CAPÍTULO II: FUNDAMENTO TEÓRICO
2.5 CARGAS PEATONALES
2.5.1 Características de carga de un solo peatón
POLICY
1. Regional Health Authorities shall offer Individualized Funding (IF) as an option of the home care program.
Individualized Funding allows the consumer, or their guardian, to accept responsibility to manage and direct supportive service.
The Regional Health Authority is authorized to provide funding to an individual to arrange and manage his/her own supportive care services. The level of funding is based on assessed need and used for approved services only. These services may include personal care, home management and other supportive services.
The Regional Health Authority shall inform the Saskatchewan Ministry of Health of new clients and discontinuance of clients to the IF program (See Appendix A and B).
2. To be Eligible for Individualized Funding, the Consumer:
a) meets the eligibility requirements to receive home care supportive services; b) requires long term supportive services for at least 6 – 12 months;
c) has relatively stable supportive service needs;
d) has indicated the desire and ability to manage the required care and the
willingness to assume the responsibilities and risks associated with Individualized Funding, or has a guardian who will do so;
e) has no other party (e.g. SGI, WCB, other agency, etc.) which may be responsible for the cost of the required services; and,
f) is accepted as an employer eligible for coverage under The Workers’
Compensation Act. Where a guardian is entering an Individualized Funding
Agreement, the guardian must be eligible for coverage under The Workers’ Compensation Act.
3. Needs Assessment and Review:
a) A needs assessment will be done jointly by the Regional Health Authority staff and the consumer to determine the need for supportive care services, and the level and type of services that are required;
b) An individualized plan will be developed;
c) Professional services such as registered nursing or therapies are excluded from Individualized Funding and will continue to be available as required through the regional home care program;
Home Care Policy
Special Programs
Date of Issue: September 2006 Revised September 2013Subject:
Individualized Funding
d) A needs review will be done annually or more frequently if required; e) The Regional Health Authority will remain in contact with the consumer as
required for the duration of the Agreement; and,
f) The consumer will not be eligible to receive home care supportive services directly from the home care program, if those services have been funded for and defined in the Individualized Funding Agreement.
4. Funding Level:
a) The funding level for supportive services will be based on assessed need and calculated at a per unit of service rate as determined by the Saskatchewan
Ministry of Health. One unit of service equals one hour (See Schedule A Services and Payment Schedule, and Amendment to Schedule A);
b) A monthly administrative allowance is provided in addition to the calculated funding level. The administrative allowance can be used for payroll services or other costs of managing the agreement. (See Schedule D);
c) The annual insurance premium for WCB coverage is included in the calculated funding level;
d) The total maximum monthly client care cost to the home care program will not exceed the amount paid by the Saskatchewan Ministry of Health for long term care funding for the same period. (See Schedule D). This will be reviewed by the Saskatchewan Ministry of Health and updated for implementation on October 1st yearly;
e) The maximum monthly level is based on the provincial average publicly funded contribution to the cost of institutional long-term care per resident using the most recent data available. This maximum will be reviewed annually;
f) Consumers will continue to be subject to applicable home care fees. Charges for home care fees will be calculated based on the number of actual hours of service that the consumer employs staff (but not greater than the assessed hours); and, g) Home care fees will be invoiced to the consumer. However, in exceptional
circumstances, as requested by the consumer, the fee may be deducted from the payment made to the consumer from the Regional Health Authority.
5. Use of Individualized Funding:
a) Funding will be used by the consumer/guardian to hire workers to provide those supportive services described in the individualized plan;
b) Funds may not be used to hire family members such as the consumer’s spouse, parent, child, sibling, grandparent, or grandchild, related directly or through
Individualized Funding
c) Regional Health Authority conflict of interest guidelines may prohibit Regional Health Authority employees from also being employed under an Individualized Funding agreement;
d) Funds may not be used to hire workers on a contract basis who would be
considered self employed (i.e. service providers are to be considered employees who receive benefits, etc.) except as a short term emergency backup. (The client must be made aware that their purchasing power is reduced);
e) Funds may not be used to purchase services from a person or organization when that person or organization owns, leases, rents, or otherwise manages or provides care in the residence in which the consumer lives (e.g. personal care home, licensed group home);
f) Funds may not be used by the consumer/guardian to pay for services provided in any hospital or long-term care facility, or for services related to any other health program funded by the Regional Health Authority;
g) Funds may not be used for any product or service not usually provided by home care (e.g. food allowances for service providers), or for any other item not identified in the care plan or Agreement; and,
h) A consumer/guardian who wishes to use funds to pay for needed services outside of Saskatchewan must obtain written approval from the Regional Health
Authority in advance.
