Caregivers Count Too! Section 4: Selected Annotated Bibliography for Caregiver Assessment

This annotated bibliography includes brief summaries of 48 publications (journal articles, book chapters, monographs) concerning the assessment of family and informal caregivers of older persons and adults with disabilities. The following references are provided for background information on the rationale for implementing caregiver assessment in care settings; the use of this approach to enhance practice; and the issues and challenges in assessing family care. Citations used in the bibliography were compiled from resources at FCA’s National Center on Caregiving and Internet searches using the Medline/PubMed database.

Selection Criteria and Organization: Most publications included in this bibliography have a primary focus on caregiver assessment. Some, however, make a contribution through their secondary focus on this subject. For example, documents are included that focus on the general assessment of older adults but recommend assessing the family caregiver also. A vast research literature exists on specific measures to assess family caregivers. The citations here only include articles and reports which review multiple measures or conduct a meta-analysis of caregiver measures useful for caregiver assessment in a practice setting.

The bibliography is organized in three sections:

As a “work in progress” this bibliography is not meant to represent an exhaustive collection of literature on this topic. If you would like to recommend additional citations for inclusion, please contact FCA’s National Center on Caregiving at (800) 445-8106 or info@caregiver.org.

General Literature on Caregiver Assessment

Bass, D. (2002). Content and Implementation of a Caregiver Assessment. [Issue Brief]. Washington, D.C.: Administration on Aging.
Provides tips for developing the content of a caregiver assessment as well as describes the procedures for implementing and responding to assessment information. The brief includes user-friendly tables which present a broad range of characteristics that might be considered for inclusion in caregiver assessment.

Baxter, E. (2000). Caregiver assessment: Learn about the caregiver, distinct from the person with dementia. Alzheimer’s Care Quarterly, 1 (3), 62-70.
Proposes areas of assessment related to the caregiver that can be gathered over time while carrying out the care plan for a person with dementia. A few of the key areas described include; identifying the caregiver’s learning/communication style, determining the caregiver’s understanding of dementia, assessing the caregiver’s physical and emotional health, and establishing what coping strategies he/she utilizes. Each area described is intended to be conducted in addition to, not instead of, a traditional assessment of the person with dementia.

Berg-Weger, M., Rubio, D., & Tebb, S. (2001). Strengths-based practice with family caregivers of the chronically ill: Qualitative insights. Families in Society, 82 (3), 263-272.
Involving the family and care recipient in the assessment and planning process is stressed in this paper. Also addressed is the need to intervene early to assess caregiver needs, reframe education and utilization of services as a strength and resource for caregivers, stress the positive aspects of caregiving, and plan for future needs. Reframing of the caregiving experience is also emphasized.

Berkman, B., Maramaldi, P., Breon, E., & Howe, J. (2002). Social work gerontological assessment revisited. Journal of Gerontological Social Work, 40 (1-2), 1-14.
Presents the evolution of assessment research and identifies critical assessment factors as they relate to changing social work practice and the country’s changing health care enviornment. The authors highlight the importance of the informal caregiving network and assert the need for social workers to consider both the elderly person’s biopsychosocial needs and the family’s adapting and coping capacity.

Bogardus, S., Bradley, E., Williams, S., Maciejewski, P., Gallo, W. & Inouye, S. (2004). Achieving goals in geriatric assessment: Role of caregiver agreement and adherence to recommendations. Journal of the American Geriatrics Society, 52 (1), 99-105.
Argues for discussion of caregiver expectations, involving caregivers in a shared care plan from the beginning, and emphasizes the importance of communication between the clinicians, patients and caregivers to maximize goal attainment. This approach is consistent with the movement of patient and family-centered care.

Bradley, P. (2003). Family caregiver assessment – Essential for effective home health care. Journal of Gerontological Nursing, 29, 29-36.
Home care nurses collected data on 51 older family caregivers from their caseloads to assess their health. Approximately half of caregivers reported poor or fair health and almost a quarter required home health services themselves. The author concludes that in order for home health care to be effective, nurses serving the geriatric population need to conduct systematic family caregiver assessments to identify caregiver health needs that could impair their caregiving ability.

