Rethinking Needs Assessment in Planning Services for Older Adults

ABSTRACT

Needs assessments are widely used in the field of aging, and are considered valuable tools for planning service responses to unmet and undermet needs of older adults. This article describes a comprehensive needs assessment of Bermuda's older population and presents some of its findings to illustrate concerns about needs assessments that emerged from this experience. We suggest that even when needs assessments are carefully planned and adhere to generally recognized best practice principles, they may not be able to fully provide desired information. A revision of key assumptions about needs assessment is offered for researchers, planners, and community workers.     

老年健康照顾需求评估与个案管理——基于昆明市实证调查

随着社会经济的发展和医疗卫生条件的改善,高龄化及慢性病的快速增长,老年多元照顾的需求使“个案管理”成为中国社会工作急需解决的课题。本文在对昆明市独居、丧偶、空巢及高血压老人做健康照顾需求评估的基础上,就“个案管理”的制度建设及运作,提出“政府主导、NGO（NPO）资源整合、强化老人（家庭、社区）支援”的建议。     

Settling In and Moving On: Transience and Older People in Care Homes

This paper reports on a study which examined the experiences of 46 older people who moved into nursing and residential care homes, interviewing them at four points, from before the move to up to six months afterwards. A key finding was that older people were actively involved in the process of settling into homes and forming new friendships. Participant data also indicated that these older people had often experienced many moves in recent years, as their need for care had changed, and following them through after their inclusion in the study indicated that, for some, there were more moves to come. These data place the debates about assessment, and the identified problem of "misplacement" in a different light. The problem is not simply one of improving assessment techniques so that needs and provision can be matched more accurately, but it may mean accepting that the needs of older people are likely to change over time. The question then is whether we can develop services and forms of provision which ensure that care moves to older people, rather than older people having to move to care.     

Assessment of the developmental needs of children in need: Estonian child protective workers' case reflections

Child protective workers must be able to evaluate children's developmental needs in order to assess problems and delays. Skilful and comprehensive assessment leads to outcomes for children that promote their well‐being and development. This paper presents the findings of a qualitative study on a sample of Estonian child protective workers that investigated their assessments of the developmental needs of children in cases with child protection concerns. Only half of the child protective workers considered some dimension of the child's developmental needs in their assessment, suggesting a profound need to incorporate a developmental assessment framework and implement training of such in Estonia to increase child protective workers' competencies to conduct consistently comprehensive assessments.     

The experience of older people of entering into the phase of asking for public home help – a qualitative study

The aim of this qualitative study was to explore older persons' (n = 28, 75–96 years of age) experience of becoming in need of public home help, their experience of participation and of having influence on the needs assessment procedure and the decisions made about public home help. A content analysis revealed a broad overarching category, labelled: experiencing discontinuity in life as a whole – the countdown has begun . In addition, four principal categories emerged from the data: comparing the past with the present and losing parts of oneself and connectedness; worrying about the losses and what they will bring about; struggling against losing abilities to avoid dependency and home help; and struggling with conflicting feelings about being/becoming in need of help, and from whom. That older people can so perceive their life situation needs to be recognised if they are to be empowered to become involved in and exert influence on the assessment process and its outcome as well as on their life situation as a whole.     

Implications of Male and Female Same-Gender Dyads

ABSTRACT

A sample of 222 Swedish social services officers were surveyed in regard to their opinions on a fictitious case addressing the needs of a same-gender client. The 49-question survey was statistically analyzed through a comparison of female and male same-gender dyads. The findings suggest that gender is an important factor in assessment, and this seems to be influenced by the gender of the client, the gender of the assessor, and how the problem area or situation of the client is “gendered.” Also, same-gender dyads tend to strengthen stereotypical expectations of men and women as clients and influence what forms of assistance are offered to the client. The male same-gender dyad tends to reduce the likelihood of assistance being offered, while the female same-gender dyad increased it. These results suggest that assessments are based upon stereotypical beliefs about men and women rather than being focused directly on individual differences and needs. Further research is recommended that incorporates a number of more refined “gendered” problem areas and situations and how these assessments can affect social work practice.     

Giving Courts the Information Necessary to Implement Limited Guardianships: Are We There Yet?

A retrospective analysis of written court records and audiotapes of court testimony for adult guardianship cases in 2 Kentucky counties was conducted. Two hundred forty clinical assessments were reviewed for 80 court petitions. The purpose of this research was to learn how interdisciplinary assessment teams contributed to the guardianship process for older adults. Guardianship assessments and court testimony were reviewed to explore the comprehensiveness of reports to the court, the consideration of less restrictive alternatives, and the use of limited guardianships. Recommendations are given for ways in which social workers can improve information given to the courts and advocate for elders in this situation. The role of social work in this national phenomenon is discussed.     

