The assessment of older people's needs in care homes

Worden, Angela; Challis, David; Pedersen, Irene

doi:10.1080/13607860600637794

Cited by 18 publications

(9 citation statements)

References 45 publications

(43 reference statements)

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“…Assessment of many domains of health status and impairments was represented as crucial in building a picture of an individual’s complex needs and views about their personal priorities and goals 36. Unlike discipline-specific needs assessment that may focus on a particular syndrome or care pathway, structured comprehensive assessment requires an overview of all domains 37…”

Section: Resultsmentioning

confidence: 99%

Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review

et al. 2019

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ObjectivesComprehensive geriatric assessment (CGA) may be a way to deliver optimal care for care home residents. We used realist review to develop a theory-driven account of how CGA works in care homes.DesignRealist review.SettingCare homes.MethodsThe review had three stages: first, interviews with expert stakeholders and scoping of the literature to develop programme theories for CGA; second, iterative searches with structured retrieval and extraction of the literature; third, synthesis to refine the programme theory of how CGA works in care homes.We used the following databases: Medline, CINAHL, Scopus, PsychInfo, PubMed, Google Scholar, Greylit, Cochrane Library and Joanna Briggs Institute.Results130 articles informed a programme theory which suggested CGA had three main components: structured comprehensive assessment, developing a care plan and working towards patient-centred goals. Each of these required engagement of a multidisciplinary team (MDT). Most evidence was available around assessment, with tension between structured assessment led by a single professional and less structured assessment involving multiple members of an MDT. Care planning needed to accommodate visiting clinicians and there was evidence that a core MDT often used care planning as a mechanism to seek external specialist support. Goal-setting processes were not always sufficiently patient-centred and did not always accommodate the views of care home staff. Studies reported improved outcomes from CGA affecting resident satisfaction, prescribing, healthcare resource use and objective measures of quality of care.ConclusionThe programme theory described here provides a framework for understanding how CGA could be effective in care homes. It will be of use to teams developing, implementing or auditing CGA in care homes. All three components are required to make CGA work—this may explain why attempts to implement CGA by interventions focused solely on assessment or care planning have failed in some long-term care settings.Trial registration numberCRD42017062601.

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Section: Resultsmentioning

confidence: 99%

Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review

et al. 2019

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“…Needs assessment has become a central issue following the growing recognition that it could lead to more appropriate and effective provision of care, services and resource usage (Worden et al, 2006 ). Overall, and in line with previous studies (Holmquist et al, 2003 ; Hancock et al, 2006 ), unmet needs were prevalent across these three nursing homes, and clustered in particular domains, namely the psychosocial, such as daytime activities, company and psychological distress (Martin et al, 2002 ; Hancock et al, 2006 ; Cohen-Mansfield et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Needs in Nursing Homes and Their Relation with Cognitive and Functional Decline, Behavioral and Psychological Symptoms

Ferreira

Dias

Fernandes

2016

Front. Aging Neurosci.

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Unmet needs are becoming acknowledged as better predictors of the worst prognostic outcomes than common measures of functional or cognitive decline. Their accurate assessment is a pivotal component of effective care delivery, particularly in institutionalized care where little is known about the needs of its residents, many of whom suffer from dementia and show complex needs. The aims of this study were to describe the needs of an institutionalized sample and to analyze its relationship with demographic and clinical characteristics. A cross-sectional study was conducted with a sample from three nursing homes. All residents were assessed with a comprehensive protocol that included Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Neuropsychiatric Inventory (NPI) and Adults and Older Adults Functional Inventory (IAFAI). To identify needs, the Camberwell Assessment of Need for the Elderly (CANE) was used. The final sample included 175 residents with a mean age of 81 standard deviation (SD = 10) years. From these, 58.7% presented cognitive deficit (MMSE) and 45.2% depressive symptoms (GDS). Statistically significant negative correlations were found between MMSE score and met (rs = −0.425), unmet (rs = −0.369) and global needs (rs = −0.565). Data also showed significant correlations between depressive symptoms and unmet (rs = 0.683) and global needs (rs = 0.407), and between behavioral and psychological symptoms (BPSD) and unmet (rs = 0.181) and global needs (rs = 0.254). Finally, significant correlations between functional impairment and met (rs = 0.642), unmet (rs = 0.505) and global needs (rs = 0.796) were also found. These results suggest that in this sample, more unmet needs are associated with the worst outcomes measured. This is consistent with previous findings and seems to demonstrate that the needs of those institutionalized elderly remain under-diagnosed and untreated.

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“…After careful scrutiny of the resource allocation tools received and any accompanying guidance an analytic framework was developed. This reflected earlier studies of assessment documentation used in adult social care (Stewart et al, 1999;Worden et al, 2006) and findings from an audit of case files in social care agencies (Sutcliffe et al, 2014). The framework analysis was undertaken on two levels (Table 1).…”

Section: Analytic Frameworkmentioning

confidence: 99%

Understanding Resource Allocation Processes in Social Care for Frail Older People: Lessons from a National Survey

Stewart¹,

Hughes²,

Challis³

et al. 2021

Journal of Long Term Care

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Context: Traditionally local authorities in England allocated resources in social care following a professional assessment of need and a costed care plan. With the introduction of personal budgets, resource allocation tools have been used to provide service users with an initial indicative budget for their care. This is promoted as being more transparent, equitable and giving people greater control over decisions about their care. Objective: This study examined the different approaches to resource allocation and the content of resource allocation tools used for social care in England. Methods: Information was obtained from local authorities about their resource allocation systems. An analytic framework was developed and applied to the tools to explore: who identified needs; whether informal and formal support were recorded; and whether 17 need indicators covering functional status, mental health, and health and wellbeing were present and in what detail. Findings: Ninety-one per cent of 152 authorities responded and 61 per cent of authorities' tools were analysed. Three approaches were identified: points-based self-assessment tools; standardised assessment data (FACE); and non-points-based/ready reckoner tools. Most authorities used a points-based selfassessment tool. All tools included the service user's views and a high proportion included a professional's view, while fewer covered the carer's view on need. Coverage and presence of detail for the 17 need indicators showed high variation and was least on points-based self-assessment tools. Limitations: The study is the first to examine a large sample of resource allocation tools and provides a valuable baseline for future work. However, non-points-based/ready reckoner tools were under-represented in the sample. Implications: Further research could build upon this study to examine key properties of the tools used such as reliability, validity, sensitivity and specificity; and explore their impact upon service users and staff in terms of time use, cost, utility and equity.

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The assessment of older people's needs in care homes

Cited by 18 publications

References 45 publications

Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review

Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review

Needs in Nursing Homes and Their Relation with Cognitive and Functional Decline, Behavioral and Psychological Symptoms

Understanding Resource Allocation Processes in Social Care for Frail Older People: Lessons from a National Survey

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