A new national model of needs assessment implemented by local governments

Why was this example implemented?

The rationale for introducing a new approach came from deficits experienced within the former model where health and social aspects of client´s needs were assessed in a separated way. This was considered as a major problem (gap) by the local governments, who were dissatisfied with the previous approach; social services were left without knowing enough about the client’s health status and of his/her related social needs when they applied for social services provision.

The main aim was thus to increase the comprehensiveness of the assessment and make the status of the social service users more visible within local and regional administrations, so that the latter could improve the way they met LTC needs. So in the new proposed model, health and social care needs assessment were to be organised and conducted jointly by doctors and social workers under an integrated process in order to reach a joint decision. The fact that both worked under a common organisational umbrella would facilitate this.

Description

The example presents ongoing national practice relating to a model of needs assessment established under the new legislation framework. It targets older people as well as adults with disabilities when they apply for any type of social services and who are, according to the health assessment criteria, dependent on the help/care of other person for ADLs and IADLs.

The new model is based on national legislation requiring that needs assessment be carried out by a multidisciplinary team (health and social professionals) at local and regional level with a process divided into two parts:

1. medical assessment: done by a physician, a member of the local or regional government´s staff
2. social assessment: provided by social workers belonging to the local or regional government´s staff

Using agreed forms of mutual cooperation such as a common check list for comparing findings and agreeing appropriate changes, both professionals jointly assess client´s ADLs and IADLs needs for assistance through the individual person’s eligibility. This is based on an assessment of health status which is sectioned into the six care dependency levels, the family environment and the wider living environment which can impact the person´s needs for ADLs/IADLs. Their assessment conclusions result in a comprehensive report of dependency which includes statements on:

• the level of dependency on other  people and  assistance/care,
• disadvantages that the care dependent person faces in the area of self-care, household keeping and in basic social activities,
• proposals for appropriate  social services,
• date of a next re/assessment.

The client is entitled to be actively involved in the assessment process (to express his/her own needs and to suggest solutions to issues raised), to choose another person (e.g. children, friend,) to participate and to use an advocate to express his/her rights and interests. If the person is not satisfied with the decision of the municipal or regional office he/she also has the right to appeal to the Regional court.

The expenditures for comprehensive needs assessment process are completely covered by municipalities and regional offices´ budgets.

What are/were the effects?

The implementation period is too short for assessing outcomes based on evidence and potential impacts of the new assessment model on the users, their families or social services providers.

Nevertheless, some process results exist that have been done by towns and municipalities involved during 2009 and the first half of 2010. This includes for example the number of health and social assessment reports. According to Bednárik´s surveys the towns and municipalities (824 in 2009, 728 in 2010) made 21,097 health and 21,300 social assessments for a total amount of €913,184. The eight regional governments issued 16,741 health and 17,623 social assessments in the same monitored periods for a cost of €830,045.  

As no comparable data from the previous period exists, no evidence regarding cost saving of the new model has been performed. Also no qualitative research on the potential impact of the new model regarding different aspects (users, providers’ satisfaction or funders’ perspectives) has been put in place.

However, some basic unofficial feedback has been conducted by users, social services providers and government officials. This has pointed out that there is a heavy administrative burden (too much paperwork). Also they highlighted that slowing down the assessment process resulted in a delay to receiving entitlements. That is a reason why some non-public representatives call for a change to the legislation that simplifies the whole assessment process for those applying, particularly for those self-paying.

What are the strengths and limitations?

Strengths

• strong client involvement – the client has an active role in its arrangement, in expressing his/her own needs and formulating own suggestions about how to solve his/her social situation
• more “tailor-made” social services for dependent people

Weaknesses and threats

• high administrative time due to the complexity of the assessment involving various stakeholders 
• a risk  of duplication in the assessing process conducted at municipal and  regional levels
• in the beginning, the governments had to address the fact that the assessing doctors were not particularly interested in assessment
• because of a central crisis, local governments were left without funds to help them overcome any difficult situations  

Opportunities

The preparation of an amendment of the present legislation on social services (since 2011) could lead to:

• simplification  and improvement of the whole assessment process (e.g. less paper work, less financial burden for preparing health administrative documents/health findings)
• cooperation between municipalities and regional offices to prevent duplication and to utilise flexibility in meeting their residents' ADLs/IADLs needs

Credits

Links to other INTERLINKS practice examples

• Single Assessment Process

External Links and References

• Bednárik, R. 2010a. Monitoring implementácie zákona č. 448/2008 Z.z. o sociálnych službách v obciach a vyšších územných celkoch. Súhrn ra rok 2009. (Monitoring on implementation of the Act No. 448/2008 Coll. on social services by municipalities and regions. 2009 Summary). Bratislava: IVPR.
• Bednárik, R. (2010b) Monitoring implementácie zákona č. 448/2008 Z.z. o sociálnych službách v obciach a vyšších územných celkoch. I. polrok 2010. (Monitoring on implementation of the Act No. 448/2008 Coll. on social services by municipalities and regions. First half of year 2010). Bratislava: IVPR.
• Bušová, B. (2010) Financovanie sociálnych služieb a posudzovanie potrieb starších ľudí (Financing of social services and needs assessment of older persons). Bratislava: IVPR, work in progress.
• Usmernenie pre obce a mestá k použitiu finančných prostriedkov poukázaných na základe monitoringu implementácie zákona o sociálnych službách (Regulation for municipalities and towns how to use financial resources based on  implementation of the Act No. 448/2008 Coll. on social services)
• Zákon o sociálnych službách (the Act No. 448/2008 Coll. on social services)