Know Your Legal Rights is a bi-monthly column distributed by the State Bar of Wisconsin. It is sponsored by the State Bar of Wisconsin’s Lawyer Referral Service (LRS), which connects Wisconsin residents with lawyers throughout the state. To find an attorney in your area, visit wislaw.org.
By McKenna K. Coffeen
Your mother still lives alone, but lately she has missed doses of medication and left the stove on. You help when you can, but you are beginning to wonder whether she can safely remain at home—and whether help is available.
For Wisconsin families facing questions like these, the Long-Term Care Functional Screen may be an important step. It helps determine whether someone’s health, abilities and need for daily assistance qualify them for publicly funded long-term care services.
The screen is separate from the financial review required for Medicaid eligibility. Here is what families should know about the process, how to prepare and what to do if they disagree with the decision.
What Does the Screen Evaluate?
A certified screener collects information about the person’s:
- Physical health and medical needs
- Memory and decision-making
- Behavior
- Ability to complete everyday tasks
- Need for help, supervision or reminders
The screen considers activities of daily living. These are basic self-care tasks such as bathing, dressing, eating, moving around the home, getting in or out of a bed or chair, and using the toilet.
It also considers more complex tasks needed to live independently, including preparing meals, managing medications and money, using a telephone and arranging transportation.
The screen does not look only at whether someone can physically perform a task. It also considers whether the person can complete it safely and reliably.
For example, someone with memory loss may be physically able to cook but may forget to turn off the stove. That safety risk may affect the person’s functional eligibility.
How Should I Prepare?
Think about what daily life is usually like—not only what the person can do on a particularly good day.
Be prepared to explain:
- Which activities require help
- Whether someone provides reminders or supervision
- How often help is needed
- What happens when help is unavailable
- Whether the person has fallen, wandered, missed medications or experienced other safety problems
- Whether the person’s needs change from day to day
Gather information about medical conditions, medications and recent hospital or rehabilitation stays. A family member, caregiver or another person familiar with the individual’s needs may participate in the screening.
Answer questions honestly and give specific examples. Some people minimize their needs because they want to remain independent or do not want to burden others. The screen should reflect the assistance the person actually needs to remain safe.
What Happens After the Screen?
The agency must provide written notice of its functional-eligibility decision.
Meeting the functional requirements does not automatically qualify someone for a long-term care program. A separate review determines whether the person meets Medicaid’s financial and other eligibility requirements.
Someone who qualifies may have options that include Family Care, Family Care Partnership, PACE or IRIS. The programs and services available may depend on the person’s needs and where the person lives.
These programs may provide services that help someone remain at home or elsewhere in the community. In some circumstances, an approved care plan may allow a family member to be paid for providing certain services. The rules vary by program, service and family relationship.
What If I Disagree With the Decision?
A person has the right to appeal an adverse functional-eligibility decision, including a finding that the person is functionally ineligible or qualifies only at a non-nursing-home level of care.
The written notice should include information about requesting a fair hearing. Review the notice carefully and act before the stated deadline. The right to appeal also may apply if the agency takes more than 30 days to determine functional eligibility.
How Do I Begin?
Contact your local aging and disability resource center, commonly called an ADRC, or Tribal aging and disability resource specialist. They can explain the available programs and arrange the initial functional screen.
The goal is not to “pass” the screen. It is to give the screener a complete and accurate picture of the help the person needs to live safely.
McKenna K. Coffeen is an estate planning attorney with Ruder Ware in Eau Claire, where she assists clients with estate planning, elder law, long-term care and Medicaid planning. Raised in Wisconsin’s agricultural community, she also helps farm families preserve their legacies and transfer their farms to the next generation.
Know Your Legal Rights is sponsored by the State Bar of Wisconsin’s Lawyer Referral Service, which helps connect the public with appropriate legal counsel. Learn more at wislaw.org.
This column provides general legal information, not legal advice. Laws may change. Consult an attorney about your specific situation.
Photo caption: When an aging parent begins to need help at home, Wisconsin’s Long-Term Care Functional Screen can help determine whether they qualify for publicly funded services.
