These facilities are shared accommodation settings in which a 24-hour shared model of support is provided to residents by an Attendant Care provider.

Shared support is where support and/or supervision is safely provided to a number of residents at the same time, either individually or in a small group, where a client can be safely left during an activity to enable a support worker to attend to another client.

These supports can include personal care and support, engaging residents in day to day activities, assistance with medication, behavioural support (if required) and completing exercises/rehabilitation as recommended by a health professional.

To be considered for approval, a client’s need for shared supported accommodation must be:

• Directly related to their transport accident, and
• Due to the severity of the injuries/ impairment and the resultant need for high levels of care and/or accessible living environment.
• The requested accommodation must be registered with the TAC and the appropriate government regulator as applicable.

The TAC will pay the cost of the following shared supported accommodation items, up to an agreed amount:

• Daily Support Fee
• Attendant Care in addition to support provided under the Daily Support Fee
• DLE gap payment at 18 months post initial discharge from hospital
• Holding Fee for planned leave
• Program Establishment Fee for new residents
• Daily Living Expenses (DLE)

Fees payable by the client for SSA are:

• Under the Transport Accident Act 1986, from 18 months after their discharge from hospital clients over the age of 18 years will be required to pay a daily contribution towards the cost of their Daily Living Expenses (DLE).
• Extra service fees for upgrades or non-standard inclusions, for example paid TV services.

Daily Support Fee

The TAC can pay a Daily Support Fee (previously referred to as Daily Bed Fee) for a TAC client living in a shared accommodation support setting. This fee covers the provision of assistance and/or supervision with daily tasks within the shared support model.

The shared support is provided to each client living in the home in accordance with their individual needs, with the staffing for support provision being available over a 24-hour period. Support provided must be person centred, focussing on maximising the client’s capacity to be as independent as possible and enabling engagement in valued life roles wherever possible.

The Daily Support Fee (DSF) rate has been calculated based upon a staffing roster allowing 20 hours daytime support provision (includes 4 extra hours per day to account for busy times) and 8 hours of inactive (sleepover) overnight care. Note that the inactive overnight shift is inclusive of 1 hour of active support, in line with the TAC Attendant Care policy.

Fee modelling is based on the current TAC Attendant Care hourly rates, factoring in weekend and public holidays. For the current Daily Support Fee rate please refer to the Shared Supported Accommodation fees.

Determining what support is necessary and can be reasonably provided to a TAC client by the shared care model of a shared supported accommodation property is based upon consideration of:

• A client’s individual needs and goals.
• Recommendations made by the appropriate TAC funded health professionals.
• The TAC’s determination of reasonableness.
• The sharing of support between residents to maximise the efficient use of resources and ensuring the smooth operation of the household.

Active support provision which the TAC expects to be provided under the 24 hour shared support model (and therefore included in the Daily Support Fee) includes (but is not limited to):

• Assistance, supervision or prompting with personal care tasks, showering, bathing, dressing, grooming
• Toileting, bladder and bowel care.
• Maintenance exercise programs, such as daily stretches, walking program (as prescribed by the recommending health professional).
• Assistance or supervision with meals/feeding/PEG feeds
• Actively engaging clients in day to day household activities such as meal preparation and cooking, cleaning, laundry activities, routine development.
• Enabling client participation and inclusion in structured or ad hoc meaningful activities within the home
• Assisting clients with planning and organising of activities and appointments, including attending telehealth appointments
• Implementing and adhering to behavioural support strategies with clients (as directed by the recommending health professional)
• Monitoring and administering medication.
• Support with supervision, prompting, safety and security
• Fitting and using aids, orthotics and appliances, hearing and communication devices
• 8 hour sleepover shift where the support worker can sleep, but is available to respond to client’s personal support needs if required, for example assistance with toileting. Sleepover shifts includes one hour of active support, measured in 2 x 30 minute increments.

