Abstract
BackgroundWhile the Resident Assessment Instrument-Home Care (RAI-HC) tool was designed to support comprehensive geriatric assessment in home care, it is more often used for service allocation and little is known about how point-of-care providers collect the information they need to plan and provide care. The purpose of this pilot study was to develop and test a survey to explore the geriatric care assessment practices of nurses, occupational therapists (OTs) and physiotherapists (PTs) in home care.MethodsLiterature review and expert consultation informed the development of the Geriatric Care Assessment Practices (G-CAP) survey—a 33 question, online, self-report tool exploring assessment and information-sharing methods, attitudes, knowledge, experience and demographic information. The survey was pilot tested at a single home care agency in Ontario, Canada (N = 27). Test-retest reliability (N = 20) and construct validity were explored.ResultsThe subscales of the G-CAP survey showed fair to good test-retest reliability within a population of interdisciplinary home care providers [ICC2 (A,1) (M ICC = 0.58) for continuous items; weighted kappa (M kappa = 0.63) for categorical items]. Statistically significant differences between OT, PT and nurse responses [M t = 3.0; M p = 0.01] and moderate correlations between predicted related items [M r = |0.39|] provide preliminary support for our hypotheses around survey construct validity in this population. Pilot participants indicated that they use their clinical judgment far more often than standardized assessment tools. Client input was indicated to be the most important source of information for goal-setting. Most pilot participants had heard of the RAI-HC; however, few used it. Pilot participants agreed they could use assessment information from others but also said they must conduct their own assessments and only sometimes share and rarely receive information from other providers.ConclusionsThe G-CAP survey shows promise as a measure of the geriatric care assessment practices of interdisciplinary home care providers. Findings from the survey have the potential to inform improvements to integrated care planning. Next steps include making adaptations to the G-CAP survey to further improve the reliability and validity of the tool and a broad administration of the survey in Ontario home care.
Highlights
While the Resident Assessment Instrument-Home Care (RAI-HC) tool was designed to support comprehensive geriatric assessment in home care, it is more often used for service allocation and little is known about how point-of-care providers collect the information they need to plan and provide care
Additional academic and grey literature searching and consultation with the clinical leadership group led to refinement of the domains and item pool for inclusion in the survey, including the addition of eight standardized assessment tools, items related to opinions, use and knowledge of the RAI-HC and clinician observation and interview skills
Another study strength includes the psychometric testing of the Geriatric Care Assessment Practices (G-CAP) survey tool, as the results indicate preliminary support for use of the instrument to explore the geriatric assessment practices of interdisciplinary point-of-care providers in home care and may be useful for exploring geriatric care assessment practices of interdisciplinary providers in other geographies and care settings
Summary
While the Resident Assessment Instrument-Home Care (RAI-HC) tool was designed to support comprehensive geriatric assessment in home care, it is more often used for service allocation and little is known about how point-of-care providers collect the information they need to plan and provide care. Repetition and frustration, a common assessment approach is preferred over each care provider completing their own assessment This allows for the development of a comprehensive picture of health care needs, while effectively reducing the demand on older adult home care clients and their family/friend caregivers to repeat their story and health history multiple times to different people [5,6,7]. CGA has been used by Mobile Geriatric Assessment Teams to coordinate the provision of targeted multidisciplinary primary care to rural-dwelling, and frail, older adults and has been applied in a preventive context for at-risk community-dwelling older people [18,19,20]
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