Australian Occupational Therapy Journal (2009) 56, 315–323 doi: 10.1111/j.1440-1630.2008.00760.x Blackwell Publishing Asia Research Article Assessment of need and capacity to benefit for people with a disability requiring aids, appliances and equipment Malcolm Masso, Alan Owen, Tara Stevermuer, Kathryn Williams and Kathy Eagar Centre for Health Service Development, University of Wollongong, New South Wales, Australia Aim: To develop an equitable system for allocating equip- ment, aids and appliances to adults with disabilities based on assessment of need and capacity to benefit for use by occupational therapists, who are the main professional group involved in assessing and prioritising applications. Methods: An assessment tool was developed, pilot tested and field tested at four sites in New South Wales. Assessments were undertaken in parallel with existing systems. Feedback on use of the tool was obtained from those conducting the assessments and those making decisions to fund applications for equipment based on the assessments. Results: One hundred and six assessments were undertaken. Applications for bed, sleeping and seating equipment and equipment to assist with mobility, toileting, showering and transfers accounted for 94.2% of equipment requested. Provision of equipment was expected to have greatest impact on the physical effort and safety of carers and the safety and quality of life of applicants. Regression analysis identified assessment items that explain variation between applicants and that can avoid unnecessary data collection. Conclusions: The assessment tool provides a standardised method for assessing requests for equipment based on the twin concepts of need and capacity to benefit. The results support the use of both concepts as the foundation of the assessment process. Further development is required, par- ticularly to move to the next stage of using the assessment tool as the basis for prioritising applications for equipment. KEY WORDS capacity to benefit, disability, function, health priorities, needs assessment. Introduction Providing health and community care services to pro- mote independence rather than dependence requires decisions at many levels regarding how to allocate resources. Some of the parameters for such decisions are indicated by a systematic review of occupational therapy interventions for elderly people living at home (Steultjens et al., 2004). The review found that assistive devices, train- ing, comprehensive occupational therapy, home hazard assessment, counselling of the primary caregiver and information on fall prevention and social participation were useful in promoting an independence model. The main principles identified in the literature regarding how allocation should occur fall into three categories: need, maximising and egalitarian principles, that is, resources should be distributed according to ‘need’ to obtain maximum benefit and to reduce inequality (Cookson & Dolan, 2000). Need and equality come together around the idea that persons in equal need should be treated the same and those in greater need should be treated more favourably than those with less need (Hauck, Smith & Goddard, 2002). For health services ‘need’ is characterised as degree of ill health. For disability services the equivalent is degree of disability, typically assessed as degree of functional limitations. At its most extreme this has been called the ‘rule of rescue’, recognising that extremes of ill-health, or disability, require a response by society, irrespective of any potential benefits (Hadorn, 1991). Often, the processes underpinning decisions about how to allocate resources are not explicitly stated or, if they are, are based on a mix of ‘custom and practice’ and local policies. Prioritisation essentially involves a two-step process, however simple or sophisticated, or implicit or explicit, that process might be. It involves translating concepts such as ‘need’ and ‘benefit’ into something that can be measured and then taking the results from that measurement (assessment) and assigning priority. Malcolm Masso BSc(Econ), MNA, MPH; Senior Research Fellow. Alan Owen BSc(Hons); Senior Research Fellow. Tara Stevermuer BA, MAPPStat; Research Fellow. Kathryn Williams BA(Hons), BA(Journ); Research Fellow. Kathy Eagar PhD; Professor, Director. Correspondence: Malcolm Masso, Centre for Health Service Development, University of Wollongong, NSW 2522, Australia. Email: mmasso@uow.edu.au Accepted for publication 16 May 2008. © 2008 The Authors Journal compilation © 2008 Australian Association of Occupational Therapists