Wisconsin Long Term Care Functional Screen Instructions

1 Wisconsin Long Term Care Functional Screen Instructions Department of Health Services Division of Medicaid Services October 20, 2021 The information provided in this document is published in accordance with Wis. Stat. P- 00946 (10/2021) Table of Contents Module #1: Overview of the Long Term Care Functional Screen (LTCFS) .. 1-1 History .. 1-1 The LTCFS Determines Eligibility for Long-Term Care Programs .. 1-2 Other Functions of the LTCFS .. 1-4 Requirements for Screener Qualifications .. 1-4 Requirements for Quality Assurance .. 1-4 The LTCFS is Voluntary.

2 1-5 1-5 Screening and Rescreening Requirements .. 1-6 The Screening Process .. 1-8 Reliability of Screen and Screeners .. 1-9 Screening Limitations and Strategies to Mitigate Limitations .. 1-10 Module #2: LTCFS Target Groups .. 2-1 LTCFS Target Groups .. 2-1 Target Group Assignment .. 2-2 Frail Elder Target Group .. 2-2 Physical Disability Target Group .. 2-3 FEDERAL Definition of Intellectual/Developmental Disability .. 2-3 STATE Definition of Developmental Disability .. 2-4 Alzheimer s Disease or Other Irreversible Dementia Target Group.

3 2-4 Terminal Condition Target Group .. 2-5 Brain Injury Information .. 2-5 Severe and Persistent Mental Illness Target Group .. 2-6 Mental Illness and Substance Use Co-Morbidity .. 2-6 What If No Target Group Applies? .. 2-6 Module #3: LTCFS Basic Information, Screen Information, Demographics, and Living Situation .. 3-1 Overview .. 3-1 Basic Information .. 3-1 Screen Information .. 3-3 Demographics .. 3-5 Living Situation .. 3-6 Module #4: Diagnoses .. 4-1 The Importance of Diagnoses .. 4-1 Diagnoses Must be Verified .. 4-1 Completing the Diagnoses Table.

4 4-3 Identifying Primary and Secondary Diagnoses .. 4-4 Module #5: Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) .. 5-1 General Guidance for ADLs/IADLs .. 5-2 Communal Living Situations .. 5-4 Coding for Who Will Help in the Next Eight Weeks .. 5-5 Identifying Primary and Secondary Diagnoses .. 5-5 Activities of Daily Living (ADLs) .. 5-8 Bathing .. 5-9 Dressing .. 5-11 Eating .. 5-13 Mobility in Home .. 5-15 Toileting .. 5-19 Transferring .. 5-22 Instrumental Activities of Daily Living (IADLs).

5 5-25 Meal Preparation .. 5-25 Medication Administration and Medication Management .. 5-28 Money Management .. 5-36 Laundry and/or Chores .. 5-38 Telephone Use .. 5-41 Transportation .. 5-43 Module #6: Additional Supports .. 6-1 Introduction .. 6-1 Identifying Primary and Secondary Diagnoses .. 6-1 Overnight Care or Overnight Supervision .. 6-3 Employment .. 6-6 Educational Information .. 6-11 Guardianship .. 6-12 Diagnoses with Onset Before Age 22 .. 6-12 Expected Duration of Diagnosis and Social Security Disability Determination.

6 6-12 Module #7: Health-Related Services (HRS) Table .. 7-1 Background of the HRS Table .. 7-1 The HRS Table and Need for Health Care Provider Consultation .. 7-1 Completing the HRS Table and General Rules for its Use .. 7-1 Avoid Double-Dipping on the HRS Table .. 7-4 Person is NOT Independent in Completing and Managing a Health-Related Service .. 7-6 Person is INDEPENDENT in Completing and Managing a Health-Related Service .. 7-6 Person is INDEPENDENT With Some Tasks, but NOT Independent With Others .. 7-7 Person Declines the Task .. 7-7 Indicate Frequency of Skilled TASKS, Not Duration of Condition.

7 7-8 Identifying Primary and Secondary Diagnoses .. 7-8 Behaviors Requiring Interventions .. 7-10 Exercises/Range of Motion .. 7-14 IV Medications, Fluids, or IV Line Flushes .. 7-15 Medication Administration (not IV) or Assistance with Pre-Selected or Set-Up Medications .. 7-16 Medication Management: Set-up and/or Monitoring Medications (for Effects, Side Effects, Adjustments, Pain Management) and/or Blood Levels .. 7-20 Ostomy-Related Skilled Services .. 7-25 Positioning in Bed or Chair Every 2-3 Hours .. 7-26 Oxygen and/or Respiratory Treatments: Tracheal Suctioning, C-PAP, Bi-PAP, Nebulizers, IPPB Treatments (Does NOT include inhalers).

8 7-27 Dialysis .. 7-30 TPN (Total Parenteral Nutrition) .. 7-31 Transfusions .. 7-32 Tracheostomy Care .. 7-32 Tube Feedings .. 7-33 Ulcer Stage 2 .. 7-34 Ulcer Stage 3 or 4 .. 7-35 Urinary Catheter-Related Skilled Tasks (Irrigation, Straight Catheterizations) .. 7-35 Other Wound Cares (Not Catheter Sites, Ostomy Sites, IVs or Ulcer Stage 2, 3, or 4) .. 7-36 Ventilator-Related Interventions .. 7-37 Requires Nursing Assessment and Interventions .. 7-37 Other Row .. 7-40 Skilled Therapies: PT, OT, SLP (Any One or a Combination, at Any Location).

9 7-40 Module #8: Communication and Cognition .. 8-1 Identifying Primary and Secondary Diagnoses .. 8-1 8-3 Memory Loss .. 8-5 Cognition for Daily Decision Making .. 8-7 Physically Resistive to Care .. 8-9 Module #9: Behavioral Health .. 9-1 Overview of the Behaviors/Mental Health Module .. 9-1 Wandering .. 9-2 Self-Injurious Behaviors .. 9-3 Offensive or Violent Behavior to Others .. 9-4 Mental Health Needs and Substance Use Disorder Questions .. 9-6 Behavioral Information Supplement .. 9-7 Module #10: Risk .. 10-1 Overview .. 10-1 Part A - Current Adult Protective Services or Elder Adult/Adult at Risk Client.

10 10-1 Part B - Risk Evident During Screening Process .. 10-2 Module #11: Completion of the LTCFS and Notes .. 11-1 Screen Completion Date .. 11-1 Face-to-Face Contact with Person .. 11-1 Collateral Contacts .. 11-3 Other Screen -Related Activity (Paperwork) .. 11-3 Travel Time .. 11-4 Notes .. 11-4 Calculating Eligibility .. 11-5 No Active Treatment .. 11-6 Wisconsin Department of Health Services ( October 20, 2021) 1-1 Module #1: Overview of the Long Term Care Functional Screen (LTCFS) Objectives By the end of this module, the screener should be able to: Explain the major criteria used to develop the LTCFS.