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Fill Out Your Locet Form

The LOCET form, or Level of Care Eligibility Tool, is essential for determining an individual's eligibility for nursing facility admission as governed by the Louisiana Department of Health and Hospitals. This form requires detailed information about the applicant, including personal, medical, and insurance details, to accurately assess their care needs. Completing the LOCET form is a crucial step in facilitating access to appropriate care; fill out the form by clicking the button below.

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Article Structure

The LOCET form serves as a crucial tool in assessing eligibility for nursing facility admission within the Louisiana Department of Health and Hospitals. This comprehensive document collects vital information about an applicant's identity and personal circumstances, including their social security number, Medicaid details, and private insurance coverage. Critical demographic data, such as gender, birth date, and race or ethnicity, is gathered to ensure that all relevant factors are considered. Further sections of the form examine the applicant's medical background through the collection of diagnoses and treatment history, alongside details about their current living situation. The LOCET incorporates assessments of Activities of Daily Living (ADLs), cognitive performance, and behavioral conditions, which provide insights into the applicant's functional capabilities. Additionally, this tool includes provisions for obtaining input from various informants, ranging from family members to healthcare professionals, thereby ensuring a well-rounded perspective on the applicant’s needs. It emphasizes the importance of accurate and objective reporting during the interview process, which ultimately supports the determination of appropriate long-term care services. As such, the LOCET is vital for facilitating access to necessary medical and social support for individuals requiring nursing home admission.

Locet Example

	Louisiana DHH Nursing Facility Client Face Sheet for LOCET p. 1
	Level of Care Eligibility Tool for Nursing Facilities pp.2-5
	Hardcopy version is for use in Nursing Facility Admission Process
A1.	Client’s Name: _________________________________________________________________________________
A.3.a.	Social Security #: _________________________________ b. Medicaid #: _______________________________
	(1 if pending, 0 if none)
c.	Private Insurance #: ___________________________ Private Insurance Name: ___________________________

d.Veteran’s Administration #: _____________________________ e. Medicare #: _____________________________

(or Comparable Railroad Insurance #)

B.2.	DHH Region #: ____________________
C.1.	Gender	1 = Male	2 = Female	_________	C.2. Birthdate ______________/________/_________

C.3. Race/Ethnicity: Please answer all ( 0 = No

a.Amer Indian/Alaskan Native _____

b.Asian _____

c.Black/African-American ______

1 = Yes)

d. Native Hawaiian or other Pacific Islander _______

e. White ________

f. Hispanic or Latino ________

C.4.	Marital Status:			1.	Never Married		3. Widowed	5. Divorced	____________
				2.	Married		4. Separated	6. Other
D.1.	Client Contact Information:
	Home Address:			_______________________________________________________________________________
	Address 2:			_______________________________________________________________________________
	City: _____________________________________ State: _______________________ Zip: ________________
	Home Tel:		___________________________________
	Facility Name if known: __________________________________________________________________________
	Parish:	_______________________________________________________________________________________
	Mailing Address (if different from Home Address)							Please leave this section blank if same as Home Address
	Name:	_______________________________________________________________________________________
	Address 1:		____________________________________________________________________________________
	Address 2:		____________________________________________________________________________________
	City: ___________________________________ State: _________________________ Zip: _________________
D.4.	Other Contact Information:
	Type of Other Contact:					1. Personal Representative		4. Power of Attorney		_______________
						2. Tutor		5. Other (specify):
						3. Curator		___________________________________________
	Name:	______________________________________________________________________________________
	Address:		____________________________________________________________________________________
	Address 2:		___________________________________________________________________________________
	City: _____________________________________ State: _______________________ Zip: ________________
	Telephone		___________________________________
Applicant Name _____________________________							Last 4 digits of Applicant SSN ____		____	____ ____ OAAS PF-06-010
Revised 05/10/2010										Page 1 of 5

Louisiana DHH Nursing Facility Client Face Sheet for LOCET p. 1

Level of Care Eligibility Tool for Nursing Facilities pp. 2-5

Hardcopy version is for use in Nursing Facility Admission Process

SECTION A. SETTING THE STAGE

1.The intake analyst will discuss the eligibility determination process/issues generally with the informant, then read the statement to the informant and ask if he/she understands, clarify any misunderstandings, and finally, select the answer given.

