Supported accommodation services policy

What WorkSafe will pay for

WorkSafe can pay the reasonable costs of supported accommodation services under Victorian workers' compensation legislation (the legislation) where the worker requires residence in a supported accommodation facility on a permanent or semi-permanent basis in order to meet their care and support needs as a result of a work-related illness or injury. WorkSafe will periodically review a worker’s entitlement to supported accommodation to ensure that the level of support and services remain reasonable for the work-related injury or illness and remains payable under the legislation.

This policy must be read in conjunction with the following policies:

Background

Supported accommodation is a model of care that responds to the needs of workers who have multiple physical, sensory and/or cognitive disabilities arising from their work-related injury or illness which impacts significantly on their capacity for independent living. The care provided may relate to physical assistance and/or assistance required to address cognitive and psychological issues.

The Agent can pay for supported accommodation 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

Supported accommodation services may provide personal care, domestic and community services, supervision, nursing care, or a combination of all of these.

Supported accommodation facilities should offer:

• a separate bedroom
• a 'home-like' environment with furnishings
• standard equipment appropriate to the worker’s care and support needs
• varied meal choices with high nutritional value
• appropriate staffing to meet all personal care needs of the worker
• supervision and/or nursing care relevant to the needs of the worker, and
• accommodation that is clean, hygienic and kept in good repair

The accommodation service should endeavour to maximise a worker's personal dignity, choice, independence, functional skills and capabilities and should encourage and facilitate his/her participation in social and community activities.

The Agent can consider engaging a case manager to facilitate admission into a supported accommodation facility in circumstances where a worker requires additional support.

Definitions

In this policy:

Supported Accommodation

Refers to the following four accommodation facility options available:

• Shared Supported Accommodation (SSA).
• Supported Residential Services (SRS) within the meaning of section 5 of the Supported Residential Services (Private Proprietors) Act 2010.
• Residential Aged Care (RAC).
• Group Home (within the meaning of Section 3(1) of the Disability Act 2006 and formerly known as Community Residential Unit (CRU)).

Shared Supported Accommodation (SSA)

SSA facilities provide care and support for people with disabilities. They are houses with paid carers that may provide personal care, nursing, rehabilitation, housekeeping, meals and laundry services, provided within a shared care model, 24 hours a day, 7 days a week.

Supported Residential Services (SRS)

SRS facilities are private businesses that provide accommodation and personal care for people who do not demonstrate the ability to return to living independently. SRS facilities vary in the services they provide, the people they accommodate and the fees they charge. Services may include assistance with personal activities of daily living (showering, personal hygiene, toileting, dressing, medication), domestic activities of daily living (preparation of meals, laundry) and community activities of daily living as well as physical and emotional support. Some SRS facilities also provide nursing or allied health services.

These facilities do not receive Government funding but must be registered with the Victorian Department of Health and Human Services (DHHS) as a SRS and remain compliant with the criteria for registration.

Residential Aged Care (RAC)

RAC facilities (also referred to as Aged Care Facility/Nursing Home/Hostel) provide care and support services to people who are no longer able to care for themselves or be cared for by others in their own homes. Care is provided under the Commonwealth Aged Care Act 1997 and facilities must be certified by the Commonwealth as a Residential Aged Care (RAC) service.

There are two types of residential aged care:

• Low level care (also referred to as a hostel) refers to the provision of suitable accommodation and related services which includes laundry, meals, cleaning and personal care services such as bathing, dressing and toileting assistance.
• High level care (also referred to as nursing home) refers to accommodation and related services which includes personal care services, nursing care and equipment.

More information on eligibility of workers entering into RAC facilities can be found on the Australian Government Department of Health (DoH) website.

Group Home

(within the meaning of Section 3(1) of the Disability Act 2006) and formerly known as Community Residential Unit (CRU) is a residential service that provides housing for four to six residents with support provided by rostered staff. In most cases, workers will not be eligible for a Group Home as their primary disability existed before the work-related injury or illness.

Daily Living Expenses (DLE)

DLE, also known as the basic daily fee or the basic daily care fee, are a worker's expenses associated with accommodation as well as food and household items, power, water and other utility services and room temperature control expenses that are incurred when living in a supported accommodation facility.

Guidelines

The Agent can pay for supported accommodation when a worker has:

• sustained a work-related injury or illness which precludes them from returning to their pre-accident/preinjury or illness accommodation; and
• been assessed by an appropriate therapist and/or multidisciplinary team as requiring supported accommodation services or by an Aged Care Assessment Team (ACAT) as requiring care and supported accommodation in an Aged Care Facility/Nursing Home/Hostel

Shared Supported Accommodation (SSA)

This section of the policy communicates expectations of the delivery of SSA services. It has been created to reduce risk and ensure compliance with WorkSafe legislative requirements. The setting, ongoing review and maintenance of expectations contained within this policy will promote consistency, efficiency and transparency across the delivery of services.

This section of the policy should be read in conjunction with the Attendant Care Policy which provides information about WorkSafe expectations for the delivery of care to injured workers who live in a private home. This care is paid for as part of a 24 hour shared care model in an SSA facility.

