A nationally consistent screening and assessment process The national screening and assessment process has three components: Screening conducted by My Aged Care contact centre staff. By asking a broad and shallow set of questions, contact centre staff will be able to facilitate the appropriate client pathway – to home support assessment, comprehensive assessment and/or direct to Home Support Programme services. Home support assessment conducted face-to-face by the RAS. This holistic assessment will determine eligibility for Commonwealth Home Support Programme services and will result in the development of a support plan. This will include the consideration of both formal and informal services that are most appropriate to provide the client with support. Comprehensive assessment conducted face-to-face by Aged Care Assessment Teams (ACATs). This holistic assessment will include the development of a goal-oriented support plan and will determine eligibility for services under the Aged Care Act 1997. This will include the consideration of both formal and informal services that are most appropriate to provide the client with support. Screening and assessment principles The following overarching principles form the basis of conducting screening and assessment using the NSAF. Holistic assessment of client need The screening and assessment process provides the opportunity for contact centre staff and assessors to understand a client’s needs holistically. The NSAF facilitates the collection of information on: The client’s current level of support (formal and informal) and engagement availability and sustainability Health concerns and priorities Functional status Psychosocial and psychological concerns Home and personal safety considerations Decision making capabilities. It also identifies any complexities a client may have that indicate a level of vulnerability. It is important that clients receive an assessment that is relevant to needs and that a client is not under-assessed or over-assessed. While the NSAF provides the ability to collect information on a range of considerations (such as alcohol
as a client’s appearance, change in behaviors, voice, speech, concentration and attention can signal possible declines in a person’s cognitive health. If a person is displaying cognitive decline, this can impact on the client’s ability to undertake all or elements of their everyday activities such as showering, dressing, attending appointments, meal preparation, managing finances. Cognitive issues may be perceived by older people, their families and health professionals as a result of ageing, not as health problems that could respond to treatment. Various cultures view cognitive impairment differently, i.e. with shame or as madness and should be considered when asking about changes in thinking and memory. For example, dementia may be a sensitive issue for Aboriginal people and people from CALD backgrounds, people with dementia may revert to their first language. It is important to help the client maintain their sense of self and include them in decision-making. The following table is a brief overview of elements that distinguish differences between dementia, delirium and depression: Dementia Delirium Depression Onset Insidious (over months); symptoms often fluctuate. Relatively sudden – over to days, symptoms tend to fluctuate. Over days to weeks. Prognosis Not reversible but manageable. Recovery likely with treatment; high mortality if left untreated. Risk of suicide, recovery likely with treatment. Behaviour Social skills may be preserved, withdrawal from social activities as memory deteriorates; may get lost in unfamiliar environments. Disturbed sleep/wake cycle; hyperactive - may be restless, hypoactive - may present as somnolent, withdrawn. Often slowed, occasionally agitated, changes to sleep, energy and appetite. Affect May be normal; may be flat or withdrawn; mildly perplexed. Fluctuating; may be irritable; may be flat, withdrawn. Sad or withdrawn or irritable; depressed, worried; helpless, guilty. Thought Shallow content; may appear to have paranoid ideas due to memory problems. May lack coherence; possible delusions. Slowed or decreased focus on past [guilt]; hypochondria; thoughts of death.
carer does not have the skills or knowledge to care for a dependent person. They may not be aware of the types of support that are available, they may be ill themselves and unable to provide care. Should it becoming or happening more frequently, document the details as provided by the client. Should the client be scared for their safety, document the details as provided by the client. It is important to be as accurate as possible when documenting what the client states about the duration and frequency of the harm caused by the person who hurts, insults, controls or threatens them, or prevents them from doing what they want. Does the client have any legal issues that may affect services (E.g. AVO)? Assessor recorded RAS ACAT This question asks whether the client has any legal issues that may affect services. Should the client have legal issues that may affect services, specify the details as provided by the client. It is important to be as accurate as possible when documenting the legal issues impacting on the client that may affect services. For example, does the client: Have an Apprehended Violence Order (AVO) in place against a family member, friend or person who makes them fear for their safety, or to protect them from further violence, intimidation or harassment. Need help or advice with making a will. Need help or advice with the administration of finances and legal decisions. Need help or advice with Enduring Power of Attorney or Guardianship Issues. Fear for their safety from family, friends or other persons. Comments/Further information All This section allows you to document any additional general comments and information provided by the client that you have been unable to record in the Screening questions. Types of comments or information that could be included here: Prompt the client or carer about the assistance that may be required to maintain safety and wellbeing at home. Information about why you have been unable to determine a response to a question in this section.
