What Is the Determination of Need (DoN) Score for Illinois Home Care?

The Determination of Need (DoN) assessment helps Illinois determine the level of home care services a person may qualify for through Medicaid programs. This episode explains how the assessment works, what it measures, and how it affects care plans and approved service hours.

• What the Illinois DoN assessment measures
• Why the DoN score is important for home care
• Daily activities and safety factors included in the evaluation
• Who performs the Determination of Need assessment
• How assessment results affect approved care hours
• What happens after the assessment is completed
• How to prepare for a successful DoN assessment

Learn how the Illinois Determination of Need assessment helps create personalized home care plans that support independence and improve quality of life.

Blog Link: What Is the Determination of Need (DoN) Score for Illinois Home Care?

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Transcript

SPEAKER_01 0:00

Welcome to the Home Care Powered by AUA podcast. You know, um, imagine your father is a severe fall risk. Like he his balance is just completely deteriorating day by day.

SPEAKER_00 0:12

Oh, yeah. That's a terrifying situation for any family.

SPEAKER_01 0:16

Right. But because he can still technically, you know, stand at the kitchen counter and microwave a bowl of soup for himself, the state might actually look at his file and heavily restrict the home care hours he gets.

SPEAKER_00 0:27

I mean, it sounds completely backward, doesn't it?

SPEAKER_01 0:29

It really does. It's this wild paradox of the determination of need score. And if you are listening to this deep dive today, you probably already understand the stakes of navigating senior care in Illinois.

SPEAKER_00 0:40

Yeah, you definitely know the urgency firsthand.

SPEAKER_01 0:42

Exactly.

SPEAKER_00 0:43

Yeah.

SPEAKER_01 0:43

But today, our mission is to look under the hood of that whole bureaucratic engine, the one that actually decides, you know, what kind of help your loved one is allowed to get.

SPEAKER_00 0:51

Aaron Ross Powell Because it is a notoriously opaque system. I mean, you are dealing with state budgets, overlapping agencies, and these really subjective evaluations of highly intimate daily struggles.

SPEAKER_01 1:01

Aaron Powell Which is overwhelming. So we want to turn this as confusing process into a clear roadmap for you. We've got a couple of key sources on the table today to help us do that. Aaron Powell Right.

SPEAKER_00 1:11

We're looking at the operational framework of home care powered by AUAF, since they provide the actual caregivers on the ground.

SPEAKER_01 1:18

Yeah, their about us materials are super detailed. And we're pairing that with this really insightful article by Rhana Bhutani from July 2026.

SPEAKER_00 1:27

Aaron Powell That article is fantastic because it completely breaks down the mechanics of that determination of need score, or the dawn score, as it's usually called.

SPEAKER_01 1:35

So before we can understand how the state actually scores your need for care, I think we have to look at what that care physically looks like in practice, right? Like the safety net itself.

SPEAKER_00 1:44

Aaron Ross Powell Oh, absolutely. You have to understand the execution first.

SPEAKER_01 1:46

Aaron Powell So we're looking at home care powered by AUAF. And I mean, they have been operating in the Chicagoland area for over 30 years now.

SPEAKER_00 1:55

Aaron Ross Powell 30 years is a massive footprint. They are licensed by the Illinois Department on Aging and they work under the Illinois Community Care Program, the CCP.

SPEAKER_01 2:02

Aaron Powell Right. And their service area is huge. We are talking about Chicago, obviously, but also Arlington Heights, Barrington, Bloomingdale. Trevor Burrus, Jr.

SPEAKER_00 2:11

Evanston, Hoffman Estates, Lincolnwood. I mean the list goes on.

SPEAKER_01 2:15

Yeah. Morton Grove, Mount Prospect, Niles, Palatine. It's expansive.

SPEAKER_00 2:20

Yeah.

SPEAKER_01 2:20

Roselle, Schaumburg, Skokie, Streamwood, and all those surrounding areas.

SPEAKER_00 2:24

They cover a whole lot of ground. And they're providing non-medical in-home care for seniors. Aaron Powell Right.

SPEAKER_01 2:30

So we're talking about personal care, meal preparation, medication reminders, lighthouse keeping, errands, companionship. Trevor Burrus, Jr.

SPEAKER_00 2:37

Even private sitters and specialized Alzheimer's and dementia care.

SPEAKER_01 2:41

Exactly. But what really jumps out to me from their model isn't just the geography or the list of services, it is the cultural competency.

SPEAKER_00 2:47

Oh, the language aspect, yes.

SPEAKER_01 2:49

Because their staff actually reflects the community. They have caregivers speaking English, obviously, but also Syrian, Arabic, Spanish, Polish, Russian. Yeah. Ukrainian and Persian.

SPEAKER_00 2:59

Oh.

SPEAKER_01 2:59

Okay, let's unpack this. Because a lot of people might view bilingual caregivers as just like a nice customer service perk.

