The Health Services Appeal and Review Board (Board) recently rescinded a decision of a Community Care Access Centre (CCAC) involving the personal support services of a client.  In JC v South West Community Care Access Centre, the CCAC revised the client’s plan of service and, in particular, withdrew the services it was providing to the client.  The client sought to have the CCAC continue to provide the services to her.  The issue for the Board was to determine what services the client was entitled to and on what basis.

The client argued that she required four hours a day of personal support services to assist her in her daily activities, including washing, dressing, bathing and eating.  However, evidence at the hearing revealed that CCAC staff had significant challenges in providing services to the client.  The evidence revealed that:

  • The client was perceived to be and had been reported to be abusive by the personal support workers providing services to her;
  • The client insisted on having a witness present during all CCAC visits;
  • The client refused all or part of an in-home exercise program;
  • The client refused to be admitted to a convalescent care bed, despite the recommendations of CCAC; and
  • Third party service providers withdrew their services as a result of alleged abusive behaviour on the part of the client and the unsafe work environment for their staff.

Consequently, the CCAC advised the client that it was no longer able to provide her with the personal support services.  While subsequent attempts were made to provide the client with CCAC services, the client insisted that she have a witness at her home whenever the CCAC visits occurred.  When the client was unable to arrange for a witness to be with her, she refused to let the CCAC worker enter her premises.  After this happened a number of times, the CCAC once again suspended its services.

The CCAC subsequently wrote to the client and proposed to provide her with personal support services for one hour a day on the condition that the client treat all service providers and CCAC staff respectfully, accept all visits offered and allow all service providers to provide service to her.  The client refused and appealed the decision of the CCAC to suspend her services.

The Board found that the CCAC’s action in reducing and then suspending the personal support services for the client was reasonable and consistent with the intent and purposes of the Home Care and Community Services Act, 1994 that include, among other things, to “ensure that a wide range of ‘community services’ is available to people in their own homes and in other community settings so that alternatives to institutional care exist”.  The Board ultimately rescinded CCAC’s decision to suspend services to the client and directed it to provide one hour personal support services to the client.  It also directed that any services to be provided by the CCAC be subject to the provisions of a Service Agreement to deal with issues involving staff safety.

This decision demonstrates the balance that must be struck between the duty to provide care to the community, even to clients who are perceived as difficult, as well as CCAC staff safety.