Chapter 05 - Attendance Allowance

Introduction

The purpose of this chapter is to provide criteria for use in determining the entitlement and assessment for an Attendance Allowance award.

Entitlement to Attendance Allowance is based on three legislative requirements of the Pension Act.

Assessment of Attendance Allowance is the grade level determination of the extent of attendance required for specific elements, as outlined in this policy.

Related Legislation

Subsection 38(1) of the Pension Act reads as follows: A member of the forces who has been awarded a pension or compensation or both, is totally disabled, whether by reason of military service or not, and is in need of attendance shall, on application, in addition to the pension or compensation, or pension and compensation, be awarded an attendance allowance at a rate determined by Veterans Affairs Canada in accordance with the minimum and maximum rates set out in Schedule III.

Related Policy

Article 38(1)(2)(3) of the Pension Policy Manual provides guidance regarding, application, reassessment, effective date, survivor benefits and termination upon death of pensioner.

Entitlement

Definitions:
For the purposes of Attendance Allowance eligibility:

"awarded a pension or compensation" is defined as in receipt of a Disability Pension of 1% or more or Prisoner of War compensation.

"totally disabled by reason of military service or not" is defined as an applicant who meets the definition of "totally disabled" in accordance with Table 1 of this policy.

"in need of attendance" is defined as the need for assistance or supervision with feeding, bathing, dressing, toileting, mobility and medication administration.

Relevant Table:

• TABLE 1 is used to determine whether an individual is "totally disabled" for the purposes of establishing eligibility for Attendance Allowance.

Establishing Entitlement:

To establish entitlement, an applicant must meet all three legislative requirements. Use the following steps to verify that each requirement is met.

• Step 1 - Is the applicant in receipt of Disability Pension of 1% or more and/or POW compensation?
• Step 2 - Is the applicant "totally disabled"? Use TABLE 1 to establish this requirement. In accordance with TABLE 1, if the evidence establishes that the applicant suffers from a prolonged impairment which has lasted or is expected to last 12 months and the applicant meets the criteria outlined in TABLE 1, the applicant is determined to be "totally disabled" for the purposes of Attendance Allowance eligibility.
• Step 3 - Is the applicant in "need of attendance"? If the applicant demonstrates a need for attendance in feeding, bathing, dressing, toileting, mobility or medication administration; then the applicant meets this requirement.

Assessment

As with any other award under the Pension Act, once entitlement is granted, an assessment determination is made for payment purposes.

With respect to Attendance Allowance, once the three legislated requirements are met and an applicant is found to be eligible for an award, the extent of the applicant's need for attendance is then assessed to determine the grade level for payment purposes. The extent of the need for attendance is expressed as the "grade level".

Attendance Allowance is assessed based on a record of factual information covering the applicant's actual need for attendance. The need for attendance is assessed using five grade levels ranging from Grade 5 (occasional attendance) to Grade 1 (total attendance).

The elements which are taken into consideration in the determination of a grade level include:

1. The need for assistance or supervision with:
   - Feeding
   - Bathing
   - Dressing
   - Toileting
2. The need for attendance or supervision with Mobility.
3. The need for attendance or supervision with the administration of Medications.

Relevant Tables:

Assessment of grade levels for Attendance Allowance are to be determined by using TABLE 2, TABLE 3 and TABLE 4 of this chapter.

• TABLE 2 outlines the five Grade Levels ranging from Grade I to Grade V.
• TABLE 3 outlines Special Categories and their prescribed Grade Level assessments.
• TABLE 4 contains guidelines to be used in conjunction with TABLE 2. The guidelines help determine the extent of attendance required.

Establishing Assessment:

• Step 1 - If "Special Categories" exist, i.e. paraplegics, blindness or amputations, refer to TABLE 3 and establish the prescribed grade level. If no "Special Categories" exist, skip this step.
• Step 2 - Refer to TABLE 2 and accompanying TABLE 4. Using TABLE 4 as a guide, rate the level of attendance required for each of the six elements indicated in TABLE 4.
• Step 3 - Based on the ratings from TABLE 4, establish the grade level determination using the following instructions:
  1. In cases where a client demonstrates a need for attendance at the same level for two or more of the elements found in TABLE 4, i.e. feeding, bathing, dressing, toileting, mobility or medications, assign the grade level based on this level.
     
     Example: if a client demonstrates a need for attendance at level 5 for feeding, dressing and medications and a level 4 for toileting and mobility, the client will be awarded a grade level of Grade 4.
  2. In cases where a client demonstrates a greater degree of attendance in only one of the elements of TABLE 4 i.e. feeding, bathing, dressing, toileting, mobility or medications, which is one or two levels higher than the remaining elements, the isolated higher level will not be used to establish the grade level determination. In such cases, the assessor will refer to the next highest degree of attendance required for the remaining elements in TABLE 4 to establish the grade level determination.^{Footnote 1}
     
     Example: If a client demonstrates a degree of attendance at level 5 for feeding, bathing, and dressing, level 4 for toileting and level 2 for mobility, in accordance with this policy, the client will not be awarded Grade 2 on the basis of the degree of attendance for mobility alone, but will be awarded the next highest degree of attendance required, which in this example is Grade 4.
  3. In cases dealing with "Special Categories", i.e. paraplegia; blindness or amputations, the applicant will be awarded the most beneficial grade level for which he/she qualifies using TABLE 3 and TABLE 2/TABLE 4.
     
     Example: Using the Special Categories TABLE 3, a Grade 4 is prescribed for blindness where an individual cannot count fingers beyond several feet. Using TABLE 2 and accompanying TABLE 4, the client demonstrates a need for attendance at level 4 for feeding,. bathing and dressing and level 3 for mobility and medications. In cases such as this, compare the assessment resulting from TABLE 3 with the assessment resulting from the rating from TABLE 4 and select the higher assessment. In this example, Grade 3 would be awarded.

Related Definitions

Prolonged:

An impairment is prolonged if it has lasted, or is expected to last, for a continuous period of at least 12 months.

Markedly Restricted:

One may be markedly restricted if, all or almost all the time, one is unable (or it takes you an extremely long time) to perform a basic activity of daily living, even with therapy (other than life-sustaining therapy) and with the use of appropriate devices and medication.

For the purposes of establishing "total disability" for AA eligibility purposes, the following elements have been taken into consideration:

• walking
• perceiving, thinking or remembering
• basic personal care, i.e. washing
• feeding
• dressing
• toileting, i.e. bowel or bladder functions

Life-sustaining Therapy:

Life-sustaining therapy includes therapy to help in breathing, i.e. oxygen, or kidney dialysis to filter blood. Life-sustaining therapy does not include implanted devices such as a pacemaker or special programs of diet, exercise, hygiene, or medication. Medical evidence must certify that you need, and dedicate time specifically for, this therapy at least three times per week, to an average of at least 14 hours per week. The need for this therapy must have lasted, or be expected to last, for a continuous period of at least 12 months.

Inordinate amount of Time:

An "inordinate amount of time" is defined as significantly more time than it would take an individual of the same age to complete an activity in the absence of the impairment.

These "Special Categories" shall be considered in conjunction with TABLE 2 and the applicant shall be awarded the most beneficial grade level for which he/she qualifies under the two systems.