Conversational Assessment

Have a think about a time that you were applying for a loan or looking to make a large purchase.

If you’re around my age, it’s probably occurred a few times through your life.

Now consider how the person ‘interviewing’ you, or trying to help you get what you wanted, interacted with you. Did they simply ask you a series of set questions, or did they take the time to find out more about you and what you were seeking?

If the interviewer or sales person was focussed on making the sale, barking out questions like, size, make or model, how much you earned and how you wanted to pay for the item, rather than taking the time to find out why you wanted the loan or the item and what your goal was in making the purchase, you possibly felt like you were being interrogated rather than being supported through a buying process.

For me, the process felt impersonal, like the person was just ticking boxes and are not really concerned about helping you attain your goals or aspirations – simply ticking off their list, making decisions based on meeting their set processes and not giving any real thought on the outcome sought for both parties.

When you sit down to assess your clients in a community setting, do you take the time to get to know them really well? Do you seek to find out their goals and what is important to them?

It’s not really something that you can just ask outright is it? Asking someone you don’t know well to articulate their aspirations and goals can be difficult. Often they are unsure of what they can ask for, or even what they really want. It takes a bit of exploration and observation on your part to discover what is important to them. This is where what I call ‘conversational assessment’ comes into play.

The more you know about the background and current situation of a person, the more information you have to form a successful support plan.

I always found that assessing a client over a cup of tea in their home, or while participating in activities, was more effective than having a set of questions. Asking a senior Aboriginal person about the services they wanted often resulted in a request for meals and laundry, because that’s what everyone else got.

But as we got to know them more, we discovered they often wanted and needed more.

So what’s the right approach?

Observation and picking up on clues is key. You are the curator of information and this is not the time to expound on your own life or story – it’s about discovering the client’s story.

Finding out more about the person and their family supports.

Firstly, we want to find out what sort of support the client has. This allows us to plan better and not encroach on things that the family or friends of a client already do for them. Instead of asking the standard questions of ‘do you have family nearby?’ or ‘what family support do you have?’, try instigating a natural conversation that allows them to reveal the relationships that are important to them or, sometimes, the losses they may have faced.

In an urban setting, perhaps you could talk to them about family photos on the wall, old photos of parents, the war years and children. This can give you a starting point. A simple comment relating to something in one of the photos such as, ‘that’s a lovely photo, when was it taken?’ or ‘I love these old posed photos, they are a real snapshot in time’, can spark a relevant conversation.

When assessing a client in a remote setting, we often need to take cues from the people who are with the old person. The client will usually identify who the person is (‘this is my daughter’ or ‘this is my grandson’). It’s easy then to follow up with a ‘great, so you live here as well?’

But maybe you don’t even need to do this. When you take a group of ladies out for a bush trip, you often find the conversation leads to discussions about family and what is happening with grandchildren, sons or daughters, or stories of old times.

At other times you will pick up information about relatives and who’s who from the conversation. ‘I need to visit my granddaughter in Papunya, it’s her birthday’ or ‘Jeannie wants to go to Yuendumu to sit down with her sister’.

If relevant snippets of information are recorded in the client’s file or in a life book, you build up a picture of the client and it makes care planning easier.

Observation

Physical and mobility needs

Observation is an important part of assessment. We make assessments based not just on what someone says, but by reviewing that against what we observe.

If we asked the client if they had any problems with moving around or their mobility, they may reply in the negative. However, we might observe the person has difficulty getting out of the chair they are sitting in, or reveal they keep everything for making the tea on the bench because they find reaching up difficult.

Personal Care needs

This is sometimes evident through observation. An unkempt appearance such as cuts on the face from shaving, uncombed hair, misapplied makeup, etc. can all be indicators of where assistance is required, along with noting any strong personal hygiene odour.

Getting the person to admit to any issues however, can be more difficult and takes tact and the development of a trusting relationship.

