WCB Procedures

Personal care allowance

Procedure summary

Published On

May 28, 2026

Purpose

To determine if a worker is eligible for personal care allowance (PCA) including any retroactive periods, identify the appropriate level of care, and monitor/manage the allowance until entitlement ends.

Description

The decision maker reviews the medical information to confirm if the worker has a compensable severeA worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. Severe injuries include such injuries as spinal cord injuries, severe burns, moderate to severe brain injuries, major amputations, significant respiratory conditions, total loss of vision, terminal cancers, bilateral arm or bilateral leg fractures, and any other injuries of similar severity. i A worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. Severe injuries include such injuries as spinal cord injuries, severe burns, moderate to severe brain injuries, major amputations, significant respiratory conditions, total loss of vision, terminal cancers, bilateral arm or bilateral leg fractures, and any other injuries of similar severity. njury with prolonged functional limitations, and because of those limitations, needs temporary or permanent assistance with communication, mobility or self-care.

Additional information is gathered to confirm the worker's needs. The decision maker first determines if assistive devices would help. A referral is made for an occupational therapy (OT) assessment to consider if medical aids or assistive devices can help the worker regain independence to complete the personal care tasks. If training or assistive devices are not sufficient or only help with some tasks, the decision maker determines if the worker qualifies for PCA to cover the cost of hiring someone for the personal care tasks they are unable to complete. Refer to Policy 04-07- Services for workers with severe injuries.

When PCA is approved the decision maker monitors and reviews the worker's ongoing needs, considers any changes to their injury, functional limitations, and/or living situation that may affect the required level of care and adjusts the care level, as appropriate.

Decision makers use discretion and reasonable judgment to guide their decision and conversations to arrive at fair and evidence-based decisions.

Key information

PCA is a monthly payment for management of self-care. It is meant to cover the cost for nursing and/or attendant care for a severely injured worker so they can safely live at home, and agency care is not available and/or based on circumstances, not the best option for the worker. Without assistance, the worker would be required to be in a hospital or care facility. The type and amount of assistance required is based on medical evidence and/or an occupational therapist's recommendation. Not all severely injured workers require the same level of support. For example, some workers may require short-term PCA (less than three years from the benefit start date) and others may require long-term care (more than three years from the benefit start date). Some worker's may need agency care while others are able to self-manage their care. Each claim is assessed based on its individual circumstances.

PCA is paid directly to a worker to obtain care through an agency or individual. It does not include services for home maintenance allowance (HMA); this is a separate benefit. In most cases, a decision maker will review a worker's eligibility for PCA and HMA at the same time. Refer to the 5-4 home maintenance allowance procedure.

Personal care services should be considered when the worker has:

Received treatment in a hospital (inpatient or outpatient) and there is a discharge care planThis may include nurses chart notes, social worker or home care program recommendations. supporting that the worker needs assistance with communication, mobility, self-care or supervision prior to the worker being discharged.
Not received treatment in a hospital (terminal illness related to the work injury or occupational disease, treated at a medical clinic, etc.) but the worker's health care provider has recommended services, or the decision maker determines assistance with personal care tasks is necessary.

Eligibility criteria

A worker qualifies for PCA when all of the following criteria are met:

A worker is not eligible for PCA:

The worker has a compensable severeA worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. Severe injuries include such injuries as spinal cord injuries, severe burns, moderate to severe brain injuries, major amputations, significant respiratory conditions, total loss of vision, terminal cancers, bilateral arm or bilateral leg fractures, and any other injuries of similar severity. A worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. Severe injuries include such injuries as spinal cord injuries, severe burns, moderate to severe brain injuries, major amputations, significant respiratory conditions, total loss of vision, terminal cancers, bilateral arm or bilateral leg fractures, and any other injuries of similar severity. injury.
The worker has functional limitations that result in the need for temporary or permanent assistance with communication, mobility, self-care or supervision.
Providing training or assistive aids would not enable the worker to safely perform self-care tasks or alleviate their need for assistance.

Refer to Policy 04-07, Part I - Services for Workers with Severe Injuries.

If they are seriouslySerious injuries include injuries such as rotator cuff tears, ruptured discs, severe ankle/wrist fractures, severe knee injuries [e.g., torn anterior cruciate ligament (ACL)]. Soft tissue injuries are not considered serious, unless there is unusual severity (e.g., bilateral epicondylitis, hernia repairs). i Serious injuries include injuries such as rotator cuff tears, ruptured discs, severe ankle/wrist fractures, severe knee injuries [e.g., torn anterior cruciate ligament (ACL)]. Soft tissue injuries are not considered serious, unless there is unusual severity (e.g., bilateral epicondylitis, hernia repairs).njured, in which circumstances other appropriate supports or allowances are considered in accordance with Policy 04-10, Part I.
If the worker is permanently confined to a hospital, nursing home or other institution because of their severe injury.
For compensable psychological injuries, unless objective medical informationObjective medical information means the data can be measured through physical examination findings, medical tests and/or reports from diagnostic procedures. Objective medical information means the data can be measured through physical examination findings, medical tests and/or reports from diagnostic procedures.confirms there are significant functional limitations resulting from the psychological injury. This must include a demonstrated reason the worker cannot complete the personal care task(s) as the goal of recovery is to support independence and continued activity. In rare circumstances, an exception may be made to pay the allowance on a short-term basis only.

Choosing self-managed care vs. agency care

Personal care services can be delivered in different ways depending on a worker’s medical needs, recovery expectations, and personal circumstances. The following guidelines outline when agency‑provided care or self‑managed care may be appropriate, and explain the considerations involved in choosing the most suitable approach.

Agency care is generally preferred when:

Short‑term care is needed, and the worker’s condition is expected to improve. If the worker does not want agency care, they must consult their physician to create an alternate plan. Once a plan is in place, a short‑term PCA can be approved for the recovery period.
Long‑term care is required initially, especially for more serious injuries (e.g., burns, amputations, paralysis). For long‑term needs, agency care continues until the worker reaches maximum recovery and their home environment is stable.
Family or friends cannot safely meet the care needs.
The claim owner or medical team has concerns about safety or believes professional care is medically necessary. Agency care can be re-introduced if self-managed care becomes unsafe or insufficient to meet the worker's needs.
The worker is terminally ill and requires care beyond what family or friends can provide.

Self‑managed care may be appropriate when:

The worker lives in a remote area, and an agency cannot be contracted.
The worker strongly prefers self‑managed care rather than agency services.
Long‑term, ongoing care is needed (burns, amputations, paralysis, or similar conditions), the worker has reached maximum recovery and the family’s situation is stable.

When self-managed care is approved, the monthly personal care amount is based on the level of care required and is paid directly to the worker. Refer to the Current Personal care allowance levels effective January 1, 2017 section for care levels and specific monthly rates.

The worker chooses their caregiver (e.g., hired caregiver, family member, friend, or another person) and becomes the employer of the caregiver they select. As the employer, the worker is responsible for managing all aspects of the caregiver's employment. This includes paying wages, handling government payroll requirements, and ensuring the caregiver they have has WCB coverage. Premiums for personal attendants (caregivers) for Levels 2 through 9 are covered by WCB-Alberta. Level 1 is excluded, as it relates to housekeeping services rather than caregiver support.

WCB coverage for personal caregivers hired by the worker is optional and may be obtained through optional coverage (also known as voluntary coverage). Refer to Policy 06-01, Part II, Application 3: Workers and Policy 06-02, Part II, Application 1: Coverage for Exempt Industries. If the worker hires a caregiver who does not have their own WCB coverage, they may be exposed to liability. For information on how to apply for optional coverage, refer to step 6.

Support is available to help them meet their obligations as an employer through the Residential Aide Placement Service Program. Refer to the Residential aide placement service library resource. WCB cannot pay a family member or friend directly for providing care unless that person is self‑employed. If the worker's care needs increase beyond what family or friends can safely provide or it is determined that agency care is medically necessary, the care may need to shift from self‑managed care to agency‑provided care.

Additionally, PCA benefits are only payable on one claim or for one household. When the worker:

has multiple claims, PCA is paid under the claim where the worker has more significant functional limitations impacting their ability to perform home maintenance tasks.
lives with another injured worker and both qualify for PCA, the eligible costs are equally split.

