A-25, r. 14 - Regulation respecting the reimbursement of certain expenses

Schedule Disposition versions

2012-09-01

SCHEDULE I.1

(s. 2)

DETAILED EVALUATION OF PERSONAL HOME ASSISTANCE REQUIREMENTS

Each activity in the detailed table must be evaluated do determine the personal home assistance requirements:

No assistance required: the victim is capable of carrying out the activity alone, safely and effectively.

Partial assistance required: the victim is capable of safely and effectively carrying out alone a significant part of the activity, but requires the regular help of another person to carry out de activity completely.

Maximum assistance required: the victim is incapable of safely and effectively carrying out the activity alone and requires the help of another person during the entire activity or most of it. The assistance may be physical or verbal.

DETAILED EVALUATION CHART

Personal home assistance requirements                    None     Partial    Maximum

Personal hygiene and care                                  ♦         ♦          ♦

1. personal hygiene                                        0         5          9

2. dressing and undressing                                 0         3          6

3. eating                                                  0         8         15

Bladder and intestinal elimination                         ♦         ♦          ♦

4. use of toilet                                           0         6         11

5. menstrual hygiene                                       0        0.3        0.6

6. use of disposable briefs                                0         7         14

7. emptying of bladder into a bag attached to the skin     0         5          9

8. emptying of bladder by catheterism                      0        14         27

9. emptying of bladder by a catheter à demeure             0         6         12

10. emptying of the bladder by urinary condom              0         7         15

11. emptying of the bladder by urinary    
    condom and by tapping                                  0        11         21

12. emptying of the intestine into a bag
    attached to the skin                                   0         8         15

13. emptying of the intestine through the
    use of a suppository, an enema solution 
    or annal stimulation                                   0         5          9

14. irrigation of the bladder                              0         1          2

Health care                                                ♦         ♦          ♦                               

15. taking of medication                                   0         2          3

16. tracheostomy maintenance and aspiration                0         8         15

17. clapping, thoracic pressure, postural drainage         0         2          4

18. skin care (prevention of pressure wounds)              0         2          3

19. home exercise program                                  0         2          3

20. other health care (in accordance with the
    method prescribed in the description of
    activities)                                            0        ---        36

21. putting in place a prosthesis or an orthosis           0         2          3

22. maintenance of special equipment                       0         1          2

Locomotion                                                 ♦         ♦          ♦

23. arising from bed and going to bed                      0         3          6

24. use of available facilities at home                    0         2          3

25. using a mode of transportation                         0         1          2

26. use of patient lifting devices or
    transfers with two helpers                             0        ---         6

Household activities                                        ♦         ♦          ♦ 

27. preparation of a light meal                            0         5          9

28. preparation of a complex meal                          0         4          7

29. daily housekeeping                                     0         3          6

30. weekly housecleaning                                   0         2          3

31. care of household linen and clothes                    0         1          2

32. shopping and services                                  0         2          3

33. budget management                                      0        0.5         1

34. Leisure activities                                     0        12         30

35. Sleep                                                  0        48         72

TOTAL SCORE            

DESCRIPTION OF ACTIVITIES

Personal hygiene and care

(1) personal hygiene means to wash every part of the body including hair; dental hygiene; transfer to bathtub or shower, grooming (shaving, applying makeup, combing hair; doing nails, hair removal). If the assistance requirements are for appearance purposes only, they must involve at least 3 activities to be rated “partial assistance;”

(2) dressing and undressing means to dress and undress oneself, including outdoor clothing;

(3) eating means to serve oneself a beverage, season and cut food, lift food to one’s mouth. This includes feeding oneself using special equipment, such as a nasogastric tube or a tube used in a gastrostomy;

Bladder and intestinal elimination

(4) use of toilet means to use a toilet or commode, a urinal or bedpan; wipe oneself, rearrange clothing and stand up. This activity is rated “no assistance” where a special device for bladder or intestinal elimination is used;

(5) menstrual hygiene means to put a sanitary napkin, tampon or disposable brief in place and clean the genital region;

(6) use of disposable briefs means to put on and remove the brief; ensure hygiene; put on clothing and transfer to bed if necessary. This activity is rated “no assistance” where another special device for bladder or intestinal elimination is used (activities 7 through 14) or if activity No. 4 “use of toilet” is rated;

(7) emptying of bladder into a bag attached to the skin (ileac bladder) means to use (put in place and remove) and maintain the equipment, ensure hygiene; rearrange clothing;

(8) emptying of bladder by catheterism means to use and maintain the equipment, ensure hygiene, rearrange clothing, perform transfers;

(9) emptying of bladder by a catheter à demeure (and bag) means to use and maintain the equipment, ensure hygiene, rearrange clothing;

(10) emptying of the bladder by urinary condom (and bag) means to use and maintain the equipment (including emptying the bag), ensure hygiene, rearrange clothing, perform transfers;

(11) emptying of the bladder by urinary condom with tapping (and bag) means to use and maintain the equipment; tapping, ensure hygiene, rearrange clothing, perform transfers;

