SENIOR/LTC ASSESSMENT TRAINING MODULE
SENIOR/LTC
/
ASSESSMENT TRAINING MODULE
W l
Welcome
to
t th
the SSuperior
i M
Mobile
bil M
Medics
di SSenior/LTC
i /LTC A
Assessmentt TTraining
i i Module
M d l –
Learning Objectives
•
Gain familiarity with the Senior/LTC Assessment process, including company-specific requirements.
•
Know the importance of professionalism, politeness, patience, tactfulness and attentiveness.
•
Appreciate the potential for hearing and/or vision difficulties in the age 70+ population.
•
Understand the components of the Senior/LTC Assessment.
•
R li th
Realize
the necessity
it to
t provide
id complete,
l t accurate
t and
d objective
bj ti observations/documentation.
b
ti /d
t ti
SENIOR/LTC
/
ASSESSMENT TRAINING MODULE
I
Introduction
d i
To help assess additional risk factors sometimes associated with the elderly, insurance carriers have developed
various versions of a Senior Assessment Form. These forms have a number of different of names, depending
on the company. For example:
•
Supplemental examiner’s report for age 70 and
over (Genworth)
•
Mature Supplement for Age 71 and Older
(John Hancock)
•
Aged 71+ Questionnaire (Ing)
•
Senior Assessment Form (SMM – generic)
•
Etc.
Senior Assessments are often performed as part of an application for long-term care insurance.
Long-term care insurance is a type of insurance developed specifically to cover the costs of long-term care
services, most of which are not covered by traditional health insurance or Medicare. These may include inh
home
assistance
it
with
ith Activities
A ti iti off Daily
D il Living
Li i as wellll as care in
i a variety
i t off ffacility
ilit and
d community
it settings.
tti
There is generally a great deal of choice and flexibility in long-term care insurance policies.
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
G
General
l Instructions
I
i
f the
for
h Examiner
E
i
•
A Senior Assessment is a face-to-face interview performed by an approved medical/paramedical
examiner.
•
The assessment should be completed in the applicant’s residence so that observations of the applicant’s
living environment may be made.
•
The Senior Assessment is a supplement. It is to be completed in addition to the usual underwriting
requirements. Be sure to use the correct form!
•
Read all pages of the exam form completely before meeting with the applicant.
Every company’s form is different than the next, so it is important to be familiar
with the form ahead of time.
•
All questions should be asked exactly as written and company-specific
requirements followed.
•
Results should be recorded in a consistent manner.
•
To complete the assessment, you must have a stopwatch and measure tape.
•
Some companies include word recall flash cards as part of their assessment.
These should but cut out prior to the assessment.
•
Please be sure that all answers are complete and printed legibly.
SENIOR/LTC
/
ASSESSMENT TRAINING MODULE
G
General
l Instructions
I
i
for
f the
h Applicant
A li
•
The Senior Assessment may be introduced to the applicant as an assessment of living, mobility and
memory.
•
The assessment is required based on age, regardless of health.
•
Instruct applicant to listen closely to the instructions and ask for clarification if not fully understood.
•
A sturdy straight backed chair without wheels or soft cushions (e.g., kitchen or dining room type chair)
will be required.
•
Applicant should wear properly fitting shoes that do not slip and that have flat heels.
heels
•
You should inquire as to whether the applicant has any history of dizziness upon standing.
SENIOR/LTC
/
ASSESSMENT TRAINING MODULE
C
Components
off the
h Senior/LTC
S i /LTC Assessment
A
Components of Senior Assessments vary from company to company. It is important to be familiar with the
company’s form that you are going to use ahead of time. Typical assessment components include:
1. Applicant Information/Identification
2. Orientation
3. Cognitive Questionnaire
4. Delayed Word Recall: Introducing the Words
5. Questions on Activities of Daily Living
6. Get Up and Go Test (Mobility Test)
7. Clock Drawing
8. Delayed Word Recall: Recalling and Recording the Words
9. Examiner’s Observations
10. Signature(s), Date, Stamp, etc.
11. Addendum: Chair Stand Test (Select Companies)
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
S i Assessments
Senior
A
are U
Unique
i
As a Superior Mobile Medics examiner, it is important to dress and conduct yourself in a professional manner
at all times.
