Attendant care services policy

What are attendant care services?

The WorkSafe agent (the Agent) can pay the reasonable costs of attendant care services where required as a result of work-related injury or illness under Victorian workers compensation legislation (the legislation).

The Agent will periodically review a worker's entitlement to attendant care to ensure that the services remain reasonable for the work-related injury or illness and remain payable under the legislation.

The Agent can pay for attendant care services where the services

• are identified as being the most appropriate and enabling response to a worker’s clinically justified care and support needs
• optimise functional independence and actively support the worker to achieve their independence goals
• are provided in a way that is consistent with the Clinical Framework for the Delivery of Health Services, and
• are delivered using a worker centred approach

A worker may need attendant care services to increase their independence with

• activities of daily living such as personal care
• therapy support to enable the worker's active participation in rehabilitation activities, such as a home exercise program, a personal or domestic skills retraining program, or to facilitate the learning of new skills such as using a communication device, or
• accessing the community to undertake activities such as banking and shopping

Definitions

For information about other support for carers of a person with a disability, please refer to Centrelink. Centrelink may provide financial support to eligible carers.

In this policy:

• Attendant care is a support service provided to a worker at home or in the community to promote their independence and enable them to participate optimally in all aspects of their lives. Attendant care services can be provided in the following forms:
  • Daytime support, which is a service for workers who require active provision of attendant care that is classified as either:
  • Personal care, which is physical assistance with daily living tasks as directed by the recommending occupational therapist/other allied health professional and includes the provision of domestic services by the attendant carer in down time between provision of personal care.
  • Therapy support, which assists the worker to actively participate in goal directed home or community based rehabilitation activities where the support is necessary to achieve specific goals and outcomes. Therapy support is documented in the worker's Support Plan and revised as required by a treating health professional.
  • Community access, which is to assist and support the worker to undertake community activities as directed by the recommending occupational therapist
  • Overnight support,which is a service for workers who require attendant care for a period of 8 consecutive hours covering the usual sleeping period of the worker in their home or an approved location. It comprises either:
    • Active overnight support - an overnight attendant care shift where an attendant carer is required to provide active assistance or support to a worker.
    • Inactive overnight support - an overnight shift when an attendant carer is present, but not required to actively assist or support a worker. The inactive overnight support fee includes one hour of active support (not necessarily provided consecutively) for the attendant carer to undertake manual tasks associated with the worker's care such as assisting with toileting/continence issues, managing physical issues such as spasms and pain and turning and repositioning workers.
• An On-call service is a remote service for workers who require a low level of care during the day and/or overnight, but do not require an attendant carer to be constantly present and/or sleep over in their home. This service comprises two components: the monitoring service and the attendant care service. The monitoring service will contact the worker when a call is triggered to establish which of the following calls will be made to provide appropriate support:
  • contacting the worker's nominated contact person (for example neighbour or family member); or
  • arrange a call-out for an attendant care service to provide personal care within a 30 minute period (such as personal hygiene); or
  • arrange for an emergency services response (such as police, ambulance or fire).

Refer to the On-call services policy for more information.

• Shared support is an attendant care service provided to two or more people, at least one of whom is a worker, at the same time or as part of a small group. Shared support can be for a one off event or for regular attendance at a community group/recreational activity. This service may be provided where there is a particular activity that more than one worker can engage in together, for example, a concert or holiday.
• An attendant carer is a person who is appropriately trained and employed by a registered/approved attendant care agency to provide attendant care services in a way that promotes independence and functional skills. The minimum requirements to provide attendant care services are demonstrated competency in areas relevant to the needs of workers including:
  • CPR;
  • apply first aid;
  • food safety;
  • anaphylaxis;
  • manual lifting; and
  • infection control.

Attendant carers must also complete a worker specific training program where required as a result of a worker's specialised support needs.

• Rehabilitation is the provision of time-limited, goaloriented and outcome-focused services to support the worker achieve their independence goals. A rehabilitation program is usually developed and monitored by an allied health professional and may include a home exercise program, independent gym program, retraining in daily living skills or training in new skills.
• Support plan is the document submitted by the attendant care agency that details the attendant care program that is expected to meet the worker's individual support needs.

Guidelines

What can the Agent pay for in relation to attendant care?

The Agent can pay the reasonable costs of attendant care required as the result of a work-related injury or illness for a worker who:

• has physical, sensory and/or cognitive/behavioural disabilities arising from their work-related injury or illness, and
• is assessed as requiring support with activities of daily living such as personal care, domestic and community activities and/or individual participation in recreation activities following discharge from an acute or rehabilitation hospital

The Agent can pay the reasonable costs of a range of attendant care services to provide day and/or night time support.

Daytime support – personal care

The Agent can pay the reasonable costs of attendant care to assist and support a worker to manage personal care tasks as independently as possible. Where possible, personal care support should be delivered in a way that increases a worker's independence with personal care activities.

The Agent can also pay for personal care for a worker who is assessed as being at risk of physical harm/medical emergency without supervision and when electronic communication devices, alarms or environmental control systems are not appropriate. The Agent will consider the availability of family and other informal social supports when considering a request for attendant care for this purpose.

