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Obtained by Bob Mackin via Freedom of Information

FHA File: 1-493-FOI

July 22, 2013

Via Email

Mr. Bob Mackin

Dear Mr. Mackin:

Re: Freedom of Informati on and Protection of Pri vacy Act (FIPPA) Request
Business case or report for $25 wheelchair fee

I am writing in order to provide Fraser Healths full response to the following FIPPA
request, which was received by my office on June 7, 2013:

Specifically, you have requested the following information:

"The business case or any other type of report that recommended or
justified the decision to charge a $25 a month for wheelchair use at
Mountain View Manor or any other site under the jurisdiction of Fraser

The Fraser Health FOI Office has determined that the following records, copies of which
are attached, are responsive to your request:

x PBMA Form
x BRIEFING NOTE: Wheelchair Maintenance Fee in Residential Care Owned &
Operated Facilities, dated May 6, 2013.

These records are being released to you in their entirety. No information has been

We trust that your request for information has now been satisfied and that no further
action with regard to your request is required of this office.

Should you find this response unsatisfactory, you may ask the Information and Privacy
Commissioner to review Fraser Health Authoritys decision. You have 30 business days
from receipt of this notice to request a review by writing to the Office of the Information
Fraser Health Authority Suite 400 Central City Tower Tel (604) 587-4437
Corporate Office 13450 - 102
Avenue Fax (604)-587-4666
Legal Services Surrey, BC

Mr. Mackin (1-493-FOI)July 22, 2013
Page 2 of 2

and Privacy Commissioner. Detailed information on how to request a review by OIPC is
available on the OIPC website:

If you have any questions or require any clarification regarding the processing of your
request, please email our FOI team at


Doug Luther
FOI Coordinator
Legal Services
Fraser Health Authority

Encl. Records (8 pages)

Fraser Health Authority Suite 400 Central City Tower Tel (604) 587-4437
Corporate Office 13450 - 102
Avenue Fax (604)-587-4666
Legal Services Surrey, BC

Title: (max 50 characters)
Wheelchair Rental Revenue
Initiative Type:
7 Step Framework:
Residentail Care


Provide a brief description of the proposed initiative

Contact Person:
Cathy Sleiman
Hospital Site: All FH
Community: All FH
What change to service is being proposed?
(Max 500 characters)
Residents in FH Owned and Operated sites will pay a monthly rental charge
for wheelchairs provided from FH stock
What impact will this change have on current
service levels and what service levels are
expected for this target population?
(Max 500 characters)
Currently residents do not pay for the use of FH wheelchairs. Some
residents have personal chairs which they have purchased. Residents will
be assigned an appropriate wheelchair for their sole use and they will be
charged $25 per month. Charge complies with MOH H&CC policies only if
the wheelchair is provided to a single individual. Low income residents may
not be able to afford the rental costs and a waiver process will be required
What is the target population?
(Max 500 characters)
Residents using FH supplied wheelchairs - estimated to be about 60% of
1800 residents
Who are the partners involved in this initiative
and their role? What providers will be impacted
by this change?
(Max 500 characters)
Occupational Therapists assess and assign wheelchairs based on resident
need. Families/residents will consent to pay and Finance will process bills
and collect fees

What key assumptions are being made with this
initiative (e.g., demographics, HHR capacity)?
(Max 500 characters)
Processes will be streamlined to reduce administrative costs, a
waiver system will be developed for residents who can not afford
to pay, FH will continue to have sufficient equipment to meet
residents needs. Revenue estimated to 1800 beds x 60% x 8
months (adjusted to cover movement in & out of residential care)
x $25/month. Start-up will be gradual so maximum revenue will
not be obtained until 2014
Estimate total annual operating savings


Direct Program Savings
0.00 100,000 216,000 0
Physician Services Savings
0.00 0 0 0
Clinical Costs and Corporate and Support
Savings(Use 30% of the Program Savings)
0.00 0 0 0

One Time start-Up Savings(e.g. lease,

Equipment < $5,000 (operating)
0 0 0
Equipment > $5,000 (capital)
0 0 0
0 0 0
0 0 0

Total Estimated Savings




Total Investment (If some re-
investment is applicable)
0.00 50,000 0 0




Describe the impact on each criterion with supporting evidence and/or rationale where possible

The ability of FHA to deliver core

No impact
Access/ capacity/ congestion
No impact
Downstream impact on service
No net impact or forecasted increase in future use of services
No impact

