Needs Assessment

A needs assessment is a structured process for identifying the physical, psychological, social, and spiritual needs of people receiving palliative care. This ensures care is holistic and tailored to their unique circumstances. [1] The process involves comprehensive assessment at the start of care, at regular intervals, and when needs change. [2] Validated tools play a key role in guiding care planning and identifying when referral to palliative care may be appropriate. [3-5]

Are needs rounds the same as needs assessment?

A significant part of a needs assessment is having a plan to address deterioration and understand the degree of escalation needed to care for an older adult. In the residential care setting, ‘needs rounds’ are monthly meetings where care staff, led by a specialist palliative care clinician, use a checklist to assess and prioritise care for residents at risk of dying without a proper plan or symptom control. [6-8] These meetings help staff build confidence in discussing death, planning care goals, and managing symptoms. [7-9] They have been shown to reduce hospitalisations and improve the quality of death, decreasing the likelihood for hospitalisation and increasing the likelihood that residents die in their preferred place. [9-11]

Why needs assessments matter in aged care

For needs to be addressed, they must first be identified. Effective and holistic needs assessments are core to good palliative care. [12] They involve close collaboration with older people, their families, and carers and should be conducted regularly to ensure care remains responsive to changing health conditions and circumstances. [2]

Outcome 5.7 of the Aged Care Quality Standards emphasises the importance of recognising and addressing an older person’s needs, goals, and preferences for palliative and end-of-life care. [2] The Quality Standards also highlight the need for cultural competence, ensuring inclusive care for Aboriginal and Torres Strait Islander peoples, culturally diverse communities, and those with dementia. [2]

What the evidence tells us

Needs assessments should ideally be conducted at the time of diagnosis of a life-limiting condition. Reassessment is then important during major health changes, deterioration, hospitalisation, shifts in family or social support, at the family’s request, or at the start of the terminal phase. [13] Continuity of care is improved when the same assessor conducts both initial assessments and follow-ups. [13]

Tools for needs assessment

Validated assessment tools support structured and effective evaluations. [1] They can help clinical staff recognise increasing symptom burden and identify palliative care needs early. [5] The choice of assessment tool can be guided by the person’s characteristics such as age, illness, role (older person/carer), and key symptoms. [1] Brief screening tools provide a quick overview of a person’s needs and are useful when time is limited or participation is difficult. [1] This can be followed by a more detailed assessment of any identified needs. [1,5]

Examples of widely used tools for assessing a person’s palliative care needs include:

• Supportive and Palliative Care Indicators Tool (SPICT) – identifies people with deteriorating health due to serious illness, chronic conditions, or frailty [5,14,15]
• Integrated Palliative care Outcome Scale (IPOS) – assesses physical, functional, psychosocial, and practical needs. [3,16] A version for dementia is also available (IPOS-Dem) [3,17]
• Comprehensive Geriatric Assessment (CGA) – evaluates the multidimensional needs of older adults [4,18]
• Needs Assessment Tool for Progressive Disease (NAT:PD) – assesses the needs of patients with a progressing chronic illness [1]

Tools to assess carer needs are discussed below.

SPICT™ is a tool used to identify people with deteriorating health due to serious illnesses, chronic conditions, or frailty in older age. [14,15] You can read more about recognising deterioration here. SPICT™ is simple to use and designed for use by all multidisciplinary team members across care settings. [14,15] It helps timely discussions about care preferences and planning by highlighting clinical indicators such as worsening health, increasing care needs, or repeated hospital visits. [14] It can help assess a person’s readiness for an advance care planning conversation and to explore their expectations, diagnosis, what matters to them, treatment options, and future plans. [5,14] As an illness progresses, it can support adjustments to care goals and the recording of a person’s end-of-life care plans and wishes. [14] The SPICT™ guide offers helpful prompts, tips, and the REDMAP (Ready, Expect, Diagnosis, Matters, Actions, and Plan) framework to support these conversations. [15]

Care of people with dementia

People with dementia often have multiple chronic conditions, making needs assessments more complex. [19] Standardised tools may not always capture their needs effectively, requiring input from family and observations from the clinical care team. [19] The IPOS-Dem tool assesses symptoms and concerns specific to people with dementia over a week, including physical, functional and psychosocial aspects of the person’s life. It also incorporates family perspectives, ensuring a holistic view of the person’s care needs. [17]

Implications for families

A life-limiting illness affects not just the person but their family and carers as well. [20,21] Assessing family needs helps monitor their wellbeing, support their caregiving role, and connect them to appropriate services. [20,21]

Carer needs assessment tools can help you identify the support, resources, and services carers require. Tools include:

• Needs Assessment Tool for Carers (NAT-C) [22]
• Needs Assessment Tool for Carers of People with a Chronic Condition (NAT-CC)
• Carer Support Needs Assessment (CSNAT). [23]

Families may also use the SPICT-4ALL™ to recognise early signs of declining health, facilitating timely discussions and support. [24]

By answering the questions in these tools, relatives and family carers can recognise key concerns and decide which ones to discuss with their GP. The tools serve as both a conversation guide and a care planning tool. [22-24]