1. Introducing the interRAI Home Care
Talking the same language for effective care of older people

2. interRAI has developed an entire range of instruments and screeners to support assessment in a wide array of community and institutional settings
SCREENERS
Self-reliance Protocol (community care)
Community & Hospital Intake Protocol (CHIP)
Emergency room*
Acute care*
* In development
INSTRUMENTS
Long term care facility
Assisted living (hostel)
Home care
Community health assessment
Mental health
Community mental health
Acute care
Post-acute care
Palliative care
Intellectual disability
interRAI specialises in aged care, disability and mental health services

3. interRAI – Community Mental Health
Comprehensive Geriatric Assessment
& Care Planning
for Acute Care
Minimum Data Set
Test Version 1.04
[Multi-column format]
Copyright interRAI, Washington D.C., 2004
International
interRAI – Palliative Care
Comprehensive Assessment
& Care Planning
for Palliative Care
Minimum Data Set
Test Version 1.04
[Multi-column format]
International
Copyright interRAI, Washington D.C., 2004
The interRAI suite includes several instruments designed for application in community care…
The interRAI Home Care is the most widely used instrument applied in the community setting
interRAI – Community Health Assessment
Comprehensive Assessment
& Care Planning
for Acute Care
Minimum Data Set
Test Version 1.04
[Multi-column format]
Copyright interRAI, Washington D.C., 2004
International
interRAI - Home Care
Comprehensive Geriatric Assessment
& Care Planning
for Acute Care
Minimum Data Set
Test Version 1.04
[Multi-column format]
Copyright interRAI, Washington D.C., 2004
International

4. There is a suite of community instruments to suit organisational and individual client needs
Entry from community
interRAI Self Reliance Screener
Complex care requirement?
Yes No
Specialist care requirement? No
Yes
interRAI CMH
interRAI PC
interRAI ID
interRAI CHA
interRAI HC

5. The interRAI Home Care is designed as a general purpose assessment instrument for persons with complex care requirements
It is now in its 3rd version (the interRAI HC)
Previous versions were the RAI-HC and RAI-HC 2.0
It is used extensively in many areas of North America and Europe, and is currently being trialled in Australia and New Zealand

6. The interRAI HC offers multi-dimensional assessment
Screening
Delirium
Dementia
Malnutrition
Depression
Problem lists
Diagnoses
Geriatric syndromes
Social & environmental
Severity measures
Cognitive performance
Communication
Depression
Activities of daily living
Instrumental ADL
Pain
Health stability
Risk assessment
Delirium
Falls
Functional decline
Pressure ulcer
Rehab. potential
Need for services

7. Re-assessment as needs change Standard review assessments
interRAI instruments support management of entire episodes of care, not only admission assessment
Discharge plans
Outcome assessment
Quality monitoring
Baseline assessment
Progress review
Establish care plans
Re-assessment as needs change
Standard review assessments
Admission profiling
Discharge profiling
… one integrated system reduces duplication, improves documentation & increases care quality.

8. A successful interRAI HC implementation brings a wide array of benefits…
Integrated information systems across care settings
Electronic information sharing
Improving clinical skills and standards
Consistent decision-making among clinicians and agencies
Reduced documentation burden
Quality monitoring
Benchmarking among providers
Casemix evaluation

9. Reducing duplication in the Australian setting
The interRAI HC contains sufficient information to meet most of the ACAT, HACC and ACCR data reporting requirements
Once completed, with appropriate software, it can automatically fulfil this function eliminating much of the duplicate paperwork

10. interRAI assessment instruments are built to specific principles and standards
Each assessment creates a minimum data set which provides an entire range of measures to assist in care planning, client monitoring and administration.
High quality data is COLLECTED ONCE and then used for multiple purposes.
This encourages accuracy and reduces duplication
All items are carefully crafted and tested across many countries to ensure good reliability and cultural appropriateness

11. The interRAI HC performs many tasks - not just recording observations
Profiling of cognitive, functional and psycho-social status including:
Screening for common geriatric syndromes
Risk assessment for adverse events
Measuring severity of disability
Identifying opportunities for prevention or improvement
Assessment of quality of care being delivered
Evaluation of case complexity (casemix)

12. The interRAI HC is not only a data set
It includes…
Data collection forms
a set of clinical observations and measures
A training manual
including definitions, case studies and clinical protocols
Codesets
computer code to enable software to calculate scales, quality indicators, clinical assessment protocols and casemix groupings
It is a “system” to support assessment, care planning, communication, quality monitoring and administration.

