Single Assessment Tool (SAT) National Implementation of a Standardised Care Needs Assessment for Older People Dr. Natalie Vereker, Ms. Linda McDermott- Scales Services for Older People, HSE Social Care Directorate 21 May 2015

Why do we need SAT? International best practice advocates standardised comprehensive care needs assessment to appropriately identify older persons’ care needs. In Ireland this requirement also recognised: The Leas Cross Report (O’Neill, 2006) The Health Information and Quality Authority’s (HIQA) ‘National Quality Standards for Residential Care Settings for Older People in Ireland’, to support Standard 10: Assessment (HIQA, 2009). Action 35 in ‘Future Health, a Strategic Framework for Reform of the Health Service 2012-2015’

Why do we need SAT? Currently do not have one standardised care needs assessment for service provision 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, duplication Lack of connectivity between hospital and community providers SAT provides standardised language of assessment across hospitals and community.

Why do we need SAT? SAT Project Scope Critical for future planning of services for older people at network level, regional level and nationally Without foundation of a standardised assessment, difficult to assess priorities, risks and achieve equity Replace current variable care needs assessment practices with standardised SAT for entry into NHSS, HCPS, Home-Help provision. SAT will replace the CSAR in both community and acute settings for required access to the schemes

How was SAT selected? 2010 SAT Working Group established (multi-agency/disciplinary) Extensive consultation and research included; Literature Review Long list of Assessment Tools compiled/ reviewed & shortlisted. Short list of 3 tools reviewed against 37 criteria – interRAI selected for progressing to pilot. Piloted in in 2 locations (S.Tipperary & Dublin West) in 3 settings- Long Term Care, Community Health Centres and Acute Hospitals Final Report of Working Group issued recommending the SAT selected was the interRAI suite of tools as most fit for purpose for Ireland. Progressed to Business Case & approved for implementation by HSE / Dept of Finance (DPER)

SAT Implementation Business Case for SAT Implementation submitted and approved by HSE ISD Management Team and CMOD Dec 2012 Additional funding sought and received from Atlantic Philanthropies SAT Project Board established Jan 2013. Project end date 2017 Contracts signed with external vendors for development of SAT Information System (SATIS) & e-Learning

SAT Governance SAT Governance structures established including separate Advisory Working Groups Carers Needs Working Group developing a separate Carers assessment. New development with Ireland as leading partner in conjunction with interRAI International Development Committee and Irish Carers Organisations SAT Project Board SAT Project Team Regional Implementation through CHOs Regional Implementation though CHOs Advisory Working Groups – SUCAG, Carers Needs, Communications, ICT, Evaluation

SAT Implementation 2015 4 priority areas have been identified (through indices of need) for implementation in 2015 with additional 4 identified for early 2016 Implementation Teams established in 4 priority areas- 2 dedicated SAT personnel along with representation from hospital, community, management and ICT. Currently Live Testing nationally in priority hospitals

SAT Implementation – expected benefits SAT will be required assessment for entry into services in the community - the Home Care Package scheme & Home Help scheme and also entry into Long Term Care – the Nursing Home Support Scheme (a Fair Deal). Current system of multiple assessment systems will cease by 2017 – better for both client and service provider. Benefit older people and their carers through better information on their needs and options for care. Reduce assessment duplication, support the transfer of information between hospital and community.

SAT Benefits It supports effective care planning with the older person. Provides information on unmet needs. Additional information on dementia. Supports health professionals by prioritising access to services based on need & facilitates the provision of integrated care. Quality and reliable data produced which can be aggregated to produce measures of outcome, casemix, quality of care and eligibility criteria for access to services. It will deliver a fully developed, robust, reliable, standardised multi-dimensional assessment system. interRAI is a collaborative network of researchers resulting in years of rigorous research and testing to establish the reliability and validity of items, outcome measures, assessment protocols, case-mix algorithms, and quality indicators. With continual research o improve the usefulness of our tools in a systematic fashion

What is interRAI? Research collaborative: 65 members/32 nations Non-profit corporation Key interests Science (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 data Licenses software vendors around the world www.interrai.org

Countries using interRAI tools Europe Iceland, Norway, Sweden, Denmark, Finland, Netherlands, Germany, UK, Switzerland, France, Poland, Italy, Spain, Belgium, Estonia, Lithuania, Czech Republic, Austria, Portugal, Ireland North America Canada, USA, Mexico, Belize, Cuba Middle East/Asia Israel, India, Lebanon South America Chile, Brazil, Peru Africa Ghana Far East/Pacific Rim Japan, South Korea, Taiwan, China, Australia, Hong Kong, New Zealand, Singapore

Applications of interRAI Data- One Take of Information – Many Uses Care Planning Policy Screening ASSESSMENT Case-Mix Quality

Comprehensive Assessment interRAI HC Domains Identification Information Intake/ Initial History Cognition Communication/ Vision Mood/Behavior Psychosocial Well-being Functional Status Continence Disease Diagnoses Health Conditions Oral/Nutritional Status Skin Condition Medications Treatment/ Procedures Responsibility Social Supports Environmental Assessment Discharge Potential/ Overall Status Discharge

Applications of interRAI Data- One Take of Information- Many Uses Care Planning Policy Screening ASSESSMENT Case-Mix Quality

Clinical Assessment Protocols? Decision Making Frameworks Focus on key issues for the person (needs, strengths, preferences, function & QoL) & on areas that may require further assessment and care planning. “Triggered” by answers to specific assessment items Resolve problem Reduce risk of decline Increase potential for improvement Provide evidence-based guidelines & best practice recommendations for further assessment, care planning, facilitate referrals (as appropriate) & provide basis for outcome-based assessment of the person’s response to care or services.