Daytime support – On-call services

The Agent can pay for on-call attendant care for a worker who requires a low level of care and does not require an attendant carer during the day in their home. On-call attendant care can be combined with active care where appropriate. Refer to the On-call services policy.

Daytime support – therapy support

The Agent can pay the reasonable costs of attendant care for therapy support to assist the worker to actively participate in rehabilitation activities where the support is necessary to achieve specific independence goals and outcomes. Therapy support may be provided to the worker individually or as part of a structured rehabilitation program which is developed and monitored by an allied health practitioner. Rehabilitation programs may include home exercise programs or an independent gym and/or swimming program. Rehabilitation programs must be aligned to the worker's goals and have measurable outcomes and goal oriented timelines.

The Agent expects that the hours of therapy support required will reduce over time as the worker achieves their goals unless it has been approved to maintain function as recommended by the worker's allied health practitioner.

Daytime support – community access

The Agent can pay the reasonable costs of attendant care services to assist and support the worker to participate in community activities of daily living, engage in their community and participate in recreation and leisure pursuits.

Workers may share attendant care for accessing the community where intensive or personal individual support is not required.

Attendant carer travel

The Agent can also consider reimbursing reasonable travel expenses incurred by an attendant carer when accompanying the worker to hospital or medical appointments related to the work-related injury or illness (not for recreational or leisure activities). Prior approval is required and the attendant care agency must submit details of the kilometres travelled, destination and appointment being attended to the Agent.

The Agent expects that the worker's motor vehicle will be used unless there are exceptional circumstances requiring the use of the carer's motor vehicle for worker transport.

The private kilometre rate will apply to transportation of a worker in a motor vehicle belonging to a family member who is providing attendant care. For information about attendant carer travel expenses refer to the Schedule of Fees for Attendant Care.

For more information about worker travel expenses, refer to the Travel and Accommodation policy/Policy for Travel expenses for Hospital and Medical Services.

Overnight support

The Agent can pay the reasonable costs of attendant care for overnight support as follows:

• On-call service - the Agent can pay for on-call attendant care for a worker who does not require or chooses not to have an attendant carer sleep over in their home. Refer to the On-Call Services policy.
• Inactive overnight support - where there is clinical justification that the on-call service does not provide an appropriate level of support to meet the needs of a worker.
• Active overnight support - where there is clinical justification that inactive overnight support is unable to meet the needs of a worker. This level of care is for a worker who requires an attendant carer to provide active overnight assistance and support such that the attendant carer is unable to sleep during the sleepover period.

Refer to the Fee Schedule for Attendant Care for information about billing for greater than one and up to four hours of active support when unexpected situations arise within a shift of inactive overnight support. Instances of active care (in excess of the hour included in the inactive overnight fee) should be billed according to the actual time spent assisting the worker.

The attendant care provider should contact the Agent to discuss whether the current approval of inactive overnight support is meeting the worker's needs in circumstances where this level of active support is required on a regular basis. Any change to the program requires appropriate clinical justification and prior approval from the Agent.

Program establishment

The Agent can pay the reasonable costs of a one-off Program Establishment Fee to the attendant care agency to establish a quality care program for a worker in circumstances where:

• the Agent has received a Support Plan, and
• the service provider has successfully conducted a site assessment, and
• the service provider has developed a WorkSafe worker specific training program

The Program Establishment Fee assists with recruitment of new personnel; development of support and training plans; and compliance with OHS site requirements.

The attendant care agency can provide and bill for program establishment when they have provided the worker with at least four hours of attendant care in each of three consecutive billing periods.

A program establishment fee will not be paid where the service provider changes a Support Plan after a review of a worker's support needs.

Attendant carer training

The Agent can pay the reasonable costs for an allied health or other medical professional to provide worker specific training to carers. This is paid according to the fee schedule for the relevant health professional.

The Agent will not pay for attendant carers to be trained according to the WorkSafe minimum requirements for attendant carers as these costs are the responsibility of the attendant care agency.

Overseas Travel

The Agent, where required, may pay the reasonable cost of attendant care support provided to a worker while they are travelling overseas, up to a maximum of 8 weeks per year. The Agent will require details regarding a worker's travel arrangements and the care that a worker requires during this time.

Other than in an emergency situation, WorkSafe is not liable to pay the reasonable cost of attendant care provided overseas unless prior approval has been obtained from the Agent. Requests for overseas attendant care should be made at least 4 weeks in advance of travel to allow sufficient time for Agent approval.

Please see the claims manual for more information regarding overseas travel.

Information the Agent requires to consider paying for attendant care

Prior approval in writing from the Agent is required for attendant care services. The Agent requires all of the following information to consider approving attendant care services:

• A medical practitioner request stating that the worker requires attendant care services for the rehabilitation of their work-related injury or illness.
• An Agent requested Activities of Daily Living (ADL) assessment, Functional Independence Review (FIR) or a Benefit and Support Services Assessment (BASSA) completed by a WorkSafe approved and registered occupational therapist.