―I (informant) understand that the purpose of this interview is to determine if the person being assessed (applicant) meets medical

eligibility criteria for publicly funded long-term care services, and that I am expected to provide objective and accurate information about the applicant to assist in this determination.‖

2.―The following issued have been explained to me:

b. The information I provide will be used to determine medical eligibility for long-term care services funded through the Louisiana Department of Health and Hospitals.

0. No 1. Yes

c. The results of this interview, and information about how to appeal the results, will be provided in writing to the applicant.

0. No

1. Yes

d.The Louisiana Department of Health and Hospitals will conduct in-person interviews on a random sample of individuals who have applied to assess the accuracy of the information provided.

0. No 1. Yes

e. All program requirements must be met for eligibility to any particular program.‖

0. No

1. Yes

3. Informant indicates that eligibility determination process/issues have been adequately explained:

0. No

1. Yes

Signature of
Applicant / Informant:_______________________	____________________________________
	Date

**ACS/RO Users – SKIP TO SECTION EE SECTION EE. Initial Call and LOCET Type

1. LOCET Initiated by:

1 = Applicant

2. Date/Time LOCET Initiated:




Y	Y	Y	Y	M	M	D	D
Y	Y	Y	Y	M	M	D	D

3.Type of LOCET :

1.Initial Determination

SECTION FF. Program Choice
1.h. Client chooses Nursing Facility Admission:		0=NO 1=YES
SECTION GG. Diagnoses:
a. Primary Diagnosis:	________________________
b. Secondary Diagnosis:	________________________

(Military Time)

ICD-9 Codes

(If available)

SECTION B. Items/information to collect at beginning of interview process
4. Relationship of informant to applicant (select only one):

0.	Self (Skip to Item B.7)	5. Hospital discharge planner
1.	Spouse	6. Nursing Home admissions staff
2.	Child or child-in-law	7. Other health care professional.	Specify.________________________
2.	Child or child-in-law	7. Other health care professional.	Specify.________________________
3.	Other relative
4.	Friend/neighbor	8. Other. Please specify. __________________________________________
Applicant Name _____________________________ Last 4 digits of Applicant SSN			____ ____ ____ ____ OAAS PF-06-010
Revised 05/10/2010			Page 2 of 5

5.Informant’s information sources regarding the status/abilities of applicant.

(select all that apply):

0=NO	1=YES		0=NO 1=YES
a. Direct observation of the applicant ………		d. Review of agency records, care
a. Direct observation of the applicant ………		d. Review of agency records, care
b. From paid care providers……………		provider status reports, etc………


c. From family or other informal caregivers		e. Other (specify) _______________

If the only source of information in B.5. is Direct Observation of the applicant, answer B.6. Otherwise, skip B6.

6.	If information source is from direct observation of applicant, indicate how recently observation occurred:
	1. within last three days		3. within last month
	2. within last week		4. more than one month ago
	2. within last week		4. more than one month ago
7.	Current location of applicant		(select only one):
	0. Private home/apt		4. Group Home or ICF/DD
	1.	Hospital	5. Shelter (for homeless, disaster -related or otherwise)
	2.	Adult Residential Center (Assisted living)/board & care
	2.	Adult Residential Center (Assisted living)/board & care
	3.	Nursing home	6. Other, please specify____________________________ _

Pathway 1. Activities of Daily Living

*** Please use the following to describe each activity:

a. Independent:	No help or oversight --OR-- Help/oversight provided only 1 or 2 times during last 7 days.
b. Supervision:	Oversight, encouragement or cueing provided 3 or more times during last 7 days, --OR—
	Supervision 3 or more times plus physical assistance provided only 1 or 2 times during last 7 days.
c. Limited assistance:		Applicant highly involved in activity; received physical help in guided maneuvering of
		limbs or other non-weight-bearing assistance 3 or more times–OR– More help provided only

