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LTCFS Instructions Module 10: Risk

Glossary of Acronyms, P-01010 (PDF) | LTCFS Paper Form, F-00366 (PDF)

Contents

10.1 Overview

The Risk Module of the LTCFS has been designed to do the following:

  • Increase awareness of when a person may be at risk of institutionalization in a nursing home or FDD/ICF-IID.
  • Convey risk factor information to the LTC program.

Newly discovered cases of abuse, neglect, or exploitation should, in most instances, result in a referral to the APS or EA/AAR agency for investigation, case planning, and any necessary court-related services. Screeners are expected to recognize signs of abuse, neglect, or financial exploitation as defined in Wis Stat. § 46.90 and to know how to respond appropriately.

10.2 Part A - Current Adult Protective Services or Elder Adult/Adult at Risk Client

Current APS or EA/AAR Client Options:

  A1: Known to be a current client of Adult Protective Services (APS)
  A2: Currently being served by the lead Elder Adult/Adult at Risk (EA/AAR) agency

The A1 and A2 lists below contain common, illustrative examples. These lists are not all-inclusive lists of examples.

Check all applicable boxes.

A1: (Known to be a current client of Adult Protective Services [APS]) is selected when:

  • APS is pursuing or has established a temporary guardianship of the person or estate.
  • APS is pursuing a guardianship of the person or estate.
  • APS is pursuing a temporary or final protective placement order.
  • APS is working with the person to evaluate their level of competency.
  • APS is working with the person to evaluate their level of need for assistance.
  • APS has filed for, or obtained, a temporary restraining order or permanent injunction for the individual at risk. Wis. Stat. § 813.123.
  • Person has a court order for protective services or a protective placement.

REMINDER: Do not select A1 when a person’s guardianship has been finalized and there is no protective placement order in place.

A2: (Currently being served by the lead Elder Adult/Adult at Risk [EA/AAR] agency) is selected when:

  • The EA/AAR agency is working with the person to determine an appropriate response to the referral.
  • The EA/AAR agency is working with the person to evaluate their level of need for assistance.

10.3 Part B - Risk Evident During Screening Process

A person’s level of risk may be influenced by a number of factors. These may include choices they make about how they live their lives, whether they follow or disregard medical advice, or accept or refuse assistance from others. On the other hand, a person may be at risk due to the action or inaction of another individual.

A competent person has the right to live with a level of risk others may not agree with or support. Regardless of choices the person makes, they may still have a need for assistance or supervision, and that need should be recorded on the LTCFS.

Risk Evident During Screen Process Options:

  0: No risk factors or evidence of abuse, neglect, or exploitation apparent at this time.
  1: The person is currently failing or is at high risk of failing to obtain nutrition, self-care, or safety adequate to avoid significant negative health outcomes.
  2: The person is at imminent risk of institutionalization (in a nursing home or FDD/ICF-IID) if they do not receive needed assistance or person is currently residing in a nursing home or FDD/ICF-IID and needs that level of care or supervision.
  3: There are statements of, or evidence of, possible abuse, neglect, or exploitation.
  4: The person's support network appears to be adequate at this time, but may be fragile within the next 4 months.

At least one box in Part B must be checked. Check all applicable boxes; however, if box "0" is checked, do not check boxes 1, 2, 3, or 4.

0: (No risk factors or evidence of abuse, neglect, or exploitation apparent at this time)

1: (The person is currently failing or is at high risk of failing to obtain nutrition, self-care, or safety adequate to avoid significant negative health outcomes)

The "Check this for a person who" list contains common, illustrative examples. This list is not an-all inclusive list of examples.

Check this for a person who:

  • Is competent and refuses needed services.
  • Is competent and mismanages their disease. For example, a person with insulin-dependent diabetes mellitus who eats a diet high in sugar and carbohydrates.
  • Is competent and participates in high-risk behavior. For example, a person prescribed continuous oxygen who smokes cigarettes. High-risk behavior can include, but is not limited to poor nutrition, substance use, self-neglect, hoarding, refusing to take prescribed medications, or refusing to take medications as prescribed.
  • Does not receive assistance from another person to complete any ADL or IADL task, but may need access to community services (e.g., a person needing access or assistance to apply for food stamps or Medicaid coverage).
  • Is not at imminent risk that institutionalization (in a nursing home or FDD/ICF-IID) will occur within the next six to eight weeks. However, without needed assistance the person may be at risk of entering a nursing home or FDD/ICF-IID beyond eight weeks.
  • May be at risk of entering an institute for mental disease (IMD) or hospital for psychiatric services.

2: (The person is at imminent risk of institutionalization [in a nursing home or FDD/ICF-IID] if they do not receive needed assistance or person is currently residing in a nursing home or FDD/ICF-IID and needs that level of care or supervision)

This is federal language referencing when a person will be deemed nursing home eligible because they are at imminent risk of institutionalization if they do not receive needed assistance. Whether a person is at imminent risk of institutionalization is critical in determining whether they are eligible for a nursing home level of care. The federal Centers for Medicare & Medicaid Services (CMS) has advised states that imminent risk of institutionalization means the person would require nursing home or FDD/ICF-IID care within six to eight weeks if community-based services were not provided. The screener should consider carefully whether the individual meets the criteria.

