The Resident Interview

Obtaining a good history when working with the elderly—including information on social circumstances and lifestyle in addition to medical and family history—can be daunting task but it is crucial to good health care and particularly essential when it is your responsibility to ensure that your resident continues to experience his/her formerly familiar home-like lifestyle within a facility environment.

The key to the residents’ successful transfer is your ability to elicit history information and hone you’re interviewing techniques. The following guidelines can help you obtain a thorough history of current and past concerns, family history, medications, and socioeconomic situation.

The following are less time-consuming than they may appear. Some involve a single investment of time. Other healthcare professionals in the office or home may assist in gathering the information.

You may need to become skilled and particularly flexible when obtaining the medical history. Here are some strategies to make efficient use of your time while maximizing the amount of information obtained:

If feasible, try to gather preliminary data before the anticipated admission day:

Try to have the resident tell his/her story only once, not to another staff member and then again to you.

It is wise practice for the social worker to make the opportunity to meet with the resident and his/her family prior to the admission day but not always possible. This will give the resident a familiar face during the interview and help to reduce potential anxiety.

NOTE: It falls on either nursing or the social worker to look for openings to discuss issues such as advance directives*.

*Advanced Directives- Advance care planning involves learning about the types of decisions that might need to be made, considering those decisions ahead of time, and then letting others know—both family and healthcare providers—about preferred preferences. These preferences are often put into an advance directive, a legal document that goes into effect only if the individual is incapacitated and unable to speak for him/her self. This could be the result of disease or severe injury—no matter at what age illness occurs.

Use Active Listening - “Listening to Understand”

NOTE: Keep in mind that the interview itself can be beneficial. Giving your resident a chance to express concerns to an interested person can be therapeutic and can build trust. Encourage the resident (and his or her caregivers) to bring a written list of concerns and/or questions.

Providing care to residents with post-acute and long-term care needs is complex and challenging work. It utilizes clinical competence, observational skills, and assessment expertise from all disciplines to develop individualized care plans.

The majority of senior care facilities rely on the use of The Resident Assessment Instrument (RAI). The RAI helps staff to gather definitive information on a resident’s strengths and needs, which must be addressed in an individualized care plan. It also assists staff to evaluate goal achievement and revise care plans accordingly by enabling the facility to track changes in the resident’s status. As the process of problem identification is integrated with sound clinical interventions, the care plan becomes each resident’s unique path toward achieving or maintaining his or her highest practicable level of well-being.

The RAI helps facility staff to look at residents holistically - as individuals for whom quality of life and quality of care are mutually significant and necessary. Interdisciplinary use of the RAI promotes this very emphasis on quality of care and quality of life. Facilities have found that involving disciplines such as dietary, social work, physical therapy, occupational therapy, speech language pathology, pharmacy and activities in the RAI process has fostered a more holistic approach to resident care and strengthened team communication.

Understanding an older patient's usual level of functioning and knowing about any recent significant changes are fundamental to providing appropriate health care. This information critically influences the “individualized” Care Plan treatments.

Depending on the resident's status, ask about ADLs such as eating, bathing, and dressing and more complex instrumental activities of daily living (IADLs) such as cooking, shopping, and managing finances. The ability to perform basic activities of daily living (ADLs) for example, reflects and affects a resident's health. This information offers a multitude of clues that will forecast your calendar planning efforts that meet the needs and interests of the resident.

Endeavors to understand the life history helps you to come to know your residents’ unique characteristics and individualities. It also strengthens and establishes trust as the resident experiences and comes to realized realize that you are showing interest and making efforts to get to know and value these special qualities within your resident.

Be alert for information about the resident's relationships with others, thoughts about family members or coworkers, typical responses to stress, and attitudes toward aging, and work. Equally important is the resident’s view on such topics as illness and death. Particularly considering his/her emotional state during the transition from home life to long term care living. This information may help you interpret the resident's concerns and make appropriate recommendations.

The social history is also crucial. If you are aware of your resident's living arrangements you are much more likely to devise realistic, appropriate interventions. Where the resident lived; the neighborhood safety; eating habits; smoking, drug, and alcohol use; typical daily activities; and work, education, and financial situations will supply you with essential information.

In addition, knowing the family’s structure will help you to know what support may be available from family members, if needed. To this end, investigate whether you resident is a parent, has children or grandchildren, and other extended family members such as brothers and sisters nearby.

Understanding the individual’s life and daily routine can help you to understand how you might structure his/her lifestyle options and care plan appropriately and help your resident adapt to the new living environment successfully.

https://www.nia.nih.gov/health/obtaining-older-patients-medical-history
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/MDS20raich1.pdf