Hawaii Nursing Home Level of Care Assessment: The DHS 1147 Form Explained

Before your parent can receive Medicaid-funded long-term care in Hawaii — whether that's a nursing home, a Community Care Foster Family Home (CCFFH), an Expanded ARCH, or home-based services through QUEST Integration — they must pass a clinical gate: the DHS 1147 Level of Care and At Risk Evaluation. This single form determines what level of public support your parent can access.

What the DHS 1147 Measures

The DHS 1147 is a standardized clinical assessment that evaluates your parent across multiple functional domains:

Physical function (ADLs):

• Feeding — can they eat independently?
• Transferring — can they move from bed to chair?
• Mobility — can they walk or use a wheelchair safely?
• Bowel and bladder continence
• Bathing
• Dressing

Cognitive and behavioral status:

• Orientation — do they know where they are, what day it is?
• Memory — short-term and long-term recall
• Behavioral issues — aggression, wandering, sundowning
• Decision-making capacity

Sensory impairments:

• Vision and hearing limitations that affect daily functioning

Each domain is scored, and the scores are summed. The total determines which tier of support is approved.

The Scoring Thresholds

Score 15 or higher = Nursing Facility Level of Care (NF LOC)

This is the critical threshold. An NF LOC designation means your parent clinically requires the level of care provided in a nursing home. It unlocks:

• Full nursing home coverage under QUEST Integration
• CCFFH placement (Medicaid covers room, board, and care)
• Expanded ARCH placement
• High-intensity Home and Community-Based Services (HCBS) — personal care, home health, adult day health, medical equipment

Score 5 to 14 = At-Risk designation

For parents living at home who don't meet the nursing home threshold, the At-Risk pathway provides preventive community services:

• Tiers I and II (5–10 points): Home-delivered meals, Personal Emergency Response Systems (PERS), basic personal assistance
• Tier III (above 10 points): Advanced personal assistance and community transition support

Score below 5 = Does not qualify for QUEST Integration LTSS

Your parent may still be eligible for Kupuna Care (no clinical scoring requirement beyond 2+ ADL/IADL impairments), Medicare home health (short-term rehab), or private-pay services.

Who Completes the Assessment

The DHS 1147 must be completed by a licensed physician, registered nurse, or recognized primary care provider. This is not a form you can fill out yourself. The completed assessment is submitted to the Health Services Advisory Group (HSAG), Hawaii's contracted Peer Review Organization, which reviews the scoring and issues the level of care determination.

Where to get the assessment done:

• Your parent's primary care physician can complete it during an office visit
• A hospital social worker or discharge planner can arrange it during an inpatient stay (this is common after a fall, stroke, or other acute event)
• Your county ADRC can help connect you with a provider who will complete the form
• QUEST Integration managed care plans can arrange an assessment through their care coordination team

How to Prepare Your Parent

The assessment captures your parent's functional status on the day it's completed. If your parent tends to rally or minimize difficulties in front of professionals — which is extremely common — you need to provide context.

Before the assessment:

• Write down specific examples of functional decline: how many times they've fallen in the past month, what tasks they can no longer do safely, any wandering or safety incidents
• Bring a current medication list with all prescribers
• Document any hospitalizations or ER visits in the past 6 months
• Note behavioral changes — sleep disruption, agitation, confusion about time or place

During the assessment:

• Be present if possible — you can provide information the assessor needs without speaking for your parent
• Don't coach your parent to perform better than their actual daily function. An assessment that understates the need results in a lower score and fewer services.
• If your parent has a "good day" during the assessment and the score doesn't reflect their typical status, you can request a reassessment or provide supplemental documentation

What Happens After the Assessment

HSAG reviews the DHS 1147 and issues a determination. If your parent meets NF LOC:

1. The determination is sent to the Med-QUEST Division
2. Financial eligibility is assessed separately (asset limit $2,000 single, income limit $1,530/month)
3. If both clinical and financial criteria are met, QUEST Integration enrollment begins
4. A managed care plan (Ohana, UnitedHealthcare Community Plan, or Humana) is assigned
5. A care coordinator develops a service plan — you can request community-based services instead of nursing home placement

The NF LOC determination typically needs to be recertified annually. If your parent's condition changes significantly (better or worse), a new DHS 1147 can be submitted.

The Full Process

The DHS 1147 is one piece of a larger eligibility puzzle. The Hawaii Care Decision Guide walks through the complete QUEST Integration application process — clinical assessment, financial eligibility, asset protection strategies, and how to coordinate with your managed care plan once enrollment is approved.

See more Hawaii guides →