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8 Attendant Care

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This chapter provides information about attendant care services available through the Military Rehabilitation and Compensation Act 2004 (MRCA) and the Safety, Rehabilitation and Compensation Act 1988 (SRCA).

Details about attendant care services, and personal and respite care services through the Veterans' Home Care (VHC) program can also be found in specific sections of this chapter.

8.1 Attendant Care Services

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Last amended 
27 July 2015

Attendant care services are provided for in Division 3 of Part 7 of Chapter 4 of MRCA [3], and section 29 of SRCA [4].

Attendant care services are defined as …”services (other than household services, medical or surgical services or nursing care) that are required for the essential and regular personal care of the person.” The aim of attendant care services is to assist clients whose health or capacity to live independently at home is compromised by their service related injury or illness.

Attendant care services may be available to current and former ADF members, including non-Continuous Full Time Service (CFTS) (part time) Reservists, ADF Cadets, Officers of Cadets and Instructors of Cadets who have suffered a service injury or disease for which liability has been accepted by the Military Rehabilitation and Compensation Commission (MRCC).

To be eligible, the person must first make a claim for compensation for attendant care services.  Section 217 of the MRCA and Subsection 29(3) of SRCA provides that the Commonwealth will meet the cost (to a statutory upper limit) of such services that are reasonably required by a person as a result of a service injury or disease for which liability has been accepted.

The amount of compensation payable for attendant care services is capped by a statutory limit which is indexed as at 1 July each year, by reference to the Consumer Price Index. Rehabilitation Coordinators must not approve attendant care services in excess of this statutory limit. Further information about the approval and review procedures for attendant care services can be found in section 8.5 [5] of this Guide.

The current limits are published in the CLIK Compensation and Support Reference Library Current Payment Rates [6]. The MRCA limit is listed on the MRCA Rates and Allowances page.  The SRCA limit is listed on the SRCA and Defence Act payments page.

Note:  Some clients who qualify for attendant care services may also qualify for household services. In such cases, they may be entitled to payment up to the statutory limit for both household services and attendant care services. In other words, the statutory limits that apply to attendant care services and household services are mutually exclusive. Further information about household services can be found in chapter 7 of this Guide [7].

8.1.1 Attendant Care services for serving members

Date published 
Friday, August 5, 2016
Last amended 
Friday, August 5, 2016

The attendant care services provisions are contained in the compensation provisions in chapter 4 of the Military Rehabilitation and Compensation Act 2004 (MRCA [3]) and in part 2 of the Safety, Rehabilitation and Compensation Act 1988 [8] (SRCA). This provides the legislative basis for DVA to provide these services to current serving members of the ADF while the Chief of the Defence Force (CDF)remains their rehabilitation authority. Please refer to section 4.1 of the Rehabilitation Policy Library [9] for specific information about which members the CDF is the rehabilitation authority for.

Consistent with the legislative provisions, attendant care services can be provided where a delegate is satisfied that the services are reasonably required due to a service injury or disease. Please refer to section 8.4 of the Rehabilitation Policy Library [10] for the issues that must be considered before making an attendant care determination. 

Before DVA can provide attendant care services to serving members, the following additional criteria must be met:

  • the need for attendant care services is supported by an ADFRP assessment report; and
  • the ADFRP Regional Rehabilitation Manager requests that DVA provides attendant care services to a client; and
  • DVA has agreed that attendant care services can be provided.

This approach ensures that both the ADFRP and DVA are aware of the client’s needs, circumstances and the range of services that may be provided while they adjust to, and learn to manage, their service related conditions or injuries.

The exception to this general rule that attendant care services will be provided on the basis of an ADFRP referral, is where a serving member contacts DVA directly for attendant care services. In this case, the delegate needs to consider the person's request for attendant care services using the usual DVA processes which in most circumstances, will include a home assessment by an independent and suitably qualified Occupational Therapist.

Rehabilitation Coordinators must refer to the Procedures for providing attendant care [11]services to serving members [11], in chapter 8 of the Rehabilitation Procedures Guide, for procedural information.

8.2 What are Attendant Care Services?

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Last amended 
23 May 2017

Definition of attendant care services

Attendant care services are provided to assist a person to manage their essential and regular personal care needs.

Generally attendant care services are provided to assist people with activities such as grooming, bathing, feeding, dressing, toileting and other personal or hygiene needs.

However, for clients who have severe physical, mental health or cognitive injuries, a broader definition of attendant care can apply. For these clients, personal care needs may also encompass assistance and support to make decisions, assistance with controlling mood, encouragement and prompting to undertake routine personal care tasks, assistance attending treatment and emotional support to manage challenging situations.

If DVA delegates have a case where they are unsure if the support the person requires falls into the definition of attendant care, particularly where the client has been receiving ongoing attendant care services for a long period of time, they are requested to seek policy advice by emailing rehabilitation@dva.gov.au [13]. It is important that this advice is sought, before any changes are made to the existing level of services that the client is receiving.

Assessments for attendant care services

Claims for attendant care services are assessed on evidence from the client’s treating doctor and/or suitably qualified health professional or suitably qualified rehabilitation service provider.

Where a delegate is not satisfied they have sufficient information upon which to base a decision that a person requires attendant care services, a further assessment should be arranged by an independent and qualified medical professional or rehabilitation service provider with specialist skills, such as a contracted Community Nursing Program Provider, or an Occupational Therapist or Social Worker with specific expertise (for example in assisting people with brain injury or mental health issues).

As part of the assessment, consideration should always be given to the purchase of aids and appliances that may enable a person to perform normal activities of daily living themselves. This facilitates a greater degree of independence for the client, improves their overall ability to function normally in the community and aligns with DVA’s focus on whole-of-person rehabilitation and promotion of independence and self-management. Further information about aids and appliances through RAP, including the one-off approval process for non-scheduled items, can be found in chapter 10.2 of the Rehabilitation Policy Library [14].

