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)