ALWPP Scoring Assessment Tool:


Scoring System For CALWPP Assessment Tool

I. Activities of Daily Living (ADLs)

A. Measure Self-Performance of the following (Section D1, p.4)

Transfer

Locomotion in Residence

Dressing

Eating

Toilet Use

Personal Hygiene

Bathing

If Self-Performance = Supervision, Score=1

If Self Performance =Limited Assistance, Score=2

If Self Performance=Extensive Assistance, Score=3

If Self Performance =Dependent, Score=4

B. Score

If ADL total score is < or = 3, ADL=0

If ADL total score is >or = 4 and < or =13, ADL=1

If ADL total score is >13, ADL=2


II. Assign Points as Follows:

A. Cognitive Patterns (Section B 2&3, p.2)

Memory and Use of Information

Minimal Difficulty=5

Difficulty=7

Can’t remember=10

Cognitive Skills for Daily Decision Making

Moderately Impaired=5

Severely Impaired=10

B. Behavioral Symptoms (Section C 2 A-E p.3)

1. Sleep

Up wandering Most of Night=7

2. Wandering

Wanders Within Residence=10

Wanders Outside=12

3. Behavioral Demands

Attitudes, habits, etc. create frequent difficulties=10

4. Agitated, Disruptive, and/or Aggressive

Sometimes agitated, disruptive or aggressive=10

Frequently agitated, disruptive or aggressive=15

5. Awareness of Needs

Will not cooperate=10

C. Continence (Section E, 1 p 4)

1. Bladder

Occasionally incontinent and needs assistance=3

Frequently incontinent and needs assistance=5

Incontinent and needs assistance =10

2. Bowel

Occasionally incontinent and needs assistance = 3

Frequently incontinent and needs assistance =5

Incontinent and needs assistance =10

D. Communication/Hearing Patterns (Section F 4&5, p.5)

Sometimes Understood=5

Rarely Understood=10

Sometimes Understands=5

Rarely Understands=10

E. Medications (Sections IC-F, p.6)

If answer on any C-F = no (indicating need for med administration), Score =5

If there is a need for medication administration then score number of drugs (A):

1-5 drugs =3 points

6-10 drugs =7 points

>10 drugs =10 points

F. Skin Condition (Section K 3 C-I, p.6)

If any skin treatments are checked and are not performed by outside resource =10 points

G. Other Treatments, Programs or Services (Section L 1, 2&3 p.7

Needs assistance with treatments = 3 points/treatment

Behavioral management programs or modification of environment = 2 points each

Need for rehabilitative/restorative care =1 point/program

H. Total Possible Points

Cognition=20

Behavior=54

Continence=20

Communication=20

Medications=15

Skin Treatments=10

Need for Other Treatments, Programs and Services

Treatments = 18

Behavior=4

Rehab=10

TOTAL POSSIBLE POINTS = 161

Calculating Tiers

Not Eligible: ADL Score =0, regardless of points or ADL Score =1 and points are <10

Tier 1 (NF-A): ADL Score=1 and Points > or =10 and < or =30

Tier 2 (NF-B): ADL Score=1 and Points >31 and < or = 64

Tier 3 (NF-B):

ADL Score=1 and Points > or = 65

ADL Score=2 and Points < 45

Tier 4 (NF-B): ADL Score=2 and Points >45 

Table 1 Assisted Living Benefit Service Tiers and Rates

Tier Daily Rate

One $52.00

Two $62.00

Three $71.00

Four $82.00

Total Daily Reimbursement Rate =

ALWPP daily reimbursement rate x 30 days + patient's SSI contribution ($870)= 

Tier One:  2430 (52 x 30 days + 870)

Tier Two:  2730 (62 x 30 +870)

Tier Three: 3000 (71 x 30 +870)

Tier Four:   3330 (82 x 30 + 870)