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8.5.1 Exceptional Circumstances
What are “exceptional circumstances”?
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:
- there is documented medical evidence that the client is likely to experience a high degree of anxiety and/or distress and/or hostility if the care is provided by an external service provider;
- where it is desirable for family to provide the care, for example where a person has an acquired brain injury and routine and familiarity are important to the person continuing to be able to be supported to manage their activities of daily living; or
- the client requires care for a short period of time only (for example while recovering from surgery) and there are issues with accessing professional care providers for the period required, in the client’s location.
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 firstname.lastname@example.org for advice.
Long term care
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 email@example.com 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:
- the client's accepted conditions are such that they would experience a high degree of anxiety and/or distress and/or hostility if the attendant care services to meet intimate care needs were provided by an external provider; or
- the client’s accepted conditions are such that having their family, who they are familiar with, provide their care is important for the routine and structure of their day, for example, for those with an acquired brain injury.
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 ]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 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:
- whether the client would receive high quality care appropriate to their needs, if their partner, relative or friend provided the care;
- if attendant care services have been provided previously, were these services provided by a professional, rather than a partner, relative or friend;
- in the context of the client’s injuries, whether there are real benefits to having a familiar person providing support to the person;
- the need to avoid physical injury and carer burnout particularly if heavy lifting or high or complex levels of care may be involved; and
- whether there is risk of conflict of interest issues arising which prevent the best quality and most appropriate care being provided to the client. This may include, for example, the risk that the family or friend may become dependent on ongoing attendant care payments as a form of income and be reticent to change care arrangements when a client’s needs and circumstances change.
If a Rehabilitation Coordinator is concerned about any of these issues, they must contact the rehabilitation policy section at firstname.lastname@example.org 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. Further information about recording exceptional circumstances decisions can be found in the Rehabiliation Procedures Guide.
Short term care
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 reasonable for a partner, relative or friend to provide care on an unpaid basis; and
- if the partner, relative or friend is able to provide this care without a substantial disruption to their own activities.
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.
Rate of payment when family or friends provide Attendant Care
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.
DVA Rehabilitation Coordinators are asked to refer to the Rehabilitation Procedures Guide for how to find this rate, and for further information about payment to family members who provide attendant care.