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:
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 [2] 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 [3] 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 [4] of this chapter.
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:
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 [6] for advice.
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 [6] 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:
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 [7]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 [7]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:
If a Rehabilitation Coordinator is concerned about any of these issues, they must contact the rehabilitation policy section at rehabilitation@dva.gov.au [6] 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.
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 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.
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.
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. This rate can be found on the Fair Work Ombudsman [8] website by searching for “personal care worker” and then identifying the base rate (level 2) under the Health Professionals and Support Services Award.
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 [6]
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 [6] 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 [2] 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 [6] 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.
Links
[1] https://clik.dva.gov.au/user/login?destination=comment/reply/80148%23comment-form
[2] https://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
[3] https://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
[4] https://clik.dva.gov.au/rehabilitation-policy-library/8-attendant-care/88-community-nursing-care
[5] https://clik.dva.gov.au/user/login?destination=comment/reply/80157%23comment-form
[6] mailto:rehabilitation@dva.gov.au
[7] https://dvashare.dvastaff.dva.gov.au/BusinessUnits/Support/RehabServices/_layouts/15/start.aspx#/SitePages/Household%20Services%20and%20Attendant%20Care.aspx
[8] https://calculate.fairwork.gov.au/FindYourAward
[9] https://clik.dva.gov.au/user/login?destination=comment/reply/80158%23comment-form
[10] https://clik.dva.gov.au/user/login?destination=comment/reply/80159%23comment-form