Assessment of Older People's Health and Social Care Needs and ...

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Introduction to ConferenceProceedingsThe Structure of the ReportThe structure of this report reflects the format of the National Conference on the Assessment of OlderPeople's Health and Social Care Needs and Preferences. It begins with a welcome and introduction tothe conference from the Chairperson of the National Council on Ageing and Older People, Dr MichaelLoftus. The conference presentations follow.The conference programme incorporated four sessions. A series of speakers presented papers atthree of these sessions, with discussion time scheduled at the end of each one. The final session wasa panel discussion, with brief contributions from three speakers, intended to trigger an exchange ofviews with conference participants. Outline details of the four sessions are set out below.The Opening Session included presentations on:the policy context for the assessment of older people's health and social care needs• old age screening and assessment in the community, incorporating Public Health Nurse andGeneral Practitioner perspectives• a project promoting an integrated hospital and community-based approach to assessment andprovision of home supports to a targeted group of older people.The second session, Specialist and Comprehensive Assessments, included presentations on• physiotherapy needs assessment• psychiatric needs assessment in older peoplecomprehensive geriatric assessmentDue to a late change in the schedule of presentations, a paper on the assessment of competence todrive was not delivered at the conference, but is included as an appendix to this report.The third session, Current Initiatives, included presentations on:• the development of standardised approaches to the assessment of older people's needs andpreferences, with perspectives from the Southern Health Board and the North Eastern HealthBoard• the single assessment process in the UK.The final session focused on a theme, The Way Forward and raised questions as follows:• a national framework for multi-disciplinary assessment?• are there other priorities?;,j,Conference Proceedings
-Conference Presentations-'---------------------------------Considering the policy context, Eamon 0' Shea said that good policy has been developed in respectof older people over the past fifteen years, but the issue is that the policy has not beenimplemented. He proposed that the approach to funding the long-stay care of older people should beunderpinned, not by available funding and resources such as bUildings and Nursing Homes, but bythe care requirements of older people. These would best be determined by broad-based assessmentof the older person's needs, incorporating the range of social and economic factors that impact onhis/her capacity to continue living in the community. He clarified a distinction between thedependency of an older person and their situation of dependency as a consequence of social andeconomic factors. He went on to advocate a national approach to conduct in conducting dependencyassessment for publicly-funded long-stay care on the basis that it would reduce inequity and he alsorecommended systemic changes, including the introduction of community subvention, to enable olderpeople of low and medium dependency to continue living in the community.Public Health Nurse (PHN) Perspectives on old age screening and assessment in the community werepresented by Margaret Daly, Geraldine Tabb and Marion Duffy. Margaret Daly characterisedassessment as a process rather than an event and she described how the patient-centred philosophyof PHN's influences their approach to assessment. She located the approach to assessment in theSouthern Health Board within the framework of its strategy for the development of services for olderpeople in Cork and Kerry, 'Ageing with Confidence'.Geraldine Tabb's presentation concerned the piloting of the Winchester Disability Rating Scale(WDRS) as an approach to old age screening and assessment in the Waterford Community Care areaof the South Eastern Health Board region. Among the reasons why this approach was developed werethe requirement to develop anticipatory care and an 'at risk' register for older people in thecommunity and the fact that the commonly used Barthel Index was insufficient on its own tomeasure the needs of older people. One of the outcomes of the project was the development ofpackages of care for 583 maximum dependency older people living in the community during the year2001.Marian Duffy described the approach t'J assessment developed in the Western Health Board. Thisincorporates a contact and overview assessment and four specialist assessments, one of whichinvolves the application of a locally-developed functional and social assessment screening tool. Thehealth board's intention was to develop a tool that was brief, easy to use, involved no extra cost andwas pertinent for use in home/community settings by PHNs. Limitations of the tool included its failureto both highlight persons suffering physical and emotional abuse due to family distress anddisharmony and to identify those suffering from depression. The benefits of the screening programmeincluded the early identification:Jf potential or actual problems and earlier referral and follow-up ofproblems.Speaking from a GP perspective, Dr. Sheelagh Prosser shared the findings of a European workinggroup for the standardised assessment of elderly people in the community called STEP. She identifiedthe group's emphasis on the concept of proactive assessment as an impo'rtant contribution to overallunderstanding of assessment. STEP has designed a standardised assessment tool for use in theAssessment of Older People's Health and Social Care Needs and Preferences
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