Australia & New Zealand Newsletter  
Issue 2  -   September 2009





Research projects

Recent publications









'Talking the same language
for effective care for
older people'











interRAI Australia

Coordinating Centre
Telephone: +61(7)-32406420
Facsimile: +61(7)-32405399
Email: interRAI mail





interRAI New Zealand

Coordinating Centre






















Len Gray

Please send feedback to:
Nadine Krueger







From the editor

There is a great deal of interRAI activity now occurring in Australia and New Zealand. This newsletter provides updates on the home care rollout in New Zealand, and highlights some of the research occurring in Australia. Take a look at the interRAI Publishing Portal, which offers just a taste of what is to come.

I draw your attention, particularly, to the Regional interRAI Conference planned for May 3-4 in Brisbane, Queensland in 2010. We have confirmed participation from many international speakers, including Brant Fries, John Morris and Katherine Berg. It will be an excellent opportunity to hear of research and demonstrations occurring in our region. The meeting will precede the ANZSGM Annual Scientific Meeting to be held close to Brisbane. Formal notices of the meeting will be circulated shortly.

Len Gray


>> Major interRAI conference planned for 2010 in Brisbane, Australia

interRAI publishing portal launched

Feedback from the 2009 Canadian RAI Conference

Demonstration Trial for interRAI MDS-LTC in New Zealand Residential Aged Care Facilities

Implementation Pilot in Residential Care in Canterbury, New Zealand

interRAI ED Multi-Nation Study


Major interRAI conference planned for 2010 in Brisbane, Australia
interRAI Australia will host a major regional interRAI conference in Brisbane on May 3rd and 4th, 2010. Although only in its early planning stages, the meeting will feature numerous international speakers from Europe and North America. There will be a regional focus, with the program configured to reflect developments and research in Australia, New Zealand, Singapore and Hong Kong. The meeting is scheduled immediately prior to the Annual Scientific Meeting of the Australian & New Zealand Society for Geriatric Medicine, to be held in Coolum, just outside of Brisbane, on May 5 -7.
Mark this date in you diary!

interRAI publishing portal launched
High quality publications are now available for purchase thanks to the establishment of a publishing portal, accessible via the interRAI website. Instruments and manuals can now be purchased online.
Initially, the interRAI HC forms and manual are available. Other instruments will come online in the next few months.

Materials may be purchased either in electronic form or in hard copy. The publications are printed "on demand" and therefore are always completely up to date. There are a variety of options for production, ranging from highly professional, carefully edited versions (where there is likely to be high demand) to more simple (yet well presented) versions for languages where low demand is expected. Many Fellows have committed to preparation and support of materials over the next few years.

The portal represents a major advance for interRAI. To view it, click on the "PUBLICATIONS" tab on the home page of the interRAI website.

New Zealand readers who are affiliated to a District Health Board may be interested to know that a bulk purchase of the Home Care and Contact Assessment manuals is being arranged centrally through the interRAI National DHB Implementation Project.

Feedback from the 2009 Canadian RAI Conference
by Sally Heppenstall, interRAI Trainer, Nurse Maude Association, Care Coordination, New Zealand

The theme of the conference which was held in Halifax, Nova Scotia, 22-24 June, was “Pulling It All Together: Integrating Health Information for Planning, Policy and Practice”.

Key note speakers included presentations by interRAI fellows on current research:
John Hirdes and Brant Fries – STRIVE and CAN-STRIVE research – an update on RUGs
John Morris - interRAI initiatives for Quality of Life and Wellness which allow clients to speak for themselves on their preferences, desires and wishes
Palmi Jonsson and John Hirdes - interRAI Solutions for Improving Care of the Elderly in Acute Hospital Settings
John Hirdes - ED Screener study which has shown correlation between ED visits and CHESS and identified the need to pick up those with low medical needs but high carer stress, ADL and depression.

CIHI (Canadian Institute for Health Information) facilitated a half day pre-conference workshop: “Sailing Toward Sustainability: Sharing Knowledge along the RAI Education Journey” with panel and group discussions of what Educators would do more of, less of or differently for sustainable RAI education. Issues raised were similar to those discussed in New Zealand e.g.
• Competency testing
• Increased reporting to staff
• Establishing an Educators network
• Sharing of resources between jurisdictions e.g. SHAREPOINT
• Need for evaluation and research into training

Various jurisdictions are at different phases of implementation of RAI tools, with the Long Term (residential) Care, Home Care and Mental Health tools being those most in use in Canada. Some are still grappling with the transition from using a paper tool to becoming electronic. It was a great opportunity to hear how RAI data is being used e.g. Pharmacoepidemiologic Reseach: Heart Failure Management in Home Care

Other presentations of interest were :
Linda Dieltgens on RAI Speak which stressed the importance of Managers, GPs, hospital staff, Providers, understanding RAI-Speak (CAPs, CHESS, MAPLe, Outcome scores etc) for evidence based decision making and the need for interpretation training.
Suzanne Atkinson on Recognizing and Preventing RAI Drift i.e. assessors drifting away from the original intent of questions. She identified common areas of the HC tool where drift occurs and suggested the use of customised support materials, regular reviews and updates and Increased use of competency testing for assessors to ensure data quality.

This conference was an exciting opportunity to learn more of the interRAI suite of tools and their use in health planning and practice. The 2010 conference is in Toronto.