Refer to the Benefit allocation for multiple claims or shared household section.

As of January 1, 2024, all PCA proposals require supervisor approval.

Monitoring PCA

Following initial benefit approval, a worker's eligibility for PCA benefits is periodically reviewed to determine if the benefit continues to meet the worker's care needs and whether the benefit will be extended or discontinued. Reviews may occur at a pre-determined time depending on the claim circumstance (i.e. short-term or long-term PCA, or changes in care). For PCA monitoring details, refer to the Monitor personal care allowance eligibility section.

PCA benefits end when the worker is able to complete all personal care tasks independently, when they have the necessary aids or equipment to manage on their own, when their living situation changes in a way that increases their independence, or when their care is fully provided by an agency or a long‑term care home that is paid directly.

Retroactive PCA

Requests for retroactive requests for PCA may be considered for severely injured workers if they met the eligibility criteria that was in effect for the retroactive period under consideration. Refer to the Retroactive personal care allowance section.

Initial personal care allowance decision

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1. Determine severe injury status If PCA benefits were previously approved and a review is required to determine if the benefits can be extended, continue to the Monitor personal care allowance eligibility section. Determine if the worker meets the criteria for a severely injured worker as outlined out in Policy 04-07, Part I Services for Workers with Severe Injuries. If the worker: Is not severely injured, they do not qualify for PCA. Continue to step 6 to communicate the decision. Consider if the worker is eligible for other services or allowance benefits such as home health care, aids or equipment, short-term home assistance (STHA), housekeeping allowance or HMA. may be severely injured, proceed to the next step. Note: The decision maker may assess PCA and HMA eligibility at the same time. Consult and follow the relevant procedures to determine the worker's eligibility for other allowances.	Administrative tasks Follow the following internal procedures if required: 4-5 Home health care 4-6 Special services and equipment 5-2 Short term home assistance 5-3 housekeeping allowance 5-4 home maintenance allowance.
2. Call the worker to gather information for the PCA review Have a collaborative discussion with the worker to get a better understanding of their current capabilities and any difficulties they are having with completing routine personal care tasks. When speaking to the worker, listen to their concerns and gather specific information to determine the type of support they may need. Questions to ask: How has the worker been managing? What physical activities can worker do or not do? What personal assistance does the worker require and who has been providing these services? Who is completing the tasks the worker can no longer do? Does the worker use any aids or equipment to assist with the restrictions? What aids and equipment would assist the worker to complete the tasks? Is the worker in a wheelchair or do they use a similar mobility aid on a constant basis? Note: In most cases when a worker needs assistance with communication, mobility, self-care, or supervision a social worker or other person from the hospital would have identified their needs before their being discharged. Discuss that a referral for an OT assessment will be made to identify their personal care needs. Explain that medical information will be provided to the OT to help them understand the injury(s) accepted and that aids, equipment, supports or strategies may be recommended to help them remain independent.	Administrative tasks Document the discussion in a file note (Contact/Claimant Contact) and attach it to the Severe Injury Line. . To make a referral for an OT assessment, follow the 4-1 Medical testing, referrals and program support procedure.
3. Review the OT assessment results and discuss with the worker Review the OT assessment report and any recommendations provided. If there are questions or clarification is needed, follow up with the OT promptly to ensure accuracy while the assessment details are still current. Consider the complexity and type care required that will best support the worker's needs related to their compensable injury. Determine if the worker requires: Assistance with mobility, communication, self-care, and/or supervision. Assistive aid(s), equipment, adaptive equipment or home modifications. Note: Home modifications may be recommended to maximize the worker's mobility and ability to independently carry out their daily routine. Providing these services may alleviate the need for agency care or PCA. Short term (less than three years) or long-term care (more than three years) is required and if home health care services (agency care) is appropriate based on the worker's medical condition. Consider: Agency care when the care is too complex or the worker may not be capable of supervising staff, etc. Self-managed care when the worker can demonstrate that managing their own care would be a more effective option (e.g., they live in a remote area where services are not available, the worker's spouse/family member is the best option and will be staying home to look after the worker, etc.). For these circumstances, payment of a PCA may be appropriate. Counselling services to support them in managing the impacts of their injury or illness. Evaluate medical aid(s)/equipment recommendations If medical aid(s)/equipment was recommended, consider the reason for the recommendation(s) and how it will benefit the worker. Ask: Will the aid/equipment address a functional limitation resulting from the worker's compensable injury? For example: A severely injured worker has difficulties with mobility and as a result requires assistance getting in and out of the bathtub. Providing the worker with a grab bar and bath chair may alleviate the need for personal care assistance. What is the impact on the worker if the aid/equipment is not provided? How often will the aid/equipment be used? Why a specific brand was recommended (if applicable) and whether there are cost-effective alternatives that will still meet the worker's needs. Is the cost for the aid/equipment reasonable given the benefit it provides to the worker? Will providing the medical aid/equipment resolve the worker's permanent functional limitations or will the worker still need additional support to compete personal care tasks? Are home modifications required for the equipment or are they recommended to help the worker get around in their home or carry out their activities of daily living? Refer to Policy 04-07, Part I and Policy 04-07, Part II, Application 2: Mobility. Discuss recommendations with the worker Call the worker and review the OT recommendations including any medical aid equipment, adaptive equipment, home modifications needed for their compensable injury. Discuss complexity of care and the options for support (i.e., agency care or self-managed care) that will best support the worker's needs for their compensable injury including whether the care is required for short-term or long-term basis. When the level of care is complex, (e.g. the worker requires daily care, or they are not capable of supervising staff), consider agency care. Educate the worker or family member on the benefits of agency care and why it may be more appropriate (e.g., challenges to the family unit to complete tasks such as lifting or wound care on a long-term basis). When the worker can demonstrate that self-managed care would be a more effective option or if agency care is not available (e.g., worker lives in a remote location where services are not available, the worker's spouse/family member is the most suitable caregiver etc.), consider payment of a PCA. Note: For remote care, some agencies may consider extending employment to a local caregiver with sufficient accreditations, etc. Provision of aids/equipment When medical aid equipment or adaptive equipment is required, explain what aid(s)/equipment will be approved and that arrangements for purchase and delivery will be made through a WCB special needs coordinator. If the medical aid equipment or adaptive equipment: resolves the need for assistance with personal care, discuss the decision to not approve agency or self-managed care (PCA). Arrange for the recommended equipment and continue to step 6 communicate the decision in writing. does not resolve the need for assistance with personal care, arrange the recommended equipment and continue to the next step to determine the worker's eligibility for agency or self-managed care. Note: All medical aids/equipment (e.g., reachers, sock aids, wheelchairs, bathroom equipment) must be arranged through the special needs coordinator who arrange delivery of the items. Items may be purchased or rented from a medical supply vendor or they may come from the WCB recycle pool depending on the needs of the injured worker. Additionally, the special needs coordinator coordinates repairs of medically required assistive devices. When home modifications are recommended to improve the worker's access into and within their home, further evaluation may be needed to determine the scope of work required for the home modification project. Additionally, it must be determined whether the work requires involvement of a consultant, contractor or both, and whether a home modifications specialist should be involved to oversee the project. Refer to Policy 04-07, Part I and Policy 04-07, Part II, Application 2: Mobility.	Administrative tasks Document the discussion in a file note (Contact/Claimant Contact). Attach the file note to the Severe Injury Line. Provision of aids/equipment Follow the 4-6 Special services and equipment procedure when approving medical aids/equipment and ensure the appropriate letter is sent to the worker. Document the approval for a medical aid/equipment in a file note (Medical Payment Processing/Equipment Request) and send it to the Medical Aid Special Needs, Team Desk. Follow the 5-6 Home and workplace modifications procedure.