BBecause off the
th nature
t
off some questions
ti
in
i Senior
S i Assessments,
A
t it is
i particularly
ti l l important
i
t t to
t develop
d l a good
d
rapport with the applicant. This includes exercising patience, tactfulness, politeness and objectivity when
interacting with the applicant. It is also important to be an attentive listener.
Remember that poor vision and/or poor hearing may be factors in communicating effectively with the elderly.
The sequence of events in Senior Assessments varies from company to company. Be sure to understand and
follow the specific instructions provided with each exam form.
The assessment should be conducted in a private and quiet
location, free of distractions and conducive to good
communication and concentration.
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
S i Assessment
Senior
A
P
Procedures
d
•
If more than one person is being assessed, they should be completed one at a time, and the second
applicant should not observe or overhear the first interview. A different set of delayed word recall
words are required for the second applicant’s exam.
•
Be sure to sit close enough to the applicant to ensure that you can be easily seen and heard. Speak
clearly, audibly, and in a non-rushed manner.
•
Ask all questions exactly as stated on the form.
•
Allow the applicant adequate time to think about each question before answering.
•
Record the applicant’s responses exactly as they are given. Be objective and avoid any judgment or
interpretation of the applicant’s answers, behaviors or performance.
•
Any observations or remarks that you make will be
taken seriously.
y
•
Any observations or remarks that may be of a sensitive
nature should be recorded after leaving the applicant’s
premises.
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
1 Applicant
1.
A li
Information/Identification
I f
i /Id ifi i
Record the following applicant information, as instructed:
•
Name
•
DOB
•
Driver’s License Number
•
Driver’s License State
•
ID verified
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
2 Orientation
2.
Oi
i
Record the applicant’s answers to questions such as:
•
Today’s date
•
Current month
•
Current year
•
Day of week
•
Day of month
•
Home address
•
Home telephone number
•
Current season
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
3 Cognitive
3.
C
i i Questionnaire
Q
i
i
The Cognitive Questionnaire includes orientation questions as well as mental exercises such a subtraction or
noting the similarities between two objects.
A k applicant
Ask
li t th
the questions
ti
and
d check
h k "Y
Yes" or "N
No" to
t indicate
i di t correctt or incorrect
i
t answers. For
F example:
l
•
Date
•
Day of Week
•
Address
•
Telephone number
•
Age
•
Birthdate
•
Current US President
•
Immediate prior US President
•
How are the following objects alike
(e.g., orange/banana, horse/dog)
•
Subtraction exercise
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
4 Delayed
4.
D l
d Word
W dR
Recall:
ll Introducing
I
d i the
h Words
W d
Note: If required, be sure that single word flash cards are separated
(by cutting along the dashed line) prior to beginning the evaluation.
•
Explain to applicant that this is a memory test.
•
Tell the applicant that you are going to read out loud a list of words (or have applicant read words off
of flash cards) one at a time. Then, ask the applicant to say the word and then use the word in a
sentence. The sentence may be as long or as short at the client likes.
•
Proceed through the list of words, one at a time, having the applicant repeat/read
/
each word and use
it in a sentence. Be sure that the applicant understands each word before going on to the next.
•
Continue until all the words have been used and a sentence for each has been given.
•
Many companies ask that the applicant then repeat/read each word a second time and use it once
again
g in a sentence. The second sentence mayy be the same as or different from the first. The sentences
do not need to be recorded.
•
Note the time when completed.
•
The “recall” part of this test should occur with 5 and 10 minutes after this time.
•
If there
h
is
i a spouse on a jjoint
i application,
li i use a diff
different set off words
d for
f the
h second
d applicant.
li
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
5 Questions
5.
Q
i
on A
Activities
i i i off Daily
D il Living
Li i
•
Activities of daily living include such things as bathing, dressing, toileting, transferring, continence, and
feeding.
•
Ask the series of questions related to activities of daily living exactly as written.
•
Record the applicant’s exact responses.
•
Please provide any additional information,
as requested.
•
Some companies have an additional “advanced”
advanced
activities of daily living section. In such cases,
please ask the applicant the additional questions
and record answers as provided, along with any
additional information requested.
