Single Assessment Tool (SAT) for Older People   Bernie Carroll/Clare Mc Hugh SAT Educator Clinical Leads ICHN Annual Conference 23rd May 2018

Why do we need a Single Assessment Tool? 2 Why do we need a Single Assessment Tool? Ireland does not currently have one standardised care needs assessment for older people Different assessment tools in use geographically Can lead to variations in outcome and inequity for service users All assessment tools are currently paper based Difficulty sharing information Lack of connectivity between hospital and community National & international best practice advocates standardised care needs assessment Single standardised assessment required to provide a standardised language of assessment across hospitals and community.

3 What is interRAI? Collaborative network of researchers in over 35 countries Non-profit corporation Key interests: Promoting evidence informed clinical practice / policy decision- making Research and quality (e.g. cross-national comparisons) Instrument development Support implementation in other nations Holds copyright to interRAI assessment instruments Grants royalty-free licenses to governments / care providers in exchange for de-identified data Licenses software vendors around the world www.interrai.org Over 20 different interRAI assessment tools/systems in the interRAI integrated suite of tools e.g. Home Care; Long term care; Intellectual Disability; Child & Youth Mental Health; Community Mental health; Acute Care; Paediatric Home Care, etc. In Ireland- interRAI Home Care (interRAI HC) & interRAI Home Care for Acute Care (interRAI HC for AC) being implemented in Phase 1 with interRAI LTC to follow.

Comprehensive Assessment -interRAI Domains Domains = areas covered in a SAT (interRAI) assessment. The interRAI Assessment System is designed to be user friendly, reliable, person-centered system that informs and guides comprehensive care planning. The interRAI Assessment form is a Minimum Data Set (MDS) screening tool that enables assessment of multiple key domains of function, health, social support, and service use, while focusing on the person’s capabilities by assessing needs, strengths, and preferences.

Outputs generated from the assessment Inbuilt algorithms generate scales Clinical Use Evaluate current status/ outcomes of the person Use to support decision-making in care planning/service provision Evaluate care/service provision Aggregated Use Track outcomes of care Performance appraisal for quality improvements/ quality monitoring/ benchmarking/ client profiling

Inbuilt Clinical Decision Supports Systems – 25 Clinical Assessment Protocols (CAPs) in Home Care Assessment FUNCTIONAL PERFORMANCE Physical Activities Promotion Instrumental Activities of Daily Living Activities of Daily Living Home Environment Optimisation Admission Risk (Long-Term Residential Care) COGNITION/MENTAL HEALTH 6. Cognitive Impairment* Delirium Communication Mood Behaviour Vulnerability SOCIAL LIFE 12. Family Carer Support Social Relationships CLINICAL ISSUES 14. Falls 15. Pain Pressure Ulcer Cardio-Respiratory Conditions Undernutrition Dehydration Feeding Tube Health Promotion Appropriate Medications Tobacco and Alcohol Use Urinary Incontinence/ Continence Promotion Bowel Conditions Online supports for clinical decision-making – evidenced based (Irish Editions) of clinical guidelines accessible via info-buttons.

Inbuilt Clinical Decision Supports Systems – 13 Scales and Outcome measures Activities of Daily Living (ADL) Hierarchy Scale Body Mass Index Cognitive Performance Scale (CPS) Communication Scale Changes in Health, End-Stage Disease & Signs & Symptoms (CHESS) Depression Rating Scale (DRS) IADL Performance Scale IADL Capacity Scales Geriatric Screener Pain Scale Pressure Ulcer Rating Scale (PURS) Method for Assigning Priority Levels (MAPLe) Resource Utilisation Group (RUG) III One take of information prevents duplication.

Applications of SAT assessment One take of Information – Many Uses Care Planning Policy Screening ASSESSMENT Overview: Examples of how we can use interRAI assessment information (data) at an individual level for the benefit of services users (in holistic, person centred care planning based on the individual’s assessed needs, capabilities and wishes), to aggregated level (de-identified data) in assisting with quality assuring care & services, to research & service development, to policy decision-making. Research Quality

9 SAT Implementation SAT Pilot Report available following conclusion of pilot National SAT implementation to be progressed 2018-2019 SAT recommended by HIQA to underpin new Statutory Home Supports Scheme (HIQA 2017) SAT will be the new national standard for the assessment of all older people seeking support under: Nursing Home Support Scheme Home Care support. SAT will replace Common Summary Report (CSAR) in both Acute and Community sites for access to the above schemes across all CHOs.

Data Analysis – Demographics & Reason for Assessment 10 Data Analysis – Demographics & Reason for Assessment Patient Age: Patient Age ranged from 37 to 101 years with a national average age of 82 years. 54% were female and 46% male. Reason for Assessment 90% of patients were assessed for entry to the NHSS with 10% assessed for HCP Supports. Local Placement Forum Outcome Information on LPF Outcome was provided for 91% of NHSS applicants: HCP Outcome Information on HCP outcome was provided for 54% of HCP applicants:

Family Carer Support prior to admission 11 Family Carer Support prior to admission NHSS HCP 87% of patients had family carer support 93% of patients had family carer support SAT Pilot Results Patient Age Minimum Age: 37 years Maximum Age: 101 years Average Age 82 years

Data Evaluation – Patient supports 12 Data Evaluation – Patient supports NHSS APPLICANTS HCP APPLICANTS 59% of patients in receipt of home support services prior to admission.  36% of patients were in receipt of home support services prior to admission.  41% of patients were not in receipt of home support services prior to admission 64% of patients were not in receipt of home support services prior to admission

Data Analysis – Family Carer / Length of Stay / Reason for Admission 13 Data Analysis – Family Carer / Length of Stay / Reason for Admission NHSS APPLICANTS HCP APPLICANTS 87% of patients had family carer support:  93% of patients had family carer support Actual Discharge Date recorded for 89% of patients – Length of stay ranged from 3 to 733 days with an average of 69 days.   Actual Discharge Date recorded for 81% of patients - Length of stay ranged from 6 to 87 days with an average of 32 days  The top five reasons *for admission to hospital:   The top five reasons *for admission to hospital:   * Some patients had multiple primary co-morbidities. * Some patients had multiple primary co-morbidities.

