P A R T C D e c i s i o n u n d e r A p p e a l T h e d e c i s i o n u n d e r a p p e a l i s t h e m i n i s t r y ' s r e c o n s i d t h e a p p e l l a n t ' s a p p l i c a t i o n f o r f u n d s t o c o v e r t h e c o f a m i l y t r i p s . T h e m i n i s t r y f o u n d t h a t t h e a p p e l l a n t m u n d e r t h e E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s h o w e v e r t h e d e v i c e h e i s s e e k i n g f u n d i n g f o r w a s n S c h e d u l e C . P A R T D R e l e v a n t L e g i s l a t i o n E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L e r a t i o n d e c i s i o n d a t e d J u l y 2 4 , 2 0 1 4 t h a t d e n i e d s t o f a p o r t a b l e f l o o r l i f t f o r u s e a t h o m e a n d o n e t t h e r e q u i r e m e n t s t o r e c e i v e h e a l t h s u p p l e m e n t s w i t h D i s a b i l i t i e s R e g u l a t i o n ( E A P W D R ) s e c t i o n 6 2 o t a n e l i g i b l e d e v i c e a s d e s c r i b e d i n E A P W D R i l i t i e s R e g u l a t i o n ( E A P W D R ) s e c t i o n s 6 2 a n d 6 9 i l i t i e s R e g u l a t i o n ( E A P W D R ) S c h e d u l e C
APPEA I PART E -Summary of Facts With the consent of both parties, the hearing was conducted as a written hearing, pursuant to section 22(3)(b) of the Employment and Assistance Act. The information before the ministry at the time of reconsideration included the following: • A quote from a medical equipment supply company dated March 12, 2014. The quote is for one patient lift and extra battery pack priced at $3425.16 and for two spacers with head support priced at $662.40 for both. • A letter from the appellant's physiotherapist dated March 26, 2014. The letter described the appellant as a young man who is completely dependent on others for care. He lives at home with his parents and has a lift installed in the bathroom and his bedroom however he would like a portable lift in the living room to lift him out of his wheelchair onto the floor and back again. The physiotherapist adds that the appellant requires time on the floor in the living room to move around and to do his exercises, as this is the only space large enough to do this in the home. " A medical equipment request form dated March 25, 2014 requesting the ministry provide funding for a portable floor lift. The form states the appellant has severe developmental delay, no leg/arm function, and is totally dependent for mobility. " A letter from the appellant's physiotherapist dated June 23, 2014. The letter contains the same information as the March 26, 2014 letter. " The Request for Reconsideration dated July 10, 2014 completed by the appellant's parents on his behalf. The parents write they want to keep their son in their home as long as possible however they need a lift to assist them getting him in and out of his wheelchair. Both parents are in their sixties and his moth�r suffers from arthritis making it difficult to move him. They have had the lift above their son's bed and in the bathroom for many years. With the Notice of Appeal the appellant's mother submitted a letter reading that the appellant is non verbal and totally dependent on others for all aspects of his daily life. Although he has a lift installed above his bed and the bathtub, he enjoys spending time on the living room floor to stretch, exercise, roll, and explore. Other than time the appellant spends in his walker daily for exercise, he has limited mobility. The appellant's parents are in their sixties and in order for them to allow him to get from his chair to the floor and back again, they need the assistance of a mechanical lift because they suffer from health limitations and it is becoming too