How Care Management Tools Can Help with Care Planning and Goal Setting for Patients

Asha Neil

Written on 7 February, 2023
Goal setting is pivotal in providing personalized patient care that’s centered around an individual’s needs. Care management tools can help you set and work toward patient goals.

We know that care management software is a valuable tool for running a home care business. It improves your efficiency, boosts employee engagement and keeps you HIPAA compliant. But your clients also benefit greatly from its adoption.

The right tools will help ensure that your care management efforts prioritize patients’ goals, needs and concerns. They will help you empower patients and improve their quality of life.

Goal Setting in Home Care

Creating home care plans begins with a discussion of needs, goals, strengths and risks. Setting a goal for home care services can help ensure that the resulting care management program meets the patient’s needs and will truly improve patient outcomes.

It can also help patients respond positively to their care. People receiving home care can feel disempowered and dependent, especially if they’re not used to being cared for. Setting goals helps avoid this by ensuring the focus is on what a patient can do and what they want to do in the future. 

For these reasons, goals should be a central part of home care services, from onboarding through to service delivery and care reviews. 

Creating Goals

Asking a patient about their goals should be one of the first steps in providing patient-centered care. While the discussion ought to be led by the patient, they may need support in fleshing out the goal. 

Make sure the goal is specific, measurable and achievable. This will help you measure progress toward it. For example, the client might begin by saying that they want to be less lonely. You could then work with the client to further define their goal as “attend the weekly bridge club” or “host family members and friends on Sunday afternoons.”

It’s important to remember that while the goals should center around the patient’s health and wellness, there are many facets to this. Some patients may focus on their physical fitness, but others will wish to set goals relating to living independently or being an active member of the community.

Aligning Care Management Programs With Patients’ Goals

The next step is to create a care management program that will help the patient achieve their goals. This may involve coordinating various care services. You should then draw up a care plan with detailed information on care delivery and the patient’s needs.

Your care management tools should allow you to add goals, along with strategies for achieving those goals, to each patient’s profile.

Delivering Goal-Oriented Patient Care

Home care management tools can facilitate goal-centered care by ensuring that your caregivers have instant access to the patient’s care plans, goals and strategies.

Using a mobile app for caregivers, your team can quickly check a client’s documentation before and during the home visit. Well-organized document management systems will ensure they have all the information they need to provide exceptional care.

Enabling Patient Feedback

Patients should have an active say in the care they receive, from selecting goals to choosing their caregivers. It's important to not only involve them in the initial discussions surrounding their goals, but also keep an open channel of communication with you.

Home care agency software with a client portal will allow patients and their loved ones to select their preferred caregivers, receive updates on their progress and request additional services. Patients will feel in control of the care they receive and can advocate for their needs and wants. 

Tracking Progress

Care management software can help you track a patient’s progress. You can set custom-made templates for progress notes based on each patient’s individual goals and the strategies for achieving them.

Plus, mobile applications will allow your team to access and update these progress notes on the go, and in doing so, improve their accuracy. You can also instantly share them with relevant team members, and in doing so, improve care coordination.

Care Goal Reviews

Regular care plan reviews will allow you to discuss with patients the progress being made toward their goals. Care documentation management tools can help you do this by making valuable information instantly available, from the original goals and care plan to progress notes and incident reports.

You’ll have all the details you need to talk to the client about the improvements they’ve made. Together, you’ll be able to explore what has worked, whether a change in strategy is needed and if it’s time to set a new goal.

Systems That Help Patients Achieve Their Care Goals

Systemized care has a bad reputation for being impersonal and inflexible, but the right systems can actually help you take a patient-centered approach to health care. By improving information-sharing and giving patients a way to advocate for their needs, you can make sure that patients’ care coordination and delivery revolves around their personal goals.

Plus, centralizing all this information can help you reduce miscommunication, avoid errors and save hours of time.

ShiftCare’s care management software is designed around the needs of home care agencies and patients alike. Its document management settings will help you instantly share client goals and updates with relevant team members, and you can use the template settings to ensure nursing notes track progress toward a patient’s goals. 

What’s more, patients can use their dedicated portal to mark their favorite caregivers, request additional services and more.

Discover how care management tools can help you provide personalized care of the highest quality. Try ShiftCare for free.

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