DON-R Assessment Georgia: How the Scoring Works and How to Prepare

The Determination of Need-Revised (DON-R) is the functional assessment that decides whether your parent qualifies for Georgia's Medicaid home care waivers. If they score high enough, they can access the CCSP or SOURCE program. If they don't, they're ineligible regardless of their financial situation. Knowing how the scoring works — and how to prepare — gives your family a significant advantage.

What the DON-R Measures

A nurse or care coordinator from your regional Area Agency on Aging conducts the DON-R in your parent's home. The assessment evaluates fifteen domains across Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs):

BADLs include bathing, dressing, toileting, transferring (moving from bed to chair), mobility, and eating. These are the core physical tasks your parent may struggle with.

IADLs include meal preparation, housekeeping, laundry, managing medications, managing finances, using the telephone, shopping, and transportation. These measure whether your parent can live independently without supervision.

How the Scoring Works

Each domain receives two scores:

Column A — Level of Impairment (0 to 3):

• 0: Completely independent, no assistance needed
• 1: Needs some verbal or physical help with most of the task
• 2: Cannot perform most of the task, needs substantial physical help, or experiences frequent fatigue
• 3: Completely dependent on another person

Column B — Unmet Need for Care (0 to 2):

• 0: The need is fully met, no risk to health or safety
• 1: The need is met most of the time, minimal risk
• 2: The need is not met most of the time, moderate to severe safety risk

The critical threshold: Your parent must score a minimum cumulative Impairment Score of 15 across all fifteen domains to meet the nursing facility level of care standard required for CCSP or SOURCE enrollment.

A score of 15 across fifteen domains means an average of 1.0 per domain — essentially, your parent needs at least some assistance with most activities. Parents with moderate dementia, significant mobility limitations, or multiple chronic conditions that affect daily functioning typically score well above 15.

How the Score Affects Waitlist Priority

Meeting the clinical threshold (score of 15+) gets your parent on the waiver waitlist. Their position on that waitlist depends on a separate triage score:

Triage Score of 7.0 or higher: Classified as High Priority, placed on the Tier 1 waiting list. These applicants are likely to receive a waiver slot within twelve months. The AAA rescreens them every six months.

Triage Score below 7.0: Classified as Not High Priority, placed on the Tier 2 waiting list. Not expected to receive a slot within twelve months. Contacted annually by mail for status updates.

The triage placement is dynamic. If your parent's condition worsens — a fall, an ER visit, a new diagnosis, or the loss of their primary caregiver — contact the AAA immediately for a reassessment. A significant change in status can elevate the triage score and move your parent from Tier 2 to Tier 1.

How to Prepare for the Assessment

The DON-R captures a snapshot of your parent's functioning on the day of the assessment. That snapshot needs to be accurate, which means you should avoid two common mistakes:

Don't coach your parent to perform better than they normally do. Many parents instinctively try to demonstrate independence during the assessment because they don't want to appear dependent. If your mother normally can't get dressed without help but pushes through it during the evaluation, the impairment score drops and she may fall below the threshold.

Don't exaggerate limitations. Assessors are trained clinicians who can distinguish genuine impairment from performance. Overstatement undermines credibility and can delay the process.

What to do instead:

• Prepare a written list of your parent's daily difficulties, specific incidents (falls, medication errors, unsafe cooking episodes), and the help they require for each activity
• Keep a two-week care log before the assessment documenting what you did each day — bathing assistance, meal preparation, medication management, transfers
• Have medical records available showing diagnoses that affect daily functioning: dementia evaluations, orthopedic assessments, cardiology reports
• Be present during the assessment to provide context the assessor needs — your parent may minimize their limitations or not remember recent incidents

The assessor's job is to score accurately, not to qualify or disqualify your parent. Your job is to make sure the assessment reflects your parent's actual daily reality, not a best-day performance.

The Georgia Home Care, Waivers & Support Guide includes a DON-R preparation worksheet that maps each of the fifteen domains with space to document your parent's specific limitations, incidents, and care needs — so nothing gets missed during the in-home assessment.

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