national service framework for older people single assessment process milestone : april 2004
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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
Designed by Kate Bebe
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
Designed by Kate Bebe
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
Designed by Kate Bebe
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
Designed by Kate Bebe
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
Designed by Kate Bebe
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
Designed by Kate Bebe
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
Designed by Kate Bebe
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
Designed by Kate Bebe
SINGLE ASSESSMENT PROCESSTYPES OF ASSESSMENT
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
Designed by Kate Bebe
SINGLE ASSESSMENT PROCESSTYPES OF ASSESSMENT
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.
Designed by Kate Bebe
SINGLE ASSESSMENT PROCESSTYPES OF ASSESSMENT
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)
Designed by Kate Bebe
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
Designed by Kate Bebe
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
Designed by Kate Bebe
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.
Designed by Kate Bebe
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
Designed by Kate Bebe
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
Designed by Kate Bebe
SINGLE ASSESSMENT PROCESSCASE STUDIES
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
Designed by Kate Bebe
SINGLE ASSESSMENT PROCESSCASE STUDIES
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
Designed by Kate Bebe
SINGLE ASSESSMENT PROCESSCASE STUDIES
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
Designed by Kate Bebe
SINGLE ASSESSMENT PROCESS
Local Contacts:
Name:Tel:
Name:Tel:
Designed by Kate Bebe
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
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