What are the client's current areas of difficulty or activities where the client needs support? Assessor recorded Mandatory RAS ACAT This question is identifying any current areas of difficulty or activities where the client needs support. When the client identifies their difficulties and/or supports they become individualised for the client. Choices have been discussed and made unique to their situation. By doing so the client is not a passive recipient of the support but a determinant of it and therefore far more likely to achieve any goals related to the support. How satisfied are you with your current level of independence? Mandatory RAS ACAT This question asks the client how satisfied they are with their current level of independence on a scale from 1 (not at all satisfied) to 5 (very satisfied). This question can start a conversation with the client leading to goal setting. What do you hope will change is you are to receive support? Mandatory RAS ACAT This question asks the client what they hope to change by receiving support. Empower the client to make suggestions and contribute. This provides them with the opportunity to take the lead, set the direction and reinforces your commitment to collaborative planning. How can we best help/support you? Finish this sentence, “If I I would …” What changes do you think would support you to improve your situation? What are you hoping for, when we work together? What would you like to work towards? What do you think are the most important things for us to work on? Does the client have any cultural and/or religious RAS ACAT This question asks the client about their cultural and/or religious values and beliefs that are important to them and could affect services to be provided.
Associated people Item Level Guidance People associated with support plan RAS ACAT This question asks who is involved in the support plan. It is often appropriate to involve not only the client, but their care coordinator, carer, GP, other professionals and/or organisations in the development of the support plan, particularly when the client’s needs are more complex. Identifying and including who is involved in the support plan assists the client to achieve their goals and address their identified needs. Including the people and/or organisations who are involved in the support plan: Assists the client in setting and achieving and enables these to be made known to all involved in the client’s care and service provision Encourages the client to be actively involved Manages long-term service delivery in a concise way Provides an essential checklist to ensure continuity of service delivery Encourages a team approach Increases client and carer awareness of support services available, and how and when to access them Facilitates monitoring of the client’s health and social wellbeing. An assessor can associate such people with the support plan. This can be completed by recording name, relationship to client and contact details. It also requires the assessor to identify whether the person has been involved in the support planning process, and whether they have been provided with a copy of the support plan. An assessor may set a review date of the support plan at the time of the assessment. A review may also be requested by a client or a service provider. It may be completed over-the-phone with the client. A review by an assessor will look at the following aspects: The reason a review has been requested and its impact on the client’s existing assessment information and support plan The appropriateness of the services in meeting the client’s goals
Conclusions: Because the IQCODE provides information complementary to brief cognitive tests, harnessing them together can improve screening accuracy. K10 RAS ACAT The K10 is recommended as a simple measure of psychological distress and as a measure of outcomes following treatment for common mental health disorders. It is a self-report measure to identify need for treatment. The 10 item scale has five response categories and the score is the sum of those responses: None of the time scores 1 A little of the time scores 2 Some of the time scores 3 Most of the time scores 4 All of the time scores 5 Questions 3 and 6 are not asked if the preceding question was ‘none of the time’ in which case questions 3 and 6 would automatically receive a score of one. scores range from 10 (no distress) to 50 (severe distress). People who score 0-15 have one quarter the population risk of meeting criteria for an anxiety or depressive disorder as identified by the CIDI, and a remote chance of reporting a suicidal attempt in their lifetime. People who score 16-30 have a one in four chance (three times the population risk) of having a current anxiety or depressive disorder and 1% chance (three times the population risk) of ever having made a suicide attempt. People who score 30-50 have a three out of four chance (ten times the population risk) of meeting criteria for an anxiety or depressive disorder and 6% chance (20 times the population risk) of ever having made a suicide attempt. The group comprise 78% of the population and are told their score is low and that they probably do not need the self-help information. The second group, 20% of the population, are encouraged to use the information and self-help techniques. The third group, 2% of the population, are strongly encouraged to seek medical help.
