Writing an Individual Service Plan (ISP): A Practical Overview
An Individual Service Plan (ISP) — sometimes called a negotiated care plan — describes a resident’s needs and how the home will support them. It is a living document that is typically reviewed on a regular schedule and whenever a resident’s needs change.
This is general, educational information, not clinical or legal advice. The specific content and review cadence an ISP requires should follow DSHS, the WAC, and any RN delegation or clinical guidance for the resident.
What an ISP commonly includes
- Assessment of activities of daily living (ADLs) and support levels
- Medical diagnoses, providers, and emergency preferences
- Specific interventions, routines, and caregiver instructions
- The resident’s strengths, preferences, and personal goals
- A review schedule and signatures
Keep it person-centered
The most useful care plans describe the actual person — how they like their day to go, what matters to them — not just tasks. Capturing preferences alongside needs helps caregivers deliver consistent, respectful care.
Keep it current
A plan that reflects last quarter’s needs can create confusion. Building a habit of reviewing and updating the ISP on schedule — and after any significant change — keeps it accurate and useful.