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Guidance for completion of the ‘Add Resident & Review Needs’ screen

Written by Rachel Martin
Updated over 10 months ago

Each of the definitions is included in the on-screen ‘Help’ by clicking the ‘?’ symbol. Please bear in mind that these definitions are for guidance only and are modified over time based on user feedback. Further comments and suggestions for enhancing the definitions are most welcome!

Key Care Factors

Nursing Care Required

This factor will not appear if the home is set as residential, i.e. has been defined in the setup as not providing nursing care. Set to YES only if this Resident specifically requires Nursing care, otherwise leave as NO to assume residential care needs.

Daily One-to-One Care Hours

If the Resident requires a member of staff to be specifically allocated to be with the Resident on a one-to-one basis for parts or all of the day; please enter the number of hours. For example, if 1:1 supervision is required for all waking hours from 0800-2200, enter ‘14’ hours.
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Note that the total care hours can exceed 24 where, for example, 1:1 care is required throughout the 24-hour day reflecting the input of a second member of staff. For example, if the Resident is in category R5 then 5 hours’ care will be needed; if 1:1 care is also needed at all times, the total hours would be 24 + 5 = 29.

Daily Additional Skilled Hours

If the Resident requires additional skilled time to perform specific interventions such as complex wound dressing, these hours can be entered here.

An example is where a nurse carries out bilateral leg ulcer dressings every third day, and it takes one and a half hours; as DepenSys times are based on a single 24-hour day, it is necessary to calculate the daily time. In this case 1.5 hours every third day would be 0.5 hours per day.

Recent Admission

This factor is active if the date of admission - or readmission - is within 30 days of the latest dependency assessment. This factor takes account of the time and skill required to plan the Residents care.
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This block is indicative, you cannot change this value directly.

Discharge Planning

This factor is active if a date for discharge has been set. An approximate date can be set if the exact date is not known. This factor takes account of the time and skill required to plan for a Residents discharge, including liaison with community services, for example.
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This block is indicative - you cannot change this value directly.

Accompany out of home

Mark this if the Resident goes out of the home on a regular basis and needs to be accompanied by a member of staff; selecting 1, 2 or 3 depending on the time involved in accompaniment as follows:
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  1. if less than 30 minutes per day or a total of 2.5 hours per week;

  2. if between 30 minutes and one hour per day or between 2.5 and 5 hours per week;

  3. if greater than 5 hours per week.

Note that the equivalent weekly hours are based on 5 days.

Psychological, Emotional & Social Care

Sensory / Communication Deficits
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This area is to reflect impaired sensory function and ability to communicate. Please note this does not include cognitive impairment – use ‘cognition / withdrawal’ either instead of or in conjunction with this area as appropriate. Sensory issues are mainly hearing and sight, but also consider touch, taste and smell, and functional communication difficulties such as expressive dysphasia. Score as follows:

  1. if hearing is impaired so that the person speaking to the Resident cannot be fully understood speaking at a normal level (whether a hearing aid is used or not), or the Resident has visual impairment beyond correction with spectacles, or the Resident has difficulty making themselves understood verbally;

  2. if hearing is impaired making verbal communication very difficult, or sight is impaired to the extent that hazards cannot be identified whilst walking, or the Resident has to use other means than verbal to make themselves understood, e.g. pictures, sign language;

  3. if hearing is impaired to the point that communication is impossible by speech, or sight is impaired so that the Resident cannot identify visually the person they are with, or the person is unable to communicate for expressive or receptive reasons.

Impaired Consciousness

(1-3)
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Score 1-3 if there is any impairment of the Resident’s level of consciousness according to the following scale:

  1. if the Resident has temporary periods of impaired consciousness at least once per month, e.g. epileptic seizures.

