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ISD Scotland better information, better decisions, better health

Measuring Function/Dependency

Older People in the Community

NHS National Services Scotland ISD Scotland & NHS National Services Scotland

Older People in the Community

What is the Indicator of Relative Need (ioRN)?

The Indicator of Relative Need (ioRN) Download PDF file is a practice/clinical tool for people delivering and planning care and support services. Used by professionals the ioRN provides a summary of a person's functional needs and/or their degree of dependence/independence. It can be used to show the outcome of interventions such as during reablement or intermediate care.

The ioRN, originally developed in 2003, supports the growing demand for good objective information to inform actionable intelligence at all levels for older people living in the community. A new version ioRN2 Download PDF file was launched in 2015 and brings greater sensitivity and benefits over the original ioRN.

Practice and clinical staff find the ioRN easy-to-use. Recording the ioRN information takes minutes to do yet delivers key information for frontline practice, for effective delivery of care and support and for ensuring public resources are used well within an integrated health, social care and housing landscape.

Why is measurement of function important? People seeking support and care do not all have the same needs, even if they have the similar conditions or diagnoses. It is therefore vital that we begin to understand their different characteristics and needs in order to deliver the best possible outcome for them.

Versions of the ioRN are available for use in the community, for use in care homes as part of a staffing model, and more recently for use in hospital settings.

How to use the ioRN

The ioRN includes a questionnaire containing carefully selected questions that are designed to inform an agreed algorithm using information gathered by frontline staff. The questionnaire covers characteristics such as activities of daily living, food and drink preparation and mental health and behavioural issues to categorise the individual to a 'relative need' group.

It is however essential that staff are familiar with the person, such as might be achieved through a comprehensive assessment or through 24-hour care delivered in residential or a hospital setting. A prerequisite is that staff follow carefully the guidance that is available Download PDF file.

Examples of use of ioRN data:

Use of the ioRN2 when the person's needs are reviewed greatly enhances the potential use of the tool in outcome assessment. Uses include:

  • Supporting information for validating decisions in care plans, e.g. when considering possible care home admission.
  • Alongside other information as a way of identifying individuals with high support needs. When used at review, as a way of objectively demonstrating changes in (in)dependence, e.g. in intermediate care or reablement.

Further information on the potential use of the ioRN and how you can get started within your context or your team/service should be directed to peter.knight7@nhs.net.

Useful Links

ioRN Resources Download PDF file

The resources available here provide more detail for anyone interested in adopting the Community ioRN (ioRN2)

ioRN Questions Jan16 Download PDF file

The questionnaire shows the questions and the range of responses that are included in the ioRN.

NB alternative versions of the IoRN questionnaire that include score values for manual calculation of the ioRN group are available on request.

User guidance Jan16 Download PDF file

Accurate use of the Guidance is essential if correct assignment to an ioRN group is to be done time after time.

IoRN Group descriptions Jan16 Download PDF file

A description of what the different ioRN2 groups mean.

Grouping Diagram IoRN Final Definite Download PDF file

The diagram shows the way that the allocation to an ioRN group is achieved using the answers to the ioRN questionnaire.

Excel Calculator Download Excel file

The EXCEL calculator (prepared by ISDScotland) included here uses the answers to the individual questions to assign an ioRN2 group. A downloadable App that can be used on any suitable portable device (eg a smart phone or tablet) is also available from ISDScotland at isdscotland.org/IoRN2

Care Home Report

The Changing functional needs and dependency of people living in care homes: Evidence from use of the Indicator of Relative Need in Scotland Download PDF file

This report, published Download PDF file by Information Services Division in February 2017, describes the findings of a survey of functional needs/dependency levels of residents in a sample of care homes in Scotland in late 2014. The report shows the variation in needs across homes and uses data from earlier surveys to evidence how dependency levels have changed over time. The measurement of functional need uses the Indicator of Relative Need (IoRN). The important trends presented will be of interest to people planning, commissioning and delivering care.

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