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Primary Caregivers (Veterans Independence Program)

Issuing Authority: Director General, Policy and Research
Effective Date: December 23, 2015
Document ID: 1221

Care has been taken to ensure these policies accurately reflect the acts and regulations. Should any inconsistencies be found, the acts and regulations will prevail.

Purpose

This policy provides guidance on recognizing an individual as a primary caregiver, as well as the criteria that must be satisfied before a financial contribution may be approved to provide housekeeping and/or grounds maintenance services to a qualified primary caregiver in accordance with section 16 of the Veterans Health Care Regulations.

Policy

General

  1. For the purpose of this policy:
    1. the term “Veteran” is interpreted to include all individuals eligible for the Veterans Independence Program (VIP), excluding a primary caregiver or survivor;
    2. a reference to a Veteran, primary caregiver or survivor includes a duly authorized representative, if applicable; and
    3. a health care facility is defined as a public or privately operated establishment that provides accommodation and meals and health care services. This definition encompasses assisted-living or similar facilities, as well as those that provide intermediate or chronic care.
  2. The term “primary caregiver” is applicable to situations involving Veterans who were in receipt of housekeeping and/or grounds maintenance services at the time of their death or admission to a health care facility.
  3. An individual who does not satisfy the criteria to be recognized as a primary caregiver may be eligible for housekeeping and/or grounds maintenance services as indicated in the policy, Survivors – Veterans Independence Program (VIP). The term “survivor” is applicable to situations involving an income-qualified Veteran, an income-qualified civilian, a Veteran pensioner or a civilian pensioner who was not in receipt of housekeeping and/or grounds maintenance services at the time of his/her death.

Primary Caregiver Defined

  1. A “primary caregiver” is defined as the adult person (18 years of age or older) who, immediately before the Veteran died or was admitted to a health care facility, was:
    1. primarily responsible, without receiving a wage, for ensuring that care was provided to the Veteran; and
    2. for a continuous period of at least one year, resided in the principal residence of the Veteran and was maintained by or maintained the Veteran.
  2. Generally, a primary caregiver takes responsibility for the Veteran’s day to day care and comfort. In situations where the caregiver may not be providing hands-on care, he/she could still be contributing to the Veteran's care simply by providing emotional support and companionship. A primary caregiver is most often a Veteran’s spouse or common-law partner, although an adult child or other individual may qualify if they satisfy the criteria set out in paragraph 4.

Entitlement

  1. A primary caregiver (as described in paragraph 4) is entitled to receive financial support to obtain the housekeeping and/or grounds maintenance services that the Veteran was receiving at the time the Veteran died or began residing in a health care facility, if:
    1. within one year after either the Veteran’s death or admission into a health care facility (whichever comes first), the primary caregiver is assessed; or, at any point in time, the primary caregiver presents evidence relating to his/her health condition during that period on the basis of which an assessment can be made;
    2. the assessment and all subsequent assessments indicate that the provision of the housekeeping and/or grounds maintenance services are necessary for health reasons and to assist the primary caregiver to remain self-sufficient at his/her principal residence;
    3. the primary caregiver is resident in Canada; and
    4. the services are not available to the primary caregiver as insured services under a provincial health care system or a private insurance policy.
  2. The needs of the primary caregiver are to be assessed initially within one year after the Veteran’s death (or admission to a health care facility) and on a periodic basis thereafter. Alternatively, the initial assessment may be conducted at a later date, provided it is based on evidence relevant to the one year period after the veteran’s death or admission to a health care facility.
  3. The decision-maker is responsible for gathering a body of evidence that provides an understanding of the primary caregiver’s health-related needs, home situation and available supports in order to appropriately identify the interventions that are required to meet his/her needs. Refer to Requirements for Decision Making and Determination of Need for guidance on the necessary documentation and action required.
  4. A primary caregiver is entitled to receive only the housekeeping or grounds maintenance services that the Veteran was receiving. If a Veteran was receiving only housekeeping services, then the primary caregiver may only continue to receive housekeeping. The same applies for grounds maintenance.

Primary Caregivers of Veterans with Exceptional Health Needs or $1 Benefit Arrangements

  1. A primary caregiver of a Veteran who was receiving housekeeping and/or grounds maintenance services as a result of exceptional health needs (see section 18 of the Veterans Health Care Regulations), or under a provincial or community-based program (recorded as a $1 Benefit Arrangement) is entitled to continue to receive those services if the primary caregiver meets the criteria noted in paragraph 6, and:
    1. the provincial/community services cease when the Veteran dies or is admitted to a health care facility; or,
    2. the primary caregiver must pay in order to continue receiving the services.

