Assessment of Individual Care Needs
Conduct regular and thorough assessments of each resident’s cognitive, physical and emotional needs to tailor care plans that are person-centered and responsive to changes.
Assessment is what makes the rest legitimate
Every claim DWARAA makes depends on knowing the individual resident well enough to make it. A medication that is unnecessary for one resident is load-bearing for another. The restraint-reduction section of the review opens with exactly this: a comprehensive assessment of physical, mental and emotional health, identification of the root cause of a behavior, review of medical history for underlying conditions, input from family on past triggers, and regular reassessment.
The causes that get missed
Behavior in a resident with dementia is communication by someone who has lost the other channels. The review names the usual suspects explicitly: pain, discomfort, boredom, confusion, and underlying conditions including urinary tract infection, dehydration, infection and dementia progression.
One of those deserves a caution, because it is the one most often got wrong in both directions. New confusion in a resident is a reason to assess, and it is not on its own a reason to culture urine and start an antibiotic — the infectious-disease guidance says so explicitly, and a quarter to half of long-term care residents have bacteria in the urine without infection. Why the reflex urine culture is the wrong reflex.
Baseline
You cannot detect change without a starting point, which is what the intake panel is for. Ongoing monitoring.
The assessment items in the review.
DWARAA is six steps. Back to the overview.
The five assessment items, in order
- Comprehensive assessment of the resident’s physical, mental and emotional health.
- Identified root cause of the behavior — pain, discomfort, boredom, confusion.
- Medical history reviewed for underlying conditions that may contribute: urinary tract infection, dehydration, infection, dementia progression.
- Input from family or caregivers on past triggers and what has worked before.
- Regular reassessment, so an intervention that has stopped being appropriate is noticed.
Why the family item earns its place
A relative can tell you that this person worked nights for thirty years, or was a teacher and settles when given something to organize, or has never in their life liked being touched from behind. None of that is recoverable from a chart, and all of it changes a care plan.
The reassessment trap
An intervention that works gets written into the plan and then stops being questioned. Dementia progresses; the approach that settled someone in January can be the thing that agitates them in October. Reassessment is not administrative box-ticking — it is the only mechanism that catches an intervention that has quietly become part of the problem.