September 2017

8.1 Budgetary Requirements for Recipients Living in Residences Providing Specialized Care

Summary of Policy

Defines places that are considered residences providing specialized care for the purposes of ODSP.

Describes the budgetary requirements for a recipient who is living in a residence providing specialized care.

Legislative Authority

Sections 1(1), 4(1)3.1, 3.2, 3.3, 5, 4.2 and 32 of the ODSP Regulation

Summary of Directive

A recipient who lives in a residence providing specialized care is provided with a monthly amount for personal needs (i.e., the Personal Needs Allowance or PNA) and a monthly amount to assist with the cost of services provided by the residence or to cover the co-payment charged by a Long-Term Care home as described under section 32 of the ODSP General Regulation.

Intent of Policy

To provide ODSP recipients who reside in places that are prescribed under the ODSP General Regulation with a monthly amount for their personal needs and, depending on the type of residence, a monthly amount to assist with the cost of residential services.

Application of Policy

In all cases, a person must be determined to be in financial need to be eligible for income support.

Specialized Care Residences where a Personal Needs Allowance is Payable and Residency is a Prescribed Class

The monthly budgetary requirements for a recipient who resides in one of the following is a Personal Needs Allowance:

  • A psychiatric facility under the Mental Health Act that was formerly under the Mental Hospitals Act;
  • The Centre for Addiction and Mental Health in the City of Toronto;
  • The Homewood Health Centre in the City of Guelph;
  • A home under the Homes for Special Care Act.

For the list of the designated psychiatric facilities under the Mental Health Act that were formerly under the Mental Hospitals Act, refer to Appendix “A”.

An applicant, who is living in one of the above-listed specialized care residences is a member of a prescribed class based on residency and does not require adjudication to be eligible for income support. If the applicant is determined to be financially eligible, the application is processed according to ODSP Policy Directive 1.4 Date of Grant.

Note: For the purpose of determining budgetary requirements, a recipient who is temporarily admitted to a specialized care residence is considered the same as a person who is temporarily a patient in a general hospital rather than as a person who resides in a residence providing specialized care (see ODSP Policy Directive 8.2 Budgetary Requirements for Recipients/ Dependants Temporarily In a Hospital, Psychiatric Facility, or Substance Abuse Recovery Home).

Specialized Care Residences where a Personal Needs Allowance and an Additional Amount is Payable and Residency is a Prescribed Class

The monthly budgetary requirements for a recipient who lives in one of the following are a Personal Needs Allowance and a residential amount:

  • an intensive support residence or a supported group living residence under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008.

A person who lives in one of the above residences, is a member of a prescribed class and does not require adjudication to be eligible for income support.

If a person leaves one of the above residences, they do not require adjudication as they are a person who is already determined eligible for services and supports and funding under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008.

The persons budgetary requirements would change based on their new living situation provided the person continues to meet all other eligibility requirements for ODSP.

When to Adjudicate a Recipient who is a Prescribed Class Member based on Residency in a Specialized Care Residence

If a recipient’s prescribed class status is solely due to the fact that the recipient lives in a specialized care residence, eligibility for income support will cease upon leaving the residence unless the recipient is adjudicated and determined to be a person with a disability prior to leaving or is otherwise a member of a prescribed class that is not based on living in the specialized care residence (e.g. recipient is in receipt of Canada Pension Plan Disability Benefits or Quebec Pension Plan Disability Benefits or is a person eligible for services and supports and funding under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008.

ODSP staff should facilitate discussions with the applicant or their advocate and/or residence staff to establish the anticipated length of the applicant’s stay in order to determine if and when a referral to the Disability Adjudication Unit (DAU) should be made.

In some cases, it may be appropriate to wait until an applicant/recipient has a discharge plan before making a referral to the DAU. However, an applicant/recipient is not required to have a discharge plan before a referral to the DAU can be made. Based upon the anticipated length of an applicant’s/recipient’s stay in the specialized care residence, ODSP staff may determine that it is appropriate to make the referral to the DAU when the initial application is completed.