While the need for attendant care services may be identified through a rehabilitation assessment, the provision of attendant care services is not dependent on participation in a rehabilitation program. It is however, desirable that attendant care services are delivered as part of a "package of support" that may include rehabilitation supports, to facilitate the client’s recovery and independence and ensure that their whole of person needs are met more effectively. This is particularly important where a client has severe impairments due to their service injury or disease.

Long term attendant care services

The provision of attendant care services for a short period of time may be relatively common for persons who are recovering from surgery or other treatment of an accepted service injury or disease. However, where a client has significant, complex injuries, including for example, spinal or brain injuries, ongoing attendant care services may be required.

Long term assistance should generally only be approved where clients have ongoing seriously incapacitating medical conditions. Regular reviews are encouraged to ensure that delegates have a good understanding of the client’s circumstances and needs.

It is particularly important that where clients have been receiving attendant care services for a long period of time, including where that support is provided by family, that decisions are not made to immediately cease or change services. Instead, delegates are asked to contact rehabilitation@dva.gov.au [15] for policy advice before any decisions are made.

Attendant care services and community nursing

The key differences between attendant care services and nursing care are:

Attendant Care

  • meets personal care needs (eg. grooming, bathing, feeding, dressing, cognitive and emotional support) and not medical care or treatment needs;
  • services are provided by professional carers to ensure that clients receive high quality care which is consistent with industry best practice;
  • services can only be provided by a relative in rare and  exceptional circumstances where there is documented evidence from a suitably qualified medical professional that a client becomes highly anxious or distressed by a professional carer providing assistance with care of an intimate nature. Evidence is required to support a determination in these cases (see section 8.4.6 in this chapter [16] for further information); and
  • services will usually attract GST.

Nursing Care

  • is necessary for the treatment or medical care of the compensable condition to address clinical needs (ie. administration of medication, dressing of wounds, bowel care, catheter care etc);
  • will require the services of either a registered or enrolled nurse;
  • may include support to address personal care needs identified through an assessment by a contracted community nursing care service provider;
  • will be provided at the direction or request of a legally qualified medical practitioner;
  • services should not be provided by family members – this applies regardless of whether the family members holds the appropriate nursing qualifications (see section 8.4.6 in this chapter [16] for further information); and
  • should not attract GST.

8.3 Investigating a claim for attendant care services

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Last amended 
22 November 2017

Making a claim for attendant care services

Claims for attendant care services must be investigated with reference to whether the services are reasonably required by the client and to ensure that the need for the services are due to the client’s service related injury or disease. Claims must be supported by documentary evidence from the client’s treating doctor, other suitably qualified medical or allied health professional or rehabilitation service provider.

From 29 May 2017, all new attendant care services claims will need to be managed through a specific services plan using R&C ISH processing.

Attendant care services and the National Disability Insurance Scheme (NDIS)

Attendant care services can be provided by both DVA, through a specific service plan, or by the NDIS, through an individual care plan. Where DVA clients are accessing support through the NDIS, they can choose which of these options suits them best. However, an important principle is that the same attendant care service must not be provided by both NDIS and DVA. Therefore, it is important for Rehabilitation Coordinators to advise Occupational Therapists or other allied health professionals undertaking assessments for attendant care services, that they should:

  • ask the client whether they are receiving any services or equipment from the NDIS;
  • provide details of any services or equipment being provided through the NDIS;
  • explain to the client that they cannot receive attendant or personal care services through both the NDIS and DVA; and
  • document that they have made the client aware that they cannot receive the same services through both DVA and the NDIS.

Assessment for attendant care services

Where a delegate is not satisfied they have sufficient information upon which to base a decision that a person requires attendant care services, a further assessment should be arranged by an independent and qualified medical professional or rehabilitation service provider with specialist skills, such as a contracted Community Nursing Program Provider or Occupational Therapist with specific expertise (for example in assisting people with brain injury or mental health issues).

For guidelines about referring a client for an activities of daily living assessment, please refer to chapter 8 [18] of the Rehabilitation Procedures Guide.

Statutory limit

The amount of compensation payable for attendant care is capped by a statutory limit which is indexed as at 1 July each year, by reference to the Consumer Price Index. Details of the maximum attendant care limits are available in the current payment rates [6] chart in the CLIK Compensation and Support reference library. The MRCA limit is listed on the MRCA Rates and Allowances page.  The SRCA limit is listed on the SRCA and Defence Act payments page.

Rehabilitation Coordinators must not approve attendant care services in excess of this statutory limit.

Note: Some persons, who are eligible for attendant care services, may also qualify for household services. In such cases, they may be entitled to payment up to the statutory limit for both attendant care services and for household services. In other words, the statutory limits that apply to both are mutually exclusive.

Payments of a similar nature

Attendant Allowance under the Veterans’ Entitlements Act 1986

There is no dual entitlement for attendant care services under the MRCA or SRCA and Attendant Allowance under the VEA. This means that if a person is entitled to attendant care under MRCA, then no attendant care under SRCA or attendant allowance under the VEA can be paid.

Carer Payment under the Social Security Act 1991

In cases where a person is receiving a Carer Payment from Centrelink, this does not preclude eligibility for Attendant Care services under the MRCA or SRCA. That is, a person can be receiving a carer payment and attendant care services at the same time. However any person being paid to provide attendant care services under MRCA or SRCA, should advise Centrelink as it may affect their Social Security payments, including carer payment. For example, if the partner or family member of a DVA client is being paid a carer payment by Centrelink and they receive attendant care payments from DVA, they must advise Centrelink that they are receiving attendant care payments. These clients should be aware of their obligations under Social Security Law.

