Assessing the needs of the elderly

22 May 2017

This article appeared in Kai Tiaki Nursing New Zealand vol 23 no 4 May 2017 Written by Co-editor Teresa O'Connor

Treve Swan is one of just two enrolled nurses (ENs) in the country working in needs assessment and service co-ordination for older people.

Based in Gisborne, her hometown, she works for Hauora Tairawhiti (formerly Tairawhiti District Health Board). Her role involves assessing non-Mâori aged over 65 and Mâori aged over 55 for either home-based support or residential care, with the home-based care provided by CCS.

She brings close to 30 years’ experience to the role. She trained in Hawke’s Bay, completing the 14-month course in 1989. She returned home and worked in a variety of roles – on the casual district nursing pool, in a geriatric ward providing long-term and palliative care, and then in an acute orthopaedic ward.

She left in 2006, “despondent and deflated” as responsibilities she had previously performed were taken from her – the nursing powers-that-be in the DHB decided they could no longer be performed by ENs. “I was stripped of what I’d been able to do for 14 years and became more like a health care assistant. I was not given any responsibility or decision-making. Not being able to use my practical nursing skills was soul destroying.”

Swan had her first son in 1992. After 10 months’ maternity leave, she returned to the orthopaedic ward three days a week. In 1995, her twins were born, after which she took 18 months leave and returned to work two days a week.

She also joined the casual nursing pool, working in maternity surgical services, specialist orthopaedic, general medicine and gynaecological outpatient clinics, and as a needs assessor/service co-ordinator. Nine years ago, she got a full-time position as a needs assessor and is still loving the job.

Penny Forrester and Treve Swann

NASC Manager Penny Forrester and Treve Swann

Transitioning to new scope

Swan transitioned quickly to the new expanded scope of EN practice in 2011. She has never had a desire to do her RN training. “I believe in my heart of hearts that we need a second-level nurse.” But she thinks there should be better recognition of EN training for those wanting to do the bachelor of nursing.

Swan’s colleagues are all registered nurses, although in other parts of the country other health professionals, such as physiotherapists, occupational therapists and social workers are needs assessors. To work in the role as an EN, Swan must maintain her “accomplished” level on Hauora Tairawhiti’s performance development recognition programme. She is the only EN to have remained at that level since attaining it in 2008. Swan must also complete the annual online interRai exams.

“I am treated with the utmost respect by my colleagues. In this role, I have the opportunity to use my EN scope of practice to the max. I am well supported by the RN team, which is a bonus of my job.”

Her manager reviews all referrals to the service and allocates clients to the needs assessors, which is where the required direction and delegation for ENs occurs. Hauora Tairawhiti does not have its own dedicated older persons service, which can be a challenge. A psycho-geriatrician from Napier visits two days a month.

Complex role

“The role of needs assessor is a complex one and getting more complex as people live longer and have more co-morbidities,” Swan said.

Two days a month, she works with rural health nurses, practice nurses, and Ngâti Porou iwi provider nurses around the East Cape. “I am very happy and privileged to work with the Ngâti Porou people. I’m well entrenched with the patients and whânau living on the East Coast, and love working with this part of our community.”

Every three months, she does “the hospital run”. This involves assessing Gisborne Hospital patients for residential care. The needs assessors rotate through this role, which is additional to their usual responsibilities.

Swan also has monthly meetings with CCS care co-ordinators to review how clients are coping at home.

She loves the autonomy of her role, the challenges she encounters and the decision-making involved.

But there are some frustrations, including the fact that services to older people are under-resourced. And needs assessors are often the bearers of news people don’t want to hear, eg that they are not eligible for a home support package or for residential care. “We bear the brunt of people’s frustrations.”

The rewards outweigh the challenges. “I love helping people stay in their own homes, as this is where most people are happiest. It’s a privilege to work with older people – they are such copers, and they have wonderful stories to tell. I feel very privileged being able to make a difference to their lives.”