difficult to lift him. The appellant's mother clarified that the lift is not intended for vacations, but rather, the lift will be used at home, at his respite family, and eventually to a home-share situation in the future. She was concerned that the suggestion that the lift would be used on family vacations was the reason that the request for ministry funding was denied and she wanted to be clear that the lift was not going to be used simply for family vacations. The panel finds as fact: • The appellant has requested funding for a piece of medical equipment, a mechanical floor lift, to assist him in and out of his chair to access the floor in the living room for exercises and recreation. • The appellant has a lift installed in his bedroom and another one in the bathroom EMT003(10/06/01)
I APPEA PART F -Reasons for Panel Decision The decision under appeal is the reasonableness of the ministry's decision to deny the appellant's application for funds to cover the cost of a portable floor lift for use at home in the living room and on family trips. The ministry determined that it did not meet the criteria set out in the applicable legislation. The ministry found that the appellant met the requirements to receive health supplements under the EAPWDR sections 62 however the device he is seeking funding for was not an eligible device as described in EAPWDR Schedule C. The applicable legislation is the EAPWDR section 62, 69 and the EAPWDR Schedule C: EAPWDR Section 62 62 (1) Subject to subsections (1.1) and (1.2), the minister may provide any health supplement set out in section 2 [general health supplements] or 3 [medical equipment and devices] of Schedule C to or for a family unit if the health supplement is provided to or for a person in the family unit who is (a) a recipient of disability assistance, EAPWDR Section 69 69 The minister may provide to a family unit any health supplement set out in sections 2 (1) (a) and (f) [general health supplements] and 3 [medical equipment and devices] of Schedule C, if the health supplement is provided to or for a person in the family unit who is otherwise not eligible for the health supplement under this regulation, and if the minister is satisfied that (a) the person faces a direct and imminent life threatening need and there are no resources available to the person's family unit with which to meet that need, (b) the health supplement is necessary to meet that need, (c) the person's family unit is receiving premium assistance under the Medicare Protection Act, and (d) the requirements specified in the following provisions of Schedule C, as applicable, are met: (i) paragraph (a) or (f) of section (2) (1) ; (ii) sections 3 to 3.12, other than paragraph (a) of section 3 (1). EAPWDR Schedule C 2 General health supplements (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; (ii) the supplies are (A) prescribed by a medical practitioner or nurse practitioner, (B) the least expensive supplies appropriate for the purpose, and (C) necessary to avoid an imminent and substantial danger to health; (iii) there are no resources available to the family unit to pay the cost of or obtain the supplies; (a.1) the following medical or surgical supplies that are, at the minister's discretion, either disposable or reusable, if the minister is satisfied that all the requirements described in paragraph (a) (ii) and (iii) are met in relation to the supplies: (i) lancets; (ii) needles and syringes; (iii) ventilator supplies required for the essential operation or sterilization of a ventilator; (iv) tracheostomy supplies; a.2 consumable medical su lies, if the minister is satisfied that all of the followin re uirements are met: EAAT 003(10/06/01)
