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S-4.2, r. 3 - Regulation respecting the classification of the services provided by intermediate resources

Table of contents
Occurrences0
Full text
Replaced on 1 January 2012
This document has official status.
chapter S-4.2, r. 3
Regulation respecting the classification of the services provided by intermediate resources
Act respecting health services and social services
(chapter S-4.2, s. 303).
Replaced, M.O. 2011-017, 2011 G.O. 2, 3784; eff. 2012-01-01; see c. S-4.2, r. 3.1.
However, the provisions of this Regulation remain in force to the extent that they are necessary for the application of any provision of Division VII of the Regulation respecting the application of the Act respecting health services and social services for Cree Native persons (chapter S-5, r. 1), the Regulation respecting the contribution of users taken in charge by intermediate resources (chapter S-4.2, r. 7) or the Regulation respecting financial assistance to facilitate tutorship to a child (chapter P-34.1, r. 5).
FORM FOR DETERMINING THE EXTENT OF SERVICES REQUIRED FROM AN INTERMEDIATE RESOURCE
Instructions
(Frame of reference for intermediate resources - November 1998)
Table of contents
Form for determining the extent of services required from an intermediate resource
PART A - IDENTIFICATION OF USER(S) AND INSTITUTION
1. User’s name
1.1 Date of birth and age
1.2 Sex
1.3 Problems
2. Authority responsible for identifying extent of services required by user and provided by resource
PART B - DETERMINATION OF EXTENT OF SUPPORT SERVICES OR ASSISTANCE REQUIRED BY USER AND PROVIDED BY RESOURCE
1. Characteristics of user and of intervention
1.1. Characteristics of user
1.1.1. Distinction between state and functioning
1.1.2. Special considerations for rating children
1.1.3. Choice of descriptors
1.2 Characteristics of intervention
2. Basic services required by user and provided by resource
3. Classification of services
PART C - IDENTIFICATION OF RESOURCE

___________________________________________________________________________________

FORM FOR DETERMINING THE EXTENT OF SERVICES REQUIRED FROM AN INTERMEDIATE RESOURCE
___________________________________________________________________________________
___________________________________________________________________________________

PART A - IDENTIFICATION OF USER(S) AND INSTITUTION
___________________________________________________________________________________

1. User’s name: ______________ or standard profile: □

1.1 Date of birth: _____/_____/_____ or Age: _____ to____ 1.2 Sex: _____

1.3 Problems: 1.3.1 Main problem: _____ 1.3.2 Associated problems: ___ ___ ___

2. Authority or body responsible for identifying extent of services required by
user and provided by resource:

2.1 Institution _____________________ 2.2 Code: _______________________

2.3 Caseworker _____________________ 2.4 File N°: _____________________
___________________________________________________________________________________
___________________________________________________________________________________

PART B - DETERMINATION OF EXTENT OF SUPPORT SERVICES OR ASSISTANCE REQUIRED BY USER AND PROVIDED BY RESOURCE
___________________________________________________________________________________
________________________________________________________ _________________________

Characteristics of user and of intervention
________________________________________________________

Facet of Characteristics Characteristics Basic services
personal life of user of intervention
______________________________________ _________________________

(C.1) State Funct. Nature Expertise Services Rating
(C.2) (C.3) (C.4) (C.5)
________________________________________________________ _________________________

3.1 Physical 3.10 Meal services
________________________________________________________ _________________________

3.1.1 Eating X
________________________________________________________ _________________________

3.1.2 Dressing X 3.11 Laundry services
________________________________________________________ _________________________

3.1.3 Hygiene X
________________________________________________________ _________________________

3.1.4 Excretory
functions X 3.12 Housekeeping
________________________________________________________ _________________________

3.1.5 Mobility X
________________________________________________________ _________________________

3.2 Cognitive 3.13 Personal presence
________________________________________________________ _________________________

3.3 Affective
________________________________________________________ _________________________

3.4 Behavioural 3.14 Night-time
supervision
________________________________________________________ _________________________

3.5 Relational
________________________________________________________ _________________________

3.6 TOTAL 3.15 Presence of a
second person
________________________________________________________ _________________________

