Assessments (Veterans Independence Program)

Issuing Authority: Director General, Policy and Research
Effective Date: April 1, 2019
Document ID: 877

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 outlines the requirement to conduct an assessment prior to approving Veterans Independence Program (VIP) services. There are various approaches to conducting an assessment as outlined in the Requirements for Decision Making and Determination of Need document.

Policy

General

  1. VIP services may be granted only if a need is identified through a current assessment (completed within the past three months) which indicates that:
    1. the requested Home Care Service, Ambulatory Health Care Service, Transportation Service or Home Adaptations Service is appropriate and required to assist an eligible client to remain self-sufficient at the principal residence; or
    2. the provision of the requested intermediate care service or continued Adult Residential Care is appropriate under the circumstances, i.e. an eligible client cannot or should not be maintained in a home environment, and the type and degree of care provided addresses the client's health needs.

Assessment (Determination of Need)

  1. The decision-maker is responsible for gathering a body of evidence that provides an understanding of the client’s health-related needs, home situation and available supports in order to appropriately identify the interventions that are required to meet the client’s needs. Refer to Requirements for Decision Making and Determination of Need for guidance on the necessary documentation and action required.
  2. While screening may be conducted by phone, the standard for conducting an assessment is that it be completed in person; preferably, but not necessarily, in the client’s home environment.
  3. The gathering of information should not be conducted in the client's home when there are staff safety concerns, issues relating to lack of trust, or when the client refuses to be seen at home, etc.

Consultation with the District Medical Officer (DMO)/Senior District Medical Officer (SDMO)

  1. In keeping with current decision-making processes whereby the decision maker obtains   recommendations, along with full consultation and collaboration from subject matter experts and other advisors; approval of VIP services, including any element of VIP Home Care Service, to Veteran pensioners, civilian pensioners, special duty service pensioners, military service pensioners and award recipients may be granted only after the following two requirements have been met:
    1. an assessment establishes the existence of a need for VIP services; and,
    2. a departmental medical officer recommends that the need for the service is related to the client's disability benefits entitled condition (unless the client is a medium or seriously-disabled Veteran pensioner or civilian pensioner, or a frail pensioner).
  2. If an assessment identifies a need for further evaluation such as a nursing, occupational therapy or medical assessment to identify specific care or treatment interventions, these specialized assessments must be completed before health care interventions are approved. In such cases, the decision-maker is responsible to ensure that a nursing, medical and/or other health professional assessment is obtained.
  3. The DMO or SDMO may be called upon to assist in the assessment process for clients with complex physical or mental health problems.
  4. Current medical documentation on the client's file may be used if it is determined to be relevant to the request and acceptable for departmental purposes (e.g. a current medical report for the Veterans Review and Appeal Board).
  5. An assessment conducted by the province may be used if:
    1. it is a complete and current assessment of the client's total health care needs (i.e. it is not based solely on what is available through provincial programs); and
    2. it meets departmental assessment criteria, including being “current” and comprehensive.
  6. If the provincial assessment does not satisfy both criteria noted in paragraph 9, it may still be used to complement the body of evidence gathered by the decision-maker.
  7. If a provincial assessment is used, and issues requiring case management are evident, the decision-maker is responsible to consult with a Case Manager to ensure the client’s needs are addressed.  Refer to the directive entitled Criteria/Situation Requiring Referral to Case Manager for Potential Case Management.
  8. When a client eligible for Intermediate Care Service or continued Adult Residential Care in a community facility is in receipt of this care by virtue of a non-departmental assessment, a Benefit Arrangement for these services may be approved only if the departmental approval authority is satisfied that the client meets the criteria for eligibility, i.e. has the type of health need that requires those services and that the facility to which the client is admitted has the capacity to provide the services which the assessment indicates are needed.
  9. The following assessments are required prior to approval for intermediate care:
    1. Non-case managed clients: The need for intermediate care should be based on a departmental Nursing Assessment, or other written assessment by an external agency, which, following review by the District Nursing Officer (DNO), is confirmed to meet departmental assessment criteria. All assessments must be current. The DNO must ensure the client’s health status requires Type II or Type III care.
    2. Case managed clients: In addition to the criteria outlined in paragraph 13 a), a Case Manager Assessment is needed to identify case management services which are required pending placement.

Reassessment

  1. Once a change in need has been identified, the appropriate level of client contact required to assess this change should be determined based on the nature of the change and the degree of impact it has on the client’s health-related needs, living situation and supports.

Consultation with the DNO

  1. Consultation with the DNO must take place when an assessment/reassessment identifies that the client’s health has been compromised. This consultation is required to:
    1. determine if a nursing assessment is required in order to obtain a complete profile of the client's health status and care requirements;
    2. ensure that appropriate referrals are made to health professionals (e.g. occupational therapists); and
    3. ensure that appropriate health-related interventions are included in the case plan.

Nursing Assessments

  1. Nursing assessments must provide a thorough description of:
    1. the client's physical status, covering each of the following systems:
      1. integument;
      2. musculo-skeletal;
      3. cardiovascular/respiratory;
      4. gastro-intestinal;
      5. genito-urinary;
      6. sensory functioning.
    2. the client's mental status;
    3. activities of daily living;
    4. behavioural function;
    5. specific care and treatment interventions required;
    6. teaching required;
    7. recommendations arising from the evaluation; and
    8. care-giver status and capacity to assist the client.
  2. The nursing assessment must indicate the type of care required.
  3. The Nursing Assessment form and optional tools are used to record the information noted in paragraphs 16 and 17.
  4. A current nursing assessment conducted by the province or community may be used in place of a departmental nursing assessment only if a departmental Nursing Officer (e.g. District Nursing Officer/Regional Nursing Officer/National Nursing Officer) determines that it:
    1. covers all aspects of the client's physical and mental health status (i.e. addresses all the points noted in paragraph 16); and
    2. meets departmental assessment criteria.
  5. If the departmental Nursing Officer (e.g. District Nursing Officer/Regional Nursing Officer/National Nursing Officer) determines that a provincial assessment does not meet departmental assessment criteria, it is his/her responsibility to obtain a departmental nursing assessment to replace or complement the provincial assessment.

Other Health Professional Assessments

  1. Assessments by other health professionals are required for consideration of certain VIP services, such as specific home adaptations services that require occupational therapist or physiotherapist reports, or applications for institutional admissions requiring professional geriatric assessments (i.e. assessments by geriatricians or the following health care professionals who also have specialized training in geriatrics -- nurses, nurse practitioners, occupational therapists, physiotherapists, or activity therapists).

Financial Assessments

  1. An assessment of the client's financial circumstances is required only:
    1. for VIP applications made under the exceptional health care needs provision (see Exceptional Health Care Needs Clients (VIP) policy);
    2. to calculate accommodation and meal contributions for clients in receipt of VIP Intermediate Care Service or continued Adult Residential Care in community facilities, except for clients who are receiving the care for a disability benefits entitled condition and Veteran/Civilian Pensioners who are seriously disabled (see Accommodation and Meals policy); and
    3. to establish a client's eligibility as an income-qualified Veteran, an income-qualified civilian, or a Canada Service Veteran; or if such eligibility has not already been established, to confirm such eligibility when required.

References

Veterans Health Care Regulations    

Adult Residential Care in Community Facilities

Accommodation and Meals Contributions

Exceptional Health Care Needs Clients (VIP)

Primary Caregivers (VIP)

Survivors (VIP)

Home Care Services (VIP)

Ambulatory Health Care (VIP)

Transportation (VIP)

Home Adaptations

Intermediate Care (VIP)

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