Individual attendant care

The TAC may consider paying for individual Attendant Care support when a client’s health professional recommends an additional level of support beyond what can be safely provided within the shared support model. Examples of these situations may include:

• when a client cannot safely be left unsupported for the completion of a task or activity
• when a staffing ratio of higher than 1:1 is required for a set period of time for the safe completion of a task
• where a task or activity consistently requires a support worker for an extended duration, or is of high frequency
• unplanned support requirements (for example client illness resulting in increased support needs for a limited duration, unplanned medical appointments).

Attendant care must be considered reasonable, be clinically justified in writing by the appropriate health professional and be approved by the client’s TAC coordinator. Approval will be for a time-limited period only, following which a further request for appropriate clinical justification may be required by the TAC. The TAC may request copies of staffing rosters from the provider in order to understand where the support needs are not able to be met under the shared care model.

Other fees the TAC can pay for clients living in shared supported accommodation

• Daily Living Expenses (DLE): A client's usual living expenses associated with accommodation including food and household items, power, water and other utility services. DLE is paid in full by the TAC for the first 18 months post client discharge from hospital. After 18 months post hospital discharge the client is expected to pay a contribution towards the DLE which is indexed annually. The TAC may consider paying the SSA support provider the reasonable costs of any daily living expenses above the client’s capped contribution amount (a gap payment).
• Holding Fee: The TAC will pay a holding fee in place of the Daily Support Fee when a client is on planned leave. Planned leave means a period during which a client will not be living at the residence and the provider has been given at least 10 business days’ notice of the leave. It includes leave such as planned hospital admissions, holidays and leave over holiday periods (e.g., Christmas). Daily Living Expense contribution will not be paid by the TAC where a client is on planned leave and a holding fee is being paid.
• Program Establishment Fee: The TAC will pay this fee to service providers when establishing a support program for a new client. The funds assist in the recruitment and induction of support workers to their employer, as well as the development of care plans and rosters. The Program Establishment Fee does not include client specific training.
• TAC client death: The TAC will pay the Daily Support Fee for two weeks after a TAC client's death. The TAC does not pay a Daily Living Expenses contribution, or any other Attendant Care hours provided in addition to the Daily Support Fee following a client’s death. The provider must notify the TAC as soon as possible via the Serious Incident Reporting portal.
• Staff Training: The TAC can help pay the reasonable costs for an allied health or other medical professional to provide client specific training to SSA support workers if a client requires tailored support. The SSA provider is responsible for staff to be trained according to the minimum requirements

The TAC may consider paying for individual Attendant Care support when a client’s health professional recommends an additional level of support beyond what can be safely provided within the shared support model. Examples of the situations may include:

• when a client cannot safely be left unsupported for the completion of a task or activity
• when a staffing ratio of higher than 1:1 is required for a set period of time for the safe completion of a task
• where a task or activity consistently requires a support worker for an extended duration, or is of high frequency
• unplanned support requirements (for example client illness resulting in increased support needs for a limited duration, unplanned medical appointments).

Attendant care must be considered reasonable, be clinically justified in writing by the appropriate health professional and be approved by the client’s TAC coordinator. Approval will be for a time-limited period only, following which a further request for appropriate clinical justification may be required by the TAC. The TAC may request copies of staffing rosters from the provider in order to understand where the support needs are not able to be met under the shared care model.

• Directly to the service provider, when the client has given the service their TAC claim number.
• The client can pay for the service and then using myTAC, send a copy of their receipt to TAC for reimbursement.

The TAC won’t pay for services that:

• Do not treat, or are not related to, a client’s transport accident injuries.
• Are not reasonable, necessary or appropriate.
• Are not clinically justified, safe and effective.

In relation to supported accommodation services, the TAC cannot pay for:

• supported accommodation services for a person other than the injured client
• supported accommodation services for a condition that existed before a transport accident injury or that is not as a direct result of a transport accident injury
• supported accommodation services that are not consistent with the level of care that a client requires as a result of their transport accident injury
• supported accommodation services that do not have the required accreditation/registration specific to that setting type (as specified by the TAC in this policy)
• related costs such as rent, accommodation bonds and rates
• the physical building development or maintenance
• room temperature controls/air-conditioning, unless deemed medically necessary and approved as reasonable by the TAC
• capital expenses
• extra services (e.g., dry-cleaning, hairdressing, paid TV, room upgrade)
• care provided to a client in the client's private home
• care provided in hospital
• additional attendant care services for the facilitation of community access and participation where approval has not been given by the TAC
• supported accommodation services provided outside the Commonwealth of Australia
• treatment or 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.