Nursing care needs

Where clients have complex or high care needs, an assessment of their care needs should involve the Community Nursing Program. The Rehabilitation Policy Section works closely with the Community Nursing Program to jointly assess these clients to ensure that the client’s care requirements are met in a coordinated way using best practice principles, and properly accredited care providers. This approach allows tailored approaches delivering high levels of care to be developed where needed. If delegates are aware of clients who require high levels of nursing and/or attendant care services in excess of the statutory limit, due to their accepted conditions, please contact the Rehabilitation Policy section through rehabilitation@dva.gov.au [19].

Where a client's conditions are such that they are likely to require nursing care, as well as personal care and/or household services, a Clinical Nurse Consultant recommended by DVA's Community Nursing Program may be utilised to conduct a detailed assessment of the person's needs and make recommendations about the type and level of services that they require. In this context, a Clinical Nurse Consultant can be regarded as having the appropriate skills and experience to provide evidence to inform attendant care determinations.

Veterans’ Home Care Program

Personal care services through the Veterans’ Home Care Program (VHC) can be considered to fill any gaps in service provision when:

  • the required services cannot be provided using the Safety, Rehabilitation and Compensation Act 1988 (SRCA) and Military Rehabilitation and Compensation Act 2004 (MRCA) provisions, as the need is not related to the client’s accepted conditions; and
  • the client holds a DVA Health Card; and
  • a VHC assessment confirms that the services can be provided.

Further information about the VHC can be found in section 8.9 [20] of this chapter.

Provision of attendant care services outside Australia

When a person moves overseas and requests assistance with attendant care services, the same decision making principles should be followed. The person should still be asked to provide supporting documentation from their treating doctor, specialist or allied health provider, to enable a decision to be made about the reasonableness of the level of support that the person is seeking. Information about reimbursements for attendant care services payments for clients living overseas can be found in section 8.6 [21] of this Guide.

Approval and review procedures for attendant care services

The process for approving new claims, and reviewing and renewing existing claims for attendant care services are outlined in Section 8 of the Rehabilitation Procedures Library. [22]

8.4 Criteria for assessing what is reasonably required

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Last amended 
12 September 2014

A claim for attendant care services should be considered carefully in regard to what is reasonable for the client to receive. In determining whether attendant care services are reasonably required the delegate must consider the matters outlined in section 218 of MRCA [3] and subsection 29(4) of SRCA [4] the nature of the client’s injury or disease:

  1. the degree to which that injury or disease impairs the client’s ability to provide for his or her personal care;
  2. the extent to which any medical service or nursing care received by the client provides for his or her essential and regular personal care;
  3. the extent to which the attendant care services are necessary to meet any reasonable wish by the client to live outside an institution;
  4. the extent to which attendant care services are necessary to enable the client to undertake or continue defence service or any other work;
  5. any assessment made in relation to the rehabilitation of the client;
  6. the extent to which a relative of the client might reasonably be expected to provide attendant care services; and
  7. any other matter that the Commission considers relevant.

Further details about these criteria are explained in the following subsections and must be used to guide decision making.

8.4.1 Injury implications

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Last amended 
12 September 2014

Delegates should be satisfied that the client’s service related injury or illness creates the need for essential and regular personal care. Medical evidence or evidence from another suitably qualified medical or allied health professional or rehabilitation provider should be obtained to inform decision making.

Serious, long-term injuries, such as those resulting in paraplegia, quadriplegia, brain injury and conditions where clients are bed-ridden are likely to require indefinite or long-term attendant care services. However, even in these circumstances, there still remains a requirement to obtain supporting medical and other documentary evidence to confirm the extent and likely duration of the effects of a compensable injury and the person’s need for ongoing assistance.

The requirement for attendant care services must be specifically linked to the condition(s) for which liability has been accepted. Medical and any recent rehabilitation assessments should establish the degree to which a client’s condition impairs his or her ability to meet his or her personal care needs.

8.4.2 Medical services or nursing care received by the person

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Last amended 
8 January 2015

Where clients have complex injuries, or can be regarded as having high needs, the Community Nursing Program must be involved in assessing the client’s nursing and attendant care needs.

Delegates need to ensure they are not approving attendant care services where other services are being provided that meet personal care needs. This is particularly important where a DVA Health Card holder is receiving Community Nursing services via Part 7.3 of the MRCA Treatment Principles [26], or services through the Veterans’ Home Care program (see section 5.4.3 [27] and section 5.4.4 [28] of this Guide for further information) or where the client’s attendant care needs are being met through other arrangements for a specific period of time.

For example, if a client is in hospital or respite care, then their attendant care needs are being met through these arrangements for the period that they are not at home. Likewise, if the client is receiving assistance through a Home Care Package managed by a community provider, while still remaining in their own home, then their attendant care needs are likely to being met through these arrangements.

In these circumstances, and particularly where a client is way from home, the “usual” care arrangements will need to be adjusted and any invoices presented by attendant care providers must be scrutinised carefully to ensure that payments are only made for attendant care services that are actually provided to the client. This applies to attendant care services provided by professional, qualified attendant care providers or by a partner or relative, where the exceptional circumstances criteria are met.

The Rehabilitation Policy team works closely with the Community Nursing Program to ensure that the client’s care requirements are met in a coordinated way using best practice principles, and properly accredited care providers. This approach also allows tailored approaches to delivering high levels of care to be developed where needed. If delegates are aware of clients who require high levels of nursing and/or attendant care services due to their accepted conditions, please contact the Rehabilitation Policy team through rehabilitation@dva.gov.au [15]

8.4.3 Remaining or returning to the person's home

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Last amended 
12 September 2014

An important consideration with provision of attendant care services is the extent to which such services will assist the client to live in his/her own accommodation rather than in an institutional environment (such as residential care or a hospital based setting).

The goal of providing attendant care services and support is encourage the client to live as independent a life as possible within their capabilities.

