Which statement best describes the elements required in the comprehensive care plan for the RD according to OBRA CFR?

• A. Problem; resident strengths; realistic/measurable goals and times of completion with designated party responsible; interventions with party responsible; implementation; evaluation/re-evaluation; discharge plan
• B. Problem and interventions only
• C. Discharge plan and evaluation only
• D. Resident strengths and goals only

Answer: (A)

The main idea is that OBRA CFR requires a comprehensive, individualized care plan that covers more than just listing problems. The plan should start from the assessment and include the resident’s problems as well as their strengths to guide care and support motivation. It must establish realistic, measurable goals with clear completion times and designate who is responsible for each goal. For every goal, there should be specific interventions and the party responsible for carrying them out. The plan then needs to be implemented and continuously evaluated or re-evaluated to track progress and make revisions as needed. Finally, a discharge plan is included to ensure a smooth transition after leaving the facility. This combination keeps care targeted, accountable, and coordinated across all staff and stages of care. Options that cover only problems and interventions lack goals, timelines, evaluation, or discharge planning, while others that focus only on discharge or only on strengths and goals omit essential elements of action, accountability, and ongoing assessment.