Home Care After a Motor Vehicle Accident

Care by condition

A collision changes a household in an afternoon. Someone comes home from hospital needing help with washing, dressing, moving and medication — and at the same time the family is handed a claim number, an adjuster, and a set of forms nobody has seen before.

Home care after a motor vehicle accident is paid for differently from almost every other kind of home care in Ontario, and that is the part families most often get wrong.

What actually changes at home

• The injuries are usually plural. A fractured limb, soft tissue damage, and often a head injury together — each with its own restrictions, and they interact.
• Pain and sleep collapse together. Pain that is not controlled at night undoes the daytime rehabilitation.
• A head injury may not be obvious. Irritability, poor concentration, sensitivity to noise and light, and memory lapses are common after a concussion and are frequently mistaken for the person “coping badly”.
• The paperwork becomes a second job at the exact moment the family has least capacity for it.
• Someone usually stops working to provide the care, which creates a second financial problem on top of the first.
• Recovery is measured in months, and the level of help needed changes several times along the way.

How this care is usually paid for

Ontario auto insurance is a no-fault system for accident benefits: your own insurer pays, whoever caused the collision. Attendant care — help with washing, dressing, transfers, toileting and supervision — is one of the benefits that may be available.

• The amount is set by a Form 1, the Assessment of Attendant Care Needs. Only an occupational therapist or a registered nurse can complete it, and it is submitted to the insurer through the HCAI system.
• The insurer must respond within 10 business days of receiving the Form 1.
• A catastrophic impairment designation changes the limits substantially. If that is being discussed in your case, it is worth proper advice.
• If a family member provides the care, the benefit is capped at that person’s actual economic loss — the wages or income they genuinely gave up, evidenced. A professional provider is paid at the service rate instead. Families are very often surprised by this, and it is worth understanding before a daughter or spouse gives up a job.
• There are deadlines, and they are short. Speak to your adjuster — and to your lawyer if you have one — early rather than after the fact.

This is a description of how the system generally works, not legal or insurance advice. Your entitlement depends on your policy, your injuries and your claim. Your adjuster and your lawyer are the people who can tell you what applies to you.

How we help

• Attendant care — washing, dressing, toileting, transfers and supervision — at the level the Form 1 sets out
• Support with the exercises the physiotherapist or occupational therapist has prescribed, so the funded therapy is not undone between visits
• Medication reminders, with pain controlled ahead of activity rather than after it
• A quieter, more structured day where a head injury makes noise, light and disorder hard to tolerate
• Overnight support during the period when nights are the hardest part
• Respite so the family member who has become the carer can go back to work, or simply sleep
• Written notes of the care provided, which is what an insurer will ask for
• Invoicing the claim directly where the adjuster has approved it, so the family is not paying up front and chasing reimbursement

Who provides the care

Personal support workers provide attendant care. Where the plan includes nursing tasks — wound care, catheter care, injections — we place an RN or RPN, because in Ontario those are controlled acts and a PSW may not perform them. We work alongside the occupational therapist, physiotherapist and case manager already funded on your claim rather than duplicating them.

Common questions

Who pays for home care after a car accident?

In most cases your own auto insurer, through accident benefits, regardless of who was at fault. The amount of attendant care is set by a Form 1 completed by an occupational therapist or registered nurse. Some people also qualify for publicly funded support through Ontario Health atHome, and some pay privately for hours beyond what the insurer approves.

What is a Form 1?

The Assessment of Attendant Care Needs. An occupational therapist or registered nurse assesses what help you need with personal care and supervision, and that assessment determines the monthly attendant care benefit. It is submitted to the insurer through the HCAI system, and the insurer has 10 business days to respond.

Can my daughter be paid to look after me instead?

She can be the attendant, but the amount payable to a family member or friend is limited to their actual economic loss — the income they genuinely gave up, which has to be evidenced. That is often far less than the assessed value of the care. A professional provider is paid at the service rate. This catches a lot of families out, and it is worth getting clear on before anyone resigns a job.

Do you bill the insurer directly?

Where the adjuster has approved it, yes — so you are not paying up front and waiting to be reimbursed. We keep the care records insurers ask for. If approval is still pending, tell us and we will be straight with you about what that means.

The insurer has denied or reduced the attendant care. What now?

That is a claims question rather than a care question, and it is the point at which a personal injury lawyer is worth speaking to. We can continue privately funded care in the meantime if you want continuity, and we will tell you plainly what that costs.

What if the head injury is the main problem, not the fractures?

That is common and it is often the part that lasts longest. Supervision, routine, a calmer environment and prompting are the practical work, and they matter as much as the physical care. Our acquired brain injury page goes into it further.

Where we provide this care

We provide this support across 146 communities in Ontario, from the Greater Toronto Area to Thunder Bay. If your town is not listed, call us — we will tell you honestly whether we can staff it properly rather than promising and then failing to turn up.

Related

• Acquired brain injury
• Spinal cord injury
• Amputation and limb loss
• Falls and fracture recovery
• Wound care
• Post-hospital and transitional care
• 24-hour home care