8.4.4 Provision of Attendant Care to undertake or continue employment

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Last amended 
12 September 2014

Attendant care services may enable a person to undertake or continue employment by providing targeted assistance, particularly to get ready for work at the beginning of the day. These services can be a key support in assisting a person to live as full a life as possible after a service related injury or illness, particularly where a person is managing the impact of severe disabilities.

It is important when discussing attendant care services with a client that these services are viewed as supports that can “enable” a person and facilitate their independence. As part of a targeted, whole of person rehabilitation program, attendant care services can help a person meet their rehabilitation goals of undertaking employment even when they have severe service related injuries.

8.4.5 Any assessment made in relation to the rehabilitation of the person

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Last amended 
12 September 2014

The medical or other information provided in any rehabilitation assessment may help substantiate the need for attendant care services. Such an assessment might also provide important information about what other assistance may be provided to address a client’s needs and facilitate independence.

This could, for example, includes aids and appliances that could assist a person to manage tasks more independently. The provision of aids and appliances may have an impact on the level of attendant care services that the person may require in the future.

8.4.6 Any other relevant matter

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Last amended 
22 November 2017

What other matters may be relevant in considering a claim for attendant care services will be entirely dependent on the circumstances of a particular case.  The most obvious example of any other relevant matter is any report obtained from a Community Nursing assessor or an Occupational Therapist in relation to what attendant care services are reasonably required due to the nature of the accepted service injury or condition.

Matters considered relevant also include whether the attendant care services are reasonably required for a particular period of time due to a change in circumstances. For example, if the client is in hospital or respite care temporarily, then they will not require assistance from DVA with personal care needs (grooming, bathing, feeding etc) as these should be provided by the facility they are in and not by a service provider in the person’s own home.  If the client is on a rehabilitation plan, it is expected that the rehabilitation service provider will know when the person is in hospital or away from their home, and will advise the Rehabilitation Coordinator.  If any invoices are presented by attendant care service providers they must be scrutinised carefully to ensure that payments are only made for attendant care when the client was in their own home and not in a facility.

If the client moves into palliative care or residential aged care on a permanent basis, then attendant care payments should be ceased from the date that they entered care on a permanent basis. If the person returns home, then their attendant care payments may be reactivated however, an assessment by an independent and qualified medical professional or rehabilitation service provider with specialist skills, such as a contracted Community Nursing Program Provider or Occupational Therapist with specific expertise may be required if the client's needs have changed as a result of their hospitalisation.

Rehabilitation and the National Disability Insurance Scheme (NDIS)

Attendant care services can be provided by both DVA, through the rehabilitation plan, or by the NDIS, through an individual care plan. Where DVA clients are accessing support through the NDIS, they can choose which of these options suits them best. However, an important principle is that the same attendant care service must not be provided by both NDIS and DVA. Therefore, it is important for Rehabilitation Coordinators to advise Occupational Therapists or other allied health professionals undertaking assessments for attendant care services, that they should:

  • ask the client whether they are receiving any services or equipment from the NDIS;
  • provide details of any services or equipment being provided through the NDIS;
  • explain to the client that they cannot receive the same attendant care or personal care services through both the NDIS and DVA; and
  • document that they have made the client aware that they cannot receive the same services from both DVA and the NDIS.

 

8.5 When attendant care services might reasonably be provided by a partner, relative or friend of the person

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Last amended 
24 March 2016

It is a legislative intention that attendant care services are not provided by a partner, relative or friend. It is therefore important to note that where attendant care services can be reasonably provided by a partner, relative or friend, then DVA will not pay for these services. Where it is unreasonable to expect family members to provide attendant care services, because this would create a substantial burden on them, then these services should be provided by a suitably qualified external attendant care provider.

Using professionally qualified providers helps to ensure that clients are receiving high quality and best practice care in line with industry standards. It also ensures:

  • that the risk of carer burn out is managed appropriately by not burdening a partner, relative or friend with the expectations that they are required to manage the client’s ongoing personal care needs;
  • that replacement carers will be available in times of sickness or absence at short notice;
  • that carers have appropriate insurance cover and deliver services that meet work health and safety legislation;
  • that qualified and credentialed staff are available to meet the client’s needs;
  • that client needs are monitored appropriately and that care plans are put in place to ensure appropriate provision of services; and
  • financial and taxation accountability of expenditure of government funds.

The legislative intention means that DVA will only consider requests for a partner, relative or friend to provide attendant care services to a client where there is evidence that exceptional circumstances apply. For more information about exceptional circumstances, please see section 8.5.1 [34] of this Guide.

For a client who has high or complex care needs, if exceptional circumstances apply, Rehabilitation Coordinators must not approve requests for a partner, relative or friend to provide anything other than simple attendant care services, such as assistance with feeding or drinking, or setting up computers. The policy guidelines on attendant care services for high and complex care needs clients can be found in section 8.5.2 [35] of this Guide.

Attendant care services are quite distinct from medical treatment or nursing care services. Treatment or nursing care can only be provided by trained health professionals who are unrelated to the client. Further information about the Community Nursing Program can be found in section 8.8 [36] of this chapter.

8.5.1 Exceptional Circumstances

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Last amended 
23 May 2017

What are “exceptional circumstances”?

A delegate may consider that it is reasonable for a partner, relative or friend to provide simple attendant care services to a client when exceptional circumstances apply. These circumstances may include instances where:

  • there is documented medical evidence that the client is likely to experience a high degree of anxiety and/or distress and/or hostility if the care is provided by an external service provider;
  • where it is desirable for family to provide the care, for example where a person has an acquired brain injury and routine and familiarity are important to the person continuing to be able to be supported to manage their activities of daily living; or
  • the client requires care for a short period of time only (for example while recovering from surgery) and there are issues with accessing professional care providers for the period required, in the client’s location.

