Objectivity in needs assessment practice: admission to a residential home

In 1997, the Dutch government installed independent agencies to assess the long-term care needs of individual clients and to give advice on the allocation of appropriate services. Needs assessors assess, among other things, the eligibility of clients requesting admission to a residential home. According to guidelines, needs assessors should do this objectively and independently from care providers and health care insurers. The present paper examines how needs assessors explore the clients' expressed needs, determine their normative needs and advise on allocation. Needs assessors perform these tasks in a situation where a clear professional framework is absent, and moreover, residential home capacity is limited. A qualitative study was undertaken, observing 13 house calls of clients requesting admission to a residential home. Furthermore, interviews were held with all needs assessors and a document analysis was made. It was found that needs assessors use comparable methods in exploring the clients' motivation and assessing their needs in the relevant areas, apparently using a professional framework. However, when transforming the needs of clients into an adequate allocation, needs assessors struggled with interpretation of criteria and included their personal ideas of services into the allocation decision. The paper concludes with the suggestion that further professionalisation may lead to a greater uniformity in needs assessment practice, and will assist needs assessors in the difficult task of transforming clients' needs into long-term care allocation advice.