SPEAKER_00 3:05

Like a concierge who happens to speak your language.

SPEAKER_01 3:08

Exactly. But it's so much more than that. I see AUAF as this massively equipped home base ready to deploy help. And that linguistic matching, it's a fundamental safety mechanism.

SPEAKER_00 3:21

It really is, especially if you are dealing with a senior experiencing cognitive decline. Because often their secondary language degrades first.

SPEAKER_01 3:29

Oh wow. I hadn't thought of that. They revert to their native tongue.

SPEAKER_00 3:32

They do. So if the person who is helping them bathe or managing their medication cannot understand a sudden expression of physical pain in, say, Polish or Arabic, then that language barrier immediately becomes a health hazard. Exactly. It's a clinical disaster waiting to happen.

SPEAKER_01 3:48

So having a caregiver who speaks the language removes the friction from an already vulnerable situation. But here's a crucial caveat: AUAF doesn't actually decide who qualifies for this state-funded care.

SPEAKER_00 4:00

Right. They are the execution arm, they do the work.

SPEAKER_01 4:02

So if we use a utility grid analogy, AUAF is this massive, powerful generating plant. They have the 30 years of experience, the languages, the staff, but they don't control the meter on the side of your house.

SPEAKER_00 4:14

That is a perfect analogy.

SPEAKER_01 4:15

They don't give the green light. So if AUAF is the team ready to help, who is the gatekeeper actually reading that meter?

SPEAKER_00 4:22

Well, that brings us to the determination of need score, the Don score. That is the green light.

SPEAKER_01 4:28

Okay. So how does that actually work? Roni and Botani's article really dives into this.

SPEAKER_00 4:33

Aaron Powell It does. The DON score is a structured assessment and it's used across Illinois home care programs. So the CCP we mentioned, but also the home services program, the HSP.

SPEAKER_01 4:44

But the home care agency itself doesn't do the assessing, right?

SPEAKER_00 4:47

No, never. It's a separate entity. For the CCP, it's done by a care coordination unit, a CCU.

SPEAKER_01 4:53

And what if they are using the home services program?

SPEAKER_00 4:56

Then it's handled by the Illinois Department of Human Services, usually through their division of rehabilitation services.

SPEAKER_01 5:01

Okay, so the state separates the evaluation from the provision of care?

SPEAKER_00 5:05

What's fascinating here is that this assessment does not actually diagnose medical conditions. That's not its purpose.

SPEAKER_01 5:10

Aaron Powell Wait, really? It doesn't look at the medical diagnosis?

SPEAKER_00 5:14

Not primarily. It only evaluates the ability to safely perform daily activities and household tasks. Can they bathe? Can they dress? Can they prep a meal? What's their mobility and balance like?

SPEAKER_01 5:25

Aaron Ross Powell Okay. So it it's less like getting an MRI to officially diagnose a bad knee. Yeah. And more like a practical audition to see if you can safely walk up your own front steps with that bad knee.

SPEAKER_00 5:36

That is exactly it. They are looking at practical function.

SPEAKER_01 5:39

Aaron Powell So how does that functional audition actually translate into real hours of care? Because they have to build a blueprint somehow.

SPEAKER_00 5:46

Well, it's not a simple point system. You don't just hit a score of, say, 40 and suddenly unlock a rigid, fixed package of 10 hours a week.

SPEAKER_01 5:53

Aaron Powell So it's not a one-size-fits-all generic package.

SPEAKER_00 5:55

Not at all. The assessment feeds into a highly individualized service plan.

SPEAKER_01 5:59

Aaron Powell So two people could get the exact same overall Dawn score, but get totally different services.

SPEAKER_00 6:04

Yes. Because their underlying practical needs might look entirely different. The state heavily weighs specific safety factors, fall risk, balance, whether they use a walker.

SPEAKER_01 6:15

If we connect this to the bigger picture, this individualized approach protects everybody.

SPEAKER_00 6:20

It really does. It ensures seniors with high specific needs aren't overlooked by some generic checklist.

SPEAKER_01 6:27

Right. Here's where it gets really interesting, though. Just think about the relief families must feel. Knowing their loved one isn't just being shoved into a generic care box.

SPEAKER_00 6:38

Exactly. And it also protects the community resources, ensuring the program isn't drained by over-serving lighter needs.

SPEAKER_01 6:44

But that means everything rides on that one assessment day. Since this individualized plan dictates their daily life, how on earth do families make sure the assessor gets a perfectly accurate picture?

SPEAKER_00 6:56

Well, preparation is critical, and families absolutely can and should request to be present during the assessment. Do not let your loved one do this alone.

SPEAKER_01 7:04

Because what stands out to you about human nature in these moments, we tend to downplay things, right?

SPEAKER_00 7:09

No, constantly. It's human nature to hide our struggles.