SAT Pilot recommendations / progress to date 14 SAT Pilot recommendations / progress to date Services for Older People No. Recommendation Progress to date 1 Services for Older People should consider issuing national guidelines to standardise the use of SAT information for both home care and long term care. National Home Care guidelines currently being developed by Services for Older People 2 SAT outputs should be utilised to prioritise access to services and to guide the delivery of appropriate care in the most appropriate settings. inform appropriate levels of support required for both home care and long term care. identify older people at risk of decline/ acute hospital admissions and poor health outcomes. monitor levels of cognitive impairment and appropriate care provision Exercise undertaken involving case studies to examine how SAT outputs can be utilised to prioritise service, inform service allocation, identify people at risk and monitor levels of cognitive impairment

15 ICT No. Recommendation Progress to date 3 Resolution of hardware (in particular tablet) issues —a dedicated SAT support service is required. Full access to emails and connectivity between hardware and software needs support. This is currently being progressed by ICT with the introduction and ongoing support of Surface Pro tablets. Surface Pro tablets (configured for email) being rolled out to users. Processes being developed in conjunction with ICT related to hardware provision and support. 4 Resolution of software issues (Opensky) - software development / support in timely manner required. Software issues escalated to senior ICT management. Meeting held between senior IT management and software provider

16 Training No. Recommendation Progress to date 5 SAT assessors require ‘Protected Time’ to complete training assessments and eLearning competencies (following this pilot this has been identified as approx. 20 hours). Communicated to Heads of Social Care in each CHO by Head of Operations & Service Improvement for Older People 6 Assessor support pre, during and post training is critical to SAT Implementation. 7 Line managers should carefully consider the clinicians they nominate for SAT Assessor Training, and only train those clinicians who will actually undertake assessments. Other SATIS training options should be delivered to clinicians directly involved in clients care and to those using SAT outputs (Decision Maker training & Read Only training). Appropriateness of Assessor nominations communicated to Heads of Social Care Decision maker / read only training being provided to relevant personnel

17 SAT Implementation No. Recommendation Progress to date 8 Ensure that a functioning Local Implementation Team is in place in all sites so that communication lines are open and team members are aware of roles, responsibilities and the integration of SAT in any process (for both NHSS and HCP access) Implementation Framework provided to CHOs which identifies the recommended LIT membership . Monthly monitoring of implementation in CHO sites. 9 Ensure that all those involved in using SAT outputs in both LPFs and Home Care provision have access to and use the necessary information to assist the decision making process. Decision Maker training programme is being provided to LPF members and Home Care Managers Personnel are set up on SATIS live system where relevant. 10 Careful planning is required for the implementation of SAT in any area to conduct process mapping in terms of pre and post SAT process, identification of SAT assessors to be trained and strong management leadership to support this. Routine meetings between Head of Services for Older People and Heads of Social Care in CHOs. Monthly monitoring of progress being made by CHOs

SAT Benefits SAT supports effective care planning with the older person. Provides information on unmet needs. Supports health professionals by prioritising access to services based on assessed need & facilitates the provision of integrated care. High quality and reliable data available which can be easily shared between hospital and community sectors. Aggregated data will be available to produce measures of outcome, quality of care and eligibility criteria for access to services. SAT will deliver a fully developed, robust, reliable, standardised multi-dimensional electronic assessment system.

SAT Implementation Update 19 SAT Implementation Update Funding provided to 9 x CHOs for 2 x SAT Educators per CHO 9 SAT Educators in post: CHO 2 (2 x SAT Educators) CHO 3 (2 x SAT Educators) CHO 4 (1 x SAT Educator) CHO 7 (1 x SAT Educator) CHO 8 (2 x SAT Educators) CHO 9 (1 x SAT Educator) SAT Steering Groups established in 9 CHOs Live SAT Assessments being undertaken in CHOs 2, 3, 7 and 9 Assessor Training provided to 108 personnel Over 2,100 Clients recorded on SAT Monthly monitoring of SAT implementation in each CHO

Live SAT Assessments 20 CHO 2 University Hospital Galway Merlin Park University Hospital Clifden District Hospital Ballinasloe CNU Sacred Heart Hospital Belmullet District Hospital Swinford District Hospital Roscommon Community Dementia Nurse CHO 9 Beaumont Hospital North Dublin LHO La Verna Day Care Centre Lusk Day Care Centre HCP Review Team CHO 3 University Hospital Limerick Network 7 CHO 7 Tallaght Hospital Dublin SW Community Care Integrated Care Team – DSW Dublin SC Re-enablement Team

SAT Training & Information Sessions 21 SAT Training & Information Sessions No. of Trainees / Attendees Assessor Training 108 Information Sessions 1120 Decision Maker / Read Only Training 427 Discipline of Assessor Trainees Nursing – 84 Social Work – 12 Physiotherapy – 3 Occupational Therapy – 6 Dietetics – 1 Admin/Management - 2- 1

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