In the last issue of INsite, the team at TAS offered some reassurance that the sector’s mounting concerns about interRAI would be addressed. However, a recent survey of aged care providers delivers some worrying home truths about the realities of day-to-day life with interRAI.
On 1 July it will be one year since interRAI was made mandatory for the aged care sector. Since its earliest days interRAI has polarised the sector; like Marmite, it was one of those things people seemed to either love or hate. However, more recently the assessment tool appears to be gathering more haters than lovers.
A recent survey, conducted by the owner and manager of Glenbrook Rest Home in Waiuku, Peter Mathyssen, confirms that many aged care providers are fed up with the system.
The survey was sent to 830 interRAI users and completed by 128. It asked respondents about a range of topics, including the time taken to complete assessments, its ease of use, what they liked about interRAI, and what they didn’t.
Mathyssen says the negative atmosphere around interRAI prompted him to do the survey. Other than a few officials, he didn’t know of anyone with hands-on experience in a rest home who had anything positive to say about interRAI.
While Mathyssen’s survey revealed some positive voices in support of interRAI, the majority of responses confirmed his gut feeling – that interRAI was not well received by the sector.
The most common theme emerging from the survey results was how much time interRAI is costing facilities that were time-poor from the outset.
The question on how long a full interRAI assessment takes was met with a large range of responses. The shortest time given was two hours; the longest three to four days. The majority of responses hovered around the six to eight hour mark.
“I have recently had issues with an interRAI trainer who says an assessment should take 40 minutes,” remarked on respondent. “I find a simple interRAI assessment will take me a shift which is six hours; a complicated one can take two to three shifts.”
Lead DHB Chief Executive for Older People Chris Fleming says the length of time a typical interRAI assessment should take is approximately two hours, provided they know the resident well and they know the interRAI assessment well. He acknowledges that there are bound to be variations to this.
Some survey respondents voiced frustration at how the time spent on interRAI assessments detracted from their core responsibilities.
“I am a sole RN manager at present,” shared one respondent. “The time it takes me away to do the assessment and in the time frame required is very difficult and it takes me away from the resident and has not improved the care given.”
“The whole thing just seems so time consuming,” says another. “I am so exceptionally busy as the general, clinical and human resource manager I simply haven’t had time to keep up with all the little tests I get sent to maintain my competency as I have so many other tasks of greater priority, I can’t do these after hours as I have a baby. It seems a lot of additional work on top of what we are already having to do.”
Training still a concern
The lengthy wait for training is still a concern, despite the best efforts of TAS.
NZACA chief executive Simon Wallace says he has received a lot of comments about interRAI in recent months, particularly around training and the very long waiting times, sometimes six months, to get RNs on to training courses.
“We need to get the training situation fixed because our members have certain obligations in their ARRC agreement with respect to the completion of interRAI assessments and those are at risk unless we get the staff who are trained to do those assessments. In this regard, some NZACA members have received partial attainments in audits because they don’t have the trained staff to do the assessments when required.
“This is a flagship policy of government that needs to be supported by training when and where we need it.”
TAS has trained in excess of 3,100 Registered Nurses from the 679 facilities across the country and is continuing to train 720 additional nurses per annum. They have also trained 330 facility managers in the use of the software and reporting capabilities.
However, Chris Fleming says training is still their biggest concern and TAS is currently exploring options to try and increase the training capacity available.
“Ironically, one of the biggest issues is the waiting times for training,” says Fleming. “All facilities reached the target of 1 RN trained per 15 beds, however training demands have continued from two sources, firstly the level of staff turnover in Aged Residential Care, and also many facilities are now choosing to request training for a far higher level of coverage (more RNs trained than previously planned), and this is placing significant demands on the training resources.”
Part of the problem is that TAS wants to maintain control over the training process, despite struggling to keep up with demand. Meanwhile, many providers are keen to roll out training themselves, maintaining that this would be a much more efficient solution, especially given the high turnover of aged care nurses. This response from the survey reflected many:
“Many of our nurses will leave if opportunities for jobs within the DHB and in areas other than aged care come up and so we keep ending up at starting point all over again with staff not trained for this.”
“My nurses have been on a waiting list since last year,” writes another respondent. “The one nurse we had trained recently has since left, only one other is currently training as no other spaces available for my other nurses.”
Concerns were also raised about the costs associated with the training.
