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Workshop 6:SAT: Assessment and Care of Older People using the Single Assessment Tool

Dr. Natalie Vereker, National Specialist, Services for Older People, HSE Ireland

Linda McDermott-Scales, SAT National Education & Development Manager, Services

for Older People, HSE Ireland

Room -TBC

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Welcome!

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Workshop objectives

Overview SAT and SAT selection

Overview of SAT- interRAI System & interRAI Applications

Facilitate discussion on the importance of SAT in the provision of older persons care

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Single Assessment Tool (SAT)Recap in brief:

The Single Assessment Tool (SAT) is an IT enabled comprehensive health & social care needs assessment (interRAI System©).

SAT is the new national standard for the assessment of people (primarily for those aged 65 & over) applying for:

Nursing Home Support Scheme (NHSS) Home Supports (Home Care Package Schemes / Home

Help Service)

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The SAT Information System (SATIS)

The SAT & it’s supporting infrastructure the Single Assessment Tool Information System (SATIS) will replace the current paper-based Common Summary Assessment Report (CSAR).

Software operates on Tablet / PC devices.

Two SATIS Applications:

Web Application

Mobile Application

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SAT Selection

In 2010 a multi-agency / multi-disciplinary SAT Working Group was established to select, pilot and recommend a Single Assessment Tool.

interRAI was selected as the most fit for purpose tool for implementation in Ireland.

interRAI assessment tools have been developed by an international network of clinicians, researchers, & service users in over 35 countries.

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SAT Governance

2017- 2019

Roll Out

7 Advisory

Working Groups

SAT National Project

Team

National Director Social Care

CHOs Areas 1 to 9- SAT Implementation Teams Led by CHO Heads

of Social Care

All Areas (Community and Acute Care)

SAT Project Board

Working Groups- SUCAG, CNAD, SATIS, RUGs, Knowledge Transfer, Evaluation, Research.

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What is interRAI? Collaborative network of researchers in over 35 countries Non-profit corporation Key interests

Promoting evidence informed clinical practice/ policy decision-making

Research and quality (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 www.interrai.org

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Applications of interRAI Data- One take of Information – Many Uses

ASSESSMENT

Care Planning

Screening

QualityResearch

Policy

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Comprehensive AssessmentinterRAI HC & interRAI HC for AC/CU Domains

A. Identification Information

B. Intake/ Initial History

C. Cognition

D. Communication/ Vision

E. Mood/Behaviour

F. Psychosocial Well-being

G. Functional Status

H. Continence

I. Disease Diagnoses

J. Health Conditions

K. Oral/Nutritional Status

L. Skin Condition

M. Medications

N. Treatment/ Procedures

O. Responsibility

P. Social Supports

Q. Environmental Assessment

R. Discharge Potential/ Overall Status

S. Discharge

T. Assessment Information

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Assessment Sections - Examples

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Online

Assessment

User Manual

Assessment

Notes

Audit

Trail

Applications of interRAI Data- One Take of Information- Many Uses

ASSESSMENT

Care Planning

Screening

QualityResearch

Policy

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Clinical Assessment Protocols? Decision Making Frameworks

Focus on key issues for the person (needs, strengths, preferences, function & Quality of Life) & on areas that may require further assessment and care planning.

“Triggered” by answers to specific assessment items that aim to: Resolve a problem Reduce the risk of decline Increase the potential for improvement

Provide online evidence-based guidelines & best practice recommendations for further assessment, care planning, facilitates referrals; & provide basis for outcome-based assessment of the person’s response to care or services.

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Clinical Assessment Protocols

FUNCTIONAL PERFORMANCE

1. Physical Activities Promotion2. Instrumental Activities of Daily Living3. Activities of Daily Living4. Home Environment Optimisation5. Admission Risk (Long-Term Residential

Care)6. Physical Restraints

COGNITION/MENTAL HEALTH

7. Cognitive Impairment8. Delirium9. Communication10. Mood11. Behaviour12. Vulnerability

SOCIAL LIFE

13. Leisure and Social Activities14. Family Carer Support15. Social Relationships

CLINICAL ISSUES

16. Falls17. Pain18. Pressure Ulcer19. Cardio-Respiratory Conditions20. Undernutrition21. Dehydration22. Feeding Tube23. Health Promotion24. Appropriate Medications25. Tobacco and Alcohol Use26. Urinary Incontinence/ Continence

Promotion27. Bowel Conditions

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Online CAP Guidance

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CAPs Drill down for Person Centered Care

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Applications of interRAI Data- One Take of Information- Many Uses

ASSESSMENT

Care Planning

Screening

QualityPolicy

Research

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What is a Screener? Subset of question items from the larger assessment

instrument

Software uses algorithms - these are scientifically derived data “recipes” that stream information from individual questions into different risk scales, etc.

