This manual provides information to facilitate an accurate and uniform assessment of persons served by community-based programs — home care, board and care, assisted living, etc.
Use of the interRAI HC. The interRAI HC is a standardized, minimal assessment and screening tool designed for clinical use. It is not a questionnaire for analyzing the characteristics of a population, nor does it include all of the information that might be necessary to construct a comprehensive plan of care. Supplemental information, relevant to the person, should be assessed and incorporated as necessary. The items in the interRAI HC measure a person’s objective performance and capacity in a variety of areas, with the majority of items serving as triggers for specific CAPs.
Key points regarding completion of the interRAI HC assessment follow:
The interRAI HC is designed for use by clinical professionals (e.g., nurses, social workers, physicians, therapists, etc.). However, individuals without a clinical background can generally perform an accurate assessment with appropriate training. While there are no requirements regarding who performs the assessment, the provider agency is responsible for implementing a quality assurance system to ensure the accuracy of assessments.
The interRAI HC Assessment form consists of items and definitions. It should be used as a guide to structure a clinical and social assessment in planning for community-based care and services.
The assessment process requires communication with the person and primary caregiver/family member (if available), observation of the person in the home environment, and review of secondary documents when available. Where possible, the person is the primary source of information.
Items on the interRAI HC flow in a reasonable sequence and can be completed in the order in which they appear on the assessment form. However, the assessor is not bound by this sequence of items. Items may be reviewed in any sequence that works for the assessor and the person. Note — See “Process for Initiating the interRAI HC Assessment” below for additional ideas on how to sequence the assessment.
Sometimes the assessor must reconcile multiple sources of information yielding seemingly inconsistent results (e.g., the person may report something that is very different from the daughter’s response). In this case, the assessor must use his or her clinical judgment to determine the most appropriate response for the particular item(s).
Assessors should talk in private with each informant, if possible.
The assessment should be performed in the person’s home whenever possible. Parts of the assessment can be completed in settings other than the person’s home (e.g., a hospital, day care center, outpatient clinic) with no loss in information quality. However, certain critical items (e.g., environmental factors) can best be assessed in the home.
The initial interRAI HC assessment should be completed when the person is first referred for service by an agency. Subsequent assessments should be completed according to the schedule prescribed by the adopting agency.
Introducing the person to the interRAI HC process
In introducing the HC assessment to a person you will normally be dealing with someone who has applied for or is eligible for a home-based program of care. You should emphasize the assessment is an integral part of the overall service program. If service options are limited, be realistic in channeling the conversation.
Address the person directly whenever possible. The word "person" is used throughout the interRAI HC Assessment form to provide a standard reference throughout. However, you can substitute words such as “older adult”, “patient” or “client” when talking to others. You could also use phrases such as “Mrs. X” or “your mother.”
Basic Principles of the interRAI HC Assessment Process
You are a guest in the person’s home.
Your purpose is to complete a comprehensive assessment of the person with the goal of:
Maximizing the individual’s functional capacity and quality of life;
Addressing health problems, and
Ensuring that the individual remains in his or her home as long as possible.
To do this requires:
Identifying the purpose of your visit.
Identifying functional, medical, and social issues that presently are limiting or which likely will become limiting.
Identifying the person’s strengths and assets.
Integrating what you see and hear in order to accurately code each of the interRAI HC items.
Information collected using the interRAI HC:
Provides a basis for further education of unrecognized or unmet needs.
Development of a care plan which assures that each limiting or potentially limiting factor is both viewed in the context of the life circumstances unique to that particular individual and managed so as to maximize that person’s quality of life and function.
Do not expect that all functional, medical and social matters that you identify will be fully and comprehensively addressed during your initial visit. Rather, it is more important that all major functional, medical, and social circumstances that limit the individual’s quality of life be identified in order to develop a plan for further evaluation or management.
Any acute medical matter should be brought to the attention of the person immediately and the person should be vigorously counseled to seek appropriate medical care, whether or not that can be provided in the home setting.
If there is evidence of abuse or neglect, referral to an appropriate agency/authority and immediate intervention may be warranted, in accordance with the laws of your local jurisdiction.