  2. if the Resident has weekly or more frequent temporary periods of impaired consciousness, or has a permanently impaired level of consciousness.

if the Resident is unconscious or unable to respond to stimuli, or has temporary periods of impaired consciousness on a daily basis.
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Cognition / Withdrawal

(1-3)
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Score 1-3 on the degree of cognitive issues, disorientation to time and space, or the degree to which the Resident withdraws from interacting with others or the environment. Do not score this area if the Resident is unconscious.
Score as follows:

  1. if there is any degree of cognitive impairment, disorientation, or withdrawal;

  2. if cognitive impairment is moderate, but rational responses can be given to questions about basic needs e.g. ‘Would you like a drink?’, or the Resident withdraws from participation in activities other than basic care;

if the Resident is suffering from severe cognitive impairment or has fully withdrawn from interactions.
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Behaviour Management (1-3)

Score 1-3 depending on the degree of behavioural management required. This is a complex area, and needs to be judged on the following factors;

  1. if the Resident actively refuses to participate in care and requires persuasion to do most things, or exhibits manipulative behaviour which is easily managed;

  2. if the Resident actively refuses to participate in care and may occasionally and unpredictably become abusive or aggressive, or exhibits manipulative behaviour which is difficult to manage;

if the Resident is regularly abusive or aggressive towards staff and others when care is offered or being performed, or is acting out on delusions; or exhibits manipulative behaviour which is unmanageable.
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Special Emotional Needs

Mark a ‘1’ if the Resident needs significant reassurance or emotional support, for example in emotional lability following CVA. If ‘High Psychological Needs’ is scored you will not be able to set this value.

High Psychological Needs
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Mark a ‘1’ if the Resident has significant psychological problems and needs regular counselling; for example, in terminal illness or the recent death of a close family member. If this is marked, ‘Special Emotional Needs’ cannot be set.

Special Family Needs
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Score a ‘1’ if one or more of the following apply:

  • the Resident’s family requires a high degree of support due to specific issues arising from the Resident’s condition (for example terminal illness or coping with a recently-discovered serious condition);

  • one or more family members are particularly anxious and need significant support;

the Resident has little contact with family or no family at all.
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Educational Needs
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Enter a ‘1’ if the Resident – or family – require significant education in understanding care or specific conditions, e.g. diabetes / diet. Only enter this if this is a new issue, or teaching is significant and continuing.

Physical Care

Airway / Breathing Problems

Enter ‘1’ if the Resident has any breathing difficulties including regular use of inhalers.

Mobility Needs
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Mark 1-3 according to the degree of mobility restriction and/or falls risk;

  1. if the person needs any degree of assistance in mobilising, e.g. assistance to stand even if he/she can walk unaided, or assistance in and out of their own wheelchair if they can move independently once in the wheelchair, and/or is at low risk of falls.

  2. if the Resident needs assistance to walk or if a wheelchair is used to transfer from bedroom to lounge, for example, and/or is at medium risk of falls;

if any degree of hoisting is required, and/or the Resident is at high risk of falls. The system automatically marks this as ‘3’ if the Resident is living in bed.
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Bed Rest / Living in Bed

Enter ‘1’ if the Resident has to stay in bed or in equivalent specialist seating (not wheelchairs) at all times for any reason, e.g. severe illness or physical disability, or on medical advice. Leave blank if it is the Resident’s own choice to remain in bed. Setting this to ‘1’ will also automatically mark ‘Mobility Needs’ as ‘3’.

Nutrition / Fluid Needs

Score 1-3 depending on the degree of risk, assistance or support required;

  1. if the Resident requires routine prompting to take food or drink, is on a simple diet, e.g. diabetic or reducing, requires a modified diet such as soft or pureed.

  2. if the Resident has a MUST score of 1 (at risk), or if the Resident needs some assistance to take food and drink, e.g. needs their hand guiding to their mouth, or has swallowing problems (e.g. requiring thickened fluids); is on a complex diet; or has known mild to moderate food allergies.

  3. if the Resident has a MUST score of 2 or more (high risk); is unable to take food or drink independently; has a PEG tube; is unable to take adequate nutrition and/or fluids e.g. at end of life; or has significant food allergies.

Do not mark if the Resident can take food independently if it is cut up, or by the provision of adapted utensils, or if minimal prompting is required.
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Personal Care Needs

Score 1-3 depending on the degree of assistance or support required;

  1. if the Resident requires routine prompting to wash or dress, or help selecting appropriate clothing; or requires more than minimal assistance e.g. beyond putting on stockings or socks; or needs supervision when bathing;

  2. if the Resident needs assistance to wash and dress but is able to perform some tasks e.g. washing face and hands, cleaning teeth, shaving, brushing hair, putting on makeup;

if the Resident requires full staff assistance to wash and dress.
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Incontinence / Stoma
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Score 1-3 depending on the degree or complexity of the problem;

  1. if the Resident has occasional ‘accidents’, but is normally able to indicate when they wish to go to the toilet, or can be managed by regular toileting;

  2. if the Resident is incontinent of urine more than once a day, or faeces more than twice a week, and / or is unable to indicate when they need to go to the toilet;

if the Resident has no control over bowel or bladder, is regularly doubly incontinent or has a stoma that he/she is unable to manage independently.