13. The interRAI model Assessment Case Mix Outcome Minimum Measurement
Data Set
Outcome
Measurement
Scales
The other compelling reason why governments have increasingly adopted MDS is because the instrument is multi faceted. It can be used for :
Care Planning, improving quality, developing case mis and funding, outcome scales. I will explain each of these in a little more detail. Firstly let me gein with the MDS data itself…next slide
Care planning
protocols
Quality
Indicators

14. Clinical decision support: interRAI systems help clinicians to…
Interpret observations
Organise information
Plan care
Monitor clinical progress

15. Logic systems are applied to assist clinicians to interpret their recorded observations
These “algorithms” calculate scales, screeners, clinical assessment protocols (CAPs), quality indicators and casemix groupings
The development of algorithms is based on extensive and ongoing research performed by interRAI…
interRAI makes extensive use of clinical databases provided by user organisations to undertake this work

16. The clinical algorithms enable screening for common conditions…
PRESENCE OF:
Dementia
Delirium
Depression
Malnutrition
Dehydration
Elder abuse
Social isolation
RISK OF:
Pressure ulcer
Falls
Institutionalisation
Screeners and scales are validated against “gold standard” clinical assessment or best available existing tools

17. Clinical assessment protocols identify key issues for care planning
Activities
Adherence
ADLs
Behaviour
Bladder
Bowel
Brittle support
Cognitive
Communication
Dehydration
Delirium
Depression
Discharge
Drinking
Elder abuse
Environment
Falls
Feeding
IADL
Institutional risk
Nutrition
Oral
Pain
Physical activity
Pressure ulcer
Prevention
Restraints
Skin care
Smoking
Social function
Unsettled relationship
Vision

18. Scales assist in diagnostic screening and evaluating severity…
ADL Hierarchy, Short & Long Form
IADL Capacity & Performance
Cognitive Performance Scale
Communication Scale
Depression Rating Scale
Pain Scale
Changes in Health End-stage disease Signs & Symptoms of medical problems (CHESS) (Health stability)
Body Mass Index

19. Quality Indicators assist in assessing service performance
Prevalence HCQIs
Inadequate meals
Weight loss
Dehydration
No medication review
Difficulty with mobility & no aids
Rehab potential & no treatment
Falls
Social isolation with distress
Delirium
Negative mood
Disruptive pain
Inadequate pain control
Neglect or abuse
Any injuries
No flu vaccination
Hospitalization
Failure to improve HCQIs
Bladder incontinence
Skin ulcers
ADL impairment
Impaired mobility at home
Cognitive function
Difficulty in communication

20. Something for everyone…
Improved clinical information
Electronic information sharing
Clinical decision support
Improved reliability & consistency
Reduced paperwork
Clinicians
Service administrators
Planners and policy makers
Caseload profiling
Better information for service planning
Ability to benchmark within and among service providers
Improved productivity
Caseload profiling
Ability to allocate resources among services and clients
Service quality monitoring
Improved productivity

21. Implementation of an interRAI instrument requires careful planning
The interRAI Home Care is one important building block to improving performance in community care…
Consideration of other aspects of implementation may result in failure
Organisations must consider:
how the instrument will be used;
who will perform assessments;
how often they will be repeated;
what reports are required – when and for whom;
how will training be conducted - for existing and future staff;
which software to use.

22. Three building blocks to success….
Clinical data systems:
interRAI HC
Work
processes
Software

23. Training is important…
Good training enables:
A broad understanding of the interRAI approach and vision
Detailed knowledge of item definitions and scoring leading to improved reliability
Interpretation of scales, screeners and quality indicators
Application of Clinical Assessment Protocols for care planning
Use of software applications

24. How training is best delivered…
Small group, interactive format lead by a facilitator with extensive clinical experience
Review of all clinical items aided by the HC manual
Interpretation of scales, Clinical Assessment Protocols and screeners
Software utilisation
Interpretation of reports
Training requires approximately 3 days, which may be divided into 2 steps (2 + 1 days)

25. The interRAI HC is a powerful clinical tool that will…
Support clinical evaluation
Enable electronic communication
Reduce duplication and paperwork
and…
IMPROVE THE QUALITY OF CARE

26. Talking the same language for effective care of older people
For more information
visit the interRAI websites
(International)
(Australia)