - Enter Question text
- Required - Click Yes or No
- Click Next
- Answer - Enter the answer text and click the plus sign (+) button
- Repeat to add up to seven additional answer criteria
- Click Save to return to the Additional Question screen
- Repeat either the Canned or Custom process to add additional questions as needed
- Canned – This question type applies to more than one client. To add canned task questions, see the step-by-step instructions below for Create a Canned Task Question.
- Click Save and Yes to confirm
- Task Details tab:
Link Goals to Funding Account
- Log in with the appropriate profile
- Click Authorization on the main menu
- Click Funding Accounts on the submenu
- Enter the search criteria in the filter (i.e., client, cost center) and click Search
- Click anywhere on the Service Account row in the results table to open the Account Details page
- Click Actions
- Select Add/Remove Goals from the drop-down menu
- The Add/Remove Goals wizard will open
- Select a goal(s) in the Available Goals column
- Click the right triangle button to add a goal to the Selected Goals column
- Click the double right triangle >> button to add all goals to the Selected Goals column
- Click the left triangle button to remove the goal from the Selected Goals column
- Click the double left triangle << button to remove all goals from the Selected Goals column
- Click Save andYes to confirm
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