Resource: Nursing facility level of care (NF LOC) criteria guide

Page posted: 6/28/24

Lead agencies must complete a MnCHOICES assessment to determine institutional LOC for people who seek home and community-based services. The LOC determination is a part of determining program and service eligibility. For more information, refer to CBSM – LOC. Use this page as an informational guide only.

Note: Providers also must submit the Senior LinkAge Line’s preadmission screening before NF admission to determine NF LOC. For more information, refer to Senior LinkAge Line – Providers & Partners. This page does not include instructions for this situation.

Criteria

For NF LOC, a person must meet one of the following five categories of need:

· Criteria related to cognitive or behavioral needs.

· Activities of daily living (ADLs).

· Critical ADLs.

· Clinician monitoring.

· Living arrangement and risk.

Criteria related to cognitive or behavioral needs

A person must meet one of the following criteria.

Assessment item	NF LOC based on at least one need
Self-preservation	Score 02 or greater = Y
Orientation	Score 02, 03 or 04 = Y
Mental status: Mini-Cog	Score 3 or less
Behavioral need	Score 01 or greater = Y

If the person does not meet any of the above criteria, continue to the ADLs section.

ADLs

The following table includes qualifying thresholds for dependency scores for NF LOC. A person can meet NF LOC by either meeting four of the eight ADLs listed or by having one critical ADL.

Assessment item	NF LOC based on 4 or more ADL dependencies	NF LOC based on at least one critical ADL
Dressing	Score 02 or greater = Y	N/A
Grooming	Score 02 or greater = Y	N/A
Bathing	If the person is age 18 or older, score 04 or greater = Y If the person is age 17 or younger, score 03 = Y	N/A
Eating	Score 02 or greater = Y	N/A
Walking	Score 02 or greater = Y	N/A
Bed mobility (positioning)	Score 02 or greater = Y	Score 02 or greater = Y
Transferring	Score 02 or greater = Y	Score 02 or greater = Y
Toileting	Score 01 or greater = Y	Person needs supervision throughout activity or physical assistance from another to complete toileting = Y

If the person does not meet the above criteria, continue to the clinical monitoring section.

Clinical monitoring

Assessment item	NF LOC based on clinical monitoring
Clinical monitoring at least once every 24 hours	Score 01 or greater = Y

If the person does not meet the above criteria, continue to the living arrangement and risk section.

Living arrangement and risk

The person’s planned living arrangement must be one of the following:

· Will live alone (01).

· Will remain homeless (05).

· Requires a shared living environment and support must be/continue to be available from others to mitigate risk (06).

· Requires a shared living arrangement that is necessary for housing stability (06).

Additionally, the person must meet one of the following risk criteria.

Assessment risk criterion	NF LOC based on at least one risk factor (when combined with planned living arrangement)
Falls with a fracture in the past 12 months	Score 03 = Y
Vision: · Has difficulty seeing environmental objects, with or without correction · Does not have useful vision, even with correction	Score 02 or 03 = Y
Hearing: · Has difficulty understanding speech in most situations, even with corrective aids · Hears and responds to loud, intense sounds, with or without corrective aids · Does not have useful hearing, even with corrective aids	Score 02 or 03 = Y
Person is at risk of self-neglect	True = Y
Person is at risk of exploitation	True = Y

If the person does not meet the designated criteria in at least one of the five categories above, the person does not meet NF LOC.

Additional information

CBSM – Assessment and support planning overview
CBSM – LOC
CBSM – Assessment applicability and timelines
Senior LinkAge Line – Providers and partners resources
Senior LinkAge Line – Make a referral
AC, BI, CADI, EW Case Mix Classification Worksheet, DHS-3428B (PDF)