Learn how to use the Norton Scale for skin risk assessment in home health nursing. Discover scoring, documentation tips, and how it supports Medicare compliance.
Introduction: Why the Norton Scale Still Matters
In home health, skin integrity is everything. Pressure ulcers (a.k.a. bedsores) can develop quickly, cause major complications, and lead to costly hospital readmissions. That’s why Medicare requires RNs to assess skin risk during the Start of Care (SOC) visit.
One of the classic tools? The Norton Scale. It may be simple, but it’s a trusted way to screen patients at risk for pressure injury and document skilled need.
What Is the Norton Scale?
The Norton Scale was developed in the 1960s to predict a patient’s risk of developing pressure ulcers. It scores patients in five categories:
- Physical Condition
- Mental Condition
- Activity
- Mobility
- Incontinence
Each is scored 1–4, with lower scores indicating higher risk. The total score ranges from 5 to 20.
- 16 or below = at risk
- 12 or below = high risk
Why Use the Norton Scale in Home Health?
- Quick & Simple: Easy to complete during SOC, even in busy homes.
- Standardized: Provides measurable data for compliance and care planning.
- Preventive Power: Identifies risks early so you can educate caregivers and prevent breakdown.
- Supports Skilled Need: A low score helps justify ongoing nursing visits for skin monitoring, wound care, or caregiver teaching.
👉 For a deeper dive into related screens, see my post on Risk Screens: Falls, Depression, Nutrition, Pain & Skin.
How to Apply the Norton Scale at SOC
- Pre-Chart: Review hospital notes for skin issues (see my post on Pre-Charting & Call-Ahead).
- Assess Each Category: Observe mobility, ask about incontinence, and evaluate mental status.
- Score & Document: Record the total score and include interventions.
- Educate: Teach caregivers about repositioning, barrier creams, and skin checks.
- Plan of Care: Align findings with your skilled interventions.
Common Pitfalls (and How to Avoid Them)
- Overestimating mobility: Patients may seem more active than they are day-to-day.
- Forgetting incontinence: Even “occasional leaks” matter for skin risk.
- Not linking to interventions: Medicare expects documentation that ties risk scores to actual nursing care.
👉 Need a refresher on how to tie assessments to compliance? Check out my post on Comprehensive Assessment & Functional Testing.
Final Thoughts: Small Tool, Big Impact
The Norton Scale may be an old-school tool, but it’s still a reliable, evidence-based way to assess skin risk in home health. It’s not about filling out another form—it’s about preventing painful complications and proving the skilled need that justifies your care.
✨ Want step-by-step guidance on SOC visits, including skin assessments like the Norton Scale?
Check out my RN Home Health SOC Guidebook on Kindle. It’s packed with real-world examples, compliance tips, and checklists to make SOC visits smoother, faster, and more effective.
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