APPEAL I PART C -Decision under Appeal The decision under appeal is the Ministry of Social Development and Social Innovation (the ministry) reconsideration decision of April 15, 2014, which denied the appellant's request for a floor-to-ceiling pole for his living room. The ministry determined that the appellant did not meet the program criteria because a floor-to-ceiling pole is an eligible item only when it is intended for use in a bathroom or bedroom pursuant to Section 3.5 of Schedule C of the Employment and Assistance for Persons with Disabilities Regulation. Additionally, the ministry determined that the floor-to-ceiling pole is not listed under any of the other health supplements in schedule C and the criteria of section 69 were not met because the floor-to-ceiling is not required to meet a life-threatening health need. PART D -Relevant Legislation Employment and Assistance for persons with Disabilities Regulation (EAPWDR), Sections 62 and 69. Employment and Assistance for persons with Disabilities Regulation, Schedule C.
PART E -Sum mary of F a ct s · The evidence b efo r e the minis tr y at re con siderat ion • A Request for A ids o r Adap tat ions dated Ma r Occupation al Therapis t ( OT) . • A Physic ian Refe rral/Order s dated Feb ruary • A Quotatio n for an installed S u perpole date d • Th e appe l l ant's Request f o r R econs ide r at ion appella nt's physici an that the appellant' s con difficulty st anding and wa lki n g; a nd he nee ds In t he Re qu e st for A i d s or A d a pt a tio n s, the a p pellant's spe ci f ically an inst alled Supe r p ole whic h for t he p u rpos p ole, for t he appe llant who has a history of a rt hri tis and di bala nc e and requires ass i s t an c e t o ambul ate and t ran need of a Su p er p o le next to th e chair in the living room wher wit h saf e t r ansf ers i n and out o f his c ha i r and i s differe pr o vided and i nstalled in h is bedro om f o r bed transfe In the Physic ian Referral/Ord ers, it is rep orte d t ha t t in nee d of a floor to c ei l i ng pole i n t h e liv ing roo m next him to safely tra n s fe r in and out of his chair . In the Noti ce o f A pp ea l dated Ap r i l 23, 2014, it is wr a n d he needs equip men t t o g e t up . It fur t h e r states t a n d b oth his OT an d Doct or h ave said th e equip m e nt At t he hearing, the app el lant's son who rep resen t ed to loo k aft er his f a t her wh ose h ea lth has been fail ing testifi ed th at his fath er i s 5' 11" an d wei g hs 170 l bs ., helps his father t o get up abo u t 6 times every night to go to the bathroom. The appellant's son t hat he was told by a case worker that he cou ld get help a the liv ing ro om where the appellant's spends most of his time. the appellant's son indicated that the appellant also uses a walker. The panel determined the additional oral evidence from the appellant's son was admissible under section 22(4) of the EAA as it was in support of the record before the minister at reconsideration as it provided particulars about the appellant's condition and needs. No additional evidence was provided by the ministry on appeal. Findings of Fact The appellant is designated as a Person wit h Disability an provided under section 62 and Schedule C of the EAPWDR. APPEAL I c onsisted of the f ollowi n g : c h 14, 201 4 sig n ed b y the ap pe llan t's 17, 201 4 signed by the ap pe llan t's physicia n. Marc h 13, 201 4 for $22 6 . 80. d ate d A p ri l 4 , 2 01 4 where it was in dica t ed b y the dition h as wo rsen ed; he is now b li nd a nd has a Superpole in the bathroom an d l iving r oom. OT r ecomm ended ther a p eu tic e qui p me nt; e o f t he legi s l a tion is called a floor-to-ce ilin g abetes an d h as red u ce d mobility, poo r sfer. The appell ant i s at r i s k fo r falls and is in e he regularly sit s. Th e pole wi l l a ssi st n t t ha n th e p ole t ha t wa s rece ntly approv ed , rs. he app ellant h as b e en a s se s se d by the O T an d is t o the chair whe r e he re g u l arly sits, in order fo r itt en that th e appel lan t's h ealt h h as worsened, h a t the app ellant has d e ment ia a n d blindness is nee ded. him stated that he does n o t wo rk a n d s tays home part icul arl y s ince March. The appe ll a nt's son has a h a rd ti me t o get up on h i s own and t hat he stated nd that a Su p erpo l e wa s reco mmended for In response to a question by the pane l, d is eligible t o r eceive h eal th supple ments
