national service framework for older people single assessment process milestone : april 2004

National Service Framework for Older People

Single Assessment Single Assessment ProcessProcess

Milestone : April 2004Milestone : April 2004

Designed by Kate Bebe

SINGLE ASSESSMENT PROCESSPERSON-CENTRED CARE : STANDARD TWO, NSF FOR OLDER

PEOPLE

Managers & Professionals should:

Listen to older people Respect their dignity and privacy Recognise individual differences and specific needs

including cultural and religious differences Enable older people to make informed choices, involving

them in all decisions about their needs and care Provide co-ordinated and integrated service responses Involve and support carers wherever necessary


SINGLE ASSESSMENT PROCESSREASONS

Local variations in depth and quality of assessment Information about assessment may be limited Older people not at the centre of assessment and care

planning Treatable health conditions are missed or mis-diagnosed i.e. dementia, depression, incontinence, etc. Scales adapted for local use Assessment not in proportion to older people’s needs Assessments duplicated and information may not be

shared… Professionals may not accept each other’s assessments


SINGLE ASSESSMENT PROCESS

Key Aspects:

Person Centred Information given once Views and wishes are central Holistic picture of needs Assessment proportionate to need Consent to sharing Written details to older person


SINGLE ASSESSMENT PROCESSPURPOSE

The process should not: displace existing good practice replace clinical judgement be thought of as separate to the NSF, but inherent within

The Single Assessment Process should: encourage raising of standards within the care of older

people be a continuous process for an older person, but a joint

process for professionals Be outcome centred for the older person


SINGLE ASSESSMENT PROCESSPROFESSIONALS / AGENCIES INVOLVED

GP surgeries Community Health Services Social Services Housing Ambulance Hospitals (A & E, Outpatients. Medical Assessment Units, Old age psychiatry units, Wards, Other locations caring for older people, Dentists and podiatrists)

Other NHS facilities


SINGLE ASSESSMENT PROCESSSTAGES OF ASSESSMENT AND CARE MANAGEMENT

Publishing information about services / case finding Completing assessment

Contact Overview Specialist Comprehensive

Evaluating assessment information Deciding what help to offer Care planning Monitoring Review


SINGLE ASSESSMENT PROCESSDOMAINS OF THE SINGLE ASSESSMENT PROCESS

User’s perspective Clinical background Disease prevention Personal care & physical well-being Senses Mental health Relationships Safety Immediate environment and resources


SINGLE ASSESSMENT PROCESSTYPES OF ASSESSMENT

Contact assessment

nature of the presenting problem; significance for the older person; duration of the problem; potential solutions identified by the older person; other problems experienced; recent relevant life events; perception of family and carers



Overview assessment

all, or most of the domains are explored; may be sufficient to fully describe person’s needs; may trigger areas where further assessment is

required; may occur as soon as basic personal information

has been collected



Specialist assessment

exploration of specific domains as indicated by either contact or overview assessment;

requires the involvement and judgement of appropriately qualified and experienced professionals;

may require the use of specific tools and scales i.e. Geriatric Depression scale; O.T. assessments; etc.



Comprehensive assessment

maybe necessary following initial contact if needs are perceived by the professional to be complex and multiple;

may follow on from an overview assessment will be required for all older people where the level of

support and treatment likely to be offered is intensive and complex (including permanent admission to a care home, intermediate care facilities, or intensive packages of care at home)


SINGLE ASSESSMENT PROCESSCOUNTY PROGRESS TO DATE

Cumbria and Lancashire Partnership Group [senior management in older people services across Lancashire and Cumbria’s Health & Social Services]

Local steering groups Local project leads Developed joint training strategy Information sharing agreements Initial roll out of Single Assessment started in all

localities


SINGLE ASSESSMENT PROCESSLOCAL PROGRESS TO DATE

Multi-professional and multi-agency working groups have:

Agreed purposes; outcomes & shared values Agreed terminology Mapping care processes Agreed link between medical diagnosis and

assessment Piloted strategies for joint staff development

Sharing of demographic information, imminent Awareness raising high on agenda


SOME OF THE WORK DONE SO FAR IN SINGLE ASSESSMENT

Eleven shared values have been agreed across Cumbria and Lancashire:

1. Respect and promote the autonomy of the individual2. All service provision to be seen by the user as a single

package of care3. Informed consent is needed for every element of the

care package4. Age (of itself) should not determine how services are

accessed or provided5. If an individual lacks capacity to make decisions,

agencies to have procedures for maximum participation and safeguarding the older persons interests.


SOME OF THE WORK DONE SO FAR IN SINGLE ASSESSMENT

Eleven shared values have been agreed across Cumbria and Lancashire (continued)

6. SAP should promote health and well being and optimise independence

7. Service information should be understandable and accessible8. Professionals should be competent to work with older people

and should be active in Continuing Professional Development.

9. Care workers will promote and maintain good practice and adhere to legal requirements and relevant standards of practice.

10. Communication will be open and straightforward11. A holistic approach to assessment will incorporate the whole

picture of individual needs


SINGLE ASSESSMENT PROCESSCASE STUDIES

Example 1:

Mrs Brown presents at the surgery with a sore throat. She has no other health or

social problems

Mrs Brown does not enter into the Single Assessment Process



Example 2:Mrs Brown presents herself at the GP surgery. She is complaining of weight loss over the last 6 months and is finding it increasingly difficulty to get in and out of her bath safely.

In contact assessments, professionals need to explore health and social care problems where the:

Presenting problems are not clear Other potential problems maybe identified



Example 3:Following the death of her husband, Mrs Brown has been living on her own, without support, for the last 6 years. Recently, she has found it difficult to bend down which has affected her ability to manage her own personal care. She experiences dizziness and becomes tired if she exerts herself physically. Mrs Brown also admits to feeling “quite low at times”.

Mrs Brown requires an holistic overview assessment. Key factors include:

Personal care; medical and mental health issues



Example 4:Mrs Brown has had several admissions to hospital, instigated by her GP. She has complex health conditions, which result in reduced mobility. Considerable support is necessary to maintain her personal care. Social Services provide home care four times per day. Mrs Brown also has a private cleaner.

On her last admission to hospital, Mrs Brown discussed, withher named nurse, the fact that she is “tired of managing on her own” and wants “to live somewhere she feels safe”.

Mrs Brown requires a comprehensive assessment including several specialist assessments


SINGLE ASSESSMENT PROCESS

Local Contacts:

Name:Tel:

Name:Tel:


FURTHER INFORMATION General:

http://www.dh.gov.uk/scg/sap/index.htm

Tools and Scales:http://www.dh.gov.uk/scg/sap/toolsandscales/index.htm

Guide to implementation:http://www.dh.gov.uk/scg/sap/locimp.htm

http://www.dh.gov.uk/scg/sap/index.htm

http://www.dh.gov.uk/scg/sap/toolsandscales/index.htm










http://www.dh.gov.uk/scg/sap/locimp.htm










national service framework for older people single assessment process milestone : april 2004

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