DR JUDITH DAVEY reflects on the progress that has been made during her time on the interRAI Governance Board. Her original post, which first appeared on the Age Concern website, can be found here.
One of my blogs in May 2016 was entitled “A new tool for assessing need” and talked about interRAI assessments for aged care services which have been recently introduced into New Zealand. This is something of an update, as the 2016-17 interRAI (this is how it is presented) Annual Report has just been published. This combines, for the first time, the Governance Board Annual Report and the National interRAI Data Analysis Annual Reports.
There has certainly been progress in the interRAI sphere. The whole idea of interRAI is gaining acceptance among service providers, health professionals and the public, after some reservations about shifting to a new system, time taken for assessments and potential diversion of nurses’ time away from patient care. Some of these concerns figured in an independent review of the implementation of interRAI in aged residential care, which was published in March 2017. Since then, processes and policies have been “bedded in”, changes have been made in training and record-keeping, and new ways of using interRAI data are being explored. Numerous research projects are under way using this data, hopefully showing how aged care can be improved, once their results are publicised.
New interRAI instruments are being introduced, for example the interRAI palliative care assessment and there is talk of expansion into the mental health area and into ACC’s ambit. There is a question of whether interRAI will retain its current focus on older people as these new instruments can be expanded to cover all age groups. I wonder how Age Concerns would view this.
A lot of effort is going into the handling of data, to make it more accessible and useful. “Data visualisation “is intended to “make data come alive”. This is intended to be interactive and to allow data at national, regional, DHB and population sub-group levels to be extracted (see http://www.interRAI.co.nz/data). This will still need a good level of computer literacy and care in its use as some of the data refers to assessments rather than people (individuals may have more than ONE assessment over the period in question). Also, of the population aged 65 plus, only 13% of women and 8% of men have had assessments. This will all have to be made clear. Most of the people involved are aged 85 plus. Females and people of European descent predominate, but this is in line with the demographic group as a whole.
Working with the Aged Care Association a new workshop for residential care managers and senior nurses, to make interRAI work better has been piloted and will be rolled out in the coming year. It also now possible for all aged residential care facilities to have individualised quarterly reports, which will help improve decision-making and planning, not to mention comparisons and “bench-marking.”
The report contains two case studies, which, for many people, will be more illuminating than graphs and statistics. The first focuses on people with dementia living at home. There are some interesting findings about this group (based on data from 35,500 home care assessments in 2016-17):
17% of home care clients with dementia live independently, without support;
18% have full-time care from family and friends;
33% have daily episodes of troubling behaviour;
35% require extensive assistance or are completely dependent.
And of the people who care for those living with dementia:
44% report feeling distressed or angry because of the demands of care
55% report being overwhelmed by the person’s support needs.
This paints a worrying picture of individuals and families coping with a condition which is predicted to become more common as the population ages.
The second case study reports how a registered nurse in a residential care home is “making the most of interRAI”. Instead of being frustrated that assessments were diverting her from caring responsibilities, the nurse now sees their relevance; allowing her to identify key areas for care planning and monitoring. Nurses can compare the prevalence of various conditions with national averages and with other DHBs. They can track improvement or otherwise on an individual basis over the course of several assessments.
There has certainly been significant growth in the use of interRAI in New Zealand. It is to be hoped that this will continue and that the focus should clearly remain on outcomes, especially for older people, improving their wellbeing and alleviating their health problems – also giving support to informal carers. The interRAI processes must not be ends in themselves. There is a danger that complicated high-tech “solutions” could go this way. I also hope that research based on interRAI data will always have an applied rather than a purely academic focus.
I have been a member of the interRAI Governance Board for over two years, representing the consumers’ point of view, which I have tried to apply whenever I could. My term has now come to an end and I will not be re-appointed. I have learned a lot!