1 or 2 times during last 7 days.

d. Extensive assistance: While applicant performed part of activity over last 7-day period, help of following type provided 3 or more times:

-Weight bearing support

-Full performance by another during part (but not all) of last 7 days

e.Total Dependence: Full performance by another during all of last 7 days.

f.Activity did not occur during entire 7 days (regardless of ability).

g.Unknown to Informant

12A. Locomotion. Describe how the applicant moves between locations inside his/her place of residence. (If the applicant uses a wheelchair, code self-sufficiency once in chair.) Use the above codes to describe the applicant’s self-performance during last 7

days:

__________________	A through G only

12B Eating. Describe how the applicant eats and drinks (regardless of skill). (Includes intake of nourishment by other means, e.g., tube feeding...) Use the above codes to describe the applicant’s self-performance during last 7 days:

__________________	A through G only

12C. Transfer. Describe how the applicant moves to and from surfaces, e.g., bed, chair, wheelchair, standing position. (EXCLUDE transferring to/from bath/toilet.) Use the above codes to describe the applicant’s self-performance during last 7 days:

___________________

	A through G only
12D. Bed Mobility. Describe how the applicant moves to and from a lying position, turns side to side, and positions body while
in bed. Use the above codes to describe the applicant’s self-performance during last 7 days:
___________________	A through G only

12E. Toilet Use. Describe how the applicant uses the toilet (or commode, bedpan, urinal). (Includes transfer on/off toilet, cleaning self, changing pad, managing ostomy or catheter, adjusting clothes.) Use the above codes to describe the applicant’s

self-performance during last 7 days:

___________________ A through G only

12F. Dressing. Describe how the applicant dresses and undresses him/herself, including prostheses, orthotics, fasteners, belts, shoes, and underwear. Use the above codes to describe the applicant’s self-performance during last 7 days:

___________________

A through G only

Applicant Name _____________________________	Last 4 digits of Applicant SSN ____ ____ ____ ____ OAAS PF-06-010
Revised 05/10/2010	Page 3 of 5

0 or 1 or 2 only

A through E only

12G. Personal Hygiene. Describe how the applicant grooms him/herself, including combing hair, brushing teeth, washing/drying face/hands, shaving. (EXCLUDE baths and showers.) Use the above codes to describe the applicant’s self-performance during

last 7 days:

_____________________

A through G only

12H. Bathing. Describe how the applicant takes a full-body bath/shower or sponge bath (excluding hair or washing back). Use the above codes to describe the applicant’s self-performance during last 7 days:

_____________________

A through G only

Pathway 2. Cognitive Performance

13A. Short-term Memory. Does the applicant appear to recall recent events, for instance, when the applicant ate at his/her last meal and what he/she ate?

0 = Memory OK

1 = Memory problem

2 = Unknown to Informant

0 or 1 or 2 only

13C. Cognitive Skills for Daily Decision-making. How does the applicant make decisions about the tasks of daily life, such as planning how to spend his/her day, choosing what to wear, reliably using canes/walkers or other assistive equipment if needed?

a. Independent – decisions consistent/reasonable

b. Minimally impaired – some difficulty in new situations or decisions poor and requires cueing/supervision in specific situations only

c. Moderately impaired – decisions consistently poor or unsafe; cues or supervision required at all times d. Severely impaired – never/rarely made decisions

e. Unknown to Informant

13D. Making Self Understood. How clearly is the applicant able to express or communicate his/her needs/requests? (Includes speech, writing, sign language, or word boards.)

a. Understood—expresses ideas without difficulty

b. Usually understood – difficulty finding words or finishing thoughts; prompting may be required c. Sometimes understood – ability is limited to making concrete requests

d. Rarely/never understood e. Unknown to Informant

Pathway 3. Physician Involvement

14A. Physician visits. In the last 14 days, how many days has a physician (or authorized assistant or practitioner) examined the
applicant? (Do not count emergency room exams or hospital in-patient visits.)
0 1 2 3 4 5 6 7+	0 through 15 only

