1. 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

2. 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 ’

3. 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.

4. 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

5. 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)

6. 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 Project end date 2017
Contracts signed with external vendors for development of SAT Information System (SATIS) & e-Learning

7. 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

8. 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

9. 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.

10. 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

11. 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

12. 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

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

14. 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

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

16. 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.

17. 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

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

19. 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.

20. 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.

21. 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

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

23. 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

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

25. 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

26. 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.

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

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

29. 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

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

31. Thank You
Any Questions?