When should an ETR be requested?

  • If a resident’s personal care needs are truly exceptional


  • If a resident’s behaviors differ from the majority and require special interventions


  • If you have attempted alternative options but the resident’s care needs remain beyond the level of care scored in his/her assessment
  • Ensure your request does not contradict your Disclosure of Services (i.e. if you disclose that you have awake at night staff, then you may not have grounds for an ETR requesting an increased daily rate for awake at night staff)
  • Make sure the resident’s assessment is accurate and reflects the care needs

What information needs to be included in an ETR request?

  • Details of resident’s diagnoses and personal care tasks that support the request
    • List the frequency and duration of the tasks (and the caregiver costs associated with the tasks)
  • Details of resident’s behaviors and extent of interventions required to ensure the resident’s safety
    • List the frequency and duration of the interventions (and the caregiver costs associated with the interventions)
  • The alternatives explored prior to requesting the ETR and why they did not work
  • Potential negative outcomes (i.e. risks to resident’s health and safety or risk of institutionalization) for the resident if the ETR is not approved
  • List if you are requesting a custom/temporary ETR or a plan period/ongoing ETR

If you believe your resident’s care needs are exceptional and would like assistance with an ETR, please have the resident or resident representative sign this release of information form to share their assessment (service summary and assessment details) with the AFH Council: Release of Information Form and complete the following form:

Details of the client's diagnoses and/or behaviors and personal care tasks or interventions that support the ETR request.
An ETR request needs to be based on how much, above and beyond the daily rate, it would cost to care for this client because of their exceptional circumstances. (i.e. if a client needs awake staff at night and you hire a new caregiver for this position and pay him/her $XX.XX/hour x X hours = $ amount of the ETR request)
Have you tried any other approaches? Why didn't they work? (i.e. community supports, alternative staffing, equipment, etc.)
If this ETR is not approved, what are the potential negative outcomes for this client? Is there a risk to the client's health or safety? Is the client at risk of institutionalization?
Are you requesting a temporary ETR while a client recovers from an illness or surgery? Or, are you requesting an ongoing ETR?