APPEAL I PART F -Reasons for Panel Decision The issue in this appeal is whether the ministry reasonably determined that the appellant is ineligible for an installed floor-to-ceiling pole for his living room as a health supplement as the criteria pursuant to sections 62 and 69 and Schedule C, of the Employment and Assistance for Persons with Disabilities Regulation were not met. Relevant Legislation EAPWDR ,Schedule C Medical equipment and devices 3 (1) Subject to subsections (2) to (5) of this section, the medical equipment and devices described in sections 3.1 to 3.12 of this Schedule are the health supplements that may be provided by the minister if (a) the supplements are provided to a family unit that is eligible under section 62 [general health supplements] of this regulation, and (b) all of the following requirements are met:(i) the family unit has received the pre-authorization of the minister for the medical equipment or device requested; (ii) there are no resources available to the family unit to pay the cost of or obtain the medical equipment or device; (iii) the medical equipment or device is the least expensive appropriate medical equipment or device. Medical equipment and devices -toileting, transfers and positioning aids 3.5 (0.1) In this section: "positioning chair" does not include a lift chair; "transfer aid" means a transfer board, transfer belt or slider sheet. (1) The following items are health supplements for the purposes of section 3 of this Schedule if the minister is satisfied that the item is medically essential to facilitate toileting or transfers of a person or to achieve or maintain a person's positioning: (a) a grab bar in a bathroom; (b) a bath or shower seat; (c) a bath transfer bench with hand held shower; (d) a tub slide; (e) a bath lift; (f) a bed pan or urinal; (g) a raised toilet seat; (h) a toilet safety frame; (i) a floor-to-ceiling pole in a bathroom or bedroom; U) a portable commode chair; (k) a standing frame for a person for whom a wheelchair is medically essential to achieve or maintain basic mobility; (I) a positioning chair for a person for whom a wheelchair is medically essential to achieve or maintain basic mobility; (m) a transfer aid for a person for whom the transfer aid is medically essential to transfer from one position to another. (2) The period of time referred to in section 3 (3) (b) of this Schedule with respect to replacement of an item described in subsection (1) of this section is 5 years from the date on which the minister provided the item being replaced. General Health Supplements -medical supplies 2 (1) The following are the health supplements that may be paid for by the minister if provided to a family unit that is eligible under section 62 [general health supplements] of this regulation: (a) medical or surgical supplies that are, at the minister's discretion, either disposable or reusable, if the minister is satisfied that all of the following requirements are met: (i) the supplies are required for one of the following purposes: (A) wound care; (B) ongoing bowel care required due to loss of muscle function; (C) catheterization; (D) incontinence; (E) skin parasite care; (F) limb circulation care.
