RESIDENTIAL OPTIONS

1. Family Homes

Many people who have mental disorders are living with relatives and getting day to day care and supervision from family members, as well as room and board.

Persons with disabilities who are on the Saskatchewan Assistance Plan (SAP) and are receiving room, board, and care from relatives, may get a “Level of Care” payment from SAP. The “Level of Care” that is needed is decided by a standardized assessment. When it is a psychiatric disability, a Mental Health Services worker does the assessment. The payments range from $422/month to $721/month (May ’99), depending on the “Level of Care”, and cover room and board as well as care services.

The person with the disability will also receive a Personal Living Allowance of $85/month (May ’99) and Supplementary Health Benefits. Extra funds for Special Needs such as transportation may also be provided.

Anyone who is providing room, board and care for a family member who has a psychiatric disability and is on SAP but who is not receiving a “Level of Care” payment, should get in touch with that person’s mental health worker to find out whether a “Level of Care” payment would be appropriate.

2. Approved Homes

An Approved Home is a building that has been certified by Saskatchewan Health to provide long term supervised accommodation for up to five persons who have mental disorders. An Approved Home must be inspected annually to meet fire and health standards.

An Approved Home Operator must also be certified by Saskatchewan Health and may be required to take certain training. The Operator is screened and has to be considered to be a suitable and responsible person to undertake this important role. The Operator must live in the Approved Home.

Admissions to Approved Homes are made by the District Mental Health Services which is also responsible for supervising Approved Homes.

Each resident in an Approved Home is responsible to pay for his or her own room, board and care. The fee as of May 1999 ranges from $460/month to $1,510/month depending on the “Level of Care” provided. If a resident is eligible for financial aid from Social Services, the fee will be paid by the Saskatchewan Assistance Plan (SAP). The resident then receives $85/month for clothing and personal needs and a $25/month activity allowance. Supplementary Health Benefits for medications and other health care such as dental work or eye glasses are provided as well. Extra costs for special needs, like transportation may also be covered. A senior resident with income from Old Age Security and Guaranteed Income Supplement may require partial assistance from SAP to pay resident fees.

3. Group Homes

Group Homes for persons with psychiatric disabilities are administered by non-profit societies, such as the Phoenix Residential Society, Regina. They are regulated by the Residential Services Act, and supervised by District Mental Health Services. Operating grants are provided for these group homes from District Health Boards.

Group Homes usually provide rehabilitation and training for more independent living. They do not usually provide a long-term home for persons with psychiatric disabilities. To find out if there is a Group Home in your area, check with your nearest Mental Health Clinic. (See Appendix V)

There is no residential fee for persons who receive financial assistance from Social Services (Saskatchewan Assistance Plan). Residents who are not eligible for SAP because they have their own income may be charged a fee.

Residents getting SAP will receive a Personal Living Allowance for clothing and personal needs, which in May 1998 is $85/month. They will also receive Supplementary Health Benefits and may get more for Special Needs, such as a transportation allowance.

4. Personal Care Homes

These are privately owned and operated homes for the care of up to 40 residents. They are regulated by the Personal Care Homes Act and supervised by District Health Services. These homes do not receive any government subsidy, and the fee for care is negotiated between each resident and the Personal Care Home owners.

For persons who receive financial assistance from Social Services (SAP), there is a maximum charge depending on the “Level of Care” required (determined by a standard assessment), but Personal Care Homes do not have to accept persons who receive SAP. The maximum charge covered by SAP in May 1999 is between $520 and $844/month.

Residents whose care costs are covered by SAP receive a Personal Living Allowance of $85/month (May/99) as well as Supplementary Health Benefits. They may also get extra for Special Needs.

5. Special Care Homes

In Saskatchewan, Special Care Homes provide nursing care for persons who need full time care and supervision. Funding grants for Special Care Homes are provided to District Health Boards by Saskatchewan Health.

Residents also pay fees which usually cover about 25% of the cost. The maximum fees that may be charged depend on income, and are set for all the province by Saskatchewan Health. The fee structure is determined by the federal Old Age Security (OAS) and Guaranteed Income Supplement (GIS) rates, (which are adjusted quarterly), since most of the residents of Special Care Homes are over 65 years of age. The maximum fees which vary between about $800 to $1,100/month (May 1999) depending on income, will usually leave a senior resident about $100/month for clothing and personal needs.

