Community Needs Assessment
Appendices
Appendix C - Review of Current Home and Community Care Services and Needs in Your Community
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This tool asks for information that will result in a detailed description of your current home and community care services and needs. It will also provide you with information on training needs that will assist with the development of your
training plan.
The majority of this information should be available from the community based health and social service staff. If records or referrals have not been kept, refer tothe expertise and experience of the health and social service team to estimate
the number of clients seen, hours of service provided and by whom, and the number of community members who needed but did not receive care because of the lack of services.
Table 1
- Home and Community Care Essential Service Elements:
- Client Assessment
- assessment to make sure that the health care provided is based on the unique needs of each person
- a care plan put into place to guide the services provided
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: XX
- Home and Community Care Essential Service Elements:
- Managed Care
- discharge planning
- coordination with health and social service care providers
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: XX
- Home and Community Care Essential Service Elements:
- Home Nursing
- teaching to prevent secondary complications of existing disorders
- post hospital care
- wound management
- lifestyle counseling
- supervision of personal care
- palliative care
- medication management/ administration
- foot care
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: XX
- Home and Community Care Essential Service Elements:
- Home Support
- personal care (e.g. bathing assistance, etc.)
- homemaking
- in-home meal preparation
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session:
- Home and Community Care Essential Service Elements:
- Medical Supplies and Equipment
- assistance to acquire equipment to assist with independent living
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: XX
- Home and Community Care Essential Service Elements:
- Program Management and Supervision
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: X
- Home and Community Care Essential Service Elements:
- Information and Data Collection
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: XX
- Home and Community Care Essential Service Elements:
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: XX
- Home and Community Care Essential Service Elements:
- Rehabilitation and Therapy Services
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: XX
- Home and Community Care Essential Service Elements:
- Emotional Health (e.g. spiritual/ emotional support, wellness support, reassurance visits)
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: X
- Home and Community Care Essential Service Elements:
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: XX
- Home and Community Care Essential Service Elements:
- Special Dietary Needs Requiring Diet Counseling
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: XX
- Home and Community Care Essential Service Elements:
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: XX
- Home and Community Care Essential Service Elements:
- Any other Home and Community Care Services
Description and Utilization of Services provided over the previous 12 month period:
- Received Care in the Community:
Number of Clients who Received Service: XX
Number of Hours of Service Provided: XX
Type and Number of Staff Providing Service (e.g. Nurse, Homemaker, etc.): XX
- Number who Needed but did not Receive Care (Due to Lack of Services): XX
- Education and/or Job Training Needed:
- Minimum Training/Education Required for the Service: XX
- Number of Staff who Require Training/Education to Meet Minimum Requirements: XX
- Type of Initial and Future Training/Education Required: XX
- Number of Staff per Training/Education Session: XX
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