S e c t i o n s 2 . 1 , 2 . 2 , · 4 , 4 . 1 , 5 , 6 , 7 , 8 a n d 9 s e t o u t a d d i t i o n a l h e a l p r o v i d e d t o a f a m i l y u n i t t h a t i s e l i g i b l e u n d e r s e c t i o n 6 2 [ g e n e a n d d e n t a l , t h a t a r e n o t t h a t a r e r e l e v a n t t o t h e r e q u e s t . E A P W D R H e a l t h s u p p l e m e n t f o r p e r s o n s f a c i n g d i r e c t a n d i m m 6 9 T h e m i n i s t e r m a y p r o v i d e t o a f a m i l y u n i t a n y h e a l t h s u p p l e s u p p l e m e n t s ] a n d 3 [ m e d i c a l e q u i p m e n t a n d d e v i c e s ] o f S c h e d p e r s o n i n t h e f a m i l y u n i t w h o i s o t h e r w i s e n o t e l i g i b l e f o r t h e h e s a t i s f i e d t h a t ( a ) t h e p e r s o n l a c e s a d i r e c t a n d i m m i n e n t l i f e t h p e r s o n ' s f a m i l y u n i t w i t h w h i c h t o m e e t t h a t n e e d ; ( b ) t h e h e a l p e r s o n ' s f a m i l y u n i t i s r e c e i v i n g p r e m i u m a s s i s t a n c e u n d e r t h e s p e c i f i e d i n t h e f o l l o w i n g p r o v i s i o n s o f S c h e d u l e C , a s a p p l i c a b s e c t i o n s 3 t o 3 . 1 2 , o t h e r t h a n p a r a g r a p h ( a ) o f s e c t i o n 3 ( 1 ) . T h e a p p e l l a n t ' s p o s i t i o n i s t h a t t h a t h e r e q u i r e s a f l o c h a i r w h e r e h e r e g u l a r l y s i t s a n d s p e n d s m o s t o f h i s o u t o f t h i s c h a i r . T h e a p p e l l a n t ' s p h y s i c i a n a n d o c c u l i v i n g r o o m w o u l d p r o v i d e t h e a p p e l l a n t a s s i s t a n c e t b e c a u s e o f h i s w o r s e n i n g c o n d i t i o n . T h e m i n i s t r y ' s p o s i t i o n i s a s f o l l o w s : 1 . T h e c r i t e r i a o f s e c t i o n 3 . 1 t o 3 . 1 2 o f S c h e d u l e e a c h c a t e g o r y . S u p e r p o l e s a r e s e t o u t u n d e r b a t h i n g a n d t o i l e t i n g a i d s a s f o l l o w s : ( i ) a f l o o r t o c e i l i n g p o l e i n a b a t h r o o m o r b e d T h e E A P W D R e g u l a t i o n , S c h e d u l e C , s e c t i o n b a t h r o o m o r b e d r o o m i s a h e a l t h s u p p l e m e n t d e f i n e d a s a t r a n s f e r b o a r d , t r a n s f e r b e l t o r s l s u p e r p o l e i s n o t o n e o f t h e o t h e r i t e m s s e t o u b e c a u s e i t i s n o t l i s t e d u n d e r m e d i c a l e q u i p m w h e e l c h a i r , s c o o t e r , a g r a b b a r , a f l o o r o r c e i l a c u s t o m m a d e o r t h o t i c a n d / o r a h e a r i n g a i d 2 . T h e c r i t e r i o n o f s e c t i o n 2 ( 1 ) ( a ) o f S c h e d u l e C u n d e r d i s p o s a b l e o r r e u s a b l e m e d i c a l o r s u r g o u t i n s e c t i o n 2 ( 1 ) ( a . 1 ) ; w o u n d c a r e , o n g o i n g p a r a s i t e c a r e a n d / o r l i m b c i r c u l a t i o n c a r e ; a n d p u r s u a n t t o s e c t i o n 2 ( 1 ) ( a . 2 ) . 3 .I A P P E A L t h s u p p l e m e n t s t h a t m a y b e p a i d f o r b y t h e m i n i s t e r i i r a l h e a l t h s u p p l e m e n t s ] o f t h i s r e g u l a t i o n i n c l u d i n g o p t i c a l i n e n t l i f e t h r e a t e n i n g h e a l t h n e e d m e n t s e t o u t i n s e c t i o n s 2 ( 1 ) ( a ) a n d ( I ) [ g e n e r a l h e a l t h u l e C , i i t h e h e a l t h s u p p l e m e n t i s p r o v i d e d t o o r f o r a a l t h s u p p l e m e n t u n d e r t h i s r e g u l a t i o n , a n d i i t h e m i n i s t e r i s r e a t e n i n g n e e d a n d t h e r e a r e n o r e s o u r c e s a v a i l a b l e t o t h e t h s u p p l e m e n t i s n e c e s s a r y t o m e e t t h a t n e e d , ( c ) t h e M e d i c a r e P r o t e c t i o n A c t , a n d ( d ) t h e r e q u i r e m e n t s l e , a r e m e t : ( i ) p a r a g r a p h ( a ) o r ( I ) o f s e c t i o n ( 2 ) ( 1 ) ; ( i i ) o r t o c e i l i n g p o l e i n h i s l i v i n g r o o m n e x t t o t h e d a y s , i n o r d e r f o r h i m t o s a f e l y t r a n s f e r i n a n d p a t i o n a l t h e r a p i s t a g r e e t h a t t h e S u p e r p o l e i n t h e o a m b u l a t e a n d t r a n s f e r , a s h e i s a t r i s k o f f a l l s C s e t o u t t h e s p e c i f i c e l i g i b i l i t y r e q u i r e m e n t s f o r E A P W D R e g u l a t i o n , S c h e d u l e C , s e c t i o n 3 . 5 r o o m . 3 . 