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
6 Get
6.
G Up
U and
d Go
G Test
T (Mobility
(M bili Test)
T )
Note: You will need a stopwatch and tape measure for this task. Applicant should provide a hard-backed
chair without wheels or soft cushions (e.g., kitchen or dining room type chair). Applicant should wear properly
fitting shoes that do not slip and that have flat heels. You should inquire as to whether the applicant has any
hi t
history
off dizziness
di i
upon standing.
t di
•
If required, please ask the applicant the questions provided regarding
mobility, along with additional information as requested.
•
Tell the applicant that this is a walking test.
•
If the applicant does not feel able to perform the test, do not
proceed. Record this on the exam form, and follow any indicated
indicated company-specific guidelines.
•
Similarly, the test should be stopped immediately if you have any concerns about the applicant’s safety.
•
The instructions for the Get Up and Go Test (Mobility Test) generally include recording how long it takes
(in seconds) for the applicant to get up from a seated position, walk 10 feet, return and sit down again.
•
Sample instructions: “Please stand up, walk 10 feet, turn around, walk back to the chair and sit down.”
•
You should be in a position such that you are adequately
able to observe and assess the applicant’s gait.
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
6 Get
6.
G Up
U and
dG
Go TTest (M
(Mobility
bili Test)
T ) - continued
i
d
•
Be attentive in observing whether the applicant appeared steady, with arms swinging alternately at the
sides or if the applicant’s gait showed any difficulties or abnormalities, such as lack of balance, inability
to walk straight, any limping or shuffling of feet, etc.
•
Also be sure to document whether any assistive devices (e.g., cane, walker, etc.), physical assistance of
another person or any supportive structures (holding onto arms of chairs, furniture, walls, etc.) were used.
•
Timing should begin when the applicant first starts when they get out of the chair and end when he/she
sits back down again. Some companies ask that the time be recorded to the tenth of a second (e.g.,
11 4 sec),) if possible.
11.4
ibl
•
If you do not have a measuring device, take ten steps heel-to-toe (or three strides) for measuring
purposes. At the ten foot measurement, put a pencil or piece of paper on the floor to identify the
distance to be walked.
•
Note the applicant’s mobility, any abnormalities (e.g., was unable to do so without help, lost balance,
require more than one attempt, used walking aid, mild staggering but catches self, almost falls, or
collapses into chair when sitting back down), or if it took the applicant greater than 20 seconds to
complete the task.
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
7 Clock
7.
Cl k Drawing
D
i
•
Read the exact instructions to the applicant as instructions for this test may vary slightly from company to
company.
•
Have applicant complete/draw a clock face in the designated area on the exam form.
•
The clock face should include all of the numbers, 1 to 12, within a circle (as if it were a clock).
•
Have the applicant draw the hands of the clock to reflect the time indicated in the instructions.
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
8 Delayed
8.
D l
d Word
W dR
Recall:
ll Recalling
R lli and
d Recording
R
di the
h Words
W d
•
If at least five minutes (but no greater than 10 minutes) have lapsed since completing the first part of
the Delayed Word Recall test (Introducing the Words), it is now time to finish the test.
•
Tell the applicant that a few minutes ago you asked them to read/repeat a list of words and use them
in sentences.
•
Ask the applicant to please recall as many of these words as possible.
•
Confirm and indicate the correct words recalled on the form as well as how many of the works were
correctly recalled.
•
Be sure to record the recall start and end times as indicated on the form.
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
9 Examiner’s
9.
E
i ’ Observations
Ob
i
•
Please answer the questions listed and provide any additional comments.
•
Any observation or remarks you make will be taken seriously.
•
Please be detailed and clear in offering observations.
•
Any comment of a sensitive nature should be recorded after leaving the applicant’s premises. This may
include such things as applicant demeanor, living environment, anything unusual not previously
mentioned in the assessment, etc.
•
Be sure that any supplemental pages are properly identified.
identified
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
10 Si
10.
Signature(s),
( ) Date,
D
Stamp,
S
etc.
Please provide all information required. For example:
•
Examiner name
•
Examiner signature
•
Date
•
SMM info
•
Location of exam
•
APPLICANT SIGNATURE (Most companies do not require an applicant signature on Senior
Assessment/LTC Forms, but some do. Please be sure to check carefully!)