3.7 Maximum 3.16 Total (Add 3.10
authorized 25 30 20 35 to 3.15)
________________________________________________________ _________________________

3.8 Applicable Carry total on 3.16
score to line 3.17
________________________________________________________ _________________________

3.9 TOTAL (L.3.8 C.2+C.3+C.4+C.5)
Carry to line 3.17 ▭
________________________________________________________ _________________________
___________________________

Classification of services
___________________________

3.17 Characteristics of user _______ + Basic services (L.3.16) _______ = _______
and of intervention (L.3.9)

3.18 Level of service: ________ 3.19 Type of residential organization: ____________
___________________________________________________________________________________

PART C - IDENTIFICATION OF RESOURCE
___________________________________________________________________________________

4.1 Name of resource:
_______________________________________________________________________________

4.2 Name of person in charge:
_______________________________________________________________________________

4.3 Address:
_______________________________________________________________________________

4.4 Telephone N°: _________ 4.5 Guaranteed compensation: ________________ per day

4.6 Client program or field of activity targeted: _________________________________

Signature: _______________________ Date: ___________ / ____________ / ____________
Year Month Day
Appendix I
GUIDE FOR THE FORM
FOR DETERMINING THE EXTENT OF SERVICES REQUIRED
FROM AN INTERMEDIATE RESOURCE
The Form for determining the extent of services required from an intermediate resource is used to establish the amount of support or assistance to be provided by the resource for a user or a group of users.
It may be filled out by one user only, or for a group of users using a representative sample establishing a standard profile as regards level of services required and expected from the resource. The form is based on knowledge of the user and the user’s needs. If knowledge is lacking or insufficient, (when the form is used for the first time), the form will have to be completed over again within a short time. Review of the form is also necessary if a change is noted in
• basic services from the resource;
OR
• the characteristics of the user;
OR
• the characteristics of the required intervention.
PART A - IDENTIFICATION OF USER(S) AND INSTITUTION
1.Name of user
— If a single user is being evaluated, enter his name.
— If a standard profile is being established for a group of users, check off the appropriate box.
1.1Date of birth and age
Enter the user’s date of birth, in “year/month/day” order. If a standard profile is being established for a group of users, enter the age category of the users.
1.2Sex
Enter 1 for female, 2 for male and 3 for a standard profile for both sexes.
1.3Problems
Enter in the space in 1.3.1 the number corresponding to the user’s main problem. If other associated problems are also significant, enter the corresponding number(s) in the spaces in 1.3.2.
(1) Need for social protection: Refers to a person’s vulnerability, resulting from a loss of autonomy, or the absence or inadequacy of, or threats from, his family or social environment (sexual abuse, neglect, social isolation, violence, etc.)
(2) Social maladjustment: Refers to the presence of behavioural or social adjustment problems (behaviour disorders, alcoholism, etc.)
(3) Loss of autonomy due to age: Refers to all the biological, psychological and social problems associated with normal or premature aging
(4) Mental health problem: Refers to mental illness, personality disorders or psycho-affective disturbances
(5) Physical health problem: Refers to physical illness or organic impairments
(6) Sensory impairment: Refers to the loss of or a permanent anomaly in a sensory organ
(7) Motor impairment: Refers to the loss of or a permanent anomaly in a limb
(8) Intellectual impairment: Refers to the simultaneous presence of a significant intellectual handicap and problems related to adaptive behaviour
2.Authority responsible for identifying extent of the services required by the user and provided by the resource
Enter in the appropriate space:
2.1 The name of the institution responsible for determining the extent of the services.
2.2 The institution’s code.
2.3 The name of the caseworker who made the determination.
2.4 The user’s file number.
PART B - DETERMINATION OF EXTENT OF SUPPORT SERVICES OR ASSISTANCE REQUIRED BY USER AND PROVIDED BY RESOURCE
1- CHARACTERISTICS OF THE USER AND OF THE INTERVENTION
For each facet in this section, you must enter the rating corresponding to the descriptor that best reflects:
— the user’s state (enter rating in column C.2);
— the user’s functioning (enter rating in column C.3);
— the nature of the intervention provided by the resource (enter rating in column C.4);
— the expertise required to enable the resource to provide the required service (enter rating in column C.5).
Fill in the 4 columns for a given facet before going on to the next facet (for example, Cognitive: C.2-C.3-C.4-C.5).
Then add up the ratings in each column and enter the result on line 3.6.
For each column, enter the lesser of lines 3.6 (total) and 3.7 (maximum authorized) on line 3.8 (applicable score). Add up all the amounts on that line and enter the result on line 3.9.
Finally, enter on line 3.17 the total thus obtained.
1.1 CHARACTERISTICS OF THE USER
1.1.1Distinction between state and functioning