Clinical Assessment Protocols (CAPs) (27 CAPs in Total) FUNCTIONAL PERFORMANCE Physical Activities Promotion Instrumental Activities of Daily Living Activities of Daily Living Home Environment Optimisation Admission Risk (Long-Term Residential Care)* Physical Restraints COGNITION/MENTAL HEALTH Cognitive Impairment* Delirium Communication Mood Behaviour Abusive Relationship SOCIAL LIFE Leisure and Social Activities* Family Carer Support* Social Relationships CLINICAL ISSUES Falls Pain Pressure Ulcer Cardio-Respiratory Conditions Undernutrition Dehydration Feeding Tube Health Promotion* Appropriate Medications Tobacco and Alcohol Use Urinary Incontinence/ Continence Promotion* Bowel Conditions

Applications of interRAI Data- One Take of Information- Many Uses Care Planning Policy Screening ASSESSMENT Case-Mix Quality

What is a Screener? Subset of items from larger assessment instrument. Uses algorithms = scientifically derived data “recipes”. Variety of uses Trigger further assessment Rule out further assessment Identify target sub-populations.

Why Use Screeners? Identify and target priority groups. Identify and target relative risk of adverse outcomes. Replaces subjective "informed guess" policy with evidence-based decision tools using systematic, standardised methods and measurements. Reduces assessment burden (duplication) on individual/ clinician- screeners are inbuilt into the system. Triage principle: uses costly staff resources more efficiently. Measure relative urgency of services need or overall care complexity, e.g. MAPLe, Outcome Scales: Status and Outcome measures (status/ risk): CHESS, PURS, etc.

Scales: Status and Outcome Measures for interRAI HC Tool 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

Applications of interRAI Data- One Take of Information- Many Uses Care Planning Policy Screening ASSESSMENT Case-Mix Quality

Quality Indicators- 23 HC QIs ADL Improvement ADL Decline Bladder Decline Bladder Improvement Cognitive Improvement Cognitive Decline Communication Improvement Communication Decline Falls IADL Improvement IADL Decline Injuries/ Skin breaks & Burns Mood Improvement Mood Decline Pain & either Meds not Controlling pain or No Meds Pain Improvement Daily Severe Pain Continued Caregiver Distress Alone & Distressed Client no longer going out but used too Not Received Influenza Vaccine Acute Hospital ER/ Care Unintended Weight Loss

Applications of interRAI Data- One Take of Information- Many Uses Care Planning Policy Screening ASSESSMENT Quality Case-Mix

Case Mix Relative measure of cost of caring for an individual person Accumulated to any group of persons Can be the basis for payment or allocation For Home Care: RUG-III/HC For Nursing Homes: RUG-III

RESOURCE UTILISATION GROUPS (RUGS) Rehabilitation Clients /Residents receiving physical, speech or occupational therapy Extensive Services Clients/ Residents receiving complex clinical care or with complex clinical needs such as IV feeding or medications suctioning, tracheostomy care, ventilator/ respirator and co-morbidities that make the resident eligible for other RUG categories. Special Care Clients/Residents receiving complex clinical care or with serious medical conditions such as multiple sclerosis, quadriplegia, cerebral palsy, respiratory therapy, ulcers, stage III or IV pressure ulcers, radiation, surgical wounds or open lesions, tube feeding and aphasia, fever with dehydration, pneumonia, vomiting, weight loss or tube feeding. Clinically Complex Clients/Residents receiving complex clinical care or with conditions requiring skilled nursing management and interventions for conditions and treatments such as burns, coma, septicaemia, pneumonia, foot/ wounds, internal bleeding, dehydration, tube feeding, oxygen, transfusions, hemiplegia, chemotherapy, dialysis, physician visits/ order changes. Impaired Cognition Clients/Residents having cognitive impairment in decision making, recall and short-term memory. Behaviour Problems Clients/Residents displaying behaviour such as wandering, verbally or physically abusive or socially inappropriate, or who experience hallucinations or delusions Reduced Physical Functions Clients/Residents whose needs are primarily for activities of daily living and general supervision.

Uses of Case Mix Payment Comparing facilities Management Monitoring changes in admission status, populations over time Measuring outcomes

Applications of interRAI Data- One Take of Information- Many Uses Care Planning Policy Screening ASSESSMENT Case-Mix Quality

Policy- Service Planning/ Quality Use of aggregated information Identification of service need Enhances knowledge of client care populations Allows managers to track & compare their organisations’ responses to quality of care issues Better management of services / resources/ Demonstration of effective care/ value for money

A Standardised Language of Assessment-One Collection of Information - Many Uses Care Planning Policy Screening ASSESSMENT Case-Mix Quality

Thank You Any Questions?