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7.2.5 Any other relevant matter
Any other matters that are relevant to considering a claim for household services will be entirely dependent on the circumstances of a particular case. The most obvious example of any other relevant matter is a report obtained from an Occupational Therapist in relation to what household services are reasonably required. However, other issues such as the impact of a deterioration in a client's accepted condition(s) may also be considered.
Household services and the National Disability Insurance Scheme (NDIS)
Household services can be provided by both DVA, through a specific services 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 household services 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:
- ask the client whether they are receiving any services or equipment from the NDIS;
- provide details of any services or equipment being provided through the NDIS;
- explain to the client that they cannot receive the same household services or domestic support services through both the NDIS and DVA; and
- document that they have made the client aware that they cannot receive the same services from both the NDIS and DVA.
Participation in a rehabilitation program
Where a person is actively involved in a rehabilitation program and especially when the rehabilitation program involves return to work activities (e.g. a work trial), claims for household services which will enhance the likelihood of successful rehabilitation should be given favourable consideration.
Change in circumstances
Compensation for household services are provided due to a client’s inability to complete tasks of a domestic nature, required for the proper running and maintenance of their household, as a result of their accepted conditions. Household services can only be approved where the client was responsible for the task prior to their service related injury or illness, and is now unable to complete that task due to the impact of their injury or illness. However, a delegate does also have the discretion to consider other issues, such as safety risks, or a client's individual circumstances when making decisions about whether to approve the provision of household services. Delegates are encouraged to seek policy advice where doubt exists.
Household services are provided to address the needs of the DVA client, not their family or other members of their household. It is recognised however, that provision of household services can benefit all members of the household.
For this reason, matters considered relevant to a household services claim also include whether the household 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, or if they are a serving member who has been deployed, then household services cannot be provided. This is because it is not the client’s accepted conditions that prevents them from undertaking household tasks, but the fact that are not in their home. In these circumstances, if the client is already approved for household services their "usual" household services arrangements need to be put on hold, and any invoices presented by household services providers must be scrutinised carefully to ensure that payments are only made for assistance that was actually provided to the client while they were in their own home. This applies to household services undertaken by professional providers or by a partner or relative of the client.
Individual circumstances must be taken into account when determining whether the service is reasonably required for a specified period. For example, if the client is away from home for an extended period, it may be considered reasonable that a lawn mowing service and a household clean be provided before the client returns home.
A person should be given at least 28 days notice of any intention to reduce or cease the level of household services approved so that they have a fair opportunity to provide further evidence in support of their claim or discuss the change in circumstances. Please refer to section 7.4 of this Guide for further information about approving and reviewing household services decisions.
Pre-prepared meal delivery
Pre-prepared meal delivery can only be approved for a limited period of time. This service is intended to address temporary changes to a client’s ability to manage meal preparation because of a change in circumstances related to their accepted conditions. This type of service is distinct from meal preparation services to meet ongoing needs.
The delegate must be satisfied that pre-prepared meal delivery is necessary under the circumstances, and reasonably required for a short period in-line with the criteria outlined in section 7.2.
Examples of where this type of service may be reasonably required are during a period of recovery immediately after surgery or ill-health related to the client’s accepted condition.
The amount that can be funded under this arrangement will be for meal preparation and delivery only. The cost of ingredients cannot be funded.
Where the invoice for delivery of pre-prepared meals is itemised and can be separated into costs for ingredients, meal preparation and delivery, DVA will fund 100% of the specified costs for meal preparation and delivery only up to the approved amount (i.e. the costs of ingredients will not be funded).
Where the invoice for delivery of pre-prepared meals is not itemised and has not been separated into costs for ingredients, meal preparation and delivery, DVA will fund 70% of the total amount specified on the invoice up to the approved amount.
Moving into care
If the client moves into palliative care or residential aged care on a permanent basis, then the household services payments should be ceased from the date that they entered care on a permanent basis. If the person returns home from care, then their household services payments can be reactivated from the date that they were discharged from the care facility. Another OT assessment may be required if the client's needs have changed as a result of their hospitalisation.
Where household services are to cease following a client’s entry to care, the person should still be given 28 days notice of the intent to cease the level of household services approved. This provides them a fair opportunity to discuss the change in circumstances if required and for their spouse or family if they have one, to make alternative arrangements.
Work Health and Safety
Where there is a high level of risk associated with undertaking a particular service, it is reasonable the service should be undertaken by a professional and the client cannot be compensated for that service. This applies regardless of whether the client undertook the task prior to their injury.
Community standards should be used as a benchmark to determine whether there is a high level of risk or sufficient concern for a person’s health and safety in undertaking a certain task.
Tasks undertaken at height
Where a task needs to be undertaken at height, community standards are such that most people would be unlikely to perform the task themselves, for example, where they need to physically get onto a roof or access is precarious. Consistent with the policy guidelines in section 7.1.1 of this Guide, services for which a person might usually or reasonably need to employ a professional service provider, due to the safety risk associated with the task, would not normally fall within the definition of a household service and the client cannot be compensated for such services. The following circumstances outline when it would not be reasonable to compensate a person for household services, for tasks undertaken at height:
Two storey house - it is reasonable to consider that gutter cleaning, solar panel cleaning and external window cleaning on a two storey house would generally be undertaken by a professional. Accordingly, no compensation for household services can be paid.
Single storey house - household services can be considered for gutter cleaning, solar panel cleaning and external window cleaning in the following instances:
- the solar panels were in place prior to the service-related injury or illness;
- the client was responsible for cleaning the gutters, solar panels or windows prior to their injury or illness; and
- the gutter, solar panels or windows are in a position that does not require the person to get onto the roof or place themselves at risk to clean them.
When considering whether someone reasonably requires household services, it does not matter if the person owns the property or is renting. The prime consideration is whether the person is actually responsible for undertaking the tasks that they are requesting assistance with as part of their obligations under their tenancy agreement. The best way to ascertain this information is for the OT undertaking the ADL assessment to confirm whether the client’s rental agreement stipulates the tasks that the client is responsible for outside the home. The OT may do this by viewing the rental agreement during the assessment, or contacting the real estate agent/landlord directly if a copy of the agreement is not available.
Consistent with any other claim for household services, the other criteria outlined in section 7.2 of this chapter must also be considered in determining whether the services are reasonably required. For example, if a person had not previously lived in a property with a pool, and moved into a rental property that has a pool, pool cleaning could not be provided as a household service because it was not a task the person undertook prior to their injury. In this case, a tenancy agreement stating that the person was responsible for cleaning the pool would not, by itself, be sufficient for the pool cleaning to be approved.
While each state and territory has rules around what tasks a property owner and tenant are responsible for, these responsibilities can vary according to a landlord’s preference. Therefore, if a tenancy agreement and/or real estate agent confirm that a person is responsible for a certain task this can be taken as sufficient evidence that the person is responsible for that task.