Saturday, May 4, 2019

When Do You Have Too Many Assessments?

Everyone in the ICF/IID field knows that the key to developing programs for the people we serve is assessments.  We have assessments for health, self-care, water safety, hot and cold water safety, sexual education, independent living, speech, hearing, dental, nursing, activities, and so on.  It seems the list of required and/or needed assessments is always growing.  The first question for most providers is "When do you have too many assessments?"

If you have ever gone through a survey or an investigation with a state agency, then you know there is a chance the person conducting the survey will ask for assessments.  Most of the time the request will be for a specific assessment.  The surveyor may want to see an assessment by the nurse, the physician, or even something by the direct care staff if the investigation involves a specific area in the facility.  For example, the person served may have been playing basketball outside, the ball rolled out into the street, and the person ran after the ball and got hit by a motorcycle.  We'll assume the person is okay, just a little banged up.  What assessments will the surveyor ask for during the investigation?  They will likely ask for the nurse assessment and the physician's assessment for sure.  You'll answer questions like, "Has this person ever done this before?"  "What safety precautions are you taking to ensure it does not happen to him again?" and "How are you going to make sure it doesn't happen to anyone else?"  Finally, the surveyor will look at you and ask that additional, and sometimes surprising question, "Do you have a community access assessment or an assessment like it for street or traffic safety?"  This is where some providers have the "Deer in the headlight" look.  They go through their policy book, nope there's no assessment like that there.  They then talk to the QIDP - "So, do we have community access or traffic safety assessment?"  The QIDP gives that funny look - kinda like the Deer look - and says, "No, we've never needed one." 

So, you return to the surveyor and tell them you do not have an assessment like that.   Why do we not have that assessment?  Well, the standards did not list it - or at least did not explicitly say, "Community Access" or "Traffic Saftey," but the facility obviously needed one.   The next thing you know you have a new assessment and everyone in the facility is being assessed on his or her "Traffic Safety." 

If you go through the above type situation enough times, you're going to have a ton of assessments.  You're going to have safety assessments, cooking, cleaning, traffic, swimming, shopping, crowd response, etc.  You may find one day that you have an entire book of nothing except assessments.  Naturally, some of the assessments will be required, but some of them will be situationally and placed only to ensure a problem from the past does not occur again. 

So, if we circle back to our original question, "When do you have too many assessments" the answer really and truly is, never.   There is likely a reason for each assessment you have, and there will be a reason for each one you add in the future.  The truth of the answer is you must look at each individual person you serve in the ICF not only as an individual but on an individual basis. 

Your IDTeam has a lot of authority in this area.  The answer is to, no pun intended, assess the need for any assessments not required annually.  For example, let's go back to the community access assessment.  You have a person you serve who is in a wheelchair, can not move it himself, and never wants to go anywhere.  Does that person need a community access assessment?  Well, maybe he needs one initially, but after that, if there are no changes, perhaps he does not need one annually.   On the opposite side, let's say the person walks daily to the store but has stepped in front of cars or crossed against the traffic before in the past - he may need an annual assessment and goals to address the issue. 

The driving factor here is that you do not have to use all the assessments your organization may have.  You can take each person as an individual and decide what assessments need to be done annually - provided they are not required annually by standards - and move forward.   You only have too many assessments when the IDTeam decides one is not needed for someone. 

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