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10.3.2 Issues to be considered when assessing reasonableness
When reviewing requests for alterations, modifications, aids and/or appliances to be provided through the rehabilitation provisions, the following issues are to be considered:
whether, based on an assessment from a suitably qualified health provider and advice from the client’s treating practitioners, Occupational Therapist (OT), Physiotherapist, Podiatrist or other allied health provider, the client has an assessed need for the item or service due to their accepted conditions;
- to achieve an agreed rehabilitation goal;
- to promote recovery (e.g. to help alleviate pain);
- to provide remedial support for the client’s accepted condition;
- to help ensure the client’s personal safety; and/or
- to assist clients to gain greater independence and work towards self-managing the impact of their accepted condition(s);
whether the items or services will have a positive impact on the client’s:
- quality of life – mobility, independence, community engagement, and maintenance of physical and emotional wellbeing; and/or
- general functioning, particularly their ability to contribute to the activities that must be undertaken in their household; and/or
- capacity to return to, or perform at work, or to undertake retraining or study; and/or
whether provision of the support requested is above the level that would normally be required for the medical condition or level of impairment.
Where there are concerns about the type of support that is being requested, a DVA Rehabilitation Coordinator may seek advice from an appropriate Departmental Adviser, or seek further information from the health professional who conducted the assessment. DVA Rehabilitation Coordinators can access the list of the department's Advisers from the CHO.SUPPORT.UNIT@dva.gov.au.
Serving ADF members
If the client is still fulfilling a role within the ADF, the following issues must also be addressed when considering if the item requested is reasonably required:
- whether their civilian employment or education would be at risk were the aid or appliance not provided; or
- if the client is still serving, whether they have been identified as “likely to be discharged” or providing the aid or appliance would be likely to increase the length of time that client would serve as a Permanent Forces Member.
Further information about providing alterations, modifications, aids and/or appliances to serving members can be found in section 10.8 of this chapter.
Determining the most appropriate way to provide the item
Once the above issues have been considered a number of additional issues must be considered in the context of determining the most appropriate means to provide the item to the client. These include:
- the availability of the items or services at the time required, especially if the item is required urgently;
- the likely time the item will be required with regard to the duration of the client’s impairment and the cost effectiveness of purchasing the item, taking into account:
- cost of the item or service;
- impact on future liability;
- improvements to the client’s general functioning, work opportunities, community involvement, or psychological wellbeing;
- alternatives to purchasing such as, leasing or hiring options for costly items or services; and
- the client’s involvement in discussions and development of the request for the service or item.
There may be instances where clients request a different aid to that recommended by the OT or other suitably qualified health professional. For example, an OT may recommend a shower chair to assist a client with bathing and grooming. The client may, for aesthetic reasons, ask that a stool be provided instead. In these circumstances, Rehabilitation Coordinators must contact one of the department's OT Advisers, for their opinion on whether the requested alternative aid is likely to create a health and safety risk, or be unsuitable for the client's needs, given their accepted conditions.
Rehabilitation Coordinators must take the OT Adviser's feedback into account when deciding whether to approve purchase of the client's requested item, and document the reasons for their decision in the determination letter to the client.
Workplace aids and appliances
As the rehabilitation authority, DVA has a responsibility to ensure that a client has access to appropriate aids and appliances to meet their needs. This applies regardless of what type of rehabilitation support the person is receiving. Therefore, requests for the provision of, workplace aids and appliances must always be considered, regardless of whether the client is already employed in either the public service or private enterprise. This particularly applies where a client’s employment is in jeopardy due to the impact of their accepted conditions.
DVA Rehabilitation Coordinators are asked to refer to section 10.7.4 of the Rehabilitation Policy Library for information to guide their decision making about considering workplace aids and appliances.
Aids and appliances to support psychosocial rehabilitation
Clients undertaking psychosocial rehabilitation activities may need access to adaptive or other types of equipment to enable them to participate in community activities. These may include activities such as leisure/lifestyle programs to help overcome social isolation, sporting activities and programs or short adult learning courses. It is important that a lack of appropriate equipment does not create a barrier to a person being able to participate in these types of activities. Further details about the provision of equipment to support participation in psychosocial rehabilitation activities can be found in 6.7 Equipment for psychosocial activities