Introducing the interRAI Home Care

1. Introducing theinterRAI Home Care Talking the same language for effective care of older people

2. interRAI has developed an entire range of instruments and screeners to support assessment in a wide array of community and institutional settings • SCREENERS • Self-reliance Protocol (community care) • Community & Hospital Intake Protocol (CHIP) • Emergency room* • Acute care* • * In development • INSTRUMENTS • Long term care facility • Assisted living (hostel) • Home care • Community health assessment • Mental health • Community mental health • Acute care • Post-acute care • Palliative care • Intellectual disability interRAI specialises in aged care, disability and mental health services

3. interRAI – Community Mental Health Comprehensive Geriatric Assessment & Care Planning for Acute Care interRAI – Community Health Assessment Comprehensive Assessment & Care Planning for Acute Care interRAI – Palliative Care Comprehensive Assessment & Care Planning for Palliative Care interRAI - Home Care Comprehensive Geriatric Assessment & Care Planning for Acute Care Minimum Data Set Test Version 1.04 [Multi-column format] International Copyright interRAI, Washington D.C., 2004 Minimum Data Set Test Version 1.04 [Multi-column format] International Copyright interRAI, Washington D.C., 2004 Minimum Data Set Test Version 1.04 [Multi-column format] International Copyright interRAI, Washington D.C., 2004 Minimum Data Set Test Version 1.04 [Multi-column format] International Copyright interRAI, Washington D.C., 2004 The interRAI suite includes several instruments designed for application in community care… The interRAI Home Care is the most widely used instrument applied in the community setting

4. There is a suite of community instruments to suit organisational and individual client needs Entry from community interRAI Self Reliance Screener Complex care requirement? Yes No Specialist care requirement? No Yes interRAI CMH interRAI PC interRAI ID interRAI CHA interRAI HC

5. The interRAI Home Care is designed as a general purpose assessment instrument for persons with complex care requirements • It is now in its 3rd version (the interRAI HC) • Previous versions were the RAI-HC and RAI-HC 2.0 • It is used extensively in many areas of North America and Europe, and is currently being trialled in Australia and New Zealand

6. The interRAI HC offers multi-dimensional assessment interRAI HC • Screening • Delirium • Dementia • Malnutrition • Depression • Problem lists • Diagnoses • Geriatric syndromes • Social & environmental • Severity measures • Cognitive performance • Communication • Depression • Activities of daily living • Instrumental ADL • Pain • Health stability • Risk assessment • Delirium • Falls • Functional decline • Pressure ulcer • Rehab. potential • Need for services

7. Baseline assessment Establish care plans Admission profiling Quality monitoring Progress review Re-assessment as needs change Discharge plans Standard review assessments Outcome assessment Discharge profiling interRAI instruments support management of entire episodes of care, not only admission assessment … one integrated systemreduces duplication, improves documentation & increases care quality.

8. A successful interRAI HC implementation brings a wide array of benefits… • Integrated information systems across care settings • Electronic information sharing • Improving clinical skills and standards • Consistent decision-making among clinicians and agencies • Reduced documentation burden • Quality monitoring • Benchmarking among providers • Casemix evaluation

9. Reducing duplication in the Australian setting • The interRAI HC contains sufficient information to meet most of the ACAT, HACC and ACCR data reporting requirements • Once completed, with appropriate software, it can automatically fulfil this function eliminating much of the duplicate paperwork

10. interRAI assessment instruments are built to specific principles and standards • Each assessment creates a minimum data set which provides an entire range of measures to assist in care planning, client monitoring and administration. • High quality data is COLLECTED ONCE and then used for multiple purposes. • This encourages accuracy and reduces duplication • All items are carefully crafted and tested across many countries to ensure good reliability and cultural appropriateness

11. The interRAI HC performs many tasks - not just recording observations • Profiling of cognitive, functional and psycho-social status including: • Screening for common geriatric syndromes • Risk assessment for adverse events • Measuring severity of disability • Identifying opportunities for prevention or improvement • Assessment of quality of care being delivered • Evaluation of case complexity (casemix)

12. The interRAI HC is not only a data set It includes… • Data collection forms • a set of clinical observations and measures • A training manual • including definitions, case studies and clinical protocols • Codesets • computer code to enable software to calculate scales, quality indicators, clinical assessment protocols and casemix groupings It is a “system” to support assessment, care planning, communication, quality monitoring and administration.

