Daily Living Expenses

POLICY

The TAC can, for a specified period, pay or reimburse the reasonable costs of daily living expenses where a client is required to reside in a supported accommodation facility as a direct result of a transport accident injury under section 60 of the Transport Accident Act 1986 (the Act).

After this time, the client 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 Act, a client who is required to make a contribution towards their daily living expenses cannot be required to pay more than the capped amount when residing in a shared supported accommodation (SSA) or a supported residential service (SRS) facility. Clients residing in a residential aged care (RAC) facility are not required to contribute more than $10 to their daily living expenses.

The purpose of these capped amounts is to keep supported accommodation services affordable by ensuring clients 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
  • Residential aged care (RAC) facility
  • Supported residential service (SRS)
  • 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.

Please note that:

• the Supported Accommodation Services policy was previously known as the Residential Care policy
• a shared supported accommodation (SSA) service was previously known as a community group home or a shared group home
• a residential aged care (RAC) facility was previously known as an aged care facility or nursing home or hostel
• a group home was previously known as a Community Residential Unit (CRU).

• Capped amount refers to the maximum amount a client can be charged per day as a contribution towards their daily living expenses whilst residing in a supported accommodation facility. The capped amount for shared supported accommodation (SSA) or supported residential service (SRS) facilities may be indexed by CPI each financial year.
• First discharged from hospital is when a client is discharged from an acute or rehabilitation hospital for the first time after the transport accident injury

GUIDELINES

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

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

• the the first 18 months after a client is first discharged from hospital where, due to a transport accident injury, the client is residing in a supported accommodation facility
• a client who is under 18 years of age and who, due to a transport accident injury, is residing in a supported accommodation facility
• a client receiving respite services due to a transport accident injury. Refer to the Respite Services policy.

When the client is absent from a supported accommodation facility due to a hospital admission directly related to their transport accident injury, the period where the TAC is liable to pay the reasonable costs of daily living expenses without requiring a client 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 TAC is liable to pay the reasonable costs of daily living expenses without requiring a client contribution has elapsed, the client 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 Shared Supported Accommodation services (SSA) are included in a set fee charged by the SSA service provider.

The fee for daily living expenses for Supported Residential Services (SRS) are set by each SRS facility and can vary from provider to provider.

a. During the non client contribution period i.e. within 18 months of hospital discharge For the period where the TAC is liable to pay the reasonable costs of daily living expenses without requiring a client contribution, the SSA service provider is entitled to claim payment from the TAC for the reasonable costs of daily living expenses.

For example, during the first 18-month period following the date the client is first discharged from hospital, if the daily living expenses were determined by the SSA or SRS provider at $36.05 per day and the TAC accepts that this is a reasonable amount, then the TAC pays $36.05 per day to the SSA or SRS provider.

b. After the non client contribution period has elapsed i.e. 18 months after hospital discharge and beyond Where the period the TAC is liable to pay the reasonable costs of daily living expenses without any client contribution has elapsed, the client is responsible for paying for daily living expenses up to the capped amount.

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

For example, after the first 18 months following the date the client is first discharged from hospital, if the daily living expenses were determined by the SSA/SRS provider at $36.05 per day, and the current capped amount is $35.00 (as of 1 July 2017) then:

• the client pays $35.00 per day to the SSA/SRS provider
• the TAC can pay the reasonable costs of the balance of the daily living expenses at $1.05 per day to the SSA/SRS provider.

2. Residential Aged Care

The fee for daily living expenses for residential aged care (RAC) is determined by the Department of Health and Ageing (DoHA). For RAC facilities, the TAC has capped the client contribution for daily living expenses at $10 per day. The TAC is liable to pay to the RAC facility the reasonable costs of any daily living expenses above the client's capped contribution of $10 per day.

For more information see http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-finance-resfees.htm.

a. During the non client contribution period i.e. within 18 months of hospital discharge For the period where the TAC is liable to pay the reasonable costs of daily living expenses without any client contribution, the service provider is entitled to claim payment from the TAC of the amount determined by DoHA.

For example, during the first 18 months following the date the client is first discharged from hospital, if the daily living expenses are determined as $32.05 per day, then the TAC pays $32.05 per day to the RAC provider.

b. After the non client contribution period has elapsed i.e. 18 months after hospital discharge and beyond Where the period the TAC is liable to pay the reasonable costs of daily living expenses without any client contribution has elapsed, the client is responsible for paying $10 per day towards the cost of the daily living expenses fee to the RAC facility.

For example, after the first 18 months following the date the client is first discharged from hospital, if the daily living expenses are determined as $32.05 per day, then:

• the client pays $10.00 per day to the RAC facility provider
• the TAC can pay the reasonable costs of the balance of $22.05 per day to the RAC provider.

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

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

The TAC will not pay daily living expenses for:

• a person other than the client
• a service that is not consistent with the level of care that a client requires as a result of their transport accident injury
• when a client is absent from a facility for non transport accident injury reasons
• a client residing in privately rented accommodation
• services subcontracted to, or provided by, a non-registered provider
• services provided outside the Commonwealth of Australia
• treatment or services provided by telephone or other non face to face mediums
• the cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
• services provided more than two years prior to the request for funding except where the request for payment is made within three years of the transport accident. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.