California Workgroup on Guidelines for Alzheimer’s Disease Management. (2002). Guidelines for Alzheimer’s Disease Management. Los Angeles, CA: Alzheimer’s Association of Los Angeles, Riverside and San Bernadino Counties.
A general guide for the ongoing management of people with Alzheimer’s disease. In addition to addressing the patient’s condition, the guide recommends the family caregiver’s needs and risks be assessed and reassessed on a regular basis. The guide also suggests that physicians solicit and consider the input of family caregivers in treatment planning.

Coon, D., Williams, M., Moore, R., Edgerly, S., Steinbach, C., Roth, S., Phillips, C., Nguyen, H., Dowling, G., Dunning, E., & Feigenbaum, L. (2004). The Northern California Chronic Care Network for Dementia. Journal of the American Geriatrics Society, 52, 150-156.
Describes the Northern California Chronic Care Network for Dementia’s intervention model that provides coordinated care to individuals with dementia and their families. This model is grounded in the identification, assessment, and care management of those with dementia, as well as family caregiver information and support. The paper emphasizes the importance of ongoing care and intermittent assessment of caregivers because family needs for information, support, referrals, and education change over time.

Davis, L. (2001). Assessing functional ability in persons with dementia: Using family caregivers as informants. Journal of Neuroscience Nursing, 33 (4), 194-202.
Explores factors that influence family caregiver assessments of functional abilities in older individuals with some degree of cognitive loss or impairment. The paper also presents suggestions for enhancing the accuracy and dependability of functional assessments by family informants. The author concludes that assessments are valuable in determining both the older persons’ abilities as well as the family member’s continuing ability to be a caregiver.

Etten, M. & Kosberg, J. (1989). The hospice caregiver assessment: A study of a case management tool for professional assistance. The Gerontologist, 29 (1), 128-131.
The Hospice Caregiver Assessment Inventory was developed to identify the problems of those caring for dying patients. Findings revealed the problems of caregivers and suggested that they often need counseling and assistance prior to the death of their loved one, as well as following death. The authors conclude that the systematic assessment of caregiver needs, and plans for caregiver assistance should be a major component in hospice care.

Family Caregiver Alliance (2006). Caregiver Assessment: Principles, Guidelines and Strategies for Change. Report from a National Consensus Development Conference (Vol. I). San Francisco: Author.
Reflects the professional consensus achieved at the National Consensus Development Conference for Caregiver Assessment: the importance to policy and practice of systematically assessing a caregiver’s own needs in health care and in home and community settings; fundamental principles and practice guidelines for caregiver assessment applicable to a range of practitioners in a variety of settings; and strategies and actions to advance caregiver assessment as a basic component of practice.

Family Caregiver Alliance (2006). Caregiver Assessment: Voices and Views from the Field. Report from a National Consensus Development Conference (Vol. II). San Francisco: Author.
Provides two personal accounts of the family caregiving experience and four background papers on the topic of caregiver assessment from a research, practice, policy and international perspective. Together they portray key issues in caregiver assessment and illustrate the impact of caregiving at home on the family members who provide the care and support.

Feinberg, L.F. (2004). The State of the Art: Caregiver Assessment in Practice Settings. San Francisco, CA: Family Caregiver Alliance.
Summarizes the reasons for assessing family caregivers and identifies what, whom, when and where to assess. In addition, the article explores commonalities as well as differences in caregiver assessment instruments and points out areas of caregiver assessment that have been neglected. The article also discusses training issues for practitioners.

Feinberg, L.F., Newman, S., Gray, L., Kolb, K. & Fox-Grage, W. (2004). The State of the States in Family Caregiver Support: A 50-State Study. San Francisco, CA: Family Caregiver Alliance.
The first national study to examine publicly funded caregiver support programs throughout all 50 states. It focuses on caregiver support provided through the Older American Act’s National Family Caregiver Support Program (NFCSP), Aged/Disabled Medicaid waiver programs, and state funded programs. The study found that about one-fourth of the states use a uniform assessment tool for all HCBS programs for the elderly and adults with disabilities and systematic assessment of family caregivers is a component in just five states’ uniform assessment protocols.

Feinberg, L.F., & Newman, S. (2002). Family Caregiver Support: Policies, Perceptions, and Practices in 10 States Since the Passage of the National Family Caregiver Support Program. San Francisco, CA: Family Caregiver Alliance.
Describes the preliminary experiences of 10 states in providing support services to family or informal caregivers of elderly adults and adults with disabilities focusing on the National Family Caregiver Support Program, state general funds, Medicaid-waiver programs, and other state-funding streams. State and local implementation of caregiver assessment policies, tools and procedures under the NFCSP were found to be at very different stages. At the time, Pennsylvania and Florida were the only case-study states that utilized a consistent assessment instrument including a caregiver component for all HCBS programs.

