PM 11-03-02.

Document the need for care and point count assessment on Evaluation of Need for Care (Form 184b).

The total point count is the sum of all points allowed for the services required and received by the client. Use the total point count to figure the level of care required.

When necessary, refer cases to the HFS Bureau of Long Term Care (BLTC) Regional Supervisor before allowing points or determining placement. The phone number and address for the Regional Supervisor can be obtained by calling BLTC at 217-782-0545. The BLTC Regional Supervisors are free to contact Regional Public Health Nurses, Office of Mental Health staff, or other professional medical or nursing personnel for consultation as needed.

Include services identified with an (*) only in the point count of a client in an approved home not subject to licensing. Do not allow a point count for services with an (*) for a client who receives sheltered care services.

Services not identified by an asterisk (*) may be provided in a sheltered care facility or an approved home not subject to licensing.

As used in the point count guidelines, daily means the service must be provided at least the number of times specified with the following exception: When a service is started or stopped by a new order from the doctor, daily means continuously during the service period from:

  • the date of the order to the end of the service period, or
  • the beginning of the service period to the date of the stop order, or
  • the date of an order to start to the date of a stop order.

Assign points for each area of service listed below. Assign the points for the highest level of service needed and received by a client during the service period.

  1. Points Service - Eating
    • 0 -Client can eat without help.
    • 1 -Client needs help in cutting food, buttering bread, placing utensils for a blind client, etc.
    • 2 -Client needs and receives individual help to eat from a staff member.
    • 4 -Client needs and receives individual attention by a staff member at all meals. The staff member remains in constant attendance at the patient's side throughout mealtime to feed the client or insure enough intake of food.
    • *8 -Client is unable to take food by mouth and tube feeding or gastrostomy feedings are given by licensed nurses, based on a doctor's order.
  2. Points Service - Mobility
    • 0 -Client is free in movement with or without aid devices and no help is needed to move from place to place. This includes the client who can transfer themselves to and from a wheelchair.
    • 2 -Client can move about but needs a staff member to:
      • help them get into a wheelchair,
      • begin walking with the walker, or
      • walk beside them to give assistance, etc.
    • Allow points in a sheltered care facility for a client who can move about freely but needs help to get into a wheelchair or begin walking with a walker if:
      • the facility is determined safe for the client by DPH,
      • the client's living area is on the first floor, and
      • access to the facility is on grade level or ramps are provided.
    • Obtain prior approval from the BLTC Regional Supervisor who will verify safety with DPH.
    • *3 -Client is unable to move about under their own power. Client must be moved by a staff member. This may include pushing a wheelchair or lifting the client. This also includes the client who can move except that their size or other physical condition requires more than one nursing staff member be at their side to give assistance in moving about.
  3. Points Service - Behavior or Mental Condition
    • 0 -Client is usually able to act in a way that takes into account their needs and the needs of others and staff. Client can be reasoned with and adjust their behavior. On the whole, their behavior is consistently cooperative. Client is aware of whom they are and what is expected of them within the home. Client does not need special supervision.
    • 3 -Client needs occasional supervision from a staff member. Client presents problems such as:
      • hyperactivity,
      • confusion,
      • occasional strong reactions to frustration or disappointments,
      • prolonged periods of silence,
      • excessive pacing or sleeping, or
      • inability or unwillingness to interact.
    • During such "ups and downs" client needs temporary help from staff.
    • *8 -Client needs special and continuous supervision by a licensed nurse. Client's tolerance is so low and unpredictable that a licensed nurse must always be present in the facility.
  4. Points Service - Current Physical Rehabilitation Needs

    Rehabilitation nursing consists of services ordered by a doctor, such as:range of motion exercises, positioning, transfer activities, gait training, parallel bars, pulleys, and training of the aphasic.

    Bowel and bladder training programs are not included.

    • The acute illnesses and injuries for which 8 or 12 points may be given include: 