14B. Physician orders. In the last 14 days, how many times has a physician (or authorized assistant or practitioner) changed the
applicant’s orders? (Do not include order renewals without change; do not count hospital in-patient order changes.)
0 1 2 3 4 5 6 7+	0 through 15 only

Pathway 4. Treatments and Conditions

15A. Has the applicant received any of the following health treatments, or been diagnosed with any of the following health

conditions?	0. No	1. Yes	2. Unknown to Informant

a. Stage 3-4 pressure sores in the last 14 days…………….			e. Pneumonia in the last 14 days…………………0
b. Intravenous feedings in the last 7 days………………...			f. Daily respiratory therapy in the last 14 days….

c. Intravenous medications in the last 14 days……………			g. Daily insulin injections with 2 or more


d. Tracheostomy care, ventilator/respirator,				order changes last 14 day s…………………….
suctioning in last 14 days…………………………………			h. Peritoneal or hemodialysis in the last 14 days

0 or 1 or 2 only

Pathway 5: Skilled Rehabilitation Therapies

16A. Record the total minutes each of the following therapies was administered or scheduled (for at least 15 minutes a day).

Enter ―0‖ if none or less that 15 minutes daily.

a = Total number of minutes provided in last 7 days

b = Total number of minutes scheduled for next 7 days but not yet administered

1.	Speech Therapy	a =	_____	b =	_____
2.	Occupational Therapy	a =	____	b =	____
3.	Physical Therapy	a =	_____	b =	_____

0 through 999 only

Applicant Name _____________________________	Last 4 digits of Applicant SSN ____ ____ ____ ____ OAAS PF-06-010
Revised 05/10/2010	Page 4 of 5

Pathway 6. Behavior

****Please use the following codes for behavior symptom frequency in last 7 days:

a. Behavior not exhibited in last 7 days	d. Behavior of this type occurre d daily
b. Behavior of this type occurred 1 to 3 days in last 7 days	e. Unknown to Informant
c. Behavior of this type occurred 4 to 6 days, but less than daily

17A. Wandering. In the last seven days, did the applicant wander, that is, move around with no rational purpose, seemingly

oblivious to his/her needs or safety?	___________
oblivious to his/her needs or safety?	___________	A through E only
		A through E only

17B. Verbally abusive behavior. In the last seven days, did the applicant threaten or scream at others? Code for behavior

symptom frequency in last 7 days:	___________
symptom frequency in last 7 days:	___________	A through E only
		A through E only

17C. Physically abusive behavior. In the last seven days, did the applicant hit, shove, scratch, or otherwise act physically abusive or sexually abusive toward other people? Code for behavior symptom frequency in last 7 days:

___________

A through E only

17D. Socially inappropriate/disruptive behavior. In the last seven days, did the applicant make noise, engage in self-abusive acts, disrobe in public, hoard items, or rummage through others’ belongings? Code for behavior symptom frequency in last 7

days:

___________

A through E only

17E. Mental Health Problem/Condition.

Applicants who need long term care may experience delusions and hallucinations that impact the applicant’s ability to live independently in the community. If present at any point in last 7 days, code:

0 = NO This applicant DID NOT experience delusions or hallucinations which impacted his/her ability to function in the community within the last 7 days.

1 = YES This applicant DID experience delusions or hallucinations which impacted his/her ability to function in the community within the last 7 days.

2 = Unknown to informant

a. Delusions

b. Hallucinations

0 or 1 or 2 only

Pathway 7: Service Dependency

18.Code if the applicant is currently being served by EDA Waiver, ADHC Waiver services, LT PCS or is currently in a nursing home.

a =

Not approved for or receiving

these services before 12/01/2006.

b =

Was approved for these services prior to 12/01/2006, has had no break in service since

12/01/2006, and requires ongoing services

to maintain current functional

status.