Approval may be granted at the discretion of the case manager to a maximum of 30 cumulative days during any calendar year.
The Regional Health Authority may consider requests for approval of periods beyond 30 cumulative days per year, if supported by the home care manager.
6. The Consumer/Guardian is Responsible for:
a) recruiting, hiring, training, scheduling, paying, managing the performance of, and terminating their workers;
b) negotiating reasonable and fair salary and benefits for their workers; c) making deductions at source such as Income Tax, Canada Pension Plan,
Employment Insurance and any other benefits (the consumer/guardian may use funding to purchase payroll and accounting services);
d) applying for coverage under Section 12 of The Workers’ Compensation Act. If
WCB coverage is not available, individualized funding will not be an option; e) complying with all applicable legislation such as The Labour Standards Act, The
Occupational Health and Safety Act, The Income Tax Act, The Employment Insurance Act, etc.;
f) establishing an emergency back up plan for supportive services that does not rely on the home care program, in the event their scheduled care provider is absent;
Home Care Policy
Special Programs
Date of Issue: September 2006 Revised September 2013Subject:
Individualized Funding
g) submitting a copy of their employee time sheets to the Regional Health Authority on a monthly basis as determined by the Regional Health Authority (See
Employee Time Sheet, Schedule B.); and,
h) Upon the death of the client funding for the workers may continue for two (2) weeks.
7. Agreement:
a) The consumer or their guardian will enter into an Individualized Funding Agreement with the Regional Health Authority;
b) The consumer/guardian is legally responsible for compliance with the Agreement and will be responsible for all specified duties;
c) The Agreement will describe the types of services that funding can be used for, the amount of funding, the duration of the Agreement, and other terms;
d) The Agreement expiry date shall be no later than one year from the date of signing; and,
e) A needs review will be completed thirty (30) days prior to the expiry of the Agreement and a revised Agreement negotiated if the consumer continues to meet the program criteria.
8. Financial Management:
a) The consumer/guardian will open a bank account specifically for Individualized Funding that provides monthly statements and cancelled cheques, and allows for direct deposit;
b) A quarterly financial report will be submitted to the Regional Health Authority, including monthly banking statements (see Quarterly Financial Statement, Schedule C); and,
c) Any funding surplus accumulated by the consumer/guardian in excess of one month’s payment will be returned quarterly to the Regional Health Authority. 9. Financial Accountability:
a) The Regional Health Authority will undertake a financial review with all consumers/guardians in the first year of an Individualized Funding Agreement; and,
b) The Regional Health Authority may undertake a random financial review as part of the accountability process (see Financial Audit).
Individualized Funding
10. Temporary Stoppage of Payment:
a) The consumer/guardian will notify the case manager of any circumstances in which funds are not required for a period of two (2) weeks or more;
b) Recovery of overpayments will made on quarterly basis; and,
c) The case manager will notify the appropriate Regional Health Authority personnel of the temporary stoppage of payment, and also the date that payment will be resumed.
11. Termination of the Agreement:
a) The term of the Agreement will be for a maximum period of one year. It will be reviewed and renewed annually if the consumer continues to meet the eligibility criteria;
b) The Regional Health Authority or the consumer/guardian may terminate the Agreement for any reason with 30 days notice;
c) The Regional Health Authority may terminate the Agreement immediately if the consumer/guardian is:
not managing the funds appropriately;
no longer eligible for Individualized Funding; or,
in breach of the Agreement.
d) Following termination of the Agreement, the consumer may be eligible to receive direct home care services;
e) The Regional Health Authority may undertake a review within 30 days of termination of the Agreement, regardless of the reason for termination. 12. Review Process:
a) The consumer/guardian may use the Regional Health Authority client representative to review decisions.