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Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC)

Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

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Page 1: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

Long

-Ter

m C

are

Div

isio

nEl

igib

ility

Cri

teri

a fo

rN

ursi

ng F

acili

ty B

(N

F-B)

Leve

l of C

are

(LO

C)

Page 2: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

PRES

ENT

ERS

�C

hris

tine

Kin

g-Br

oom

field

, RN

Nur

se E

valu

ator

IVC

hief

, In-

Hom

e O

pera

tions

, Nor

ther

n Se

ctio

nC

hris

tine.

Kin

g@dh

cs.c

a.go

v

Pegg

y Ba

rrow

, RN

Nur

se E

valu

ator

III

Supe

rvis

or, I

n-H

ome

Ope

ratio

nsM

arga

ret.B

arro

w@

dhcs

.ca.

gov

CA

Dep

t. of

Hea

lth C

are

Serv

ices

2

Page 3: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

HA

ND

OU

TS

�A

vaila

ble

for

dow

nloa

d at

:ht

tp://

ww

w.d

hcs.

ca.g

ov/s

ervi

ces/

med

i-ca

l/Pag

es/A

DH

C/A

DH

C.a

spx

1.Po

wer

Poin

t2.

Initi

al A

sses

smen

t R

epor

t (1

6 pa

ges)

3.A

DH

C C

over

She

et4.

Exce

rpts

from

Cal

iforn

ia C

ode

of

Reg

ulat

ions

(C

CR

), Titl

e 22

�Se

ctio

n 51

124

�Se

ctio

n 51

335

CA

Dep

t. of

Hea

lth C

are

Serv

ices

3

Page 4: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

ON

-LIN

E C

CR

REF

EREN

CE

�T

he C

alifo

rnia

Cod

e of

Reg

ulat

ions

can

be

acc

esse

d at

htt

p://w

ww

.oal

.ca.

gov/

�C

lick

on t

he t

ab la

bele

d “C

CR

�C

lick

on t

he w

ord

“Titl

es”

in t

he s

econ

d se

nten

ce

�C

lick

on “

TIT

LE 2

2. S

OC

IAL

SEC

UR

ITY

�C

lick

the

+ be

fore

“D

IVIS

ION

3. H

EALT

H C

AR

E SE

RVIC

ES”

�C

lick

the

+ be

fore

“SU

BDIV

ISIO

N 1

. CA

LIFO

RN

IA M

EDIC

AL

ASS

ISTA

NC

E PR

OG

RA

M”

�C

lick

the

+ be

fore

“C

HA

PTER

3. H

EALT

H C

AR

E SE

RVIC

ES”

�C

lick

the

+ be

fore

“A

RTIC

LE 4

. SC

OPE

AN

D D

UR

ATIO

N O

F BE

NEF

ITS”

CA

Dep

t. of

Hea

lth C

are

Serv

ices

4

Page 5: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

NF-

B LE

VEL

OF

CA

RE

�Pr

ovis

ion

of c

are

by a

lice

nsed

nur

se

(not

lim

ited

to):

�Tr

ache

osto

my

care

�A

dmin

istr

atio

n of

rou

tine

and

as-n

eede

d m

edic

atio

n�

Tube

feed

ings

�Su

ctio

ning

�In

dwel

ling

cath

eter

s in

con

junc

tion

with

ot

her

cond

ition

s

CA

Dep

t. of

Hea

lth C

are

Serv

ices

5

Page 6: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

NF-

B LE

VEL

OF

CA

RE

�Pr

ovis

ion

of c

are

by a

lice

nsed

nur

se

(con

tinue

d):