— state refers to a trend, a predisposition or a given condition. For some characteristics (physical and relational), a state can be identified through the signs or symptoms a person displays, and through individual attitudes and behaviour. For other characteristics (cognitive, affective and behavioural), a state must be subjected to an overall intellectual assessment of the usual quality of the affect or of the type of personality that determines a behavioural tendency.
Bear in mind that the state refers to more basic, continuous or permanent elements of the facet evaluated. Hence, a temporary, transitory or non-significant element that could affect the evaluation of the user’s state for any of the facets examined in this section should not be considered.
The question to ask here is:
• Is the user or is the user not ___? OR Does the user or does the user not have ________?
— functioning represents the more dynamic or fluctuating nature of the characteristic, its actualization or operationalization, the degree to which it is realized or expressed. For all characteristics, the type of functioning is established through direct or indirect observation (by an outside observer) of the attitudes or behaviour displayed by the user, or of the user’s activities.
Bear in mind that functioning refers to the user’s behaviour. The regularity and continuous nature of the functioning are major indicators for determining the ability or the attitude of the user with respect to the various facets.
The question to ask is:
• Does the user do it? OR Does the user not do it?
— Example for the cognitive facet
A schizophrenic user, that is, someone with a severe mental problem who, despite having an average or above-average intelligence (rating of 2 or 1 for his cognitive state) may not be functional with respect to any of the cognitive components in terms of attention, understanding, judgment, memory or spatial and temporal orientation (rating of 5 for cognitive functioning).
1.1.2 Special considerations for rating children
• In evaluating and determining the state and functioning of a child, reference must be made to the way children of the same age generally act and behave. Whatever the characteristic under study, if there is no significant deviation from a normal state or normal functioning for that age, enter the rating 1. For example,
• With reference to physical functioning, it is normal for a child to require help. If the help required is the help normally given a child of the same age, enter the rating 1 for the ADL considered. Otherwise, choose the rating that best describes the user’s functioning in terms of what should normally be accomplished at that age.
• With reference to cognitive functioning, the normal sensory-motor development of a baby must be taken into account. In particular, alertness, coordination and recognition of persons in his surroundings must be analysed. It is only normal that a young child does not actualize the cognitive functions to the same extent as an adult does. For example, a year-old baby is considered functional for all the facets. A baby at that age is not expected to be able to accomplish those functions. If, however, problems have been assessed in relation to those facets, they must be taken into account.
• With reference to the emotional or behavioural aspect, determination of the child’s or baby’s characteristics must be weighed against how children of the same age usually are or act.
• With reference the relational and social aspect, a 2-month old baby having no interaction with social networks other than the parental network is considered to interact with all the networks involved to the extent that the interaction is significant.
1.1.3 Choice of descriptors
For each facet (physical, cognitive, affective, behavioural and relational), you must identify the descriptor that best represents the user, given his state and his functioning (see page 8). A rating of 1 always refers to the best or most favourable state or level of functioning, while 5 describes the worst or least favourable.
In order to choose the right descriptor, it is important to refer to the meaning given to state and functioning for each facet.
• PHYSICAL FACET (3.1)
Physical state refers to the presence or absence of organic impairments (illnesses), physical disabilities (motor-related) or sensory impairments (visual, auditory).
• State of health refers to health condition in general with reference to the presence or absence of illnesses and organic deficiencies.
• Physical (motor) or sensory (auditory or visual) deficiency refers to the loss of or a permanent anomaly in a limb or sensory organ.
• Examples:
• a user is considered to have a visual impairment when the state of his vision creates a disability that prevents him from performing a usual visual task satisfactorily with a conventional ophthalmological correction. For example: reading, writing, moving about.
• an auditory anomaly is considered to be an impairment only when it results in a significant loss of hearing that limits the person’s ability to hear adequately. In this respect, the definition given by the Commission des centres de réadaptation pour personnes ayant une déficience physique of the Association des centres d’accueil du Québec is used:
“Any person whose hearing evaluation reveals a permanent decrease in auditory acuity or the capacity to discriminate speech that limits him in his ability to hear spoken language and the sounds around him so that he is hampered in his social, occupational and academic integration.”
• Organic impairments or illnesses such as epilepsy, multiple sclerosis, cardiovascular disorders, arthritis, diabetes and cancer are considered to be health problems, no matter what the extent of the disease or the degree to which it is controlled.
• Occasional or temporary illnesses such as the flu or chicken pox are not considered to be health problems.