13. Case Mix Minimum Data Set Outcome Measurement Scales Quality Indicators Care planning protocols The interRAI model Assessment

14. Clinical decision support:interRAI systems help clinicians to… • Interpret observations • Organise information • Plan care • Monitor clinical progress

15. Logic systems are applied to assist clinicians to interpret their recorded observations • These “algorithms” calculate scales, screeners, clinical assessment protocols (CAPs), quality indicators and casemix groupings • The development of algorithms is based on extensive and ongoing research performed by interRAI… • interRAI makes extensive use of clinical databases provided by user organisations to undertake this work

16. The clinical algorithms enable screening for common conditions… • PRESENCE OF: • Dementia • Delirium • Depression • Malnutrition • Dehydration • Elder abuse • Social isolation • RISK OF: • Pressure ulcer • Falls • Institutionalisation Screeners and scales are validated against “gold standard” clinical assessment or best available existing tools

17. Clinical assessment protocols identify key issues for care planning • Activities • Adherence • ADLs • Behaviour • Bladder • Bowel • Brittle support • Cognitive • Communication • Dehydration • Delirium • Depression • Discharge • Drinking • Elder abuse • Environment • Falls • Feeding • IADL • Institutional risk • Nutrition • Oral • Pain • Physical activity • Pressure ulcer • Prevention • Restraints • Skin care • Smoking • Social function • Unsettled relationship • Vision

18. Scales assist in diagnostic screening and evaluating severity… • ADL Hierarchy, Short & Long Form • IADL Capacity & Performance • Cognitive Performance Scale • Communication Scale • Depression Rating Scale • Pain Scale • Changes in Health End-stage disease Signs & Symptoms of medical problems (CHESS) (Health stability) • Body Mass Index

19. Prevalence HCQIs • Inadequate meals • Weight loss • Dehydration • No medication review • Difficulty with mobility & no aids • Rehab potential & no treatment • Falls • Social isolation with distress • Delirium • Negative mood • Disruptive pain • Inadequate pain control • Neglect or abuse • Any injuries • No flu vaccination • Hospitalization Quality Indicators assist in assessing service performance • Failure to improve HCQIs • Bladder incontinence • Skin ulcers • ADL impairment • Impaired mobility at home • Cognitive function • Difficulty in communication

20. Improved clinical information • Electronic information sharing • Clinical decision support • Improved reliability & consistency • Reduced paperwork • Caseload profiling • Better information for service planning • Ability to benchmark within and among service providers • Improved productivity • Caseload profiling • Ability to allocate resources among services and clients • Service quality monitoring • Improved productivity Something for everyone… • Clinicians • Service administrators • Planners and policy makers

21. Implementation of an interRAI instrument requires careful planning • The interRAI Home Care is one important building block to improving performance in community care… • Consideration of other aspects of implementation may result in failure • Organisations must consider: • how the instrument will be used; • who will perform assessments; • how often they will be repeated; • what reports are required – when and for whom; • how will training be conducted - for existing and future staff; • which software to use.

22. Success Three building blocks to success…. Clinical datasystems: interRAI HC Work processes Software

23. Training is important… • Good training enables: • A broad understanding of the interRAI approach and vision • Detailed knowledge of item definitions and scoring leading to improved reliability • Interpretation of scales, screeners and quality indicators • Application of Clinical Assessment Protocols for care planning • Use of software applications

24. How training is best delivered… • Small group, interactive format lead by a facilitator with extensive clinical experience • Review of all clinical items aided by the HC manual • Interpretation of scales, Clinical Assessment Protocols and screeners • Software utilisation • Interpretation of reports Training requires approximately 3 days, which may be divided into 2 steps (2 + 1 days)

25. The interRAI HC is a powerful clinical tool that will… • Support clinical evaluation • Enable electronic communication • Reduce duplication and paperwork and… IMPROVE THE QUALITY OF CARE

26. Talking the same language for effective care of older people For more information visit the interRAI websites www.interrai.org (International) www.interrai-au.org (Australia)