( i ) t h e s u p p l i e s a r e r e q u i r e d t o t h i c k e n f o o d ; ( i i ) a l l t h e r e q u i r e m e n t s d e s c r i b e d i n p a r a g r a p h ( a ) 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 3 ( 1 ) S u b j e c t t o s u b s e c t i o n s { 2 ) t o ( 5 ) o f t h i s s e c t i o n 3 . 1 t o 3 . 1 2 o f t h i s S c h e d u l e a r e t h e h e a l t h s u p p l e m e ( a ) t h e s u p p l e m e n t s a r e 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 h i s r e g u l a t i o n , a n d ( b ) a l l o f t h e f o l l o w i n g r e q u i r e m e n t s a r e m e t : ( i } t h e f a m i l y u n i t h a s r e c e i v e d t h e p r e a u t h o r i z a t i o n r e q u e s t e d ; ( i i ) 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 f a m i l y u n d e v i c e ; ( i i i ) t h e m e d i c a l e q u i p m e n t o r d e v i c e i s t h e l e a s t e x { 2 ) F o r m e d i c a l e q u i p m e n t o r d e v i c e s r e f e r r e d t o i n s r e q u i r e m e n t s i n t h o s e s e c t i o n s a n d s u b s e c t i o n ( 1 ) o o n e o r b o t h o f t h e f o l l o w i n g , a s r e q u e s t e d b y t h e m i n ( a } a p r e s c r i p t i o n o f a m e d i c a l p r a c t i t i o n e r o r n u r s e p { b } a n a s s e s s m e n t b y a n o c c u p a t i o n a l t h e r a p i s t o r p m e d i c a l e q u i p m e n t o r d e v i c e . 3 . 5 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 t o i l e t i n g , ( 0 . 1 ) I n t h i s s e c t i o n : " p o s i t i o n i n g c h a i r " d o e s n o t i n c l u d e a l i f t c h a i r ; " t r a n s f e r a i d " m e a n 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 ( 1 ) T h e f o l l o w i n g i t e m s a r e h e a l t h s u p p l e m e n t s f o r t h s a t i s f i e d t h a t t h e i t e m i s m e d i c a l l y e s s e n t i a l t o f a c i l i t a m a i n t a i n a p e r s o n ' s p o s i t i o n i n g : ( a ) a g r a b b a r i n a b a t h r o o m ; { b ) a b a t h o r s h o w e r s e a t ; ( c ) a b a t h t r a n s f e r b e n c h w i t h h a n d h e l d s h o w e r ; { d ) a t u b s l i d e ; ( e ) a b a t h l i f t ; ( f ) a b e d p a n o r u r i n a l ; ( g ) a r a i s e d t o i l e t s e a t ; ( h } a t o i l e t s a f e t y f r a m e ; ( 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 r o o m : U ) a p o rt a b l e c o m m o d e c h a i r ; ( k ) a s t a n d i n g f r a m e f o r a p e r s o n f o r w h o m a w h e e l c m o b i l i t y ; ( I ) a p o s i t i o n i n g c h a i r f o r a p e r s o n f o r w h o m a w h e e l c m o b i l i t y ; ( m ) a t r a n s f e r a i d f o r a p e r s o n f o r w h o m t h e t r a n s f e r a n o t h e r . ( 2 ) T h e p e r i o d o f t i m e r e f e r r e d t o i n s e c t i o n 3 ( 3 ) ( b ) d e s c r i b e d i n s u b s e c t i o n ( 1 ) o f t h i s s e c t i o n i s 5 y e a r s r e p l a c e d . 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 f l o o r o r c e i l i n g 3 . 8 ( 1 ) I n t h i s s e c t i o n , " f l o o r o r c e i l i n g l i f t d e v i c e " m e c e i l i n g a n d t h a t u s e s a s l i n g s y s t e m t o t r a n s f e r a p e r { 2 ) A f l o o r o r c e i l i n g l i f t d e v i c e i s a h e a l t h s u p p l e m e n f o l l o w i n g r e q u i r e m e n t s a r e m e t : ( a ) t h e m i n i s t e r i s s a t i s f i e d t h a t t h e f l o o r o r c e i l i n g l i f t p e r s o n i n a b e d r o o m o r a b a t h r o o m ; ( b ) t h e c o s t o f t h e f l o o r o r c e i l i n g l i f t d e v i c e d o e s n o t d o e s e x c e e d $ 4 2 0 0 , t h e m i n i s t e r i s s a t i s f i e d t h a t t h e E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L ( i i ) a n d ( i i i ) a r e m e t i n r e l a t i o n t o t h e s u p p l i e s ; , t h e 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 d e s c r i b e d i n s e c t i o n s n t s t h a t m a y b e p r o v i d e d b y t h e m i n i s t e r i f 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 r a l h e a l t h s u p p l e m e n t s ] o f o f t h e m i n i s t e r f o r t h e m e d i c a l e q u i p m e n t o r d e v i c e i t t o p a y t h e c o s t o f o r o b t a i n t h e m e d i c a l e q u i p m e n t o r p e n s i v e a p p r o p r i a t e m e d i c a l e q u i p m e n t o r d e v i c e . e c t i o n s 3 . 1 t o 3 . 8 o r s e c t i o n 3 . 1 2 , i n a d d i t i o n t o t h e f t h i s s e c t i o n , t h e f a m i l y u n i t m u s t p r o v i d e t o t h e m i n i s t e r i s t e r : r a c t i t i o n e r f o r t h e m e d i c a l e q u i p m e n t o r d e v i c e ; h y s i c a l t h e r a p i s t c o n f i r m i n g t h e m e d i c a l n e e d f o r t h e t r a n s f e r s a n d p o s i t i o n i n g a i d s r s l i d e r s h e e t . e p u r p o s e s o f s e c t i o n 3 o f t h i s S c h e d u l e i f t h e m i n i s t e r i s t e t o i l e t i n g o r t r a n s f e r s o f a p e r s o n o r t o a c h i e v e o r h a i r i s m e d i c a l l y e s s e n t i a l t o a c h i e v e o r m a i n t a i n b a s i c h a i r i s m e d i c a l l y e s s e n t i a l t o a c h i e v e o r m a i n t a i n b a s i c a i d i s m e d i c a l l y e s s e n t i a l t o t r a n s f e r f r o m o n e p o s i t i o n t o o f t h i s S c h e d u l e w i t h r e s p e c t t o r e p l a c e m e n t o f a n i t e m f r o m t h e d a t e o n w h i c h t h e m i n i s t e r p r o v i d e d t h e i t e m b e i n g l i f t d e v i c e s a n s a d e v i c e t h a t s t a n d s o n t h e f l o o r o r i s a t t a c h e d t o t h e s o 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 o f t h i s S c h e d u l e i f t h e d e v i c e i s m e d i c a l l y e s s e n t i a l t o f a c i l i t a t e t r a n s f e r s o f a e x c e e d $ 4 2 0 0 o r , i f t h e c o s t o f t h e f l o o r o r c e i l i n g l i f t d e v i c e e x c e s s c o s t i s a r e s u l t o f u n u s u a l i n s t a l l a t i o n e x e n s e s .
( 3 ) T h e p e r i o d o f t i m e r e f e r r e d t o i n s e c t i o n 3 ( 3 ) ( b ) d e s c r i b e d i n s u b s e c t i o n ( 2 ) o f t h i s s e c t i o n i s 5 y e a r s r e p l a c e d . T h e a p p e l l a n t ' s a r g u m e n t i s t h a t h e r e q u i r e s t h e p o e a s e t h e b u r d e n o n h i s p a r e n t s w h o h a v e l i m i t a t i o n d u e t o t h e i r a g e a n d h e a l t h p r o b l e m s . T h e m i n i s t r y ' s a r g u m e n t i s t h a t t h e a p p e l l a n t d o e s n p r o v i d e d b y t h e m i n i s t r y b e c a u s e t h e r e q u e s t d o e s C . T h e p a n e l r e v i e w e d t h e r e c o n s i d e r a t i o n d e c i s i o n a n t h e a p p e l l a n t ' s r e q u e s t . S i n c e t h e m i n i s t r y d e t e r m i n E A P W D R s e c t i o n 6 2 t h e p a n e l w i l l d e t e r m i n e t h e r e t h e a p p e l l a n t ' s r e q u e s t i n e l i g i b l e b a s e d o n t h e o t h e r F i r s t t h e p a n e l c o n s i d e r e d t h e r e a s o n a b l e n e s s o f t h r e q u e s t d o e s n o t m e e t t h e r e q u i r e m e n t s a s m e d i c a l C , s e c t i o n 3 i n c l u d i n g t h e c r i t e r i a s e t o u t i n s e c t i o n 3 r e q u i r e s t h a t t h e i t e m b e m e d i c a l l y e s s e n t i a l t o f a c i l i m a i n t a i n a p e r s o n ' s p o s i t i o n i n g . T h e m i n i s t r y d e t e r m b a t h r o o m i s a h e a l 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 r