Defining and assessing need : an ethnographic study of the community care needs assessment of older people

Richards, Sally Claire (1996) Defining and assessing need : an ethnographic study of the community care needs assessment of older people. University of Southampton, Doctoral Thesis.

Abstract

The inquiry started from two separate concerns. The first relates to the concept of needs-based assessment, which has a central role in the reorganisation of community care under the NHS & Community Care Act. Yet it is a concept which rests on an essentially contradictory approach to the definition of need, and it was unclear how these contradictions would be resolved in practice. The second stems from the limited and stereotyped view of need that is the norm in work with older people. Would this view be challenged by a new approach to assessment?

The work of assessment was studied in two social services teams, in hospital and area settings. Following a period of exploratory fieldwork data was collected on twenty individual assessments, which form extended case studies of the assessment process. Data collection was guided by a model of assessment as a series of interlinked dialogues, each of which might frame the elderly person's needs in a different way. These dialogues, involving professionals, service users and carers, were accessed directly where possible through observation, otherwise indirectly through research interviews. This also enabled observations of the assessment process to be linked to the experiences of the professionals and service users as reported in interview.

Analysis of the data revealed a process that lacked a coherent theoretical basis for understanding the needs of older people, in which attention was focused primarily on the need for personal care, thus excluding or distorting the consideration of other needs. It was also a process that could resemble the children's game of Chinese Whispers. For the professionals struggled to make sense of agency policies, and to communicate effectively with each other, whilst the exchanges between the practitioners and the elderly people were subject to many difficulties. It is argued that this picture points beyond the weaknesses in the legislation, and even beyond organisational and resource issues, to a fundamental principle of assessment. This is that assessment is a process which requires effective communication and an appropriate theoretical underpinning if it is to achieve an adequate understanding of need and meaningful participation by service users.

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