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Identifying Needs of Clients entering Long Term Care

Identifying Needs of Clients entering Long Term Care




Learn how to identify the needs of clients entering nursing homes. This article contains detailed instructions on how to conduct a resident assessment which can then be used to create a care plan.
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An Identification of Needs process should be undertaken within the first few weeks of a new client arriving at a nursing home facility.

Clients should be assessed on various aspects of their lives; sleeping patterns, diet, cognitive ability and mobility among other things.

The assessment is a team effort involving RNs, Leisure & Lifestyle staff, and other care providers.

The Role of Recreation Staff in Client Assessment

Recreation staff have the task of assessing the Social and Human Needs of clients which includes leisure and recreation.

Leisure defines 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 Recreation 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 Resident Assessment. The more elaborate and detailed the information collected, the better.

Identifying Needs: The Social Profile

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 at your facility.

Related: Social & Cultural Form Template

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

Identifying Needs: The Resident Assessment

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

Related: Client Assessment: Getting to Know your Client

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?

Related: 10 Spiritual Activities for People piving with Alzheimer's Disease

Their Abilities:

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

Family dynamics

  • What role did they have in their family? Mother, father, older sister, bread-winner etc.
  • Are there any estranged family members?

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? For example Alzheimer’s, stroke, or a 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 any 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?

Assessment is concluded, what's next?

Now that the needs are assessed you can 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 any other activities you may have. The same applies for motor function. Areas to consider:

Activity related needs and problems:

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

Issues that may encumber participation:

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

Related: How to Motivate Residents in Long Term Care

Emotional components

Emotional needs, when met in a balanced way 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...

Reassured respected accepted safe
Secure understood successful supported
Clear headed (not confused) appreciated in control
Challenged productive loved proud

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?

Finalising the Idenfication of Needs Process

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

  • Defining Goals & Interventions
  • 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 necessary).

You are now ready to write your Care Plan. Good luck!

Related: How to Write a Care Plan


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Comments

Nuhan 15th Aug 2013
I'm doing diploma in community services and require to conduct complex assessment and referral found your web insightful thanku
cindy lusted 20th Jun 2013
excellent website going for an interview
Linda 26th Oct 2012
Hi
Bianca's assessment of ACFI's effect on Lifestyle is accurate. As it is secondary to all nursing requirements, hard to assess & 1:1 care is not a financially viable option.
Nikki 30th Sep 2012
I am doing Cert IV in Kinesiology and this requires information on Complex Client Needs. This website is most helpful. Thanks!
Maria 22nd Sep 2012
Great source to use on my level VII leisure & health & apply in the Facility I work.
Thank you
Bianca 9th May 2012
Whilst we have comprehensive tools to evaluate and to asses Residents needs in aged care, the question has to be posed can we meet these needs? We collate, observe, document and communicate to gather information about residents’ likes, dislikes, capabilities, deficits, diagnosis, and personal history and personality characteristics. Hancock, G. A. et al (2006) conducted a study where the goal was to quantify the unmet needs of residents with dementia in an aged care setting and the characteristics linked with high levels of needs. Needs were identified using the Camberwell Assessment of Needs for the Elderly (CANE). The study concluded that whilst physical and environmental needs were satisfactorily addressed, social & emotional needs were consistently unmet. Due to these unmet needs there were clear escalations of psychological disorders.

Meaney, A. M et al (2005) conducted a similar study in a community setting and concluded that similar outcomes were experienced in community dwelling Elderly with dementia, the study was able to identify, using The Care Needs Assessment Pack for Dementia (CareNap-D) that there were also elevated levels of unmet need. It was concluded that these elevated levels impacted on behaviour and mental state (84% of those experienced agitation) and on social interaction and access.

We hear the term person centered care constantly bandied around in our industry. According to Dawn Brooker (2003) this term is predominantly used in the context of outcomes for residents with dementia. What lies behind this terminology in terms of practical application, may be disputed as being unrealistic and at best marginally achievable to address these key issues of unmet social emotional needs in aged care.

With the introduction of ACFI (Aged Care Funding Instrument) Diversional therapy was removed as a means of generating funding, as ACFI is designed to ‘focus on the core measurable needs and to allocate funding to services on this basis’. Though ACFI also states that according to the Accreditation Standards under the Aged care Act (1997) the Aged care standards and accreditation agency will continue to monitor aged care homes to ensure that the expected outcomes under the Accreditation standards are met. In that case why was there not more importance placed on including Diversional Therapy as part of a multi disciplinary approach to funding in Aged care? As it stands at this time our departments (Diversional Therapy) do not generate funding and are therefore not regarded as a priority when funding is provided for staffing levels. These key issues highlights the importance of developing a funding tool on the basis of the actual needs identified.

Online resources:

The ACFI and Allied health professionals.

Australian Government Department of Health and Ageing

Camberwell Assessment of Need for the Elderly (CANE)

References:

Hancock, G. A., Woods, B., Challis, D. and Orrell, M. (2006), ‘The needs of older people with dementia in residential care’. Int. J. Geriat. Psychiatry, 21: 43–49. doi: 10.1002/gps.1421 viewed: 4th of May 2012

Meaney, A. M., Croke, M. and Kirby, M. (2005), Needs assessment in dementia. Int. J. Geriat. Psychiatry, 20: 322–329. doi: 10.1002/gps.1284 viewed: 4th of May 2012

Dawn Brooker (2003). What is person-centred care in dementia?. Reviews in Clinical Gerontology, 13 , pp 215-222 doi:10.1017/S095925980400108X viewed: 4th of May 2012rn - Hancock, G. A., Woods, B., Challis, D. and Orrell, M. (2006), ‘The needs of older people with dementia in residential care’. Int. J. Geriat. Psychiatry, 21: 43–49. doi: 10.1002/gps.1421 viewed: 4th of May 2012rnrnMeaney, A. M., Croke, M. and Kirby, M. (2005), Needs assessment in dementia. Int. J. Geriat. Psychiatry, 20: 322–329. doi: 10.1002/gps.1284 viewed: 4th of May 2012rnrnrnDawn Brooker (2003). What is person-centred care in dementia?. Reviews in Clinical Gerontology, 13 , pp 215-222 doi:10.1017/S095925980400108X viewed: 4th of May 2012rn
Solange 9th May 2012
Hi Bianca, Thank you for the feedback. The term 'person centered' tends to be overused without the support needed to carry it out. This is especially true for leisure staff who try their hardest to care for the spiritual and emotional needs of the residents as well as the social needs. Residents considered 'high care' for instance, unable to follow or participate in the 'Monthly Leisure Program' fair poorly, despite extensive assessment of needs. Their needs require 'one-on-one' attention from staff which is often not catered for by management.
cristina lladoc 20th Nov 2011
I am doing Cert. 3 in Aged Care and have found helpful tips from your site. Thank you very much.
Karen 21st Mar 2011
Thanks, this information is extremely helpful. This website is such a gift to us all.

With gratitude
Karen Moren :)
neeru 8th Oct 2010
I am doing cert 4 in Ageing & Disability and really thankfull for information I got clearly from your sight
Donna 19th Aug 2010
Am doing cert III aged care and have found the information on your page very useful THANKS!!!
Jude 22nd Jun 2010
Thanks for the info on assessment on clients needs when entering an aged care facility. Would you have a template of an assessment form I could use. Thanks
Christine 28th Jan 2010
I am so pleased to have found your website and the information here. Thank you.
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