Giving courts the information necessary to implement limited guardianships: are we there yet?

A retrospective analysis of written court records and audiotapes of court testimony for adult guardianship cases in 2 Kentucky counties was conducted. Two hundred forty clinical assessments were reviewed for 80 court petitions. The purpose of this research was to learn how interdisciplinary assessment teams contributed to the guardianship process for older adults. Guardianship assessments and court testimony were reviewed to explore the comprehensiveness of reports to the court, the consideration of less restrictive alternatives, and the use of limited guardianships. Recommendations are given for ways in which social workers can improve information given to the courts and advocate for elders in this situation. The role of social work in this national phenomenon is discussed.     

Role of Expertise,Consensus, and Informational Valence in Children's Performance Judgments

Two experiments examined the role of expertise, consensus, and informational valence on children's acceptance of informant testimony about the quality of work produced by a target child. In Experiment 1, 96 4‐ to 5.9‐year‐olds and 6‐ to 8‐year‐olds were told about an expert who gave a positive or negative assessment of art or music that was contradicted by one layperson or a consensus of three laypersons. Generally, participants endorsed positive assessments as correct irrespective of expertise and consensus, but older children were more likely than younger children to want to learn from the expert in the future. To examine whether reluctance to accept expertise was due to the negative quality of the information, the expert in Experiment 2 simply stated that additional work was needed. Both age groups selected the expert as correct and reported wanting to learn from the expert in the future. Contributions to social learning models are discussed.     

In their Own Right: Translating the Policy of Carer Assessment into Practice

Successive legislation has underscored the importance of assessmentsthat are sensitive to the needs of carers and take into accounttheir ability and willingness to continue caring. This papersynthesizes qualitative and quantitative findings from a continuingprogramme of carer-related research that began in 1993 and hascontinued in parallel with legislative changes. It considersthe process and characteristics of carer assessment from theperspectives of carers for individuals with a range of healthand social care needs, and practitioners. This paper exploresthe assessment of carer need over time and highlights the considerableand enduring gap between policy and practice. It considers practitioners’reluctance to offer separate carer assessments, identifies confusionrelating to the interpretation of eligibility criteria and documentsthe limited contribution of health service staff. The need foran evidence-based framework for good practice, that distinguishesbetween carer needs, service provision and carer outcomes, ishighlighted. The paper concludes by identifying key changesthat are necessary to promote future good practice, such asstaff training and information strategies and the need for practitionersto engage with carers as partners in the care process.     

Creating Supportive Environments for LGBT Older Adults: An Efficacy Evaluation of Staff Training in a Senior Living Facility

ABSTRACT

Supportive housing later in life tends to be a key concern for lesbian, gay, bisexual, and transgender (LGBT) elders. Most senior care providers are un(der)prepared to meet the needs of older LGBT adults. This study evaluated the efficacy of a 4 hours, face-to-face, research-based, LGBT-diversity training designed to improve senior housing facility staff’s cultural competency regarding the needs of LGBT elders. Findings from this study found a significant increase in LGBT content knowledge between pre- and post-intervention assessments and a significant decrease in perceived preparedness when working with LGBT elders. These effects remained significant after controlling for staff designation, religion, educational attainment, and training session. Findings suggest that staff’s cultural competence affected their perceived readiness to address LGBT elders’ needs. Implications are related to the concept of cultural humility or the lifelong process of understanding others’ experiences based on the recognition of lack of un(der)preparedness to create a culturally supportive residential environment.     

Managing the Care Home Closure Process: Care Managers' Experiences and Views

This paper reports case study research that set out to identifywhat care managers do during independent care home closures.Little research has focused on the way in which care homes forolder people are closed in England, or what those involved thinkabout the process. This paper reports the activities and viewsof care managers directly involved in helping older people relocatefrom care homes that were closed by their owners. During suchclosures, residents and their families have no choice but tomove, usually to a deadline, and with little control over theprocess. Care managers have a responsibility to help arrangealternative care for those current residents who are publiclyfunded, and to offer information and support to those fundingtheir own care (the ‘self-funded’). Closure relatedactivities could involve considerable staff time. Care managementarrangements, including the organization of teams and provisionof needs assessments, varied across authorities. The care managersdescribed drawing on emotional counselling and inter-personalskills, as well as practitioner knowledge and experience, particularlywhen offering support and advice about finding appropriate newhomes. Tensions between aims, constraints on their actions andviews of good practice are identified.     