Physical functioning
• (Line 3.1, column C.3) Refers to the degree of autonomy a person has in carrying out the activities required to stay in good health and communicate.
• (Lines 3.1.1 to 3.1.5, column C.3) Refers to a person’s ability to carry out the activities of daily life (ADLs).
• For each ADL, i.e., personal hygiene, eating, dressing, excretory functions and mobility, it must be determined whether the user can manage and be autonomous, regardless of the technical means required (prosthesis, orthesis, wheel chair, grab bars, cane, adapted utensils, velcro fasteners, incontinence pads, etc.).
• For a user whose ability to carry out an ADL varies over time, enter the rating 3, which represents the midpoint.
• Examples:
• Someone in a wheelchair is considered mobile if he can move about without help.
• Someone who needs help to get to the bathroom but who can wash himself is considered functional with respect to his personal hygiene, but not mobile.
• Someone who must be accompanied outside during the winter simply because he is afraid of falling but who, in any other circumstance, has no difficulty moving about is considered mobile. The problem lies in the obstacle encountered, which the person must find a way to deal with.
• A person who must be accompanied simply because he might get lost is considered mobile. It is the need to supervise the person’s behaviour that is a problem, not his mobility.
• COGNITIVE STATE (3.2)
Cognitive state refers to a general appreciation of the person’s intellectual level.
• This does not necessarily involve an IQ test to evaluate a person’s intellectual potential.
• Rather it involves a comparison with the general population of the same age.
• It is a matter of deciding which descriptor best represents the user, given the information available.
• When an illness or an accident affects the user’s cognitive state, the rating must be based on the user’s state after the illness or accident, presuming that the state is not transitory and that in all probability, it will continue. Alzheimer’s disease and strokes are examples.
• Example: a user suffering from Alzheimer’s disease in its advanced stages will probably be given a 5, i.e., “displays severe or acute cognitive impairment”.
Cognitive functioning refers to the user’s ability as regards the five main cognitive components: attention, understanding, judgment, memory, and spatial and temporal orientation.
• It must be determined whether the user can use these functions without help, whether help be in the form of stimulation, assistance or other. A user who can manage alone and use the main cognitive functions is considered autonomous, regardless of the technical means used (topographical reference points, reminders, learning and conditioning, role-playing, standard forms, etc.)
• In short, for the user to be considered non-functional, his ability must differ significantly from what is seen in the general public of the same age.
• For a user whose functioning with respect to various cognitive components varies sporadically over time because, for example, of significant fluctuations in tolerance to stress, give a rating of 3, which represents the midpoint.
• If the user has one or more problems in this regard, consider them only if they have a major and significant impact on the user’s daily activities.
• Example:
• A user with an intellectual impairment, who has not integrated the abstract concept of space, is considered functional with respect to spatial orientation if he manages to go from his home to various regular destinations using landmarks or as a result of conditioning.
• AFFECTIVE FACET (3.3)
• Affective state refers to a general appreciation of the habitual quality of a user’s affect. It refers to states of pleasure and neutrality as well as to simple or complex feelings of displeasure (happiness, serenity, anguish, anxiety, insecurity etc.).
Emotional functioning refers to the degree of control exercised in expressing emotions and not to the nature of the emotion, such as fear, tenderness, joy or anger.
• BEHAVIOURAL FACET (3.4)
Behavioural state refers to a strong probability, a propensity or a tendency to act or react according to a certain behavioural model, given the user’s personality.
Behavioural functioning refers to the way of acting or reacting, in terms of self-respect and respect for others (usual behavioural model exhibited).
• RELATIONAL AND SOCIAL FACET (3.5)
Relational and social state refers to the various social networks with which the user interacts significantly, excluding interaction in the resource, regardless of the manner of interacting. Thus, if the user’s interactions are limited to the people at the resource, including other users, he is considered to have no significant support from identified social networks (rating of 5).
• Examples:
• A user who has always interacted with all the networks but who, due to particular circumstances, no longer interacts with one or more networks must be given a rating based on the extent of the change. If it seems significant, i.e., if it seems to be more than a temporary cold shoulder given the network, the user should be rated as not interacting with that network.
• A user who meets with his social worker is considered to have a link with the formal or institutional network, as long as the interaction is significant, that is, regular and continuous. The social worker is a member of the service network in the same way as a physician, a nurse or a psychologist, for example.
Relational and social functioning refers to the manner of interacting, that is, of entering into contact with others, regardless of the individuals or social networks involved.

