InterRAI stands for “International Resident Assessment Instrument” and is a non-profit organisation in over 35 countries, in which health professionals and researchers collaborate to promote evidence-based practice in health care.1 New Zealand is the first country in the world to implement interRAI tools on a national basis. The use of these tools was made mandatory in the aged care sector – that is, residential and home care – from July 2015.
In his foreword to the first annual report, Professor Paul McDonald, who chairs the interRAI Governance Board, quotes the vision of interRAI – “to ensure the continuous improvement of health outcomes for New Zealanders as they age.” He calls upon providers, professionals and all organisations in the sector to use the information presented. I am a consumer representative on the Governance Board, nominated by Age Concern and reporting to National Office after every meeting. So my blog is a great opportunity to report back to all of you. (Hoping that some of you are still out there!)
The interRAI assessments are done by specially trained nurses, either in people’s homes, in a rest home or in a hospital. Some items are common regardless of location, but others apply to a particular situation. The material can follow people, on an individual basis, across different care settings as their circumstances change, avoiding the need for multiple re-assessments. On the wider scale interRAI data can be used to inform planning and policy in older people’s services.
The rest home evacuations following the February 2011 Canterbury earthquake highlighted the value of interRAI.2 The system had been trialled in Canterbury residential and home care. Older people assessed through the DHB’s NASC (Needs Assessment and Coordination) system had their data put into the interRAI database. This can be accessed throughout the country, so it was invaluable for rest homes receiving older people who had been evacuated. It was also used to identify vulnerable people in the aftermath of the earthquakes.
The scope of the assessment is very wide. It collects information on activities of daily living, home environment, physical and mental health, medication, informal support and social relationships and specific risk factors, such as risks for falls, abuse or neglect. The information will inform decisions about access and type of home care and entry into residential care. People in residential care are expected to have an assessment twice a year unless there is a change in health status.
The Annual Report presents information about older people who have had home care or long term care interRAI assessments. In the 2014-2015 year, 40% of the former were for people over 85 and 55% of the latter. This reflects the fact that the residential care population is older and in need of more support. According to the interRAI data, this group are more likely to have multiple diseases compared to the home care group, in particular dementia and stroke.
More females than males receive interRAI assessments, consistent with the gender imbalance in the older age groups. And females are less likely to be partnered. Older women are more likely to live alone than older men and this may increase their likelihood of being in residential care.
The information from interRAI assessments is brought together in outcome scales and Clinical Assessment Protocols (CAPs). These are used in care planning and can be monitored for change over time – “Scores identify risks and opportunities.” For example, the Cognitive Performance Scale combines information on memory, consciousness and functioning. Only 6% of home care assessments show severe or very severe impairment, as opposed to 21% of long term care assessments. In the Activities of Daily Living Scale, 79% of home care assessments show independence or limited assistance requirements, as opposed to 24% of long term care assessments.
CAPs assess an individual’s needs, strengths and preferences. They indicate areas where there is a need for care and support and can monitor responses to care interventions. For example, the Falls CAP is triggered where a person has a history of falling and a higher risk of falling again. Falls can lead to hip fractures and loss of mobility and independence. This CAP is more often triggered in Home Care assessments, as there is a higher risk of falls in a home environment where people are more mobile.
Requests for interRAI data are coming in from researchers, planners and policy-makers as well as management in the aged care sector. So watch this space for further developments.
1 Information in this blog comes from the National InterRAI Data Analysis Annual Report 2014/2015, which was published in April 2016.
2 As shown in the report to the EQC, Earthquake Preparedness in an Ageing Society, by Judith Davey and Jenny Neale, October 2012.