Transitioning to a Health Care Facility

  1. When a Veteran is no longer able to stay in their family home and moves to an assisted-living or other similar facility, or into a facility providing intermediate or chronic care, the primary caregiver is entitled to receive the housekeeping and/or grounds maintenance services that were in place at the family home. The primary caregiver must meet the criteria set out in paragraph 6.
  2. When the Veteran is admitted to an assisted-living or other similar facility, the Veteran and the primary caregiver both receive VIP services under separate Benefit Arrangements (See policy entitled Benefit Arrangement for more details). The Benefit Arrangement for the primary caregiver is authorized in his/her own right and is not split with the Veteran.

Effective Date

  1. After an assessment is completed, the following circumstances determine the effective date of a Benefit Arrangement for a primary caregiver (i.e. when funding can start):
    1. If a qualified primary caregiver applies within one year of the date that the Veteran dies or is admitted to a health care facility, the effective date of the Benefit Arrangement will be the day following the Veteran’s death or admission to the facility; or
    2. If a qualified primary caregiver applies later than one year after the date that the Veteran dies or is admitted to a health care facility, the effective date of the Benefit Arrangement will be the date of application.

Benefit Arrangement

  1. A Benefit Arrangement for a primary caregiver is to be completed in accordance with the policy entitled, Benefit Arrangement. See policy entitled Benefit Arrangement for more details.
  2. A Benefit Arrangement of $1 is not to be used for a primary caregiver.

Payment Method

  1. The exclusive payment method for housekeeping and grounds maintenance services is the grant method for any Benefit Arrangement established after January 1, 2013; wherein the recipient will receive an annual grant provided in two instalments, subject to continued eligibility of the recipient.
  2. The amount of the grant for housekeeping and grounds maintenance services will be determined in accordance with the Grant Determination Tool based on the needs of the recipient, the need for services, the determination of required hours for services, the scope of services required, and the rates for services in that area.
  3. The recipient is not required to obtain or retain receipts for housekeeping and grounds maintenance services acquired via a grant payment.

Maximum Rates Payable

  1. Financial support for housekeeping and ground maintenance services is subject to yearly maximum rates. These rates are adjusted annually on January 1.
  2. Maximum rates may be exceeded in accordance with the policy entitled, Exceeding Rates for Veterans Independence Program (VIP) and Long Term Care (LTC).

Termination of Benefit Arrangement

  1. Financial support to obtain housekeeping and/or ground maintenance services shall be terminated if the periodic review (refer to business process entitled Three Year Benefit Renewal with Veterans Independence Program (VIP) Recipients) reveals that the primary caregiver no longer meets the criteria noted in paragraph 6.
  2. If a Benefit Arrangement is terminated due to a change in the primary caregiver’s living arrangements (i.e. remarriage and spouse assumes responsibility for housekeeping and/or grounds maintenance; or relocation to a residence in which the services are provided), the services may be reinstated at a later date, if the primary caregiver meets the criteria noted in paragraph 6.
  3. If a Benefit Arrangement is terminated due to the absence of a health need, the services cannot be reinstated at a later date.

No Eligibility for Additional Benefits, Services or Care

  1. Primary caregivers are eligible for the home care services of housekeeping and/or ground maintenance only. Primary caregivers are not eligible for health and support, personal care, or access to nutrition services under the home care element of the VIP, nor are they eligible for any other health care benefits, services or care under the Veterans Health Care Regulations.

Primary Caregiver - Right of Review

  1. A primary caregiver who is dissatisfied with a decision made under the Veterans Health Care Regulations may request a review of that decision (see Review of Health Care Decisions policy).

References

Veterans Health Care Regulations 

Home Care Services (Veterans Independence Program) policy 

Review of Health Care Decisions policy 

Benefit Arrangement (Veterans Independence Program) policy 

Client Relatives (Veterans Independence Program) policy 

Exceeding Rates for Veterans Independence Program (VIP) and Long Term Care (LTC) policy 

Principal Residence (Veterans Independence Program) policy 

Exceptional Health Needs Clients (Veterans Independence Program) policy

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