Abstract
The interRAI is a clinical assessment tool to measure the health and functioning (clinical, psychological and social) of elderly people. This is used as part of a formal needs assessment process to inform a care plan related to the level and type of funded care they require, what the government will provide and informal supports available. There are different kinds of assessments, which take place in the community, hospital and rest home care. In the community, there are non-complex assessments done primarily by homecare providers, and complex assessments done by Needs Assessors employed by Te Whatu Ora.
We identified barriers to accessing interRAI assessments. GPs are main referrers: this means people with poor access to GPs, or no regular GP, face particular barriers. Those without support from their whānau or others may be more likely to miss out. There is very little public knowledge or awareness of the needs assessment process and even participants and whānau who had been involved with a needs assessment sometimes misunderstood the process. Getting an assessment required health literacy and persistence. This is a significant barrier to accessing needs assessments, and therefore funded services.
Assessments often occurred in a context of an older person’s declining health and abilities, and significant family input into their care. Pressures on the health system did not affect assessment outcomes themselves but meant that people might not actually get the care they needed. For example, people might be assessed as eligible for respite care, but not get it because of lack of available respite beds.
Needs Assessors demonstrated remarkable skills, both clinical and inter-personal. These included building rapport, managing emotions (often the assessment comes at a difficult time and raises difficult questions for older people and their families), keeping people on-track, not taking sides, being alert to the possibility of elder abuse etc.
Needs Assessors drew on a variety of sources of information: what the client said, what they observed, what others said, and clinical notes. These sources of information were often incomplete, and sometimes conflicting. Needs Assessors were at the front line of working out what care was and should be provided by families, and what the government will provide.
The interRAI requires assessors to assign either a code from a response set or, for some items, record the person’s opinion. Free text notes may be written also. Needs Assessors used both the boxes and the notes to record their professional understanding of the client’s situation. Behind the scenes algorithms create a set of outcome measures that provide decision-support to the assessors to understand the assessed persons’ level of need.