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 prescr escripti iption! on! 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.
Remember . . . To “remain focussed on the client’s needs in an environment of competing interests .” Ontario Society of Occupational Therapists. (2011). Who is asking for the assessment? Who is your client? REALITY TORT SABS
SABS vs. 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 or family on which to rely they must hire privately. Private agencies are 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?
Another dose of reality 24 hour care under the SABS = $72,000.00 per year 24 hour care from a private agency at $28.95/hour with statutory holiday pay = $257,076.00 per year Is a spouse equivalent to a live-in care giver? Is a live- in caregiver a replacement for 24 hour care?
Live-in Care Giver – a substitute for 24 hour care? 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 overtime rate of 1.5 times wage 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
Identify and validate appropriate needs “ Determine those activities that the client is not able to do for themselves as a result of injuries sustained in the accident as opposed to determining what they have others doing for them ” Ontario Society of Occupational Therapists. (2011). 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?
Performance of skills and activities: “ Determine the extent to which the client can perform the skills and activities identified on the Form 1 safely and functionally.” Ontario Society of Occupational Therapists. (2011). “Objectively identify what assistance, if any, is needed from the present time into the future until another such re-assessment may identify modified needs .” Ontario Society of Occupational Therapists. (2011). How does the introduction of assistive devices impact attendant care recommendations and when?
Assessing time required “… 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?
Lifelines and attendant care “ lifeline is an easy-to-use personal response service that lets you summon help any time of the day or night - even if you can't speak. All you have to do is press your Personal Help Button, worn on a wristband or pendant, and a trained Personal Response Associate will ensure you get help fast” 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
Is a lifeline appropriate? Designed for those at risk of falls Will it reduce or eliminate the need for attendant care for those with severe physical or cognitive impairments? Is it appropriate for the cognitively challenged client? is cost savings a motivator? Does it recreate the person’s pre -accident ability to respond in an emergency?
Case law example 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 one who only needs a nanny to pick up after him. He needs 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.”
Marcoccia v. Gill, 2007 CanLII 11322 (ON SC) 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 of care from a rehabilitation support worker and 16 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.
Medical expert opinion Dr. Scherer 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 occur in the context of normal intelligence. He can learn but is not able to use whatever he learns in an organized and focused fashion.
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