Foot Care Services (POC 8)

Purpose

This policy provides direction on the approval of basic and advanced foot care under nursing services.

Policy

Definitions

1. Basic foot care is foot care that is limited to non-invasive strategies and interventions, including non-invasive cutting and filing of toenails, non-invasive filing to reduce calluses, corns and hypertrophic nails, packing of involuted nails, moisturizing to help reduce hyperkeratotic skin and corrective foot health education.
2. Advanced foot care is foot care that includes in-depth assessment and short-term interventions to address complex conditions of the foot due to deformities, neurological and circulatory problems and infections.

Eligibility

3. Refer to the Nursing Services (POC 8)  policy.
4. Basic and advanced foot care may be provided where there is no entitled condition of the feet themselves, but where another existing entitled condition renders the client unable to undertake essential foot care. That is, the inability to undertake foot care and the requirement for foot care as a treatment benefit may be related to the entitled condition (see Treatment for a Disability Benefits Entitled Condition policy). Entitled conditions that may merit this consideration might include:
    
   1. Internal derangement of the knee(s)
   2. Hip disability
   3. Low back conditions

General

5. Advanced foot care will be approved in exceptional circumstances only. The approval will be based on the provision of a prescription by the attending physician and a treatment plan from the service provider which indicates the need, duration, cost and frequency for advanced foot care services.
6. Foot care under Nursing Services may be provided in a clinic, in the home, or in a Long Term Care (LTC) facility. However, if foot care can be provided in a clinic, this should be the first option considered. Foot care should be provided in the client’s home only if necessary (e.g. absence of clinic, medical need). Rates charged in a clinic should not exceed the rates charged to non-Veteran clients. Rates charged in the home are in accordance with the dollar limits set in the appropriate Veterans Affairs Canada Benefit Grid.
7. Basic foot hygiene, such as washing feet and clipping nails, can be provided under the VIP program (see Home Care Services policy) where there is no medical condition which requires special attention.
8. Foot care services may also be provided under (Related Health Services (POC 12)) by a podiatrist/chiropodist.

Approval of Nursing Services - Foot Care on the Benefit Grid

9. Nursing foot care services (including services for Rehabilitation Program clients) will be approved by the designated decision-maker for Foot Care Services (POC 8). See also Nursing Services (POC 8) policy.
10. The procedure for approval of nursing foot care services is identified in the related Business Process: POC 8 - Nursing Foot Care (excluding Foreign Countries Operations).

Qualifications of Providers

11. Payment may be made for basic foot care services provided under Nursing Services by a Registered Nurse (RN), Registered Nursing Assistant (RNA), Licensed Nursing Assistant (LNA), Licensed Practical Nurse (LPN) or Registered Practical Nurse (RPN).
12. The practitioners in paragraph 11 must have obtained competence in basic nursing foot care through an educational program which:
     
    1. Includes both theoretical instruction and supervised practice; and
    2. Possesses a valid certification which entitles them to practice nursing foot care under provincial/territorial regulations (i.e. permitted by provincial standards of practice).
13. If approved, payment may be made for advanced foot care services provided under Nursing Services by the practitioners listed in paragraph 11 who have:
     
    1. Obtained competence in advanced nursing foot care through an educational program which includes both theoretical instruction and supervised practice; and
    2. Possess a valid certification which entitles them to practice advanced nursing foot care under provincial/territorial regulations.
14. In exceptional circumstances, such as in some remote geographic areas, approval for basic foot care services may be authorized where the foot care education criteria in paragraph 12 cannot be met by any of the available local resources. Nevertheless, the person providing service must be certified as one of the practitioners listed in paragraph 11 above. Approval in this situation should only be granted in rare instances where there is no alternative, and where:
     
    1. The attending physician identifies foot care as part of the treatment plan, and specifically refers the client to the provider in question; and
    2. Follow-up or routine monitoring by a physician or independent registered nurse is available to ensure that proper foot care is being provided.
15. The exceptional approval provisions in Paragraph 14 do not apply to advanced foot care.

Long-term Care Facilities

16. Basic or advanced foot care services may be provided to VAC clients in an intermediate or chronic care facility only when it is verified that non-VAC clients are being charged user fees for foot care service in that facility. Payment for the service will not exceed that charged to non-VAC clients in the same facility.

References

Veterans Health Care Regulations, paragraph 4(a), subparagraphs 19(a)(i) and (ii)

Nursing Services (POC 8)

Veterans Independence Program - Benefits at Home Policy

Related Health Services (POC 12)

Treatment for a Disability Benefits Entitled Condition

Benefit Grids