Also see general items the TAC cannot pay for.

What is not included in the Daily Support Fee

Support provision not included in the Daily Support Fee (therefore able to be requested and billed as attendant care) are the following:

• TAC approved planned community access activities that require a staff member to accompany a client to an offsite activity or planned appointment Note: A client should be encouraged to choose an attendant care provider other than the SSA provider for their community access.
• Attending a planned medical appointment. Note: It is the TAC coordinator’s decision whether attendance with a client is paid for under the client’s approved Community Access attendant care hours, or paid for in addition to regular Community Access hours. Factors such as the type of appointment, reason for appointment and time frame required for attendance are considered. A client may choose to be accompanied by a support worker who provides the in-home SSA support to accompany them to certain appointments, as they may be able to provide support and knowledge of the client’s current health and functional status.
• Therapy Support where the client is assisted to actively participate in goal directed home or community based rehabilitation activities where support is needed to achieve specific goals and outcomes. Therapy support is documented in the client’s Support plan, and will be revised as required by a treating health professional.
• TAC approved active overnight support where the support worker stays awake and works with the client on planned or scheduled activities. Examples of activities considered to be active support include:
• Assistance with personal care such as toileting and continence management
• Medication and pain management
• Managing spasms, turning, repositioning
• Assisting clients with medical needs requiring frequent attention
• Activities to reduce behaviours of concern, including implementing strategies identified in a client’s behaviour support plan

If a client unexpectedly requires more than one hour of active support during a sleepover shift, the additional active support hours will be paid at the appropriate hourly attendant care rate. If the support worker performs more than 4 hours of active support during the sleepover shift the entire 8 hour shift will be paid at the appropriate attendant care rate.

The TAC may request supporting documents from service providers, such as duty logs, which demonstrate the time and tasks undertaken during active support hours. For further information on Overnight Support please refer to the Attendant Care policy.

Approval in writing is required for all clients. The TAC requires an initial request for SSA services from the client or the client's family or treating team.

The TAC may request completion of one of the following reports from an appropriately qualified health professional/treating team before deciding whether to pay for SSA services for a client:

• Transition allied health and support plan.
• Occupational therapy review of capabilities.
• Occupational therapy supported accommodation review of capabilities.
• Letters of recommendation from relevant treaters will also be considered.

All shared supported accommodation providers must meet and maintain the TAC’s disability provider registration requirements in order to deliver services to a client with disability.

The requirements outlined in the policies for each service type must be adhered to as part of TAC’s provider registration requirements.

The property where shared support is delivered must also meet the TAC’s Shared Supported Accommodation Property Enrolment requirements for each property in which shared support is provided.

Supported accommodation services can support TAC clients with services that fulfil the following conditions:

• Are required as a direct result of a transport accident injury (not for a pre-existing condition).
• Are safe and effective.
• Promote recovery, functional independence, or self-management.
• Are reasonable.
• Comply with all responsibilities relating to the profession or service.
• Comply with all relevant legislative requirements, including the Transport Accident Act 1986, the Health Records Act 2001, the Disability Act 2006, the Income Tax Assessment Act 1997 and the Charter of Human Rights and Responsibilities 2006.

Monitoring Requirements

New client entries into shared supported accommodation will require their holistic support needs to be reviewed for changes once the client has settled into their new home environment. The TAC will arrange an assessment by the appropriate health professional to help determine the level of support required by the client, ideally within 3 months of entering the accommodation.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

2. Reasonable

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.

3. Clinical justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:
  • results in a measurable benefit to the injured person
  • reflects the adoption of a biopsychosocial approach
  • empowers the client to self-manage their injury
  • has goals focused on optimising function, participation and return to work and health
  • is based on the best available research evidence.
• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions maybe more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan. Please refer to Treating clients with severe injury or permanent disability section above.
• The treatment or service should be discontinued and the client discharged when either:
  • the client can independently manage their recovery,
  • the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
  • there is no measurable benefit on outcome measure scores from continued treatments or services.

