1.1 This Part applies in relation to services referred to in section 4(1) of the Act.
1.2 The LSA recognises that there are benefits to participants being offered services in the community. The assistance of funded support staff may enable a participant to achieve and maintain health and wellbeing, enhance quality of life and provide opportunities to participate and contribute to social and economic life, respecting the abilities and the capacity of the individual.
1.3 These supports can also have the effect of providing participants and their families with respite.
1.4 The LSA will only pay for the necessary and reasonable expenses of support, attendant care and domestic services to meet the participant’s assessed treatment, care and support needs.
1.5 The LSA may issue guidelines regarding the appropriate level of support, attendant care and/or domestic services for different injury types and publish these on the LSA’s website. Where such guidelines are published, the LSA will use these as a guide to assessing necessary and reasonable levels of service.
2.1 Support services are those that are necessary and reasonable to enable participation in the community including (but not limited to):
2.1.1 assistance with cognitive tasks of daily living such as communication, orientation, planning and task completion;
2.1.2 community access;
2.1.3 selecting and planning activities;
2.1.4 establishing informal networks to reduce the need for formal (paid) services when engaging in activities;
2.1.5 caring for dependents; and
2.1.6 attending rehabilitation or medical appointments.
2.2 Some support services may be appropriately delivered by assistance dogs used to reduce reliance on human caregivers and to overcome social isolation.
2.3 The LSA's assessment of whether support services are necessary and reasonable takes into account the participant’s abilities, care needs and pre-injury participation in the community. The participant’s Discharge Plan or MyPlan will also be considered when approving services to be provided.
3.1 Attendant care services are those that are necessary and reasonable to maintain health and wellbeing including (but not limited to):
3.1.1 personal care (assistance to move around and take care of basic personal needs such as bathing, dressing, eating, toileting, grooming, fitting and use of aids and appliances, fitting and use of hearing and communication devices); and
3.1.2 therapy support to implement a therapy program under the guidance and supervision of a health professional.
3.2 Attendant care services may be provided when the participant is on day leave or weekend leave while an inpatient in hospital or a rehabilitation facility.
3.3 Factors impacting upon whether attendant care services are necessary and reasonable include the degree to which attendant care:
3.3.1 facilitates participation in valued roles;
3.3.2 is the appropriate service for the participant’s age and circumstances (when compared with alternatives to meet the participant’s care needs);
3.3.3 facilitates development of functional skills and roles;
3.3.4 balances participant safety, dignity of risk and learning;
3.3.5 reduces or eliminates the risk of harm to the participant or others; and/or
3.3.6 is the least restrictive response to meet the participant’s injury related needs.
3.4 Where a pre-existing injury or condition is exacerbated by the motor vehicle injury, the LSA will only pay for the additional services required as a result of the motor vehicle accident.
3.5 Attendant care services will not be provided in an unsafe environment or if the attendant care worker is placed at risk of harm.
For example lifting a participant where this has been assessed as a manual handling risk.
4.1 The LSA does not pay for:
4.1.1 services for an injury, condition or circumstance that existed before the motor vehicle accident or that are not a result of the motor vehicle accident;
5.1 Domestic services are those that are necessary and reasonable to assist the participant with a variety of household services, including (but not limited to):
5.1.1 meal preparation and associated tasks;
5.1.2 cleaning, ironing and similar tasks involved in the everyday operation and maintenance of a household;
5.1.3 routine home maintenance for the purposes of upkeep, that would usually have been undertaken by the participant (provided the participant is no longer able to carry out such maintenance as a result of the motor vehicle accident);
5.1.4 home maintenance to ensure safe and easy access; and
5.1.5 gardening where necessary to ensure safe and easy access – this will usually occur no more frequently than monthly.
5.2 The LSA's assessment of whether domestic services are necessary and reasonable will take into account what normal household tasks it is reasonable to expect other co-residents of the household to perform.
5.3 The LSA may consider paying the necessary and reasonable expenses of support or domestic services in place of some attendant care services in order to allow a domestic partner or family member to meet a care need that is related to the motor vehicle injury. This will only be considered where the arrangement does not result in any increase in the total hours of support needed.
6.1 The LSA will not pay to effect ordinary household repairs.
For example, painting, fence repairs or plumbing.
7.1 Decisions as to the provision of support, attendant care and domestic services for a child participant will be made with reference to:
7.1.1 the care needs of a typically developing child at the same age; and
7.1.2 the extent to which additional care needs are a result of the accident.
7.2 Services provided for children do not replace the usual care and supervision provided by a parent or paid for by a parent, such as babysitters, nannies, child care costs and out of school hours care and vacation care.
7.3 The role of an attendant care worker is to provide care services to the child participant and not to provide direct care or supervision to other family members such as the participant’s siblings or other children.
7.4 In the case of children, the LSA may consider paying the necessary and reasonable expenses of support or domestic services in place of attendant care services in order to allow the parent/guardian/family member to meet a care need that is related to the motor vehicle injury.
For example, when a child participant with behavioural needs, due to cognitive impairment, requires additional supervision beyond that which would be developmentally and behaviourally appropriate given the child’s age, support or domestic services may be provided in place of attendant care to allow a parent/guardian/family member to supervise the participant more closely than would be required given the child’s age. Alternatively, in the same situation, child-minding for the participant’s siblings may be provided in place of attendant care to allow the parent/guardian/family member to provide one-on-one supervision to the participant.
7.5 Documentation of the support or attendant care needs of a child participant, for tasks ordinarily provided by a parent/guardian/family member as part of their parental responsibilities, must include a description of why the assessed care needs of the child participant require the assistance of a support or attendant care worker.