Feinberg, L.F., Wolkwitz, K. & Goldstein, C. (2006). Ahead of the Curve: Emerging Trends and Practices in Family Caregiver Support. Washington, DC: AARP Public Policy Institute.
This report highlights three emerging trends that have important implications for addressing the needs of family caregivers: caregiver assessment; consumer direction in family caregiver support services; and collaborations between the aging network and the health care system, for example, in identifying family caregivers who may be at risk for their own health problems and emotional strain associated with the caregiving role. The report addresses barriers to conducting assessments of caregiver needs, new directions, and the outcomes or benefits of conducting caregiver assessments.  Results suggest that the concept of a single, universal assessment tool for long-term care clients, including family caregivers, is gaining attention in a number of states.

Fulmer, T., Firpo, A., Guadagno, L., Easter, T., Kahan, F., & Paris, B. (2003). Themes from a grounded theory analysis of elder neglect assessment by experts. The Gerontologist, 43 (5), 745-752.
Describes a program to screen for assessing for elder mistreatment and neglect. This program stresses the importance of understanding both the health status as well as the socioeconomic and life circumstances of the caregiving dyad. The authors conclude that future screening and assessment procedures should be developed with these themes in mind.

Gaugler, J., Kane, R., Kane, R., Clay, T. & Newcomer, R. (2003). Caregiving and institutionalization of cognitively impaired older people: Utilizing dynamic predictors of change. The Gerontologist, 43 (2), 219-229.
Identifies reliable predictors of nursing home entry among people with dementia, including caregiver burden and depression. The authors conclude that efforts to target at-risk older adults, particularly those with Alzheimer’s disease, for community-based services may enjoy greater success and precision if indices of caregiver stress, burden, and caregiver physical well-being are incorporated into assessment tools.

Gitlin, L. & Gwyther, L. (2003). In-home interventions: Helping caregivers where they live. In D. Coon, D. Gallagher-Thompson & L. Thompson (Eds.), Innovative Interventions to Reduce Dementia Caregiver Distress – A Clinical Guide (139-160). New York, NY: Springer Publishing Company.
Includes a section on “Identifying Caregiver Needs” and offers different approaches to conducting family caregiver assessments. Also highlights the need for standardized assessments that can be used uniformly by service providers to elicit caregiver needs systematically.

Goetschius, S. (2001). Caring for families: The other patient in palliative care. In M. Matzo & D. Sherman (Eds.), Palliative Care Nursing: Quality Care to the End of Life (245-274), New York, NY: Springer Publishing.
Provides interventions and suggestions for palliative care for families. The author asserts that the fundamental principle of palliative care is that the patient and family together are the unit of care. Assessing the familly as a system is the first step in developing a plan of care. Nurses must help family members identify what their own needs are in end-of-life care.

Kaye, L., Turner, W., Butler, S., Downey, R. & Cotton, A. (2003). Early intervention screening for family caregivers of older relatives in primary care practices – Establishing a community health service alliance in rural America. Family and Community Health, 26 (4), 319-328.
Describes the Maine Primary Partners in Caregiving project as an example of how community health, social service, and higher education institutions can build a successful rural service alliance for the purposes of screening for family members experiencing stress during the provision of care to impaired older relatives. The assessment measures caregiver well-being levels, including the degree of stress/burden, life satisfaction/morale, depression, confidence, competence/skill, quality of family relations and extent of social supports among caregivers.

Levine, C., Reinhard, S., Feinberg, L.F., Albert, S., & Hart, A. (2003-2004). Family caregivers on the job: Moving beyond ADLs and IADLs. Generations, 27 (4), 17-23.
Argues the need to change the current perception of caregivers as “the mirror image of the care recipient’s limitations.” By describing current approaches, or lack of approaches to caregiver assessment, the authors conclude that in addition to asking questions about their caregiving tasks and burdens, there is a need to ask caregivers to assess their own needs and emotional health.

