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medical care plan of treatment for a client if the physician determines that an individual client

requires 24-hour licensed nursing care.

Guidance §483.460(a)(2)

A medical care plan of treatment is developed for those clients who are either acutely ill and

require licensed nursing care and monitoring temporarily on a 24 hour basis or clients whose

chronic medical conditions require or indicate 24 hour licensed nursing care and monitoring.

The physician determines when 24 hour nursing care is required.

The medical care plan is based upon the orders from the physician for treatments and care and

nursing standards of practice. There is evidence in the client’s record that the physician and the

nursing staff at the facility work together to ensure that the medical care plan is current and

appropriate (e.g. changes in physician written orders for care pursuant to observations from the

nursing staff and/or direct observations and interactions with the client, and nursing

documentation of care).

The fact that a client has a medical care plan in place should not preclude him/her from an

active treatment program, except in instances of acute illness where the active treatment

program is temporarily suspended. For clients with chronic medical conditions, it may be

necessary for their active treatment program to be modified due to the tolerance level of the

client or adapted to accommodate medical limitations. However, active treatment must be

provided on a continuous basis.