The matrix of care: a heuristic for assessment and placement

Policymakers and practioners have attempted to enhance the quality of long-term care, and thereby provide appropriate care, by using the notion of levels of care. This approach assumes that the needs of those requiring long-term care can be easily ordered along a single continuum. This conceptual position, however, has led to confusion with the diagnosis of patient needs and conflicting approaches to assessments of those needs. Invariably problems of patient placement and alternative levels of care result. A more productive approach to the issue of providing appropriate care is to separate physical from psychosocial needs when performing functional assessment and to rearrange them into a matrix. By examining each need separately, and the point at which they overlap in the matrix, more direct assessment can be performed, and specified interventions can be designed.