A or B only

Items to be filled out by intake analyst after completing LOCET form:

J19A. How many minutes did this contact and interview take? ________________

J19B. Date LOCET completed

J19C.a. Signature of Intake Analyst

My signature below indicates that I attest to the fact that I have conducted the LOCET interview recorded within this document, and that the Intake Analyst Registration number shown below in Item J19.C.c. has been issued to me by the Office of Aging and Adult Services.

Signature

Print ed Name

J19C.b. Date of Intake Analyst Signature

Telephone Number of Intake Analyst _________________________________________

J19C.c. LOCET Intake Analyst Registration Number		___________________________________________
Applicant Name _____________________________	Last 4 digits of Applicant SSN ____ ____ ____ ____ OAAS PF-06-010
Revised 05/10/2010		Page 5 of 5

Get Locet PDF Form

Form Characteristics

Fact Name	Details
Document Title	Louisiana DHH Nursing Facility Client Face Sheet for LOCET
Purpose	This form is used to determine medical eligibility for long-term care services funded through the Louisiana Department of Health and Hospitals.
Governing Law	Regulated under Louisiana Revised Statutes, Title 46, Chapter 27, and relevant federal laws.
Client Information Sections	The form collects demographic information, including name, Social Security number, Medicaid number, gender, race, and marital status.
Contact Information	Includes sections for home and mailing addresses, as well as other contact persons such as personal representatives or power of attorney.
Eligibility Determination Process	The intake analyst explains the process to the informant, ensuring understanding before proceeding with the eligibility assessment.
Informant's Relationship	The form allows selection from various relationships of the informant to the applicant, such as spouse, child, or friend.
Sections for Health Info	Includes pathways to assess activities of daily living, cognitive performance, physician involvement, and skilled rehabilitation needs.

Guidelines on Utilizing Locet

Completing the LOCET form is a necessary step in the eligibility process for nursing facility admission. It is crucial to provide accurate and comprehensive information to ensure that the applicant receives appropriate assessments and services. Follow the steps below carefully to fill out the form correctly.

Start with Section A. Provide the client's full name and complete applicable fields such as Social Security number, Medicaid number, and private insurance details.
Fill in the DHH Region number and gender (1 for Male, 2 for Female).
Add the client's birth date.
Indicate the client's race/ethnicity by checking the appropriate boxes.
Specify the marital status of the client.
Provide the client's contact information, including home address, city, state, and zip code. If the mailing address differs, fill that section out as well.
Include contact information for a personal representative or power of attorney, if applicable.
For the informant, fill in their relationship to the applicant and their information sources regarding the applicant's status.
Indicate the current location of the applicant using the designated options provided.
Describe the applicant's ability to perform activities of daily living (ADLs) using the provided codes.
Evaluate the applicant’s cognitive performance by answering questions about memory and decision-making abilities.
Complete pathways related to physician involvement, treatments, rehabilitation therapies, and behavior patterns as needed.
Lastly, ensure that an intake analyst records the duration of the interview, the date LOCET was completed, and their signature along with their registration number.

What You Should Know About This Form

What is the purpose of the LOCET form?

The LOCET form, or Level of Care Eligibility Tool, is designed to help determine the medical eligibility of individuals applying for publicly funded long-term care services in Louisiana. It collects essential information about the applicant's health, living situation, and support needs. By accurately completing this form, the intake analyst can assess whether the individual qualifies for services, ensuring that those in need receive the appropriate care they deserve.

Who needs to complete the LOCET form?

The LOCET form is typically completed by an informant who knows the applicant's health status well. This could be a family member, a friend, or a healthcare professional. It's crucial that the informant provides objective and detailed answers to facilitate an accurate evaluation. In some cases, the applicant may be able to provide their own information, especially if they are capable of understanding the questions and their implications.

What information is required on the LOCET form?

The LOCET form requests a wide range of information. This includes the applicant's personal details, such as name, date of birth, and contact information, as well as specifics about their medical history and daily living activities. It asks about diagnoses, current medications, recent physician visits, and any treatments received. By gathering this data, the form aims to create a comprehensive picture of the individual's needs for care.