Variety of uses Trigger further assessment

Rule out further assessment

Identify target sub-populations

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Status and Outcome Measures for interRAI HC & interRAI for AC/CU Tools (Scales)

Activities of Daily Living (ADL) Hierarchy Scale

Body Mass Index (BMI)

Cognitive Performance Scale (CPS)

Communication Scale

Changes in Health, End-Stage Disease & Signs & Symptoms (CHESS)

Depression Rating Scale (DRS)

IADL Performance Scale

IADL Capacity Scale

Geriatric Screener

Pain Scale

Pressure Ulcer Rating Scale (PURS)

Method for Assigning Priority Levels (MAPLe)

Resource Utilisation Group (RUG) III

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Click on Arrow for Drill Down

Method of Assigning Priority Levels (MAPLe)

Decision support tool

Informs the allocation of homecare services & prioritisation of individuals requiring community or facility based services

Identifies individuals at risk of admission to Long Term Care

Assists in the care planning process

Supports the monitoring of clients

Higher scores indicate a higher priority client / caregiver distress

September, 2011

1. Low

2. Mild

3. Moderate

4. High

5. Very High

Information & Referral

Home Care

LTC Facility

Low MAPLe

MAPLeExpected

Service Type

Very High MAPLe

MAPLe

1. Low

2. Mild

3. Moderate

4. High

5. Very High

Expected Service Type

Information & Referral

Home Care

LTC Facility

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Applications of interRAI Data- One Take of Information- Many Uses

ASSESSMENT

Care Planning

Screening

QualityPolicy

Research

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Quality of Care Measurements

Quality Indicators (QIs) can provide a measure usable for: Performance appraisal; Comparing programmes (benchmarking);

Monitoring programmes; Quality improvement

interRAI QIs measure multiple dimensions Individual/ aggregated QI Summary Measures

Prevalence and Incidence QIs

All case-mix risk adjusted (except Physical Restraints)

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Quality Indicators- Types Available

1. ADL Improvement

2. ADL Decline

3. Bladder Decline

4. Bladder Improvement

5. Cognitive Improvement

6. Cognitive Decline

7. Communication Improvement

8. Communication Decline

9. Falls

10. IADL Improvement

11. IADL Decline

12. Injuries/ Skin breaks & Burns

13. Mood Improvement

14.Mood Decline

15.Pain & either Meds not Controlling pain or No Meds

16.Pain Improvement

17.Daily Severe Pain

18.Continued Caregiver Distress

19.Alone & Distressed

20.Client no longer going out but used too

21.Not Received Influenza Vaccine

22.Acute Hospital ER/ Care

23.Unintended Weight Loss

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Applications of interRAI Data- One Take of Information- Many Uses

ASSESSMENT

Care Planning

Screening

QualityResearch

Policy

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Applications of interRAI Data- One Take of Information- Many Uses

ASSESSMENT

Care Planning

Screening

QualityResearch

Policy

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SAT Assessment Comprehensive holistic assessment system - places the individual at

the centre (assessment/ care planning processes) to support a capabilities- based approach to care & equitable service provision.

Provides clinicians with additional online Care Planning supports:

CAPs – Decision Support Frameworks e.g. Cognitive Impairment; Mood; Behaviour; Delirium; Social Relationships; Activities, etc.

Status & Outcome measures - e.g. Cognitive Performance Scale; Depression Rating Scale (DRS); IADL Capacity Scale; Activities of Daily Living (ADL) Hierarchy Scale; Communication Scale; Frailty.

SAT does NOT provide automated care rather it generates information to facilitate better informed, and higher quality decision-making .

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SAT Benefits • SAT supports effective care planning with the older person.

• Provides information on unmet needs.

• Supports health professionals by prioritising access to services based on assessed need & facilitates the provision of integrated care.

• High quality and reliable data available which can be easily shared between hospital and community sectors.

• Aggregated data will be available to produce measures of outcome, quality of care and eligibility criteria for access to services.

• SAT will deliver a fully developed, robust, reliable, standardised multi-dimensional assessment system.

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Thank You- Any Questions?

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