The fact that a referral to the DAU has been made and disability determination is pending does not mean an applicant cannot be granted income support. A member of a prescribed class based on residency in the specialized care residence is eligible for income support, if financially eligible, while living in the residence and awaiting a decision from the DAU.

If a recipient is adjudicated and determined to be a person with a disability prior to discharge from the specialized care residence, the budgetary requirements remain a Personal Needs Allowance.

Specialized Care Residences where a Personal Needs Allowance is Payable and Residency is not a Prescribed Class

The monthly budgetary requirements for a recipient living in one of the following specialized care residences is a Personal Needs Allowance:

  • A hospital for chronically ill patients, a chronic care hospital, or a chronic care unit in a general or convalescent hospital;
  • A Community Resource Centre (for a person who is on parole or probation from a facility) under section 15 of the Ministry of Correctional Services Act;
  • A community residence if the applicant or recipient is on temporary absence, parole or probation or is serving a conditional sentence and if his or her placement in the community residence is funded in whole or in part by the Ministry of Community Safety and Correctional Services;
  • A facility providing treatment, care or rehabilitation under the Child and Family Services Act; or
  • A provincial residential school for persons whose vision or hearing is impaired.

In addition to meeting financial eligibility requirements, a recipient who resides in one of the above must be adjudicated by the DAU and found to be a person with a disability to be eligible for income support, unless he or she is otherwise eligible as a member of a prescribed class (e.g. a person who is in receipt of Canada Pension Plan Disability benefits).

A recipient who lives in a specialized care residence that provides chronic care may be eligible for an amount determined by the Director for the cost of special items and services such as dental services, dentures and prosthetic devices. See ODSP Policy Directive 8.3 Special Items and Services for Residents in Chronic Care.

Specialized Care Residences where a Personal Needs Allowance and an Additional Amount is Payable and Residency is not a Prescribed Class

The monthly budgetary requirements for a recipient, who resides in a long-term care home under the Long-Term Care Homes Act, 2007 are a Personal Needs Allowance and a residential amount.

ODSP Specialized Care Residence Amounts

There are two amounts. The amount payable depends on the type of residence.

Monthly Amount of $1,001
(in addition to PNA of $146)

Monthly Amount of $1,005
(in addition to PNA of $146)

A long-term care home under the Long-Term Care Homes Act, 2007

An intensive support residence or a supported group living residence under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008

A recipient, who resides in a home under the Long-Term Care Homes Act, 2007, which was formerly an approved charitable home for the aged under the Charitable Institutions Act, may be eligible for an amount for community travel and transportation. See ODSP Policy Directive 8.4 Travel and Transportation Allowance.

Determining the Budgetary Requirements for a Single Recipient

The budgetary requirements for a single person are a Personal Needs Allowance and, depending on the specialized care residence, a residential amount.

In the month of admission to a specialized care residence, a recipient’s budgetary requirements are determined according to the recipient’s circumstances in the community.

In addition, if a recipient is being admitted to:

  • a long-term care home under the Long-Term Care Homes Act, 2007, or
  • an intensive support residence or a supported group living residence under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008;

the recipient’s budgetary requirements for the month of admission must also include a specialized care residence amount to compensate the residence for the number of days the recipient resided there.

