Guide to Getting Self Managed Care (SMC) in Alberta

Self managed care allows seniors and those with chronic health conditions to live at home for as long as possible. Paying for in-home health services out of pocket can be tremendously expensive, but there are programs designed to help. Making the necessary arrangements can be time-consuming, but the benefit of aging at home and continuing to enjoy a normal life is worth the hours of investment. As long as you or a family member qualify for in-home personal care and/or household maintenance services or health-care services, you might also qualify for the self managed care option.

Self Managed Care (SMC) is a program offered by Alberta Health Services. Eligible Home Care clients can enter into a legal agreement with Alberta Health Services in which they receive the funds to pay for personal care and in-home support services. Instead of working through an existing provider agreement, this arrangement allows you to find and hire a service provider of your choice — providing they meet the hiring requirements. The amount of money provided to support your self managed care services will be based on your estimated unmet health care needs. Each year, those needs will be re-assessed unless your health status changes in the interim. A significant change in your health care needs will trigger a mid-year re-assessment.

Eligibility Requirements for SMC in Alberta

Arranging to take advantage of the self managed care option in Alberta requires you to meet a few eligibility requirements. If you already receive in-home personal care, you can probably switch fairly easily. If you don’t you will need to prove eligibility to get approved. Participation requires you to have a valid Alberta Health Care Card and live in a community setting. If you live in a care facility or have already transferred to an assisted living community, you won’t qualify.

If you meet those qualifications, you will need to get approval from an AHS case manager. During the assessment, they will check to determine if you have:

• Unmet health care needs
• A stable health condition that requires reasonable and expected care needs.
• An ongoing need for support with daily activities and home maintenance.
• Ready, willing and able to take on the responsibilities and risks that come with employing a home health aid directly.

If you are not able to assume the responsibility of hiring and paying an employee, a family member or legal guardian can take over these tasks, if needed.

Who Can You Hire?

When looking for a person to provide home health services, it is important to ensure they meet the criteria for employment via the SMC program. First, they must be legally allowed to work in Canada. Those traveling without a work visa or those too young to seek employment do not qualify.

Additionally, family members can not be the paid home health services provider, even if they have experience in the field. That means no parents, grandparents, spouses, children, in-laws or other relatives living in the same household. Relatives includes those related via legal adoption. If a relative lives with you, or is a close relation, they do not qualify to receive payment for any home support they provide.

You can hire directly through an agency or on a contract basis. There are many providers out there that can help you find and interview different service providers until you find one that fits well into your family unit.

How Can I Arrange Home Care?

Your local Home Care Office should be your first call when trying to contract a service provider. You can make the call, or have family or friends call on your behalf. You can also have a neighbour or health professional make the call, if you do not have anyone else available or would rather not involve family members in the decision-making process.

Expectations of the SMC Agreement Holder

When you sign up for the SMC program, you are referred to as the agreement holder. Along with enrolment, you agree to meet the program requirements. Before you can get started, you’ll need to ensure that all of the documentation is signed and submitted, prior to using the funds. For example, if you are using a legal representative, you’ll need to ensure they have documentation that they are legally allowed to sign for these services on your behalf. Other responsibilities include general employer responsibilities like recruiting and interviewing prospective candidates, making the final hiring decision, supervising the new hire as they assume their job responsibilities and creating a work schedule.

You will also need to arrange for back-up care if your regular home health aid is unavailable. Illness, weather and family emergencies make it almost impossible for one person to guarantee availability all of the time. You must have an alternative care provider lined up to handle these situations.

Part of the responsibility of becoming the agreement holder is becoming the boss. You must provide employees with regular assessments of their work and be prepared to fire them, if necessary. As the employer, you determine the scope of their job duties and work to ensure they meet the criteria you set.

You’ll also need to handle payroll and salary. In many cases, the hourly wage for these services is set by the SMC program, but you will be responsible for paying the care provider, directly. Based on the schedule you set, you will disburse wages and handle any tax reporting necessary. In addition to tax reporting, you may need to obtain a business number, withhold income tax and money set aside for the Canada Pension Fund. Employment Insurance must also be kept up to date. All of this goes back to you becoming the employer and meeting the Alberta Employment Standards.

As part of the documentation for the program, you will need to reconcile the money spent on services each quarter. The AHS provides a set amount of funds, and you will need to document how much was spent versus how much was deposited to cover services.

As part of the agreement, you will need to notify the AHS within 72 hours if anything changes. If you are admitted to the hospital, change living arrangements, need more or less care or have a change in your health status, you must report the change to the AHS. Any changes can impact the amount of funding and eligibility requirements for the SMC program.

What if I Don’t Want to Be an Employer?

Direct hire leaves you with a laundry list of financial reporting, and you may not want to deal with the increased documentation. If that is the case, you can also hire through a home health service agency. In those cases, you contract for the service and the provider is employed by the agency. This arrangement dramatically reduces the burden on you to handle things like employer tax withholdings and obtaining a business number.

Types and Scope of Services Under the SMC

The type of services you need will determine what is covered under the SMC. Your Home Care assessment will determine the type of services (personal care, home support services and/or respite care) needed to maintain your quality of living.

Personal care includes services like helping you with personal hygiene, medication reminders, getting dressed and making your way to the bathroom. Services in this category might also include transportation and help moving around the house.

Home support services fall into help around the house. You might not be able to stand for long periods of time, making it difficult to tackle basic house chores. With home support services, you have someone on hand to help with meal preparation and clean up.

Respite care gives your primary caregivers a break. Unpaid caregivers offer hours and hours of support which can become emotionally and physically draining. Respite care takes over for days or weeks, giving your loved ones a chance to rest, recharge or take a vacation.

Staying at Home

The SMC program helps you stay at home as long as possible. With the right combination of services, you can enjoy a fulfilling and active community life. When safety concerns make it inadvisable to live at home along, the SMC program can help you meet the cost of having someone come in and help.

Need more help in getting home care in Alberta?

We’d love to help! We provide home care services to seniors in Alberta. Call us at 1–800–856–2836 for free consultation or get started online here.

Originally published at blog.mavencare.com.