Increasing aging and advocacy competency: the intergenerational advocacy pilot project

The Council on Social Work Education's (CSWE) Strengthening Aging and Gerontology Education for Social Work (SAGE-SW) project, funded by the John A. Hartford Foundation partnered with the National Committee to Preserve Social Security and Medicare (NCPSSM) to develop an Intergenerational Policy and Advocacy Project (IAP). This curriculum pilot project, based on a community organization model, was conducted with 13 baccalaureate social work (BSW) and master's social work (MSW) programs across the country and 122 students. The project was one method to pursue CSWE SAGE-SW's efforts to infuse aging content into social work foundation curricula, to support intergenerational teaching, to strengthen social work advocacy skills, and to provide social work students with positive experiences working with older adults. Pilot sites were asked to carry out the project as part of an existing course foundation or field practicum course. Project activities included collaboration with a variety of community agencies, holding issues or "town hall" forums in order to educate community members about critical policy issues affecting older adults; making contacts and establishing relationships with local, state and/or federal legislators; and conducting assessments of the service needs of older adults in the students' communities. Questionnaires, feedback, pre-post evaluations as well as brief accounts of each project are presented. Participants considered the IAP to be a successful project in terms of the objectives of increasing awareness and competency among social work students of aging issues and of promoting intergenerational linkages between older people and social work students.     

The assessment relationship: interactions between social workers and parents in child protection assessments

Summary This paper is concerned with a relatively unresearched areaof child protection practice: the comprehensive assessment.The study comprises qualitative research of social workers conductingthese assessments. Sixteen assessments are analysed in detail.It is noted that these assessments, like many other in-depthsocial work assessments, are mainly based on verbal interactions.Some of the core evidence cited by social workers as formingthe basis of their assessment decisions is based on verbal interactionbetween social workers and parents. Such verbal interactionsare viewed as being inextricably intertwined with the socialworker-client relationship. A particular aspect of the relationship,the ability to agree a plausible explanation for the familysituation, is highlighted as particularly important in determiningthe outcome of the assessment. The possible implications ofthese findings for assessment practices are outlined.     

Social work knowledge of community-based services for older adults: an educational model for social work students

Social workers are often the key link between older adults, their families and community-based services. Thus, knowledge about older adults and community-based care is imperative for social work practice. Evaluation data are provided on a national multisite effort (N = 353) from 35 schools to assure graduate social work student's competency related to community services for older adults. Results suggest that the educational model as described in this article sets forth positive outcomes in the education of aging savvy social workers. Ongoing social work education is needed to meet the burgeoning needs of the geriatric population.     

Social Work Knowledge of Community-Based Services for Older Adults: An Educational Model for Social Work Students

Social workers are often the key link between older adults, their families and community-based services. Thus, knowledge about older adults and community-based care is imperative for social work practice. Evaluation data are provided on a national multisite effort (N = 353) from 35 schools to assure graduate social work student's competency related to community services for older adults. Results suggest that the educational model as described in this article sets forth positive outcomes in the education of aging savvy social workers. Ongoing social work education is needed to meet the burgeoning needs of the geriatric population.     

Unmet home care service needs of rural older adults with Alzheimer's disease: a perspective of informal caregivers

This study assessed unmet service needs of rural older adults with Alzheimer's disease (AD) and identified factors that were related to these needs. Data were collected from 109 informal caregivers of AD patients. Over half of the patients experienced unmet service needs in 1 or more areas of activities of daily functioning. Informal caregiver burden and patient's gender and functional status were significantly related to patients' unmet service needs. Patients' use of formal services was marginally related to their unmet service needs. To better address patients' service needs, a comprehensive needs assessment should be conducted with both patients and their caregivers.     

Prioritising care services: Do the oldest users lose out?

Population ageing is a major concern in most European countries. Demands for health‐ and care services will increase, as older people typically have a higher need for such services. What is often overlooked, however, is that older users increasingly compete with younger users for the same limited care resources. We ask: How do employees in the Norwegian care sector make decisions regarding the allocation of services to younger and older users? To answer this question, we interviewed decision‐makers in Norwegian municipalities. Despite providing for equal rights to services, laws allow for an interpretation of needs and this can result in the unequal distribution of services. Our study indicates that needs are defined differently for younger and older users, which affects the amount, type and content of the services allocated to younger and older people. When resources are scarce and priorities must be established, the services to the oldest suffer. Key Practitioner Message: ● The article lays the groundwork for an open debate about the allocation of resources to users in different life phases; ● The analysis conceptualises and makes explicit important normative decisions made by practitioners.