Example 1 Single disabled recipient, receiving board and lodging, moves into a home under the Homes for Special Care Act on December 15, 2017

November 2016

Recipient Resides in Community

December 2016

Recipient is Admitted to a Home for Special Care
December 15th

January 2017

First Full Month Recipient Resides in Home for Special Care

Board and Lodging
$881

Board and Lodging
$881

PNA
$146

Example 2 Single recipient, renting and receiving the maximum shelter allowance, is admitted to a Long-Term Care home on December 10, 2017

November 2016

Recipient Resides in the Community

December 2016

Recipien. Admitted to a
Long-Term Care home
December 10th

Januar. 2017

First Full Month Recipient Resides in Long-Term Care home

Basic Needs - $662

Shelter - $489

Total - $1,151

1st to 31st Basic Needs & Shelter - $1,151

10th to 31st Specialized Care Residence Amount - $710.38

Total - $1861.38

PNA - $146

Specialized Care Residence Amount - $1,001

Total - $1147

Calculation: December 1st to 31st $662 BN + $489 Shelter = $1151
December 10th to 31st $1,001 Specialized Care Residence Amount ÷ 31 days = $ 32.29
$32.29 x 22 days = $710.38

Determining the Budgetary Requirements for a Recipient and Spouse who is not a Person with a Disability/Prescribed Class Member

Recipient admitted to a Specialized Care Residence

In the month of admission, the budgetary requirements for a benefit unit are determined according to the accommodation arrangements in the community (Basic Needs + Shelter Allowance or Board and Lodging). The calculation of the budgetary requirements in the month of admission includes all members of the benefit unit.

In addition, if a recipient is being admitted to:

  • a long-term care home under the Long-Term Care Homes Act, 2007, or
  • an intensive support residence or a supported group living residence under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008;

the recipient’s budgetary requirements for the month of admission must also include an specialized care residence amount to compensate the residence for the number of days in the month of admission that the recipient resided there.

The recipient’s spouse and any dependants are removed from the benefit unit effective the month following the month of admission. If they are in financial need, they may apply for Ontario Works financial assistance.

Example 3 A recipient and spouse with a dependant under 12 years of age are renting and receiving the maximum shelter allowance. The recipient is admitted to a Long-Term Care home on December 16, 2017

November 2017

Recipient, Spouse and Dependant Reside in the Community

December 2017

Recipient is Admitted to a Long-Term Care home December 16th

January 2018

First Full Month Recipient Resides in Long-Term Care home

Basic Needs - $954

Shelter - $833

Total - $1787

1st to 31s. Basic Needs/Shelter - $1787

16th to 31st Specialized Care Residence Amount - $ 516.64

Total - $ 2303.64

PNA - $146

Specialized Care Residence
Amount - $1,001

Total - $1147

Calculation. December 1st to 31st - $954 BN + $833 Shelter = $1787
December 16th to 31st - $1,001 Specialized Care Residence Amount ÷ 31 days = $32.29
$32.29 x 16 days = $ 516.64

The spouse and dependant are removed from the benefit unit effective January 1st, 2018 and are referred to Ontario Works if in financial need.

Spouse or Dependant is Admitted to a Specialized Care Residence

If a spouse or dependant is admitted to a specialized care residence, the member admitted to the residence is deleted from the benefit unit effective the month following the month of admission.

A spouse or dependant admitted to a specialized care residence may be eligible for income support under ODSP in his or her own right. The option of making an ODSP application should be discussed with the member upon admission to the specialized care residence. The member may also be eligible for Ontario Works financial assistance.

Example 4 - A recipient and his/her spouse are renting and receiving the maximum shelter allowance. The spouse is admitted to a Long-Term Care home on December 16, 2017

November 2017

Recipient and Spouse Resides in Community

December 2017

Spouse is Admitted to a Long-Term Care home o. December 16th

January 2018

First Full Month Spouse Resides in Long Term Care home

Basic Needs - $954

Shelter - $769

Total - $1723

Basic Needs - $954

Shelter - $769

Total -$1723

Basic Needs - $662

Shelter - $489

Total -$1151

The spouse is deleted from the benefit unit effective January 1, 2017.

Note: In this situation, the recipient’s spouse may be eligible for ODSP income support in his or her own right. The option of applying for ODSP income support should be discussed with the recipient’s spouse upon admission to the Long-Term Care home. If an application for ODSP is not made, the recipient’s spouse may apply for Ontario Works if in financial need.

