Families members dealing with an elderly infirm relative cannot simply check their loved one into a skilled nursing facility. Skilled nursing care requires an assessment to determine whether a person is appropriate for that level of care. The patient review instrument, or PRI, is an assessment tool used by hospitals and nursing homes to determine the cognitive and physical skill levels of a person.
The primary function of a PRI is to determine an individual's mental and physical abilities. These assessments are New York State law for candidates seeking placement in a skilled nursing facility. The assessment is not necessary for those entering assisted living or independent living facilities, although the test is performed in many cases to determine whether assisted living or skilled nursing is most appropriate. While required by law in New York State for nursing home admission, many other states use PRIs as a guideline to determine skill levels of seniors in need of institutional care.
The PRI screening is typically good for 30 days and is performed by a nurse. The test is performed in one of two environments. The majority of PRIs are completed at a hospital as the result of an emergency room visit. People with dementia or a advanced chronic illness are assessed before discharge in order to determine their cognitive and physical impairment. At this point, the discharge nurse uses the tool to determine whether the person should be released to return home or whether skilled nursing care is appropriate. People can also be assessed at home by a private nurse. Many times, families calling nursing homes are offered a home visit from a nurse. This nurse performs the PRI to determine whether skilled nursing is the next step. This can either be paid privately or, if qualified, through Medicaid.
The New York State's PRI guide is 73 pages long, however the assessment is only four pages. The remaining pages address how to complete the document, as well as how to assess the individual. While brief, the test takes a high-level view of the individual. While the assessment is a guideline and the state law, many times nurses offer their opinions when deciding about whether an individual is appropriate for skilled nursing care. The New York State PRI is the model for PRIs used nationwide.
The PRI looks at not only which disease affects the assessed person, but the skill level at which they operate. The first 26 questions of the exam measure both the person's ability to carry out activities of daily living, such as mobility, toileting and eating, and behavioral issues—hallucinations, verbal outbursts and physical aggression. The nurse rates the person based on a predetermined set of ratings that covers that person's level of independence. Questions 27 to 29 deal with the therapies and treatments being administered, from pharmaceutical drugs to physical and occupational therapies.
Question 30 is the most important question in the PRI. This is the part of the form where a medical diagnosis is assigned. The nurse is called upon to enter an ICD-9 Code, which comes from the International Classification of Disease, 9th Edition. The most used code on PRIs is 294.1, or dementia. While dementia is not actually a disease, this code is the the most prevalent of any code assigned on PRIs. The results of the PRI, including the diagnosis assigned, determines whether the patient requires skilled nursing care.
- Seniorliving.org. “Nursing Home vs. Skilled Nursing.” August 4, 2020.
- Medicare.gov. “What's an Assessment in Skilled Nursing Facilities?” August 4, 2020.
- Medicare.gov. “Skilled Nursing Facility Rights.” August 4, 2020.
- Medicare.gov. “Skilled nursing facility (SNF) Care.” August 4, 2020.
- Genworth. “Cost of Care Trends & Insights.” August 4, 2020.
Jared Paventi is the communications director for a disease-related nonprofit in the Northeast. He holds a master's degree from Syracuse University's S.I. Newhouse School of Public Communication and a bachelor's degree from St. Bonaventure University. He also writes a food appreciation blog: Al Dente.