Process for Initiating the interRAI HC Assessment
You can begin the assessment process with a series of optional “icebreaker” questions that will serve to begin a dialogue with the person and family, and may begin to elicit much of the information required to complete the assessment.
Icebreaker Questions (not on the assessment form — can vary by country/local custom or depending on whether this is an initial or follow-up assessment)
How are you (is the person) doing? How do you (does he or she) get around in the house?
How do you (does the person) perceive your (his/her) present health as compared to a year ago (or when last seen)?
Do you (does the person) feel well enough to do what you (he/she) want to do?
Can you (the person) do the things that you (he/she) wants to do? What type of assistance or services do you need?
Structuring the Order of the Assessment
When conducting an assessment in a person’s home, the assessor needs to consider the order in which the items in the assessment will be addressed. It is generally helpful to assess the person’s cognitive status and ability to communicate early on, so that you can gauge the reliability of the information you are gathering from the person. There is also a need to be sensitive to the person’s reaction to the assessment process and particular issues. There is no one right order in which the sections of the interRAI HC should be addressed. Take your follow-up cues from the person’s responses to the “icebreaker” questions for prioritizing areas for assessment. Remember, this is not a questionnaire — the person’s needs should set the pace and priorities for the assessment process, although you must gather all the information necessary to complete the interRAI HC. More than one interview with the person or follow-up contacts with family members, other caregivers, or the person’s physician may be necessary.
How to use this manual. Use this manual alongside the interRAI HC form, keeping the form in front of you at all times. The interRAI HC form itself contains a wealth of information. Learn to rely on it until you internalize the item definitions and procedural instructions necessary for accurate assessment. The amplifying information in this manual should be reviewed in total prior to completing your first interRAI HC assessment. Then keep the manual handy so that you can continue to refer to it as questions arise during the completion of subsequent assessments. The initial time investment in this multi-step review process will have a major payback.
The chart that follows summarizes the recommended approach to assist you in becoming familiar with the interRAI HC.
Approach for Becoming Familiar with the interRAI HC
(A) First, review the interRAI HC form itself.
Notice how sections are organized and where information is to be recorded.
If you previously worked with Version 2 or earlier versions of the MDS HC, begin by reviewing the form for changes in codes and new items.
Work through one section at a time. Examine item definitions and response categories. Review procedural instructions, timeframes, and general coding conventions.
Are the item definitions and instructions clear? Do they differ from your agency’s current practice? What areas require further clarification?
(B) Complete an interRAI HC assessment for a person in your program.
Draw only on your existing knowledge of this individual. Enter the appropriate codes on the interRAI HC form.
Note where your assessment could benefit from additional information. Where might you secure specific information? Asking the person? Talking with the family?
(C) Complete an initial pass through — interRAI HC Item-by-Item Definitions.
Included are:
The intent of items included on the interRAI HC;
Supplemental definitions and instructions for completing interRAI HC items;
Reminders of which interRAI HC items refer to a time frame for observing the person other than the standard 3-day observation period generally used throughout the assessment instrument; and
Sources of information to be consulted for specific items.
As you read the item definitions, review questions that arose as you used the interRAI HC for the first time to assess a person. Note sections of this manual that help to clarify coding and procedural questions you may have had.
Read the instructions that apply to each section of the interRAI HC. Make sure you understand the information before going on to another section. Review the test case you completed. Would you still code it the same? It will take time to go through all this material. Do not rush. Work through the interRAI HC one section at a time to make sure that you thoroughly understand the definitions and instructions.
Are you surprised by any of the interRAI HC item definitions, instructions, or case examples? For example, do you understand how to code ADLs? Or Mood?
Do any definitions or instructions differ from what you thought you learned when you first reviewed the interRAI HC form? Would you now complete your initial case differently?
Do any item definitions or instructions differ from current practice patterns or terminology used in your agency?
Make notations next to any section(s) you have questions about. Be prepared to discuss these issues during any formal training program you attend.
(D) Future use of information in this manual:
Keep this manual at hand during the assessment process.
Where necessary, review the intent of each item in question.
This manual will serve as a reference as long as you are using the interRAI HC Assessment form. Use it on an ongoing basis to increase the accuracy of your assessments.