The Care Path - Assessment
Access to publicly provided or funded social care services requires an 'assessment of need' by social servcies. This is the case for some mainstream services and all specialist services. Some volunary setor services such as those provided by Age Concern, may be accessed without a social services assessment. Self-funders may also be able to buy in care from a private provider. A new or revises assessment of need may be offered at any point on the care pathway beyond primary care.
A primary care worker, usually a GP, may decide to refer a patient with a mental health problem to the local social services department for an 'assessment of need'. An assessment is required to evaluate whether a user meets the department's eligibility criteria for a range of social care services.
This process is called the ‘Single Assessment Process’ (SAP for short). It aims to be interprofessional (refers to different health and social care professionals workign together.) make sure older people's care needs are assessed thoroughly and accurately, but without procedures being needlessly duplicated. It identifies needs and explores the most effective package of services to met these.
More information
The National Health Service Plan 2000 (Department of Health, 2001a) and the National Service Framework for Older People (Department of Health, 2001) introduced the Single Assessment Process. It aims to ensure that older people receive appropriate, effective and timely responses to their health and social care needs, and that professional resources are used efficiently avoiding duplication. It is also regarded as a mechanism which health and social care agencies and professionals in a single area ‘sign up to’, ensuring that care and assessment systems are aligned and assessment and care planning are person-centred and coordinated.
The Care Path - Assessment
There are four types of SAP depending on level and type of need.
A ‘Common Assessment Framework’ is currently being developed which builds on the SAP. Work to develop this includes a commitment to allow people to self-assess wherever possible. For more information look at the Care Services Improvement Partnership website.
-
Contact Assessment: This level of assessment refers to contact between an older person and health and social services where significant needs are first described or suspected. At contact assessment basic personal information is collected, the nature of the presenting problem is established and the potential presence of wider health and social care needs is explored. The usual domains, or areas, that a contact assessment includes are (box which appears when moused over) – the nature of the presenting need, the significance of the need for the older person, the length of time the need has existed, potential solutions identified by the older person, other needs, recent life events or changes relevant to the problems, the perceptions of relatives/carers. The first time a person with moderate dementia starts to wander or cause concern to their relatives may be the point at which a contact assessment is conducted.
-
An overview assessment is conducted if, in the judgement of the assessing professional, the individual’s needs are such that a more rounded assessment should be undertaken. Sometimes validated scales or tools are part of the assessment. These assess aspects of function such as, physical activity levels, quality of life or the existence of cognitive decline or depression. An overview assessment may be appropriate for a person with dementia who lives with a carer who also has health problems.
-
Specialist assessments offer a way of exploring specific needs, often in detail, and may be indicated by a contact or overview assessment. As a result of a specialist assessment, professionals should be able to confirm the presence, extent, cause and likely development of a health condition or problem or social care need and establish links to other conditions, problems and needs. A specialist assessment by an occupational therapist may be called for when an older person with a long-term mental health need has mobility problems and difficulties performing activities of daily living such as dressing or bathing.
-
A comprehensive assessment will be needed in a circumstances where the user is likely to need support from more than one agency or service for a lengthy period of time, his/her needs are complex, their needs span a number of professional groups, and/or the user has intensive needs. Usually comprehensive assessments contain a number of specialist assessments such as those conducted by an old age psychiatrist, an occupational therapist, and a psychiatric social worker.
A ‘Common Assessment Framework’ is currently being developed which builds on the SAP. Work to develop this includes a commitment to allow people to self-assess wherever possible.
For more information look at the Care Services Improvement Partnership website:
The Care Path - Assessment
The SAP is part of a wider process called ‘Care Management’. This is a framework which facilitates the arrangement and management of services for vulnerable adults.
In addition to assessment it also includes the stages of: deciding what help should be offered and what services a person is eligible for; care planning; and reviewing the care package.
A care manager’ role is to ensure that:
- there is coordinated delivery of health and social care services including:
- a combined care plan agreed by health and social care services that takes account of the changing needs of the older person and their carers.
- named health and social care staff to operate the care plan.
- formal reviews of the plan.
- Care plans are based on the older person’s:
- life history, social and family circumstances and preferences.
- physical and mental health needs and current level of functioning.
People with ‘severe and enduring mental health problems’ are subject to a framework called the Care Programme Approach (CPA). This aims to provide a framework for the delivery of effective care (Department of Health, 2004). The specialist SAP - as part of Care Management - plus parts of CPA are applied to older people with long term mental health problems.
(CPA was implemented at the same time as Care Management with the specific aim of providing a framework for the delivery of effective care for adults with mental health problems. Although not primarily associated with older people, the CPA is relevant because one of the criteria for inclusion is a history of self-neglect, which is often a feature of distress amongst older people with severe mental health problems. It is expected that the SAP will work in an integrated way with the requirements of the CPA and that the SAP plus critical aspects of CPA will be applied to older people with severe functional or organic mental health problems.)
Specialist care management for people with dementia is evidenced as resulting in more positive outcomes for the person with dementia and their carer and as extending community based living (Dementia UK, 2007).
It is particularly important when a user has complex and multiple needs to have a named care manager or key worker to coordinate services and to have regular reviews of care packages to ensure that as needs change, services do too!
The interface between primary health care and old age psychiatry servcies continues to be clouded by the lack of generally agreed criteria for referral.
This has resulted in limited clarity about what can, and should be, done by and in primary care and what is required from, and is the responsibility of, both mainstream services and specialist psychiatric care (Alzheimer's Society, 2007).
Considerable local variations thus exist about who is referred from primary and mainstream care to specialist care, and when. This causes confusion and concern for users and carers.