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Home Health Patient Assessment Tools

This resource was developed by AHRQ as part of its Public Health Emergency Preparedness program, which was discontinued on June 30, 2011. Many of AHRQ's PHEP materials and activities will be supported by other Federal agencies. Notice of transfer to another agency will be posted on this site.

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7. The Community-Living Patient Assessment Tool for Disaster Planning (with Instructions)

The Community-Living Patient Assessment Tool for Disaster Planning creates a record for identifying patient needs and a plan for meeting those needs in the event of a mass casualty event (MCE). It should be completed for every patient/client upon admission or program entry and reviewed and updated as needed on a regular basis (at least every 60 days) or prior to an anticipated MCE. The tool should be completed by a health care professional or someone who knows the individual's physical and medical needs and the resources/support that are available in the community.

Select for an image of the tool card.

In three steps, this tool identifies the treatment/service/equipment needs of the patient (including caregiver availability), leads the user to identify the most appropriate locus or level of care if the previously noted treatments/services/equipment are interrupted by an MCE, and asks the user to estimate the length of time that the patient can safely remain at home if the usual services/equipment are interrupted by an MCE. This is not a triage tool to be used in the midst of an MCE, rather it is a tool for anticipating the needs of home care patients to aid in emergency planning.

Label the tool with a patient/client ID and enter zip code for patient/client's residence.

Step 1. Review the services/needs that are being provided for the community-living patient

Medical Procedures/Treatments

Check all that the agency provides; do not check services/needs that the patient manages on his/her own. Use the blank lines to enter additional services/needs not listed. For each service, indicate if the need priority is "high" (column 1/red box), "medium" (column 2/yellow box), or "low" (column 3/green box) using the following criteria:

High Priority. Patients in this category need uninterrupted services and/or are highly unstable.

Medium Priority. These patients are somewhat medically unstable and care should be provided on time or within 24 hours. These patients do not use life-sustaining equipment or their equipment can be easily moved with them.

Low Priority. The patient's medical condition may be stable. The patient can safely miss a scheduled visit(s) if basic care is provided by self or an informal caregiver.

Activities of Daily Living (ADLs)/Supervision/Communication/Transportation

Check all that the agency provides; do not check services/needs that the patient manages on his/her own. Use the blank lines to enter additional services/needs not listed. For each service, indicate if the need priority is "high" (column 1/red box), "medium" (column 2/yellow box), or "low" (column 3/green box) using the following criteria:

High Priority. Patients in this category need uninterrupted services and/or are highly unstable.

Medium Priority. These patients are somewhat medically unstable and care should be provided on time or within 24 hours. These patients do not use life-sustaining equipment or their equipment can be easily moved with them.

Low Priority. The patient's medical condition may be stable. The patient can safely miss a scheduled visit(s) if basic care is provided by self or an informal caregiver.

Equipment Management

Check the equipment needs of the patient.

Medication Management

Check the types of medication(s) prescribed for the patient.

Caregiver Availability

Indicate the availability of a caregiver.

Step 2. Determine the most appropriate level of care if services/care are interrupted

Review the information gathered in Step 1 and your overall assessment of the patient. Based on the services, equipment needs, and caregiver availability listed in Step 1, what level of care is most appropriate for this individual if the usual services/equipment are not available?

Step 3. Determine how long this patient will be safe in the home if services/care are interrupted

Review the information gathered in Step 1 and your overall assessment of the patient. Based on the services, equipment needs, and caregiver availability listed in Step 1, how long will this patient be safe in the home if the usual services/equipment are not available (consider the battery-life of any necessary equipment if power lost)?

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AHRQ Publication No. 11-M020-EF
Current as March 2011

The information on this page is archived and provided for reference purposes only.

 

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