Digital assessment tool for βlife-altering goodβ home care plans
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ΊμΑμ½νΉΟ±¨ PEI implements a new digital assessment tool to provide better home care assessments and care plans for Islanders
ΊμΑμ½νΉΟ±¨
ΊμΑμ½νΉΟ±¨ PEI implements CIHIβs evidence-based interRAI assessment tool to better identify individual needs and provide better assessments and care plans for Islanders.
Customer
ΊμΑμ½νΉΟ±¨product
interRAI Home Care assessment
Background
As Prince Edward Islandβs population ages, it is increasingly important for ΊμΑμ½νΉΟ±¨ PEI to understand the populationβs care needs and to plan for home care services. ΊμΑμ½νΉΟ±¨ PEI recognized this and the limitations of its Seniors Assessment Screening Tool (SAST) β a home-grown tool that has the potential to be subjective and does not provide a scientific and evidence-based assessment to develop a care plan.
To help meet these needs, CIHI, in partnership with interRAI, supported the implementation of the interRAI Home Care (interRAI HC) assessment system as a replacement for SAST.
interRAI is the gold standard for health care assessment internationally. The interRAI HC is a reliable, person-centred assessment that informs and guides comprehensive care and service planning in the home care sector. The tool is widely used around the world and in all provinces in Canada β including, as of 2019, P.E.I.
The challenge
ΊμΑμ½νΉΟ±¨ PEI needed to identify the type of home care services people required while ensuring clientsβ quality of life continued to be supported in a timely, efficient, integrated and user-friendly way.
ΊμΑμ½νΉΟ±¨ PEI also needed an electronic case management solution that could help convert assessment results into personalized, actionable care plans.
ΊμΑμ½νΉΟ±¨
We know that most people would prefer to live at home as they age. In order to do that, people need the right support and the right care plans in their homes. β Andrew MacDougall, Executive Director, Community ΊμΑμ½νΉΟ±¨ and Seniors Care, ΊμΑμ½νΉΟ±¨ PEI
The solution
With support from CIHI, ΊμΑμ½νΉΟ±¨ PEI transitioned from SAST to the interRAI HC and a new cloud-based case management system. The cloud-based platform allows assessors to use smartphones and laptops, so they can be mobile and meet clients where they are located, including in their homes.
ΊμΑμ½νΉΟ±¨
The new evidence-based interRAI assessments will lead to more accurate care planning and they will allow ΊμΑμ½νΉΟ±¨ PEI to better identify individual needs, with the ultimate goal of helping older Islanders stay safely in their own homes longer. β Andrew MacDougall, Executive Director, Community ΊμΑμ½νΉΟ±¨ and Seniors Care, ΊμΑμ½νΉΟ±¨ PEI
The assessment focuses on peopleβs functioning and quality of life, including their needs, strengths and preferences. When used on multiple occasions, it provides the basis for an outcome-based assessment of the personβs response to care or services. The interRAI HC can be used to assess persons with chronic needs for care, as well as those with post-acute care needs.
From the information gathered in the assessment, the system then uses evidence-based algorithms to generate real-time, automated outputs and recommendations (called Clinical Assessment Protocols) that help the care team develop a customized plan for the person based on their individual needs.
The impact
The implementation of the interRAI HC and the new cloud-based case management system resulted in a more efficient use of clinical hours, and it gave clinicians the ability to access and share information about a person β regardless of where they were providing care β in a timely and efficient manner. Additionally, it resulted in comprehensive and robust care planning to determine the necessity of home care services, eligibility for long-term care and supports required for enhanced quality of life.
βLife-altering goodβ decisions: This is the reaction of a person who was initially assessed for placement in long-term care. When the interRAI HC was completed, the care team determined that his needs could be met in his own home.
Impact on clients and staff:
- Consistent communication for the client and the clinician
- Ability to assess clients where they are located and to provide clinicians with real-time feedback for care planning
- Efficient use of clinical hours and ability to share results instantly
- Enhanced assistance and quality of care for clients that focus on a personβs functioning, cognitive and mental health, quality of life, services and clinical management
- Objective assessment of the necessity for long-term care
- Increased safety for clients and staff
- Improved system planning
- Benchmarking capabilities
- Better collaboration within the health care team
Reporting and analytics that use interRAI HC data include information on the volume and type of services being provided to clients, which assists with system planning/allocations and requests for new or further funding.
A need identified and addressed
Implementing the interRAI HC facilitated the conversion of assessment results into client care plans and provided electronic case management, which was previously unavailable.
The successful implementation of the interRAI HC and the enthusiasm for its benefits among clinicians is leading to interest in 2 more assessments in interRAIβs integrated suite to support continuity of care across P.E.I.βs health care system: the interRAI Contact Assessment (CA) and the interRAI Long-Term Care Facilities (LTCF).
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How to cite:
Canadian Institute for ΊμΑμ½νΉΟ±¨ Information. Digital assessment tool for βlife-altering goodβ home care plans. Accessed April 4, 2025.
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