Thank the applicant for his/her time and cooperation!
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
11 Addendum:
11.
Add d
Chair
Ch i Stand
S d Test
T (Select
(S l Companies)
C
i )
In the event that the timed Get Up and Go Test cannot be completed, some companies ask that a Chair Stand
Test be completed instead.
D nott administer
Do
d i i t th
the ttestt for
f any off the
th ffollowing
ll i reasons:
•
You are at all concerned that the applicant cannot safely complete the test.
•
The applicant cannot perform the test or is unwilling to do so.
•
The applicant is confined to a wheelchair or has any other mobility problems that prevent him/her
/
from
rising from a chair.
•
The applicant does not understand the directions.
•
A chair as described in the Chair Stand Test is not available.
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
11 Chair
11.
Ch i Stand
S d Test
T - continued
i
d
Chair Stand Test Overview:
•
You will ask the examinee to rise 5 times from a sitting position in a chair without using his or her hands.
•
You will record the time the examinee needed to perform this exercise.
•
If the test runs past 60 seconds, stop the test.
•
Also stop the test if you have a concern that the examinee is not stable. The most important thing is the
safety of the examinee.
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
11 Chair
11.
Ch i Stand
S d Test
T - continued
i
d
Important things to remember in order to administer the test correctly:
•
Use a stable, straight-back chair, preferably one without arms.
•
Make sure the examinee can sit with his or her feet flat on the ground. Do not use a chair with wheels,
that will slide, or with soft seat cushions.
•
Make sure the area around the chair is clear of all obstacles.
•
Prepare the examinee for the test using the script below.
•
Conduct the test using the script below. You must record the exact number of seconds required to rise
from a sitting position 5 times.
•
Begin timing as the examinee starts to rise the first time and end the test when the examinee is standing
the fifth time.
•
Accuracy in timing is critical. Even one second can make a difference in the final assessment.
•
Record the time and any comments in the fields provided.
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
11 Chair
11.
Ch i Stand
S d Test
T - continued
i
d
Instructions for the Applicant (Script):
EXAMINER:
•
This is a short physical test that I will be conducting today.
•
First, I’m going to explain the test. Do not start the test until I tell you to do so.
•
You will start in the chair as you’re currently sitting with your feet flat on the ground. I will ask you to
fold your arms across your chest and rise from the chair without using your arms or hands for support.
You will do this once for practice to make sure that we are both comfortable with you continuing the test
test.
•
After the practice try, we will start the test. I will ask you to rise from the chair 5 times and I will record
the total time it takes you to rise from the chair 5 times. I will count for you each time you complete a
rise so that you know how many times you have done it. The test will be over when you have risen for the
5th time.
•
Do you understand these directions?
•
(Make sure that you receive an affirmative response.)
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
11 Chair
11.
Ch i Stand
S d Test
T - continued
i
d
EXAMINER:
•
If at any time you feel uncomfortable, dizzy or like you are going to fall, let me know and we will stop
the test.
•
Do you have any questions or concerns before we begin?
•
(Answer any questions. If you or the applicant has concerns about his or her ability to do this test,
do not continue.)
•
(Position yourself so you can help the examinee if they stumble.)
stumble )
EXAMINER:
•
Ok, let's try a practice rise.
•
Fold your arms across your chest and stand up whenever you’re
you re ready
ready.
•
(Observe closely. If you believe the examinee will have difficulty with this test, do not continue.
Instead, record your concerns in the comment section.)
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
11 Chair
11.
Ch i Stand
S d Test
T - continued
i
d
EXAMINER:
•
How was that?
•
Are you ready to continue with the test?
•
Do you have any other questions before we begin?
•
(Answer any questions. Once you both are comfortable that the examinee can perform test,
continue.)
EXAMINER:
•
When I say begin, I want you to rise from your chair, sit back down and rise again.
•
You will rise 5 times in total, and I will count for you each time you rise. Are you ready?
•
(Make sure your stop watch is set. You will need to look at both your watch and the examinee to
make sure there are no concerns during the test. Remember: safety is most important. Begin when
you are ready.)
