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As the population of persons who are aged or disabled rises, so does demand for long term care services and supports. Policymakers, advocates, and providers are faced with the increasingly difficult tasks of defining priority target populations, and allocating public resources fairly and equitably. The ability to support systematic, standardized methods for such activities is one of the most important benefits of interRAI assessment systems. As of 2003, three different tools have been designed and tested:
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MAPLe
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MI Choice
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RUG-III/HC
MAPLe
MAPLe differentiates clients into five priority levels, based on their risk of adverse outcomes. The MAPLe algorithm is based on a broad range of clinical variables in the HC. Clients in the low priority level have no major functional, cognitive, behavioural, or environmental problems. They can be considered self-reliant. The high priority level is based on presence of ADL impairment, cognitive impairment, wandering, behaviour problems, and the nursing home risk CAP. Research has demonstrated that the five priority levels are predictive of risk of adverse outcomes. Clients in the high priority level are nearly 9 times more likely to be admitted to a long term care facility than are the low priority clients. MAPLe also predicts caregiver stress. Diagram 
MI Choice
MI Choice is a 32 question screening tool derived from the HC instrument. It groups individuals in one of five levels of care: nursing home, home care, intermittent personal care, homemaker, and information and referral. The screen can be used over the phone to identify persons who are not likely to meet health, cognitive, and functional criteria for home care or institutional services. This enables expensive in-person assessment resources to be targeted to persons who are screened as more likely to qualify as medically eligible for assistance. During the assessment process, MI Choice can also serve as a complement to the assessor's clinical insights and the individual's preferences about the most appropriate care setting. Diagram
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RUG-III/HC
These algorithms places individuals into distinct groups that reflect the relative cost of services they are likely to consume. This grouping system enables decision-makers to identify groups of people who can be considered presumptively eligible for a particular service or benefit, as has occurred in the US with the Medicare Prospective Payment System. In addition, while the number of sub-categories differs in the institutional and home care RUG versions, the categories themselves are defined in the same manner, thus offering the opportunity to identify similar populations of long term care services users across settings and to identify priority groups for assistance in a given setting.
References
Bjorkgren MA, Fries BE, Shugarman LR.Testing a RUG-III Based Case-mix System for Home Care. 2000. Canadian Journal on Aging 19(suppl 2): 106-125.
Fries BE, Shugarman LS, Morris JN, Simon S, James M. A Screening System for Michigan's Home and Community-Based Long-Term Care Programs. 2002. The Gerontologist 42(4):462-474.
Poss, J., Hirdes, J.P.,Fries, B.E.,McKilop, I.,Chase, M. Validation of Resource Use Groups Version III for Home Care (RUG-III/HC). 2008. Medical Care 46(4): 380-387.
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