We’re here to help you get your life back on track after your transport accident. If you or a family member has multiple physical, sensory and cognitive disabilities as a result of a transport accident, which makes it difficult to live independently, we can pay for assisted living accommodation in Australia.
If you have enough support to live at home, we can also pay for short term stays in assisted accommodation, to allow your carers to have a break. This is called respite care.
How can assisted living accommodation help?
People with multiple physical, sensory and cognitive disabilities after an accident may find it too difficult to live independently in their own home or family home. Assisted living accommodation provides a home for them.
Assisted living accommodation includes:
- Shared Supported Accommodation (group home).
- Supported Residential Services.
- Residential Aged Care.
How we approve these services
Assisted living accommodation
Your doctor, occupational therapist or treating team will let us know that because of your severe injuries you may need assisted living accommodation.
Your needs will be assessed to work out the level and type of assistance you need and the type of supported living arrangement you will require. We will work with your treating team to support you as much as possible.
Residential aged care
If residential aged care is needed, an assessment will be required by an Aged Care Assessment Team. If you need this type of care, appropriate aged care options will be given to you, and you and your family can choose the facility where you will live.
If you need help finding a residential aged care facility we can pay for an approved placement provider, case manager or occupational therapist to help you.
Following your move into supported living, we may contact your assisted living accommodation or treatment team to discuss your progress or request an assessment, to make sure that:
- You have all the appropriate support you need.
- You are getting proven, evidence-based treatment and not receiving treatment that isn't helping you recover.
- You are moving towards getting your life back on track or being able to live independently.
How these services are paid for
We pay for these services:
- Directly to your service provider, when you have provided them with your TAC claim number, or
- If you have to pay, use myTAC to send us a copy of your receipt and we will repay you.
To get the best health outcome for you, we will only ever pay for:
- Services that are conducted in a safe and effective manner by a properly qualified provider. This means that your treatment and supports need to be supported by clinical research. We require National Health and Medical Research Council Level 1 or 2 evidence that any proposed treatment or service will be safe and effective.
- Services provided to you that demonstrate continued progress towards achieving your independence goals.
We pay for your services in line with our responsibilities under the Transport Accident Act 1986.
How much we will pay
The fees paid to assisted living accommodation facilities will vary depending upon the type of assisted living accommodation facility you need.
The three main types of accommodation are:
- Supported residential services.
- Shared supported accommodation.
- Residential aged care facilities.
Supported residential services
These are privately owned facilities that are registered with the Department of Health and Human Services (Vic). They provide services that meet the criteria for their registration. We will pay in line with the residential and services agreement between us, you or your family member and the owner of the facility.
Shared supported accommodation
These facilities provide a 24 hour shared care model which includes personal care, nursing, rehabilitation, housekeeping, meals and laundry services. We pay the cost of the following, up to an agreed amount:
- Daily fee
- Daily accommodation payment (also known as the basic daily fee, daily care fee, daily living expenses)
- Residential program establishment fee
- Attendant care for support needs above the level of support provided under the 24-hour shared support. This attendant care needs to be approved by the TAC and based on clinical recommendations by a health professional. For example, if you need occasional one to one attendant care.
Under the Transport Accident Act 1986, from 18 months after your discharge from hospital you will be required to pay a daily contribution towards the cost of your daily accommodation payment. Your required contribution will be published in the TAC's Benefits Schedule, which is updated every year in July.
Residential aged care
We will directly pay the facility for the cost of the services and accommodation in line with the fees determined by the Commonwealth Government Department of Social Services. An Aged Care Assessment Team will assess your needs in the facility and conduct an assessment that determines the Aged Care Funding Instrument (ACFI). This ACFI makes up the Residential Care Subsidy along with any care supplements that might be required.
The Commonwealth Government will also determine whether the Residential Care Subsidy is minimised by charging a means tested care fee based upon an assessment of your income and assets. If it applies to you, we can pay this fee. To assess this, you may need to complete an income and assets test provided by Centrelink.
Under the Transport Accident Act 1986, from 18 months after your discharge from hospital you will be required to pay a daily contribution of $10 towards the cost of your daily accommodation payment.
We will pay all fees required for Residential Aged Care in line with the Schedule of Fees for Residential and Home Care. The services and care that you or your family member should receive in a Residential Aged Care facility should be aligned to those in Quality of Care Principles 2014.
What we won’t pay for
We can’t pay for services that:
- Do not treat, or are not related to, your transport accident injuries.
- Are not reasonable, necessary or appropriate.
- Are not clinically justified, safe and effective.
We also can’t pay for incidental items that may be provided to you as part of your stay. This includes upgrading a standard room type and other services you might request where there is no clinical need for the request that relates to your transport accident injuries.
Under the Transport Accident Act 1986 we cannot pay the cost of any accommodation bond, interest that would have been earned on an accommodation bond or council rates associated with admission into, or continued living in, an assisted accommodation facility.
If you are a provider of assisted accommodation, see our TAC Provider Guidelines for circumstances in which you can provide services to our clients.