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
11 Chair
11.
Ch i Stand
S d Test
T - continued
i
d
EXAMINER:
•
Begin.
•
(When the examinee rises for the 5th time, stop the test. If the examinee takes more than 60
seconds, stop the test and thank them for trying.)
•
(Record the time to complete in seconds. If the examinee had any difficulty performing the test,
please add observations to the comments section.)
•
(This completes the Chair Stand Test.)
Test )
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
SENIOR/LTC ASSESSMENT Self-Check
S lf Ch k (Choose
(Ch
the
h best
b answer to eachh question.)
i )
Question #1
The objective
Th
bj ti off a SSenior/LTC
i /LTC A
Assessmentt iis tto provide
id complete
l t and
d accurate
t iinformation
f
ti tto
insurance underwriters in order to make an informed decision regarding an applicant’s
insurability?
 A.
A True
T
 B. False
A. True. To help assess additional risk factors sometimes associated with the elderly, insurance
carriers
i hhave d
developed
l
d various
i
versions
i
off a Senior/LTC
S i /LTC A
Assessmentt fform to
t provide
id a reportt
of complete and accurate information. This assessment enables insurance underwriters to make
an informed decision regarding the issuance of an insurance policy.
SENIOR/LTC
/
ASSESSMENT TRAINING MODULE
SENIOR/LTC ASSESSMENT Self-Check
S lf Ch k
Question #2
Unless
U
l otherwise
th
i specified,
ifi d SSenior/LTC
i /LTC A
Assessments
t should
h ld b
be completed
l t d iin th
the applicant’s
li t’
residence.
 A. True
 B.
B False
F l
A. True. Senior/LTC Assessments should be completed in the applicant’s residence so that
observations can be made related to the applicant’s living environment. The assessment should
b conducted
be
d t d in
i a private
i t and
d quiet
i t location,
l ti ffree off di
distractions
t ti
and
d conducive
d i to
t good
d
communication and concentration. Be sure to sit close enough to the applicant to ensure that you
can be easily seen and heard.
SENIOR/LTC
/
ASSESSMENT TRAINING MODULE
SENIOR/LTC ASSESSMENT Self-Check
S lf Ch k
Question #3
Thi
Things
tto do
d prior
i to
t conducting
d ti a SSenior/LTC
i /LTC A
Assessmentt include:
i l d
 A. Review the exam form and all instructions
 B. Be sure that you have a stopwatch and measuring tape
 C.
C Cut
C t outt word
d flashcards
fl h d for
f the
th Delayed
D l
d Word
W d Recall
R ll ttestt
 D. All of the above.
D. All of the above should be performed prior to conducting a Senior/LTC Assessment.
SENIOR/LTC
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ASSESSMENT TRAINING MODULE
SENIOR/LTC ASSESSMENT Self-Check
S lf Ch k
Question #4
S i /LTC A
Senior/LTC
Assessments
t on hhusbands
b d and
d wives
i
may b
be conducted
d t d ttogether.
th
 A. True
 B. False
B. False. If more than one person is being assessed, they should be completed one at a time,
and the second applicant should not observe or overhear the first interview. A different set of
delayed word recall words are required for the second applicant’s exam.
SENIOR/LTC
/
ASSESSMENT TRAINING MODULE
SENIOR/LTC ASSESSMENT Self-Check
S lf Ch k
Question #5
The ““recalling
Th
lli and
d recording
di off words”
d ” portion
ti off th
the Delayed
D l
d Word
W d Recall
R ll test
t t should
h ld be
b
performed how long after the words were “introduced.”
 A. 3-5 min
 B.
B 5-10
5 10 min
i
 C. 10-15 min
 D. None of the above
B. 5-10
B
5 10 min.
i The
Th “recalling
“
lli and
d recording
di off words”
d ” portion
ti off th
the D
Delayed
l
dW
Word
d RRecallll ttestt
should be performed no sooner than 5 minutes and no later than 10 minutes after the words
were “introduced.”
SENIOR/LTC
/
ASSESSMENT TRAINING MODULE
Congratulations!
You have completed the Superior Mobile Medics Senior/LTC Assessment Training Module.
(06.03.2011)