When looking at your care options in Ohio, you may hear the term “Nursing-Facility-Level-of-Care” or its initialism “NFLOC.” This refers to a term used by Medicaid to describe a patient whose wellbeing is compromised to such the extent that they require — quite literally — a nursing facility level of care.
Being deemed to need an NFLOC is one of the pre-requisites to being approved for Ohio’s Home and Community Based Services waivers through Medicaid, such as the PASSPORT program and the MyCare waiver.
What Does an NFLOC Assessment Check For?
Patients qualify for NFLOC if they face significant and recurring challenges with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IALDs). These may be caused by health decline, aging, cognitive and behavioral impairments, or a combination of other medical factors.
ADLs are every-day, functional tasks like:
- Mobility (Ambulating/Transferring): The ability to move around and about. Think walking, getting up from a chair or sitting back down safely, going up and down the stairs, or transferring from a bed to a wheelchair.
- Dressing: Being able to put on clothes, closing buttons or clasps, belts, and putting and tying shoes without assistance.
- Eating: Feeding oneself, using utensils or our hands to get food from plate to mouth and consuming it.
- Personal Hygiene: Bathing or showering and completing grooming tasks like shaving, brushing teeth, and combing hair independently.
- Toileting (Continence): Getting to the toilet in time, transferring on and off the toilet, and cleaning oneself after using it.
IADLs are the broader life management tasks that make independent living possible, like:
- Shopping for Essentials: The ability to shop for groceries, pick up prescriptions, or purchase clothing and other necessities.
- Meal Preparation: Planning and cooking meals, including gathering ingredients and safely using and cleaning the kitchen.
- Housekeeping: Keeping the home clean through livable tasks like cleaning, laundry, and taking out the trash.
- Money Management: Handling finances, such as paying bills on time, managing bank accounts, and budgeting.
- Transportation: Getting around or arranging transportation, whether that’s driving oneself or using other means (public transit, ride shares, taxis) to go to appointments and run errands.
- Medication Management: Administering medications properly, remembering to take the right medicines at the right times, and refilling prescriptions.
- Communication: Using the phone or a computer to communicate (looking up phone numbers, making calls, sending emails) and keeping in touch with others.
If someone has significant and recurring issues in either of these categories, they might meet the need for a Nursing-Facility Level of Care.
How Do You Determine If Someone Meets NF LOC Requirements?
Contact your local Area Agency on Aging or the Ohio Aging and Disability Resource Network. They will organize an assessment by a state-authorized representative.
The representative is often a registered nurse or licensed assessor contracted through the Ohio Department of Medicaid or its care coordination partners.
Ohio has standards for NFLOC. These include different levels of care, and they are set out in the Ohio Administrative Code and supported by Ohio Medicaid’s NFLOC assessor resources.
This assessor will run a series of evaluations based on specific rule-based criteria set by the Ohio Dept. Of Medicaid. In Ohio, long term care assessments are conducted using standardized state approved assessment tools and a level of care determination process for nursing facility-based level of care programs.
If the assessor finds that your loved one cannot successfully perform several of these tasks without assistance, they can officially determine that the individual meets NFLOC requirements.
