Words and Phrases - "therapeutic"

The appellant ("Elim"), a B.C. non-profit organization, sought the enhanced (83%) public service body HST rebate respecting a long-term care facility with up to 118 residents (mostly with dementia, severely impaired mobility, complex medical issues and a life expectancy of between three months and three years), which was constructed and operated by it (the "Harrison"), on the basis that it was making "facility supplies." There were five nurses and 16 care aides available to provide care during the day. Before allowing Elim's appeal, Woods J found:

• Elim provided a medically necessary process of health care (noting, at para. 63, that "much of the care… is delivered through care plans, created by nurses, and which are tailored to address specific medical concerns" and rejecting, at para. 64, the Crown submission that "the term ‘medically necessary' should mean medically necessary as determined by a physician")
• there was active involvement of physicians (stating, at para. 71, that "the physicians generally have a pro-active approach by visiting their patients roughly every two weeks…[, they] receive updates from the nursing staff…[and] are available at all times and participate in The Harrison's inter‑disciplinary meetings and medication reviews")
• the residents were subject to medical management (stating at, para. 78, that "it is not necessary that the physician have management of the health care process itself")
• residents received sufficient therapeutic health care services

On the last point, she stated (at paras. 83, 86, 90-91, 95-97):

The gist of the dispute between the parties is whether the services provided by care aides at The Harrison, such as toileting and bathing, are therapeutic health care services.

…[T]he term "therapeutic" can mean "having a good effect on the mind or body": Cuthbertson v. Rasouli, 2013 SCC 53… .

…[M]any of the routine services provided to residents by care aides apply nursing expertise to address particular medical concerns…[and are] of a different type than ordinary assistance with activities of daily living… .

The agreed upon test was that therapeutic health care services had to be provided for at least 2.4 hours (10 percent) each calendar day. … [J]udicial interpretations…do not support the bright line 10 percent test. … The Harrison received funding during the relevant period for 2.8 hours of care per resident per day. Since some of the care… is provided in groups (e.g. oversight for choking risk at meals), the funding actually provides greater than 2.8 hours… .