Level of Care Determination Tool – Evaluation of Screening Tool and Algorithm Reliability and Validity

Principal Investigator(s)

Steven Albert, PhD, and Anne Newman, MD

The Pennsylvania Departments of Aging and Human Services utilize a level of care determination tool to determine if an individual is clinically eligible for nursing facility level of care. The Area Agencies on Aging (AAAs) use the tool to conduct the determination for state-funded home and community-based services, Medicaid funded nursing facility services, and Medicaid home and community-based waiver programs. The same standard for functional eligibility must occur between nursing facility services and home and community-based waiver services. 

The objectives are to:

  1. Evaluate the validity and inter-rater reliability of a new screening tool to assess level of care. A new tool, the level of care determination tool, was developed, expanding and standardizing several areas of assessment. Training has taken place and a pilot phase has begun. Using the Departments’ criteria for functional eligibility as well as eligibility tier, we propose to also assess the validity of the new tool. This will be done by comparing the two assessor’s initial determinations of eligibility versus the determination by the supervisor. A focus group effort will also allow assessors from multiple county AAAs to rate standardized consumer scenarios with pre-defined nursing facility clinically eligible status and local coverage determination tier, developed in consultation with the Departments of Aging and Human Services.
  2. Evaluate the acceptability, parsimony and ease of administration of the tool. It is important to ensure that the tool is easy to administer and is parsimonious in that it addresses only information critical to the determination. Focus groups will be used to assess the qualitative experience with the tool. The assessors, the supervisors and clients/consumers (persons assessed) will be asked separately to provide feedback on burden, sensitivity, ease of use. Secondly, using data already compiled in a database, a predictive analysis and factor analysis will be used to assess the key elements that lead to the final assessment.
  3. Create training tools for administrators.