No impact
Moderate overall negative impact
Complies with policies but the additional cost may be burdensome for some residents and families
Moderate overall negative impact
Staff may have difficulty charging for equipment that used to be free. Families/residents may
object to user payment
No impact
No impact
Number affected
estimated to be 60% of 1800
Degree of change on health status
No impact
No impact on disparities in quality of health and healthcare
Implementation challenges
Moderate risks and strong or moderate opposition
Would need to establish systems to process fees. User fees will be protested
Minimal deterioration of the coordination of care
Research and academic development
No overall impact on the culture of the organization in terms of innovation and knowledge transfer, on education
and training and on research
No impact
Great Workplaces
No overall negative impact

Weighted Score: -13


Implementation Plan
What risks does this initiative pose and how would these be mitigated?
Financial Implementation would involve minimal risks of significant negative financial impact for FHA

Safety Minimal risk that the implementation will have significant negative safety implications for staff/patients

OngoingOperations Minimal risk that implementation would have a significant adverse effect on ongoing operations

Political Moderate risk that implementation will cause significant political concerns

Technology Minimal risk that implementation will lead to significant technological challenges

Equipment Minimal risk that implementation would have a significantly negative impact on equipment

Facilityconditions Minimal risk that implementation will have a significant negative impact on facility conditions

Legal/regulatory requirements (checkmark indicates yes)





Project Manager:

Project Status:
Start Date:
Target Completion Date:
Actual Completion Date:

BRIEFING NOTE: Wheelchair Maintenance Fee in
Residential Care Owned & Operated Facilities
Date: May 6, 2013



X Discussion




Issue / Question:
A proposal to introduce Wheelchair Rental Fees at the Owned & Operated Residential Care Sites
was submitted in the PBMA process. Subsequent to that submission, the MOH requested FH to
implement wheelchair maintenance fees to align with a similar proposal made by VCHA. This
request was based on a desire to have similar practices in all Health Authorities and to align
with the practices in CCALA facilities.

Currently, residents in FH Owned and Operated residential care facilities do not pay for the use
of FH wheelchairs. FH provides the wheelchairs, Occupational Therapists may customize them
with FH owned parts and cushions to meet individual resident needs and FH provides
maintenance to keep the wheelchairs safe and functional. Some residents have personal
wheelchairs which they have purchased. FH staff will provide a safety inspection for the
wheelchair and, if maintenance is required it is the residents responsibility. In CCALA facilities,
most residents purchase or rent their wheelchairs. This creates a two-tiered system based on
which type of facility a resident enters which was noted by the Ombudsperson.

Implementing a maintenance charge for a wheelchair assigned to an individual resident is a
permissible chargeable extra which complies with the Ministry of Health Home & Community
Care regulations. Processes to collect the maintenance fee will be aligned with the current
processes to collect expenses from the residents comfort fund and a waiver system will be
developed for residents who cannot afford to pay. FH Occupational Therapists are available to
assess residents seating and mobility needs and help them select an appropriate wheelchair.
Residents will be encouraged to purchase or rent wheelchairs from outside healthcare
equipment vendors and the cost to purchase a wheelchair ranges from $1,000 to $3,500 for a
manual wheelchair and a typical wheelchair rental from an outside vendor is $70-$100 per

It is estimated that about 60% of the 1718 residents in O&O facilities use a FH owned
wheelchair. Currently, FH has sufficient equipment to meet the residents needs but the
wheelchair fleet is aging as there have been limited equipment purchases in the past five years.
Currently, equipment may be replenished from donations from families and Foundations. A
wheelchair rental program would serve as a cost recovery initiative that would finance the cost
of replacement equipment and ensure that equipment is maintained in optimal condition. This
rental program will not apply to other mobility devices such as walkers and canes.

Wheelchair Rental in Residential Care Owned &

Operated Facilities
Page 2

x Fraser Health Residential Care is committed to having a fleet of safe, reliable
wheelchairs available for residents to use as their mobility needs change.
x The introduction of wheelchair rental fees at FH Owned 8 Operated sites will align our
practice with those of our affiliated facilities where residents are required to purchase or
rent their wheelchairs and is consistent with provincial policy.
x Effective June 1, 2013 residentsffamilies wishing to rent a wheelchair from FH will be
assigned an appropriate wheelchair for their sole use at a monthly rental cost of $25.00.
x Notice of this change in practice will be given in writing to residentsffamilies 60 days
prior to the start of the rental program (by April 1
). After June 1
all new residents will
be informed of the rental option when they move in.
x Residents who receive income or premium assistance, disability benefits or who are
experiencing financial hardship will be able to apply for a waiver.
x Noney collected through the rental program will go directly into improving and replacing
aging mobility equipment.

Wheelchair Rental in Residential Care Owned &

Operated Facilities
Page 2