e a s o n a b l e a s t h e p u r p o s e o f t h e r e q u e s t e d m e c h a n b e d r o o m o r b a t h r o o m b e c a u s e t h e a p p e l l a n t a l r e a d l e t t e r f r o m t h e p h y s i o t h e r a p i s t d e s c r i b e d t h e a p p e l l a r o o m t o l i f t h i m o u t o f h i s w h e e l c h a i r o n t o t h e f l o o r a e n o u g h f o r t h e a p p e l l a n t t o d o h i s e x e r c i s e s i n t h e h w o u l d m o r e a p p r o p r i a t e l y f a l l u n d e r t h e E A P W D R S D e v i c e s s i n c e t h e d e s c r i p t i o n o f t h e r e q u e s t e d l i f t m t h e d e s c r i p t i o n i n s e c t i o n 3 . 5 . T h e r e q u i r e m e n t o f t h a b a t h r o o m i s t h e s a m e a s s e c t i o n 3 . 5 t h e r e f o r e t h e w o u l d b e t h e s a m e . T h e p a n e l f i n d s t h a t h e m i n i s t r y R e g a r d i n g t h e m i n i s t r y ' s d e t e r m i n a t i o n t h a t t h e a p p e a s m e d i c a l s u p p l y a s s e t o u t i n t h e E A P W D R S c h e d t h e m i n i s t r y f o u n d t h e a p p e l l a n t ' s r e q u e s t d i d n o t m e n o t d i r e c t l y r e q u i r e d f o r o n e o f t h e l i s t e d p u r p o s e s , n i n c o n t i n e n c e , s k i n p a r a s i t e c a r e , o r l i m b c i r c u l a t i o n c n o t e s t a b l i s h t h e n e e d f o r t h e l i f t w a s n e c e s s a r y t o a h e a l t h . T h e p a n e l f i n d s t h e m i n i s t r y w a s r e a s o n a b l e a n d t r a n s f e r r i n g t h e a p p e l l a n t i n h i s h o m e w h i c h i s n a p p e l l a n t h a s p r o v i d e d a n y e v i d e n c e t h a t t h e l i f t i s n d a n g e r t o h i s h e a l t h . R e g a r d i n g t h e m i n i s t r y ' s d e t e r m i n a t i o n t h a t a p o r t a b o t h e r s e c t i o n s o f t h e E A P W D R S c h e d u l e C t h e p a n e h e a l t h s u p p l e m e n t s ! i n c l u d i n q o p t i c a l , e v e , d e n t a l , d E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 }A P P E A L I o f t h i s S c h e d u l e w i t h r e s p e c t t o r e p l a c e m e n t o f a n i t e m f r o m t h e d a t e o n w h i c h t h e m i n i s t e r p r o v i d e d t h e i t e m b e i n g r t a b l e f l o o r l i f t f o r h i s g e n e r a l w e l l b e i n g a n d t o s t o t h e i r a b i l i t y t o l i f t h i m i n t o a n d o f f o f t h e f l o o r o t q u a l i f y t o h a v e t h e c o s t o f t h e p o r t a b l e f l o o r l i f t n o t m e e t t h e c r i t e r i a s e t o u t i n E A P W D R S c h e d u l e d a l l o f t h e s e c t i o n s o f t h e l e g i s l a t i o n a p p l i c a b l e t o e d t h a t t h e a p p e l l a n t m e e t s t h e c r i t e r i a o f t h e a s o n a b l e n e s s o f t h e m i n i s t r y ' s d e c i s i o n t h a t f o u n d s e c t i o n s o f t h e E A P W D R . e m i n i s t r y ' s d e t e r m i n a t i o n t h a t t h e a p p e l l a n t ' s e q u i p m e n t a s s e t o u t i n t h e E A P W D R s c h e d u l e . 5 , B a t h i n g a n d T o i l e t i n g A i d s . T h i s s e c t i o n t a t e t o i l e t i n g o r t r a n s f e r s o f a p e r s o n t o a c h i e v e o r i n e d t h a t o n l y a f l o o r l i f t i n t h e b e d r o o m o r f t h i s s e c t i o n . T h e p a n e l f i n d s t h e m i n i s t r y w a s i c a l l i f t i s f o r u s e i n r o o m s o t h e r t h a n t h e y h a s l i f t s i n b o t h t h e b e d r o o m a n d b a t h r o o m . T h e n t ' s n e e d f o r a p o r t a b l e l i f t f o r u s e i n t h e l i v i n g n d b a c k a g a i n a s t h i s i s t h e o n l y f l o o r s p a c e l a r g e o m e . T h e p a n e l n o t e s t h a t t h e a p p e l l a n t ' s r e q u e s t c h e d u l e C , s e c t i o n 3 . 