These circumstances are not exhaustive and if a delegate believes they have a case where exceptional circumstances may apply, they are requested to contact rehabilitation policy at rehabilitation@dva.gov.au [15] for advice.

Long term care

It is important that where clients have been receiving attendant care services for a long period of time, particularly where that support is provided by family, that decisions are not made to immediately cease or change services. Rather, delegates must contact rehabilitation@dva.gov.au [15] for advice before a decision is made.

The decision that exceptional circumstances apply can only be made where there is clear evidence from a suitably qualified health or medical professional that:

  • the client's accepted conditions are such that they would experience a high degree of anxiety and/or distress and/or hostility if the attendant care services to meet intimate care needs were provided by an external provider; or
  • the client’s accepted conditions are such that having their family, who they are familiar with, provide their care is important for the routine and structure of their day, for example, for those with an acquired brain injury.

As a general rule, before a decision can be made that exceptional circumstances apply for longer term care, the Exceptional Circumstances for attendant care form [38]]must be completed by a suitably qualified health or medical professional who has a relationship with the client and understands their current circumstances and needs. This form can be found on the rehabilitation page of the R&C support site.  It is not sufficient that the health professional describes the client as a private person, or states that the current arrangements should continue as this is what the client prefers. The decision that exceptional circumstances apply must be supported by evidence from a suitably qualified health professional and documented in the Exceptional Circumstances for attendant care form.

However, there will be cases where a flexible approach is required and the Exceptional Circumstances for attendant care form [38]does not need to be completed. This will be applicable where it is clear on the basis of available information that the person’s family are most appropriate people to provide their care. For example, where a person with an acquired brain injury has difficulties managing change to their routine, and their family has provided attendant care services for a long period of time, there is no requirement for the form to be completed, if there is evidence from an assessment by a suitably qualified health professional that the current arrangement is appropriate.   

When a Rehabilitation Coordinator is satisfied that there is sufficient evidence that exceptional circumstances apply, the next step is to investigate whether it is appropriate for a partner, relative or friend of a person to be approved to provide time limited and straightforward attendant care services, by considering the following points:

  • whether the client would receive high quality care appropriate to their needs, if their partner, relative or friend provided the care;
  • if attendant care services have been provided previously, were these services provided by a professional, rather than a partner, relative or friend;
  • in the context of the client’s injuries, whether there are real benefits to having a familiar person providing support to the person;
  • the need to avoid physical injury and carer burnout particularly if heavy lifting or high or complex levels of care may be involved; and
  • whether there is risk of conflict of interest issues arising which prevent the best quality and most appropriate care being provided to the client. This may include, for example, the risk that the family or friend may become dependent on ongoing attendant care payments as a form of income and be reticent to change care arrangements when a client’s needs and circumstances change.

If a Rehabilitation Coordinator is concerned about any of these issues, they must contact the rehabilitation policy section at rehabilitation@dva.gov.au [15] for policy advice, before a determination is made.

It is essential that if a partner, relative or friend is approved to provide attendant care services, these arrangements are regularly reviewed to ensure that the care continues to be appropriate to the client’s needs.

The decision must be correctly recorded with relevant documentation, including policy advice, saved into TRIM. Further information about recording exceptional circumstances decisions can be found in the Rehabiliation Procedures Guide [39].

Short term care

There may be exceptional circumstances where a person requires a short period of attendant care services and there are issues with accessing an external attendant care services provider. Examples include where the client only requires a short period of support each day, and this does not meet a provider’s minimum time limit for services. A client may also be living in a regional or rural area where there are a limited number of service providers, and none are available at the time that the client requires them. Before a delegate can decide that exceptional circumstances apply, they must first consider:

  • if it is reasonable for a partner, relative or friend to provide care on an unpaid basis; and
  • if the partner, relative or friend is able to provide this care without a substantial disruption to their own activities.

If it is not considered reasonable for the care to be provided on an unpaid basis, then the partner, relative or friend may be funded to provide an appropriate level of attendant care services to meet the client's assessed needs, for the required period of time. Services cannot be provided in excess of the statutory limit.

Example

A client requires surgery and the Occupational Therapy (OT) assessment confirms that the client needs twenty minutes of assistance with showering and dressing at the beginning of each day for a period for a period of approximately two months, prior to and after the surgery. The OT assessment clarifies that there are no aids or appliances that will enable the client to shower and dress themselves without assistance from another person. As a first step, the client's rehabilitation provider should be asked to assist with sourcing providers to meet the client's needs. If there are barriers to finding an attendant care provider, such as providers requiring the care to be for a minimum of one hour per service, then this may be considered an exceptional circumstance. The rehabilitation provider confirms that the client's partner works shift work and is not usually at home in the mornings and therefore cannot provide assistance with showering and dressing the client. However, the client's brother lives nearby and is able to provide the twenty minutes of attendant care services on his way to work. In this case, the delegate can decide that exceptional circumstances apply, and the person’s brother can be paid to provide attendant care services of twenty minutes for day for a period of two months.

Rate of payment when family or friends provide Attendant Care

As a general rule, the industry standard that would be most appropriate for attendant care services provided by a partner, relative or friend of the person would be the base level rate for a personal care worker or disability support worker.

DVA Rehabilitation Coordinators are asked to refer to the Rehabilitation Procedures Guide [40] for how to find this rate, and for further information about payment to family members who provide attendant care.

8.5.2 High or complex care needs clients

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Last amended 
24 March 2016

Clients with high or complex care needs will generally be receiving ongoing nursing care services through the Community Nursing Program, in addition to attendant care services. In this circumstance, even if exceptional circumstances are found to apply, a Rehabilitation Coordinator may only approve a limited range of simple attendant care services to be provided by the partner, relative or friend. This might include, assistance with feeding and/or drinking, setting up computers or other communication devices, or assisting with physiotherapy or speech pathology exercises. Services to meet personal care needs, such as showering and dressing, must not be approved as these services should be provided by the Community Nursing Program. The reason for limiting the services that can be provided is to ensure the client is receiving care most appropriate to their needs and to avoid carer health and safety issues and the risks of carer burn out.

