Home Care and Independence Policy 25-003 | Effective Date: November 24, 2022

Policy

WorkSafeNB may provide home care and/or home maintenance services for workers who have severe and prolonged injuries where it is determined by WorkSafeNB that these services are necessary as a result of a worker's injury by accident and evidence supports contraindications to performing home care and/or home maintenance tasks. 

While WorkSafeNB has the discretion to meet the special needs of workers on an individual case basis, home care and related services generally include:

• Professional health care services such as nursing, physiotherapy, occupational therapy; and speech therapy;
• Physical care including assistance with the activities of daily living, such as bathing, toileting, transferring and grooming; and
• Home making and home support to assist with the activities of daily living, such as cleaning, doing laundry and meal preparation.

Interpretation

1. For an expense to be eligible the worker must have a severe and prolonged injury and either:

• be eligible for the disability tax credit;
• have a written certification from a medical practitioner that states that the worker will  likely, for a long continuous period of indefinite duration, be dependent on others for personal needs and care because of an impairment in physical or mental functions.

   This policy does not apply to post-surgical and acute care. Please see Policy 25-004 Acute and Post Surgical Home Services. 

2. WorkSafeNB provides home care and independent living services based on the identified needs of the worker, as assessed by healthcare professionals such as occupational therapists or nurses. Hospital discharge planners, Commission staff, or other approved healthcare providers assess the specific needs of each individual worker, and the duration of services required, using standardized tools.

3. During the assessment, WorkSafeNB may identify home care and independence needs for:

• Physical care;
• Assistance with activities of daily living;
• Home making;
• Home maintenance;
• Assistive devices or equipment;
• Mobility or communication aids;
• Home or vehicle modification; and/or
• Other special needs.

4. To meet the home care needs of workers, services may be provided by:

• Professional health care providers;
• Contracted homemaking agencies; and/or
• Informal caregivers.

5. Whether workers receive their care from professional providers, homemaking agencies, informal caregivers, or a combination of providers, WorkSafeNB communicates with workers and their families throughout the period of care. WorkSafeNB communicates on topics related to:

• Needs assessments;
• Services to be provided;
• The providers or caregivers to deliver the care;
• The duration of the care or services; and
• The method and amount of payment for the care.

 Professional Health Care

6. When WorkSafeNB determines that professional health care providers are required, WorkSafeNB:

• Approves and contracts directly with the provider or agency;
• Pays the professional or agency rate directly to the provider or agency; and
• Ensures that quality care is provided.

7. WorkSafeNB ensures that standards for care are met, and requires that professional health care providers:

• Conduct timely assessments of workers’ post-acute or long-term needs for home care;
• Follow WorkSafeNB’s guidelines for care and treatment;
• Foster worker self-care and independence to the extent possible;
• Instruct the worker, and/or informal caregivers in techniques of care and operation of equipment, if requested; and
• Advise WorkSafeNB when needs for care have changed, and care plans need revision.

8. In addition, WorkSafeNB manages requests for changes in health care providers by using:

• Policy 25-001 Medical Aid Principles; and
• Directive 25-001.20 Certification of Health Care Providers. 

 Contracted Homemaking Agencies

9. When WorkSafeNB determines that home care services are required, WorkSafeNB may approve and contract directly with a homemaker agency. When that is the case, WorkSafeNB:

• Pays the fee-for-service rate directly to the agency; and
• Ensures that quality care is provided.

10. WorkSafeNB ensures that standards for care are met, and requires that homemaker agency providers:

• Follow WorkSafeNB’s guidelines for care and treatment;
• Foster worker self-care and independence to the extent possible; and
• Advise WorkSafeNB when needs for care have changed, and care plans need revision.

 Informal Caregivers

11. In cases where a worker has prolonged impairment requiring attendant care, and the worker or family, prefer that home care be provided by a family member or friend, WorkSafeNB:

• Determines that the informal caregiver is 18 years or older and is not the spouse or common-law partner;
• Determines if an informal caregiver can safely and appropriately provide the required care;
• Approves the informal caregiver as the provider;
• Ensures that quality care is provided. 