4. Determine eligibility for PCA and the level of care needed Based on the available medical information (e.g., home health care plan, discharge information, OT assessment report, etc.) determine if the worker requires agency care or if they can self-manage their personal care. Ensure the worker has a severe injury and the need for support is due to functional limitations related to their compensable injury. If the functional limitations or their relationship to the compensable injury are unclear, consult with a medical or clinical consultant. If the worker requires agency care, refer to the 4-5 Home Health Care procedure and start at step 2. If the worker can self-manage their personal care or agency care is not available where they live, determine the level of PCA, the length of time care is needed, and whether it will be based on shared or single accommodation. For assistance in determining the level of care needed, complete the Personal Care Needs form and refer to the Current Personal care allowance levels effective January 1, 2017 section. Considerations for determining PCA eligibility: Short‑term PCA is care required for under three years. Long‑term PCA is care required for more than three years from the benefit start date. Shared accommodation applies when the worker lives with at least one other adult and the principle that they share housekeeping and transportation responsibilities. The allowance therefore covers 50% of the required care for these activities, reflecting the portion that would normally be the worker’s responsibility in a shared living arrangement. Single accommodation applies when the worker is the only adult in the household and there are no shared housekeeping or transportation responsibilities. In this situation, the full allowance for the PCA level is payable. When self‑managed care is provided by someone who does not live with the worker, the worker is considered the employer of the caregiver(s). For out-of-province or out-of-country care, the rates outlined in the Current Personal care allowance levels effective January 1, 2017 section should be used. If the worker hires an outside caregiver and the Alberta PCA rates do not cover the care costs, consider switching to agency care. Refer to the 4-5 Home Health Care procedure. When PCA benefits start after the first of the month, Medical Aid will issue a partial PCA payment for that month by prorating the PCA rate for the number of days it is payable. Identify the PCA effective date When the worker is eligible for PCA, determine the effective date by reviewing the available medical information (e.g., home health care plan, discharge information, OT assessment report, etc.). Use the date that best supports when the worker's injury was determined to be severe with functional limitations requiring care. The effective date for a PCA should not be: the date of accident. The worker would be in the acute phase of recovery from the injury; the restriction is considered temporary and not confirmed to be permanent. Consider STHA. Refer to the 5-2 Short-term home assistance procedure the date of a Medical Consultant memo confirming permanent restriction. The memo may be after the worker has a confirmed permanent restriction according to file information. Additionally, if the severe injury and functional limitations were confirmed for a date in the past, the worker may be eligible for retroactive PCA benefits if they can provide support that they incurred additional costs to hire someone to complete home maintenance tasks. Refer to the Retroactive Personal care allowance section.	Administrative tasks If not already completed, add the Severe Injury Line and update the benefit details screen. Follow the 11-2 internal consultant referrals procedure. Complete the Personal care Needs (FM719A) form.
5. Obtain approval to pay PCA benefits Send a recommendation to the supervisor requesting approval to pay PCA benefits. Include the following information: Medical reporting that supports the worker has a compensable severe injury and functional limitations resulting in the need for temporary or permanent assistance with communication, mobility, self-care or supervision. Information to support the worker is able to self-manage their care and who will provide the care. The PCA level recommended, the reason for selecting that level, whether the allowance will be paid as a single or shared accommodation. Refer to the Current Personal care allowance levels effective January 1, 2017 section. The length of time care is required (i.e. short-termShort‑term PCA is care required for under three years from the benefit start date. or long-termLong‑term PCA is care needed for more than three years from the benefit start date.). Include PCA effective date, information used to confirm the start date, and the end date, if applicable. The supervisor reviews the recommendation and approves or does not approve PCA, including the effective date and the proposed review schedule. The supervisor may adjust the recommended effective date and review schedule, if required.	Administrative tasks Send file note (Allowances/Personal Care Allowance) to Supervisor for approval. Supervisor: Send a file note (Allowances/Personal Care Allowance) documenting the decision to approve or not approve PCA.
6. Make and communicate the decision Review the supervisor's recommendation to approve or not approve PCA. Action any recommendations as appropriate and return to step 5 to resubmit for approval, if required. Call the worker to discuss the decision and rationale to approve or not approve PCA. PCA not approved If the decision is to not approve PCA, clearly explain why the worker does not qualify (e.g., not severely injured, aids or equipment resolved the need for care, agency care is recommended because self-managing their care, etc.). If applicable, discuss whether the worker may qualify for another benefit like HKA, HMA, Home care (agency care) or STHA and explain the next steps for the review. Refer to Policy 04-10, Part I for other available allowances for serious injuries or Policy 04-07, Part I Services for Workers with Severe Injuries. Communicate the decision in writing and end this procedure. PCA is approved If the decision is to approve PCA discuss the PCA level that is approved and what services the level includes, the next review date and the approved amount based on single or shared accommodation. Refer to the Current Personal care allowance levels effective January 1, 2017 section. Discuss the following information to ensure the worker understands their responsibilities for self-managed care: The worker becomes the employer when they hire a caregiver (i.e. nurse, attendant, family member). PCA benefits are paid directly to the worker who then pays the caregiver. WCB does not issue payments directly to caregivers. Note: PCA is considered medical aid and does not increase the worker's annual personal income. The caregiver must have WCB coverage. If they do not, the worker may apply for optional coverage (also known as voluntary coverage) to ensure the caregiver is protected in case of a work-related injury. WCB-Alberta premiums for caregiver coverage for PCA levels 2 through 9 are eligible for direct billing under the claim number. PCA level 1 is excluded from premium coverage as this level relates to housekeeping services rather than caregiver support. Refer to Policy 06-01, Part II, Application 3: Workers and Policy 06-02, Part II, Application 1: Coverage for Exempt Industries. Explain to the worker that they can apply for optional coverage by completing the Account Registration form located on the WCB-Alberta website or by contacting WCB Employer Account Services at: 780-498-3999 (Edmonton) 403-517-6000 (Calgary) 1-866-922-9221 (toll-free). Note: When applying for voluntary coverage, the worker must notify Employer Account Services to set the account up as WCB Sponsored – Self Managed Care account to arrange for direct billing of premiums to the claim. Canada Revenue Agency (CRA) payroll requirements apply. Federal guidelines must be followed for employment insurance (EI) and tax, vacation and statutory holiday pay. For questions about CRA obligations, direct the worker to the Canada Revenue Agency (CRA), an accountant, or the Residential Aide Placement Service Program. Additional information is available in the Residential aide placement services (RAPS) library resource. Payroll support is available. Payroll education and consultation can be accessed through the Residential Aide Placement Service Program. RAP can assist with managing payroll responsibilities for hired caregivers. Additional information is available in the Resource Library. Respite care options are available so the caregiver may take time off. All respite care must be arranged through a home health care agency. The monthly PCA amount is adjusted to reflect periods when agency care is provided. Communicate the decision in writing and include copy of the Personal care allowance worker fact sheet. Notify the Medical Aid Team of the approval to set up the allowance. Note: If a worker in receipt of PCA benefits updates their address, an auto-task will be triggered for the claim owner to review for any changes to the ongoing benefit entitlement.	Administrative tasks Document the discussion in a file note (Contact/Claimant Contact). PCA not approved Send the appropriate letter: the Personal Care Allowance (CL602A) letter, or the Combined PCA & HMA (CL062G) letter if making a decision for PCA and HMA at the same time. To review eligibility for other supports or allowances, follow the appropriate procedure: 4-6 Special services and equipment 5-2 Short term home assistance 5-3 Housekeeping allowance 5-4 Home maintenance allowance PCA is approved: Add a file note (Allowances/Personal Care) documenting the decision and rationale to approve PCA. Include the following information: The level of PCA approved. Whether it is based on single or shared accommodation. Effective start date, next review date and end date, if known. Name of service provider, if known. Attach the file note to the Severe Injury Line and send it to the Medical Aid Allowances/Team Desk to set up the monthly PCA payments. To make a referral for respite care, follow the 4-5 Home health care procedure. Send the appropriate letter: the Personal Care Allowance (CL602A) letter, or the Combined PCA & HMA (CL062G) letter if making a decision for PCA and HMA at the same time.
7. Set up the PCA review schedule PCA does not end at a certain time frame if the worker's abilities have not changed. The next scheduled review date should be set up taking into consider the worker's compensable injury, changing needs and when it would be reasonable (e.g., annual, scheduled for expected changes, three years). Review the claim on a regular basis as the worker's condition progresses to ensure the level of care meets the worker's needs. Short-term PCA must be reviewed annually for the first two years or more frequently if the worker is expected to progress in recovery. A comprehensive review must be completed in year three. Long-term PCA must be reviewed every three years at a minimum if the worker's condition is stabilized or sooner if there are indications their care level has changed. Note: Other allowance types or care may require more frequent monitoring (i.e. yearly) such as HMA or wound care. When the worker's functional levels have changed or their living situation has changed, refer for an OT assessment. If no further active case management is required, assign the claim to the case assistant, outlining any monitoring requirements and the next scheduled review date.	Administrative tasks Declare the PCA Accepted event for review in one year or review as necessary. Short term PCA, set a task for: the yearly review (or less than one year, if changes are expected). a year three review. Long-term PCA, set a task for: the yearly review (or less than one year, if changes are expected) case manager contact every three years. To assign the claim to the case assistant: Complete the CPCM to CPCA Transfer file note template. Include details related to monitoring, the next scheduled PCA review date, and when the claim should be reassigned back to the case manager. Copy and paste the template information into a file note (Case Assistant) with the Description line: Transfer claim to home care planning CA.

