Development of a measure of perceived health-related needs of residents of nursing homes

Dr Lynne Parkinson, Associate Professor Julie Byles, Professor Kichu Nair, Dr Jon Adams, Dr Isabel Higgins

The number of Australians aged 65 years and over has grown by more than 1 million in the last 20 years, with approximately 12% of the Australian population now aged 65 and over. This proportion is expected to more than double in the next 30 years. In 1993, 16% of those aged 65-79 and 41% of those aged 80+ were living in aged care facilities. At June 1996, there were 75,008 nursing home beds in Australia, with 47% of these in the high dependency categories. Residents of nursing homes are characterised by chronic medical diseases, multiple co-morbidities, functional dependency and poor perceived health.

In recent years, there has been a plethora of studies on quality of life and satisfaction with care in this setting. However, these types of approach are limited by their focus on the problems of patients, often as perceived by family or care givers, rather than the issues that are perceived by patients to be most important to them. Needs assessment is a measurement technique that can provide a direct index of patients' perceptions of issues with which they need help. This project takes the first step in the development of a tool which directly assesses needs across a range of domains (physical, daily living issues, social, psychological, interpersonal, health information, access to services). The project aims to develop a draft measure of the perceived needs of Nursing Home residents, using a qualitative framework.

In-depth qualitative interviews will be conducted with residents, family and care providers from 3 Hunter Nursing Homes (Warrabrook, Kara and Wallsend), which were recruited to involvement in 2002. Aged care facilities have been seen as a difficult place for the measurement of needs, particularly given that around 60% of Nursing Home residents suffer from dementia, with 41% of these being classified as severe. However, when this group conducted qualitative interviews with 5 staff members and 5 competent residents from one Nursing Home in the Hunter, to explore the functional and cultural environment of the Aged Care setting, and the pragmatic aspects of obtaining the opinions of residents, it was evident from staff members' responses that a needs assessment tool for the residents was considered feasible and practical for residents who are competent and able to communicate. The general feeling was that such a tool would introduce some individualism into the Nursing Homes, by allowing residents to feel they have some ownership over their care and that they can maintain a degree of independence. The most significant barriers identified by staff to talking to residents were dementia, confusion, depression, communication problems, anger, hearing and speech difficulties, short term memory loss and short attention spans. Staff estimated that between 25% and 50% of residents would be able to easily discuss their needs with a staff member. Staff members felt that a tool of this nature was essential in any Nursing Home, and should be developed and implemented as part of routine practice.