The Illinois Choices for Care preadmission screening decides more than paperwork — here is how it works on a Hyde Park discharge and what the DON score means.
By Chicago Senior Advisor Care Team · August 30, 2026
If a parent is admitted to University of Chicago Medicine in Hyde Park after a fall, a stroke, or a long stretch of pneumonia, and the care team begins using the phrase "skilled nursing placement," there is a step most South Side families have never heard of that happens before any of it becomes real. It is called the Illinois Choices for Care preadmission screening, and it is administered through the Illinois Department on Aging. Before a person can be admitted to a licensed Illinois nursing facility, a certified screener from a Care Coordination Unit — not the hospital, and not the nursing home — sits down with the patient and the family, completes a Determination of Need assessment, and walks through the long-term care options that exist. The Illinois Hospital Licensing Act requires the hospital to notify the designated Care Coordination Unit at least 24 hours before a pending discharge to a skilled nursing facility, which is why the screener sometimes seems to appear out of nowhere on the day everything is moving fastest. Families on Cottage Grove and in South Shore, Woodlawn, and Bronzeville routinely tell us the same thing afterward: nobody explained that this conversation was the moment where a different outcome was still available.
The state's stated purpose for the screening is blunt about that. Choices for Care exists so that a person is informed about home and community-based options and is not placed in a facility when their needs could be met at home. In practice, that means the screening is not a rubber stamp on a decision the discharge planner has already made. It is the point at which a family can say out loud that the goal is to get Mom back to her apartment near 71st Street with help coming in, and have the state's assessment tool actually evaluate whether that is workable. Screenings most often occur in the hospital before discharge, but they can also happen in a nursing facility after an admission has already taken place, or in a person's own home in the community before any admission at all.
The screener comes from a Care Coordination Unit, a regional agency under the Illinois Department on Aging system rather than an employee of the hospital or of any nursing home. That independence is the whole design. A discharge planner at UChicago Medicine, Rush University Medical Center, or Advocate Christ Medical Center in Oak Lawn has a bed-day pressure the family does not share, and a nursing facility admissions director has an occupancy target. The Care Coordination Unit screener is supposed to be neutral about the destination and is specifically charged with presenting the home and community-based alternatives, including the Community Care Program and the Supportive Living Program, alongside institutional care. For Chicago residents, the City of Chicago Area Agency on Aging inside the Department of Family & Support Services is the front door to the aging-services network; for suburban Cook County families — Oak Park, Evanston, Skokie, Orland Park — that role belongs to AgeOptions. The statewide Senior HelpLine at 1-800-252-8966 can point you toward the Care Coordination Unit that covers a specific address if you want to make contact before a crisis rather than during one.
It is worth knowing that a separate federal requirement, PASRR (Preadmission Screening and Resident Review), also applies to nursing facility admissions and looks specifically at serious mental illness and intellectual or developmental disability. Families sometimes hear both terms in the same afternoon and assume something has gone wrong. It has not — they are parallel reviews with different purposes, and both can be underway while a patient is still on a medical floor in Hyde Park.
The instrument the screener completes is the Determination of Need, universally shortened to DON. It scores functional limitation across activities of daily living — bathing, dressing, transferring, toileting, eating — and instrumental activities of daily living such as managing medication, preparing meals, handling money, and getting to appointments. The higher the score, the greater the documented unmet need. For Illinois publicly funded community services, 29 is the threshold: a person must reach a minimum DON score of 29 to qualify for the Community Care Program, and that same score gate governs access to Supportive Living Program settings. Above the minimum, a higher score generally opens the door to a larger service package rather than simply a yes or no. The statewide average DON score among Community Care Program participants runs around 46 points, which gives families a rough sense of where a typical served participant actually sits.
This is where preparation matters more than most families realize. The DON captures what a person needs help with on an ordinary day, not what they can perform once, carefully, in front of a stranger in a hospital room. An 84-year-old from Chatham who has not managed her own insulin or gotten into a tub unassisted in eight months may still summon a convincing performance of independence during a 45-minute assessment, particularly if she is frightened of the word "nursing home" and believes the right answers will get her home. Adult children who are present, who can describe the last three months honestly, and who bring specifics — falls, missed medications, the stove left on, the weight loss — are not sabotaging their parent. They are producing the accurate record the score depends on.
A nursing facility, licensed by the Illinois Department of Public Health under the Nursing Home Care Act (210 ILCS 45), is the most intensive of the three and in the Chicago metro generally runs in the range of $7,500 to $10,500 a month privately, before any Medicaid pathway is established. The Supportive Living Program is the state's Medicaid-funded assisted-living alternative, administered by Illinois Healthcare and Family Services, where residents apply most of their income toward room and board and Medicaid covers the services. The Community Care Program, run by the Illinois Department on Aging, is the stay-at-home option — homemaker services, adult day service, in-home care — built expressly to prevent premature nursing facility placement. There is also the private-pay path: an assisted living or shared housing establishment licensed under the Assisted Living and Shared Housing Act (210 ILCS 9), typically $4,500 to $6,500 a month in the Chicago area, with memory care delivered inside that same license rather than under a separate one, subject to Alzheimer's Special Care Unit disclosure requirements.
The screening does not obligate a family to any of these. What it does is establish, on the record and at the moment of decision, whether the person meets the state's level-of-care and need thresholds — which is the prerequisite for the publicly funded doors. A family that skips or rushes the conversation and signs a private-pay nursing facility admission can find months later that the Supportive Living or Community Care route was open the entire time and would have cost the household a fraction of what it spent. South Side and south-suburban families in particular should ask directly during the screening what the person's DON score was and what each score would qualify them for, and write it down.
Assemble a short written record before discharge planning starts, not after. Useful items: a current medication list with who actually fills the pillbox; a plain list of falls or near-falls in the last six months with rough dates; whether the person is bathing, dressing, and toileting without hands-on help; who cooks; who drives; whether bills are being paid on time. Add the housing facts — a Bronzeville walk-up with fourteen steps to the unit and no elevator is a different discharge than a South Loop building with a doorman and a ramp, and the screener cannot factor in what nobody mentions. Bring the Illinois health care power of attorney if one exists. If it does not, this is the moment to find out, because the absence of that document complicates everything that follows.
Ask two questions before the screener leaves: what the DON score came out to, and who at the Care Coordination Unit will be the ongoing contact. Then verify the facilities under consideration independently rather than accepting a printed list at face value. Any Illinois nursing facility or assisted living establishment can be looked up through the IDPH Health Care Facilities & Programs directory at idph.illinois.gov, and nursing homes carry both an IDPH report card and a federal Medicare Care Compare profile. If something goes wrong later at a nursing facility, the IDPH Central Complaint Registry takes complaints at 1-800-252-4343, and the Illinois Adult Protective Services hotline operates 24 hours a day at 1-866-800-1409. None of these numbers help a family that does not know they exist until after the admission papers are signed.
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