Concept: Level of Care (LOC) - in Personal Care Home (PCH)

Introduction

This concept contains information on the level of care assigned to residents of Personal Care Homes (PCHs). The level of care is based on an assessment of the individual's ability to perform activities of daily living (ADL), their need for professional intervention and their degree of behavioural problems. The information found in this concept is taken from two MCHP reports: Using Administrative Data to Develop Indicators of Quality Care in Personal Care Homes , (Doupe et al., 2006) and Population Aging and the Continuum of Older Adult Care in Manitoba , (Doupe et al., 2011).

Assessment Process

Assessments occur as part of the panelling process for admission to a personal care home (PCH) and at regular intervals during the residents' stay in a PCH. All residents are assigned a level of care based on their assessed dependence in six areas:


1. bathing and dressing,
   
2. assistance with meals including feeding,
   
3. ambulation/mobility/transfers,
   
4. elimination,
   
5. professional intervention (such as oxygen therapy, skin care, recording of vital signs, and treatments/medications), and
   
6. behaviour management/support and supervision required.

In each of the six areas of care, people receive a score ranging from:


• Independent (score of X) - requires no supervision or assistance
  
  
• Minimum dependence (score of A) - requires some supervision/encouragement and/or intermittent assistance
  
  
• Partial dependence (score of B) - requires ongoing supervision and/or assistance
  
  
• Maximum dependence (score of C) - completely dependent and/or requires ongoing supervision
  
  
• Chronic care indicator (score of D) - as 'score C' but requires ongoing attention by medical staff and/or multiple people to provide assistance.

NOTE: Individuals that are assigned a score of 'chronic care indicator' in any of the six areas of care may be considered for placement into a chronic care facility in Manitoba, such as Deer Lodge or Riverview located within the Winnipeg Regional Health Authority (WRHA).

The assessment is currently done using a standardized tool called the Dependency Assessment Supplement (DAS). Based on the scores in each of the six areas, an algorithm is used to assign people to one of four levels of care. Unfortunately, only the assessment date and assigned level of care (not the individual scores for each area) are recorded electronically. Therefore, this detailed score information is not available in the data at MCHP.

Level of Care

Based on the individual area scores, the level of care is defined using the following rules:


• Level of Care I : Score of 'independent' or 'minimal dependence' in all six items.
  
  
• Level of Care IV : Score of 'maximum dependence' in four or more items.
  
  
• Level of Care III : a) Score of 'maximum dependence' in two or three areas of care plus a score of 'independent' or 'minimal dependence' in all other items OR
  b) Score of 'maximum dependence' in the behavioral management item plus a score of 'partial dependence' in at least two other items.
  
  
• Level of Care II : All remaining combinations.

Hours of nursing care in a PCH have been estimated for residents assigned to different levels of care. Residents assigned to Level of Care I are estimated to require 0.5 hours of care in a 24-hour period. Residents assigned to Level of Care II are estimated to require 2.0 hours of care in a 24-hour period, while those assigned to Level of Care III or IV are estimated to require at least 3.5 hours of nursing care during a 24-hour period.