Allergies–skin Alzheimer’s disease–see Dementia Amnesia Amputation of to injury or accident Amputation of the toe/ankle/foot/leg—related to injury or accident Anaemia Aneurysms (arterial or aortic)—see also Abdominal aortic aneurysm Anger Angina Anxiety disorders Arterial embolism Arthritis and related disorders—see also Rheumatoid arthritis Arthrosis Asperger’s syndrome Asthma Ataxic gait Atherosclerosis Autism B Back problems Bedsores Behavioural & personality Bell’s palsy Blackouts Blindness—see also Poor vision Blood pressure—abnormal reading without diagnosis Blood pressure—low Blood pressure—high Boil Bowel (colorectal) cancer Bowel incontinence Brain damage—acquired—see Injuries Brain cancer Brain disease/disorders Breast cancer Breast disorders Breathing difficulties/shortness of breath Bronchitis/bronchiolitis—acute Burns C Cardiac arrest Cataracts Cellulitis Cerebral infarction1, 2 Cerebral Cerebrovascular accident—subarachnoid haemorrhage1, 2 Cerebrovascular accident—intracerebral haemorrhage1, 2 Cerebrovascular accident–other intracranial haemorrhage1, 2 Cerebrovascular accident–cerebral infarction1, 2 Cerebrovascular accident–unspecified1, 2 Cholecystitis Cholesterol—high Chromosomal abnormalities—other Chronic obstructive airways disease (COAD) Chronic/postviral fatigue syndrome Cirrhosis of liver COAD
Coeliac disease Cold—common Colitis Colorectal (bowel) cancer Confusion Congenital brain damage/malformation Congestive heart disease Congestive failure Conjunctivitis Constipation Convulsions Cough Cramp Cushing’s syndrome CVA—see Cerebrovascular accident Cystitis D Deafness/hearing loss Deformities of joints/limbs—acquired Deformities of joints/limbs—congenital Delirium—not superimposed on dementia Delirium—superimposed on dementia Delirium—other Delirium—unspecified Dementia—alcoholic Dementia in Alzheimer’s, atypical or mixed type3 Dementia in Alzheimer’s, unspecified3 Dementia in Alzheimer’s with early onset (<65 yrs)3 Dementia in Alzheimer’s with late onset (>65 yrs)3 Dementia in Creutzfeldt-Jakob disease Dementia in HIV disease Dementia in Huntington’s disease Dementia in specified diseases classified elsewhere Dementia in Parkinson’s disease Dementia in Pick’s disease Dementia—mixed cortical & subcortical vascular Dementia—multi-infarct Dementia—other vascular Dementia—subcortical vascular Dementia—unspecified (includes presenile & senile dementia) Dementia—vascular of acute onset Dementia—vascular, unspecified Depression/mood affective disorders Dermatitis Deterioration—general physical Developmental disorders of motor function Developmental disorders of speech & language Developmental learning disorders Diabetes mellitus—Type 1 (IDDM) Diabetes mellitus—Type 2 (NIDDM) Diabetes mellitus–other specified/unspecified/unable to be specified Diarrhoea Diarrhoea & gastroenteritis of presumed infectious origin Dislocation—arm/hand/shoulder—from injury/accident Dislocation—leg/knee/foot/ankle/hip—from injury/ accident Dislocation—unspecified Disorientation Diverticulitis Dizziness
Dorsopathies Down’s syndrome Duodenal ulcer Duodenitis Dysphagia (difficulty in swallowing) Dyspraxia Dystonia E Ear & mastoid process—other diseases of Eating disorders Eczema Emphysema Encephalitis (excl. viral) Enteritis Epilepsy Erythema Excessive eating & thirst F Faecal incontinence Fainting Falls—frequent with unknown aetiology Fatigue Fibrosis of liver Fluid retention n.o.s Fracture at & hand level Fracture of (incl. hip (neck of femur)) Fracture of lower leg & foot Fracture of lumbar spine & pelvis (incl. lumbar vertebra, sacrum, coccyx, sacrum) Fracture of neck (incl. cervical & vertebra) Fracture of rib(s), sternum & thoracic spine (incl. thoracic spine & vertebra) Fracture of shoulder, upper arm & forearm (incl. clavicle, scapula, humerus, radius, ulna) Fracture—unspecified Fractures—multiple Frostbite G Gait and mobility abnormalities Gangrene Gastritis Gastroenteritis & diarrhoea of presumed infectious origin Giddiness Glaucoma Gout H Haemophilia Haemorrhage from respiratory passages Haemorrhoids Headache Head & neck cancer Headache syndromes Head injuries/acquired brain damage—see Injuries Hearing loss Heart attack Hemiplegia Hernia–abdominal (except congenital) High blood pressure High cholesterol HIV/AIDS Hostility Huntington’s disease Hypertension