As a general rule, these limitations do not apply where the person is being provided with short term care, such as following surgery, unless the client also requires nursing care services to help facilitate their recovery.

If a Rehabilitation Coordinator identifies a client with high or complex care needs, who is not receiving services through the Community Nursing Program, they are requested to advise the rehabilitation policy section through rehabilitation@dva.gov.au [15]

8.5.3 Transition plan for clients who have been receiving long term attendant care services from a partner, relative or friend

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Last amended 
23 May 2017

Any decisions on whether it is appropriate for clients to continue to receive attendant care services provided by a partner, relative or friend must be informed by evidence of the client's current needs and circumstances. It is important that where clients have been receiving attendant care services for a long period of time, particularly where that support is provided by family that decisions are not made to immediately cease or change services.  Instead, delegates are requested to contact rehabilitation@dva.gov.au [15] for advice before a decision is made.

Prior to the expiration of a client’s attendant care approval period, Rehabilitation Coordinators are required to organise a whole of person assessment in the client's home, by an Occupational Therapist or other suitably qualified health professional. The assessment should consider attendant care, household services and the provision of aids and appliances or home alterations that may assist the client to be more independent in self managing the impact of their accepted conditions.

The Rehabilitation Coordinator must also gather evidence about whether exceptional circumstances apply, by seeking evidence from the client’s treating health professional, who has a good understanding of the client’s health status, current needs and circumstances. Rehabilitation Coordinators must follow the guidelines in section 8.5.1 [34] of this Guide when gathering evidence and making decisions about the ongoing care arrangements for clients who have been receiving care from a partner, relative or friend.

Depending on the client's individual circumstances, community nursing services may need to be considered. Where this occurs, please contact rehabilitation@dva.gov.au [15] and the rehabilitation policy section will liaise with the Community Nursing Program.

Where there is no evidence that exceptional circumstances apply, the client should be carefully and gradually transitioned to an external attendant care provider. The transition to an external provider must be managed sensitively. To ease the transition process, the client's rehabilitation provider should assist with finding a suitable external provider with the skills, qualifications and experience to meet the client's needs, and with gathering quotes for services, based on the recommendations of the home assessment.

The transition plan should be negotiated with the new external provider so that the client can slowly become used to the new care arrangements. For example, the external provider may initially provide care for one day or two days a week (and be paid accordingly) in order to provide respite support for the partner, relative or friend. The partner, relative or friend would therefore be paid for the balance of the attendant care services that they provide. Once the client is comfortable with the external provider, then the provider could build up to taking over the person's total attendant care needs.

Any transition should be closely monitored by the rehabilitation provider and issues should be dealt with sensitively as they arise. These arrangements should be clearly communicated to the client so that they understand that this approach is time limited and that by the end of the six month period it is expected that the external provider will be providing all of the client's attendant care services.

8.6 Attendant Care Service Provider issues

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Last amended 
26 May 2017

It is important that attendant care service providers have appropriate and sufficient skills to enable them to provide high quality personal care, in line with best practice and industry standards. A care plan should be developed to direct the services to be provided to the client, and ensure that their needs are being effectively met. There are clearly defined roles and responsibilities that related to the provision of attendant care services. It is really important that these are communicated clearly to the client.

The DVA delegate is responsible for determining:

  • whether attendant care services are reasonably required;
  • the amount of compensation that is payable; and
  • making payments of compensation for attendant care services.

The client is responsible for:

  • choosing a suitable provider;
  • ensuring that an appropriate standard of service is provided;
  • arranging the times when the provider is to undertake the attendant care services and the conduct of the service provider in the client’s home; and
  • any public liability issues arising from having service providers undertake work in and around their home.

There is no flexibility under the attendant care legislative provisions for payments in excess of the legislated statutory limits to be made under any circumstance. If delegates are aware of clients who require high levels of nursing and/or attendant care services (in excess of the statutory limits) due to their accepted conditions, please contact the Rehabilitation Policy section through rehabilitation@dva,gov.au [15].

DVA may, at times, need to reimburse a client for attendant care payments made while the client is living overseas. With the production of receipts and confirmation of the approval of the service, DVA can reimburse the client in $AUD to an Australian bank account or to an overseas payment address.  

8.7 Travel and Other Expenses for Carers

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Last amended 
12 September 2014

Sections 290(2) and 291(2) of MRCA [3] provide compensation for journey and accommodation costs reasonably incurred by an attendant who is approved by a delegate to accompany a client to obtain compensable treatment. Approval must be given in advance of the travel being undertaken.

Attendant’s costs for travel to accompany a client to attend vocational rehabilitation or a medical review are not normally payable. However, where a medical practitioner has certified that the attendant is required to accompany a client or attend separately when it is clinically recommended that they participate in a Commission approved treatment program, such as a PTSD course, and that attendance is identified as being of benefit to the client, reasonably incurred travel and accommodation costs may be approved by a delegate using the existing legislative provisions as endorsed by the Commission.

Further details about travel and other expenses for carers can be found in section 9.1.2.8 of the MRCA Manual [45] and chapter 90 of the SRCA General Handbook [46] in the Military Compensation library.

Travel, accommodation and associated ancillary costs of carers can also be met where a client has severe disabilities and needs an attendant carer to accompany them to approved activities under a psychosocial rehabilitation plan. Delegates must refer to the policy guidelines in section 6.7 of this Guide [47]to guide decision making.

8.8 Community Nursing Care

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Last amended 
12 September 2014

MRCA and SRCA clients who hold a DVA Health Card are able to access nursing services through the Community Nursing Program. The program provides community nursing services to address a client’s assessed clinical or personal care needs.

