Identifying Needs of clients entering aged care facilities

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The ‘Identification of Needs’ for residents of Nursing Homes is undertaken on the first or second week of arrival in a facility. The care assessment documents are requisites of the Australia Health Department authorities and fundamental to the development of the Care Plans. Residents are assessed on various aspects of their lives; sleeping patterns, diet, cognitive ability and mobility amongst others. The assessment is a team effort involving RNs, nurses, Diversional Therapists, and other care providers.

Diversional Therapists and recreation staff have the task of assessing the ‘Social and Human Needs’ of residents which includes leisure and recreation.

‘Leisure’ consists of various activities an individual may engage in during his/her free time. ‘Recreation’ is any pursuit engaged in during leisure time that is organised for social purposes.

However the ‘Social and Human Needs’ assessment of residents encompasses much more than just leisure and recreation. Some of the areas the Diversional Therapist must also consider are social needs, emotional needs and physical and spiritual needs.

Identification of Needs: Where to Start?

The identification of needs is usually collected in two documents; the ‘Social Profile’ and the ‘DT Resident Assessment’. (NOTE: sample forms will soon be available from the website). The more elaborate and detailed the information collected, the better. The ‘Social Profile’ is a form that is usually given to the residents to fill in upon admission. If the resident is not able to fill it in, then a relative will do so. Each facility has its own ‘Social Profile’ which may go by a different name in your facility.

The ‘Social Profile’ form should include background information and personal preferences: family dynamics (which relative is closer to the resident), education, country of origin, age, status of war service and relevant details, whether they lead a sedentary life (prefer solitary pursuits) or enjoyed socializing, whether they are currently enrolled in the electoral roll, whether they have any special possessions that could be brought to facility to make their adjustment a little easier, sleeping habits, any cultural date the resident enjoys celebrating etc

The ‘DT Resident Assessment’ endeavours to collect social, emotional and spiritual needs and also all sorts of information that could hinder or enhance recreation and leisure.

Start with the resident:

• Pay the resident a visit to develop rapport and establish trust.
• Observe the resident; their demeanour, how often do they smile? Do they have any concern about staff or another resident? Are they nervous? Do they dislike crowds? Do they need encouragement to attend programmed activities?

Interview family and friends:

• Family can provide information about routines and past and present leisure.
• Friends may shed light on different facets of their personalities.
• Don’t be put off by anecdotal information; it may come in handy when you are reminiscing with the resident.

Other Health care providers and staff:

• AINs, Registered Nurses and other staff may discover important information for the assessment. In fact, any member of staff including office workers and support staff who may have had the opportunity to chat with the resident can add to your collection of data.

Past and present skills and interests
Find out what hobbies they enjoyed, jobs they had and which aspect of the job they liked. We should not assume that just because a lady was a dress-maker she necessarily enjoys needlework. The reality may be that it was financial hardship which compelled her to take up this occupation and she may even resent it.

Religious (and cultural) background
Religion plays a central role in the lives of many older people. Does this person wish to attend Church services? Can you meet this need by providing transport? Find out if you need to engage ministers of religion and/or lay people to make individual visits to residents who are bed ridden or unwilling to attend religious programs. Do they wish to have access to broadcasts or telecasts of religious programs? Have they expressed what sort of religious rites they would like to receive when the time comes?

Their abilities:

1. Physical: mobility, dexterity
2. Sensory: sight, heating, touch, smell, taste.
3. Psychological: attention span.

Family dynamics
What role they played in the family? Mother, father, older sister, bread-winner. Is there any estranged member in the family?

Personality What sort of personality do they have: sensitive, loving, controlling. Sensory loss can affect the personality of certain people. They may become angry and/or aggressive.

Dementia What sort of diagnosis do they have? Alzheimer’s, stroke, neurological disorder? Even mild dementia plays often havoc with a person’s social life and often propels personality change.

Community affiliations Did they belong to clubs, choirs, folk dance groups in the past? Would they like to continue to do so?

Past memories (reminiscing) Are there painful memories you should know about? Sad memories of wars, refugee camps etc. Do they mind talking about their memories in WWII?

Identification of Needs: Assessment is concluded, what do we do with it?

Now that the needs are assessed you have to establish what sort of problems relating to activities this person may have. Various degrees of cognitive function are needed to participate in games, craft, gardening, exercises and all other activities you may have. The same applies for motor function. Some of the areas to consider are:

1. Activity related problems
2. Issues that may encumber participation
3. Emotional components
4. Social interaction

Some activity related needs and problems:

• Assistance necessary
• Skills required
• Strength
• Co-ordination
• Body posture
• Dexterity

You also look into other issues that may encumber their participation in activities such as:

• Money (to go on community outings)
• Poor health(endurance)
• Skills (range of motion)
• Lack of concentration (restlessness)

Emotional components:
Emotional needs, when met in a balanced way are said to have the power to improve mental health. Many of our most basic human emotional needs are expressed as feelings. Despite sharing those feelings, we all differ in the intensity of the need. One may crave security where another craves independence. One may have a longing to be understood and another to be left alone (solitude). That’s why it is imperative that you find out exactly what is the resident’s most neglected emotional need. Does he/she wish to feel?

Social interaction:

• What level of communication is necessary?
• Can the resident follow directions?
• Does the resident interact with his peers?
• How much prompting and encouragement is needed?
• Would this resident prefer passive or active activities?
• Would he/she feel comfortable in a small group setting?

As you ask yourself these questions, you will start to get a mental notion of what is required. You can now consider:

• Setting goals.
• Scrutinizing your ‘Program Planner’ to see if any of the existing activities match the needs of the resident.
• Devising therapeutic interventions specifically designed for this resident (if needed).

Indeed, you are now ready to write your Care Plan. Good luck! Don’t forget to download samples of goals and interventions.

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