For example, a ten year-old participant who was previously supervised to walk to and from school by an older sibling, now requires the assistance of an attendant care worker due to cognitive and behavioural issues from the motor vehicle injury, because there is an increased need for supervision that is beyond the capabilities of the participant’s sibling.
7.6 The presence of a support or attendant care worker to meet care needs related to the motor vehicle injury does not replace parental responsibility to supervise and provide non-injury related care to the child participant.
8.1 The LSA may pay the necessary and reasonable expenses for support and attendant care services for participants with caring responsibilities for the purpose of assisting the participant to perform their role as a parent or caregiver when the need for this assistance is related to the motor vehicle injury. These services will only be provided for those caring roles where the participant lived with and provided care to an immediate family member before the motor vehicle accident and who continues to live with the participant at the time of the service.
8.2 Support and attendant care services for participants who have caring responsibilities will not be considered necessary and reasonable, if a suitable alternative, age appropriate caring option is available.
8.3 The LSA's assessment will also take into account what standard caring/child care tasks it is reasonable to expect other co-residents of the household to perform.
8.4 Payment of support and attendant care service expenses aims to assist the participant’s autonomy and support them in their role as a parent and/or caregiver. The role of the support or attendant care worker is to provide services to the participant. The presence of worker for care needs related to the motor vehicle injury cannot replace parental or caregiver responsibility.
For example, an attendant care worker may assist a participant to travel with their children to and from school, but is not solely responsible for taking the children to and from school.
8.5 The LSA may set limits on the provision of these services and will make these available on the LSA website.
9.1 The LSA will consider paying necessary and reasonable expenses of alternatives to support and attendant care services such as school holiday programs, child care and community-based groups or community access programs. This will be considered when such alternatives are age appropriate, provide suitable support and are assessed as a cost-effective alternative to meet the participant’s treatment, care and support needs.
9.2 The LSA will not pay for everyday activity costs that are not related to the participant’s treatment, care and support needs.
For example, swimming, music, gymnastics, ballet, drama.
10.1 The LSA recognises that family members often want to assist participants with personal care in addition to paid care providers, and that training may be beneficial to fully understand the care required and provide the most appropriate assistance and care, particularly where equipment, medical aids or manual handling may be required.
10.2 The LSA will pay for training of immediate family members or people who live with the participant if, in the opinion of the LSA, the training will assist the participant and family to achieve greater independence and/or cohesion and it represents a cost effective option.
10.3 When deciding whether it is necessary and reasonable to pay for training in care provision to family members or people who live with the participant, the LSA will consider:
10.3.1 whether the training has been recommended by an appropriately qualified health or disability professional;
10.3.2 the preference of the participant for their care arrangements;
10.3.3 whether training has been provided before to the participant’s carers;
10.3.4 the cost of training and whether it will lead to greater independence and/or cohesion for the family unit;
10.3.5 the risks associated with the proposed care provision; and/or
10.3.6 the availability of suitable training.
10.4 The LSA will not pay family members or others living with the participant to provide care services except in accordance with Part 8 of these Rules.
11.1 The LSA will pay the necessary and reasonable expenses of support and attendant care services for a participant when away from home.
For example, when on holiday or away from their usual place of residence.
This does not include nursing, support or attendant care services while the participant is in hospital or inpatient rehabilitation.
11.2 The LSA will consider paying necessary and reasonable expenses for support and attendant care services when the participant is away from home, additional to a participant’s existing services in the following circumstances:
11.2.1 when continuity of support or attendant care is required, that is, when it can be demonstrated that a change would cause secondary care complications, behavioural complications, or may increase the need for care;
11.2.2 when the participant requires support and attendant care services to travel to and from their destination beyond that provided by airlines, boat, bus or rail systems; or
11.2.3 when there is an additional need for support or attendant care services or a change to service delivery when away from home because of the participant’s level of function, accommodation environment, unfamiliar surroundings, unfamiliar routine or need to access additional equipment.
11.3 The LSA may require additional documentation of the care needs of the participant, in order to assess their needs for attendant care when they are away from home, in the following circumstances when:
11.3.1 additional support and attendant care hours are being requested for the duration of the participant's absence;
11.3.2 the participant will use a different support and attendant care provider from the one engaged to provide their regular attendant care; or
11.3.3 attendant care worker travel or accommodation expenses re being requested.
11.4 The LSA will pay the necessary and reasonable expenses of hire of equipment required for support and attendant care service provision, such as a hoist or shower commode, where it is not practical or reasonable to transport equipment from the participant's home to their destination.
11.5 The LSA will pay reasonable expenses of any additional cost for recreational equipment hire that is required as a result of the motor vehicle injury.
12.1 Attendant care while away from home does not include, without limitation:
12.1.1 expenses for recreational activities or recreational equipment, while the participant is away from home;
12.1.2 expenses for the participant’s entry to tourist attractions or any other participation in activities relating to a holiday;
12.1.3 a participant’s personal holiday expenses such as travel, meals and accommodation;
12.1.4 support or attendant care worker’s travel expenses to accompany a participant to and from their destination, where a participant is assessed as being able to travel without a support or attendant care worker present and with the support provided by airlines, boat, bus or rail systems;
12.1.5 any participant travel expenses such as air, rail, bus or boat fares;
12.1.6 costs associated with international travel such as immunisation, passports or visas for the participant;
12.1.7 attendant care assistance for any tasks other than to meet an assessed care need; or
12.1.8 travel insurance or any other expenses associated with changes to travel plans for the participant.