“We paid an extra 40 hours in last fortnight’s pay to cover nurses completing interRAI assessments. The other negative is that nurses can turnover quite quickly in residential care; they get experience and then get hired by the local DHB (where they don’t have to do interRAI) then we have to train another one.”
However, while the vast majority held disparaging views about interRAI, there was an abundance of praise – even from those who were not fans of interRAI – for the tool’s ability to help them gain a much deeper knowledge of the resident’s needs.
“You get to know the residents very well,” says one respondent. “The residents respond well to the time spent with them.” And a handful of survey respondents were clearly impressed with interRAI.
“We love interRAI here,” says one, “It gives a clear picture of where a client is at and what elements need to be focused on in a care plan. We have totally aligned our care plan to the CAPs, which has made a great difference.”
Chris Fleming says this reflects feedback they’ve received, which suggests that the facilities that have fully integrated the interRAI process into the way in which they do all of their assessments and care planning are finding that the tool improves quality for both the assessment and care planning.
“Where providers are using the interRAI assessment simply as a compliance tool there is great frustration and concern about the tool.
“We do not apologise for this as the single most important driver for the implementation of the interRAI tool was improving and enhancing the standard of care being delivered to this vulnerable group of clients.”
Mathyssen believes those making policies around interRAI “have no idea” what aged care providers who are using the tool on a daily basis are up against.
“There is a large rift between those who make the decisions re interRAI and those who have to use it in real life. That’s where the problem lies,” he says.
However, Fleming says they acknowledge the sector’s concerns about interRAI. He says plans are afoot to commission an independent review of its implementation in aged care from 2011 to 2015. The review will seek objective feedback from the sector. We are about to commission an independent review of the implementation of interRAI in aged care from 2011–2015, which will investigate a range of aspects of the implementation and seek objective feedback from the sector.
“Feedback is always helpful and we will certainly consider the issues raised and review and assist where we can. We intend to address concerns and queries from interRAI users through our regular communications with the sector.”
It’s fair to say that the sector expected and tolerated some inevitable teething trouble during the bedding-in phase of interRAI, but is the grace period coming to an end? It would seem there needs to be some much-needed communication between those making the policy decisions around interRAI and those who are required to use it on a daily basis, for the sector to push through these prolonged early days.
interRAI survey results at a glance
- 58% of respondents think interRAI is a waste of time or almost a waste of time. Only 15% think it is brilliant or almost brilliant.
- 61% of respondents do not enjoy completing interRAI assessments, only 27% do.
- 66% would NOT continue with interRAI given the choice, only 27% would.
interRAI data now available
The release of the inaugural National interRAI Data Analysis Annual Report 2014–15 is a step in the right direction to offset the sector’s concerns over interRAI.
The release of the first interRAI data report has answered providers’ concerns that they weren’t receiving any data back despite putting a lot of time and effort into meeting interRAI requirements.
The report, prepared by the interRAI National Data Analysis and Reporting Centre in TAS, includes a range of information gathered from the use of interRAI assessment in New Zealand.
The report has been described as a “major step forward” in the journey of interRAI in New Zealand. It makes it possible, for the first time, for a large variety of stakeholders in the aged care sector to freely and publicly access interRAI data and information at an aggregated level from a national perspective.
It provides information on interRAI assessments and the key features and trends for the year July 2014 to June 2015 and has been drawn from the 19,600 Contact Assessments, 36,900 Home Care Assessments, and 27,200 Long Term Care Facility Assessments completed over this period.
While the data has been analysed, the National Data Analysis and Reporting Centre has not attempted to interpret the implications of the information or comment on how it should be used by stakeholders.
The intention, as chair of the interRAI New Zealand Governance Board Professor Paul McDonald says, is to encourage “stakeholders in the wider aged care sector to take the opportunity to use the information presented in this report and to start asking the ‘so what?’ questions”.
InterRAI is a key focus for the New Zealand Aged Care Association. In its ARRC submission, it called for a more consistent approach to data provision at both the individual and aggregate level to shape future policy settings. The release of the inaugural report goes some way towards meeting these needs. However, chief executive Simon Wallace says it’s not enough.
“We welcome the annual report, which offers some early insights, however what we’re really looking for is data relating to individual member facilities.”
Wallace says he is looking forward to interRAI staff presenting a range of findings at the NZACA’s annual conference in October.
Chris Fleming says TAS is looking to expand the suite of reports over time and respond to sector feedback about what is valuable.
“We are happy to receive suggestions at any time from facilities about what data might be useful to support and develop their services.”