Services are considered based on evidence from an assessment completed by a contracted community nursing service provider. Access to the Community Nursing Program requires referral from an authorised referrer, such as the client’s treating medical practitioner, treating doctor, specialist in hospital, a hospital discharge planner or a Veterans’ Home Care (VHC) assessment agency.  More information can be found on the Community Nursing [49] page of the DVA website.

The Community Nursing program has an Exceptional Case Unit [50] that assesses the clinical and/or personal care needs of those entitled persons whose care requirements, due to their complexity and care regimes, are significantly outside the scope of normal community nursing services. The Exceptional Case Unit is an independent unit of Clinical Nurse Consultants contracted by DVA.

It is likely that clients who require community nursing services through the Exceptional Case Unit will also require levels of attendant care in excess of the legislated statutory limits under MRCA or SRCA. In these cases, Rehabilitation delegates are requested to contact rehabilitation@dva.gov.au [15] so that the Community Nursing Program and the Rehabilitation Policy section can work together to ensure that coordinated assessments can be organised and an appropriate level of services can be provided to meet the client’s assessed needs.

A partner or relatives should not be paid to provide nursing care services to any of our clients. This applies regardless of whether the person has the appropriate nursing qualifications to deliver the care to meet the client’s needs. Approving such payments creates a conflict with the Code of Professional Conduct for Nursing provided by the Nursing and Midwifery Board of Australia, and conflicts with procurement guidelines and DVA’s community nursing contractual arrangements.

Where a serving member may need access to nursing care services just prior to discharge and being issued with a DVA Health Card, consideration should be given to accessing one of the DVA contracted Community Nursing providers, even if the cost of these services may initially be met by Defence or via reimbursement to ensure continuity of care. Please contact the Assistant Director, Community Nursing Program Policy in the first instance to discuss this.

Persons requiring ongoing nursing care should be provided with a DVA Health Card as soon as possible following discharge from the Australian Defence Force (ADF).

There is potential for overlap between Community Nursing care and Attendant Care services.  Both services provide for persons’ personal care needs.  While it is possible for a person to receive Community Nursing and Attendant Care services, particular care needs to be taken to ensure a person is not provided with duplicate services.  Accordingly any such cases require a case management approach to ensuring all of the persons’ needs are met.

Paragraph 7.3.7 of the MRCA Treatment Principles [26]precludes services such as cooking, shopping, cleaning, laundry, transport and companionship from community nursing services. These services should therefore be provided through the household services provisions of the MRCA or the SRCA. More information about household services can be found in chapter 7 of this Guide [7].

The Community Nursing program has an Exceptional Case Unit [50] that assesses the clinical and/or personal care needs of those entitled persons whose care requirements, due to their complexity and care regimes, are significantly outside the scope of normal community nursing services. The Exceptional Case Unit is an independent unit of Clinical Nurse Consultants contracted by DVA.

8.9 Veterans' Home Care Program

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5 February 2016

For clients who hold a DVA Health Card, the following services can be provided through the Veterans’ Home Care (VHC) Program:

  • personal care - includes assistance with daily self-care tasks, such as eating, bathing, toileting, dressing, grooming, getting in and out of bed and moving about the house. These are tasks that the person would normally do themselves, but because of illness, disability or frailty, they require the assistance of another person.
  • respite care - means relief for a carer who has responsibility for the ongoing care, attention and support of another person who is in ill health or incapacitated. It provides an alternative form of care and enables carers to have a break. Respite care services may be provided in an appropriate accommodation setting or at home (including overnight or emergency care), or a combination of these.

Co-payments apply to VHC personal care services, but not respite care services.

The VHC program also provides domestic assistance and safety-related home and garden maintenance. Information about these additional VHC services can be found in section 7.5 of this Guide [52].

Duplicate benefits

Where personal care services are required due to an accepted condition under the MRCA [3] or the SRCA [4] then the attendant care provisions in the appropriate Act should be used, instead of the VHC Program. It is legislatively prescribed in the MRCA Treatment Principles [26] that double-dipping is not permitted for similar services provided by VHC. With respect to SRCA, although it is not legislatively prescribed, for consistency, double-dipping should also be avoided between the SRCA provisions and VHC. Utilising the attendant care provisions in the respective Acts is part of a client-centric approach to the provision of services because a wider range of services are available through these provisions, than through the VHC. Additionally, no co-payments are required when services are provided through the MRCA/SRCA attendant care provisions.

This approach does not apply to respite care services through the VHC program.

Referrals to VHC

When a request for personal care services is received, VHC can be considered to fill gaps in service provision when:

  • the client holds a DVA Health Card;
  • a VHC assessment confirms that the services can be provided; and
  • the required services cannot be provided using the SRCA and MRCA provisions, as the need is not related to the client’s accepted conditions.

Clients who hold a DVA Health Card may be referred to a VHC assessment agency for consideration of their respite care needs.

To refer a client to a VHC assessment agency, please ask the client to contact 1300 550 450. Alternatively, delegates may contact the VHC Contract Support team for assistance.

Changes have been made to VHC View to alert VHC assessment agencies to potential MRCA/SRCA entitlements. It is therefore important when making the referral that the assessment agency is aware that the client’s eligibility for attendant care services has already been tested. This will help to prevent a client being referred back to the department unnecessarily.

If clients are experiencing barriers or issues to being considered for the VHC Program, please contact the Rehabilitation Policy team at rehabilitation@dva.gov.au [15], who will liaise with the VHC Contract Support team.

Wholly dependent partners and eligible young persons do not have access to the attendant care provisions in Chapter 4 of the MRCA. Therefore, personal care assistance can only be accessed through the VHC program.

