Diana Choy-Shan Featured in Care.com Article

One of Cona Elder Law’s Partners, Diana Choy-Shan, was recently featured in a Care.com article titled “What is nursing home level of care, and how is it determined?”. This article discusses NFLOC criteria and what it means for Medicaid coverage. Diana explains what NFLOC is and how it’s calculated.

What is Nursing Facility Level of Care (NFLOC)?

Nursing facility level of care — care that aligns with the type of 24-hour medical services provided by nursing homes — is a numerical score generated by an assessment designed to evaluate a senior’s needs, explains Diana Choy-Shan, an elder law attorney specializing in Medicaid benefits at Cona Elder Law. “This assessment tool considers applicants’ medical needs and functional limitations and utilizes the data collected to identify appropriate services and programs,” she says.

NFLOC and Medicaid HCBS Waivers

HCBS waivers provide long-term care services through Medicaid outside of an institutionalized setting, i.e. nursing homes, Choy-Shan explains. Waivers are designed at the state level, and eligibility is based on certain cost criteria and NFLOC qualification, she says.

What happens during an NFLOC assessment?

Licensed healthcare professionals conduct NFLOC assessments — think nurses, social workers or physician assistants, Milanowski says. Assessors must also have completed Uniform Assessment System (UAS) training, a program that teaches people how to evaluate individuals in need of home care or long-term care, Choy-Shan adds.

How an NFLOC assessment is scored

“Within each section of the assessment, the assessor is trained to specify the degree of assistance needed,” Choy-Shan says. This is how they rate degrees of assistance:

• Independent.
• Setup help.
• Supervision.
• Limited assistance.
• Extensive assistance.
• Maximal assistance.
• Total dependence.

Each degree of assistance is then linked with a numerical score, and each section has a minimum number of points an applicant must earn to qualify for NFLOC, Choy-Shan explains. “In theory, the greater the Medicaid applicant’s needs, the higher the NFLOC score,” she says.

Can You Prepare For an NFLOC Assessment?

As for NFLOC applicants, Choy-Shan reminds her clients that an ideal NFLOC assessment is performance-based and not only based on personal testimony. Therefore, she recommends the Medicaid applicant be prepared to do the following:

• Attempt to perform a series of activities of daily living, as well as other physical tests (walking, transferring in and out of a bed, climbing stairs, etc.).
• Accurately report and recite diagnoses.
• Report dates and incidents for recent hospitalizations.
• Prepare a list of current medications.