4. Outcome focused

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.

Considerations

• How can SSA enable the client to undertake activities that support participation in valued social and economic roles?
• What is the client’s long term accommodation goal and how will the client’s current living situation support them to get their lives back on track.
• How will the client’s transition to the SSA contribute to what they want to achieve and their current goals.
• How can it be ensured that the SSA enables increased participation in activities of daily living and work that are important to the client.

Supported Residential Services (SRS) are privately operated businesses that provide accommodation and support or residents. SRS is for people who need a low to medium level of support and are suited to living in a shared living and shared support environment.

Each SRS determines the services it offers and its fee structure. For the TAC to consider paying for a client’s support within an SRS, the SRS setting must be registered with Social Services Regulator and comply with its regulations.

SRS settings vary widely in the support they provide, the quality of the accommodation and therefore the fees they charge. Staff at an SRS may provide care including assistance, supervision and/ prompting to complete showering, personal hygiene, toileting, dressing, meals and medication. Some SRS may also provide social, recreational and community access support. Depending on the SRS, there may be up to 60 people receiving housing and support in the one setting.

To be considered for approval, a client’s need for SRS must be:

• Directly related to their transport accident, and
• Due to the severity of the injuries/ impairment and the resultant need for high levels of care and/or accessible living environment.
• The requested accommodation must be registered with the TAC and the appropriate government regulator as applicable.

The TAC will pay a reasonable fee in line with the residential and services agreement between the TAC, the client or their family member, and the owner of the facility.

The fees that can be paid by the TAC for SRS are:

• A set daily or weekly fee as determined by the SRS and set out in the written residential and services agreement between the TAC client and the SRS. This fee includes the Daily Living Expense fee. The daily or weekly fee must be approved in writing by the TAC before the client takes up residence. The TAC may accept full or partial liability for the SRS fees.
• Attendant Care in addition to support provided under the residential and services agreement, where clinically justified and considered reasonable by the TAC.

Fees payable by the client in an SRS are:

• All TAC clients over the age of 18 years will be required to pay a contribution of towards their Daily Living Expenses (DLE) from 18 months post first discharge from hospital.
• Extra service fees for upgrades or non-standard inclusions, where these are not covered by the residential and services agreement.

Daily Living Expenses (DLE). The SRS fee includes the DLE component associated with accommodation including food and household items, power, water and other utility services. The client will be required to pay a contribution towards their DLE from 18 months post hospital discharge. The client’s DLE contribution is Indexed by CPI each July.

Equipment. The TAC will consider paying for specific equipment in SRS for use by a particular client with the consent of the owner of the facility.

The TAC will only pay for SRS services provided by facilities registered with the Social Services Regulator. The services and care that a client should receive in a Supported Residential Services facility should be aligned to those in the Social Services Regulation Act 2021.

• Directly to the service provider, when the client has given the service their TAC claim number.
• The client can pay for the service and then using myTAC, send a copy of their receipt to TAC for reimbursement.

The TAC won’t pay for services that:

• Do not treat, or are not related to, a client’s transport accident injuries.
• Are not reasonable, necessary or appropriate.
• Are not clinically justified, safe and effective.
• Supported accommodation providers that do not have the required accreditation/registration specific to Specialist Disability Accommodation.
• Incidental items that may be provided to clients as part of their stay. This includes upgrading a standard room type and other services clients might request where there is no clinical need for the request that relates to the client’s transport accident injuries.
• Supported accommodation services for a person other than the injured client.
• Supported accommodation services for a condition that existed before a transport accident injury or that is not as a direct result of a transport accident injury.
• Supported accommodation services that are not consistent with the level of care that a client requires as a result of their transport accident injury.
• Supported accommodation services that do not have the required accreditation/registration specific to that setting type (as specified by the TAC in the guidelines).
• Related costs such as rent, accommodation bonds and rates.
• The physical building development or maintenance.
• Room temperature controls/air-conditioning, unless deemed medically necessary and approved as reasonable by the TAC.
• Capital expenses.
• Extra services (i.e. dry-cleaning, hairdressing, paid TV, room upgrade).
• Care provided to a client in the client's private home.
• Care provided in hospital.
• Additional attendant care services for the facilitation of community access and participation where approval has not been given by the TAC.
• Supported accommodation services provided outside the Commonwealth of Australia.
• Treatment or 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.

