Risk Factor Score for Nursing Facility Eligibility

 

Measures:

(1) history of placement in a nursing home within the past 5 years

(2) history of severe neurological diagnosis

(3) leaves residence 0 or 1 days per week

(4) requires hands-on guidance or physical assistance on 3 or more occasions during the last 7 days to accomplish activities of daily living (see below)

(5) has multiple episodes of urinary incontinence daily

(6) has had a functional decline in the past 90 days

 

Severe neurological diagnosis - indicate which of the following are present:

(1) Alzheimer's disease

(2) dementia, non-Alzheimer's

(3) status post head injury

(4) multiple sclerosis

(5) Parkinsonism

 

where:

• I am surprised severe stroke and cerebral palsy are not listed.

• The number of episodes of urinary incontinence daily is not specified. I used >= 3 in the implementation.

• I would think incontinence should be expanded to included fecal incontinence.

 

Activities of daily living:

(1) dressing (putting clothes on and taking clothes off)

(2) personal hygiene (combing hair, brushing teeth, shaving, applying makeup, washing hands and face, washing perineum; excludes baths and showers)

(3) eating (taking food by any method, including tube feeding)

(4) toilet use (using toilet, bedpan or urinal, transferring on or off toilet, cleaning self after toilet use, changing pad, managing special devices including ostomy or catheters, adjusting clothing afterwards)

(5) bathing (shower, full tub, or sponge bath; not washing hair or back): any assistance, including supervision

Criteria Met	Points
no	0
yes	1

 

total score =

= SUM(points for all risk measures)

 

Interpretation:

• minimum total score: 0

• maximum total score: 6

• A score >=2 is required to continue the eligibility process.

• A person with a score of 0 or 1 does not meet risk factor criteria and is sent a denial notice. Re-evaluation is considered if there is a subsequent increase in the risk score.