�A

pplic

atio

n of

dre

ssin

gs w

ith p

resc

ribe

d m

edic

atio

n�

Exte

nsiv

e w

ound

car

e�

Inta

ke a

nd o

utpu

t m

onito

ring

CA

Dep

t. of

Hea

lth C

are

Serv

ices

6

Page 7: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

NF-

B LE

VEL

OF

CA

RE

�T

here

are

alte

rnat

ives

to

rece

ivin

g lo

ng-t

erm

ser

vice

s an

d su

ppor

ts in

in

stitu

tiona

l set

tings

�R

equi

rem

ents

:�

Hav

e on

e or

mor

e ph

ysic

al d

isab

ility

�El

igib

le t

o re

ceiv

e se

rvic

es in

a s

kille

d nu

rsin

g fa

cilit

y

CA

Dep

t. of

Hea

lth C

are

Serv

ices

7

Page 8: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

NF-

B LE

VEL

OF

CA

RE

�R

equi

rem

ents

(co

ntin

ued)

�M

edic

al n

eed

for

cont

inuo

us n

ursi

ng c

are

for:

�Te

achi

ng o

f spe

cific

tas

ks a

nd p

roce

dure

s�

Obs

erva

tion

�A

sses

smen

t�

Judg

men

t�

Supe

rvis

ion

�D

ocum

enta

tion

CA

Dep

t. of

Hea

lth C

are

Serv

ices

8

Page 9: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

NF-

B LE

VEL

OF

CA

RE

�Ph

ysic

al li

mita

tions

�C

onfin

ed t

o be

d�

Qua

drip

legi

a�

Inab

ility

to

feed

one

self

�Ps

ycho

logi

cal l

imita

tions

�Se

vere

inca

paci

tatio

n du

e to

men

tal h

ealth

or

dev

elop

men

tal i

ssue

s

CA

Dep

t. of

Hea

lth C

are

Serv

ices

9

Page 10: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

NF-

B LE

VEL

OF

CA

RE

�R

evie

w:

�In

itial

Ass

essm

ent

Rep

ort

�Ex

plai

n:�

Purp

ose

of A

DH

C C

over

She

et�

Proc

ess

for

subm

ittin

g co

mpl

eted

Initi

al

Ass

essm

ent

Rep

orts

CA

Dep

t. of

Hea

lth C

are

Serv

ices

10

Page 11: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

Cas

e St

udy

#1�

Age

:91

Year

-Old

�D

x:St

atus

Pos

t C

VA W

ith R

esid

ual R

ight

-Si

ded

Wea

knes

s; H

TN

, Dem

entia

, H

ypot

hyro

idis

m, H

yper

chol

este

role

mia

, D

M T

ype

2�

Mob

ility

:Wal

ker, W

heel

chai

r, 1-

2 Pe

rson

Ass

ist

With

Tra

nsfe

rs�

Feed

ing:

Gas

tros

tom

y Tub

e Fe

edin

g�

Elim

inat

ion:

Inco

ntin

ence

�A

DLs

:D

epen

dent

CA

Dep

t. of

Hea

lth C

are

Serv

ices

11

Page 12: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

Cas

e St

udy

#2�

Age

: 63

Yea

r-O

ld�

Dx:

Stat

us P

ost

MI(1

982)

and

CVA

(19

86);

Mod

. Ex

pres

sive

Aph

asia

; Die

t C

ontr

olle

d D

M;

�M

obili

ty:

Non

-Am

bula

tory

; Pow

er W

heel

chai

r; M

inim

al

Func

tiona

l Mob

ility

; Una

ble

to M

ove

All

Extr

emiti

es; C

ontr

actu

re –

R A

rm &

Bila

tera

l Lo

wer

Ext

rem

ities

; 2

Pers

on L

ift F

or T

rans

fers

; PT

Dai

ly�

Feed

ing:

Req

uire

s M

eal S

et-U

p an

d A

ssis

tanc

e�

Elim

inat

ion:

Inco

ntin

ent

of B

owel

; Sup

ra-P

ubic

C

athe

ter

�A

DLs

:D

epen

dent

�Sk

in:

Red

dene

d H

eels

CA

Dep

t. of

Hea

lth C

are

Serv

ices

12

Page 13: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

Cas

e St

udy

#3�

Age

: 79

Yea

r-O

ld�

Dx:

Stat

us P

ost

Brai

n In

jury

; DM

--D

iet

Con

trol

led;

CO

PD--

Oxy

gen

Dep

ende

nt;

Seiz

ure

Dis

orde

r; H

xof

Fre

quen

t U

TIs

�M

obili

ty:

Wal

ker;

Req

uire

s Su

perv

isio

n an

d A

ssis

tanc

e�

Feed

ing:

Req

uire

s M

eal S

et-U

p an

d A

ssis

tanc

e�

Elim

inat

ion:

Con

tinen

t of

Bow

el; B

ladd

er

Urg

e In

cont

inen

ce

�A

DLs

:R

equi

res A

ssis

tanc

e�

Cog

niti

on:

Shor

t an

d Lo

ng T

erm

Mem

ory

Def

icits

; Po

or Im

puls

e C

ontr

ol CA

Dep

t. of

Hea

lth C

are

Serv

ices

13

Page 14: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

Cas

e St

udy

#4

�A

ge:

41 Y

ear-

Old

�D

x:St

atus

Pos

t M

I; A

noxi

c Br

ain

Dam

age;

Sta

tus

Post

pac

emak

er/d

efib

rilla

tor

plac

emen

t�

Mob

ility

:1:

1 A

ssis

t to

Am

bula

te; R

equi

res

Supe

rvis

ion

and

Ass

ista

nce

�Fe

edin

g:R

equi

res

Mea

l Set

-Up

and

Ass

ista

nce

�E

limin

atio

n:In

cont

inen

t�

AD

Ls:

Req

uire

s Ass

ista

nce

�C

ogni

tion

: Sh

ort

and

Long

Ter

m M

emor

y D

efic

its

CA

Dep

t. of

Hea

lth C

are

Serv

ices

14

Page 15: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

Cas

e St

udy

#5

�A

ge:

82 Ye

ar-O

ld�

Dx:

DM

II; O

steo

arth

ritis

; Alz

heim

er's

�M

obili

ty:W

heel

chai

r D

epen

dent

; tw

o pe

rson

tr

ansf

er; U

nabl

e to

bea

r w

eigh

t�

Feed

ing:

Req

uire

s M

eal S

et-U

p an

d A

ssis

tanc

e –

Diff

icul

ty F

eedi

ng S

elf

�E

limin

atio

n:In

cont

inen

t�

AD

Ls:

Dep

ende

nt�

Cog

niti

on:

Shor

t an

d Lo

ng T

erm

Mem

ory

Def

icits

; Ori

ente

d to

Per

son

Onl

y

CA

Dep

t. of

Hea

lth C

are

Serv

ices

15

Page 16: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

Cas

e St

udy

#6�

Age

: 78

Yea

r-O

ld�

Dx:

DM

II; S

tatu

s Po

st C

VA; H

emip

legi

a; H

TN

�C

ogni

tion

: So

me

Dis

orie

ntat

ion

�M

edic

atio

ns:

Insu

lin (S

lidin

g Sc

ale)

and

Ora

l H

ypog

lyce

mic

Med

icat

ion

�M

obili

ty:

Una

ble

to A

mbu

late

–W

heel

chai

r Bo

und;

R

equi

res

Hoy

er L

ift fo

r Tra

nsfe

rs�

Feed

ing:

Req

uire

s M

eal S

et-U

p an

d A

ssis

tanc

e�

Elim

inat

ion:

Inco

ntin

ent;

Supr

apub

icC

athe

ter

�A

DLs

:D

epen

dent

CA

Dep

t. of

Hea

lth C

are

Serv

ices

16

Page 17: Long-Term Care Division · Long-Term Care Division Eligibility Criteria for Nursing Facility B (NF-B) Level of Care (LOC) PRESENTERS Christine King-Broomfield, RN Nurse Evaluator

NF-

B LE

VEL

OF

CA

RE

Ope

n tim

e fo

r qu

estio

ns

CA

Dep

t. of

Hea

lth C

are

Serv

ices

17