Also see general items the TAC cannot pay for.

Providers of SRS properties must meet the TAC’s Shared Supported Accommodation Property Enrolment requirements for each SRS property in which shared support is provided AND recommended SRS must be registered with the Victorian Department of Families, Fairness and Housing (DFFH).

Approval in writing is required for all clients before they reside in SRS. The TAC requires an initial request for supported residential services from the client or the client's family/advocate, treating medical practitioner or health professional.

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

• Transition allied health and support plan.
• Occupational therapy review of capabilities.
• Occupational therapy supported accommodation review of capabilities.
• Letters of recommendation from relevant treating providers will also be considered.

The TAC will ask the proposed SRS provider for information about their services and fees before deciding whether the service can be approved. The Supported Residential Services (Private Providers) Act 2010 requires the 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 TAC.

Following a client’s move into supported accommodation, the TAC may contact the supported accommodation provider or treatment team to discuss the client’s progress or request an assessment, to make sure that:

• The client has all the appropriate support they need.
• They are getting proven, evidence-based treatment and not receiving treatment that isn't helping them recover.
• They are moving towards getting their life back on track or being able to live as independently as possible.

For the TAC to consider paying for a client’s support within an SRS, the SRS setting must be registered with Social Services Regulator and comply with its regulations.

All shared supported accommodation providers must meet and maintain the TAC’s disability provider registration requirements in order to deliver services to a client with disability.

SSA properties where shared support is delivered must also be enrolled with the TAC and meet the TAC’s Shared Supported Accommodation Property Enrolment requirements.

Supported accommodation services can support TAC clients with services that fulfil the following conditions:

• Are required as a direct result of a transport accident injury (not for a pre-existing condition).
• Are safe and effective.
• Promote recovery, functional independence, or self-management.
• Are reasonable.
• Comply with all responsibilities relating to the profession or service.
• Comply with all relevant legislative requirements, including the Transport Accident Act 1986, the Health Records Act 2001, the Disability Act 2006, the Income Tax Assessment Act 1997 and the Charter of Human Rights and Responsibilities 2006.

Specific registration requirements to be an eligible SRS provider are:

• registered with DFFH
• registered with Social Services Regulator and comply with its regulations.
• registered with TAC for both – disability provider registration and supported accommodation property enrolment.

Conditions

The TAC can help pay the reasonable costs of support in SRS accommodation when the client’s need to live in this type of supported accommodation is related to a transport accident. The daily or weekly fee is determined by the SRS provider but must be approved in writing by the TAC before the client takes up residence. The TAC may accept full or partial liability.

Authorisation

Prior approval in writing is required for all clients before they reside in a TAC-funded SRS. The TAC requires an initial request for SRS from the client or the client's family, treating medical practitioner or health professional. The client and providers should be made aware of the quality and safety risks that can be associated with an SRS, and the TAC’s view that it is a last resort option.

The TAC may request completion of at least one of the following reports from an appropriately qualified provider before deciding whether to pay for SRS:

• Occupational Therapy Review of Capabilities
• Occupational Therapy Supported Accommodation Review of Capabilities
• Transition Allied Health and Support Plan
• Letters of recommendation/support from relevant treating providers

It is preferred that the recommending provider visits the SRS or has direct contact with the SRS to determine the supports included in the fees.

Once liability for SRS has been established, it is also recommended that the client visits the potential SRS prior to the funding decision being finalised. If the client does not have a support person to assist in exploring options, the TAC can fund support to assist the client such as a specialised housing case manager or occupational therapist.

If the request is urgent, such as due to a client crisis, consider what mainstream options are available to the client while TAC makes a liability and funding decision. Consider the future impact of rushed SRS decisions on TAC liability as it may be difficult to relocate a client once moved in.