The selection of Risk Box 2 is appropriate if the person’s health, without any needed assistance from another person, within six to eight weeks, would likely decompensate to the point where they would need to consider entering a nursing home or FDD/ICF-IID to receive care. It is not an issue of whether the person states they will never agree to or never plans to enter a nursing home or FDD/ICF-IID.

When evaluating a person’s level of risk, the screener should review the type and amount of assistance the person needs from another person. This review needs to consider how the person would be doing within six to eight weeks if they went without any paid or unpaid assistance from others. Assistance includes needed care provided by a spouse, partner, friend, neighbor, or other person providing informal support. Whether a person is paid or not for providing assistance does not diminish the value of that assistance in helping a person live outside of a nursing home or FDD/ICF-IID.

The evaluation of a person’s level of risk should not factor in the person’s need to use an adaptive aid to complete an ADL or IADL task. A person’s independent use of an adaptive aid does not indicate a need for assistance from another person and does not indicate a level of risk.

REMINDER: When a person has a guardian or activated power of attorney for health care, do not automatically select Risk Box 2 without reviewing whether the person being screened would be at risk of entering a nursing home or FDD/ICF-IID.

The “Check this for a person who” list and the “Do NOT check this for a person who” list contain common, illustrative examples. These lists are not all-inclusive lists of examples.

Check this for a person who:

  • Has daily daytime incontinence and needs assistance with changing incontinence pads, if used.
  • Has fallen more than once in the last month and sustained at least one injury requiring medical treatment.
  • Is in the end-stage of a terminal illness.
  • Due to a physical health exacerbation, had three or more hospital admissions in the last six months.
  • Is currently residing in a nursing home or FDD/ICF-IID and needs that level of care or supervision.
  • Requires assistance from another person with three or more ADLs.
  • Is residing in a licensed residential care facility and needs that level of care or supervision.
  • As a result of intellectual/developmental disability, degenerative brain disorder, serious and persistent mental illness, or other like incapacities, the individual will incur a substantial risk of physical harm or deterioration or will present a substantial risk of physical harm to others if protective services are not provided. Wis. Stat. § 55.08(2)(b).
  • Meets at least one of the criteria above, but the person or the person’s family members or authorized representative express unwillingness to have the person ever reside in a nursing home or FDD/ICF-IID.

Do NOT check this for a person who:

  • Uses an adaptive aid or mobility device independently to complete an ADL or IADL task and as a result, does not need any assistance from another person to complete the ADL or IADL task.
  • Only needs assistance with grocery shopping.
  • Only needs assistance with snow removal or lawn care.
  • Only needs assistance with the Transportation IADL.
  • Is at risk of admission to a hospital or IMD for psychiatric services.
  • Is at risk of entering a correctional facility.
  • Voluntarily or by court order receives community-based services without first reviewing whether they are at risk of entering a nursing home or FDD/ICF-IID.
  • Has a guardian of the person without first reviewing whether they are at risk of entering a nursing home or FDD/ICF-IID.

REMINDER: Risk Box 2 should not be selected based solely on a person’s target group. Although a person’s condition meets a target group definition, this is not in and of itself sufficient to meet the imminent risk criteria.

3: (There are statements of, or evidence of, possible abuse, neglect, or exploitation)

The screener should select this box to provide notification to the person's selected LTC program that the person is at risk.

Risk Box 3 should be selected when an applying minor child (age 17 years and 6 months or older), adult, or an adult at risk is at imminent risk of serious bodily harm, death, sexual assault, or exploitation and is unable to make an informed judgment about whether to report the risk.

An adult at risk is defined as any adult with a physical or cognitive condition that substantially impairs their ability to care for their needs and who has experienced, is currently experiencing, or is at risk of experiencing abuse, neglect, or exploitation.

When Risk Box 3 is selected, the screener will most often make a referral for an investigation to the local APS or EA/AAR agency in accordance with Wis. Stat. §§ 46.90(4) and 55.043(1m).

The “Check this for a person who” list contains common, illustrative examples. This list is not an all-inclusive list of examples.

Check this for a person who:

  • Is an adult at imminent risk of serious bodily harm, death, sexual assault, or exploitation and is unable to make an informed judgment about whether to report the risk.
  • Is being referred to the APS or EA/AAR agency for an investigation of abuse, neglect, or exploitation.
  • Is not being referred to the APS or EA/AAR agency, because it is the screener’s professional judgment that making the referral will not be in the best interest of the person.

4: (The person's formal and informal support network appears adequate at this time, but may be fragile in the near future [within next 4 months])

The “Check this for a person who” list contains common, illustrative examples. This list is not an all-inclusive list of examples.

Check this for a person who:

  • Has an informal caregiver who is physically or emotionally exhausted from providing the person’s care.
  • Has an informal caregiver who will no longer be able to provide care (for example, caregiver winters in a southern state, caregiver grandchild will be attending college out of the area).
  • Is at risk of losing their residential care due to a change in their financial circumstances, the residential care facility closing, or their increased physical, cognitive, or behavioral care needs.

Glossary

 
Last revised July 3, 2024