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

Dependency and PlacementThe assessment process should focus on the real needs of older people, recognising that dependencyis just one part of the process. With regard to dependency, there are a number of factors to beconsidered, as outlined below.Common UnderstandingsThere is a need for the establishment of a common dependency assessment for all types of publiclyfundedlong-stay care, or at a minimum, some discussion of the assessment and dependencymeasures and tools currently in use. Within and across health boards, there is variation in themeasures and tools in use and, where there is such wide variation, inequity is inevitable.There is a need for national gUidelines for the measurement of dependency or, again at a minimum,some broad agreement as to what is being measured when the dependency of older people, includingtheir physical and mental dependency, is assessed. This is a need which could be addressed withinthree to six months.People with Low or Medium DependencyOlder people with low or medium dependency ought to be cared for in an expanded community caresystem rather than in long-stay care, unless they themselves choose otherwise. However, the mostrecently published statistics on people in long-stay care' show that one in three of those are of low ormedium dependency. People working with the Nursing Home Subvention Scheme will also knowabout 'dependency creep' through which older peopie are assigned to higher levels of dependencysimply to take advantage of higher levels of subvention. If we are changing the behaviour of thoseassessing dependency because of funding mechanisms, this is an irrational way of allocating olderpeople to care, of measuring dependency and of funding long-stay care and it needs to stop.In the context of changing the structure of the system to enable people of low and mediumdependency to be cared for within community care settings, we need also to identify and address theeconomic and social determinants of dependency.An Integrated ApproachFor high dependency older people, there should be a guarantee that all possible community carestrategies will be explored before a decision on admission to residential care is taken. This requiresan expansion of the community care system, but does not imply the creation of a dichotomy betweencommunity and institutional long-stay systems.We need one subvention payment for dependency instead of the three-tiered payment mechanismcurrently in use, because only seriously dependent people should now be in care.. ;"Public hospital beds should be reserved for those in need of intensive nursing care, with significantpublic investment in, and development of, both rehabilitation and step-down facilities for olderpeople, In other words, what is needed is an integrated care system for long-stay care, predicated onthe view that community care is a viable option.Conference Proceedings