Chapter 5: Embedding the system of care’s components
5.7 Integrating the LoTS care assessment booklet
5.7.1 Scope of the assessment structures
The three assessment tools (LoTS care, Easy-Care and the Overview) sub-divided groups of potential problems into domains with prompt questions to indicate what should be discussed. The LoTS care assessment consisted of sixteen domains,
compared to seven in the Easy-Care, and ten in the Overview. However, many problems included as part of the LoTS care assessment were also addressed in the service tools, but were amalgamated into fewer domains. To illustrate this point, table 12 below depicts the LoTS care assessment domains in the left hand column (numbered 1-16). The middle and right hand column indicate whether similar problems were addressed within a domain in the Easy-Care and/or the Overview, or if they were absent from these tools.
Table 12: Assessment domains
It is apparent from the table that the domains addressed were broadly similar across the three tools. For example, 13 of the 16 assessment sections contained within
LoTS care
assessment domain
Addressed in Easy-Care
Addressed in Overview
1
Transfer of care
Absent
Absent
2
Communication and
information
Absent
Absent
3
Medicine and general
health
Looking after yourself / looking after your health
General Health /Medication issues
4
Pain
Your well being
General Health
5
Mobility and Falls
Looking after yourself
Mobility issues
6
Personal Hygiene &
Dressing
Looking after yourself
Personal care and domestic needs
7
Shopping & Meal
Preparation
Looking after yourself
Personal care and domestic needs
8
House & Home
Looking after yourself
Personal care and
domestic needs
9
Cognition
Your Memory
Emotional well being
10 Driving and general
transport
Absent
Environmental needs and resources
11 Finance & Benefits
Your accommodation
and finance
Financial advice
12 Continence
Looking after yourself
General Health
13 Sexual Functioning
Absent
Absent
14 Patient Mood
Your well being
Emotional well being
15 Patient Social Needs
Your well being
Emotional well being
LoTS care are also addressed in the Overview, and 12 are addressed in Easy-care. The novel sections introduced at both services were ‘transfer of care’, ‘communication and information’, and ‘sexual function’. ‘Driving and General Transport’ was also absent from Easy-Care. The main difference between the three tools is in the way they have categorised the problems, for example, 5 sections in Easy-Care include questions that addressed the 12 overlapping LoTS care domains. Table 13 below, provides the questions contained in the Easy-Care domain ‘Looking After Yourself’, and show how these questions have been categorised differently in the LoTS care assessment.
Table 13: Categorisation of the Easy-Care questions in LoTS care
Easy-Care section: Looking After Yourself
LoTS-Care assessment
domain
Questions provided
Can you do your housework?
House and Home
Can you take your own medicine?
Medicines and general
health
Do you have accidents with your bladder?
Do you have accidents with your bowels?
Can you use the toilet?
Continence
Do you have any problems with your feet?
Can you wash your hands and face?
Can you use the bath or shower?
Do you have any problems with your mouth or
teeth?
Can you keep up your personal appearance?
Can you dress yourself?
Personal Hygiene and
dressing
Can you walk outside?
Can you get around indoors?
Can you manage stairs?
Have you had any falls in the last six months?
Can you move yourself from bed to chair, if next
to each other?
Mobility and Falls
Can you go shopping?
Can you prepare your own meals?
Can you feed yourself?
Shopping and meal
preparation
Do you have any difficulties getting public
services?
Table 13 demonstrates that questions addressing a wide range of problems are grouped together under the broad and vague heading, ‘Looking After Yourself’ in Easy-Care. In the LoTS care assessment, the same questions have been divided into six domains with headings that provide clarity on what will be addressed. For example, the section ‘Mobility and Falls’ contains questions that focus on these areas only. In comparison to Easy-care, the Overview assessment contains ten assessment domains and incorporates the thirteen overlapping LoTS care domains in seven. Table 14 below depicts how the questions presented in the Overview domain ‘Personal Care and Domestic Needs’ have been categorised in the LoTS care assessment.
Table 14: Categorisation of SAP Overview questions in LoTS care
SAP Overview section: Personal Care and
Domestic Needs
LoTS-Care Section
Do you have difficulty with any of the
following and have you got any equipment
that supports you?
Doing housework?
Doing laundry?
House and Home
Washing and bathing?
Using toilet/commode?
Personal Hygiene and dressing
Preparing food and drinks?
Doing shopping?
Do you need a special diet
Shopping and meal
preparation
Keeping warm / cool?
Not addressed
Table 14 demonstrates that the questions provided in ‘Personal care and domestic needs’ were separated into four domains in the LoTS care assessment. Signifying that the LoTS care assessment structure provides more clarity than both service tools. However, despite differences in the categorisation of the problems there is much overlap between all three tools. This overlap can be explained as the Easy- Care and the Overview assessments were developed as holistic tools for use in elderly care. The needs and problems experienced by the elderly population overlap with that of stroke e.g. problems with mobility, continence, and cognition can link to ageing, but can manifest as a result of stroke regardless of the age of the individual. However, one theory underpinning the system of care was that the stroke specific
structure would provide a superior guide for problem identification. The extent to which this was realised in practice is explored further in chapter 8. However at the service level, adaptations to the LoTS care structure were noted, this is explored further in the following section.