8.5.1 Exceptional Circumstances

What are “exceptional circumstances”?

The following matters are considered key to whether exceptional circumstances exist:

• there is documented evidence the client is likely to experience a high degree of anxiety and/or distress and/or hostility if personal care services of an intimate nature such as assistance with showering or toileting are provided by an external service provider;
• there is evidence the client’s partner or relative is experiencing significant disruption to normal family life (including employment) because of the need to support the client to meet their essential and regular personal care needs.

Determinations must be based on evidence

When a delegate is satisfied there is sufficient evidence that exceptional circumstances apply, the following issues should also be considered:

• whether the client would receive high quality care appropriate to their needs, if their partner or relative provided the care;
• who has previously provided assistance with personal care tasks; 
• work health and safety issues; and 
• the need to avoid physical injury to the client or the provider, particularly if heavy lifting may be involved; 
• a range of potential safety, social, emotional and financial risks including the risk of carer burn out and risks to the psychological wellbeing of the carer, challenging changes in family dynamics, the risk of social isolation, financial risks including lack of access to superannuation and independent income; and
• the risk the family may become dependent on ongoing attendant care payments as a form of income and be reticent to change care arrangements if/when a client’s needs and circumstances change, or the relative or partner is no longer coping with the demands of their role.

Delegates are encouraged to discuss any issues of concern with their team leaders in the first instance. If policy advice is required, delegates are requested to contact rehab.policy@dva.gov.au before a decision is made.

It is essential that if a partner or relative or partner is approved to provide attendant care services, these arrangements are monitored on a regular basis to ensure:

• care continues to be appropriate to the client’s needs and circumstances; and
• social, safety, emotional and financial risks to the partner or relative’s wellbeing are understood, discussed and escalated where appropriate.