Rehabilitation and Life Care Planning Symposium Joyce Sharp, OT and - - PowerPoint PPT Presentation
Rehabilitation and Life Care Planning Symposium Joyce Sharp, OT and Jodilynn Pitcher, DMARehability London, Ontario May 1, 2014 Wor orking wit king within hin a pr a prescr escribed f ibed for orm . . .w . . .without ithout the pr the
Rehabilitation and Life Care Planning Symposium Joyce Sharp, OT and Jodilynn Pitcher, DMARehability London, Ontario May 1, 2014
Ontario Society of Occupational Therapists. (2011). Supporting Occupational Therapy Practice in Ontario’s Auto Insurance Sector, Assessment of Attendant Care Needs, Form 1: A Resource for Reflective Practice. Toronto, ON. Wor
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Ontario Society of Occupational Therapists. (2011).
SABS REALITY TORT
SABS: rates are set by FSCO for professional services and the Form 1 is
calculated by the number of minutes by the prescribed rate, subject to limits (up to $6,000.00 per month or $72,000.00 per year)
Tort: limitations do not exist and care over and above the SABS can be
claimed and recovered.
Reality: due to SABS limits family and friends are often forced to
provide care without compensation. If a claimant does not have friends
not bound by fee schedules set out by FSCO and typically have minimum visit charges.
Fifteen minutes of basic supervision under the SABS equates to .25 x
$8.75/hour = $2.19 per hour. A one hour minimum charge from a private agency for a “check in” equates to $28.95/hour on average. Depending on geographic location, agencies may even have a 2 or 3 hour minimum charge.
Does this change how you calculate attendant care needs?
24 hour care under the SABS = $72,000.00 per year 24 hour care from a private agency at $28.95/hour with
Is a spouse equivalent to a live-in care giver? Is a live-
Live-in caregiver: prevailing wage $10.86/hour, $11.00/hour as of June 1, 2014
Maximum hours per week – 48 hours per week; after 44 hours per week entitled to
Daily rest period: 11 hours or 8 hours between shifts and successive shifts can total no more than 13 hours
Weekly rest period: 24 consecutive hours or 48 consecutive hours/2 consecutive work weeks
Meal breaks: 30 minutes if work shift exceeds 5 hours (break may be split in 2)
Vacation leave: 2 weeks/year Vacation pay: 4% of wages/year
Entitled to take public holidays off work
Room and Board deductions: $31.70/week for private room; $53.55/week for meals or $2.55 per meal or $85.25/week for private and board
Room must be reasonably furnished and supplied with clean bed linens and towels and be reasonably accessible to proper toilet and wash basin facilities
Statutory payroll deductions apply (CPP, EI and Income tax); WSIB coverage is mandatory in Ontario www.esdc.gc.ca/eng/jobs/foreign_workers/caregivers/#a07 www.labour.gov.on.ca/english/es/pubs/is_fn_esa.php www.labour.gov.on.ca/english/es/pubs/factsheets/fs_domestics.php
“Determine those activities that the client is not
For example: supervision during bathing
Client has accessible washroom (grab bars, non-slip mat etc.)
and is observed to perform transfers safely
Spouse is always present due to mutual anxiety and fear of a
potential fall
Supervision is addressing anxiety . . . is a recommendation
indicated on the form 1?
“Determine the extent to which the client can
“Objectively identify what assistance, if any, is
How does the introduction of assistive devices impact
attendant care recommendations and when?
“… predictability and consistency of a client’s
performance (physical, cognitive, behavioural) must be considered.” Ontario Society of Occupational Therapists. (2011).
“...assessment and/or screening of physical,
psychosocial, behavioural, cognitive/perceptual functions lends to comprehensive insight into the client’s ability to manage daily living skills independently.” Ontario Society of Occupational Therapists. (2011).
Consider that assessments are artificial and behavioural
and cognitive considerations are vastly different in day to day life versus in an assessment situation.
How do you capture this in one assessment?
“ lifeline is an easy-to-use personal response service
we help thousands of seniors and disabled people live
with greater independence and dignity in their own homes.
dedicated to helping seniors, the physically challenged,
and patients with medical conditions live confidently and safely at home.”
http://www.lifeline.ca
Designed for those at risk of falls Will it reduce or eliminate the need for attendant care
is cost savings a motivator?
Does it recreate the person’s pre-accident ability to
Morrison v. Greig [2007] O.J. No. 225 at par.125 Defence argued that catastrophic spinal cord injured
claimant would benefit from a lifeline over attendant care.
Justice Glass stated:
“For example if there were a fire and it was going to take a
personal care worker a half an hour to come to his residence the Plaintiff might die in the meantime. This Plaintiff is not
someone who can be there right away and some one who understands the limitations of a spinal cord injured person so that he can be assisted properly.”
Mr. Marcoccia was 20 years old when he suffered frontal and
temporal lobe impairments, leftsided hemi-paresis in a motor vehicle accident. He displayed prominent disinhibition, impulsivity and lack of insight into his own impairments. Plaintiff Counsel argued that this left him unsuitable for assisted group home living and that he required instead 24-hour day/7-day week care for the duration of his lifetime (8 hours/day
from an attendant care provider).
The defence presented scenarios for Mr. Marcoccia’s future care
at trial including that he be placed in a group home and that he could use a Lifeline to call for assistance if needed, reducing the amount of hourly wage attendant care required.
