• 1.1This Part applies in relation to services referred to in subsection 4(1) of the Act.
  • 1.2The 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.
  • 1.3These supports can also have the effect of providing Participants and their families with respite.
  • 1.4The LSA will only pay for the necessary and reasonable expenses of support, attendant care and Domestic Services to meet the Participant’s assessed TCS needs.
  • 1.5The LSA may issue guidelines regarding the appropriate level of support, attendant care 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.

  • 2.1Support Services are those that are necessary and reasonable to enable participation in the community including (but not limited to):
    • 2.1.1assistance with cognitive tasks of daily living (such as communication, orientation, planning and task completion);
    • 2.1.2accessing their community;
    • 2.1.3selecting and planning activities;
    • 2.1.4establishing informal networks to reduce the need for formal (paid) services when engaging in activities;
    • 2.1.5caring for dependents; and
    • 2.1.6attending Rehabilitation or medical appointments.
  • 2.2Some Support Services may be appropriately delivered by assistance dogs used to reduce reliance on human caregivers and to improve and support community participation. Support is provided where the LSA considers it necessary and reasonable, clinically justified, safe and effective.
  • 2.3The LSA's assessment of whether Support Services are necessary and reasonable takes into account the Participant’s goals, 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.

  • 3.1Attendant care services are those that are necessary and reasonable to maintain the Participant’s health and wellbeing including (but not limited to):
    • 3.1.1personal care (assistance to move around and take care of basic personal needs such as bathing, dressing, eating, toileting, grooming, fitting and use of Assistive Technology, fitting and use of hearing and communication devices); and
    • 3.1.2therapy support to implement a therapy program under the guidance and supervision of a health professional.
  • 3.2Attendant care services may be provided when the Participant is on day leave or weekend leave while an inpatient in hospital or a Rehabilitation facility.
  • 3.3Factors impacting upon whether attendant care services are necessary and reasonable include the degree to which attendant care:
    • 3.3.1facilitates participation in valued roles;
    • 3.3.2is the appropriate service after considering the Participant’s age and circumstances (when compared with alternatives to meet the Participant’s care needs);
    • 3.3.3facilitates development of functional skills and roles;
    • 3.3.4balances Participant safety, dignity of risk and learning;
    • 3.3.5reduces or eliminates the risk of harm to the Participant or others;
    • 3.3.6is the least restrictive response to meet the Participant’s injury related needs.
  • 3.4Where 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.
  • 3.5Attendant 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.

  • 4.1Domestic Services are those that are necessary and reasonable to assist the Participant with a variety of household services, including (but not limited to):
    • 4.1.1meal preparation and associated tasks;
    • 4.1.2cleaning, ironing and similar tasks involved in the everyday operation and maintenance of a household;
    • 4.1.3routine 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);
    • 4.1.4home maintenance to ensure safe and easy access; and
    • 4.1.5gardening where necessary to ensure safe and easy access for a Standard Property – this should occur no more frequently than monthly and be for no longer than four hours each month. The LSA may consider funding additional gardening services in limited circumstances.
  • 4.2The LSA's assessment of whether Domestic Services are necessary and reasonable will take into account:
    • 4.2.1what household tasks the Participant or co-residents of the household were undertaking or funding prior to the Motor Vehicle Accident; and
    • 4.2.2what normal household tasks it is reasonable to expect other co-residents of the household to perform; and
    • 4.2.3what supports the Participant or co-residents of the household can access through Local, State or Commonwealth Government services; and
    • 4.2.4the size of the property, noting that the LSA would consider household tasks for a Standard Property to be necessary and reasonable; and
    • 4.2.5time since the Motor Vehicle Injury; and
    • 4.2.6the impact of previous and subsequent injuries, ageing, other disabilities or co-morbidities.
  • 4.3The LSA may consider funding additional Domestic Services in limited circumstances.
  • 4.4In limited circumstances, 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 and the domestic partner or Family member is appropriately trained to provide the relevant care.

  • 5.1Decisions as to the provision of support, attendant care and Domestic Services for a child Participant will be made with reference to:
    • 5.1.1the care needs of a typically developing child at the same age;
    • 5.1.2the normal care tasks it is reasonable to expect Family members or legal guardian to perform; and
    • 5.1.3the extent to which additional care needs are a result of the Motor Vehicle Accident.
  • 5.2Services provided for children do not include the cost associated with the usual age or developmentally appropriate 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, including vacation care. Usual care is deemed to be the care that child of the same age who had not sustained the Motor Vehicle Injury would require. The Scheme will fund services for children that are necessary and reasonable, and related to the Motor Vehicle Injury.
  • 5.3The 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.
  • 5.4In 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/ legal 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/ legal 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/ legal guardian/ Family member to provide one-on-one supervision to the Participant.

  • 5.5Documentation of the support or attendant care needs of a child Participant, for tasks ordinarily provided by a parent/ legal 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.

  • 5.6The 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.

  • 6.1The LSA may pay the necessary and reasonable expenses for the Participant to receive such support and attendant care services, as will enable the Participant to perform activities associated with caring responsibilities, in the following circumstances:
    • 6.1.1The Participant provided the care before sustaining the Motor Vehicle Injury; and
    • 6.1.2The person to whom the Participant provided the care was an immediate Family member who:
      • 6.1.2.1lived with the Participant before the Motor Vehicle Injury; and
      • 6.1.2.2still lives with the Participant; and
      • 6.1.2.3No Commonwealth, State or Local Government scheme would provide the same or substantially the same care to the immediate Family member if they applied for it or if someone applied for it on their behalf.

