In the court decision Joslin-Mielke v Pembridge, 2022 CanLII 57402 [1], the applicant was a passenger on a motorcycle that was involved in a MVA on May 23, 2016. She sustained severe orthopaedic injuries which included a fracture of the hip, femur, two toes, and ribs on the left side.
The applicant and the respondent disagreed on the monthly amount of attendant care benefit (ACB) from December 20, 2016 to May 23, 2018.
The applicant argued that she needed assistance in basic supervisory care for medical emergency needs at night, whereas the respondent submitted that this was not reasonable and necessary.
In this blog, we will be discussing ‘Basic Supervisory Care’ in the Attendant Care Assessment, Form 1 and how OTs can better address this section by drawing on the results of this court decision.
According to OSOT’s “Assessment of Attendant Care Needs, Form 1: A Resource for Reflective Practice” [2],
Basic supervisory care refers to the time an attendant spends waiting to assist with “hands-on” needs that are unpredictable and/or may present a risk. It may include the following:
- The inability to be physically, cognitively, behaviourally and/or emotionally self-sufficient in an emergency situation.
- The potential risk of a bowel accident or condom catheter displacement for a client who is dependent on care.
- The need for assistance in toileting.
Special consideration is made for night care if a client requires “supervision and/or hands-on care from the time they retire for bed at night until the expected wakening time in the morning.”
According to OSOT, the following issues at night can be allocated to basic supervisory care:
- Assistance with bed mobility to prevent skin breakdown
- Assistance with genitourinary needs e.g., the need for an attendant to be available should the client experience incontinence
- Reattachment of tubing if it becomes displaced from the trachea
- Decreased mobility and assistance into wheelchair
- Inability to be self-sufficient during an emergency
- Inability to respond to an emergency
- Needing custodial care due to changes in behavior
In the subject court decision, the main area of divergence was whether basic supervisory care for night-time emergency care was necessary.
The applicant argued that due to her complex leg injuries, reduced range of motion, and need for mobility aids to walk, she requires assistance at night should an emergency occur.
The applicant OT allotted 3,360 minutes to this section, whereas the respondent OT determined this was not necessary.
The applicant OT’s assessment on November 2, 2016 stated that the applicant was unable to bear weight on her right leg without external support, had a reduced range of motion in her leg, and reduced walking and standing tolerance and balance.
She could not access the stairs, could not walk without a walker and external supports, and needed a power wheelchair to get about the community.
In Level 2 of Form 1, the applicant OT determined that the applicant would not be self-sufficient in an event of an emergency when she is asleep at night, stating that the “applicant lacks [the] ability to independently get in and out of a wheelchair or to be self-sufficient in an emergency.”
In the respondent OT’s Attendant Care Assessment on November 30, 2016, the applicant was observed being able to access the main level of her home with the use of a walker for support, access her bathroom without her walker using the counter for support, and demonstrated safety and independence with all transfers.
The respondent OT noted that the applicant was independent under ‘basic supervisory care’ and demonstrated adequate mobility to exit her home in case of an emergency, even with the use of a walker or cane for support.
The judge sided with the respondent OT because her reports were “more reasonable and complete in their assessment of the ACB of the client.”
The arbitrator stated that there was no unique night-time challenges that would hinder the applicant’s ability to respond to an emergency.
The arbitrator added that the OT assessment did not include a formal balance assessment or observation of the client climbing stairs, to support her recommendation for assistance during an emergency at night.
The arbitrator opined that the “totality of evidence” points to the fact that the applicant’s mobility has improved to the point where attendant care in the event of an emergency at night is not reasonable and necessary, as the applicant was self-sufficient to manage on her own.
In this decision, the client mainly suffers from orthopaedic injuries as a result of the MVA. The main indicator for whether she was able to be self-sufficient at night was her mobility skills.
However, if a client suffers from more complex injuries such as brain injury, the considerations for basic supervisory care at night would be more nuanced.
Consideration would have to be made about the effects of cognitive, physical, behavioral, and environmental issues on the client’s ability to be independent.
Clients with significantly impaired balance, weakness and risk of falling will need supervision and physical assistance during the day and at night to get to the washroom safely. In these cases, a formal balance assessment must be completed.
Clients who require prompts and reminders throughout the day or that are not able to respond when under pressure may require assistance under Basic Supervisory Care. In these cases, the OT would be required to complete cognitive screening and to collect collateral information from the client’s caregivers.
Clients that are experiencing behavioral difficulties such as depression, anxiety and irritability with anger outbursts may need periodical and unpredictable assistance to calm down, to retract from a scene or to relax. In these cases, the OT may need to get support for recommendation under this section from the psychologist or psychotherapist that are familiar with the client’s behavioural problems.
Here at GLA Rehab, we have experienced OTs who regularly conduct the AC Assessment, Form 1. They assess clients holistically across all these domains using a wide range of assessment tools with the goal of providing client-centered treatment and care.
If you are in need of assistance, please reach out to us. We would love to help.
References
[1] Joslin-Mielke v Pembridge, 2022 CanLII 57402 (ON LAT), <https://canlii.ca/t/jq24n>, retrieved on 2023-01-26
[2] 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.