SAP 1

1
The single assessment process

• An introduction to the principles
• and process

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National Service Framework (NSF) for Older People

• Standard 2 Person-centred care
• Covers
• Single assessment process
• Integrated equipment
• Continence services

3
The single assessment process

• What is it?
• Why do it?
• How?
• When?

4

• Who? service users/patients/older people/their
  carers
• Who? staff/organisations

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StakeholdersIndividuals
Community psychiatric nurses (CPNs)
GPs
Housing officers
Therapists
Serviceusers and their carers
Health visitors
Ward staff
District nurses
Volunteers
Occupational therapists
Intermediate care staff
Home carers
Care managers
Residential staff
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Stakeholders Organisations
Housing
Primary care trusts
Social services
Single assessment process
Voluntary sector
Acute trusts
Mental health trusts
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Why is the single assessment process important?

• Fundamental to the delivery of the NSF for Older
  People
• Falls prevention
• Management of medications
• Long-term care (RNCC, free nursing care)
• Delayed transfers of care
• Intermediate care
• Maintaining independence

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Why is the single assessment process important?
Maintaining independence
Registered nursing care contribution (RNCC)
free nursing care
Reviews of medication
Single assessment process
Delayed transfers of care
Fair access to care services (FACS)
Falls
Continence
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Reasons for introducing the single assessment
process

• Raymond Warburton
• Local variations in depth and quality of
  assessment
• Information about assessment may be limited
• Older people are not at the centre of assessment
  and care planning
• Treatable health conditions are missed or
  misdiagnosed

continues
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continued

• Raymond Warburton
• Insensitivity to race and culture
• Scales are adapted for local use
• Assessment is not in proportion to older peoples
  needs
• Assessments are duplicated and information is not
  shared
• Professionals may not accept each others
  assessments

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Single assessment processKey benefits

• Facilitation of joint working
• Shared information
• Reduced duplication
• Improved discharge planning
• Improved prevention
• Fewer avoidable hospital admissions
• Case finding

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Single assessment process Main challenges

• Joint working cultural changes and
  organisational barriers
• Building trust
• Pressures on workforce of other targets and
  requirements
• Difficulties releasing staff from training
• Information management and technology (IMT)

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Single assessment processKey issues

• Person centred
• Information is gathered once
• Professionals work together in the best interests
  of older people
• Older peoples views and wishes are central to
  the assessment process
• The depth of the assessment is appropriate to
  their needs

14
Single assessment processKey issues

• Standardised
• Evidence based
• Enables professionals to access each others
  assessment
• Facilitates sharing of information between
  professionals and agencies

15
Single assessment processKey issues

• Outcome centred
• Promotes health, independence and quality of life
  for older people
• Helps fulfil potential for rehabilitation

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Single assessment processKey issues

• Older persons contribution
• This starts at the beginning of the contact
  assessment. There needs to be a statement of the
  persons needs, expectations, strengths and
  abilities in their own words
• Their contribution continues throughout
• Key decisions and issues should be given to the
  person in writing or in another appropriate
  format.

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Carers assessment

• The overview assessment should give
• sufficient information to establish whether
• there is a carer involved who provides
• substantial care.
• If there is, they should be advised about
• their right to an assessment of their own
• needs.

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Stages in the single assessment process

• Publishing information about services
• Assessment
• Evaluating assessment information
• Deciding what help should be offered (includes
  eligibility decisions)
• Care planning
• Monitoring
• Review

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The assessment process

• Contact
• assessment

Overview assessment
Specialist (in-depth) assessment
Comprehensive assessment



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Contact assessment

• What is it?
• Not all contacts!
• Done when significant needs are first described
  or suspected

21
Overview assessment

• Likely to be undertaken by one assessor
• Local organisations need to agree who can do
  these
• Covers the full range of domains
• Judgement will be needed about which areas to
  pursue

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Specialist (in-depth) assessment

• Examines specific needs in detail
• Undertaken by specialists e.g. nurses, social
  workers, geriatricians, therapists, housing
  officers, community psychiatric nurses
• Needs to be carried out by the most appropriate
  specialist

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Comprehensive assessment

• Involves (in-depth) assessment of all the domains
• May be obvious from the beginning that this is
  needed and therefore overview may not be needed
• Must be done for people where level of support is
  likely to be intensive and/or prolonged

continues



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Comprehensive assessment continued

• Will provide information for the Registered
  Nursing Care Contribution (RNCC) determination
  (free nursing care)
• Will include assessments from a range of
  professionals and agencies
• Will need coordination by a case coordinator

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Case coordinator role

• Required where needs are complex
• Coordinates assessment
• Coordinates care planning
• Has an ongoing role acting as the focus for
  communications
• Details need to be defined and agreed locally