      • fractures of the hip, pelvis, and extremities;
      • acute brain trauma (to include spinal cord injuries or neurological disorders, but not to include congenital brain disorders);
      • cerebral vascular accidents resulting in aphasia and/or hemiplegia; or
      • amputees requiring pre and post prosthetic care and training.
    • 0 -Client does not need rehabilitation or has no potential for rehabilitation.
    • *4 -Client needs and is receiving rehabilitation nursing services performed or supervised by a licensed nurse to maintain current function.
    • *8 -Client needs and is receiving rehabilitation nursing services performed or supervised by a licensed nurse, following selected acute illnesses or injuries, to improve level of functioning, for a period from 3 to 6 months following discharge from a hospital or rehabilitation facility, if the facility has an approved rehabilitation nursing program.
    • *12 -Client needs and is receiving intensive rehabilitation nursing services supervised by a licensed nurse following selected acute illnesses or injuries within a period of 3 months following discharge from a hospital or rehabilitation facility, if the facility has an approved rehabilitation nursing program.
  5. Points Service - Catheterization (including irrigations)
    • 0 -Client does not need catheterization or irrigation.
    • *4 -Client needs an occasional catheterization for a specimen or treatment, or an indwelling catheter for a short-term physical condition.
    • *8 -Doctor orders a retention catheter to be used continuously. This also includes full care of the catheter and irrigations. When a retention catheter is used, the client will not be considered to be needing or receiving care because of a bladder incontinence under item 6, although sometimes the client may be on a bowel and bladder training program for a short period while the catheter is used.
  6. Points Service - Incontinence (Bladder and Bowel)
    • 0 -Client has complete bladder and bowel control.
    • 1 -Client usually has control except on those rare occasions when they have an accident due to nervousness or visitors, or reaction to medications, such as cathartics.
    • 2 -Client is neither continent nor incontinent; sometimes have control; other times they do not.
    • *4 -Client needs and is receiving services to maintain bowel and bladder control following a bowel and bladder training program.
    • *6 -Client has no bladder and/or bowel control and requires care for cleanliness or comfort. This includes the patient who dribbles consistently.
    • *8 -Client has in the past no control, but is now receiving training through an active bowel and bladder program. The doctor has ordered such a program and the nursing care plan for the client includes this program. The maximum length of time for the initial period is 3 months. If successful, an additional 3 months may be added for a maximum total of 6 months.
  7. Points Service - Douches, Enemas and/or Colostomy Irrigations
    • 0 -Client does not need douches, enemas, or colostomy irrigations, or needs and receives such services at infrequent intervals for the treatment of a short-term condition.
    • *4 -Client needs and receives a douche, enema and/or colostomy irrigation on a regular basis, but less than daily.
    • *5 -Client needs and receives a douche, enema and/or colostomy irrigation at least once a day.
  8. Points Service - Diet
    • 0 -Diet ordered by the doctor is the menu used for most of the patients in the facility, with or without minor changes, such as removal of salt or sugar on trays, exchanges of salad or desserts, etc. This includes pureed and baby food, or a ground diet.
    • *3 -Diet ordered by the attending doctor is a specified diet which must be prepared separately from the daily menu.
    • This includes:
      • salt free,
      • weighed,
      • calculated caloric diets, and
      • diets and tube feedings which require the purchase of special foods.
  9. Points Service - Medications (Oral, Drops, Ointments, Suppositories)

    If the client is taking more than 2 prescribed medications and the doctor's order for self medication does not list all medications being taken, send a listing of all medications prescribed for the client to the BLTC Regional Supervisor.

    Send with the list of medications, a brief statement of: 

    • the client's condition,
    • diagnosis, and
    • the caseworker's suggestions on the client's ability to handle his own medication.

      The BLTC Regional Supervisor reviews the information and advises the Family Community Resource Center if additional contact with the doctor is needed.

      Prescribed PRN and variable dosage medications, controlled substances, and anticoagulants cannot be self-administered in a sheltered care facility. 

      • 0 -Medication is not prescribed, or the doctor gives written permission for the client to handle the medication. This includes self-administered in sheltered care facilities.
      • *1 -Client needs and receives prescribed medication (oral, drops, ointments, suppositories) given by staff on a less than daily basis.
      • *3 -Client needs and receives prescribed medication (oral, drops, ointments, suppositories) given by staff on a regular daily basis.
  10. Points Service - Injections (Hypodermic and Intramuscular)
    • 0 -No hypodermic or intramuscular injections are prescribed by the doctor, or the client is permitted to self-administer a drug by hypodermic on the written order of the doctor.
    • *2 -Hypodermic and/or intramuscular injections are administered on less than daily basis by a licensed nurse.
    • *4 -Client needs and receives a daily injection of medication by a licensed nurse throughout the evaluation period.
  11. Points Service - Intravenous and Subcutaneous
    • 0 - Client does not need intravenous or subcutaneous fluids.
    • *2 - Client needs and receives intravenous and/or subcutaneous medication or fluids given by the doctor.
    • *8 - Intravenous or subcutaneous fluids are given by an RPN upon the doctor's order.
  12. Points Service - Suctioning
    • 0 - Client does not need suctioning.
    • *3 - Client has a condition, such as tracheotomy, to which they have become adjusted to such a degree that they can care for it, with little help by nursing staff for cleaning purposes.
    • *5 - Client needs suctioning less than daily.
    • *8 - Client needs suctioning daily throughout the evaluation period.
  13. Points Service - Oxygen (Includes Positive Pressure)
    • 0 - Client does not need oxygen services.
    • *4 - Client needs oxygen on an emergency basis or occasionally during the month. This includes a client who can give their own oxygen and/or pressure treatments with supervision and little help.
    • *8 - There is a current written order, and the client needs oxygen and/or positive pressure treatments given by nursing staff on a daily basis.
  14. Points Service - Dressings and Appliances
    • 0 - Client needs no dressing or needs only an occasional small temporary dressing for minor cuts or abrasions.
    • *4 - Client needs daily application of:
      • ACE bandages,
      • additional care because of a cast, and/or
      • help with the application of appliances such as prostheses, brace, and supports.
    • *6 - Client needs dressing to a moderate size area and/or moist dressing or soaks, on an ongoing basis. Such services may be needed for, but not limited to:
      • decubiti (bed sores),
      • recurrent leg ulcers, and
      • daily colostomy dressings.
    • *8 - There is a doctor's written order for comprehensive dressings needed on a regular daily basis, performed by an RN or graduate LPN.