Overview (delete me)


Introduction

Individuals seeking Home and Community Based Services (HCBS) must meet nursing facility Level of Care (LOC). This measures the same eligibility criteria required for entry into a nursing facility as outlined in 19 CSR 30-81. LOC is determined during (re)assessments completed by Division of Senior and Disability Services (DSDS) staff or their designee.

Purpose

DSDS utilizes the InterRAI HC tool to conduct assessments. Based on the information gathered, algorithms within the electronic case record system determine the LOC score in individual categories. With an assessed LOC score of 18 points or higher, an individual is determined to be qualified for LOC and eligible for HCBS. If the individual does not meet LOC, they are determined to be ineligible and appropriate adverse action [NEEDS LINK] steps should be taken.

Categories

Cognition

  • Determine if the participant has an issue in one or more of the following areas:
    • Cognitive skills for daily decision making and ability to complete task in a sequence
    • Memory or recall ability (short-term, procedural, situational memory)
    • Disorganized thinking/awareness – mental function varies over the course of the day
    • Ability to understand others or to be understood
0 pts3 pts6 pts9 pts18 pts
No issues with cognition
and
No issues with memory, mental function,
or ability to be understood/ understand
others		Displays difficulty making decisions
in new situations or occasionally
requires supervision in decision making
and
Has issues with memory, mental function,
or ability to be understood/ understand others		Displays consistent unsafe/poor
decision making or requires
total supervision
and
Has issues with memory mental
function, or ability to be
understood/ understand others		Rarely or never has the
capability to make decisions
or
Displays consistent unsafe/poor
decision making or
requires total supervision
and Rarely or never
understood/able to understand others		Trigger:
Comatose state

Eating

  • Determine the amount of assistance the participant needs with eating and drinking. Includes intake of nourishment by other means (e.g. tube feeding or TPN).
  • Determine if the participant requires a physician ordered therapeutic diet.
0 pts3 pts6 pts9 pts18 pts
No assistance needed
and
No physician ordered diet		Physician ordered therapeutic diet
or
Set up, supervision, or limited assistance needed with eating		Moderate assistance needed with eating,
i.e. participant performs more than 50% of the task independently		Maximum assistance needed with eating,
i.e. participant requires caregiver to perform more than 50% for assistance		Trigger:
Total dependence on others

Behavioral

  • Determine if the participant:
    • Receives monitoring for a mental condition
    • Exhibits one of the following mood or behavior symptoms – wandering, physical abuse, socially inappropriate or disruptive behavior, inappropriate public sexual behavior or public disrobing; resists care
    • Exhibits one of the following psychiatric conditions –abnormal thoughts, delusions, hallucinations
0 pts3 pts6 pts9 pts18 pts
Stable mental condition
and
No mood or behavior symptoms observed
and
No reported psychiatric conditions		Stable mental condition monitored by a physician or licensed mental health professional at least monthly
or
Behavior symptoms exhibited in past, but not currently present
or
Psychiatric conditions exhibited in past, but not recently present		Unstable mental condition monitored by a physician or licensed mental health professional at least monthly
or
Behavior symptoms are currently exhibited
or
Psychiatric conditions are recently exhibited		Unstable mental health condition monitored by a physician or licensed mental health professional at least monthly 
and
Behavior symptoms are currently exhibited
or
Psychiatric conditions are currently exhibited		---

Toileting

  • Determine the amount of assistance the participant needs with toileting. Toileting includes using the toilet (bedpan, urinal, commode), changing incontinent episodes, managing catheters/ostomies, and adjusting clothing.
  • Determine the amount of assistance the participant needs with transferring on/off the toilet.
0 pts3 pts6 pts9 pts18 pts
No assistance needed
or
Only set up or supervision needed		Limited or moderate assistance needed, i.e. participant performs more than 50% of task independentlyMaximum assistance needed, i.e. participant needs 2 or more helpers or more than 50% of caregiver weightbearing assistanceTotal dependence on others---

Bathing

Determine the amount of assistance the participant needs with bathing. Bathing includes taking a full body bath/shower and the transferring in and out of the bath/shower.

