Short-term home assistance

This step is completed by an adjudicator or case manager.

Assess the injury status

Determine if the worker meets the criteria for a seriously injuredSerious injuries include such injuries 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). worker as outlined out in Policy 04-10, Part I. If the worker:

• is not seriously injured, they do not qualify for STHA. Continue to step 7 to communicate the decision.
• may be severely injured, they do not qualify for STHA benefits. End this procedure and instead assess their eligibility for other supports under Policy 04-07, Part I Services for Workers with Severe Injuries.
• If the worker is seriously injured, confirm where they are at in their recovery.

Identify if the worker is in the acute phase of recovery

Review medical reports (e.g., hospital discharge) and determine if the worker is in the acute phase of medical recoveryThe acute phase of recovery starts immediately after injury and may last between 1 to 12 weeks depending on the injury severity and required treatments such as hospitalization, surgery or complication management. from a compensable injury and/or surgery or if further improvement in function is anticipated. 

Consider:

• Is the worker in the early healing phase (i.e., two to twelve weeks from the date of accident).
• The type of injury, severity and the treatment required to stabilize the worker's condition. For example:
  • Has the worker been hospitalized?
  • Have they had or will they have surgery?
  • Is the worker experiencing complications as a result of their compensable injury and/or surgery?
  • What other medical support or treatment is required?
• If the worker has functional limitations that prevent them from doing routine (interior or exterior) home tasks?
• Are the worker's functional limitations expected to improve or are permanent limitations confirmed?
• Whether STHA was previously approved and an extension review is required.  Note: STHA may be approved for a maximum of 12 weeks, or a maximum of $1500, whichever limit is reached first. Following the initial approval, a review is completed to determine eligibility for an extension.

If worker has permanent restrictions, they are not in the acute phase of recovery. End this procedure and instead assess their eligibility for other supports under Policy 04-10, Part II, Application 2: Home Maintenance Allowance Level 1 and Policy 04-10, Part II, Application 3: Housekeeping Allowance.

If the worker has temporary restrictions, they are in the acute phase of medical recovery, continue to the next step to gather additional information for the STHA review.

This step is completed by an adjudicator or case manager.

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 tasks at home (i.e., house cleaning, lawn or snow removal, yard work).

When speaking to the worker, listen to their concerns and gather specific information to determine the type of support they may need. Ask the right questions to better understand their current needs: 

• How are they managing with interior and exterior home upkeep tasks?
• What household tasks are they struggling with (i.e., laundry, cleaning the bathtub, vacuuming, yard work, etc.). Note: STHA is not intended to provide support for cooking, pet care, landscaping, home modifications, moving/relocation or major home repairs (e.g., plumbing, electrical, roofing, appliance repair, etc.).
• Were they responsible for these tasks before their injury? If yes, how are they managing now?
• Do they live alone? If not, confirm if there is another adult who is physically capable of completing these tasks? If there is another adult but they are not capable of helping, confirm the reason why (e.g., they work out of town for extended periods or has a physical injury or limitations, etc.).

If the worker is requesting approval for retroactive STHA benefits, gather information related to the retroactive period as outlined in the Retroactive short term home assistance section.

If there is someone available in the home who previously performed housekeeping/home maintenance tasks or who is available and can safely perform these tasks, explain to the worker that they do not qualify for STHA. Continue to step 7 to communicate the decision in writing.

If the worker lives alone and/or there is not another adult in the home who can safely perform the interior and exterior home tasks, explain that a referral will be made to the Home Assistance Team (HAT) to complete the review.

If the worker is currently approved for STHA and a review for STHA extension is neededA review for extension of STHA is required when the worker STHA benefits have exceeded 12 weeks or a maximum amount of $1500.00.:

• Consider if additional referrals or medical assessments [e.g., a referral for a medical opinion or a functional capacity evaluation (FCE)] are needed to confirm if the functional limitations will be permanent. If a referral is needed, discuss the referral with the worker and obtain their agreement to attend any assessments, if needed.  
• Explain to the worker that a referral will be made to the HAT team to review for an extension of their STHA benefits. 