Communication and Hearing

This is often an easy one. If we need to raise our voice or if they ask us to sit on a certain side, or continually ask us to repeat what we said, it’s likely that there is a hearing issue. Some people with hearing loss are great at lip reading, so also note whether the person positions themselves in front of you and looks at your mouth.

In a remote setting where sign language is used as a common form of communication between people, or in settings where it is more common for another person to talk on behalf of the elder, you may need to ascertain this need in a more round about way if it is not obvious. It’s also okay to ask people around the person as to whether they have a problem with their hearing.

Allergies or intolerances

Clients with allergies or intolerances are pretty quick off the mark to let you know these, especially if they are seeking delivered meals as a service. However, you may have some people who ‘don’t want to be a bother’ and won’t reveal this or forget to mention it.

A simple statement that ‘so many people seem to have intolerances these days, it seems that everyone seems to have something they can’t eat’ could be the opening they need to disclose that ‘yes, they get reflux when eating tomatoes’ – relevant information which can then be added to the meal alert.

Activities they like to do

People can have difficulty expressing what they like to do; this is where observing the home environment is beneficial.

My mother is an avid quilter and you can’t help but know this by the amount of material, the quilting machine and some very beautiful quilts, cushions and hangings scattered around her home. It’s an easy segue to get her talking about how much she likes to attend her local quilting group and finding out how much she enjoys the activity.

If it was also revealed at that time that she could no longer attend the group because she could no longer drive, this would be a trigger for investigating whether this is something that we could help her with – after all, services are not just about showers and domestic assistance, but supporting the person’s mental and social wellbeing as well.

Look around the home and observe:

• any awards hanging on walls?
• do they still enjoy watching football even if they can no longer play?
• are there paintings of ships and lighthouses, or barometers and telescopes that reference their interest in all things nautical?
• what does a cursory glance at the books on their shelf reveal?

If it’s not as obvious what the person enjoys doing rather than asking a direct question like ‘what do you like to do?’, try some roundabout questions to help you build up a picture.

• Did you do anything interesting this past weekend?
• Do you belong to any clubs or groups?
• Make an observation – that is a lovely flower arrangement, did you grow the flowers yourself?
• If there are recent magazines in the home, ask what’s new in the world of …

Cleaning and the home environment

When assessing in an urban setting, taking the time to chat over that cuppa may have revealed that the client was making the tea using an old Bakelite topped kettle, complete with fraying cord. This raises the question of what sort of condition the vacuum might be in that staff would be expected to use and what other safety hazards do you need to be aware of?

The cup the tea was served in could have been a bit cleaner, raising the question of how good the person’s vision is or how they are coping with cleaning activities.

The presence of Fluffy the poodle, who is well-fed but slightly unkempt, could indicate some pet care is required.

And what about that pile of laundry in the corner of the room? Do they need some help with aspects of managing the washing?

Yes, you can find out so much just from observation and a 30 minute conversation that puts the person at ease and lets them know that you want to know about them as an individual, not just another client.

While we also have to collect or check some standard questions, such as date of birth and contact details, these can be left till the end after a rapport has been built with the client. And you can often obtain this information from their initial referral – let’s not ask people to continually repeat themselves.

Once that link has been formed and the client is comfortable sharing information, it’s a simple matter of asking them to confirm a few ‘standard’ questions that the organisation needs for statistical and administrative purposes.

Instead of perhaps ‘following the script’ and moving from one question to the next on your assessment form, if you pick up on clues, you can develop a more robust assessment that will inform a solid care plan. Not only do you more effectively meet the consumer’s needs, you are also easily able to demonstrate your organisation’s commitment to meeting Standard 2, Standard 3 and Standard 4 of the new Aged Care Standards.

If you are enjoying these blog posts you may also find our Total Quality Package resource hub helpful. We have developed (and continue to develop) culturally appropriate, tailored templates, forms, eBooks, fact sheets, ToolBox Talks, policy and procedure suites, and much more, and we are making all of it available to you! Click here to find out more.

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