In his opinion, the neuropsychological and motor deficits are
permanent and severe. There will be no further recovery, as such, at this point, many years after the accident.
He needs attention not just on a daily but on an hourly basis. Without cueing, daily tasks won't get done. As well, he will be
unsuccessful in problem solving, planning activities and following through.
In cross examination, Dr. Scherer admitted that there is nothing
in his reports specifically pointing to a concern that Robert would be unable to look after his own personal safety in the home or in the community.
He also admitted that, although Roberts deficits are observed
and expected in people with brain injury, they are all behavioral and psycho emotional problems, problems that people can have without brain injury.
People who are limited in their ability to self-monitor have
difficulty implementing strategies to assist with their deficits; Robert is one of those.
These people have difficulty with adapting to assistive
devices such as Palm pilots, diaries or other memory aids. They do not have the insight they need and lack the anticipatory awareness necessary to make them willing and able to plan ahead. They are too distracted by immediate gratification.
The problem with Robert is that all of his impairments
but is not able to use whatever he learns in an organized and focused fashion.
Robert needs a rehabilitation support worker with him, someone
who is trained to prompt and queue, to organize, to reason with him and to problem solve and that person should be with Robert eight hours each day.
During Robert’s remaining waking hours, he is still at risk for
flying into fits of rage, to inappropriate behavior and safety
involving someone with some understanding of his needs and limitations.
Even while sleeping, a basic attendant care person should be
with him, in order to respond to any potential emergency situations which arise and which Robert would not be able to deal with effectively.
A shared care or group home situation is not appropriate for
and he would not last in that environment.
Assistive devices are generally not useful for Robert because of
his inability to follow through with their use.
Asked about an intensive rehabilitation period followed by three
hours per day of attendant care as an option going forward [the defence scenario], she feels that Robert would not cooperate and that reducing his hours of attendant care would be
support.
She said that she feels it is important that there be someone
present for Robert at all times. She is well aware of services such as Life Line that Robert could call in an emergency situation. He is capable of pushing a button but this doctor says much depends on his perception of danger.
There are so many unpredictable situations that he may not have
the judgment necessary to make appropriate decisions, including the decision to call the lifeline facility.
This doctor maintains that 8 hours per day of
This doctor's recommendations stand even though, in
Jury award: $15,650,182 in damages including $13,953,064 for
future care, [2007] O.J. No. 1333
Med Rehab Benefit vs. Attendant Care Benefit $50 - $60/hour vs. $23 - $30/hour What are the roles and responsibilities of the RSW vs.
Is an RSW for specific task /community integration that
may require only a couple of hours a week and the remainder be accomplished by a PSW? What are the pros and cons for this?
24 year old male with C5 quadriplegia x 2 years: Lives alone; no partner; no family (no one home
At risk for UTI (due to practice of not performing IC’s
No UTI’s or skin issues for at least two years.
24 hour AACN does not pay for 24 hour AACN Does he qualify for 24 hour AACN with history of zero
Is access to help by phone enough? What about AD
Knowledge of SCI, particularly high level SCI injuries
Elderly bariatric paraplegic Cannot transfer independently; uses a ceiling mount
Frequent urinary infections, skin issues. Able to exit home with help of one person only when
Cost for two attendants Reduce to one attendant when up; How does one
45 year old female with post concussive disorder and chronic
pain; stress, anxiety, depression, passenger anxiety
Psychological Associate (supported by Psychologist)
recommends 24 hour supervision secondary to risk of suicide.
Eventually, recommendation for 24 hour supervision is lifted but
there is no change in observable behaviour or the degree of guidance, support, supervision provided and required.
Eventually, client is left alone for 4 hour intervals over a period of
6 months. A system is put into place whereby she gets up from bed two hours into her husband’s absence then has clearly, previously determined activities she follows for the second two hours (or she just sits staring out the window)
24 hour supervision clearly recommended and
How long is it continued after recommendation lifted
What if family tells you that the client does nothing
Do you include time just for cues? How can you
Do you deduct time based on history of several
30 year old male with severe ABI Strictly structured routine in place in the client’s home
where he lives alone, in a rural and isolated location.
Brother checks on client directly each morning, reviews the
day’s activity. Brother may call or visit later but reviews days events, bills, appointments, plans, etc., sets up the plan for the next day.
Brother available through the day by phone; client is able to
make phone calls when needed.
Help is needed whenever the planned and structured
routine is interrupted by an unplanned event (e.g. unexpected visitor, unexpected bill, break down of equipment or appliance, damage to house.)
24 hour care? Recommend actual time spent with client and for
if hiring privately; cannot hire for short intervals and
phone checks are not provided
How do you quantify phone check ins?
Elderly individual with subtle signs of Alzheimer’s involved in
MVA (while on scooter) resulting in concussion and full exacerbation of Alzheimers/concussion symptoms.
Client was able to walk to and from the local mall independently
and was able to monitor blood sugar and inject insulin accurately prior to the MVA
Currently, the client is disoriented consistently, does not pay
attention to time, has no recollection of when and how to monitor blood sugar or dose insulin.
Will not accept guidance or caution from wife. Wife is elderly
and cannot provide significant assistance nor contribute at all to physical requirements for assistance.
Cannot comply with any new procedures. Consistently tries to take out scooter.
24 hour supervision? Pre-existing dementia Publically funded supports in place