>> back to top

Research projects

Demonstration Trial for the interRAI MDS-LTC (Minimum Data Set-Long Term Care) tool in New Zealand Residential Aged Care Facilities
by Dr Michal Boyd, Gerontology Nurse, Waitemata DHB and University of Auckland)

In 2008, a New Zealand demonstration trial was completed using the tool in residential aged care. Waitemata and Bay of Plenty DHBs residents (n=169) were assessed in two large facilities and a small rural facility specialising in Maori elder care. The team of assessors included physiotherapist, gerontology nurse specialists, and Needs Assessor/Service Coordinators (NASC).
Overall, the interRAI MDS-LTC was found to be a far superior assessment and care planning tool than currently used in trial facilities. There was wide variation in RUG classification for Rest Home residents, and much tighter case mix groupings for private hospital and dementia care. The quality indicators were closely aligned to international standards.

The project team recommended to:
• Use patient outcomes from interRAI assessments for auditing, certification and accreditation processes.
• Implement interRAI tools for local, national and international quality benchmarking.
• Ensures the system works effectively by recognising the extent of change management required and by replacing current paper-based systems.
• Ensure New Zealand based technical support.
• Provide a co-ordinated training and support for facilities
• Add culturally specific, background questions for the Maori population as well Pacific Island and Asian people.

Implementation Pilot in Residential Care in Canterbury, New Zealand
by Cheryl Bowen, Project Facilitator, Canterbury DHB
In Canterbury the funding arm of the District Health Board decided they wished to pilot the use of the RAI 2.0 across a number of facilities in Canterbury. They purchased 25 software licences and committed a facilitator to put the project together beginning June 2008. After a number of delays the Expression of Interest was released and 18  facilities chosen. 25 registered nurses are participating in the project.
There is a mixture of large and small, rural and urban and rest home, hospital and dementia levels.

Overall the nurses have enjoyed using the new tool and can see immediate benefits of a standardised computerised tool. A lot of the care givers also are enjoying the new format of the care plan and are finding it easy to follow. Of course with any new process it is taking longer than most of their previous assessments and care plan tools. However most can see once the tool is more familiar and they have used it more often then this should be comparable to the existing processes. A total of 128 assessments have been completed so far.

Alongside the pilot a research project will be run looking at the nurses view on the tool compared the their existing ones, as well as a description of resident characteristics related to the prevalence of medical conditions: Rap’s, RUGs, outcome scores and service utilisation.

interRAI ED Multi-Nation Study
The ED study continues to develop with up to 7 nations now strongly considering participation – Australia, Canada, Germany, India, Spain, Sweden and the USA.
This is a prospective observational study, based on the interRAI ED, which will seek to identify predictors of negative outcomes after discharge from the ED.
There is still an opportunity to participate in this work. (Contact Len Gray)

>> back to top

Recent publications

Ashworth M, Hirdes JP, Martin L. (2009) The social and recreational characteristics of adults with intellectual disability and pica living in institutions. Res Dev Disabil. 30(3):512-20.

Dalby DM, Hirdes JP. (2008)
“The relationship between agency characteristics and quality of home care.”
Home Health Care Serv Q. 27(1):59-74.

Doran DM, Hirdes J, Blais R, Ross Baker G, Pickard J, Jantzi M. (2009)
“The nature of safety problems among Canadian homecare clients: evidence from the RAI-HC reporting system.” J Nurs Manag. 17(2):165-74.

Feng Z, Hirdes JP, Smith TF, Finne-Soveri H, Chi I, Du Pasquier JN, Gilgen R, Ikegami N, Mor V. (2009)
“Use of physical restraints and antipsychotic medications in nursing homes: a cross-national study.”
Int J Geriatr Psychiatry.

Giangregorio LM, Jantzi M, Papaioannou A, Hirdes J, Maxwell CJ, Poss JW. (2009)
“Osteoporosis management among residents living in long-term care.” Osteoporos Int.

Kleijer BC, Marum RJ van, Egberts ACG, Jansen PAF, Frijters D, Heerdink ER, Ribbe M. (2009)
“The course of behavioral problems in elderly nursing home patients with dementia when treated with antipsychotics.” International Psychogeriatrics 1-10.

Martin, L., J.P. Hirdes, J. Morris et al. (2009). "Validating the Mental Health Assessment Protocols (MHAPs) in the Resident Assessment Instrument Mental Health." Journal of Psychiatric and Mental Health Nursing.

Martin, L., J.P. Hirdes.
“Mental health needs and service use in Ontario.” Healthc Manage Forum. 2009 Spring;22(1):40-6.

Maxwell CJ, Dalby DM, Slater M, Patten SB, Hogan DB, Eliasziw M, Hirdes JP. (2008)
“The prevalence and management of current daily pain among older home care clients.” Pain. 138(1):208-16. Epub 2008 May 29.

Perlman CM, Hirdes JP.
“The aggressive behavior scale: a new scale to measure aggression based on the minimum data set.” J Am Geriatr Soc. 2008 Dec;56(12):2298-303.

Poss JW, Jutan NM, Hirdes JP, Fries BE, Morris JN, Teare GF, Reidel K. (2008)
“A review of evidence on the reliability and validity of Minimum Data Set data.” Healthc Manage Forum. 21(1):33-9. Review.

Smith TF, Hirdes JP. (2009)
“Predicting social isolation among geriatric psychiatry patients.” Int Psychogeriatr. 21(1):50-9.

Stolee P, Poss J, Cook RJ, Byrne K, Hirdes JP. (2009)
“Fall-related hip fractures” J Gerontol A Biol Sci Med Sci. Jun 10.

Stolee P, Poss J, Cook RJ, Byrne K, Hirdes JP.
“Risk factors for hip fracture in older home care clients.”
J Gerontol A Biol Sci Med Sci. 64(3):403-10.

>> back to top

Please click here to unsubscribe from the Australia & New Zealand interRAI Newsletter.