Personal care allowance levels effective January 1, 2017

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PCA levels general information

Personal care allowance level structure

PCA is classified into levels. Each level is clearly defined by including examples of injuries. This approach provides improved clarity and consistent interpretation of functional needs associated with each level.

PCA level 1 is designed for workers with severe injuries who require housekeeping support only and do not require personal care services.

PCA levels 2 through 9 are combined to streamline the PCA framework, address similarities between the levels and ensure consistent application of the allowance. Combined PCA levels include:

Levels 2 and 3 are grouped together.
Levels 4 and 5 are grouped together.

PCA rates are reviewed periodically using the National Occupational Classification (NOC) occupations and average hourly wages identified within the most recent Alberta Wages and Salaries Survey for light duty cleaner/housecleaner, home support worker/personal care attendant, health care aide/nurse aide/long-term care aide.

Selecting the appropriate PCA level

When referring to the PCA levels below, consider the following to select the level that best supports the worker's needs:

Base the PCA level on the OT assessment or other medical information along with information gathered through discussion with the worker about their personal circumstances.
Consider the worker’s compensable condition and the assistance required for tasks within each PCA level. Use discretion and select the level that best reflects the worker’s actual abilities and limitations.
When determining a PCA level for physical and mental impairments, determine the level of impairment for each separately. Then assign the higher of the two levels for the worker's PCA entitlement. For example, the physical impairment may be in level 4/5 and the mental impairment at level 7.
Assess the amount of care required during sleep hours. If the worker sleeps soundly and does not present safety concerns, night‑time supervisory care is not required. However, if the worker is at risk (e.g., confusion at night, flight risk), 24-hour care may be appropriate.
Refer to the levels of Disability Duration Reference, Job Classification document as a guide to determine the physical level of assistance required for homemaking, such as:
- Heavy level, would be up to 100 lbs. of lifting occasionally,
- Medium level, would be up to 50 lbs. of lifting occasionally,
- Light level would be up to 20 lbs. of lifting occasionally, etc.

Any changes to the worker's PCA should be made effective the date of the annual review. These rates are only adjusted when there is a change.

Administrative tasks

Complete the Personal Care Needs (FM719A) form to determine the level of entitlement.

PCA level 1- housekeeping

PCA level 2/3

Level 2/3 is for the provision of personal care when it removes the necessity of facility-based care.

Examples of severe injuries requiring level 2/3 PCA:

Respiratory conditions that cause permanent shortness of breath expected to worsen over time, with increased fatigue but no balance issues. Pulmonary function (PFT) may be approximately 15–40% when stabilized. Determined on a case‑by‑case basis.
Major amputations where a single lower‑limb prosthesis (leg or foot) may or may not be wearable, or where a single upper‑limb prosthesis (arm or hand) is required or cannot be worn.
Multiple major limb fractures, such as fractures involving both legs, both arms, or shoulders, resulting in temporary limitations in mobility, bending, or overhead lifting.
Severe burns affecting multiple areas of the body, with resulting skin tightening, scarring, or balance challenges.
Progressive industrial disease conditions (e.g., West Nile virus, asbestosis), with functional limitations assessed individually.
Brain injuries or impairments related to other disease processes that result in diagnosed memory issues requiring supervision or cueing for functional daily activities for approximately 1 hour per day up to 14 hours per week.

Type of assistance in addition to those listed in level 1

Personal care

Occasional assistance with medical dressing changes, changes in awkward positions or physical assistance with fasteners such as:

Button/unbutton shirts/snaps
Bending over - shoes, socks, laces or cutting toenails and other foot care
Washing hair
Donning and doffing pressure stockings
Dressing/ Undressing- shoes, socks, stockings, zippers, buttons, snaps

Homemaking

Depending on the severity of the physical restrictions where aids, equipment and supervision cannot assist, needs assistance with awkward duties or difficulty with fine motor skills, for home making tasks and/or needs assistance with some minor/light interior home upkeep such as:

Changing air filters, light bulbs
High and low dusting
Changing beds or assisting with laundry
Washing bathrooms
Stocking groceries on high shelves, etc.

PCA Level 2/3 rates

The rates below include services for general housekeeping, homemaking, personal care attendant and/or home support worker care.

Accommodation type	Time period	Monthly rate
Shared	January 1, 2017	$1029.00
	January 1, 2018	$1042.00
	January 1, 2019	$1051.00
Single (adult only)	January 1, 2017	$1638.00
	January 1, 2018	$1650.00
	January 1, 2019	$1660.00

PCA level 4/5

PCA level 6

PCA level 7

PCA level 8

Level 8 is for the provision of personal care when it removes the necessity of facility based care.

Examples of severe injuries that may require level 8 PCA include:

Respiratory conditions with pulmonary function (PFT) between 86.1–100%
Quadriplegic with care needs determined by the worker's level of function and abilities
Severe burns with blindness/hearing loss with function limitations (e.g., amputation and/or sensory loss to most digits or extremities, loss of vision/blindness and/or loss of hearing) requiring less than 18 hours of personal care per day.
Cancers in palliative care, with support needs based on level of function and abilities
Industrial Disease in palliative care with support needs based on level of function and abilities
Brain injuries or impairments as part of another disease process resulting in diagnosed memory issues and requiring caregiver assistance for supervision/cuing for functional daily activities for 18 hours or more daily but less than 24 hours of supervision.

Type of assistance in addition to those listed in levels 2 to 7

Personal care

Attendant care is required at all times, including accessing the community.

The worker is minimally able to participate in some self-care and should not be left unattended (e.g., requires physical assistance for less than 18 hours per day).

The caregiver is required to perform most of the following tasks:

Administering medication, dressing changes and wound care
Bowel, bladder routines (e.g., stimulation, suppositories, etc.) and menstrual care
Incontinent care and bed pan care
Sponge baths
Catheterization
Manual feeding (e.g., all nutritional needs are provided by the care giver, such as spoon feeding, tube feeding, liquid diet, etc.)
Positioning/repositioning the worker

Level 8 Rates

The rates below include services for general housekeeping, homemaking, personal care attendant and/or home support worker care.

Accommodation type	Time period	Monthly rate
Shared	January 1, 2017	$4672.00
	January 1, 2018	$4793.00
	January 1, 2019	$5039.00
Single (adult only)	January 1, 2017	$5280.00
	January 1, 2018	$5402.00
	January 1, 2019	$5648.00

PCA level 9

Level 9 is for the provision of personal care when it removes the necessity of facility-based care.

Examples of severe injuries that may require level 9 PCA include:

Respiratory conditions with pulmonary function (PFT) between from 86.1–100%
Quadriplegic with care needs determined by the worker's level of function and abilities
Severe burns that require 18-24 hours of personal care due to minimal functional abilities due to skin limitation, scarring, amputations or sensory loss to their digits or extremities, etc.,
Cancers in palliative care, with support needs based on level of function and abilities
Industrial Disease in palliative care with support needs based on level of function and abilities
Brain injuries or impairments as part of another disease process resulting in diagnosed memory issues requiring 24-hour caregiver/supervision assistance with built in respite care for family caregivers

Type of assistance in addition to those listed in levels 2 to 8

Personal care

Attendant care is required at all times, including accessing the community.

