Betreuungsplan

Betreuungsplan is a formal document used in health and social care to coordinate and document the support and services for a person who needs assistance. It is a person-centered plan designed to maintain safety, independence and quality of life, and it is typically adapted to the individual’s changing needs and circumstances.

The plan usually contains a comprehensive assessment of the person’s health status, everyday living situation, risks, and current supports. It sets goals and priorities in collaboration with the person and, where appropriate, their legal representatives or guardians. It describes the planned measures and services from different providers—such as nursing care, medical treatment, rehabilitation, psychosocial support, mobility aids, housing adaptations, and caregiver relief—and identifies who is responsible for each action, as well as expected timelines and funding sources. The document also records consent, rights to information, privacy considerations, and data handling.

Creation and use: Betreuungspläne are typically developed by a multidisciplinary team or case manager within health or social care, and may be initiated during hospital discharge planning, entry into a care facility, or the establishment of a guardianship arrangement. The person concerned should participate to the extent possible; the plan is a living document that is reviewed and updated regularly or whenever conditions change.

Legal and professional context: The Betreuungsplan supports coordinated care and person-centered planning, balancing autonomy with protection. It is commonly used in German-speaking countries within care and guardianship frameworks and may be integrated with legal orders, funding rules, and service contracts.