Overseas Service Veterans Who Apply for Contract Beds (Veterans Independence Program and Long Term Care)

Purpose

This policy provides direction on providing support for Overseas Service Veterans (OSVs) who apply for a contract bed.

Policy

General

1. OSVs are eligible to receive intermediate care (type II health care need) or chronic care (type III health care need) in a contract bed. If, within a reasonable time of their need for intermediate or chronic care being identified, an OSV is not admitted to a contract bed because one is not vacant within a reasonable distance from the community where they normally reside, OSVs are eligible to receive:
   1. Veterans Independence Program (VIP), excluding social transportation and intermediate care, if an assessment shows that providing those services would assist them to remain self-sufficient in their principal residence and they are resident in Canada; or
   2. Long Term Care for intermediate (type II) or chronic (type III) care in a community facility.

Applying for Admission to a Contract Bed

2. An OSV is considered to have applied to the Minister for admission to intermediate or chronic care in a contract bed if:
   1. they, or their representative, contact the Department to request support for intermediate or chronic care in a long term care facility. This contact may occur before or after an assessment is completed; and
   2. they have an assessment accepted by the Department which identifies a need for intermediate or chronic care.

Determining Reasonable Distance

3. The availability of intermediate and chronic care varies from community to community making it impractical to set a specific distance that is considered a reasonable distance from where the client normally resides.
4. The following are some considerations in determining that a contract bed is within a reasonable distance from the community in which the OSV normally resides:
   1. the contract bed is within the same travelling distance as other intermediate and/or chronic care facilities normally accessed by individuals in the area where the OSV resides;
   2. the contract bed is within the same travelling distance as facilities where individuals residing in the same area as the OSV would normally access routine medical services;
   3. the contract bed is within normal commuting patterns in the area where the OSV resides; and
   4. the location of the contract bed allows for reasonable travelling time and cost for family members of the OSV to visit on a regular basis.

Determining Reasonable Time to Wait for Admission

5. In determining the availability of contract beds, Regions are best positioned to establish benchmarks for a reasonable time to wait for admission. However, the following are some factors which should be considered in determining what is a reasonable amount of time for an OSV to wait for admission to a contract bed:
   1. whether there are any contract beds within a reasonable distance from the community where the OSV normally resides;
   2. the prognosis for the OSV and urgency of the need for intermediate or chronic care;
   3. the necessity and extent of home adaptations required to enable the OSV to remain in their principal residence; or
   4. the availability of family members or other individuals to provide support for the OSV in their principal residence while waiting for admission to a contract bed.

Eligibility for VIP Services in a Principal Residence

6. An OSV who is resident in Canada is eligible for VIP services in their principal residence, to the extent these services are not available to them under a provincial health insurance plan, if:
   1. the VAC decision-maker reviews a VAC nursing assessment, or an assessment completed by an external agency which meets departmental criteria as defined in the Assessments policy and was completed within the last three (3) months, that identifies that the OSV requires intermediate or chronic care;
   2. the OSV takes the steps outlined in paragraph 2 of this policy to apply to the Minister for intermediate or chronic care in a contract bed;
   3. considering paragraphs 3, 4 and 5 of this policy, the OSV is not admitted to a contract bed;
   4. the VIP service is connected to a need, identified in an assessment completed within the last three (3) months that impairs the OSV’s ability to remain self-sufficient at their principal residence; and
   5. the VIP services are provided in accordance with VIP regulatory requirements and policies, including the Principal Residence (Veterans Independence Program) policy.

Eligibility for Long Term Care in a Community Facility

7. An OSV is eligible for intermediate or chronic care under the Long Term Care (LTC) program in a community facility, to the extent this funding is not available as an insured service under a provincial health care system, if:
   1. the VAC decision-maker reviews a VAC nursing assessment, or an assessment completed by an external agency which meets departmental criteria and was completed within the last three (3) months, that identifies that the OSV requires intermediate or chronic care;
   2. the OSV takes the steps outlined in paragraph 2 of this policy to apply to the Minister for intermediate or chronic care in a contract bed; and
   3. considering paragraphs 3, 4, and 5 of this policy, the OSV is not admitted to a contract bed; and
   4. the LTC funding is provided in accordance with LTC regulatory requirements and policies.

Choice of Program Assistance

8. OSVs’ eligibility for benefits and services is premised on an OSV applying for admission to a contract bed combined with an identified need for intermediate (type II) or chronic (type III) care. Consequently, OSVs may have had little or no contact with the Department until they reach a point where they have a type II or type III health need. While OSVs may have choices regarding their care within this policy, they should be encouraged to access the type of care that best meets those identified health care needs.
9. An OSV may choose whether they will receive VIP services in their principal residence or LTC for intermediate or chronic care in a community facility if:
   1. it is determined that the OSV has followed the steps required in paragraph 2 of this to apply for admission to a contract bed;
   2. the OSV is not admitted to a contract bed after considering paragraphs 3,4 and 5 of this policy; and
   3. the OSV is eligible for VIP services in their principal residence considering paragraph 6 of this policy; and
   4. the OSV is eligible for LTC for intermediate or chronic care in a community bed considering paragraph 7 of this policy.
10. An OSV who chooses to receive VIP services in their principal residence or LTC for intermediate or chronic care in a community facility does not negate their eligibility for a contract bed. Also, an OSV who chooses to receive VIP services in their principal residence does not negate their eligibility for a community bed.
11. An OSV cannot receive both VIP services in their principal residence and LTC for intermediate or chronic care in a community facility at the same time. A primary caregiver may be eligible for the VIP services of housekeeping and/or grounds maintenance if the OSV accesses a contract, or community bed under the LTC program. See Primary Caregivers (Veterans Independence Program) policy.

Home Adaptations

12. If an OSV chooses to receive VIP services in their principal residence, then it is possible to authorize home adaptations in accordance with the home adaptations policy. However, when it is expected that the OSV will only be at home a short time prior to entry into intermediate or chronic care in a facility, home adaptations should be limited to those essential for the safety of the OSV and to those adaptations where no other temporary solution is available.  For more information on Home Adaptations generally, see Home Adaptations policy

VIP Social Transportation

13. OSVs are not eligible to receive the VIP social transportation service unless they have exceptional health needs. See Eligibility for Health Care Programs – Overseas Service Veterans policy.

VIP Intermediate Care

14. OSVs are not eligible to receive intermediate care through the Veterans Independence Program unless they have exceptional health needs. See Eligibility for Health Care Programs – Overseas Service Veterans policy.

Treatment Benefits

15. OSVs in receipt of VIP services in their principal residence or LTC for intermediate or chronic care under this policy are eligible for treatment and supplementary benefits in Canada for any condition to the extent that those services are not available to them as an insured service under a provincial health care system. See Eligibility for Health Care Programs – Overseas Service Veterans policy.

References

Veterans Health Care Regulations, Part II, subsection 15(4), Part III, section 21.2

Eligibility for Health Care Programs - Overseas Veteran Eligibility

Eligibility for Health Care Programs – Veteran Pensioner

Assessments (Veterans Independence Program)

Home Care Services (Veterans Independence Program)

Ambulatory Health Care Service (Veterans Independence Program)

Home Adaptations

Accommodations and Meals Contribution

Primary Caregivers (Veterans Independence Program)

Principal Residence (Veterans Independence Program)

Community Facilities (Veterans Independence Program - Intermediate Care and Long-term Care)