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

Assessment ofOlder People's Health and SocLal Care Needs_ and P!eferences.The TeamThe multi-disciplinary team comprises specialist medical, nursing, physiotherapy, occupationaltherapy, speech and language, clinical nutrition, social work and clinical psychology staff.Unfortunately, the term 'multi-disciplinary' team is much abused and very many involved with thecare of older people in Ireland do not have access to a full multi-disciplinary team. What they have isan oligo-disciplinary team (oligo = few) with perhaps two, three or four of the disciplines. Look at themake-up of the multi-disciplinary team and tell me whether you are in a multi-disciplinary or anoligo-disciplinary team. A part of the mission of any aspiring multi-disciplinary team is the struggle toensure that all the relevant disciplines are incorporated into the team.Full Team in the Community?Comprehensive Geriatric Assessment at the moment mainly occurs in the hospitai or day hospitalsetting. However, it would be possible to have a full team in the community. The Australians havealready done it. We need recognition and validation of the complement of the full multi-disciplinaryteam, to recognise that specialist skills are required and that secondary care approaches may bemore appropriate in the treatment of certain conditions. For example, studies by David Challis fromManchester have shown that secondary care approaches to the treatment of conditions such asdementia are better than primary care approaches". Trying to do Comprehensive GeriatricAssessment without the full team complement is like a breast cancer service planned withoutradiotherapy.Nursing Home AssessmentPurpose of Nursing Home AssessmentNursing home assessment is a hot topic and we need to be really clear as health and social careprofessionals where we stand on this. Why are we doing nursing home assessment? Is it to helphealth boards determine financial support? Is it to consider whether other care options might bemore appropriate? Or is it, as it ideally should be, to plan care.and support in the nursing home?Of 140 patients referred to our services as needing long-term care, forty were routed to home withtreatment and support. This represents a major issue. In the ERHA, it is policy that all those referredshould have a comprehensive assessment by the geriatrician or old age psychiatrist with their teamunfortunately, this is not yet the case for all other health boards.12. Challis, D., Van Abendorff, R., Brown, P., Chesterman, J., Hughes, J., 'Care management, dementia care and goodspecialist mental health services: an evaluation'. Int. J Geriatr Psychiatry. 2002 Apr; 17(4): 315-25.