Pre-admission screening of nursing home applicants: implications for home care

An increasing number of states are developing programs to evaluate nursing home applicants prior to admission. The purpose of these Pre-Admission Screening (PAS) programs is to assure that nursing home placement is needed and appropriate. Both the number and scope of these programs have grown considerably in the last decade as states attempt to reduce inappropriate placements and control nursing home costs and utilization. The increase in PAS can have a significant impact on community services as clients are diverted from nursing homes to home care. This article uses the results of a recently completed national survey of state-administered PAS programs to indicate the impact of PAS on community care. PAs was defined as an on-site assessment of the need or appropriateness of nursing home care conducted by a disinterested third party prior to nursing home admission. State administrators of Medicaid and/or PAS in all states and the District of Columbia were contacted by phone to determine whether or not their state conducted PAS. States with PAS were sent a comprehensive mail survey, and 25 of these (81%) returned a survey. Data is presented regarding the scope of PAS programs, the types of clients participating in PAS, the variety of services coordinated or funded in conjunction with PAS, the types of recommendations made by screening teams (institutional vs. home care), and how respondents felt that PAS was impacting community services. The article concluded with a discussion of these results.