What the Agent can pay for in relation to SSA services

The Agent can pay the reasonable costs of care in SSA in accordance with WorkSafe's fee arrangements with residential care providers. WorkSafe pays for SSA services to be provided as a 24 hour shared care model. This means that the SSA provider must have an appropriate level of staffing to ensure the care required by the worker can be delivered across the full 24 hour period.

The Agent will consider paying for clinically justified specialist equipment in a SSA facility for specific use by a particular worker with the consent of the owner of the facility. Such equipment must be prescribed by a treating health professional and pre-approved by the Agent.

It is expected that all SSA facilities will comply with local planning regulations by providing an appropriate and safe level of access for workers.

The SSA provider can charge the following for a worker:

Daily Fee (Daily Bed fee)

The Agent can pay a Daily Fee specified for a worker in a SSA residence. The Daily Fee covers the costs of providing the shared care services to the worker over the 24 hour period. It is expected that the Daily Fee will be sufficient to cater for the worker’s support needs within a shared care model. The Daily Fee includes, but is not limited to, the following irrespective of frequency:

• personal care, showering, bathing, dressing, grooming
• toileting, bladder and bowel care
• daily stretches, walking program (as directed by the recommending health professional)
• meals/feeding/PEG feeds
• participation in domestic activities such as meal preparation, shopping, laundry
• participation and inclusion in structured activities within the house
• supporting and facilitating a worker's accessing of the community, such as supporting the worker to complete shopping tasks
• assistance with planning and organising of activities, appointments, including assisting the worker to attend regular GP visits
• behavioural management (as directed by the recommending health professional)
• monitoring and administering medication
• fitting and using aids, orthotics and appliances, hearing and communication devices
• OHS requirements for transfers and mobility

SSA providers must ensure they are willing and able to meet the worker's support needs within the Daily Fee before agreeing to accept a referral and that the required level of care is provided routinely on an as needs and ongoing basis.

Daily Living Expenses (DLE)

A worker's expenses associated with accommodation including rent, food and household items, power, water and other utility services. The worker may be required to contribute to their DLE. For more information on Daily Living Expenses see the Daily Living Expenses policy.

Staff Training

The Agent can pay the reasonable costs for an allied health or other medical professional to provide worker specific training to SSA staff. This is paid according to the fee schedule for the relevant health professional. The Agent will not pay for SSA staff to be trained according to the WorkSafe minimum requirements. These costs are the responsibility of the SSA provider.

Who can provide SSA services?

SSA services can only be provided by a WorkSafe authorised/approved and registered provider. Refer to the list of registered SSA providers on the website. Supported accommodation services must be approved by the Agent in writing before the worker takes up residency.

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

The minimum requirements for staff providing care to workers in an SSA are demonstrated competency in areas relevant to the needs of workers including:

• CPR
• first aid
• food safety
• anaphylaxis
• manual lifting, and
• infection control

Staff must also complete a worker specific training program where required as a result of a worker's specialised support needs. WorkSafe registered providers must have and use:

• A complaints process and notify WorkSafe within 48 hours days of receiving a WorkSafe worker complaint. The provider must also notify WorkSafe if they cannot resolve a worker or other stakeholder complaint within 14 calendar days from the date the complaint was made.
• A fully documented Incident Reporting Procedure categorised by severity. The provider must notify WorkSafe of all serious incidents involving workers before the end of the business day after the serious incident occurs.

What information the Agent needs to consider paying for SSA services

Prior approval in writing is required for all workers. Injured workers part of the Community Integration Program may have the request and approval of SSA incorporated into the independence planning process. The Agent requires an initial request for SSA services from the worker or the worker’s family, treating medical practitioner or health professional.

The Agent may request completion of one of the following reports from an appropriately qualified therapist/treating team before deciding whether to pay for SSA services:

• Functional Independence Assessment (FIA)
• Functional Independence Review (FIR)
• Residential Functional Independence Review (Residential FIR)

Letters of recommendation from relevant treating health professionals will also be considered.

Supported Residential Services (SRS)

What the Agent can pay for in relation to SRS

The Agent can pay the reasonable costs of care in SRS accommodation in accordance with the WorkSafe fee arrangements with the individual residential care provider. The Agent will consider paying for specific equipment in a SRS for use by a particular worker with the consent of the owner of the facility. It is expected that all SRS facilities comply with the relevant supported accommodation residence requirements.

Who can provide SRS

SRSs are granted a certificate by the DoH allowing them to provide accommodation services under the Supported Residential Services (Private Proprietors) Act 2010. SRS providers must meet the supported accommodation criteria listed above and:

• employ a qualified personal care coordinator who coordinates care for all residents
• provide at least one staff member for every 30 residents
• allow for extra staff to provide adequate levels of care for residents, and
• provide sufficient staff (at least one) on site overnight to ensure the safety of residents and respond to their needs

What information the Agent needs to consider paying for SRS

Prior written approval from the Agent is required before the worker can reside in a SRS. The Agent requires an initial request for SRS from the worker or the worker’s family, treating medical practitioner or health professional.