Editorial Notes –

The purpose of paying the Participant to receive support and attendant care services is to enhance their autonomy and support them in their pre-existing role as a parent or caregiver or both. Services provided to the Participant under the Scheme do not replace the Participant’s 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 the children’s general care and safety.

  • 6.2The LSA will not pay for the Participant’s caring responsibilities to be performed by another person or service provider.
  • 6.3Support 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.
  • 6.4The 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.
  • 6.5The LSA may set limits on the provision of these services and will make these available on the LSA website.

  • 7.1Where the LSA is paying for the provision of attendant care to a child Participant, the LSA will consider paying the necessary and reasonable expenses for them to access alternate services such as school holiday programs, child care and community-based groups or community access programs that are:
    • 7.1.1age and developmentally appropriate to the individual child Participant; and
    • 7.1.2provide the individual child Participant with suitable support; and
    • 7.1.3are assessed as a cost-effective alternative to meet the child Participant’s TCS needs.

  • 8.1The LSA recognises that Family members may 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 Assistive Technology, medical aids or manual handling may be required.
  • 8.2The 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 or cohesion and it represents a cost effective option.
  • 8.3When 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:
    • 8.3.1whether the training has been recommended by an Appropriately Qualified health or disability professional;
    • 8.3.2the preference of the Participant or Decision Maker or both, as the case may require, for the Participant’s care arrangements;
    • 8.3.3whether training has been provided before to the Participant’s carers;
    • 8.3.4the cost of training and whether it will lead to greater independence or cohesion for the Family unit;
    • 8.3.5the risks associated with the proposed care provision;
    • 8.3.6the availability of suitable training.

  • 9.1The 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.

  • 9.2The 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:
    • 9.2.1when 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;
    • 9.2.2when 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
    • 9.2.3when 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 Assistive Technology.
  • 9.3The 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:
    • 9.3.1additional support and attendant care hours are being requested for the duration of the Participant's absence;
    • 9.3.2the Participant will use a different support and attendant care provider from the one engaged to provide their regular attendant care; or
    • 9.3.3Attendant Care Worker travel or accommodation expenses are being requested.
  • 9.4The LSA will pay the necessary and reasonable expenses of hire of Assistive Technology required for support and attendant care service provision, such as a hoist or shower commode, where it is not practical or reasonable to transport Assistive Technology from the Participant's home to their destination.
  • 9.5The LSA will pay reasonable expenses of any additional cost for recreational Assistive Technology hire that is required as a result of the Motor Vehicle Injury.

  • 10.1The LSA may fund respite services in limited circumstances:
    • 10.1.1where the Family unit (or equivalent) is providing the equivalent of necessary and reasonable attendant care services that the LSA would have funded for the Participant;
    • 10.1.2the need for respite is planned and is not more than 28 Calendar Days over a 12 month period;
    • 10.1.3the respite period is short term and for no longer than 14 Calendar Days at any one time; and
    • 10.1.4the respite is assessed as supporting the continuing sustainability of the Family unit or usual living arrangements where the Participant lives.
  • 10.2The LSA may fund respite services in emergency circumstances if respite was not reasonably able to be planned.

For example, the family member providing the equivalent of necessary and reasonable attendant care services is unexpectedly hospitalised.

  • 11.1Attendant care while away from home does not include, without limitation:
    • 11.1.1nursing, support or attendant care services while a Participant is in hospital or inpatient Rehabilitation;
    • 11.1.2expenses for recreational activities or recreational Assistive Technology, while the Participant is away from home;
    • 11.1.3expenses for the Participant’s entry to tourist attractions or any other participation in activities relating to a holiday;
    • 11.1.4a Participant’s personal holiday expenses such as travel, meals and accommodation;
    • 11.1.5support 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;
    • 11.1.6any Participant travel expenses such as air, rail, bus or boat fares;
    • 11.1.7costs associated with international travel such as immunisation, passports or visas for the Participant;
    • 11.1.8attendant care assistance for any tasks other than to meet an Assessed Care Need; or
    • 11.1.9travel insurance or any other expenses associated with changes to travel plans for the Participant.
  • 11.2In relation to attendant care services in general, the LSA does not pay for:
    • 11.2.1services for an injury, condition or circumstance that existed before, or subsequent to, the Motor Vehicle Accident or that are not a result of the Motor Vehicle Accident;
    • 11.2.2services for other members of the Participant’s Family or household;
    • 11.2.3travel expenses for the Attendant Care Workers except to and from approved TCS services;
    • 11.2.4services that replace parental responsibilities, such as the supervision of a young child;
    • 11.2.5others living with the Participant, family members or legal guardians to provide care services.
  • 11.3In relation to Domestic Services, the LSA will not pay:
    • 11.3.1to undertake ordinary household repairs.

For example, painting, fence repairs or plumbing.

    • 11.3.2to undertake maintenance outside what would be expected for a Standard Property.

For example, pool cleaning and maintenance, heavy pruning outside of access and safety needs, maintenance of a large property or house.

  • 11.3.3a Participant’s domestic partner or Family members to provide services to the Participant.
    • 11.4The LSA will not pay for:
      • 11.4.1everyday activity costs that are not related to the Participant’s TCS needs.
      • 11.4.2supports that are, in the course of ordinary circumstances, paid for by State and Commonwealth Governments (or other jurisdictions/ schemes) as benefits available to the community (wholly or in part) for ageing or injuries/ disabilities and the Participant remains eligible.

Page last updated: 16 September 2022