Care Plans with St Vincent's Home Care

Care plans

What is a care plan?

A care plan outlines your assessed care needs and how your home care provider will support you in achieving your goals and help you to stay in your home for longer. St Vincent’s will work with you to prepare a care plan and support you to understand and agree with it. 

Once your home care services begin, the care plan is reviewed at least once every 12 months to make sure it still meets your needs. You can request a review of your care plan at any time. At St Vincent’s our reviews form part of our ongoing care discussions with you. 

Your care plan is a document that outlines: 

  • Your home care needs
  • The services you will receive in order to meet those needs
  • Who will provide those services and when

You will be provided a copy of your home care plan within 14 days of entering into a home care agreement. In terms of review times, these will differ depending on your Home Care Package and level of support. At a level 1 package for example, it wouldn’t make sense to redo your care plan, say, once a month, if you only needed a lesser level of support and your circumstances haven’t changed.

What is included in your Care Plan?

Your St Vincent’s Care Plan will include:

  • Your needs, goals and preferences
  • The home care services that St Vincent’s will provide and/or organise
  • Who will provide your services
  • When your services will be provided – frequency, days, times
  • Your care management arrangements
  • How involved you will be in personally managing your home care package (HCP)

Preparing your Care Plan

When preparing your Care Plan, St Vincent’s will work with your and allow you to decide how involved you want to be in planning your care. We welcome you to have another person such as a carer or family member with you to help prepare the plan. 

You can also choose an advocate to represent you in your dealings with St Vincent’s. An advocate can help you to understand your rights with any form of aged care, and be an impartial guide for getting the most out of your services. If you need help or are feeling unsure about your rights, they can be an invaluable help, and can be found through the Older Persons Advocacy Network (OPAN)

If needed, we can arrange a Translation and Interpreter Service.

elderly residents sitting together in a fountain courtyard having tea together

How is my care plan decided?

Your goals will help to determine the services to best support you. We will refer to the care needs identified when you underwent your Aged Care Assessment Team assessment.

For example, if your goal is to maintain a healthy lifestyle you may require domestic services such as meal preparation. 

We will work together to decide on which services to include in your care plan. They must: 

  • Meet your care need and be within your budget 
  • Take into consideration your requests for a particular service or care worker you would like to use
  • Take into consideration the support you already have from family, carers and other services

What do staff look out for in a care plan? Are they attentive?

Home care workers report any changes back to our coordinators and are your eyes and ears when you're not there. We document any changes in our care plans which will change depending on a client’s circumstances.

At a minimum, care plans are reviewed yearly. However, staff are always working with clients to find out what works best for them depending on their level of support. At St Vincent’s, we’re always on the lookout for ways to make our clients comfortable in our care, so if there are ever any questions or queries, our staff will always be happy to answer.

In terms of review times, these will differ depending on your Home Care Package and level of support. At a level 1 package for example, it wouldn’t make sense to redo your care plan, say, once a month, if you only needed a lesser level of support and your circumstances haven’t changed.

Care plan factors

To reiterate again though, we are always watching and listening for any changes that need to be made and are working with you all the time to monitor and manage your needs.

The changes that we look for include:

  • Social (example; not being able to participate in activities or favorite past times, not being able to see people through isolation)
  • Emotional (example; withdrawing from the things someone once loved doing, grieving the loss of a loved one)
  • Physical (example; changes to mobility, memory, etc)
  • Environmental (example; bathroom not functional post a fall)
  • Financial factors (could include financial hardship)

Care plan reviews

These factors form the crux of a care plan and are the basis for the care in your home. Care plans are also reviewed at major times of change, for example:

Greg had a fall and went to hospital.

We would work with a multidisciplinary team such as Occupational Therapists (OTs) and nurses to ensure that the right supports were in the home upon Greg’s return. After Greg leaves the hospital, we would conduct our own review to make sure that nothing has been missed in terms of accommodating his needs.

His clinical needs would be assessed, his need to be able to go to the shops every Tuesday, his ability to get around the house. Rails, ramps or other assistive devices and amendments to his environment would be assessed and put in place. We could send a home worker out to his house to take him to the shops or have a cup of tea if he can’t get out and talk to people like he used to.

This is just one, short example. But it demonstrates that when it comes to care, we consider every aspect of your life, not just the clinical side.

What if there are changes to my care plan? 

Any changes to your care plan will only be done so with your agreement. 

We will always discuss any changes with you to ensure you understand and agree to them. You will receive a copy of your updated care plan for your records.

Just need answers?

Call St Vincent’s and our team can:

•    Ensure you get the right level of care for your needs

•    Simply explain the three different ways people pay for aged care

•    Discuss how you can maximise your government subsidies

•    Get the right information, quickly and easily through My Aged Care

Call 1800 778 767 to get started with us today.