May also require assistance from a licensed practical nurse (LPN) or registered nurse (RN), such as checking oxygen levels or administering intravenous treatments.

The caregiver is required to perform most of the following tasks:

Administering medication, dressing changes and wound care
Bowel, bladder routines (e.g., stimulation, suppositories, etc.) and menstrual care
Incontinent care and bed pan care
Sponge baths
Catheterization
Manual feeding (e.g., all nutritional needs are provided by the care giver, such as: spoon feeding, tube feeding, liquid diet, etc.)
Positioning/repositioning the worker (i.e., turning over in bed)

Level 9 Rates

The rates below include services for general housekeeping, homemaking, personal care attendant and/or home support worker care.

Accommodation type	Time period	Monthly rate
Shared	January 1, 2017	$5792.00
	January 1, 2018	$5948.00
	January 1, 2019	$6296.00
Single (adult only)	January 1, 2017	$6401.00
	January 1, 2018	$6556.00
	January 1, 2019	$6905.00

Monitor Personal care allowance eligibility

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1. Monitor for changes in care and the next scheduled review date This step is completed by the case assistant, unless the claim is actively managed by a case manager. Ensure a task is set for the next review and refer to the most recent file note (initial approval or latest extension) for the scheduled timeline and relevant details. Short‑term personal care is reviewed yearly for the first two years (or sooner if the worker’s condition changes), with a comprehensive review in year three. Long‑term personal care is reviewed every three years if the worker's condition is stabilized or sooner if the worker's care level has changed. Contact is required from the case manager every three years. Note: Other allowance types or care may require more frequent monitoring (i.e. yearly) such as HMA or wound care. When the worker's functional levels have changed or their living situation has changed, refer for an OT assessment. Monitor the claim for any indication that personal care needs have changed (e.g., updates from the worker or caregiver, new medical reports). Use this information to begin the PCA review at the next scheduled review date or earlier if needed. Gather information for the PCA review Call the worker to gather information for the PCA review. Note: If the worker cannot be reached after two attempts, send the appropriate letter requesting contact or a reply to the letter so the review can be completed. Include a date (i.e. two weeks) for when contact needs to be made. If there is no contact by that time, transfer the claim to the case manager. Have a collaborative discussion to confirm any changes to ensure the level of care they are receiving meets their current needs. Questions to ask: Has their personal care changed? Are tasks more difficult because of their compensable injury, or are things the same since the last review? If there are changes, ask them to explain (e.g., now unable to get in/out of the bathtub). Has anything changed in their living situation? (e.g., no longer living with a partner, moved homes.) Who helps with their personal care? How often, for how long, and what tasks do they assist with? Would additional tools or equipment help them be more independent? (e.g., a reacher.) When did you last see your doctor for treatment related to your compensable injury? Do you have any other questions or concerns? Request any outstanding medical reports, if required. Determine if PCA needs to be reassessed Some indicators include: Changes in personal care needs resulting from the compensable injury and not non-work-related factors (e.g., aging, non-work-related stroke, etc.) The worker moves or has home modifications completed. The worker's condition deteriorates, or the worker re-injures themself. Request from the worker, spouse/adult interdependent partner, or caregiver. If unsure if there are any changes in the worker's level of care, discuss the claim with the case manager. If there are no changes in the worker's level of care and they continue to meet the eligibility criteria for PCA outlined in policy, discuss the decision to extend the PCA benefits and the next scheduled review date. Refer to Policy 04-07, Part I - Services for Workers with Severe Injuries. Continue to step 5 to communicate the decision in writing. If there are no changes but the worker disagrees with their level of care, advise them that their case manager will be notified and call them to discuss their concerns. If there are changes in the worker's level of care, explain that the claim will be assigned to a case manager who will call them to discuss their care needs and make a referral for an OT assessment. If the worker requests an in-person meeting, advise the worker that the case manager will reach out to discuss their request. Transfer the claim to the case manager for review.	Administrative tasks If the worker cannot be reached after two attempts, send the Review HKA/HMA/PCA (CL602N) letter. Follow the 11-1 Requesting medical reports procedure. Document the discussion in a file note (Allowances/Personal Care Allowance) and attach it to the Severe Injury Line. Include whether the level of care remains the same or changed. If there are no changes, but the worker disagrees with their level of care, send the file note to the case manager and assign the claim to the Team Assign desk. If there are changes, send the file note to the case manager and assign the claim to the Team Assign desk. If the worker requests an in-person meeting, send a file note (In-Person Meeting, Offered/Occurred) to the case manager. Attach the file note to the Severe Injury Line. Assign the claim to the Team Assign desk.
2. Call the worker and complete the personal care needs form The following steps are completed by the case manager. Review all information gathered for the PCA review, including medical reports, to identify any changes in the worker’s personal care needs. Call the worker to discuss their current status and how they are managing personal care tasks. If an in‑person meeting is requested, follow the same process during the in‑person discussion. Note: If the worker cannot be reached after two attempts, send the appropriate letter requesting contact and include the specific date by which a response is expected. Discuss any changes to ensure their level of care remains appropriate. If there are no changes in the worker's level of care and they continue to meet the eligibility criteria for PCA outlined in policy, discuss the decision to extend the PCA benefits and the next scheduled review date. Refer to Policy 04-07, Part I - Services for Workers with Severe Injuries. Continue to step 6 to communicate the decision in writing. If it appears there may be changes in the level of care or the discussion indicates that changes have occurred: Complete the personal care needs form, reviewing each task with the worker to identify which ones they require assistance with and whether this represents a change from the last review. Explain to the worker that a referral for an OT assessment will be made to better understand how their functional limitations are affecting their ability to complete personal care tasks and to identify any aids or equipment that may help increase their independence. Make a referral for an OT assessment.	Administrative tasks If the worker cannot be reached after two attempts, send the Claimant Custom (CL000A) letter. Document the discussion in a file note (Allowances/Personal Care Allowance) and attach it to the Severe Injury Line. For in-person meetings, document the confirmed details from the meeting in a file note (In-Person Meeting, Offered/Occurred). Attach it to the Severe Injury Line. Complete the Personal care needs (FM719A) form. To arrange a referral for an OT assessment, follow the 4-1 Medical testing, referrals and program support procedure.
3. Review and discuss the OT assessment results with the worker Review the OT assessment report and any recommendations provided. If there are questions or clarification is needed, follow up with the OT promptly to ensure accuracy while the assessment details are still current. Consider the complexity and type care required that will best support the worker's needs related to their compensable injury. Determine if the worker requires: Assistance with mobility, communication, self-care, and/or supervision. Assistive aid(s), equipment, adaptive equipment or home modifications. Note: Home modifications may be recommended to maximize the worker's mobility and ability to independently carry out their daily routine. Providing these services may alleviate the need for agency care or PCA. Refer to Policy 04-07, Part I and Policy 04-07, Part II, Application 2: Mobility. Short term (temporary) or long-term care is required and if home health care services (agency care) are appropriate based on the worker's medical condition. Consider: Agency care when the care is too complex or the worker may not be capable of supervising staff, etc. Self-managed care when the worker can demonstrate that managing their own care would be a more effective option (e.g., they live in a remote area where services are not available, the worker's spouse/family member is the best option and will be staying home to look after the worker, etc.). For these circumstances, payment of a PCA may be appropriate. If the worker would benefit from counselling services to assist them in adapting to effects of the injury and any change in circumstance. Evaluate medical aid(s)/equipment recommendations If medical aid(s)/equipment was recommended, consider the reason for the recommendation(s) and how it will benefit the worker. Ask: Will the aid/equipment address a functional limitation resulting from the worker's compensable injury? For example: A severely injured worker has difficulties with mobility and as a result requires assistance getting in and out of the bathtub. Providing the worker with a grab bar may alleviate the need for personal care assistance to help the worker to get in and out of the bathtub. What is the impact on the worker if the aid/equipment is not provided? How often will the aid/equipment be used? Why a specific brand was recommended (if applicable) and whether there are cost-effective alternatives that will still meet the worker's needs. Is the cost for the aid/equipment reasonable given the benefit it provides to the worker? Will providing the medical aid/equipment resolve the worker's permanent functional limitations or will the worker still need additional support to maintain their home? Are home modifications required for the equipment or are they recommended to help the worker get around in their home or carry out their activities of daily living? Discuss recommendations with the worker Call the worker and review the OT recommendations including any medical aid equipment, adaptive equipment, home modifications needed for their compensable injury Discuss complexity of care and the options for support (i.e., agency care or self-managed care) that will best support the worker's needs for their compensable injury including whether the care is required for short-term or long-term basis. When the level of care is complex, the worker requires daily care, or they are not capable of supervising staff, etc., educate and explain to the worker or family member the benefits of agency care to ensure the worker receives quality care. Explain why agency care may be more suitable for the worker needs (e.g., discuss the challenge to the family unit of providing for a worker's care needs, such as a lot of lifting or wound care, etc., over time). When the worker can demonstrate that self-managed care would be a more effective option or if agency care is not available, (e.g., worker lives in a remote area where services are not available, the worker's spouse/family member is the best option and will be staying home to look after the worker, etc.), consider payment of a PCA. In some instances of remote care, agencies will consider extending employment to a local caregiver with sufficient accreditations, etc. For out-of-province or out-of-country workers, discuss that their level of care is based on the current Alberta PCA rates. If the worker hires an outside caregiver and the Alberta PCA rates do not cover the care costs, explain the option to switch to agency care. Refer to the 4-5 Home Health Care procedure. Provision of aids/equipment When medical aid equipment or adaptive equipment is required, explain what aid(s)/equipment will be approved and that arrangements for purchase and delivery will be made through a WCB special needs coordinator. Note: All medical aids/equipment (e.g., reachers, sock aids, wheelchairs, bathroom equipment) must be arranged through the special needs coordinator who arrange delivery of the item. Items may be purchased or rented from a medical supply vendor or they may come from the WCB recycle pool depending on the needs of the injured worker. Additionally, the special needs coordinator coordinates repairs of medically required assistive devices. If the medical aid equipment or adaptive equipment: provides all the required assistance and allows the worker to manage the personal care independently, discuss the decision to not approve agency or self-managed care (PCA). Arrange for the recommended equipment. Continue to step 6 to communicate the decision to not approve PCA benefits. does not provide all the required assistance and the worker still needs help with managing their personal care, arrange the recommended equipment and continue to the next step to determine the worker's eligibility for agency care or level of care required for self-managed PCA. When home modifications are recommended to improve the worker's access into and within their home, further evaluation may be needed to determine the scope of work required for the home modification project. Additionally, it must be determined whether the work requires involvement of a consultant, contractor or both, and whether a home modifications specialist should be involved to oversee the project. Refer to Policy 04-07, Part I and Policy 04-07, Part II, Application 2: Mobility.	