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Assessor Quick-Start Guide

This section is designed to train assessors on how to use each component of the QOL.SRI/CP:

QoL.SRI.DQ

Asking the Questions

Each closed-ended question on the QoL.SRI.DQ is designed to measure the residents’ subjective experience and the importance they place on that experience.

QoL Rating. The first part of the question calls for a ‘yes-no’ response. This is followed by a quantitative rating. Residents who answer ‘yes’ are asked to rate the frequency: ‘Always’ or ‘Often’. Residents who indicate ‘No’ are given the branching option of ‘Rarely’ or ‘Never’. This branching approach to asking the question puts as many residents as possible on a 4-point scale.

The assessor should attempt to ask both parts of the question. If residents understand and can use the 4-point scale, then it is not necessary to go through the every step of the branching question every time. After the resident seems to get it, then the assessor can just continue.

On the other hand, if the resident is able to answer the ‘Yes-No’ part, but not the frequency part, then after four tries, the assessor should skip the frequency part for all subsequent items. This will streamline the assessment process and reduce frustration and confusion for the resident.

If the resident is unable to answer 8 consecutive questions using the ‘Yes-No’ response categories then you may terminate the interview.

Importance Rating. The importance rating is asked if the resident’s response reflects poor QoL. The resident is asked to indicate the importance of the item in question by rating it ‘very important’, ‘somewhat important’, ‘not very important’, ‘not important at all’, ‘important but can’t do/no control’.

Note that the response set for these items parallels the format of the MDS 3.0.

Flow chart of QoL question

Scoring the Questions

The QoL.SRI.DQ is formatted to easily show which responses denote a poor quality of life. If a resident’s response falls into a box that is shaded gray, this reflects a poor quality of life rating. This question should be followed by the importance rating. For each QoL item that appears in a gray box a score must be calculated. To calculate this score, multiply the checked values from each of the gray boxes. This will yield a score for each QoL item with a range of 1-8, 1 being the poorest quality of life and highest importance.

Scoring Example

Refer to the QoL scoring matrix for assistance in quick scoring items. If a resident is unable to answer the importance rating than the item is considering missing for the QoL item score.

Scoring each domain

The domain scores are used to track resident and facility level QoL over time. The QoL.SRI.DQ generates scores for each of the 12 domain areas covered by the assessment. The scores range from 1-4, with higher indicating better QoL.

Upon completion of the interview, the resident’s average quality of life for each domain should be tabulated and recorded. Calculate the sum value of the always/often/rarely/never responses (yes/no response value if failure to answer four point branching) in the domain and divide by the total number of responses in that domain. If the resident failed to answer 50% of the domain’s responses that domain is considered “missing”.

Domain Scoring

The item scores and the domain scores and then recorded on the <face sheet> for each assessment time point.

Download an example of a closed ended assessment with all scoring completed

QOL.SRI.ID

Selecting Items for In-Depth

At the conclusion of the closed ended interview, the assessor reviews the item scores and ranks them by the combined lowest quality of life and highest importance. For example, if a resident responds that they are never able to reach the things that they need and this is ‘somewhat important’ this item will be ranked higher than one where the resident says they ‘rarely’ have interesting things to do on the weekends and it is ‘not important at all’. The goal of ranking the items is to identify which quality of life items are the worst and that the resident reflects as being the most important to improve.

Each decentralized assessment will instruct the assessor on how many items to select for in-depth follow up.

In the case of a tie, choose the item that was asked closest to the beginning of the interview. For example, if both CMF_2 and AUT_4 scored a 1.5, CMF_ 2 should be selected.

In addition, you may choose an additional “wild card” item based on your observations and judgment that an issue is important to a resident, even if it does not rank highly.

Face Sheet

If only one item triggers during the assessment, than that item is the only one that will need to be included for the in-depth follow up, unless an additional wild-card option is also selected.

If no items trigger during the domain questionnaire a wild-card item should still be selected as to gain further detailed insight on some area of the resident’s quality of life, even if it is how to maintain what appears to be positive quality of life areas.

Asking the Questions

The ranked items with the poorest quality of life and highest importance are then probed further. Suggested probes are provided for each item, but the assessor is not restricted to these probes and is free to ask any additional questions regarding that item that they see as relevant.

Focus on things the resident feels would improve or solve the situation. Attempt to keep the discussion in the realm of feasible actions and ones kept within facility regulations. Revisit any related comments made during the closed ended interview. The responses to these in-depth probes will then be used to create the quality of life care plan.

For practice asking In-Depth questions use the worksheets provided below

Asking Probing Questions Worksheet 1.pdf

Asking Probing Questions Worksheet 2.pdf

QOL.CP

Developing the Care Plan

Each department should use the QoL.SRI to develop a QoL.CP that addresses a practical and tangible goal of the resident. This should be incorporated into each department’s operating procedures. The initial draft of the Quality of Life Care Plan includes a problem statement written in the resident’s voice, a quality of life care plan goal, also written in the resident’s voice, the care plan goal completion date (90 days from implementation), the responsible staff, and the care tasks.

Gather all information collected during the resident interview. Using the summary of the in-depth responses as a starting point, review all of the resident responses and assess for feasibility and regulatory compliance.

Staff members should work these questions into their daily routine when working with the residents. When writing these care tasks into the care plan they should be worded as instructions, “Ask the resident if she would like the pull cord for her light tied to her bed.”

After constructing the tasks and associated questions to place into the care plan, identify the responsible staff for completing each task. For example, tasks that are the responsibility of the aides could be addressed during the change in shift report and added to the ADL flow sheet. Tasks for the social worker should be added to the care plan. Care plans involving interdisciplinary care tasks should be reviewed with the appropriate department as to assure no overlap in care plan tasks.

Care plan tasks should be simple yet very specific and individualized to the resident. Each task should take approximately five minutes to complete, therefore three care plan tasks would require around fifteen minutes to complete for the staff responsible. The goal is to make a big impact with a small change.

Creating Care Plan Tasks Worksheet.pdf

If care tasks seem to vague or broad when initially creating them return to the interview data, the observations or proxy interviews and narrow down each task. (See How to Make Care Tasks Unique Worksheet for practice individualizing tasks)

Make Care Tasks Unique.pdf

The initial care task should include one to two follow up tasks. If the resident indicates that yes he/she would like to attend a group activity once a week, follow up tasks could include asking the resident if he/she needs assistance transporting to the activity or asking the resident if they would like to be reminded the day bingo is scheduled.

Tasks requiring housekeeping, dietary, activities, spiritual advisors, social services and nursing are all possibilities depending on the triggered quality of life item. There may also be instances where a care plan includes tasks for multiple staff. In this sense the Quality of Life Care Plans will require that the facility staff work together towards improving the quality of life for each resident.

Don’t be afraid to think outside of the box and involve other residents, family members or different staff members. Ask if they would like to take part in the care planning process and what they would like to contribute. Creativity is the key.