Senior residents who do not receive GIS are charged the maximum residential fee. They have to pay up to $850 every six months for prescription drugs, before the charge for their drugs is reduced to 35%. They will also have to pay for their dental care, eye glasses, and most medical supplies.

Those residents who receive GIS will have to pay the first $100 for prescription drugs every six months (January to June, July to December) before the charge is reduced to 35% for the rest of the six month period.

A resident who has no other income except OAS/GIS, and who thus receives the Saskatchewan Income Plan Seniors Benefit (SIP), is eligible to receive Supplementary Health Benefits for drugs (no charge), dental care, eye glasses and certain medical supplies or equipment. The resident must be nominated by the Special Care Home Administration to Saskatchewan Health in order to receive Supplementary Health Benefits.

Resident fees for those who are under 65 years of age, and are on SAP, are covered by SAP at the minimum rate. These residents also receive Supplementary Health Benefits and $85 a month for clothing and personal needs. They may receive extra funds for Special Needs. Those residents under 65 who have income are charged on a sliding scale between the minimum and maximum rate, depending on their income.

Standards for Special Care Homes are regulated by the Special Care Homes and Housing Act which is administered by Saskatchewan Health, but District Health Boards are responsible for inspecting them and ensuring that the standards are met. District Health Boards are also responsible for providing assessments to determine potential residents and priorities for admission to Special Care Homes.

6. Respite Care for Caregivers

Saskatchewan Health has made funding available to help care providers of persons with psychiatric disabilities get respite breaks. Family members or others who are looking after someone full time, day in and day out, need a holiday once in a while.

Care providers may receive up to $25/day (1999 rates), for up to 14 days a year, in order to hire someone else to provide the needed care and supervision. The usual care provider will then be able to get away for a holiday. The maximum amount that a care provider may receive for this purpose is $350/year.

To obtain Respite Care funding, contact your local Mental Health Services. If you have trouble reaching a local Mental Health Services worker, try to get in touch with the Regional Mental Health Services headquarters for your Health District.

(See list of Mental Health Regions in Appendix II.)

You may also contact Saskatchewan Health in Regina to get further information about this program or to help make arrangements to obtain Respite Care funds.

Phone (306) 787-1501 and ask for a Mental Health Consultant.

1. PUBLIC SERVICES

Most health services in Saskatchewan are paid for by the taxpayer.

Saskatchewan Health Services Card

• If you have lived in Saskatchewan for at least three months, you are eligible for a Saskatchewan Health Services Card. There is no charge for this card, but if you do not have one, you have to register with Saskatchewan Health to get it. To register call 1-800-667-7551, or in Regina, 787-3251. If you have recently moved to Saskatchewan, you can apply for your health card as soon as you get here. It will come into effect once you have lived in Saskatchewan for three months.
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• The Saskatchewan Health Services Card must be shown to get most health services in Saskatchewan. It covers medical care costs (doctor bills) and most in-hospital costs, as well as mental health services provided by Health Districts.
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• The card also lets you get some other health services such as foot care from the Chiropody Program, certain equipment for persons with disabilities from Saskatchewan Aids to Independent Living (SAIL), hearing assessments and aids from Saskatchewan Hearing Aid Plan (SHAP), long term care in Special Care Homes, prescribed medicine from the Saskatchewan Prescription Drug Plan (SPDP), and Home Care Services. There are some charges for these other health services but there are no charges for medical care, most hospital care or for most mental health services.

Temporary Health Coverage

Someone who has not lived in Saskatchewan for at least three months and needs emergency health services, but cannot afford to pay for them, may be given Temporary Health Coverage (THC). Saskatchewan Social Services determines financial eligibility for THC.

If the person has come from another province or territory in Canada, the charges for medical or hospital care will be covered for the first three months by the Health Card from the former residence. Costs for other health services, such as home care, dental work, special equipment, medical supplies or prescribed drugs will be the person’s own responsibility, unless the person has THC.

A person who comes to Saskatchewan from outside Canada may not have any health coverage for the first three months. If emergency hospital or medical care is needed within that time, the person may be nominated for THC by a hospital employee or by a doctor. A Social Services worker must then do a financial assessment. If the person meets eligibility requirements for THC, it will be effective from the date of nomination.

Those persons who require financial assistance from Social Services are not eligible for Supplementary Health Benefits until they have lived here for three months. If they need essential health care, including prescribed medicine, during that three month period, a Social Services worker may issue a THC.

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2. CHARGES FOR HEALTH SERVICES

You should be aware that you may have to pay for certain mental health services. These charges are discussed in the following paragraphs.