This step is completed by an adjudicator or case manager.

When making a referral to the Home Assistance Team (HAT) to complete the STHA eligibility or extension review, include the following information in the referral:

• If the review is for Initial STHA eligibility or an extension. For extension reviews, include:
  • The date the current STHA approval expires.
  • Whether any additional referrals have been made (i.e. referral for a medical opinion, FCE to confirm permanent work restrictions).
  • How long STHA should be extended, if the review is for an extension (i.e. extension request for 3 months to allow for assessments).
• Rationale to support the worker meets the criteria for a serious injury as outlined in Policy 04-10, Part I.
• Medical reports that support the worker's fitness for work and functional limitations.
• Tasks the worker has difficulty performing.
• If there is another adult living in the home and the reason why they are unable to assist with completing the tasks (e.g., they work away from home, have a physical injury or limitations).

This step is completed by the Home Assistance Team (HAT).

Review the reason for the STHA referral (i.e., initial eligibility review or extension review) and confirm the information supports the worker has a serious injury with temporary functional limitations.

Consider if a referral for an occupational therapy assessment would be helpful in determining the worker's functional limitations and the type of support needed (i.e., medical aids, assistive devices, strategies for completing tasks, etc.).

Call the worker to confirm the details of the referral. If it is determined that an OT assessment is required, complete the Home Activity Review (HAR) form to compare the worker's perceived capabilities with the medical reports.

When an OT assessment is not required, continue to step 6.

When an OT assessment is required, explain to the worker that a referral will be made for an Occupational Therapy (OT) assessment. Ensure they understand that:

• An occupational therapist (OT) will arrange a time to visit them in their home to assess their abilities to manage interior and exterior household tasks based on their accepted injury.
• The OT will be provided with medical information to help better understand the worker's injury which will help with the assessment.
• The goal is to work together to promote and maintain their independence.
• Once the assessment results are received, the OT's recommendations will be reviewed to see if there are any aids, equipment, supports or strategies that can help them with the household tasks.

This step is completed by the Home Assistance Team (HAT)

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.

Evaluate medical aid(s)/equipment recommendations

If medical aid(s)/equipment were recommended, consider the reason for medical aid or equipment recommendations and how it will benefit the worker. Ask:

• Will the aid/equipment address a functional limitation resulting from the worker's compensable injury?
• 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 temporary functional limitations or will the worker still need additional support to maintain their home?

Consult with the OT and/or the special needs coordinator if there are questions or concerns about the recommended aids/equipment.

Discuss recommendations with the worker

Call the worker and review the OT recommendations including any aids, equipment, strategies and supports to help them complete interior and exterior household tasks.

When recommended aid/equipment is required, explain what aid(s)/equipment has been approved and that arrangements for purchase and delivery will be made through a WCB special needs coordinator. In some circumstances, the worker may be required to purchases the aid/equipment and submit the receipt for reimbursement. 

When the provision or aid(s)/equipment:

• resolves the temporary limitations and no other assistance is needed, discuss the decision to not approve STHA benefits.  Continue to step 7 to communicate the decision in writing.
• does not resolve the temporary limitations and additional assistance is needed, continue to the next step to determine the worker's eligibility for STHA.
   

When aid(s)/equipment are not required or the recommendation is not approved, continue to the next step to determine the worker's eligibility for STHA.

This step is completed by the Home Assistance Team (HAT).

Based on the available medical information and/or OT assessment (if completed), determine if the worker is eligible for STHA or an extension of STHA benefits, if applicable. Note: An extension review is complete when the initial approval period has ended (i.e. maximum of 12 weeks or $1500, whichever limited is reached first). 

The type of assistance and how often the worker needs support depends on their individual circumstances. Additionally, the amount of assistance required may change as the worker recovers and increases in their functional abilities (i.e., the worker is able to do more interior and exterior home tasks independently) or if their level of function decreases (i.e. after surgery). Review each claim on its own merits.