___________________________________________________________________________________

DESCRIPTORS DESCRIPTORS
___________________________________________________________________________________

3.8 PHYSICAL STATE PHYSICAL FUNCTIONING (cont.)
___________________________________________________________________________________

The user displays: EATING-DRESSING-HYGIENE:
the user performs

1 good health and no physical or sensory 1 all the necessary tasks alone
impairments 2 most of the necessary tasks alone
2 good health, but one or more physical 3 half of the necessary tasks alone
and/or sensory impairments 4 a few of the necessary tasks alone
3 one or more health problems but no 5 none of the necessary tasks
physical or sensory impairments
4 one or more health problems and one or EXCRETORY FUNCTIONS: the user
more physical or sensory impairments
5 one or more health problems and one or 1 never loses control of his bladder
more physical and sensory impairments or bowels and performs all the
activities related to excretory
functions autonomously
PHYSICAL FUNCTIONING (other than ADLs): 2 never loses control of his bladder
or bowels but does not always
The user: perform all the activities related to
excretory functions (using toilet
1 is able to carry out all health-related paper, flushing the toilet, getting
activities alone and to communicate dressed again, etc.)
without difficulty 3 sometimes loses control of his
2 has difficulty carrying out some his bladder or bowels but performs
health-related activities or uses a all the activities related to
substitute language for communication excretory functions
3 has difficulty carrying out most 4 sometimes loses control of his
health-related activities or making bladder or bowels and does not
himself understood always perform all the activities
4 has great difficulty carrying out some related to excretory functions
health-related activities or making 5 always loses control of his bladder
himself understood or bowels and requires assistance
5 has great difficulty carrying out most for all the activities related to
health-related activities excretory functions

MOBILITY: the user

1 can go anywhere by himself and can
move from one seat to another without
help
2 can usually go anywhere by himself
and move from one seat to another
without help
3 can hardly go anywhere by himself
but can move from one seat to another
without help
4 cannot move from one seat to
another without help
5 cannot go anywhere by himself or
or move from one seat to another
without help
___________________________________________________________________________________

3.9 COGNITIVE STATE COGNITIVE FUNCTIONING
___________________________________________________________________________________

The user displays: - Attention - Understanding
- Judgment - Memory - Orientation
in time and space

The user is functional with respect
1 above-average intelligence to:
2 average or normal intelligence
3 borderline or low intelligence 1 all everyday activities (5/5)
4 slight or average cognitive impairment 2 most everyday activities (4/5)
5 severe or acute cognitive impairment 3 half of everyday activities
(3/5 or 2/5)
4 few everyday activities (1/5)
5 no everyday activities (0/5)
___________________________________________________________________________________

3.10 AFFECTIVE STATE AFFECTIVE FUNCTIONING
___________________________________________________________________________________

The user’s affect appears: The user usually expresses emotions:

1 flexible or adapted (apparent ability 1 in a balanced manner (optimum
to feel the full range of affective control, appropriate expression)
states) 2 stereotyped manner (learned
2 flat (appearance of detachment, absence, control, automatism in expression)
neutrality, indifference) 3 inhibited manner (exaggerated
3 melancholic (tends to be sad, control, repressed expression)
pessimistic, depressed, negative) 4 unstable manner (irregular control,
4 labile (tends to be unstable, unpredictable expression)
unpredictable, inconstant) 5 impulsive manner (absence or
5 euphoric (tends to exaggerate or be significant lack of control,
exuberant or overexcited) immoderate or unconsidered
expression)
___________________________________________________________________________________

3.11 BEHAVIOURAL STATE BEHAVIOURAL FUNCTIONING
___________________________________________________________________________________

The user’s behaviour tends to be: The user generally behaves:

1 appropriate to the circumstances 1 in an assertive manner (positive,
(normality) socially adapted affirmation of self
2 marginal, bizarre (marginality) and, consequently, self-respect and
3 excessively passive (disproportionate respect for others)
tendency to remain inactive) 2 conciliatory, conformist, overly
4 disturbing, provocative or hyperactive tolerant
(disproportionate tendency to be active) 3 stubborn, rigid, obstinate or
5 compulsive, unpredictable or unstable
uncontrolled (deviance) 4 manipulative
5 aggressive, violent (no self-
respect, failure to respect others)
___________________________________________________________________________________

3.12 RELATIONAL AND SOCIAL STATE RELATIONAL AND SOCIAL FUNCTIONING
___________________________________________________________________________________

- family ties (nuclear family, extended The user displays:
family)
- no family (friends, neighbours, peers) 1 an ability to approach or withdraw
- formal or institutional (workers in the depending on the circumstances
service network) (flexible, adapted)
- informal or community (self-help groups, 2 fear of social relations (timid,
recreational groups etc.) reserved, but not overly inclined to
withdraw)
The user receives meaningful support 3 instability or temerity in social
from: relations (unpredictable, careless)
4 disproportionate social withdrawal
1 all networks (4/4) (isolated, introspective)
2 most networks (3/4) 5 disproportionate social attraction
3 half of the networks (2/4) (overwhelming, stifling, social
4 few networks (1/4) addict)
5 none of the networks (0/4)
___________________________________________________________________________________
1.2 Characteristics of the intervention
The characteristics of the intervention required from the resource must be specified for each of the 5 facets and be in line with the user’s state and level of functioning.
The characteristics of the intervention to be noted must be those that, given the age of the user, go beyond what is normally expected of the resource for the facet considered. For example, having to dress a 3-month old baby is normal and will not be considered. In such a case, the rating 0 is entered, since no specific intervention is required. However, the same activity carried out for an adult must be noted, since, in general, an adult does not require assistance in dressing.
Nature of the intervention (C.4)
The nature of the intervention must be determined for each of the facets, but only with respect to what is expected of the resource, in keeping with the user’s intervention plan. Interventions by staff caseworkers, in the resource or elsewhere, are not considered in determining this rating. Where no specific intervention s expected from the resource, other than adequately meeting the user’s needs, the facet is given a rating of 0.


Rating Descriptors: Nature of the intervention

0 Normally expected intervention that does not have to be spelled out in the
intervention plan

1 Verification: Examine with a view to determining whether the user is able
to do adequately what is expected of him (behaviour, self-expression,
activity, etc.).

2 Assistance: Help the user express himself, carry out an activity or choose
among options offered him or her.

2 Stimulation: Suggest through words or actions the behaviour, attitudes,
expressions or actions the user must show or perform, including the
continued use of acquired abilities.

3 Control: Intervene with authority to put an end to or provoke a behaviour
in the user.

3 Substitution: Perform actions, carry out activities for and on behalf of
the user, including services related to physical health that the user
should normally carry out himself.

4 Teaching: Using words, gestures and examples, have the user learn or
re-learn specific skills (knowledge), attitudes and behaviour (know-how) he
requires to function properly, and the means required to use them
specifically mentioned in the intervention plan or pursued within the
framework of specific objectives.

4 Evaluation: Participate in establishing a diagnosis with which it will be
possible to specify the services a user requires or determine the policy to
adopt with respect to the user. (The diagnosis referred to here must be
made by recognized professionals.)
Expertise required (C.5)
The amount of expertise required of the resource must be determined for each of the facets, on the basis of the abilities or knowledge needed to carry out the tasks expected of the resource.


