Question

You have been asked to develop a care plan for a new client. How would you go about identifying the needs and preferences of clients and their family members prior to developing this care plan

Answer 1

An Identification of Needs process should be undertaken within the first few weeks of a new client arriving at a nursing home facility.

Clients should be assessed on various aspects of their lives; sleeping patterns, diet, cognitive ability and mobility among other things.

The assessment is a team effort involving RNs, Leisure & Lifestyle staff, and other care providers.

The Role of Recreation Staff in Client Assessment

Recreation staff have the task of assessing the Social and Human Needs of clients which includes leisure and recreation.

Leisure defines activities an individual may engage in during his/her free time.
Recreation is any pursuit engaged in during leisure time that is organised for social purposes.

However the Social and Human Needs assessment of residents encompasses much more than just leisure and recreation. Some of the areas the Recreation Therapist must also consider are social needs, emotional needs and physical and spiritual needs.

Identification of Needs:

The identification of needs is usually collected in two documents; the Social Profile and the Resident Assessment. The more elaborate and detailed the information collected, the better.

Identifying Needs: The Social Profile

The Social Profile is a form that is usually given to the residents to fill in upon admission. If the resident is not able to fill it in, then a relative will do so. Each facility has its own Social Profile which may go by a different name at your facility.

Related: Social & Cultural Form Template

The Social Profile Form should include background information and personal preferences:

• family dynamics (which relative is closer to the resident),
• education,
• country of origin,
• age,
• status of war service and relevant details,
• whether they lead a sedentary life (prefer solitary pursuits) or enjoyed socializing,
• whether they are currently enrolled in the electoral roll,
• whether they have any special possessions that could be brought to facility to make their adjustment a little easier,
• sleeping habits,
• any cultural date the resident enjoys celebrating
• etc

Identifying Needs: The Resident Assessment

The Resident Assessment endeavors to collect social, emotional and spiritual needs and also all sorts of information that could hinder or enhance recreation and leisure.

Related: Client Assessment: Getting to Know your Client

Start with the resident:

Pay the resident a visit to develop rapport and establish trust. Observe the resident; their demeanour:

• How often do they smile?
• Do they have any concern about staff or another resident?
• Are they nervous?
• Do they dislike crowds?
• Do they need encouragement to attend programmed activities?

Interview family and friends:

• Family can provide information about routines and past and present leisure.
• Friends may shed light on different facets of their personalities.

Don’t be put off by anecdotal information; it may come in handy when you are reminiscing with the resident.

Other Health care providers and staff:

AINs, Registered Nurses and other staff may discover important information for the assessment. In fact, any member of staff including office workers and support staff who may have had the opportunity to chat with the resident can add to your collection of data.

Past and present skills and interests

Find out what hobbies they enjoyed, jobs they had and which aspect of the job they liked. We should not assume that just because a lady was a dress-maker she necessarily enjoys needlework. The reality may be that it was financial hardship which compelled her to take up this occupation and she may even resent it.

Religious (and cultural) background

Religion plays a central role in the lives of many older people.

• Does this person wish to attend Church services?
• Can you meet this need by providing transport?
• Find out if you need to engage ministers of religion and/or lay people to make individual visits to residents who are bed ridden or unwilling to attend religious programs.
• Do they wish to have access to broadcasts or telecasts of religious programs?
• Have they expressed what sort of religious rites they would like to receive when the time comes?

Related: 10 Spiritual Activities for People piving with Alzheimer's Disease

Their Abilities:

1. Physical: mobility, dexterity
2. Sensory: sight, heating, touch, smell, taste.
3. Psychological: attention span.

Family dynamics

• What role did they have in their family? Mother, father, older sister, bread-winner etc.
• Are there any estranged family members?

Personality

What sort of personality do they have? sensitive, loving, controlling. Sensory loss can affect the personality of certain people. They may become angry and/or aggressive.

Dementia

What sort of diagnosis do they have? For example Alzheimer’s, stroke, or a neurological disorder? Even mild dementia plays often havoc with a person’s social life and often propels personality change.

Community Affiliations

Did they belong to any clubs, choirs, folk dance groups in the past? Would they like to continue to do so?

Past memories (reminiscing)

Are there painful memories you should know about? Sad memories of wars, refugee camps etc. Do they mind talking about their memories in WWII?

Assessment is concluded,

Now that the needs are assessed you can establish what sort of problems relating to activities this person may have. Various degrees of cognitive function are needed to participate in games, craft, gardening, exercises and any other activities you may have. The same applies for motor function. Areas to consider:

Activity related needs and problems:

• Assistance necessary
• Skills required
• Strength
• Co-ordination
• Body posture
• Dexterity

Issues that may encumber participation:

• Money (to go on community outings)
• Poor health(endurance)
• Skills (range of motion)
• Lack of concentration (restlessness)

Related: How to Motivate Residents in Long Term Care

Emotional components

Emotional needs, when met in a balanced way have the power to improve mental health. Many of our most basic human emotional needs are expressed as feelings. Despite sharing those feelings, we all differ in the intensity of the need. One may crave security where another craves independence. One may have a longing to be understood and another to be left alone (solitude). That’s why it is imperative that you find out exactly what is the resident’s most neglected emotional need.