Daily living expenses policy

What WorkSafe will pay for

The WorkSafe Agent (the agent) can, for a specified period, pay or reimburse the reasonable costs of daily living expenses where a worker is required to reside in a supported accommodation facility as a direct result of a work-related injury or illness under Victorian workers compensation legislation (the legislation).

After this time, the worker may be required to make a payment towards the costs of residing in supported accommodation by contributing to their daily living expenses.

Background

Under the legislation, where a worker is required to make a payment towards the costs of supported accommodation, the amount of the contribution towards their daily living expenses can be capped by an Order of the Governor in Council.

Such an Order was made on 21 April 2011 with the effect that, on and from 1 May 2011, a worker who is required to make a contribution towards their daily living expenses cannot be required to pay more than $32.50 per day (capped amount). This Order applies only to workers in shared supported accommodation (SSA) and supported residential service (SRS) facilities. However the Order does not apply to workers in a residential aged care (RAC) facility.

The purpose of the capped amount is to keep supported accommodation services affordable by ensuring workers residing in these facilities contribute no more than a maximum amount for daily living expenses.

This policy must be read in conjunction with the Supported Accommodation Services Policy.

Definitions

In this policy:

• Daily living expenses, also known as the basic daily fee or the basic daily care fee, refers to:
  • accommodation related costs (i.e. rent)
  • food, household or personal items
  • power, water or any other service provided by a utility (not internet)
  • room temperature controls
• Supported accommodation facility refers to and includes any of the following:
  • Shared supported accommodation (SSA) service
  • Supported residential service (SRS)
  • Residential aged care (RAC) facility
  • Group home (within the meaning of Section 3(1) of the Disability Act 2006). A group home was previously known as a Community Residential Unit (CRU)

Refer to the Supported Accommodation Services Policy for detailed definitions of each supported accommodation facility type listed above.

• Capped amount refers to the maximum amount a worker can be charged per day as a contribution towards their daily living expenses whilst residing in shared supported accommodation (SSA) and supported residential service (SRS) facilities. The capped amount may be reviewed by the Governor in Council.
• First discharged from hospital is when a worker is discharged from an acute or rehabilitation hospital for the first time after the work-related injury or illness.

Guidelines

What can the agent pay for in relation to daily living expenses?

The agent can pay the reasonable costs of daily living expenses without any worker contribution being required for:

• the first 18 months after a worker is first discharged from hospital where, due to a work-related injury or illness, the worker is residing in a supported accommodation facility
• a worker who is under 18 years of age and who, due to a work-related injury or illness, is residing in a supported accommodation facility
• a worker receiving respite services due to a work-related injury or illness

When the worker is absent from a supported accommodation facility due to a hospital admission directly related to their work-related injury or illness, the period where the agent is liable to pay the reasonable costs of daily living expenses without requiring a worker contribution will be suspended. The period will recommence from the date that they are discharged from hospital back to the supported accommodation facility.

After the period where the agent is liable to pay the reasonable costs of daily living expenses without requiring a worker contribution has elapsed, the worker may be required to make a contribution towards their daily living expenses if they reside in any of the facility types listed below.

1. Shared Supported Accommodation and Supported Residential Services

The fee for daily living expenses for SSA is included in a set fee charged by the SSA service provider.

The fee for daily living expenses for SRS is set by each SRS facility and can vary from provider to provider.

a. During the worker non-contribution period i.e. within 18 months of hospital discharge

For the period where the agent is liable to pay the reasonable costs of daily living expenses without requiring a worker contribution, the SSA service provider is entitled to claim payment from the agent for the reasonable costs of daily living expenses.

For example, during the first 18 months following the date the worker is first discharged from hospital, if the daily living expenses were determined by the SSA or SRS provider at $35.05 per day and the agent accepts that this is a reasonable amount, then the agent pays $35.05 per day to the SSA or SRS provider.

b. After the worker non-contribution period has elapsed i.e. 18 months after hospital discharge and beyond

Where the period the agent is liable to pay the reasonable costs of daily living expenses without any worker contribution has elapsed, the worker is responsible for paying their daily living expenses up to the capped amount. As at 1 May 2011, the maximum amount that a worker can contribute towards their daily living expenses within a SSA or SRS is $32.50 per day.

The agent is liable to pay to the SSA or SRS service provider the reasonable costs of any daily living expenses above the worker's capped amount of $32.50.

For example, after the first 18 months following the date the worker is first discharged from hospital, if the daily living expenses were determined by the SSA/SRS provider at $35.05 per day then:

• the worker pays the capped amount of $32.50 per day to the SSA/SRS provider
• the agent can pay the reasonable costs of the balance of the daily living expenses at $2.55 per day to the SSA/SRS provider

2. Residential Aged Care

The fee for daily living expenses for residential aged care (RAC), referred to as the basic daily fee or the basic daily care fee, is determined by the Department of Health and Ageing (DoHA).

Please note that in a RAC facility, extra service care is not considered to be part of the fee for daily living expenses. Refer to the 'extra service care' section of the Supported Accommodation Services Policy.

How does payment or reimbursement of daily living expenses in a shared supported accommodation (SSA) service or a supported residential service (SRS) affect Centrelink rental assistance?

Prior to the end of the period where the agent is liable to pay the reasonable costs of daily living expenses without any worker contribution (the first 18 months following the date the worker is first discharged from hospital), it is expected that the worker, or the worker's representative, contacts Centrelink to determine the worker's entitlement to Centrelink rental assistance.

In relation to daily living expenses, what won't the Agent pay for?

The agent will not pay daily living expenses for:

• a person other than the worker
• a service that is not consistent with the level of care that a worker requires as a result of their work-related injury or illness
• when a worker is absent from a facility for non work-related injury or illness reasons
• a worker residing in privately rented accommodation
• services subcontracted to, or provided by, a nonregistered provider
• services provided outside Australia without prior written approval from WorkSafe
• treatment or services provided by telephone or other non face to face mediums
• the cost of telephone calls and telephone consultations between providers and workers, and between other providers, including hospitals

Note: This policy is a guideline issued by WorkSafe Victoria under Victorian workers compensation legislation in respect of the reasonable costs of services.