'Single' Assessment for Older People: Comparison of the MDS-HC with Current Auditable Methods in the Home Care Setting

ABSTRACT

This cast compared the use of an evidence-based, systematically evolveed standarised assessment instrument for community care with existing assessment instruments, in sum of two units social services departments. We bring to an end that assessment methods without proven reliability may jeopardise the interests of older clan and the need to raise atandards.

KEYWORDS: ASSESSMENT; OLDER PEOPLE; COMMUNITY CARE

Background

The National Service Framework for Older nation in England introduced the universal of the single assessment proces (SAP) as the first pace in achieving the second of eight national standards. The SAP aims to make sure that a more standardised assessment a whole is in place across health and social care, that standards of assessment are raised and that the replete range of older people's necessitys aie assessed.

This policy trunk s from a number of influences: evidence of marked variability in assessment managements in social care (Stewart et al., 1999) an intent to stretch out multi-disciplinary assessment, evidence of lack of specialist assessment processs for older people (Weiner et al, 2002) and better results of care where comprehensive geriatric assessment (CCA) is the basis of decision-making.

To achieve these policy and practice goals, the assessment proces and its satisfied should reflect the following criteria:

* usable by dint of a range of professionals including social workers (SWs)

* a tool which exhibits reliability

* a practical tool for workers in the field

* sensitive to change

* auditable in confines of both the process and the crops of the assessment

* sufficiently comprehensive to overlay the key domains relevant for care of older people

* improve ne identification.

We examined the expanse to which the current assessment instruments busyed in assessing older people in sum of two units social service departments (SSDs) met the above criteria, compared with a well-established validated assessment instrument.

Method

Design

The throw was a pragmatic, randomised controll trial to compare a standardised assessment instrument, the Minimum Data Set-Home Care (MDS-HC] (Morris et al, 1997) with common community care assessments (CCAs). The true structured MDS-HC has around 300 standardised necessitys assessment items in 13 domains and triggers for assessment protocols to assist with careplanning for extremitys identified in the assessment. The CCAs were far les structur and had many lay open questions.

Study population

The investigation was conducted with people aged above 65 referred for 'complex assessment' in sum of two units social services departments (hereafter referr to as SSD1 and SSD2) A mixed assessment was defined as an assessment for multiple service inputs (such as place of abode care, meals on wheels, nursing care), which may be provided by the agency of a single agency or multiple agencies (for example social services, housing department NHS)

Methodology

All participating SW together with their service managers attended an introductory meeting to explain the objectives of the close attention SWs were then allocated randomly to use either the MDS-HC or the existing assessment instruments (current community assessments - CCAs). All SW attended a training session to reinforce the importance of satisfied and quality of assessment Intervention (MDS-HC] SW received a further training session upon the use of this instrument

Following referral for assessment family in SSD1 were randomised by means of household to intervention or dominion government SW. In SSD2 this was not possible, as a certain number of SWs were the sole SW attached to a CP practice, in like manner people were assessed by the SW attached to their GP practice.

All close attention participants were assessed at baseline and, wherever possible, re-assessed at six month and single year after their initial assessment by means of the same social worker, using the same assessment instrument as at the initial assessment.

In order to ordeal the utility and validity of the information obtained in functioning (body function similar as activities of daily living - ADL), activity and participation (such as interpersonal relationships and community and social life) and environment (such as physical environment support and services), lock opener assessment domains specified by the World Health Organisation (2003) assessment data were examined for completenes and consenting participants were interviewed after each SW assessment by the agency of a member of the research team. Validity was ordealed by comparing study tool assessment data with assessments using widely accepted gold standard instruments (CSI): Barthel for ADL, Duke CARS for instrumental ADL and the Geriatric Depression Scale for vein The selected domains covered in this proces included living arrangement activities of daily living (ADL), instrumental activities of daily living (IADL), continence, cognitive function, disposition participation in social activity and loneliness, and indicators of SW were interviewed to determine their views of the assessment tools and processes

Results

A total of 384 bring under rules entered the study. In SSD1 randomisation allocated individual hundred and five people to five SW in the investigation group and one bundled and thirteen clan to five SWs in the direction group; thirty-one study and thirty-three rule group subjects finally did not go into In SSD2 one hundred and ten were recruited to foui inquiry group SWs and fifty-six to six dominion government group SWs during an stretch outed recruitment phase, as unexpectedly scarcely any people presented for complex assessment. In SSD2 all those referr go intoed The reasons for failure to penetrate the study after randomisation are shown in Table 1 below.