Determining the Budgetary Requirements for a Recipient and Spouse who is a Person with a Disability or a Member of a Prescribed Class

If a recipient’s spouse is a person with a disability or a member of a prescribed class and either the recipient or their spouse is admitted to a specialized care residence,

  • a new benefit unit is created for the spouse the month following the month of admission; and
  • the spouse is removed from the recipient’s benefit unit.

The budgetary requirements for each benefit unit are determined according to type of accommodation of each person (rent/own, board and lodging, or institution). In addition, if a member is being admitted to a home under the Long-Term Care Homes Act, 2007, an intensive support residence or a supported group living residence under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008, the budgetary requirements for the month of admission must also include an amount to compensate the residence for the number of days in the month of admission that the recipient resided there.

Example 5 - A recipient and his/her spouse, who is also a person with a disability, are renting and receiving the maximum shelter allowance. The spouse is admitted to a Long-Term Care home on December 10, 2017

November 2017

Recipient and Spouse Reside in the Community

December 2017

Spouse is Admitted to a Long-Term Care home December 10th

January 2018

First Full Month Spouse Resides in
Long-Term Care home

Basic Needs/ Shelter Allowance - $1941

1st to 31st Basic Needs/Shelter Allowance - $1941

10th to 31st Specialized Care Residence Amount - $710.38

Total - $2651.38

 

Recipient Residing in Community

Basic Needs/Shelter Allowance - $1151

Spouse Residing in the Specialized Care Residence

PNA $146

Specialized Care Residence Amount $1,001

Total - $1147

Calculation. December 1st to 31st - BN + Shelter = $1,941
December 10th to 31st - $1,001 Specialized Care Residence Amount ÷ 31 days = $ 32.29
$32.29 x 22 days = 710.38

Applicants who are granted ODSP and reside in a Specialized Care Residence

If an applicant is granted ODSP and resides in a specialized care residence on the date of grant and has no community residence, their budgetary requirements for the month of grant are pro-rated. This only applies to applicants and does not apply to recipients who are already receiving ODSP and move into a specialized care residence.

Example 6 - An applicant has a date of grant of November 15, 2017and resides in the Centre for Addiction and Mental Health in the City of Toronto on the date of grant with no community residence

November 2017

Recipient is granted ODSP on November 15

December 2017

Recipient resides in the specialized care residence

January 2018

Recipient resides in the specialized care residence

PNA. $73.05

PNA. $146

Total. $146

PNA. $146

Total. $146

Calculation; November 15th to November 30th
PNA $146 ÷ 30 days = $4.87
$4.87 x 15 days = $73.05

Recipients whose Eligibility is based on Living in a Specialized Care Residence

If a recipient is not eligible to receive income support after leaving a specialized care residence, he/she is eligible to receive Personal Needs Allowance in the month of discharge, regardless of the number of days he/she lived in the residence. If in financial need, the recipient should be referred to Ontario Works.

Recipients whose Eligibility is not based on Living in a Specialized Care Residence

In the month of discharge, a recipient is eligible to receive full income support determined according to his or her budgetary requirements based on their circumstances in the community.

In addition, if a recipient is being discharged from:

  • a home under the Long-Term Care Homes Act, 2007; or
  • an intensive support residence or a supported group living residence under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008;

The budgetary requirements in the month the recipient ceases to be a resident must also include a specialized care residence amount to compensate the residence for the number of days the recipient resided there.