Skin / Wound Care
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Score 1-3 depending on the degree or complexity of the problem;

  1. if the Resident requires routine care for assessed risk of skin breakdown including preventative management, or if the Resident has any skin problem requiring regular monitoring or minor attention, e.g. application of creams for dryness or localised rashes;

  2. if the Resident requires care for assessed risk of skin breakdown including planned positional changes which may include the use of dynamic / alternating cell mattresses or other specialist equipment; or if the Resident has a generalised skin rash.

if the Resident has a wound or grade 2 pressure ulcer or above requiring regular wound dressing; if the Resident is unable to take adequate nutrition e.g. at end of life resulting in probable skin breakdown; or if the Resident has significant skin problems including blistering or allergic reactions resulting in severe irritation and / or open wounds.
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Catheter / Tube Care
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Score 1-3 depending on the degree or complexity of the problem;

  1. if the Resident has an indwelling or suprapubic catheter, PEG, naso-gastric tube, or IVT present including syringe driver, but these are easily managed;

  2. if the catheter or tube requires more frequent care, e.g. frequent catheter blockage / non-drainage, IVT / syringe driver changed more frequently than four-hourly, or regular aspiration required;

if more than one catheter/tube is present, and / or attention is required hourly or more frequently.
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Specific Care Interventions

Infection Control Precautions
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Mark ‘1’ if the Resident has any infection present, e.g. MRSA in a wound, or is particularly susceptible to infection. Mark this if any special precautions are required over and above routine infection control precautions; ‘routine’ includes wearing gloves for dealing with incontinence.

Intake / Output Monitoring

Mark ‘1’ if there is specific monitoring of food and / or fluid intake, or measured output of urine.

Tests / Procedures
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Score 1-3 depending on the degree or complexity of the test or procedure;

  1. if the Resident is undergoing weekly / monthly blood glucose tests, or tests from the GP, e.g. routine blood tests e.g. INRs;

  2. if the Resident is monitored daily, e.g. blood glucose levels, TPR etc;

if the test/procedure is more than once a day, e.g. if the Resident is on a sliding scale of insulin and blood glucose monitoring is used to determine insulin dosage.
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Medication Supervision

  1. Only if the resident has no prescribed medicines.

  2. the Resident is compliant with taking their medicines; including basic assistance to take their medicines e.g. providing a glass of water and / or using a spoon to administer them; or if the resident is self-medicating. Also includes the application of prescribed topical applications by a nurse or carer.

  3. the Resident often refuses their medicines or needs regular persuasion to take it.

  4. the Resident is administered medicines by injection or PEG; is on controlled drugs; or is administered medicines covertly.

Observation / Supervision

All Residents require observation and supervision, and time for this is built into the system. This area of need is to indicate where in exceptional circumstances the individual resident requires specifically planned observation or supervision for identified risk factors. The level of supervision has to be set out in a specific risk assessment and the care plan, and the checks must be formally recorded. Examples include post-operative or neurological observations, a very high falls risk, and the possibility of harm to the Resident or others through the inability to recognise hazards, high risk of or frequent seizures, or aggressive behaviour. Score as follows:

  1. for observation and recording hourly.

  2. for observation and recording every 30 minutes;

  3. if the Resident needs close monitoring of their condition or behaviour every 10-15 minutes, e.g. where the Resident is actively attempting to leave the home unsupervised or where behaviour needs to be closely monitored. For supervision beyond this level, consider using ‘1:1 care’.

This area does not include, for example, a member of staff allocated to a communal area to routinely observe a number of Residents, or where an organisational decision has been made to routinely check all residents hourly during the day and/or at night.

Related Articles
Completing the resident assessment/review of needs
Reviewing The Results
What do the DepenSys time calculations cover?
DepenSys Calculation Breakdown
Decision Insights 2 User Guide
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