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Southern DHB Needs Assessment & Care Coordination - Dunedin

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    The Aged Care Needs Assessment and Service Coordination is a district-wide service that is based in Dunedin, Invercargill and the Rural Hospitals.

    The service provides assessment to identify the level of need for ongoing support in the home and community settings. Services are allocated based on this identified need.

    The service provides support for elderly people with an ongoing disability.

    Access to the service is Monday to Friday 8.00am to 5.00pm.

    For more information on this service in other areas please click on the following links:


    Needs Assessment

    The NASC work within a Restorative Support Service model which aims to maximise a person's independence. The service will be person centred and goal oriented, seeking to build on the individual person’s strengths. The service aims to provide flexible, integrated support services for service users, which will enable them to continue to age in place.

    Needs Assessment

    A needs assessment is a comprehensive assessment of a person's functioning, what a person can do for themselves and what support they need. It will look at how  needs can be met and whether a person qualifies for publicly funded support.

    The assessment is completed by a registered health professional employed by the DHB, called a Clinical Needs Assessor. The clinical needs assessor will come and see the person in their home. Family/whānau are encouraged to attend the assessment where possible. Clinical Needs assessors also see people in hospital to help with returning home or if entry to Aged Residential Care is indicated. 

    The assessment and support planning process is very comprehensive. The assessment used is called interRAI and can take up to two hours.

    Service Co-ordination

    Service co-ordination is a process of working with the Clinical Needs Assessor to identify, plan and review what support is required to meet the needs and goals of the person and, where appropriate, their family/whānau and carers. Service co-ordination also determines which of the assessed needs can be met by government funded services and which can be met by existing family and social support networks and other non funded services. There may be a cost for some services; others may be subsidised/funded.

    The Clinical Needs Assessor will discuss what options are available to the person and their family/whānau. Together they decide what services will be provided and who will provide them. The Clinical Needs Assessor will write a letter to the client that summarises the assessment, identified needs and goals and what support has been recommended or arranged. The plan may include support to complete daily activities such as showering, dressing, exercise, leisure/recreational activities, support for carers etc. The plan will include assistance from family/whānau, friends, other agencies and support options available in the community. It will also include any referrals sent on to other health services for further assessment or support.