Example 7 - Single person with a disability leaves an intensive support residence and moves into a rented apartment (maximum shelter allowance) on December 15th, 2017

November 2017

Recipient resides in an Intensive Support Residence

December 2017

Recipient leaves the Intensive Support Residence December 15th to a community residence

January 2018

First full month Recipient resides in community residence

 

PNA - $146

Specialized Care Residence Amount - $1005

Total - $1151

1st to 31st Basic Needs - $662
Shelter - $489

1st to 15th Specialized Care Residence Amount - $486.30

Total - $1637.30

Basic Needs - $662
Shelter - $489

Total - $1151

Calculation. December 1st to 15th - $1005 Specialized Care Residence Amount ÷ 31 days = $32.42
$32.42 x 15 days = $486.30

Recipients on a Three Month Leave of Absence from a Psychiatric Facility

Under section 27 of the Mental Health Act, the attending physician or the officer in charge may place a patient on a leave of absence from a psychiatric facility for a designated period of not more than three months, if the intention is that the patient will return.

This provision extends “admitted” status to people not physically residing in the psychiatric facility, with all patient privileges and services (e.g. drug coverage, psychiatric services), and for ODSP purposes, eligibility as a member of a prescribed class, if financially eligible.

The budgetary requirements for a recipient who is:

  • a person with a disability; or
  • a member of a prescribed class, not based on residency in a psychiatric facility (e.g. a person who receives Canada Pension Plan Disability Benefits)

are to be calculated according to the recipient’s circumstances in the community during the three-month leave of absence. Depending on the type of accommodation, a recipient may receive either the basic needs amount and the shelter allowance or the board and lodging amount during the leave of absence.

The budgetary requirements for a recipient, who is a member of a prescribed class based solely on residency in the psychiatric facility, continues to be a Personal Needs Allowance during the leave of absence. For this reason, at the time of the application, it is important that intake staff discuss with the applicant or their advocate and/or specialized care residence staff whether the applicant is likely to be granted a temporary leave of absence as part of the treatment/discharge plan. This will assist ODSP staff to determine if and when a referral to the DAU would be appropriate.

Community Treatment Orders

Community Treatment Orders are not leaves of absence, but rather, are comprehensive plans involving community based treatment or care and supervision that is less restrictive for the person than residence in a psychiatric facility.

A recipient with a Community Treatment Order is accorded the same rights and responsibilities as other recipients and must qualify financially and as a person with a disability or as a member of a prescribed class.

A recipient with a Community Treatment Order who is detained in custody is treated the same as other ODSP recipients in the same circumstance. Income support is suspended but not cancelled if a single recipient is detained in custody for one full calendar month. (See ODSP Policy Directive 2.6 Incarceration).

However, if a recipient is temporarily admitted to a psychiatric facility, his or her budgetary requirements are determined according to hospitalization policy. (See ODSP Policy Directive 8.2 Treatment of Budgetary Requirements - Temporary Stays in a Hospital or Substance Abuse Recovery Home).

Overpayments

Unless otherwise requested by the recipient, in cases where the Personal Needs Allowance is the recipient's only income, no overpayments should be recovered until the recipient's circumstances change. (See ODSP Policy Directive 11.1 Recovery of Overpayments).

Related Directives:

1.1 Applications
1.2 Disability Adjudication Process
2.1 Who is Eligible: Dependent Adults
2.3 Spouse
2.6 Incarceration
3.1 Reviewing Eligibility
11.1 Recovery of Overpayments
13.1 Notice of Decision and Internal Review Process

Appendix A

Designated Psychiatric Facilities under the Mental Health Act

  • Brockville Psychiatric Hospital (except the St. Lawrence Valley Correctional and Treatment Centre);
  • St. Joseph’s Health Care Centre for Mountain Health Services;
  • Providence Continuing Care Centre: Mental Health Services (except L. S. Penrose Centre);
  • Regional Mental Health Care London;
  • North Bay Psychiatric Hospital (except Nippissing Regional Centre);
  • Mental Health Centre Penetanguishine;
  • Regional Mental Health Care St. Thomas (except St. Thomas Adult Rehabilitation & Training Centre);
  • Lakehead Psychiatric Hospital (except Northwestern Regional Centre);
  • Whitby Mental Health Centre (except Durham Centre for the Developmentally Handicapped).