How to Prepare for the ALTCS Pre-Admission Screening Without an Attorney

You don't need an elder law attorney to prepare for Arizona's ALTCS Pre-Admission Screening — this is a clinical assessment, not a legal proceeding. The PAS evaluates whether your parent meets the medical necessity threshold for long-term care, and the single most important thing you can do is document the right behaviors in advance. Families who walk into the screening unprepared often score below the 60-point minimum and get denied — not because their parent doesn't qualify, but because the assessor only sees what's presented during a 60-to-90-minute visit.

The PAS is evaluated by an AHCCCS registered nurse or social worker. They use a standardized scoring tool. Understanding how that tool works gives you a significant advantage.

How the PAS Scoring Works

Your parent needs at least 60 points. The score comes from two categories:

Medical/Diagnostic Points (up to 20) A formal dementia or Alzheimer's diagnosis from a neurologist or neuropsychologist is worth 20 points. This is the foundation — if your parent hasn't been formally diagnosed, get that done first. A primary care physician's informal assessment ("possible cognitive decline") typically scores lower.

ADL Deficits and Behavioral Challenges (remaining 40+) The assessor evaluates how much hands-on help your parent needs with specific Activities of Daily Living:

• Bathing: Do they need physical assistance getting in/out of the shower? Do they forget to wash? Do they resist bathing?
• Dressing: Can they select appropriate clothing? Do they put items on backwards or inside out? Do they need help with buttons and zippers?
• Toileting: Do they have accidents? Do they need reminders? Do they need physical assistance?
• Transferring: Can they get in and out of bed, chairs, or vehicles independently?
• Eating: Do they forget to eat? Do they need food cut or prepared? Do they need supervision to prevent choking?
• Continence: Are they incontinent? How frequently?

Each ADL deficit scores points based on severity — needing verbal cues scores less than needing hands-on physical assistance.

Behavioral challenges also score points:

• Wandering (especially nighttime elopement — one of the highest-scoring behaviors)
• Aggression toward caregivers or others
• Resistiveness to care (refusing medication, refusing bathing)
• Disorientation (not recognizing familiar people or places)
• Sundowning (increased confusion and agitation in late afternoon/evening)

What to Document Before the Assessment

The assessor's visit is a snapshot. They see your parent for about an hour. Your parent might have a lucid day. They might be cooperative during the visit but combative every other evening. The assessor can only score what they observe or what's documented.

Keep a behavior log for at least two weeks before the screening. Write down:

• Date, time, and specific behavior (not "had a bad day" — "at 2:15 AM, found Dad in the front yard in pajamas, disoriented, didn't know his address")
• Which ADL required hands-on help and what specifically you did
• Any incidents: falls, stove left on, medication errors, getting lost driving
• Refusals: bathing resistance, medication refusal, refusal to eat
• Nighttime disruptions: how often, what happened, what intervention was needed

Collect supporting documentation:

• Formal diagnosis letter from neurologist
• Recent cognitive test results (MoCA, MMSE scores)
• Hospital or ER records from falls or acute incidents
• Any prior home health agency assessments
• Medication list showing complexity of regimen

Common Mistakes That Lower the Score

Downplaying symptoms during the visit. Caregivers instinctively cover for their parent ("Oh, she manages pretty well most days"). The assessor takes you at your word. If your parent needs help with bathing every day, say so plainly.

Not having documentation ready. The assessor will ask about behaviors they can't observe during the visit. A written log with dates and specifics is far more credible than "she wanders sometimes."

Scheduling the assessment at your parent's best time of day. If your parent sundowns (worsens in the late afternoon and evening), a 10 AM assessment will show them at their most functional. While you can't always control timing, mention the pattern explicitly and provide your behavior log showing evening episodes.

Forgetting the Mental Health Care POA. Arizona has a unique statute (A.R.S. § 36-3281) for Mental Health Care Power of Attorney that authorizes psychiatric decisions including inpatient admission. While not directly part of PAS scoring, having legal authority documents in order shows the assessor the full picture of care complexity.

What Happens If the Score Falls Below 60

A denial isn't permanent. You can:

1. Request reconsideration — provide additional documentation that wasn't available during the initial assessment
2. Appeal through the AHCCCS fair hearing process — formal administrative review of the scoring
3. Reapply after 60 days with new documentation, a more comprehensive behavior log, and updated medical records

Many families are denied on the first attempt because they didn't understand the scoring system. The second attempt, properly documented, succeeds.

Who This Is For

• Adult children preparing for their parent's first ALTCS screening
• Families whose parent was denied ALTCS and wants to understand what went wrong
• Caregivers who want to self-assess their parent's likely PAS score before applying
• Families managing dementia at home who need to determine when their parent meets the clinical threshold

Who This Is NOT For

• Families whose parent is already enrolled in ALTCS
• Families seeking financial eligibility guidance (that's a separate assessment — income cap, asset limits, Miller Trust)
• Parents who don't have a formal dementia diagnosis yet (get that first)

Frequently Asked Questions

How long does the PAS assessment take?

Typically 60 to 90 minutes. The assessor visits your parent in their current living situation — home, hospital, or facility. They evaluate ADL function through observation and interview, review medical documentation, and speak with the primary caregiver.

Can I be present during the PAS assessment?

Yes, and you should be. The assessor will ask you about daily care needs, behavioral patterns, and safety incidents. Your observations supplement what the assessor can see during a single visit.

Does the PAS assessment cost anything?

No. The PAS is part of the ALTCS application process and is conducted by AHCCCS at no cost to the family.

How often is the PAS re-evaluated?

ALTCS re-evaluates eligibility annually. For dementia, the condition is progressive — re-assessment typically confirms continued eligibility or documents increased care needs.

Where can I get a PAS self-assessment worksheet?

The Arizona Dementia & Memory Care Guide includes a self-scoring PAS worksheet based on the official AHCCCS criteria, so you can estimate your parent's score and identify which behaviors to focus on documenting before the state assessor arrives.

See more Arizona guides →