SPEAKER_01 7:12

It totally reminds me of hiring a housekeeper. Like you hire a housekeeper, but then out of pure pride, you frantically clean up the house before they even arrive.

SPEAKER_00 7:20

Yes. You don't want them to see the real mess.

SPEAKER_01 7:22

But during a Don assessment, you actually need to show them the mess. If a senior is sitting there with a state assessor out of pride, they are going to pretend they can cook and clean just fine.

SPEAKER_00 7:33

And if they do that, they won't get the hours they need, so the family has to be there. And you have to write things down ahead of time.

SPEAKER_01 7:40

Like specific examples of recent difficulties.

SPEAKER_00 7:43

Exactly. Because you will forget on the spot. Write down the recent fall, the mismedication, the time they left the stove on. Health provider documentation is super helpful too.

SPEAKER_01 7:54

You have to bring receipts.

SPEAKER_00 7:55

You really do. Now, these assessments aren't permanent, they do periodic reassessments.

SPEAKER_01 8:00

But what if something happens in between those scheduled reviews? Like a sudden health change.

SPEAKER_00 8:05

Families can trigger an early reassessment. A hospital stay, a fall. If the plan isn't working, you have to raise those concerns.

SPEAKER_01 8:13

Okay, so let's say you do all this. You advocate, you show the mess, the Don score creates the blueprint, and you get the approved hours. Someone still has to actually do the work.

SPEAKER_00 8:22

Right. The care still has to be delivered.

SPEAKER_01 8:24

And what if the person best suited to provide that care is the exact same family member who just fought for them during the assessment?

SPEAKER_00 8:32

This raises an important question about how we value caregiving in our society. Because through the Illinois Community Care Program, family members can actually be compensated for caring for their loved ones.

SPEAKER_01 8:43

Wait, they can get paid by the state to care for their own mom or dad.

SPEAKER_00 8:47

Yes. And home care, powered by AUAF, helps guide families through that entire process of becoming a paid family caregiver. Trevor Burrus, Jr.

SPEAKER_01 8:55

That is incredible. Because usually family caregiving is just this massive unpaid financial burden.

SPEAKER_00 9:00

Aaron Powell It drains families. But AUAF currently pays eligible caregivers $21 per hour.

SPEAKER_01 9:07

Wow, $21 an hour.

SPEAKER_00 9:09

Now obviously rates vary by contracted agencies and other places, but that is the current rate through AUAF. Trevor Burrus, Jr.

SPEAKER_01 9:15

So what does this all mean? It means total emotional and financial relief. It literally transforms family caregiving from this stressful, unpaid burden into a formally recognized, compensated role.

SPEAKER_00 9:26

Aaron Powell Exactly. The state and agencies like AUAF work together to alleviate that crushing financial weight.

SPEAKER_01 9:32

And you get the cultural and linguistic matching automatically because it's your own family.

SPEAKER_00 9:38

It's really a brilliant setup.

SPEAKER_01 9:39

It really is. So just to recap our journey today on this deep dive, we started by looking at this expansive multilingual support system at home care powered by AUAF.

SPEAKER_00 9:50

A true safety net for the Chicagoland area.

SPEAKER_01 9:52

Right. And then we decoded the Don assessment itself, realizing it's all about practical, functional need, not just medical labels.

SPEAKER_00 10:00

And that families have to advocate fiercely to get that individualized care plan.

SPEAKER_01 10:04

And finally, realizing that family members can actually step up, get compensated, and provide that care themselves. It's empowering.

SPEAKER_00 10:12

It really gives families their agency back. But you know, based on the source text, there is one final really provocative thought I want to leave everyone with.

SPEAKER_01 10:19

Oh, what's that?

SPEAKER_00 10:20

Well, the text noted that the assessment looks at whether assistive devices are already in place, right? Like grab bars.

SPEAKER_01 10:26

Yeah, to see how safely they can navigate the house.

SPEAKER_00 10:29

Right. So if you are a proactive family and you install grab bars and shower chairs before the assessment to protect your loved one.

SPEAKER_01 10:35

Wait, by making the home safer, do you accidentally lower their dawn score?

SPEAKER_00 10:41

That's the paradox. Could making the home safer inadvertently reduce the state-funded care hours they receive because you've temporarily fixed the functional deficit.

SPEAKER_01 10:50

Oh man, that is a brutal catch 22.

SPEAKER_00 10:53

It really is. It's this fascinating tension between proactive safety and having to demonstrate a real raw need for help. Something for you to definitely mull over if you're preparing for an evaluation.

SPEAKER_01 11:04

That is definitely something to think about. You really have to strategize. Well, if you live in the Chicagoland area and are facing this, definitely explore your options and don't be afraid to ask for help.

SPEAKER_00 11:14

Absolutely.

SPEAKER_01 11:14

Thanks for joining us on this deep dive. We'll catch you next time.