Meilillo, K. & Futrell, M. (1995). A guide for assessing caregiver needs: Determining a health history database for family caregivers. Nurse Practitioner, 20 (5), 40-46.
Asserts that the failure to consider the psychosocial and health-related consequences of caregiving for individuals with dual roles could result in greater health care costs, jeopardize the health of the caregiver, and place the care recipient at risk of institutionalization. The article offers a guide that can be used as part of a comprehensive health history to assess the caregiving situation and provide a database on which to establish a plan of action. The caregiver assessment guide can be inserted in the client’s health record and periodically reviewed during primary care visits.

Schwentor, D. & Brown, P. (1989). Assessment of families with a traumatically brain injured relative. Cognitive Rehabilitation, 7, 8-14.
Addresses the importance of a comprehensive family assessment in order to: 1) determine the extent the family can be involved in the patient’s rehabilitation process and 2) to identify areas of family need for intervention and support. In addition, a comprehensive assessment process is outlined and various assessment methods are explained.

Vladeck, B. (2004). You can’t get there from here: Dimensions of caregiving and dementias of policymaking. In C. Levine (Ed.), Family Caregivers on the Job: Moving Beyond ADLs and IADLs (123-137). New York, NY: United Hospital Fund.
Suggests the need for several basic public policies regarding the mandatory inclusion of caregiver assessments in the following areas: regular consultations between paid providers and informal caregivers, Medicare and Medicaid home care services, Meidcaid home-and community-based waivers, and Medicare and JCAHO standards for hospital discharge planning.

Wright, L. & Leahey, M. (2005). Nurses and Families – A Guide to Family Assessment and Intervention. Fourth Ed. Philadelphia, PA: F.A. Davis Company.
With a clear focus on clinical nursing practice, this book promotes better family health care by providing educational tools and ideas for assessing the needs of families. It offers clinical guidelines to assist families experiencing illness and to know when and how to intervene properly.

Zwicker, D. & Picariello, G. (2003). Discharge planning for the older adult. In M. Mezey, T. Fulmer, I. Abraham, & D. Zwicker (Eds.) Geriatric Nursing Protocols for Best Practice. Second Ed. New York, NY: Springer Publishing Company.
Describes the assessment parameters for discharge planning in: functional status, cognition, depression, and caregiver support. The guideline specifically proposes that family caregivers be evaluated on a continual basis.

Reviews of Caregiver Measures

Antonucci, T., Sherman, A., & Vandewater, E. (1997). Measures of social support and caregiver burden. Generations, 21 (1), 48-51.
Informs the reader about the personal and situational characteristics that should guide choices for an assessment instrument for older adults and their caregivers, including a conceptual and theoretical overview as well as a practical guide. The authors outline critical assessment issues unique to caregivers including social support and caregiver burden.

Deeken, J., Taylor, K., Mangan, P., Yabroff, R., & Ingham, J. (2003). Care for the caregivers: A review of self-report instruments developed to measure the burden, needs, and quality of life of informal caregivers. Journal of Pain and Symptom Management, 26 (4), 922-953.
Identifies and critically evaluates 28 self-report instruments to assess informal caregivers. The instruments are identified and evaluated in terms of their development, content, and psychometric properties. Three user-friendly tables describe the instruments according to three categories; caregiver burden, caregiver needs, and quality of life instruments. A history of each construct and its measurement development are discussed.

Deimling, G. (1994). Caregiver functioning. In P. Lawton, & J. Terest (Eds.) Annual Review of Gerontology and Geriatrics – Focus on Assessment Techniques (257-280). New York, NY: Springer Publishing Company.
Provides a broad overview of caregiver assessment measures and techniques by reviewing 15 caregiving specific measures of burden or strain. The measures are divided into two categories: caregving effects and caregiver coping resources. In reviewing the measures, the original research that created the measures are described, the basic conceptual domains are identified and information on the measurement properties are provided.

Family Caregiver Alliance (2002). Selected Caregiver Assessment Measures: A Resource Inventory for Practitioners. San Francisco, CA: Author.
Represents a select group of caregiver assessment measures specifically chosen for practical application by practitioners who work with family and informal caregivers of older persons and adults with disabilities. The purpose of the inventory is to provide a compendium of caregiver assessment measures that is practice-oriented, practical and applicable, and which conceptually addresses the multidimensional aspects of the caregiving experience. The inventory compiles more than 100 measures into a user-friendly table that is organized into six conceptual domains: positive and negative effects of caregiving, care tasks and skills, caregiver health, financial impact of caregiving, caregiver social support, and caregiver values and preferences.