Administrative tasks Document the discussion in a file note (Contact/Claimant Contact). Attach the file note to the Severe Injury Line. To arrange agency care, follow the 4-5 Home Health Care procedure Provision of aids/equipment Follow the 4-6 Special services and equipment procedure when approving medical aids/equipment and ensure the appropriate letter is sent to the worker. Document the approval for a medical aid/equipment in a file note (Medical Payment Processing/Equipment Request) and send it to the Medical Aid Special Needs, Team Desk. When the provision of equipment resolves the worker's need for assistance, send the Claimant Custom (CL000A) letter. For home modifications: Follow the 5-6 Home and workplace modifications procedure.
4. Determine eligibility for an extension of PCA and the level of care required Review the information (e.g., OT assessment report, medical reports) to determine if the level of PCA care: should be extended, increased, decreased or discontinued. will continue to be self-managed (i.e. provided by a family member or outside caregiver) or if agency care should be considered. Discontinue PCA when: the worker is able to complete all personal care tasks independently the worker has the necessary aids or equipment to manage their own personal care the worker's living situation changes in a way that increases their independence, or the worker's care is fully provided by an agency or a long‑term care home that is paid directly. If the decision is to end PCA benefits, continue to the next step. If there are no changes and PCA benefit will be extended for the same level of care, continue to step 6 to communicate the decision. If there are changes, ensure the change relates to functional limitations from the compensable injury and not other non-compensable factors (e.g. aging, non-work-related medical conditions such as a stroke or Parkinson's disease). If unsure, consult with a medical consultant. If the worker: requires agency care, refer to the 4-5 Home Health Care procedure, starting at step 2. requires an adjustment to their PCA care level and they are able to continue self-managing their care or if agency care is unavailable where they live, determine the required level of PCA, the length of time care is needed, and whether shared or single accommodation is needed. Determine PCA care level changes Considerations for determining changes in the PCA care level: Short‑term PCA is care required for under three years from the benefit start date. Long‑term PCA is care required for more than three years from the benefit start date. Shared accommodation is based on the worker living with at least one other adult, and the principle that they would share housekeeping and transportation responsibilities. Therefore, the allowance includes 50% of the required care for housekeeping and transportation responsibilities, to reflect the portion that would be the worker’s responsibility while living with at least one other adult. Single accommodation is based on the worker being the only adult in the house so there are no shared housekeeping or transportation responsibilities. The full allowance for the PCA level is payable. For self-managed care provided by a person(s) not sharing accommodations with the worker, the worker is considered the employer of the care giver(s). For out-of-province or out-of-country care, the rates outlined in the Current Personal care allowance levels effective January 1, 2017 section should be used. If the worker hires an outside caregiver and the Alberta PCA rates do not cover the care costs, consider switching to agency care. Refer to the 4-5 Home Health Care procedure. Once the changes for PCA care level have been determined, continue to the next step.	Administrative tasks Follow the 11-2 internal consultant referrals procedure.
5. Obtain approval to change to discontinue PCA or change the PCA care level Send a recommendation to the supervisor requesting approval to discontinue PCA benefits or to adjust the level of care and extend the benefits. For discontinuing PCA benefits, include the following information: the rationale and information that supports the worker no longer requires care (e.g. worker has moved to a home that provides care, the care required is no longer due to the compensable injury, the personal care needs form, OT assessment results, medical reports, medical consultant opinion). the date PCA benefits should end. For changes in level of care Include the following information: Personal care needs form, OT assessment report and any other medical reports that supports the worker's level of care has changed since the last review. What has changed since the last review and how the increase or decrease in care level relates to the worker's compensable severe injury. Information to support the worker is able to self-manage their care and who will provide the care. The PCA level recommended, the reason for selecting that level, whether the allowance will be paid as a single or shared accommodation. Refer Current Personal care allowance levels effective January 1, 2017 section. The length of time care is required (i.e. short-termShort‑term PCA is care required for under three years from the benefit start date. or long-termLong‑term PCA is care needed for more than three years from the benefit start date.), effective date for the change and the next scheduled review date. The supervisor reviews the recommendation and approves or does not approve the discontinuation of PCA benefits, or the extension with changes in the PCA care level. The supervisor may adjust the recommended discontinuation date or the effective date for the change and review schedule, if required.	Administrative tasks Send a file note (Allowances/Personal Care Allowance) to the supervisor requesting approval for the recommended change in PCA (i.e. discontinuation of extension with changes in care). Supervisor: Send a file note (Allowances/Personal Care Allowance to the decision makers documenting the decision to approve or not approve the: discontinuation of PCA, or extension with changes in PCA care level.
6. Make and communicate the decision This step may be completed by the case assistant (no changes in care) or the case manager (changes in PCA). Review the supervisor's recommendation to approve or not approve the PCA extension, if applicable. Action any recommendations as appropriate. Call the worker to discuss the decision and rationale to approve or not approve the PCA extension. Notify the Medical Aid Team of the decision to: extend PCA benefits and if there are any changes in the level of care, the approval period and next review date. discontinue PCA benefits and the date benefits should end. Medical aid requests PCA benefits based on the effective date and the approval period PCA extension not approved (discontinued) Clearly explain why the worker does not qualify for an extension of their PCA benefits (e.g., medical aids or equipment resolved the functional limitations for personal care assistance, the worker moved and no longer requires the support, etc.). If applicable, discuss whether the worker may qualify for another benefit like HKA or HMA and explain the next steps for the review. Refer to Policy 04-10, Part I for other available allowances for serious injuries or Policy 04-07, Part I Services for Workers with Severe Injuries. Communicate the decision in writing and end this procedure. PCA extension, no changes approved If the decision was previously discussed with the worker (step 2), communicate the decision in writing and continue to monitor the claim. Repeat these steps at the next scheduled review date or sooner, if required. If the decision was not previously discussed with the worker, discuss the decision to extend the PCA benefits and the next scheduled review date. Refer to Policy 04-07, Part I - Services for Workers with Severe Injuries. Communicate the decision in writing, set up the next scheduled review date and continue to monitor the claim. Repeat these steps at the next scheduled review date or sooner, if required. PCA extension with changes approved Clearly explain the decision to extend PCA benefits including the changes in the care level and the rationale used to support the decision. Ensure to discuss any of the changes that apply: PCA care level, whether it has increased or decreased, and what the personal care tasks the care level includes. Change from short-term to long-term care. The next review date Communicate the decision in writing, set up the next scheduled review date and continue to monitor the claim. Repeat these steps at the next scheduled review date or sooner, if required. Set up the next review schedule Review the claim on a regular basis as the worker's condition progresses to ensure the level of care meets the worker's needs. Short-term PCA must be reviewed annually for the first two years or more frequently if the worker is expected to progress in recovery. A comprehensive review must be completed in year three. Long-term personal care Review the claim as the worker's condition progresses and approximately every year thereafter to ensure the care plan meets the worker's changing needs. Long-term PCA must be reviewed annually at a minimum and contact by the case manager is required every three years at minimum. An OT assessment must be completed when the worker's functional levels have changed or their living situation has changed, an OT assessment must be completed. Note: If a worker in receipt of PCA benefits updates their address, an auto-task will be triggered for the claim owner to review for any changes to the ongoing benefit entitlement. If no further active case management is required, assign the claim to the case assistant outlining any monitoring requirements and the next scheduled review date.	Administrative tasks PCA extension not approved (discontinued) Send a file note (Allowances/Personal Care) to the Medical Aid Allowances/Team Desk documenting the decision to discontinue PCA benefits and the date benefits should end. Send the Special Needs Allowance Review (CL602E) letter. PCA extension approved Add a file note (Allowances/Personal Care) documenting the decision and rationale to approve the PCA extensions. Include the following information: Any changes and the level of PCA approved. Whether it is based on single or shared accommodation. Effective date for any changes (i.e. increase or decrease in level), next review date and end date, if known. Name of service provider, if known. Attach the file note to the Severe Injury Line and send it to the Medical Aid Allowances/Team Desk to extend the monthly PCA payments and adjust the level to be paid, if applicable. Send the appropriate letter. If there were: no changes, send the PCA & HMA Severe Inj. Extension (CL602M) letter. changes, send the Special Needs Allowance Review (CL602E) letter. Set the next scheduled review date For short-term care: Set a task for the yearly review (or less than one year, if changes are expected). Set a task for a year three review. For long-term care: Set a task for yearly review and a task for case manager contact every three years. To assign the claim to the case assistant: Complete the CPCM to CPCA Transfer file note template. Include details related to monitoring, the next scheduled PCA review date, and when the claim should be reassigned back to the case manager. Copy and paste the template information into a file note (Case Assistant) with the Description line: Transfer claim to home care planning CA.

