Understanding the different levels of care in nursing homes is an important first step when considering viable long-term care options for a loved one. Many state Medicaid waiver programs require that a physician assess a senior to determine if they need a nursing home level of care (NHLOC).
Determining NHLOC typically requires a comprehensive assessment and evaluation by professionals. State guidelines vary but may include considerations like cognitive functioning and a resident’s ability to manage their medications.
Level 1
Level one is typically offered in assisted living facilities (ALFs). Here, seniors receive help with ADLs but can bathe themselves and move around well. They may need a wake-up visit in the morning or simple reminders throughout the day.
Those at this stage of care may start to show signs of memory impairment or physical limitations. They may need cues to complete their daily activities, a lot of supervision and assistance, and encouragement to socialize with others.
Seniors determined to be at this level of care can usually live in an independent living community longer, as they are not considered nursing home residents. In addition, they can continue receiving Medicaid long-term care services at home through a waiver program.
Level 2
A senior in Level 2 may need cues to carry out their daily living activities, but they can still get around on their own. They can also manage their medications and go to the bathroom without issues.
It is important to understand that how a senior’s doctor determines the nursing home’s level of care differs from state to state. Most states use a specific tool to assess an old’s ability to perform their ADLs.
Many Medicaid Waiver programs use this assessment to determine whether seniors meet their long-term care needs. The same determination only sometimes applies to seniors receiving private insurance. The determination will depend on the policyholder’s situation and needs. A doctor or an RN may conduct the assessment.
Level 3
Those who require level 3 of care might have multiple physical ailments that need extensive hands-on assistance daily, or they may be living with mild Alzheimer’s disease or dementia. Their inability to dress themselves, manage their medications or eat meals without aid may also be contributing factors.
To qualify for this level of care, the senior must be assessed as needing nursing homes Albany NY s and deemed able to live safely in a skilled nursing facility (SNF). A doctor usually does this assessment after hospitalization.
How this requirement is determined varies greatly from state to state. Some states use specific terms, while others refer to it as a Nursing Facility Level of Care Determination (NFLOC). Other names include NHLOC, nursing home eligibility, and Medicare NF coverage.
Level 4
What qualifies someone for the nursing home level of care varies by state. For instance, in Albany, a senior must be assessed by a doctor and have a medical condition that results in their needing significant hands-on assistance from caregivers for the Activities of Daily Living. This includes things like help bathing, grooming, transferring, dressing, and eating. Additionally, physicians must determine that they require around-the-clock skilled nursing to monitor and assess their medical needs.
Then some states set a minimum number of ADLs to be assisted with. Finally, some have a scoring system that ranks the person based on their need. This is a common way nursing homes determine long-term care eligibility requirements, such as for Medicaid waiver programs.
Level 5
Some seniors cannot live safely in their homes and require long-term care. This may be due to severe cognitive impairments, like Alzheimer’s or Parkinson’s disease, or behavioral issues, such as wandering and being lost, agitation and aggression (physical, verbal).
Most states use a functional assessment tool to determine whether an older adult meets the nursing home level of care. These tools are typically compiled lists of questions about one’s ability or inability to complete the Activities of Daily Living.
Many states have a set number of ADLs that need to be completed with assistance before a senior will be considered to meet the nursing home level of care criteria. This criterion is often used to determine eligibility for long-term care and services through Medicaid Waivers and the regular aged, blind and disabled Medicaid program.