Ensure the worker is seriously injured, has functional limitations due to their compensable injury and is in the acute phase of recovery.

Assess the level and frequency of assistance required

• No assistance is required: Worker is independent.
• Infrequent assistance required (yearly): Worker needs assistance with a task once a year (e.g. cleaning behind appliances).
• Seasonal assistance required: Worker needs assistance for one season (e.g. winter months only).
• Multi-seasonal assistance required: Worker needs assistance for multiple seasons (e.g. winter and summer).
• Variable assistance required (monthly): Worker requires assistance once a month.
• Frequent assistance required (biweekly): Worker requires assistance once a week.

Identify the type of service and costs

Confirm:

• The type of service required is for inside the home, outside the home, or both and is required for tasks the worker is unable to do because of functional limitations due to their compensable injury.
• That the cost for the service is reasonable for the size of the worker's living situations (home, apartment or condo). For example, the costs for:
  • Inside the house would not reasonably exceed the amount of the monthly Housekeeping Allowance (HKA).
  • Outside the house would not reasonably exceed the amount of the monthly Home Maintenance Allowance (HMA), Level 1. Refer to Policy 04-10, Part II, Addendum A.
  • For both inside and outside household tasks, STHA should not exceed the maximum monthly amounts for HKA and HMA, Level 1. STHA may be authorized up to a maximum of 12 weeks or $1500, whichever comes first.

For STHA extension reviews, send the recommendation to extend the STHA benefits to the Home Assistant team (HAT) supervisor. The HAT supervisor approves or does not approve the recommended extension.

This step may be completed by a case manager or adjudicator (for some circumstances when STHA is not approved) or by the Home Assistance Team (HAT). All STHA extension decisions are communicated by the Home Assistance Team (HAT). 

Call the worker to discuss the decision and rationale to approve or not approve STHA, or an extension of STHA, if applicable.

STHA not approved

If the decision is to not approve STHA or an extension of STHA, if applicable, clearly explain why the worker does not qualify if not discussed with the worker in an earlier step (e.g., not seriously injured, not in the acute phase of recovery, or someone living with them is able to help at home, medical aids or equipment resolved the temporary limitation).

If applicable, discuss whether the worker may qualify for another benefit like HMA, HKA, or PCA and explain the next steps for the review. Refer to Policy 04-07, Part I Services for Workers with Severe Injuries. 

Communicate the decision in writing and end this procedure.

STHA approved

If the decision is to approve STHA or an extension of STHA, if applicable, inform the worker of the effective date, payment frequency to the provider, the approved services included (e.g., house cleaning, snow removal, lawn care) and the amount approved. Clarify that STHA is not include services for pet care, meal preparation, or grocery shopping.

Encourage the worker to find a local services provider (e.g., house cleaner, lawn maintenance company, etc.) and explain that a Short Term Home Assistance invoice will be included with the approval letter for their provider to submit for payment. 

Note: The Medical Aid team issues payments directly to the provider or the worker upon receipt of the invoice or receipts. 

Assign the claim back to the home adjudicator or case manager to monitor the worker's recovery and eligibility for STHA. 

This step is completed by a case manager or adjudicator.

Monitor the worker's recovery and eligibility for STHA.

Send a referral to the Home Assistance Team (HAT) to review for extension of STHA benefits when:

• the STHA benefits exceed $1500 or the approval period of 12 weeks
• the worker's limitations/restrictions are expected to be permanent, but medical confirmation is required, send a referral to the Home Assistance Team (HAT) to consider an extension. 

Home Assistance Team (HAT): Return to step 6 to complete the STHA extension review.

End STHA benefits when:

• the worker is no longer in the acute phase of recovery and/or their functional limitations improve so that they no longer require support for interior and exterior household tasks.
• Permanent limitations/restrictions are medically confirmed. Consider if the worker qualifies for another benefit type as outlined in Policy 04-10, Part II, Application 2: Home Maintenance Allowance Level 1 and Policy 04-10, Part II, Application 3: Housekeeping Allowance.

Return to step 7 to communicate the decision.