The Agent may request completion of one of the following reports from an appropriately qualified therapist/treating team before deciding whether to pay for SRS:

• Functional Independence Assessment (FIA)
• Functional Independence Review (FIR)
• Residential Functional Independence Review (Residential FIR)

Letters of recommendation from relevant treating providers will also be considered.

The Agent will ask the proposed SRS provider for information about their services and fees before deciding whether the service can be approved for the worker.

The Supported Residential Services (Private Providers) Act 2010 requires a SRS provider to enter into a written residential and services agreement with a resident about the items, services and fees applicable to the SRS. A copy of this agreement must be provided to the Agent.

What fees are payable for supported residential services

The Agent can pay the reasonable costs of SRS fees and charges as specified in the residential and services agreement between the owner of the facility and the worker.

These fees and charges include the DLE component associated with accommodation including rent, food and household items, power, water and other utility services. The worker may be required to contribute to their DLE.

Residential Aged Care (RAC)

What the Agent can pay for in relation to RAC

The Agent can pay the reasonable costs of a workers Residential Aged Care (RAC) accommodation.

Who can provide RAC

RAC must be approved by the DoH and also be accredited by the Aged Care Standards and Accreditation Agency. A worker must be assessed by an Aged Care Assessment Team (ACAT) as eligible to receive that type of care for the approved provider to be eligible to receive subsidies.

Contact the Commonwealth Respite and Carelink Centre on Freecall 1800 052 222 for information about aged care homes in your area.

What information the Agent requires to consider paying for RAC

Prior written approval from the Agent is required before the worker can reside in RAC.

That Agent requires an initial request for RAC from the worker or the worker’s family, treating medical practitioner or health professional.

The Agent will require a completed:

• ACAT assessment before a worker can enter RAC, and
• an Aged Care Funding Instrument (ACFI) before the Agent will pay for services

What fees are payable for RAC

The fees are determined once the RAC facility assesses the resident’s care requirements and submits an ACFI to the DoH. The DoH calculates the fee subsidies in accordance with the ACFI form which would normally be paid for by the DoH. The fee subsidies will be paid directly to the facility by the Agent if it has accepted liability for the worker’s care and support at a RAC facility.

WorkSafe does not have control over the calculation of the subsidies for workers in RAC facilities. All care fees and supplements will be paid at the levels prescribed by the DoH and listed in the Residential Care Manual as applicable to the particular facility and care level.

The Agent must be provided with a copy of the ACFI letter from the DoH sent to the RAC facility setting out the fee subsidies applicable to the worker. It is the RAC facility’s responsibility to contact the DoH to have the subsidies reviewed if it does not agree with them.

Information on fees, subsidies, supplements and indexation

A resident may be eligible for Government assistance with the costs of their accommodation. An assets assessment will be undertaken to test a person's eligibility for assistance. Centrelink and the Department of Veterans Affairs (DVA) undertake assets testing of new residents entering residential care facilities. A person requiring an assets assessment will need to complete a Request for an Assets Assessment form and submit it to Centrelink or the DVA (in the case of veterans).The Request for an Assets Assessment form is distributed by ACATs. Call the Aged Care Information Line on 1800 500 853 for more information.

Fees and charges will be as advised by the DoH and agreed to by WorkSafe.

The Agent will pay the residential care subsidies as assessed by DoH.

Residential Care Entry Package

Workers and their families may obtain a Residential Care Entry Pack which provides an application form and information booklet about applying for a place in an aged care home. The application form can be downloaded and instructions for printing can be found at the DoH website.

Please be aware that responsibility for aged care and ageing recently moved to the DoH. Ageing and aged care content on the DoH website will be progressively published.

Supported Accommodation Services

When will I receive a response from the Agent?

The Agent will advise within 10 working days of receiving the written service request 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.

A supported accommodation services request may be reviewed by a WorkSafe Medical Advisor to assist the Agent to make a decision on a request for supported accommodation services. The Medical Advisor may contact the requesting health professional or supported accommodation service provider to seek further information and/or discuss the proposed services before making a recommendation to the Agent about the request. The Agent will respond to the request after they have received the Medical Advisor's recommendation.

In relation to supported accommodation services, what the Agent can't pay for

• supported accommodation services for a person other than the injured worker
• supported accommodation services for a condition that existed before a work-related injury or illness or that is not as a direct result of a work-related injury or illness
• supported accommodation services that are not consistent with the level of care that a worker requires as a result of their work-related injury or illness
• related costs such as rent, accommodation bonds and rates
• room temperature controls/air-conditioning, unless deemed medically necessary and approved as reasonable by the Agent
• capital expenses, such as periodic payments in Residential Aged Care (RAC) facilities
• extra services (i.e. laundry, dry-cleaning, hairdressing)
• care provided to a worker in the worker's private home
• care provided in hospital
• additional attendant care services for the facilitation of community access and participation where prior approval has not been given by the Agent
• supported accommodation services provided outside the Commonwealth of Australia without prior written approval from WorkSafe