Monday, April 16, 2012

What MAPLe scores mean

For the most part, the easiest way to assess whether a loved one should remain in their own home, is to determine how much help they need with activities of daily living (ADLs). For some, laundry, cleaning, preparing meals, and taking care of themselves can prove a burden. Transportation to activities if independent living (IADLs; banking, shopping) may be a simple solution, but this is not always the case. The level of home care, essentially, boils down to how safe someone is in their own home.

There are many risks: falls, unsafe operation of stoves (a situation with many dementia clients), vision or mobility issues, and the like. Many, upon discharge from hospital, are told to get neighbours to come in and help. Adult children, by far the most likely of caregivers, are pressed into willing or unwilling service.

Unfortunately, it is up to case managers, in Ontario through CCAC, to determine the level of care a loved one receives, and the way they prioritize case loads and clients is using MAPLe.

The Method for Assigning Priority Levels (MAPLe) is a tool used by health care professionals to prioritize clients’ needs and to appropriately allocate home care resources and placement in long-term care facilities.

Low Clients are generally independent, without physical disabilities, and with only minor cognitive loss. There are no problems with behaviour, the home environment, medication, or skin ulcers. Some limited home care support may be needed because of early losses of function in limited areas.

Mild Clients need only a light level of care due to some problems with instrumental activities
of daily living (e.g., housework, transportation) or loss of physical stamina.

Moderate Clients are beginning to show impairments in individual functioning that may be a threat to their independence, such as problems in the home environment, difficulty managing
medications, or physical disability combined with mild cognitive impairment.

High Clients are experiencing more complex problems, including challenging behaviour or physical disability combined with cognitive impairment. These people have elevated risks of
nursing home placement and caregiver distress.

Very high Clients have impairments in multiple areas of function that have a pronounced impact on their ability to remain independent in the community. These include factors such as physical disability, cognitive impairment, falls, challenging behaviour, and wandering. Rates of nursing home placement and caregiver distress are highest in this group.

The Method for Assigning Priority Levels (MAPLe): A new decision-support system for allocating home care resources

John P HirdesJeff W Poss and Nancy Curtin-Telegdi
BMC Medicine 2008, 6:9 doi:10.1186/1741-7015-6-9

The electronic version of this article is the complete one and can be found online at:

© 2008 Hirdes et al; licensee BioMed Central Ltd. 
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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