12. WorkSafeNB will reimburse expenses for personal care up to the monthly approved care level fee. Each receipt must contain the caregiver’s social insurance number. The reimbursement for informal care is   intended to offset some of the costs for services provided by an informal caregiver.

13. This fee is structured into seven levels that are based on a combination of specific care needs (such as activities of daily living, and physical care, as assessed by WorkSafeNB) and the number of hours required to provide this care for the worker.

14. Informal care fee, at any of the seven levels, may be provided to workers as a permanent solution to long-term home care needs.

15. The informal care fee levels are:

• Level 1 – less than one hour of care per day.
• Level 2 – one hour or more, but less than two hours of care per day for five days or more per week.
• Level 3 – two hours or more, but less than five hours of care per day for five days or more per week.
• Level 4 – five hours or more, but less than seven hours of care per day for five days or more per week.
• Level 5 – seven hours or more, but less than ten hours of care per day for five days or more per week.
• Level 6 – ten hours or more, but less than thirteen hours of care per day for five days or more per week.
• Level 7 – thirteen hours or more care per day for five days or more per week.

    For information on the maximum amount that will be reimbursed at each level, see Fee Schedule 29-550 Home Care.

16. WorkSafeNB determines whether informal caregivers provide quality care that is safe and appropriate by:

• Re-assessing workers’ needs on a schedule that is appropriate to their post-acute or long-term condition, to ensure that care meets, but does not exceed individual needs;
• Adjusting care plans, as appropriate;
• Providing instruction in care and the use of equipment, when required; and
• Providing respite care for the informal caregiver.
• Ensuring definition of informal care giver has been met.

17. WorkSafeNB recognizes the need for informal caregivers to have periods of rest, especially when caring for the terminally ill, or those suffering long term or chronic illness. The physical and emotional toll of performing the role of caregiver on a long-term basis can put the informal caregiver at risk and compromise the quality of care to the worker.

18. To qualify for respite care, WorkSafeNB requires that the informal caregiver:

• Provides 40 hours per week or more of care and/or supervision;
• Has provided that care or supervision for a period of one year; and
• Applies for the respite care.

19. WorkSafeNB generally authorizes respite care for a maximum of two weeks annually.

20. When planning the respite care, WorkSafeNB:

• Arranges assessment by an occupational therapist (if one has not been conducted within the past year) to confirm care needs;
• Determines the duration of the respite care;
• Selects, contracts and directly pays a provider or facility to deliver the care to the worker during the period of the caregiver’s rest; and
• Continues the care allowance during the period of respite.

21. When WorkSafeNB determines that a worker requires a level of care that would most cost-effectively be provided in a health care or residential facility, the worker is typically admitted to an appropriate facility.

   However, if the family or the worker prefers the care to be delivered in the home, WorkSafeNB pays for care as determined by this policy.

 Meeting Independent Living Needs

22. In addition to meeting home health care needs, WorkSafeNB promotes functional restoration by providing equipment and services that increase the worker’s independence and quality of life. WorkSafeNB assesses workers individually and identifies special needs for equipment or services that increase a worker’s ability to live independently.

23. In determining independence needs, WorkSafeNB evaluates whether an item or service increases a worker’s:

• Access to the home and community;
• Mobility within or outside the home;
• Ability to be self-reliant in carrying out activities of daily living;
• Ability to communicate with family and friends; or
• Ability to participate in social activities with family and friends at home or within the community.

Home Maintenance

24. WorkSafeNB may assist with the long-term home maintenance needs to maintain a safe and accessible home of workers with a severe and prolonged injury. WorkSafeNB provides this assistance when these services are necessary as a result of a worker’s injury by accident and evidence supports contraindications to performing home care and/or home maintenance tasks

25. Assistance is intended to offset some of the costs of hiring an informal provider for home maintenance needs to maintain a safe and accessible home, such as:

• Lawn Care;
• Snow removal;
• Minor home repairs; and
• Other seasonal activities such as wood piling.

26. Home maintenance needs are assessed and paid as part of the informal care allowance. For more information, see Fee Schedule 29-550 Home Care.

27. Receipts are required and service must be provided by someone 16 years or older.

 Application

This policy applies to all decisions made on or after the effective date.