InterRAI Assessment Ontario: What the Scores Mean for Your Parent's Care
What the InterRAI Assessment Actually Is
When Ontario Health atHome sends a care coordinator to evaluate your parent, they use a standardized clinical tool called the Resident Assessment Instrument — Home Care (RAI-HC). This is part of the interRAI suite, an internationally validated system used across Canadian provinces to measure care needs consistently.
The assessment is not a simple questionnaire. The coordinator observes your parent, asks structured questions, and scores them across multiple clinical domains. Those findings inform the care plan and the long-term care eligibility assessment under the Fixing Long-Term Care Act, 2021.
The Key Scores and What They Mean
Two scores matter most for care planning decisions:
Cognitive Performance Scale (CPS2) — Records your parent's cognitive function, including short-term memory, daily decision-making ability, and communication, as part of the assessment. The result helps the coordinator understand safety and support needs; it is not, by itself, a long-term-care admission threshold.
Activities of Daily Living Hierarchy Scale (ADLH) — Records physical function, including personal hygiene, toileting, locomotion, and eating. The result helps describe assistance needs; it is not, by itself, a guarantee of a particular service level.
These findings inform the care plan and can support referrals to specialized services like Behavioural Support Ontario (BSO) teams for dementia-related behaviours; they do not, by themselves, guarantee a specific number of funded hours.
Caregiver Risk Evaluation (CaRE) — This algorithm assesses the stability of your parent's informal support network. It flags caregiver distress, burnout, and whether the family's ability to provide care is collapsing. Research from the Ontario Caregiver Organization shows 68% of the province's 4.2 million caregivers have reached their breaking point. If the caregiving network collapses, that can support a request for reassessment and may trigger Category 1 crisis placement.
How Scores Affect Long-Term Care Eligibility
To qualify for long-term care under the FLTCA, your parent must meet at least one clinical criterion: they need 24-hour nursing availability, frequent daily ADL assistance, or constant supervision for safety. The interRAI scores provide the evidence.
Significant cognitive and physical support needs may support long-term care eligibility, but the assessment also considers whether community-based services could meet the need. Since publicly funded home care is capped at roughly 60 hours per month for personal support, a parent who needs round-the-clock assistance clearly exceeds what home care can provide.
The priority category assigned on the long-term care waitlist also depends on these clinical findings. Category 1 (crisis) status — which places your parent ahead of lower-priority waitlist groups — requires evidence that care needs cannot be safely met at home due to an acute change.
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What You Can Do About the Results
Ask the care coordinator whether they can share the CPS2, ADLH, and CaRE results during or after the assessment. If the scores seem too low — if the coordinator visited on a good day and your parent performed better than usual — document what a typical bad day looks like and request a reassessment.
Bring written notes to the assessment. Falls in the past 90 days, medication errors, overnight incidents, and the number of hours you personally spend providing care all influence the scores. Coordinators can only score what they observe or what you report.
If you believe the resulting care plan does not match your parent's actual needs, request a formal review through the Ontario Health atHome Patient Services Manager. Beyond that, the Health Services Appeal and Review Board (HSARB) accepts appeals within 30 days of a final internal decision.
The Ontario Continuing Care Navigator includes a caregiver risk assessment checklist and intake call scripts designed to ensure the interRAI assessment captures your parent's real needs — not just a snapshot of their best hour.
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Download the Ontario — Elder Care Decision Checklist — a printable guide with checklists, scripts, and action plans you can start using today.