Medications

• When in hospital there is no charge for prescribed medicine, as long as the drugs your doctor orders are on the Saskatchewan Drug Formulary (the Formulary is a list of drugs that have been approved by Saskatchewan Health to be included in the Saskatchewan Prescription Drug Plan).
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• When you are getting out-patient services from a Mental Health Clinic, or treatment for a mental illness from a private psychiatrist or family doctor, you are responsible for paying for your own medication. You may be able to get some help to pay for your drugs from one of the following programs.

Programs to Help Pay for Medications

• Supplementary Health Benefits Plan 1
  

  If you receive income from the Saskatchewan Assistance Plan (SAP), you will also have Supplementary Health Benefits. That will pay for some health services that are not covered by the Saskatchewan Health Services Card, like dental care, eye glasses, and medicine ordered by your doctor. You will automatically get Plan 1 drug coverage when you get Supplementary Health Benefits. That will pay for prescribed drugs that are included in the Drug Formulary. You will be charged $2 for each prescription if you are 18 or over, but there is no such charge for children.

   

• Supplementary Health Benefits Plan 2
  

  If you are on SAP and getting 5 or more prescriptions a month on a regular basis, your doctor, or pharmacist can ask the Drug Plan to give you Plan 2 drug coverage. Then there will be no charges for your medications as long as they are on the Drug Formulary.

   

• Supplementary Health Benefits Plan 3
  

  If you are on SAP and live in an Approved Home or a Special Care Home, you will receive prescription drugs at no charge. You may also get certain over-the-counter drugs like cough syrup or laxatives at no charge.

   

• Supplementary Health Benefits – Low Income
  

  Your income might be too high for you to get any income assistance from SAP, but still be quite low. For example, you may have a little income from Canada Pension Plan disability benefits, or from part-time employment. That might not be enough income, however, to pay for health costs like dental bills and medicine. Then you may be able to get Supplementary Health Benefits.

  You have to apply for these benefits at a Social Services office. A Social Services worker will have to check your income and any savings you may have, just the same as when you apply for income assistance. The worker will also have to find out about all your health costs. That could include eye glasses, dental bills and the medicine you have to take. If your health costs are too high for you to pay with the income you have, you might be given a Supplementary Health Benefits Card.

  A Supplementary Health Benefits Card will give you Plan I drug coverage. That means you will only have to pay $2 for each prescription you get filled. If you get five or more prescriptions every month, you can ask your doctor to get you Plan 2 coverage. Then there is no charge for prescriptions that are on the Drug Plan.

  A Supplementary Health Benefits Card will also help you pay for some other health services that are not covered by the Saskatchewan Health Services Card. For example, that could be eye glasses, dental care, or certain medical supplies. Transportation costs for health care may also be covered.

   

• Employment Training
  

  If you are taking an employment training course and getting the Provincial Training Allowance, you will also get Supplementary Health Benefits. The Provincial Training Allowance is administered by Saskatchewan Post Secondary Education and Skills Training. It includes Child Care and Supplementary Health Benefits.

   

• Family Health Benefits
  

  If you have children, and your family income is low, you may get assistance from the Saskatchewan Child Benefit, as well as from the Saskatchewan Employment Supplement. (See page 39 for a description of these programs.) If you qualify for either of these programs, you will receive Family Health Benefits.

  Family Health Benefits will give your children Supplementary Health Benefits. That will help pay for their dental care and eye glasses, for example, as well as for medicine which has been ordered by a doctor.

  The adults in a family who receive Family health Benefits will not get Supplementary Health Benefits, but they may get some help in paying for their medications. Adults will have to pay the first $100 for prescribed drugs every six month period (Jan. to June, July to Dec.), but then will only pay 35% of the cost until the end of that six month period. Parents who get Family Health Benefits and need expensive prescribed drugs may get more help from the Drug Plan’s Special Support Program. This is discussed later.

  It is not necessary to apply for the Saskatchewan Child Benefit. If eligible, benefits will be received automatically based on the number of children under age 18, and family income as reported to Revenue Canada on Income Tax returns for the previous year.

  To apply for the Saskatchewan Employment Supplement, phone toll free, 1-800-488-6385 or 787-4723 in Regina.

