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6.10 Additional assistance for clients with severe disabilities who require 24 hour care
The following policy is based on a policy change made by Comcare in November 2007 and reflected in Comcare Jurisdictional Policy Advice (JPA) 2008/8. DVA's policy is consistent with this JPA and should be used to inform decision making for clients with severe disabilities who require 24 hour care and have access to rehabilitation support under the DRCA and MRCA.
This policy change is informed by the Wilby v Comcare (2003) Federal Court case. The general principle behind this policy is that while the client's level of care does not change because they are away from home, additional costs are incurred because they need to have a carer or carers to accompany them to activities because of their accepted conditions. Therefore, if based on the most recent assessment of the client's care needs, a client requires community nursing and attendant care services, and two carers to assist with transfers, showering etc, then this same level and type of care will be needed while they are away from home. There may be some exceptions to this general rule if a client has a range of aids and appliances which facilitate their independence at home, that cannot be accessed while they are away from home.
This policy recognises that participation in social, recreational and community life is an important part of the ongoing process of rehabilitation following a compensable injury or disease. To participate in these types of activities, there will be additional costs for the client with severe disabilities who requires 24 hour care, particularly where overnight travel or interstate visits are involved. These additional costs may include for example:
- travel costs for carers, which may include local, interstate or overseas travel;
- venue tickets for carers;
- meals for carers; and
- accommodation for carers.
Although the number of clients affected by this circumstance is quite low, the impact on their ability to participate in social, recreational and community life is significant.
When considering applications for additional support for clients with severe disabilities who require 24 hour care and wish to participate in community, recreational and social activities, delegates should use the full range of the support provisions available in the DRCA or the MRCA and develop a psychosocial rehabilitation plan to facilitate this. While the client's costs of participating in such activities will not be covered, the ancillary costs and expenses for a carer or carers to accompany the client may be met under such a plan.
The delegate may make a determination that a client who has suffered an injury resulting in severe impairments should undertake a psychosocial rehabilitation program for the purpose of participating in social, recreational and community related activities. This determination should be made under section 37 of the DRCA or section 51 of the MRCA. This decision enables the ancillary costs and expenses, of carer(s) supporting a client to participate in approved activities under the plan, to be met.
In making such a decision the delegate should have regard to the following:
(a) the cost of the program;
(b) the likely psychological effect on the client of not providing such a program;
(c) the client's attitude to the program;
(d) the possible merits of any alternative and appropriate rehabilitation program; and
(e) any other relevant matter.
In considering (e) 'any other relevant matter', the degree of the client's disability is extremely relevant. The following conditions should apply in order for the client to be considered for such a program:
- the client requires 24-hour care (please see note 1 below);
- the client has an accredited carer (please see note 2 below);
- the services provided by the carer shall be personal care services, such as dressing, bathing/toileting, feeding or services necessary to attend certain venues or to travel on certain forms of transport;
- the activity for which the carer's costs are to be reimbursed has been designated in advance by the Department as part of an approved rehabilitation plan;
- the delegate has assessed the activity for which the carer's cost are to be reimbursed as an activity associated with the client's disability or which, but for the compensable condition, would be a reasonable part of the client's participation in social, recreational and community activities;
- in considering the reasonableness of any activity in terms of the above point, the delegate shall have regard to 'community standards' of access to such activities, including the reasonableness of the cost and the frequency and nature of activities attended prior to the disability. What constitutes 'community standards' will vary from case to case, but would include attending social, community or recreational activities such as visits to the movies or sporting matches. It would also include events occurring less frequently such as:
- attendance at significant family event (eg. a wedding, funeral or holiday season gathering);
- attendance at a reunion or significant event in the community to which the client belongs or closely identifies with; and
- attendance at an interstate appointment where such a service is not available locally (eg. high level legal advice, specialised financial advice unrelated to the claim).
Under these provisions, any additional admission, travel and accommodation costs incurred by the client due to their need to have a carer(s) accompany them to approved activities under their psychosocial rehabilitation plan are paid in addition to the client's normal ongoing attendant care arrangements. It is important to note that these additional costs can only be paid for activities that are approved activities under the client's psychosocial rehabilitation plan.
These costs are to paid as reimbursement to the client, on submission of receipts providing evidence of expenditure assoicated with their carer's requirements. This approach is consistent with the Comcare JPA.
Note 1: Even though a person may have a clinically assessed requirement for 24 hour care, it may be possible to deliver this care in less than 24 hours direct client contact. For example, a client with partial quadriplegia may require 24 hour care, but the carer staff are able to deliver this care in 18 hours per day face to face client contact, over multiple visits throughout the day. In this case, the client may also have access and the ability to operate an emergency medic alarm call system 24 hours of every day. The client in this example would qualify for support throughout the policy.
Note 2: An accredited carer is defined as a support worker with current professional qualifications to Certificate III in home, aged, disability or community care who has the experience to meet the specific personal/clinical needs of the client.
For advice about whether activities such as travel may be considered consistent with community standards, please contact the rehabilitation policy team through firstname.lastname@example.org
There is no flexibility under the current policy guidelines and legislation to meet any third party costs for carers, such as travel, accommodation, meal and entry fees incurred while accompanying a client to approved activities under a psychosocial rehabilitation plan, unless the client has severe disabilities and requires 24 hour care.