Towards a measure of function for home and community care services in Australia: Part 1 - Development of a standard national approach

The aim of the project was to recommend, for national use, validated and reliable instruments for measuring the dependency of people eligible for Australian Home and Community Care (HACC) services. The project was split into two stages. Stage 1-reported here-reviewed the suitability of existing instruments and scales to measure levels of dependency within the target group and made recommendations on a set of measures for national field testing in Stage 2. The review covered four domains of function (domestic or instrumental, self-care, challenging behaviour, and cognitive) and recommended an instrument for each domain. A two-tier assessment system was developed. The first tier consists of a simple nine-item functional screen. It consists of seven items from the OARS instrument (Fillenbaum & Smyer, 1981) and two additional items to cover cognitive and behavioural functioning. The second tier consists of five functional assessment instruments, used only with those triggered for an assessment from the first tier assessment. The five instruments are the Barthel Index (Collin, Wade, Davies, & Home, 1988) or the Functional Independence Measure (FIM, Granger et al., 1993) to assess self-care; the Lawton's Instrumental Activities of Daily Living (IADL) Scale, with modifications to make it suitable for the HACC program, to assess domestic functioning; the Australian Resident Classification Scale (RCS), with modifications to make it suitable for the HACC program, to assess behaviour; and the Folstein Mini-Mental State Examination (MMSE [30-point]) to assess cognition. The selected instruments were, on the weight of the available evidence, those that best met our criteria in terms of validity, reliability and acceptability. The performance of the instruments with a representative sample of HACC clients and services forms Stage 2 of the research; this empirical evidence is reported elsewhere in this Journal.