CARE Classification Groups Washington

How DSHS Decides How Many Care Hours Your Parent Gets

After the CARE assessment, DSHS places your parent into one of 17 classification sub-groups. This placement — not a doctor's recommendation, not your family's judgment — determines the maximum number of monthly personal care hours the state will fund. The difference between groups is not marginal: Group A Low authorizes 22 hours per month; Group E High authorizes 393. Understanding how the classification system works is the first step toward ensuring your parent's placement reflects their actual needs.

The Five Main Groups

The CARE classification system uses five main groups (A through E), each divided into sub-groups based on ADL scores and clinical factors. The groups are defined under WAC 388-106-0125.

Group A — Low clinical complexity, low cognitive and behavioral needs. Patients in Group A are medically stable with a Cognitive Performance Scale (CPS) score below 5 and no significant mood or behavioral symptoms. Their care needs are primarily physical ADL assistance.

Group B — Behavioral and mood qualifications. Group B captures patients with mood disorders, behavioral symptoms (wandering, aggression, resistance to care), or elevated behavior point scores. The CPS score must be above 2 and the patient must have some ADL needs. Behavioral points drive placement within this group more than ADL scores alone.

Group C — Clinical complexity with lower cognitive impairment. Group C patients have active clinical conditions requiring skilled monitoring (diabetes management, wound care, oxygen therapy) but a CPS score below 4. Their medical complexity justifies higher care hours than Group A patients with similar ADL scores.

Group D — Clinical complexity with high cognitive impairment. Group D is where clinically complex patients with significant cognitive decline (CPS 4–6) are placed. These patients often have dementia combined with medical conditions, creating compound care needs that require both physical and cognitive support.

Group E — Exceptional care. Group E is reserved for patients with the most intensive needs — requiring turning and repositioning, bowel and bladder programs, and advanced therapeutic interventions. Qualification is strictly defined under WAC 388-106-0110.

The Complete Classification Matrix

Here is the full breakdown of all 17 sub-groups, the criteria that drive placement, and the monthly base care hours each authorizes:

How ADL Scoring Works

The CARE tool scores seven core Activities of Daily Living on a scale that reflects the level of assistance the patient required during the seven days before the assessment:

• Independent (0): No help needed
• Supervision (1): Verbal cues or standby assistance only
• Limited assistance (2): Physical guidance of a limb, steadying support
• Extensive assistance (3): The caregiver performed part of the task (wiping, washing a body area, buttoning)
• Total dependence (4): The caregiver performed the entire task

The seven ADL scores are summed to produce a composite score ranging from 0 to 28. This composite score determines placement within the sub-group ranges shown in the table above.

A patient who needs extensive help with bathing (3), toileting (3), dressing (3), and bed mobility (2), with limited help for transfers (2), eating (1), and personal hygiene (2) would score 16 — placing them in Group A High (59 hours) if they have no cognitive or clinical complexity, Group C Medium (115 hours) if they have clinical complexity with CPS below 4, or Group D Medium (168 hours) if they have clinical complexity with CPS 4 or above.

The same physical needs can result in dramatically different hour allocations depending on cognitive and clinical factors. This is why thorough documentation of all dimensions — not just physical ADLs — matters so much.

Cognitive Performance Score Explained

The Cognitive Performance Scale (CPS) ranges from 0 to 6 and is derived from the patient's ability to make daily decisions, short-term memory, and ability to make themselves understood. The thresholds that matter for classification:

• CPS < 4: Mild to moderate cognitive impairment — places the patient in Groups A, B, or C
• CPS 4–6: Severe cognitive impairment — moves the patient into Group D if clinical complexity is present, which typically adds 40–80 monthly hours compared to Group C at the same ADL score

For patients with dementia, documenting the CPS accurately is critical. When clinical complexity is present, a parent with Alzheimer's who scores CPS 3 can land in Group C; one who scores CPS 4 can land in Group D — a jump from 115 to 168 hours at the medium ADL range.

Behavioral Points and Group B Placement

Behavioral symptoms generate points that can push a patient into Group B regardless of ADL scores. The behavioral categories include:

• Wandering
• Verbal aggression
• Physical aggression
• Socially inappropriate behavior
• Resistance to care
• Disruptive or dangerous behavior

Each documented behavior within the observation window generates points. The behavior point thresholds for Group B sub-groups are:

• B Low: Behavior points > 1 with CPS > 2
• B Medium: Behavior points > 4
• B Med-High: Behavior points > 6
• B High: Behavior points ≥ 12

A patient with moderate physical needs (ADL 8, which would be Group A Medium at 47 hours) but significant behavioral symptoms (behavior points of 7) would be placed in Group B Med-High at 84 hours — nearly double the allocation.

What If the Placement Is Wrong

If your parent's classification does not reflect their actual care needs, you have two options:

Exception to Rule (ETR): Under WAC 388-106-0135, you can request hours above the standard allocation for your parent's classification group. The ETR requires documentation showing that the standard hours are insufficient to meet the patient's specific care needs.

Appeal: If you believe the assessment itself was inaccurate — the assessor scored ADLs too low, missed cognitive impairment, or did not account for documented behaviors — you can appeal through the Office of Administrative Hearings. The notice of action you receive after the assessment includes the appeal deadline.

Both paths require documentation. The 7-day observation log, the ADL descriptions using the CARE tool's terminology, and the behavioral incident records are your evidence. The Hospital-to-Home Transition Guide includes the complete CARE assessment workbook with ADL scoring worksheets and behavioral documentation forms designed to capture exactly the data the classification system uses.

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