How does the eligibility determination process work?

Once the LOCET form is completed, the intake analyst reviews the information provided and may conduct an interview with the informant. They will discuss the criteria for eligibility and verify all details to ensure accuracy. After the review, the analyst will provide the results in writing. This includes information on how to appeal if the applicant disagrees with the outcomes. Additionally, to maintain integrity, random audits may occur to validate the information submitted.

What happens if an applicant does not qualify for services?

If an applicant is found not to meet the eligibility requirements through the LOCET process, they will be informed in writing of the decision and the specific reasons for it. Understanding these reasons can help the applicant or their representative address any concerns. Moreover, they will be provided with details on how to appeal the decision if they believe it is incorrect. Options may also exist for personal care or alternative resources that could be pursued.

Common mistakes

Filling out the Louisiana DHH Nursing Facility Client Face Sheet for the LOCET (Level of Care Eligibility Tool) can be challenging. Many applicants and their representatives make common mistakes that could lead to delays or complications in the eligibility determination process. Understanding these pitfalls is essential for a smoother experience.

One frequent mistake involves leaving sections blank. For instance, if the client's name, Social Security number, or Medicare number is not filled out entirely, it may cause unnecessary delays. Accuracy is crucial; every part of the application should be completed as thoroughly as possible. If there is no information to provide, indicating that explicitly can help avoid confusion.

Another error is incorrectly marking fields related to diagnosis or eligibility. Misunderstanding the instructions for indicating medical conditions or diagnostic codes can result in a misinterpretation of the client's needs. This mistake might lead to the denial of services that the applicant might qualify for, impacting their care.

Often, individuals fail to provide accurate contact information. Whether it’s the home address or other relevant contact details, these should be valid and accessible. An incorrect or incomplete address can hinder communication regarding the eligibility decision. Without a reliable way to reach the applicant or their representative, important updates could be missed.

Misinterpreting the relationship of the informant to the applicant can also be a significant oversight. Selecting the wrong relationship option can lead to confusion about who is responsible for providing the necessary information, impacting the integrity of the application. Clarity on this matter ensures that the right person is providing information relevant to the applicant’s condition and situation.

Another frequent issue arises when applicants do not fully understand the requirements regarding previous treatments or diagnoses. Providing incomplete information about recent medical history or therapies can mislead evaluators. For example, if an applicant has received daily physical therapy but fails to note it, it could affect their eligibility for further support.

Failure to address behavior assessment questions accurately is also common. If informed individuals overlook behaviors exhibited in the past week or misunderstand the scales provided, this could paint an inaccurate picture of the applicant’s current needs. Such inaccuracies can hinder their chances for appropriate care interventions.

Moreover, not adhering to the coding system when describing activities of daily living is a simplistic mistake that can have serious consequences. If the informant does not follow the specified codes, it is possible the applicant’s limitations are underrepresented, thus affecting the overall assessment outcome.

Finally, skipping over the signature section or forgetting to date the form can invalidate the submission. It’s vital for the informant or applicant to affirm the information provided is accurate through their signature. If a date is missing, it could introduce unnecessary complications regarding the timeline of the application.

By being aware of these mistakes and taking proactive steps to avoid them, applicants and their representatives can help ensure their LOCET submission is complete and accurate, ultimately leading to a better outcome in receiving necessary care services.

Documents used along the form

When completing the LOCET form, it is common to utilize additional documents to provide comprehensive information regarding the applicant's circumstances. The following documents complement the LOCET form and help streamline the nursing facility admission process.

Nursing Facility Admission Application: This form collects essential details about the applicant, including medical history, demographic information, and financial details. It is typically required alongside the LOCET to assess eligibility for nursing facility services.
Verification of Medicaid Eligibility: This document verifies an applicant's eligibility for Medicaid, which is crucial for those seeking funding for nursing facility care. It includes information on income and assets to determine qualification for assistance programs.
Power of Attorney Document: A Power of Attorney establishes who can act on behalf of the applicant in healthcare and financial matters. This document is significant, especially if the applicant is unable to make decisions independently.
Medical Records Release Form: This form authorizes healthcare providers to share the applicant's medical records with the nursing facility and any involved parties. It ensures that all relevant medical history is considered during the admission process.