8 , F l o o r o r C e i l i n g L i f t o r e a c c u r a t e l y f a l l s u n d e r t h i s d e s c r i p t i o n v e r s u s e d e v i c e b e i n g u s e d f o r t r a n s f e r s i n a b e d r o o m o r d e t e r m i n a t i o n i n i n e l i g i b i l i t y b a s e d o n t h i s c r i t e r i a w a s r e a s o n a b l e i n t h i s d e t e r m i n a t i o n . l l a n t ' s r e q u e s t d o e s n o t m e e t t h e r e q u i r e m e n t s u l e C , s e c t i o n 2 ( 1 ) ( a ) t h e p a n e l c o n s i d e r e d t h a t e t t h e d e s c r i p t i o n a s a m e d i c a l s u p p l y s i n c e i t i s a m e l y : w o u n d c a r e , b o w e l c a r e , c a t h e t e r i z a t i o n , a r e . T h e m i n i s t ry a l s o f o u n d t h a t t h e r e q u e s t d i d v o i d a n i m m i n e n t a n d s u b s t a n t i a l d a n g e r t o h i s s i n c e t h e s t a t e d u s e o f t h e l i f t i s t o f a c i l i t a t e l i f t i n g o t a p u r p o s e a s d e s c r i b e d i n t h i s s e c t i o n a n d t h e e c e s s a r y t o a v o i d a n i m m i n e n t a n d s u b s t a n t i a l l e f l o o r l i f t i s n o t a n i t e m s e t o u t i n a n y o f t h e l f i n d s t h a t t h e E A P W D R S c h e d u l e C s p e c i f i e s i e t , n a t a l ) , t h e r a p i e s , a n d m e d i c a l d e v i c e s t h a t
APPEAL. I 7 the ministry may provide funding for, to applicants that meet the requirements. The panel finds that the ministry was reasonable to determine that a portable floor lift for use at home is not a device that is included in any other section of the EAPWDR Schedule C. Regarding the ministry's determination that the appellant's request for a portable lift does not meet the requirement as a life-threatening need as set out in the EAPWDR section 69, the panel considered that the ministry found that the appellant's need for the floor lift was not to prevent a direct and imminent life-threatening risk because his application fails to establish such a risk. While the physiotherapist wrote in her letter that the appellant requires time on the floor in the living room to move around and to do his exercises, the panel finds that the ministry reasonably concluded that the evidence does not establish that the appellant faces a direct and imminent life-threatening health need. The panel finds that the EAPWDR section 69 provides an applicant, who is otherwise ineligible for a health supplement under this legislation, with a health supplement set out in the EAPWDR Schedule C, sections 2(1 )(a) and (f) and 3. The panel finds that it was not disputed that the appellant is eligible for health supplements under Section 62 of the EAPWDR, and the ministry reasonably determined that Section 69 applies to provide a health supplement to a person in the family unit who is otherwise not eligible for the health supplement under the EAPWDR. Also, Since the appellant's request is for a portable floor lift for use in the living room al home, it is not an item listed in any of the above listed sections of Schedule C, as discussed above, and therefore would not be an eligible item under section 69 regardless of whether it is found to be necessary to meet a life-threatening need. The panel finds that the ministry was reasonable to determine that the appellant's request for a portable lift does not meet the requirement as a life-threatening need as set out in the EAPWDR section 69. The panel finds that the ministry's decision was a reasonable application of the applicable enactment in the circumstances of the appellant and confirms the decision. EM T003(10/06/01)
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