0 pts3 pts6 pts9 pts18 pts
No assistance needed
or
Only set up or supervision needed		Limited or moderate assistance needed, i.e. participant performs more than 50% of task independentlyMaximum assistance, i.e. participant needs 2 or more helpers or more than 50% of caregiver weightbearing assistance
or
Total dependence on others		------

Treatments

  • Determine if the participant requires any of the following treatments:
    • Catheter/Ostomy care
    • Alternate modes of nutrition (tube feeding, TPN)
    • Suctioning
    • Ventilator/respirator
    • Wound care (skin must be broken)
0 pts3 pts6 pts9 pts18 pts
None of the above treatments needed---One or more of the above treatments are needed------

Dressing and Grooming

  • Determine the amount of assistance the participant needs with:
    • Personal Hygiene
    • Dressing Upper Body
    • Dressing Lower Body
0 pts3 pts6 pts9 pts18 pts
No assistance needed
or
Only set up or supervision needed		Limited or moderate assistance needed, i.e. participant performs more than 50% of task independentlyMaximum assistance, i.e. participant needs 2 or more helpers or more than 50% of caregiver weightbearing assistance
or
Total dependence on others		------

Rehabilitation

  • Determine if the participant has the following medically ordered therapeutic services:
    • Physical therapy
    • Occupational therapy
    • Speech-language pathology and audiology services
    • Cardiac rehabilitation
0 pts3 pts6 pts9 pts18 pts
None of the above therapies orderedAny of the above therapies ordered, 1 time per weekAny of the above therapies ordered 2- 3 times per weekAny of the above therapies ordered 4 or more times per week---

Meal Prep

  • Determine the amount of assistance the participant needs to prepare a meal. This includes planning, assembling ingredients, cooking, and setting out the food and utensils
0 pts3 pts6 pts9 pts18 pts
No assistance needed
or
Only set up or supervision needed		Limited or moderate assistance needed, i.e. participant performs more than 50% of taskMaximum assistance, i.e. caregiver performs more than 50% of task
or
Total dependence on others		------

Medication Management

  • Determine the amount of assistance the participant needs to safely manage their medications. Assistance may be needed due to a physical or mental disability.
0 pts3 pts6 pts9 pts18 pts
No assistance neededSetup help needed
or
Supervision needed
or
Limited or moderate assistance needed, i.e. participant performs more than 50% of task		Maximum assistance needed, i.e. caregiver performs more than 50% of task
or
Total dependence on others		------

Mobility

  • Determine the participant’s primary mode of locomotion
  • Determine the amount of assistance the participant needs
    • Locomotion – how moves in the home, between locations on the same floor (walking or wheeling). If wheeling, how much assistance is needed once in the chair?
    • Bed Mobility – transition from lying to sitting, turning, etc. while in bed
0 pts3 pts6 pts9 pts18 pts
No assistance needed
or
Only set up or supervision need		Limited or moderate assistance needed, i.e. participant performs more than 50% of task independentlyMaximum assistance needed for locomotion or bed mobility, i.e. participant needs 2 or more helpers or more than 50% of caregiver weight-bearing assistance
or
Total dependence for bed mobility		---Trigger:
Participant is bedbound
or
Total dependence on others for locomotion

Safety

  • Preliminary safety LOC score
    • Determine if the individual exhibits any of the following risk factors:
    • Vision Impairment
    • Falling
    • Balance – moving to standing position, turning to face the opposite direction, dizziness, or unsteady gait.
  • After determination of preliminary score, history of institutionalization in the last 5 years and age will be considered to determine final score.
    • Institutionalization – long term care facility, RCF/ALF, mental health residence, psychiatric hospital, settings for persons with intellectual disabilities
    • Age – 75 years and over
0 pts3 pts6 pts9 pts18 pts
No difficulty or some difficulty with vision
and
No falls in last 90 days
and
No recent problems with balance		Severe difficulty with vision (sees only lights and shapes)
or
Has fallen in last 90 days
or
Has current problems with balance
or
Preliminary score of 0
and
Age or Institutionalization		No vision
or
Has fallen in last 90 days
and
Has current problems with balance
or
Preliminary score of 0
and
Age
and
Institutionalization
or
Preliminary score of 3
and
Age or Institutionalization		Preliminary score of 6
and
Institutionalization		Trigger:
Preliminary score of 6
and
Age Preliminary score of 3
and
Age
and
Institutionalization

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