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 [2] and subsection 29(4) of DRCA [3]the nature of the client’s injury or disease:
Further details about these criteria are explained in the following subsections and must be used to guide decision making.
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.
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 [6], or services through the Veterans’ Home Care program (see section 5.4.3 [7] and section 5.4.4 [8] 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 [9]
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.
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.
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.
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:
Links
[1] https://clik.dva.gov.au/user/login?destination=comment/reply/21284%23comment-form
[2] http://www.comlaw.gov.au/Series/C2004A01285
[3] https://www.legislation.gov.au/Series/C1988A00156
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/21287%23comment-form
[5] https://clik.dva.gov.au/user/login?destination=comment/reply/21293%23comment-form
[6] http://www.comlaw.gov.au/Series/F2013L02016
[7] https://clik.dva.gov.au/rehabilitation-policy-library/5-medical-management-rehabilitation/54-other-types-medical-treatment-support/543-independent-living-programs-veterans-home-care-and-household-and-attendant-care-services
[8] https://clik.dva.gov.au/rehabilitation-policy-library/5-medical-management-rehabilitation/54-other-types-medical-treatment-support/544-community-nursing-program
[9] mailto:rehabilitation@dva.gov.au
[10] https://clik.dva.gov.au/user/login?destination=comment/reply/21295%23comment-form
[11] https://clik.dva.gov.au/user/login?destination=comment/reply/21280%23comment-form
[12] https://clik.dva.gov.au/user/login?destination=comment/reply/21291%23comment-form
[13] https://clik.dva.gov.au/user/login?destination=comment/reply/21286%23comment-form