Utilizing these documents in conjunction with the LOCET form helps create a clear picture of the applicant's needs and eligibility for nursing facility services. It is essential to ensure that all relevant information is provided to facilitate an efficient admissions process.

Similar forms

Standardized Assessment Form: Similar to the LOCET, a standardized assessment form collects detailed personal and medical information about an individual for determining eligibility for services. Both forms aim to ensure a comprehensive understanding of the applicant's needs and conditions.
Medicaid Application: Like the LOCET, a Medicaid application requires extensive personal and financial information. It is essential for determining an individual’s qualification for Medicaid benefits, ensuring that all necessary data is captured efficiently.
Nursing Home Admission Agreement: This document shares similarities with the LOCET as it outlines the terms and conditions for nursing home residency. Both address the client's needs and eligibility, establishing a framework for care and services provided.
Level of Care Evaluation Form: This form is akin to the LOCET in that it assesses an individual's health care needs. Both tools are designed to evaluate the level of care necessary, ensuring that individuals receive appropriate support.
Individualized Service Plan (ISP): Like the LOCET, an ISP is tailored to the applicant's specific health needs and preferences. It documents the services required for the individual, ensuring that care is personalized and aligns with the outcomes of the LOCET assessment.

Dos and Don'ts

When filling out the LOCET form, keep these important points in mind:

Ensure all sections are completed accurately.
Use clear handwriting or type to avoid confusion.
Verify all personal identification numbers, such as Social Security and Medicaid numbers.
Answer all questions honestly and to the best of your ability.
Consult with the informant to gather detailed information about the applicant.
Do not skip any mandatory fields, as this can delay processing.
Refrain from using abbreviations or shortcuts that could lead to misunderstandings.
Don’t guess if you don’t know an answer; indicate “unknown” where necessary.
Avoid discussing the form with anyone outside the application process.
Remember to sign and date the form at the end to validate the information provided.

Misconceptions

Only healthcare professionals can fill out the LOCET form. This is not true. While healthcare professionals can assist in completing the form, anyone who has relevant information about the applicant can help fill it out.
The LOCET form is only for applicants already in nursing facilities. This misconception is incorrect. The LOCET form is used for determining eligibility for nursing facility admission, and it can be completed for applicants in various living situations, including at home or in hospitals.
Incomplete or inaccurate information won’t affect the outcome of the assessment. This is misleading. Providing accurate and complete information is essential. The details shared directly impact the eligibility determination for long-term care services.
The LOCET form is a one-time requirement for all applicants. This is not accurate. The LOCET form is part of an ongoing assessment process. Applicants may need to complete it again if their situation changes or if required by the Louisiana Department of Health.

Key takeaways

Ensure that all client information is accurately filled out, including names, Social Security numbers, and other identifying data. This helps prevent complications in care coordination.
Gather all necessary documents beforehand, such as proof of insurance, Medicaid numbers, and any medical records that may support the eligibility determination.
The informant should understand the purpose of the interview clearly. Misunderstandings may lead to misinformation during the eligibility assessment.
Complete all sections of the form thoroughly. Leaving sections blank could delay the evaluation process or result in the denial of services.
It is vital to document any additional contacts, such as family members or representatives, who can provide valuable insights into the applicant’s condition.
Communicate openly about the applicant's daily living activities. Specific codes help describe their level of independence and support needs.
Be mindful of the behavioral symptoms the applicant has exhibited in the week prior to the assessment. This can significantly influence the decision.
Ensure that the informant's source of information is reliable. The more credible the source, the better the chances of a fair assessment.
Understand that the completed LOCET form is only one aspect of the applicant’s journey toward receiving long-term care services and that ongoing communication may be necessary.

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