LOCET Assessment Louisiana: What the Level of Care Eligibility Tool Determines

What the LOCET Determines

The Level of Care Eligibility Tool — LOCET — is the clinical assessment Louisiana uses to determine whether a person meets the Nursing Facility Level of Care (NFLOC) standard. This matters because NFLOC is the gateway to every major state-funded long-term care program: the Community Choices Waiver, Long Term-Personal Care Services, PACE, and Medicaid nursing facility coverage.

Without an NFLOC determination, your parent cannot access these programs regardless of their financial eligibility. The assessment is functional, not diagnostic — it evaluates what the person can and cannot do, not simply what their medical diagnosis is. A dementia diagnosis alone does not automatically establish NFLOC. The assessment must demonstrate that the cognitive impairment creates functional limitations severe enough to require the level of care provided in a nursing facility.

What the Assessment Measures

The LOCET evaluates several domains of functional capacity:

Activities of daily living (ADLs). Can the person bathe, dress, toilet, transfer (move from bed to chair), eat, and maintain continence without assistance? The assessment scores each ADL based on how much help is needed — independent, needs supervision, needs physical assistance, or totally dependent.

Instrumental activities of daily living (IADLs). Can the person manage medications, prepare meals, handle finances, use a telephone, and navigate transportation? For dementia patients, medication management and financial decision-making are often the first IADLs to decline.

Cognitive status. Does the person have orientation to time, place, and person? Can they make consistent, informed decisions about their care? Do they exhibit wandering, confusion, or disruptive behaviors that create safety risks? The cognitive domain is where dementia-specific impairment gets documented.

Medical complexity. Does the person require skilled nursing interventions such as wound care, injections, catheter management, or complex medication administration?

Behavioral indicators. Does the person exhibit aggression, resistance to care, sundowning, or other behavioral symptoms that require specialized management?

Who Administers It

The LOCET is administered by trained assessors, typically through one of these channels:

Hospital discharge planners — when a parent is being discharged from a hospital stay and needs a care level determination for placement or home services. The hospital's social work team coordinates the LOCET. (PASRR is a separate federal screen for mental illness or intellectual disability; it is not the LOCET.)

OAAS intake coordinators — when you call Louisiana Options in Long-Term Care (1-877-456-1146) to request screening for the Community Choices Waiver or LT-PCS, the intake process includes a LOCET assessment to verify clinical eligibility.

Managed care organization care coordinators — for individuals already enrolled in a Healthy Louisiana Medicaid managed care plan, the MCO may coordinate the assessment through their care management team.

The assessment can be conducted in the person's home, in a hospital, or in a care facility. A family member or caregiver is typically interviewed as part of the process, especially when the person being assessed has cognitive impairment that limits their ability to accurately report their own functional status.

How to Prepare

The assessor will ask about your parent's daily functioning, and the answers drive the score. Two practical steps to ensure the assessment accurately reflects your parent's condition:

Document the bad days, not the good ones. Dementia patients often perform better in structured, one-on-one interactions with strangers — a phenomenon called "showtime" or "showtiming." Your parent may appear more coherent and capable during the assessment than they are on a typical afternoon. Bring a written log of incidents: dates your parent got lost, left the stove on, forgot to take medications, fell, or could not recognize family members.

Be specific about supervision needs. The LOCET distinguishes between someone who can perform an ADL independently and someone who needs supervision to perform it safely. If your parent can technically dress themselves but will put on winter clothes in July or go outside without shoes, they require supervision for dressing. If they can eat independently but will eat expired food or forget to eat entirely, they require supervision for nutrition. Quantify the supervision — how many hours per day, what specifically happens when they are unsupervised.

What Happens After the Score

If the LOCET establishes NFLOC, several pathways open:

Community Choices Waiver eligibility — the parent is placed on the CCW waitlist (the Request for Services Registry) with a priority level determined by a separate Screening for Urgency of Need (SUN) assessment.

LT-PCS eligibility — if the parent also meets the income limit ($994/month), Long Term-Personal Care Services can begin immediately with no waitlist.

PACE enrollment — if the parent lives in a PACE service area, the NFLOC determination is one of the enrollment prerequisites.

Nursing facility Medicaid coverage — the NFLOC determination satisfies the clinical requirement for Medicaid to cover nursing home care (the financial eligibility requirements are separate).

If the LOCET does not establish NFLOC, the determination can be appealed. Request a copy of the scored assessment and identify which functional domains were scored too high. A letter from the parent's treating physician documenting specific functional deficits that the assessment may have underweighted can support the appeal.

The Louisiana Dementia & Memory Care Guide covers the LOCET process within the broader application workflow, including how the assessment interacts with the CCW priority groups and Medicaid financial eligibility.

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