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8.2 What are Attendant Care Services?
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 firstname.lastname@example.org. 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.
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 email@example.com 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:
- 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 for further information); and
- services will usually attract GST.
- 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 for further information); and
- should not attract GST.