(12) emptying of the intestine into a bag attached to the skin (colostomy, ileostomy) means to use and maintain the equipment; ensure hygiene, rearrange clothing;

(13) emptying of the intestine with an enema solution, a suppository or anal stimulation means to use and maintain the equipment; ensure hygiene, put the disposable brief in place if necessary and rearrange clothing;

(14) irrigation of the bladder means to use and maintain the equipment; ensure hygiene;

Health care

(15) taking of medication means to prepare, ingest or apply medication (pills, ointments, drops, bandages, and injections). If the medication is associated with the accident, required assistance is rated whether or not it is a result of the accident. If the medication is not associated with the accident, required assistance is rated if it is a result of the accident;

(16) tracheostomy maintenance and aspiration means to maintain the tracheostomy and withdraw secretions;

(17) clapping, thoracic pressure, postural drainage means to apply the techniques of clearing the respiratory tract during infections. It is rated “maximum assistance” where the assistance is required more than three months a year;

(18) skin care means to carry out daily skin care to prevent pressure-induced ulcerations; repositioning regularly during the day, regular skin examination. The required assistance to turn the person over at night will be evaluated in activity No. 35 “Sleep”;

(19) home exercise program means to carry out an exercise program prescribed and supervised by a health professional. The program’s aim must be to treat injuries associated with the accident or maintain the person’s state of health, and must present advantages over direct treatment by the health professional alone;

(20) other health care means to provide medically prescribed health care other than that specifically provided for in the grid. Three points are attributed for every 15 minutes of assistance required per day. A maximum of 36 points (3 hours per day) may be attributed. If the other health care is associated with the accident, the required assistance, whether or not it is a result of the accident, must be rated according to the grid. If the other health care is not associated with the accident, the required assistance must be a result of the accident in order to be rated according to the grid;

(21) putting in place a prosthesis or an orthosis means to put on or take off a prosthesis or orthosis, including compressive clothing, splints or compensatory aids;

(22) maintenance of special equipment means to clean and maintain special equipment such as a wheelchair, prosthesis, orthosis or compensatory aid. This excludes equipment for bladder and intestinal elimination with a special device. Where maximum assistance is required less than three times, a week, it is rated as “partial assistance”;

Locomotion

(23) arising from bed and going to bed means to get out of bed and to go to bed for the night;

(24) use of available facilities at home means to move about inside the home; to enter and leave one’s home; to make use of the facilities other than those required for the activities provided for in the grid; to open and close the windows and doors; to make use of the furniture, to operate switches and use communication devices (telephone, radio, television);

(25) using a mode of tansportation means to get into a vehicle, to get out of it; put in and take out a wheelchair or walking assists if necessary. This excludes assistance required for health services associated with the accident;

(26) use of patient lifting devices or transfers with two helpers means that it is necessary to use a lifting device or two helpers are required to perform transfers; where only one helper is required, it is evaluated in the “personal hygiene and care” section;

Household activities

(27) preparation of a light meal means to plan and prepare two meals per day consisting of simple foods, reheated meals or those requiring little preparation. The activity usually corresponds to the preparation of breakfast and lunch;

(28) preparation of a complex meal means to plan and prepare one meal per day requiring several steps in its preparation. The activity usually corresponds to the preparation of dinner;

(29) daily housekeeping means to wash the dishes; to wipe the counters, the table and cooking surface; to clean the sink; to put things away; to sweep the floor; to make the bed;

(30) weekly housecleaning means to wash the floors, bathroom applicances and electrical appliances; to dust; to vacuum; to take out the garbage. The activity includes the annual cleanup: to wash the windows, walls and ceilings; to clean the cupboards, closets, floors, carpets; to wash the curtains and clean the drapes;

(31) care of household linen and clothes means to wash, dry, iron, fold and put away household linen and clothes;

(32) shopping and services means to plan and make purchases, including household items and clothing, shopping for groceries, at the drugstore, hardware store; to make appointments; to use public transit and services, including personal care (hairdresser, dentist, physician). This excludes activities related to health services associated with the accident;

(33) budget management means to plan and carry out activities related to managing personal finances and supervising income and expenses. Managing the budget is considered to occur before shopping and using services;

Other activities

(34) leisure activities means the physical or verbal assistance required to that the health and safety of the victim and those close to him are not endangered while the victim is awake and not busy with the activities listed in the grid. Having no service would result in the deterioration of the victim’s physical or mental condition. This excludes other services by accompanying persons already provided for by the Société through other measures, such as an availability allowance or rehabilitation. This includes additional assistance, but not special assistance, that is required to do school work at home;

(35) sleep means the physical or verbal assistance required so that the health and safety of the victim and those to him are not endangered while the victim is asleep. Having no service would result in the deterioration of the victim’s physical or mental condition. Assistance required to turn the victim over at a night is rated “partial assistance”.

O.C. 1332-99, s. 7.