While interRAI is still the new, and sometimes unpopular, kid on the block in residential aged care, it is already well established in the DHBs’ Health of Older People community sector. FIONA CASSIE talks to a Nelson gerontology nurse and interRAI lead practitioner GABRIELLE STENT about why she thinks interRAI is worth getting to know.
Gabrielle Stent is not without empathy for her colleagues in residential aged care still coming to grips with the interRAI tool.
But her advice – seven years on since she was trained to use interRAI for Nelson-Marlborough District Health Board’s needs assessment and service coordination (NASC) service – is to persevere, as it’s worth the effort.
“I’ve nursed in rest homes, I’ve worked in doctors’ surgeries, I’ve worked in wards and I’ve worked in NASC,” says Stent. “And from all those points of view, I can see how this tool works. And I think it’s the best tool we’ve had to assess need, as what you have is a tool that strips away personal opinion or personal preference.
“You are getting down to the grass roots functionality of somebody that is indisputable. And the information is transportable to wherever it needs to be to meet the needs of that person.”
Stent first started assessing older people in the community for the DHB’s NASC in 2007. She was trained in 2008 in interRAI leading up to the community version of interRAI becoming, in mid-2012, the national assessment system for whether older people living at home are in need of home-based support or a place in residential aged care.
She was already a convert when, in 2013, she became the DHB’s lead interRAI practitioner. Stent is also the DHB’s systems clinician who prepares the DHB’s quarterly interRAI reports for the South Island’s Health of Older People’s Service Level Alliance (HOPSLA).
The homecare interRAI tool ensures consistent assessment across the whole country, not just the South Island, though there is currently no consistent threshold for what interRAI tool score leads to older people obtaining support – be it with housework or entry to a rest home.
Stent says it is difficult to talk about interRAI’s relation to people’s eligibility for support as interRAI is an “all-encompassing tool” looking at all the areas in which a person functions, including such things as their social need for companionship. “It (interRAI) will trigger and point out to you – in league with your clinical knowledge – that there are aspects here that could improve a person’s quality of life – and they aren’t solely around the provision of housework and showering.”
Also, she adds, nurses around the country still draw on their clinical knowledge base and experience to recognise and make the call when a person is about to ‘tip over’ and require residential care.
Benefits in NASC
One of the huge benefits of introducing interRAI is the ‘readability’ of the standardised, electronic assessment tool between health professionals, not just nurses, says Stent.
For instance, it came into its own during the time Stent spent as a NASC assessor in the acute wards of Nelson Hospital. If an occupational therapist or physiotherapist quizzed her during a discharge meeting about how well an elderly patient had been functioning at home and what home support they were getting “we could go straight onto interRAI”.
“We could look at their last assessment, look at their care plan and we would know whether they had home allied health visits; we would know what their informal supports were; we would know how they were managing their ADL (activities of daily living) before they came in for this latest health event; we could see who their help agency was, and how much support they were getting a week.”
With all that information just a few keystrokes away, the multidisciplinary team had a good base from which to draw up a successful discharge plan.
“That connectivity we never used to have [pre-interRAI].”
Stent has also set up read-only access for emergency department (ED) staff so they can check out the interRAI files of elderly people when they come in – including residents of aged care facilities already using interRAI as their assessment tool.
“In the past, if a person came from a residential facility into ED for some reason the RN on duty at the rest home would have to hurriedly write up a transfer form and photocopy off drug charts and try to get all this information together before the ambulance arrived.”
Secure online access
Now the ED staff can go into interRAI online and everything they need is in front of them on a secure site where access is monitored and audited. Similarly, information can be shared with the homecare agencies contracted by the DHB to support people in their homes.
And if another disaster like the Christchurch quakes ever happened again, information about facility residents and home-based care clients could, if necessary, be accessed from anywhere in the country, including how to contact next-of-kin.
Another advantage of having a standardised tool like interRAI is it triggers trends, for example increased falls risk, for the assessing nurse to follow up on. "You are then charged as a clinician about what you are going to do to support this person with their falls risk." The aim is that the next time the client is assessed, falls don't come up as a trigger because the restorative measures, like providing equipment, have worked.
Having a standardised assessment tool and clinical record also stops duplication of effort. So data gathered by NASC teams for the home care interRAI is available to the rest home the older person goes to and helps populate the interRAI long term care facility (LTCF) assessment carried out by the rest home within 21 days of their arrival. Likewise, if the rest home resident is hospitalised and needs to be reassessed to see whether they are eligible for hospital-level residential aged care.
It is all positive, believes Stent, and yes, she agrees, it does take time to carry out initial assessments but, she adds, nurses do get quicker. This firm believer in interRAI says the rewards are worth the effort.
The Health of Older People's Service Level Alliance (HOPSLA) group recently released its third quarterly report summarising homecare interRAI data on the health of older South Island people across the five DHBs, which between them have around 160,000 residents aged 65 or older.
The homecare interRAI assessment looks at areas such as ability to carry out daily living activities, cognitive performance, wandering and behaviour problems to come up with a MAPLe (Method of Assigning Priority Level) score – the higher the score the higher the priority for starting or increasing home-based care services to try and prevent hospitalisation or admission into residential care.
In the latest quarterly report, around six per cent of the South Island's older adult populations had a homecare or contact interRAI assessment and the percentage of older people scoring a 5 out of 5 MAPle score (the higher the score, the higher the need) ranged from 27.3 per cent in Canterbury to 15.9 in the West Coast.