Retroactive Personal care allowance

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1. Confirm the severe injury status and functional limitations For all retroactive PCA reviews, information relevant to the retroactive period and the policy in effect at that time must be considered to determine if the worker met the PCA eligibility criteria. Note: Confirm if the worker has any other claims and check if they received HKA or PCA on another claim for the same period. If they did, they are not eligible for payment on a second claim. When the worker has more than one claim, ensure PCA is paid under the claim with greater functional limitations. If it is not, transition payment to that claim. For the retroactive period under consideration Review all available information that falls within (or closely relates to) the retroactive period to determine if the worker required assistance with personal care tasks because of their compensable injury. This may include any medical reports, OT or other assessments (e.g. home care, physiotherapy, functional capacity evaluations) or contact from the worker, caregiver or a treatment provider requesting assistance with care. Based on the medical information and the applicable policy at that time, determine if the worker met the criteria for a severe injury. Refer to Policy 04-07, Part I that corresponds to the retroactive period under considerationTo consider the policy in effect at that time, scroll to the bottom of the policy and select the relevant period.. Example: PCA is requested to be paid effective February 1,1987; the policy in effect in February, 1987 dictates whether or not the claimant meets entitlement criteria. For each consecutive year of PCA request thereafter (e.g., 1988, 1989, etc.,) the entitlement and rates paid are determined by taking into account any policy changes during those years. Note: For workers with temporary disability, consider if the worker may be eligible retroactive STHA benefits. Refer to the 5-2 Short-term home assistance procedure. If the worker was not severely injured, they do not qualify for PCA. Continue to step 5 to communicate the decision. If the worker was severely injured, continue to review the worker's eligibility for retroactive PCA.
2. Call the worker to gather information for the retroactive PCA review Have a collaborative discussion with the worker and gather information to confirm the type of care they received for the retroactive period under consideration. Explain that PCA is intended to ensure that a severely injured worker or their family is not incurring additional out-of-pocket expenses in order to obtain care, or that family members who provide the necessary care are compensated for their work. To assist in determining the level of care the worker required during the retroactive period, complete the Personal Care Needs form. Ask the worker: Who provided care during the retroactive period (i.e., hired caregiver, spouse or other family member)? Did their spouse quit their job or take a leave of absence from their job to provide care? Note: Retroactive PCA benefits may be considered even if no paid caregiver was hired, including situations where a family member provided care without remuneration. What type of personal care assistance did the caregiver provide? If a caregiver was hired. If one was, ask them to submit: billings from the Home Health Agency, invoices from the caregiver or other suitable proof for services they paid for, or government documents if a foreign caregiver was hired. If they were in a hospital or extended care facility during the period in question. If they were, gather the name of the facility and dates they were admitted. If the hospital arranged for follow-up care following their discharge? If care was arranged, WCB is responsible for paying the hospital directly for these services, therefore PCA may not be required. Discuss next steps and refer for an OT assessment, if needed When the medical information supports the worker had functional limitations affecting their ability to manage personal care tasks, ask the worker to submit receipts, invoices or other proof to support they incurred additional expenses if available. Continue to the next step. When the medical information supports the worker did not have functional limitations affecting their ability to perform personal care tasks, the worker is not eligible for retroactive PCA. Continue to step 5 to communicate the decision.	Administrative tasks Document the discussion in a file note (Allowances/Home Maintenance). Complete the Personal care needs (FM719A) form.
3. Determine eligibility for retroactive PCA Review the available information for the retroactive period including any additional information submitted by the worker (e.g., receipts, invoices, or other documentation) that confirms they required care or incurred out-of-pocket expenses). When there is not sufficient evidence to support that the worker required assistance with personal care, the worker is not eligible for retroactive PCA. Continue to the next step to communicate the decision. When there is sufficient evidence to support that the worker required assistance with personal care, and the worker met the eligibility criteria outlined in Policy 04-07, Part I that corresponds to the retroactive period under considerationTo consider the policy in effect at that time, scroll to the bottom of the policy and select the relevant period., identify the date PCA benefits should have started. Choose the effective date based on when medical evidence first shows the worker needed assistance, taking into consideration any additional information the worker provided about care they hired or had in place. Medical evidence to consider may include hospital or return-to-work program discharge reports, Independent Medical Examination reports, treating specialist reports, Functional Capacity Evaluation reports, medical consultant opinion regarding permanent work restrictions, etc. If required, discuss or refer to a medical consultant to help determine when the worker would have required support for personal care tasks. Once the effective date is confirmed, determine the PCA care level based on the care levels in place during the retroactive period. For retroactive care levels from: January 1, 2017 to current, refer to the Current personal care allowance levels effective January 1, 2017 section. January 19, 1973 to December 31, 2016, refer to the Resource Library.	Administrative tasks Follow the 11-2 Internal consultant referrals procedure
4. Obtain approval to pay retroactive PCA benefits Send a recommendation to the supervisor requesting approval to pay retroactive PCA benefits. Include the following information: Medical reporting that supports the worker had a compensable severe injury for the retroactive period under consideration and the functional limitations that resulted in the need assistance with personal care tasks. Who provided care to the worker during the retroactive period and what type of personal care tasks they completed. Evidence provided by the worker showing out‑of‑pocket expenses or documentation for hired caregivers, if applicable. The PCA level recommended for the retroactive period, the reason for selecting that level, whether the allowance will be paid as a single or shared accommodation. Retroactive PCA effective date, information used to confirm the start date, and the end date, if applicable. The supervisor reviews the recommendation and approves or does not approve retroactive PCA benefits, including the effective date and the end date, if applicable. The supervisor may adjust the recommended effective date and end date, if required.	Administrative tasks Send a file note (Allowances/Personal Care Allowance) to the supervisor documenting the recommendation to pay retroactive PCA. Supervisor: Send a file note (Allowances/Personal Care Allowance) to the case manager documenting the decision to approve or not approve retroactive PCA benefits. Include the effective (start and end) date for the payment.
5. Make and communicate the decision Review the supervisor's recommendation to approve or not approve retroactive PCA benefits. Action any recommendation, if appropriate. Call the worker to discuss the decision and rationale to approve or not approve retroactive PCA benefits. If retroactive PCA is not approved, clearly explain why the worker is not eligible (e.g., worker was not severely injured or the medical evidence does not support the worker needed personal care assistance for the retroactive period under consideration). If retroactive PCA is approved, discuss the rationale for the approval, the PCA level of care, the effective date and the end date, if applicable. Communicate the decision in writing. Notify the Medical Aid Team of the approval details so they can process the payment. Note: If the effective date is in the middle of the month, the Medical Aid payment clerk will process the payment based on a prorated calculation. If ongoing entitlement for PCA benefits has: not been determined, continue to the Initial personal care allowance decision section. has been determined, continue to monitor the worker's eligibility. Refer to the Monitor personal care allowance eligibility section.	Administrative tasks Document the discussion in a file note (Allowances/Personal Care Allowance). Send the appropriate letter to approve or not approve retroactive PCA and adjust the letter to include information related to the retroactive period(s): the Personal Care Allowance (CL602A) letter, or the Combined PCA & HMA (CL062G) letter if making a decision for retroactive PCA and HMA at the same time. Send a file note (Allowances/Personal Care Allowance) to the Medical Aid Allowances, Team Desk documenting approval for retroactive PCA benefits. Include the rationale for approval, the services approved and the time period payable.

