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].

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

Nursing Care

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]

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.

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.

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.  

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.

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.

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].

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.