Older People In The Community
The Indicator of Relative Need (IoRN) is a practical, nationally supported tool for local Partnerships to use to gather information about the relative dependency levels of (mainly) older people receiving support or services. Where it has been introduced in Scotland Partnerships have found it useful in support of individual decisions about care and have information to support wider planning and monitoring on an aggregate basis. Contact details for more information are provided below.
The IoRN was originally developed to support a growing demand for good objective information to support decision making at all levels in community care. Whether for individual case management or for service management and planning, the availability of good information on relative (in)dependency is increasingly recognised as an important step to better and more efficient services. In the context of a future with many more older people living at home than ever before, this information is a vital component of the information landscape for social and nursing care and for housing services.
What is the IoRN?
The IoRN is a questionnaire [440KB] containing carefully selected questions that are designed to inform an algorithm for determining the relative independence/dependence of individuals. The questionnaire covers characteristics such as activities of daily living, food and drink preparation and mental health and behavioural issues to categorise the individual into one of nine groups - where group A is 'most independent' and group I is 'least independent'. A lead practitioner will normally complete an IoRN immediately after an assessment. Experience suggest that this typically adds no more than five or six minutes on to the assessment time.
The development of the IoRN in 2001/2 (it was originally known as the Resource Use Measure) involved a large number of practitioners working across Scotland. This approach ensured that the eventual tool made sense and was not onerous to practitioners who complete IoRN routinely. Nevertheless to ensure a high degree of consistency across Scotland, it is highly recommended that practitioners are offered standard training prior to their use of the tool. Group training is available on request from Kathy McGregor at ISDScotland.
Examples of use of IoRN data:
The Indicator of Relative Need is recommended for use with older people who are living in the community, though some local examples of its successful use with younger adults with complex needs have been reported. Use of the IoRN at review (or at reassessment, etc) greatly enhances the potential use of the tool in outcome assessment. Uses include:
- As a local monitoring tool for showing who is being assessed under the different national eligibility categories.
- As supporting information for validating decisions in care plans, e.g. when considering possible care home admission.
- Alongside other information as a way of identifying individuals with high support needs (with or without a carer).
- When used at follow-up points, as a way of objectively demonstrating changes in (in)dependence, e.g. in intermediate care.
The Scottish Government's Partnership Joint Improvement Team (JIT) conducted a survey of the (plans for) use of the IoRN by partnerships during 2010. Further information is in the Scottish Government Joint Improvement Team website.
Peter Knight (email: firstname.lastname@example.org), Scottish Government.