Supporting information

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Allowance benefits during hospitalization PCA benefits are not paid when a worker is confined to an institution forDefinition of an institution can be a hospital, nursing home or other institution. Refer to Policy 04-07, Application 4. 30 consecutive days or more. PCA benefits can be paid for up to 30 days after admission to hospital to allow: WCB to assess the situation and the length of the hospital stay Consistency in caregiver treatment if the worker is discharged within the 30-day time frame In rare cases where a severely injured worker is in the hospital and medically requires a family member to act as a personal care attendant, refer to the 5-8 Initial hospitalization, treatment, and care facility benefits procedure to determine the type of benefit(s) payable.
Benefit allocation for multiple claims or shared household There can be duplication of benefits when PCA is paid to more than one worker living in the same home, or to a worker who is receiving allowances on more than one claim. When this happens for: A worker with more than one claim, consider paying the allowance on the claim that has the greatest impact on the worker's ability. Two workers who are living in the same home that both qualify for the allowance, split the costs equally. Assess what components of the allowance are a duplication (based on the level given). For example, if two workers are receiving Level 1 PCA, this would be a duplication because both individuals are being paid the same allowance, even though the housekeeping tasks only need to be completed once for the household. Discuss the issue and negotiate a resolution with the decision maker assigned to the claim for the other worker living in the same home, and the worker on your caseload. Ideally the allowance(s) will be split, but another approach can be considered if it will be more effective in eliminating the duplicate benefits given the circumstances of the claims (e.g., one person gets full benefit, one allowance to each worker when more than one allowance is being paid, etc.). Consider arranging an OT assessment to determine each worker's current functional limitations if it has been a while since one was completed.	Administrative tasks Add a file note (Allowances/Personal Care Allowance) and document the decision, how the worker's allowance payments are to be reduced (or stopped), and the claim number for the other worker living in the same home. Send the file note to the Medical Aid Allowances, Team Desk team. This is important as the Medical Aid team needs to update the skeleton and add COLAs manually. Send the Personal Care Allowance (CL602A) letter to the worker outlining the decision and clearly explaining how the duplication of benefits is being eliminated and how this impacts their benefits
Wound care A wound care assessment assists claim owners to develop care plans for workers with complex woundsComplex wounds may include pressure sores, extensive post-surgical wounds, ostomy care. that have not healed within expected time frames or wounds that are experiencing complications (e.g., infection). Any extensive or complex wound care must be completed by qualified agency personnel, such as a nurse or wound‑care specialist. Wound care assessments are completed by the third-party assessor who will assess and implement a wound care plan to promote healing and prevent further complications. They may provide direct treatment (depending on the plan) or discuss the plan with the home health care provider and educate them on managing the wound care. For more information, refer to the Wound care assessment section of the 4-5 Home Health Care procedure. If the worker is receiving self‑managed personal care, WCB is responsible for hiring an agency to deliver the wound care. If the worker’s spouse is the one providing personal care, the Enterostomal Therapy (ET) nurse can train them to do the dressing changes as well. Wound care may be covered when medically necessary for workers who qualify. This is in addition to the amounts listed for PCA levels 1 to 9 for self-managed care. If a caregiver needs more time to manage wound care, those additional hours can be approved based on medically prescribed needs and at the rates contracted through Health Care Strategy. If it appears the worker needs significantly more time for wound care, a new PCA assessment should be completed to determine whether they should be moved to a higher personal care level. Workers who perform their own wound care are not eligible for the additional wound care fee on top of their monthly PCA amount.	Administrative tasks To make a referral for a wound care assessment, follow the 4-5 Home health care procedure.

Compatibility Warning

WCB Procedures

Personal care allowance

Procedure summary

Eligibility criteria

Choosing self-managed care vs. agency care

Monitoring PCA

Retroactive PCA

Initial personal care allowance decision

Administrative tasks

Administrative tasks

Evaluate medical aid(s)/equipment recommendations

Discuss recommendations with the worker

Provision of aids/equipment

Administrative tasks

Provision of aids/equipment

Identify the PCA effective date

Administrative tasks

Administrative tasks

PCA not approved

PCA is approved

Administrative tasks

PCA not approved

PCA is approved:

Administrative tasks

Personal care allowance levels effective January 1, 2017

Personal care allowance level structure

Selecting the appropriate PCA level

Administrative tasks

Type of assistance

PCA Level 1 rates:

Type of assistance in addition to those listed in level 1

PCA Level 2/3 rates

Type of assistance in addition to those listed in level 2/3

Level 4/5 rates

Type of assistance in addition to those listed in levels 2 to 5

Level 6 rates

Type of assistance in addition to those listed in levels 2 to 6

Level 7 Rates

Type of assistance in addition to those listed in levels 2 to 7

Level 8 Rates

Type of assistance in addition to those listed in levels 2 to 8

Level 9 Rates

Monitor Personal care allowance eligibility

Gather information for the PCA review

Determine if PCA needs to be reassessed

Administrative tasks

Administrative tasks

Evaluate medical aid(s)/equipment recommendations

Discuss recommendations with the worker

Provision of aids/equipment

Administrative tasks

Provision of aids/equipment

Determine PCA care level changes

Administrative tasks

Administrative tasks

PCA extension not approved (discontinued)

PCA extension, no changes approved

PCA extension with changes approved

Set up the next review schedule

Long-term personal care

Administrative tasks

PCA extension not approved (discontinued)

PCA extension approved

Set the next scheduled review date

Retroactive Personal care allowance

For the retroactive period under consideration

Discuss next steps and refer for an OT assessment, if needed

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Supporting information

Administrative tasks

Administrative tasks

Supporting references

Policies

Procedures

Related links

Workers’ Compensation Act