Rating Descriptors: Expertise

0 No particular expertise is required, since no specific intervention is
provided for in the intervention plan.

1 Natural abilities are usually sufficient to ensure that the user receives
the services required.

2 The user requires services that usually demand special knowledge or skills.

3 The user requires services that usually demand the presence of people with
relevant training or equivalent experience.

5 The user requires services that usually demand the presence of people with
relevant training and experience.

7 The user requires services that usually demand the presence of people with
college or university training and relevant experience.
2- BASICS SERVICES REQUIRED BY THE USER AND PROVIDED BY THE RESOURCE
This section serves to identify the activities of domestic life and the support or help the user requires that the resource must provide.
For each of the elements in this section (3.10 to 3.15), enter the rating for the descriptor corresponding to the user’s needs. The descriptors and their ratings are given in the following table. Add the resulting ratings up. Enter the total obtained on line 3.16.


3.10 Meal services 3.11 Laundry services

Rating Descriptor Rating Descriptor
0 No meals required 0 No services required
2 1 meal - prepared 2 Partial service
or food supplied 3 Full service
4 1 meal - prepared
and food supplied
4 2 meals - prepared
or food supplied
6 2 meals - prepared
and food supplied
8 3 meals - prepared
or food supplied
12 3 meals - prepared
and food supplied

3.12 Housekeeping 3.13 Presence of a person able to provide
assistance

Rating Descriptor Rating Descriptor
0 No services required 0 No required
2 Partial service 1 A few hours A MONTH
4 Full service 2 A few hours A WEEK
If, on weekends,
- someone must be present 24 hours a
day, enter 9 instead of 2
4 A few hours A DAY
If, on weekends,
- someone must be present 8 hours a
day, enter 6 instead of 4;
- someone must be present 16 hours a
day, enter 8 instead of 4
8 EIGHT consecutive hours a day
If, on weekends,
- someone must be present an additional
8 hours a day, enter 10 instead of 8;
- someone must be present an
additional 16 hours a day, enter 12
instead of 8
16 SIXTEEN consecutive hours a day
If, on weekends,
- someone must be present an
additional 8 hours a day, enter 18
instead of 16
24 TWENTY-FOUR hours a day

3.14 Night-time supervision 3.15 Presence of a second person (in addition to 3.13 or 3.14) able to
provide assistance on request or call

Rating Descriptor Rating Descriptor
0 Not required 0 Not required
8 Required 2 Day or evening or both
3 Night
4 24 hours a day


3- CLASSIFICATION OF SERVICES

This section serves to identify the level of service required by the user and
provided by the resource, as well as the type of residential organization.

- On line 3.17, add up the results entered on that line.

- On line 3.18, enter the level of service corresponding to the score obtained:

Level 1: 15 to 89 points
Level 2: 90 to 109 points
Level 3: 110 to 127 points
Level 4: 128 to 142 points
Level 5: 143 to 165 points

- On line 3.19, enter the figure corresponding to the resource’s type of
residential organization.

1- Apartment One or more users living alone.

2- Rooming house The user has a room in a facility that may or may not
have common rooms or group activities.

3- Foster home The users live with the person(s) who provide(s) some
or all of the support and assistance required.

4- Group residence The users share their daily lives in a facility
where different shift workers provide some or all of
the support and assistance required.

5- Other types

PART C IDENTIFICATION OF RESOURCE

This section serves to identify the resource involved, the compensation payable and the
relevant client program or action.
- On lines 4.1 to 4.4, enter in the appropriate spaces the information requested on the
resource selected to provide the residential services and assistance the user requires.
- On line 4.5, enter the daily amount agreed to between the resource and the institution for
the provision of residential services and assistance. The amount includes any user
contribution.
Calculate the daily amount, if the agreement is based on a weekly, monthly or annual stipend.
- On line 4.6, enter the number corresponding to the client program or field of activity:
1- Physical health
2- Mental health
3- Public health
Social adaptation
4- Young people and their families
5- Alcoholism and drug addiction
6- Other
Social integration
7- Elderly people with limited autonomy
8- Intellectual impairment
9- Physical impairment
10-Other
M.O. 2000-017, Sch. 1.
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