   

• Guaranteed Income Supplement (GIS)
  

  If you are over 65 or married to someone over 65 and getting the Guaranteed Income Supplement (GIS) along with Old Age Security from the federal government, you may get some help in paying for your medications. When you or your family pay $200 for prescribed drugs during a six month period (Jan to June, or July to Dec.) you will only have to pay 35% of the cost for any more drugs until the end of that six month period. Note: To get GIS you must already be getting Old Age Security (OAS) and have low income. To apply for GIS, phone 1-800-227-9914.

  The Special Support Program from the Drug Plan may be of further help if your prescription drugs are expensive. This is explained later.

   

• Seniors Income Plan (SIP)
  

  There is further help for seniors with very low incomes. If you get the Saskatchewan Seniors Income Plan benefit as well as the federal GIS you will get a deduction on drugs that cost more than $100 in a six month period (Jan. to June, or July to Dec.). After paying the first $100 you will only pay 35% of the cost of your prescribed drugs until the end of the six month period.

  Note: You do not need to apply for SIP. If you get GIS and have little or no other income, you will automatically get SIP as well.

  If you need expensive drugs for a long time you should also apply for Special Support from the Drug Plan.

   

• Special Support Program
  

  The Saskatchewan Prescription Drug Plan may provide assistance with the costs of expensive drugs for individuals and families, depending on income. If your prescription drug costs are high compared to your income you should apply for Special Support. The amount of help you may get will depend on the costs of drugs you and your family need on a regular basis as well as on your family income.

  You can apply for this assistance wherever you get your prescriptions filled. All drug stores have application forms for the Special Support Program.

   

• Saskatchewan Prescription Drug Plan Regular Benefits
  

  Even if your family income is quite high (e.g. over $50,000), you may get some help from the Drug Plan, if prescription drugs for you and your family are very expensive. If you don’t qualify for any other assistance, you will have to pay the first $850 for your drugs every six month period (from Jan. to June, and from July to Dec.). After that you will pay only 35% of the cost of prescribed drugs that are on the Formulary, until the end of that six month period.

   

• Exceptional Drug Status
  

  Some drugs that are not on the Formulary (that is, they are not covered by the Drug Plan), may be given Exceptional Drug Status by the Drug Plan. If your doctor wants you to take medicine that has Exceptional Drug Status, the doctor can ask the Drug Plan to give you coverage for that drug. If you get this coverage, it will then be the same for you as if it were on the Drug Formulary. You will have to pay for it the same way as you do for other prescription drugs. If you have Supplementary Health Benefits you will pay $2 a prescription (Plan1) or nothing (Plan 2) if you have more than 5 prescriptions a month. If you are on the Drug Plan Special Support Program, what you pay will depend on your income, as well as the cost of your drugs.

  Your doctor has to ask the Drug Plan to get Exceptional Drug Status for you, for a drug that is not on the Drug Plan Formulary.

   

• Special Drug Authorization (SAP)
  

  If your doctor prescribes a medication for you that is not on the Drug Formulary, or does not have Exceptional Drug Status and you are getting SAP, you may get special assistance. Your doctor must ask the Drug Plan for this. If approved, the Drug Plan will contact you and arrange with your drug store to have the bills sent to the Drug Plan.

   

• Special Coverage
  

  If you are on a registered program for certain illnesses or conditions there is no charge for medicine to treat that particular condition. That includes cancer, AIDS, cystic fibrosis, spinal cord injuries or disease, kidney dialysis, transplants and palliative care. Your doctor has to refer you to these programs.

   

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• Emergency Assistance
• If you can’t pay for essential drugs, a pharmacist may give you a one month supply at a reduced charge of 35% of the cost. You will then have to make an application for ongoing assistance from the Special Support Program.

Charges for Long Term Care in a Mental Health Facility

When a person has a Court Order or a Detention Order for long term care in a mental health facility, there is no charge. If, however, a person over age 65 is receiving long term care in a mental health facility (such as the Saskatchewan Hospital, North Battleford) on a voluntary basis, there may be a charge. The charge will be the same as for care in Special Care Homes. The resident charge, which usually covers about 25% of the cost in Special Care Homes, depends on income. It is adjusted every three months according to income for seniors from Old Age Security and Guaranteed Income Supplement (Oct ’98 charges range from $779 to $1,013/month and leave the lowest income seniors about $100/month for clothing and personal needs).

Voluntary long term care residents of mental health facilities who are under 65 may also be charged the same rate as for seniors. If they do not have enough income to pay the resident charge they can apply to Social Services for assistance. The charge will be paid by the Saskatchewan Assistance Plan (SAP) for persons who qualify for this assistance. The resident will then also get $85/month from SAP for clothing and comforts.