Monitoring Requirements

Given the large variance in SRS environments, the TAC should ensure quality and safeguarding is considered. Claims staff are not solely responsible for the clients’ safety, however every effort should be made to optimise their quality and safety.

Examples include ensuring:

• The client has informal or TAC funded supports to help explore alternative accommodation options
• The client's needs and preferences are well known, and matched to the SRS
• The client and support person(s) visit the SRS prior to committing to move in
• A trial of the SRS is completed where possible
• Regular communication is arranged between the SRS and the support team
• External supports are in contact with the client and/or visiting regularly such as family, friends, providers
• The TAC has regular contact with the client and planning is completed regularly
• The client knows how to give feedback or make a complaint about the SRS.
• The client may be provided with the Your Care brochure.

The TAC Safeguarding Specialists can provide support if concerns about client safety, abuse, neglect or exploitation exist.

Given the increased vulnerability of clients living in SRS, it is important that client contact and planning is completed regularly in line with TAC Work Practices. A My Plan and service review should be completed at least every 12 months.

Some SRS funding for particular clients has remained unchanged for many years. Claims staff are required to gather as much funding information as possible, to document what support is being funded. The above information in this Work Practice regarding determining reasonable fees can also be utilised for existing arrangements. A current funding approval is still required on these claims, and any funding increase requests should be reviewed. If a client is not contributing to their daily living expenses, reasonable attempts should be made to commence the client contribution.

The suitability of SRS for clients can change over time. It is important to ensure that a client’s accommodation is continually reviewed according to their needs, preferences and goals. Regular reviews by an Occupational Therapist or other provider may assist. It is important to review whether SRS continues to be the most suitable option for a client regarding their:

• Age (Residential Aged Care is preferred for elderly clients due to higher quality and safety regulations)
• Accommodation preferences and goals
• Changing support needs or life circumstances
• Other funding options such as NDIS SDA

Effort should also be made in facilitating regular and open communication between the SRS, TAC, client and other supports.

Any changes to the client’s accommodation should be promptly updated.

Reporting

The Social Services Regulation Act 2021 requires the 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 TAC as this document states what services are included in the fees charged.

Prior to the client signing this agreement, the TAC should determine what the SRS fees are and what these fees include. A claims manager may ask the SRS:

• What is the weekly fee to be charged for support and accommodation?
• What is the staff to resident ratio?
• What support is included in this fee? (eg. how much support does each resident get, and what type of support is it)
• Does this fee include daily living expenses (eg. meals, board, utilities)? If so, is it possible to differentiate the costs between these expenses and support?

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to supported accommodation if the TAC has accepted liability for the accident-related injury that relates to supported accommodation.

The client may be eligible to be considered for SRS:

• Injuries/ impairments as result of transport accident, and
• The request for accommodation is due to the severity of the injuries/ impairment and the resultant need for high levels of care and/or accessible living environment, and
• The requested accommodation must be registered with the TAC and the appropriate government regulator.

2. Reasonable

When determining whether SRS is a reasonable cost in the circumstances, the TAC considers whether:

• the provision of SRS is reasonable and necessary in the circumstances, and
• reasonable costs, expenses or fees in relation to the SRS will produce the intended outcomes, and
• is a reasonable cost.

Circumstances

• Client unable to return to their pre-injury home, a family home or have the financial capacity to buy/ rent a home.
• Client’s capacity to pay rent/ utilities/ associated costs
• Client doesn’t have access to an attendant care program
• Consideration of client preference, client family and social supports and accommodation goal
• There is an unacceptable level of risk, due to motor vehicle accident impairment, to the client or others if they do not enter supported accommodation.

Support Needs

• SRS will support community connection, social and workplace inclusion.
• SRS will maintain or support the person’s ability to build capacity or develop independence skills
• Client requires modifications or support needs that accommodation need cannot be met through mainstream housing options
• Client or Accommodation Guardian (if applicable) have considered alternate options e.g. Home ownership, Public housing, priority housing NDIS SDA etc.

