Appendix 114-A Domains of Comprehensive Assessment

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Georgia Division of Aging Services
Home and Community-Based Services Manual

Chapter:

100

Effective Date:

Section Title:

Domains of Comprehensive Assessment

Reviewed or Updated in:

MT 2020-01

Section Number:

Appendix 114-A

Previous Update:

Comprehensive assessment is the process of reviewing the cognitive, emotional, social, health/medical and functional status of an adult to determine if there are deficits in need of support, as well as strengths that can be used to develop plans that support continued independence and/or that support family caregivers. Although the DON-R Assessment is the Level One Assessment for the ADRC, there are many other aspects of a person’s life that staff and other professionals will want to consider when working with consumers/families to develop interventions. Following is an overview of other issues that should be considered in care planning.

  • Functional Status - evaluates how well the adult manages activities and instrumental activities of daily living as measured by the Determination of Need-Revised (DON-R) instrument. Assessment of functional status includes:

    • Activities of Daily Living (ADLs)

    • Instrumental Activities of Daily Living (IADLs)

    • Use of or need for assistive devices or technology

    • Level of assistance required and who provides assistance

  • Cognitive Status – DAS measures cognitive status by the Montreal Cognitive Assessment (MoCA and the MoCA-BLIND). Establishing a baseline for cognitive status can be critical in designing interventions to assist family caregivers when providing care for a family member with dementia or other cognitive impairments. IADL impairments as noted on the DON-R may also be indicators of cognitive impairment and decline; the DON-R comments section can be used to note concerns regarding cognition issues, absent a formal assessment. See Appendix 114-B for the DON-R with dementia triggers. Assessment of cognitive status includes:

    • Orientation

    • Attention

    • Short-term and longer-term memory

    • Construction

    • Calculation

    • Judgment

  • Behavioral and Emotional Well-being – includes information about the consumer’s past and present coping mechanisms, diagnoses, management of emotional issues, and life changes that may impact functioning or well-being. Issues to be addressed may include:

    • Depression

    • Substance abuse

    • Suicide risk

    • Social stressors

    • Values and preferences

    • Mood

    • Effect

    • Coping mechanisms

    • History of behavior or emotional problems

    • Eating disorders

    • Life satisfaction

  • Social Supports - includes social networks and supports, including family, friends, formal or paid supports, and the degree and causes of social isolation. The DON-R comments section can be used to note involvement of family and friends. Assessment of social supports includes:

    • Consumer’s current marital status

    • Current living situation

    • Frequency and type of contacts with friends/friends

    • Feelings and causes of isolation or loneliness

    • Availability and duration of care if it was needed

    • Hobbies and interests

  • Environment – addresses the adequacy of residence, conditions inside the home and surrounding environment, and characteristics of the community. An environmental assessment includes:

    • Architectural barriers that limit access from the outside or that limit access within the environment

    • Accessibility of assistive devices, if used

    • Functionality of structure and design

    • Need for modification or repairs

    • Adequacy of major systems: heating, cooling, wiring, plumbing, overall structural integrity of dwelling

    • Emergency planning

    • Access to local transportation options

    • Neighborhood location and safety

  • Finances and Legal Issues – assesses the adequacy of income and resources for present and future needs, and includes:

    • Income

    • Assets

    • Expenditures

    • Health insurance

    • Affordability of health care, including medications

    • Eligibility for entitlement programs

    • Presence of guardian or conservator

    • Advance directives and awareness of support system of these

    • Retirement planning or long-term care planning

  • Health status – assesses the consumer’s current physical health status, usage of health care services, health risk factors, and preventive actions, including:

    • Nutritional status (NSI-D and Food Security

    • Medical diagnoses and chronic conditions

      • Effect on functioning

      • Ability to manage

    • Health literacy

    • Number of hospitalizations and admissions, number of readmissions, and utilization of emergency room for primary care needs

    • Current medications including prescribed, OTC, and alternative treatments/therapies

    • Need for additional health assessments, medication management assistance or assistance to obtain needed medications

    • Experience with health care (self, family and friends)

    • Cultural beliefs about illness and treatment

    • Access to health care providers, and the ability and means to make and keep appointments as necessary

    • Overuse, underuse, or misuse of health care network

  • Risk for Abuse, Neglect, or Exploitation – assessed current or potential risk for abuse, neglect, or exploitation, and possible intervention of Adult Protective Services, including:

    • Are there signs of injury, such as bruises, burns, teeth marks?

    • Is the person’s explanation of how the injuries occurred plausible?

    • Are there signs of physical neglect, such as burning, contractures, decubitus ulcers, dehydration, diarrhea or compaction, urine burns or excoriation?

    • Does neglect appear to be active or passive?

    • Do income resources appear to be adequately and properly used to provide care? Are bills being paid on time and in full, if being handled by another person?

Adapted from:

“Comprehensive Geriatric Assessment, Moving People Down the Road to Continued Independence,” training presented to Georgia Aging Network by Gregory J. Paveza, Ph.D., 1999.

Center for Aging & Disability Education and Research at Boston University

“Guidelines for Case Management Practice across the Long-Term Care Continuum, Connecticut Community Care, Inc., November 1994.