Gaugler, J., Kane, R., & Langlois, J. (2000). Assessment of family caregivers of older adults. In R. Kane & R. Kane (Eds.), Assessing Older Persons – Measures, Meaning and Practical Applications (320-359). New York, NY: Oxford University Press.
Provides a review of 23 measures of the impact of family caregiving which are compiled into a user-friendly table. Measures are grouped into two categories, measures of burden and caregiving appraisals. A general description of each measure is provided as well as its method of administration and any potential limitations. In addition, the article includes sections on the rationale for assessing family caregivers, defining family caregivers, and conceptualizing the impact of caregiving.

Kinsella, G., Cooper, B., Picton, C., Murtagh, D. (1998). A review of the measurement of caregiver and family burden in palliative care. Journal of Palliative Care, 14 (2), 37-45.
Reviews issues in and methods of measurement of caregiver and family burden in the home-based palliative care of terminallly ill patients. An overview is presented of burden measures that have been developed in palliative care research, including Caregiver Tasks, Caregiver Load Scale, Appraisal of Caregiving Scale, Caregiver Reaction Assessment, Caregiver Burden Tool, and the Modified Caregiver Appraisal Scale.

Pearlin, L., Mullan, J., Semple, S. & Skaff, M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30 (5), 583-594.
Describes caregiver stress as a consequence of a process comprising a number of interrelated conditions, including the socioeconomic characteristics and resources of caregivers and the primary and secondary stressors to which they are exposed.

International Literature

Audit Commission (2004). Support for Carers of Older People. London, UK: Belmont Press.
Examines the nature and extent of the help that is currently available to carers in the UK and makes suggestions about how this can be improved. The report states that caregivers should be offered an assessment of their needs in order to “become real partners in the provision of care to the person they are looking after…” as the national strategy clearly sets out.

Australian Institute of Health and Welfare (2004). Carers in Australia: Assisting Frail Older People and People with a Disability. Canberra, Australia: Author.
Aged Care Assessment Team guidelines require that the needs of carers are considered when making recommendations. Carers are an official target group for home and community-care services and the most recent national data collection also indicate that the key role of carers is well recognized in the delivery of assessment and care services throughout Australia.

Carradice, A., Shankland, M. C., & Beail, N. (2002). A qualitative study of the theoretical models used by UK health nurses to guide their assessments with family caregivers of people with dementia. International Journal of Nursing Studies, 39, 17-26.
Nurse education in the UK does not provide the training necessary to conduct a thorough and complete assessment of carers. This qualitative study suggested that nurses utilized the Stress Process Model to assess caregivers. Nurses underscored the importance of an open rapport with caregivers to establish a relationship that stresses listening to the caregiver, being empathetic, and allows caregivers to talk about their role. Findings suggest that nurses need additional training and education to understand the complexities of caregiver stress and thus guide assessment and intervention.

Fancey, P., Keefe, J. & Robertson, M.L. (1999). Development of Screening and Assessment Tools for Family Caregivers – Phase I Report on  Review of Non-Validated Tools – Nova Scotia Site. Ottowa, Canada: Health Transition Fund of Health Canada.
An international review of 57 articles and reports referenced 63 validated and nonvalidated caregiver assessment tools. The research did not find any of the validated tools to address a range of caregiving issues or specific service needs of caregivers. The results of the review informed the development of the Canadian caregiver assessment and screening tool.
 
Guberman, N., Keefe, J., Fancey, P., Nahmiash, & Barylak, L. (2001). Development of Screening and Assessment Tools for Family Caregivers. Ottowa, Canada: Health Transition Fund of Health Canada.
Descibes the methodology and results of a Canadian project to develop a screening and an assessment tool for assessing the context, conditions and the needs of family caregivers. An evaluation of these tools is described as well as the recomendations and policy implications of their implementation. To facilitate future implementation, the authors suggest that these tools be integrated with existing assessment tools and that caregivers become an agency priority.