5 ( 1 ) ( i ) s p e c i f i e s t h a t o n l y a s u p e r p o l e i n a f o r t h e p u r p o s e s o f s e c t i o n 3 . A " t r a n s f e r a i d " i s i d e r s h e e t ; a s u p e r p o l e i s n o t o n e o f t h e s e . A t i n t h e E A P W D R e g u l a t i o n S c h e d u l e C , s e c t i o n e n t a n d d e v i c e s t o i n c l u d e : a c a n e , w a l k e r , i n g l i f t d e v i c e , a p o s i t i v e a i r w a y p r e s s u r e d e v i c e , o r n o n c o n v e n t i o n a l g l u c o s e m e t e r . w a s n o t m e t b e c a u s e t h e s u p e r p o l e i s n o t l i s t e d i c a l s u p p l i e s r e q u i r e d f o r a n y o f t h e p u r p o s e s s e t b o w e l c a r e , c a t h e t e r i z a t i o n , i n c o n t i n e n c e , s k i n a r e n o t s u p p l i e s r e q u i r e d t o t h i c k e n f o o d
4 . T h e c r i t e r i a o f s e c t i o n s 2 . 1 , 2 . 2 , 4 , 4 . 1 , 5 , 6 , 7 t h e s u p e r p o l e i s n o t l i s t e d u n d e r t h e r e m a i n i n 5 . T h e c r i t e r i a o f s e c t i o n 6 9 w e r e n o t m e t b e c a u t h r e a t e n i n g h e a l t h n e e d , a n d b e c a u s e a s u p e s u p p l e m e n t l i s t e d i n S c h e d u l e C . T h e p a n e l f i n d s t h a t t h e m i n i s t r y h a s r e a s o n a b l y d e t l e g i s l a t i o n , t h e f l o o r t o c e i l i n g p o l e ( S u p e r p o l e ) a s s l i s t e d a s a s u p p l e m e n t u n d e r s e c t i o n 3 . 5 o f S c h e d u l b a t h r o o m , a n d i s n o t l i s t e d u n d e r m e d i c a l o r s u r g i c a o r a s a t h e r a p y o r u n d e r t h e r e m a i n i n g h e a l t h s u p p l e S u p e r p o l e w a s r e a s o n a b l y d e t e r m i n e d b y t h e m i n i s t h e a l t h n e e d a s r e q u i r e d b y s e c t i o n 6 9 o f t h e E A P W D T h e p a n e l n o t e s t h a t w h i l e t h e a p p e l l a n t ' s p h y s i c i a n S u p e r p o l e i n t h e l i v i n g r o o m w o u l d p r o v i d e t h e a p p e t h e m i n i s t r y h a s n o d i s c r e t i o n t o a u t h o r i z e t h e p u r c h t h a t t h e a p p e l l a n t h a s a r e a l n e e d f o r t h e f l o o r t o c e i l e g i s l a t i o n i s v e r y s p e c i f i c t h a t t h i s i t e m i s n o t a h e a l 3 . 5 o f S c h e d u l e C o f t h e E A P W D R , i f i t i s n o t i n s t a l l e T h e p a n e l f i n d s t h a t t h e m i n i s t r y ' s d e c i s i o n t h a t t h e a f o r t h e l i v i n g r o o m w a s a r e a s o n a b l e a p p l i c a t i o n o f t h t h e a p p e l l a n t a n d t h e r e f o r e c o n f i r m s t h e m i n i s t r y ' s d A P P E A L I , 8 a n d 9 o f S c h e d u l e C w e r e n o t m e t b e c a u s e g h e a l t h s u p p l e m e n t l e g i s l a t i o n ; a n d s e t h e s u p e r p o l e i s n o t r e q u i r e d t o m e e t a l i f e r p o l e i n t h e l i v i n g r o o m i s n o t a h e a l t h e r m i n e d t h a t p u r s u a n t t o t h e a b o v e n o t e d p e c i f i c a l l y r e q u e s t e d f o r t h e l i v i n g r o o m , i s n o t e C a s i t i s n o t t o b e i n s t a l l e d i n a b e d r o o m o r l s u p p l i e s , u n d e r m e d i c a l e q u i p m e n t a n d d e v i c e s , m e n t s . A d d i t i o n a l l y , t h e p a n e l f i n d s t h e r y a s n o t r e q u i r e d t o m e e t a l i f e t h r e a t e n i n g R . a n d o c c u p a t i o n a l t h e r a p i s t a g r e e t h a t t h e l l a n t a s s i s t a n c e t o s a f e l y a m b u l a t e a n d t r a n s f e r , a s e . A l t h o u g h t h e p a n e l a c k n o w l e d g e s t h e f a c t l i n g p o l e t o b e i n s t a l l e d i n h i s l i v i n g r o o m , t h e t h s u p p l e m e n t f o r t h e p u r p o s e s o f s e c t i o n 3 a n d d i n a b e d r o o m o r a b a t h r o o m . p p e l l a n t w a s n o t e l i g i b l e f o r a f l o o r t o c e i l i n g p o l e e a p p l i c a b l e e n a c t m e n t i n t h e c i r c u m s t a n c e s o f e c i s i o n .
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.