The attendant care agency must submit a Support Plan documenting the workers individual support needs no later than 15 business days after approved services start or after a review of the worker's support needs has occurred. The plan must specify:

• the goals of the program if it includes therapy support hours
• a description of the care services to be provided
• the specific duties of the attendant carer
• other support services to be involved
• the hours recommended
• the regular review intervals, and
• the program duration

Where there is an immediate need for attendant care services for a short period for instance, to support recovery following surgery, and where the workers needs are not considered complex, the Agent may approve the attendant care service where requested by a medical practitioner without an ADL assessment.

Any change to an attendant care program or request for additional hours must have written approval by the Agent before the change in the program or additional hours occurs. This includes any substitution between personal care, therapy support and community access approved hours even if the total approved hours remains unchanged.

The attendant care provider must contact the Agent on the next business day to discuss a proposed variation where prior approval is not possible, e.g. where there is an unexpected change in the worker's condition.

The Agent will not pay for attendant care services that have not been approved or that exceed the number of approved hours if a variation has not been sought.

The Agent requires a support plan and training plan to consider paying for attendant care program establishment.

Who can provide attendant care

The Agent will only pay for attendant care services delivered by an attendant carer who is employed by an attendant care agency registered by the approved by WorkSafe to provide attendant care services to workers. Attendant care agencies that register with WorkSafe are expected to employ staff who have appropriate knowledge and skills to meet the needs of workers e.g. knowledge of care for people with quadriplegia and acquired brain injury.

An attendant care agency must meet the registration criteria and agree to the terms and conditions of providing disability services detailed on the WorkSafe website.

Requests for a family member or friend to provide attendant care services

WorkSafe does not encourage employment of family members or friends as paid attendant carers. This arrangement may jeopardise existing relationships and create conflicting responsibilities. Requests will only be considered in exceptional circumstances such as where there is limited access to professional attendant carers.

The family member or friend must be employed by a registered/approved attendant care agency and meet all the requirements of that agency. This is to ensure that services delivered to the worker meet industry standards. The family member must also satisfy all of the minimum standards required to provide attendant care services which are referred to above in the definition of "attendant carer". It is the responsibility of the attendant care agency to ensure that all staff have received appropriate training to provide them with the skills to promote the independence and functional skills of the worker.

The Agent will consider the following when reviewing a request to pay for a family member or friend to provide attendant care services:

• Whether all other alternatives to a family member or friend providing attendant care services have been considered and exhausted
• The needs of the worker including:
  • their functional skills, independence and participation in community activities;
  • the specific attendant care tasks the worker requires and whether he/she agrees with family members or friends assisting with personal hygiene tasks.
• The level of support from the treating medical practitioner – written clinical justification for provision of attendant care services by the nominated family member or friend is required.
• The overall function of the family unit or an existing friendship and the needs of other family members, particularly children.
• Whether the family member or friend has the capacity, appropriate skills and commitment to:
  • meet the attendant care agency's employment conditions, including standards for service delivery;
  • comply with the agency's occupational health and safety guidelines and legislated standards; and
  • meet the ongoing training requirements of their employer
• Whether appropriate back-up arrangements are in place in case of illness, days off, training, annual leave, etc.

The need for an additional income source is not an appropriate justification for the provision of attendant care by a family member or friend.

When the Agent will respond to a request

Within 10 working days of receiving the request, the Agent will advise whether:

• the request has been approved
• the request has been denied, or
• further information is required to make a decision.

Where further information is required, the Agent will advise whether the request has been approved or denied within 10 working days of receiving the additional information.

An attendant care request may be reviewed by the Clinical Panel to assist the Agent to make a decision regarding a request for attendant care services. The Medical Advisor may contact the requesting health professional or attendant care agency to seek further information and/or discuss the proposed services before making a recommendation to the Agent regarding the request. The Agent will respond to the request when they have received the Clinical Panel's recommendation.

In relation to attendant care, what will the Agent not pay for?

• Services for an injury, condition or circumstance that existed before or that is not a direct result of the work-related injury or illness.
• Services that are unrelated to the work-related injury or illness.
• Services that are of no clear measureable benefit to the worker.
• Services that exceed the number of hours recommended by the worker's treater and approved by the Agent.
• Services where a worker cancels or does not attend.
• Attendant carers to undertake shadow or supernumerary shifts.
• General training for skills an attendant carer would reasonably be expected to possess in order to conduct duties within their normal scope of practice, for example manual handling and infection control.
• Services subcontracted to, or provided on behalf of, a non-WorkSafe approved provider.
• Any costs of travel for the worker or attendant carer not related to the work-related injury or illness - see also the Travel Expenses Policy.
• Costs of participating in leisure or recreational activities.
• The cost of a carer companion card (for example a NICAN card).
• Treatment or services for a person other than the worker, including a child/children or other family members.
• Non-active components of overnight care provided by a family member or friend who normally resides with the worker, for example where the worker is sleeping and no personal care is being provided.
• Support workers' meals or personal or incidental expenses.