Guberman, N., Nicholas, E., Nolan, M., Rembicki, Lundh, U., & Keefe, J. (2003). Impacts on practitioners of using research-based carer assesment tools: Experiences from the UK, Canada and Sweden, with insights from Australia. Health and Social Care in the Community, 11 (4), 345-355.
Describes the impact of three caregiver assessment tools from Canada, the UK and Sweden on the professional practice of assessors. The results reveal that the use of carer assessments can lead to changes in the adequacy and appropriateness of intervention to the service user. In addition, by giving carers a legitimate voice, acknowledging their perspective and expertise, practitioners can recognize them as individuals with their own needs and aspirations, rather than seeing them primarily as resources.

Larizgoitia, I. (2003). Evaluating long-term care – Approaches to evaluating LTC systems. In J. Brodsky, J. Habib & M. Hirschfeld (Eds.) Key Policy Issues in Long-Term Care (227-242). Geneva, Switzerland: World Health Organization Collection on Long-Term Care.
Addresses many critical long-term care (LTC) issues including the role and support of family caregivers. Recommends that LTC coverage be based on an assessment of needs of the person requiring LTC as well as their informal caregivers in order to plan resource allocation. It also states the responsiveness to the legitimate expectations of persons requiring LTC and their informal caregivers must be translated into continued improvement of services.

MacLennan, W. J. (1998). Caring for carers. Age and Ageing, 27 (5), 651-652.
Argues for assessment, treatment, and care for carers in their own right. Education for health care practitioners about caregiving in general and how to support caregivers in particular is also stressed. The employment of a “family-care worker” is suggested. The goal of this worker is not only to support the care recipient, but also the needs of the whole family. Evidence suggests that this approach improves the psychological and social well-being of both the caregiver and care recipient.

Montgomery, A. & Feinberg, L.F. (2003). The Road to Recognition: International Review of Public Policies to Support Family and Informal Caregiving. Issue Brief. San Francisco, CA: Family Caregiver Alliance.
Highlights where family caregivers stand in relation to public policies for long-term care. The six countries reviewed (Australia, Canada, Germany, Japan, United Kingdom and the United States) represent diverse philosophies and policies with regard to supporting and sustaining family care of frail elders and persons with disabilities. Included is a discussion of policy issues and approaches to caregiver assessment in the six countries.

Nankervis, J., Schofield, H., Herman, H. & Bloch, S. (1997). Home-based assessment for family carers: A preventative strategy to identify and meet service needs. International Journal of Geriatric Psychiatry, 12, 193-201.
Identifies unmet need for services among family carers and their frail or disabled relatives along with the factors associated with such needs through assessments of the carer/care recipient dyad. The authors conclude that assessment of elderly and other disabled adults should include their carers and systematically attend to carer needs, thus potentially enhancing morale, care management and access to a wider spectrum of services.

New Zealand Guidelines Group (2003). Assessment Processes for Older People. Wellington, New Zealand: Author.
These guidelines provide evidence-based recommendations for appropriate and effective assessment processes to identify personal, social, functional and clinical needs in older people. In addition, the guidelines recommend that carers of older people be assessed for health, training, and support needs with a specifically designed tool for carers that is linked with the assessment of older people.

Nicholas, E. (2003). An outcomes focus in carer assessment and review: Value and challenge. British Journal of Social Work, 33, 31-47.
Explores the benefits and challenges of implementing an outcomes approach to carer assessment and review, highlighted by a research and development project undertaken in partnership with one local authority. The project developed and tested research-based practice tools which aimed to promote carer-centered practice, together  with clarity in communication and recording of outcomes intended and achieved. Findings indicated that practice could be enhanced with the help of a clear conceptual framework and tools, flexibly and sensitively used to assist discussion and decision-making with carers about outcomes.

Pierce, G. & Nankervis, J. (1998). Putting Carers in the Picture: Improving the Focus on Carer Needs in Aged Care Assessment. Melbourne, Australia: Carers Association Victoria.
Aims to encourage more emphasis on carer needs in aged care assessment and to help the service providers who work with and support carers. The study looks at carers’ perspectives of their needs when being assessed and the formal and informal supports and interventions they need when caring.

UK Department of Health (2001). A Practitioner’s Guide to Carers’ Assessments Under the Carer’s and Disabled Children Act 2000. London, UK: Author.
A good practice tool for practitioners carrying out assessments of adults caring for adults. The guide includes eligibility and access information, the purpose, process and content of an assessment as well as intended outcomes.

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