More information about the VHC Program generally is available from the Veterans' Home Care [53] page on the DVA website.


Source URL (modified on 12/04/2016 - 9:18am): http://clik.dva.gov.au/rehabilitation-library/8-attendant-care

Links
[1] http://clik.dva.gov.au/user/login?destination=comment/reply/21288%23comment-form
[2] http://clik.dva.gov.au/user/login?destination=comment/reply/21278%23comment-form
[3] http://www.comlaw.gov.au/Series/C2004A01285
[4] http://www.comlaw.gov.au/Series/C2004A03668
[5] http://clik.dva.gov.au/rehabilitation-library/8-attendant-care/85-approval-and-review-procedures
[6] http://clik.dva.gov.au/compensation-and-support-reference-library/payment-rates/current-payment-rates
[7] http://clik.dva.gov.au/rehabilitation-library/7-household-services
[8] https://www.legislation.gov.au/Series/C2004A03668
[9] http://clik.dva.gov.au/rehabilitation-policy-library/4-adf-rehabilitation-programs/41-overview-adf-rehabilitation-programs
[10] http://clik.dva.gov.au/rehabilitation-library/8-attendant-care/84-criteria-assessing-what-reasonably-required
[11] http://clik.dva.gov.au/rehabilitation-procedures-guide/8-attendant-care-procedures/procedures-providing-attendant-care-services-serving-members
[12] http://clik.dva.gov.au/user/login?destination=comment/reply/21279%23comment-form
[13] mailto:rehabilitaiton@dva.gov.au
[14] http://clik.dva.gov.au/rehabilitation-policy-library/10-alterations-modifications-aids-appliances/102-provision-aids-and-appliances-through-rap
[15] mailto:rehabilitation@dva.gov.au
[16] http://clik.dva.gov.au/rehabilitation-library/8-attendant-care/84-criteria-assessing-what-reasonably-required/846-when-attendant-care-services-might-reasonably-be-provided-relative-person
[17] http://clik.dva.gov.au/user/login?destination=comment/reply/21294%23comment-form
[18] http://clik.dva.gov.au/rehabilitation-procedures-guide/8-attendant-care-procedures/investigating-claim-attendant-care
[19] mailto:rehabilitation@dva.gov.au?subject=Query%20about%20high%20levels%20of%20nursing%20and%2For%20attendant%20care
[20] http://clik.dva.gov.au/rehabilitation-library/8-attendant-care/89-veterans-home-care-program
[21] http://clik.dva.gov.au/rehabilitation-library/8-attendant-care/86-attendant-care-service-provider-issues
[22] http://clik.dva.gov.au/rehabilitation-procedures-guide/8-attendant-care-procedures
[23] http://clik.dva.gov.au/user/login?destination=comment/reply/21284%23comment-form
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[26] http://www.comlaw.gov.au/Series/F2013L02016
[27] http://clik.dva.gov.au/rehabilitation-library/5-medical-management-rehabilitation/54-other-types-medical-treatment-support/543-independent-living-programs-veterans-home-care-and-household-and-attendant-care-services
[28] http://clik.dva.gov.au/rehabilitation-library/5-medical-management-rehabilitation/54-other-types-medical-treatment-support/544-community-nursing-program
[29] http://clik.dva.gov.au/user/login?destination=comment/reply/21295%23comment-form
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[34] http://clik.dva.gov.au/rehabilitation-policy-library/8-attendant-care/85-when-attendant-care-services-might-reasonably-be-provided-partner-relative-or-friend-person/851-exceptional-circumstances
[35] http://clik.dva.gov.au/rehabilitation-library/8-attendant-care/85-when-attendant-care-services-might-reasonably-be-provided-partner-relative-or-friend-person/852-high-or-complex-care-needs-clients
[36] http://clik.dva.gov.au/rehabilitation-library/8-attendant-care/88-community-nursing-care
[37] http://clik.dva.gov.au/user/login?destination=comment/reply/80157%23comment-form
[38] http://dvashare/BusinessUnits/Support/DSR/RC/MRCGTools/Pages/RehabNEW.aspx
[39] http://clik.dva.gov.au/rehabilitation-procedures-guide/8-attendant-care-procedures/procedures-family-members-providing-attendant-care/recording-family-members-who-provide-attendant-care
[40] http://clik.dva.gov.au/rehabilitation-procedures-guide/8-attendant-care-procedures/procedures-family-members-providing-attendant-care/payment-family-members-who-provide-attendant-care
[41] http://clik.dva.gov.au/user/login?destination=comment/reply/80158%23comment-form
[42] http://clik.dva.gov.au/user/login?destination=comment/reply/80159%23comment-form
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[44] http://clik.dva.gov.au/user/login?destination=comment/reply/21290%23comment-form
[45] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-9-other-benefits-under-military-rehabilitation-and-compensation-act-2004/91-compensation-travel-and-accommodation-costs-reasonably-required-or-incurred-under-military-rehabilitati-1
[46] http://clik.dva.gov.au/military-compensation-srca-manuals-and-resources-library/general-handbook/ch-90-compensation-travel-and-accommodation-costs-under-safety-rehabilitation-and-compensation-act-1988-srca
[47] http://clik.dva.gov.au/rehabilitation-library/6-psychosocial-rehabilitation/67-additional-assistance-clients-severe-disabilities-who-require-24-hour-care
[48] http://clik.dva.gov.au/user/login?destination=comment/reply/21285%23comment-form
[49] http://www.dva.gov.au/providers/community-nursing
[50] http://www.dva.gov.au/providers/community-nursing/exceptional-case-unit
[51] http://clik.dva.gov.au/user/login?destination=comment/reply/21283%23comment-form
[52] file://clik.dva.gov.au/rehabilitation-library/7-household-services
[53] http://www.dva.gov.au/health-and-wellbeing/home-and-care/veterans-home-care-vhc