3. Clinical Justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• SRS will empower the client to maximise their independence
• The request considers the whole person and adopts biopsychosocial approach.
• The request complies with the principles of the Clinical Framework in that it:
  • results in a measurable benefit to the injured person
  • reflects the adoption of a biopsychosocial approach
  • empowers the client to maximise independence
  • has goals focused on optimising function, participation and return to work and health.

4. Outcome Focused

When deciding if SRS request is outcome focused, the TAC considers whether it is progressing or achieving individualised goals that are meaningful to the client and part of the plan developed with the client to identify their long term accommodation goal, and services put in place to support the achievement of this goal.

The client plan should also outline the client’s participation goals to maximise their engagement and independence within the SRS.

Considerations

• How can SRS enable the client to undertake activities that support participation in valued social and economic roles?
• What is the client’s long term accommodation goal and how will the client’s current living situation support them to get their lives back on track.
• How will the client’s transition to the SRS contribute to what they want to achieve and their current goals.
• How can it be ensured that the SRS enables increased participation in activities of daily living and work that are important to the client.

Residential aged care provides supported accommodation and 24/7 care for older people who can no longer live independently at home due to health or personal care needs.  Residential Aged Care (RAC) is usually only appropriate for people over the age of 65 years.

To be considered for approval, a client’s need for RAC must be:

• Directly related to their transport accident, and
• Due to the severity of the injuries/impairment and the resultant need for high levels of care and/or accessible living environment.
• Assessed by the Department of Health, Ageing and Disability using the Australian National Aged Care (AN-ACC) assessment.

If the client is aged under 65 years, an assessment is made in accordance with the Disability Act 2006.

The TAC can help pay the reasonable cost of a client’s Residential Aged Care if the need for the service is related to a client’s transport accident injury.

If a client needs help finding residential aged care the TAC can pay for an approved placement provider, case manager or occupational therapist to help you.

The fees and subsidies will be paid directly to the facility by the TAC if it has accepted liability for the client's care and support at a RAC facility. The TAC may accept part or full liability for a client’s RAC fees.

The TAC will pay RAC fees and supplements at the rates determined by the Commonwealth Government. The TAC does not have control over the calculation of the fees or subsidies for clients in RAC facilities.

Fees that can be paid by the TAC

• Basic Daily Fee based on the Australian National Aged Care (AN-ACC) classification fee must, at a minimum, cover the provision of services listed in part 1 and part 2 of Schedule 1 of the Quality of Care Principles 2014. The TAC will pay the entire Basic Daily Fee for the first 18 months after a client is discharged from hospital post-accident.
• Daily Accommodation Payment (DAP) or contribution. The TAC can pay a Daily Accommodation Payment (DAP) or Contribution as the guiding legislation does not allow the TAC to pay a refundable accommodation deposit (RAD) or lump sum payment.
• Means tested care fee.
• Other supplements or subsidies, for example oxygen, enteral feeding.

Fees payable by the client

• Daily living expense contribution of $10 per day after 18 months post initial hospital discharge after the transport accident. This $10 client contribution is deducted from the Basic Daily Fee amount, with the TAC paying the balance.
• Extra service fees for upgraded room, higher standard food, or extra services such as hairdressing or paid TV services.

Other fees the TAC may pay for

• Specialised equipment: The TAC expects that the facility accepts full responsibility for the provision of care and services to a resident as specified in Schedule 1 and 2 of the Quality of Care Principles 2014. In exceptional circumstances, the TAC may consider funding specialised equipment not covered by this legislation if it is clinically justified and considered reasonable by the TAC.
• Attendant care: The TAC can however provide a TAC client residing within an RAC facility with attendant care to support community access where considered reasonable and clinically justified by the TAC.

• Directly to the service provider, when the client has given the service their TAC claim number.
• The client can pay for the service and then using myTAC, send a copy of their receipt to TAC for reimbursement.

The TAC will not pay for services that:

• Do not treat, or are not related to, a client’s transport accident injuries.
• Are not reasonable, necessary, or appropriate.
• Are not clinically justified, safe and effective.

The TAC will not pay for services provided by Residential Aged Care facilities that are not accredited by the Australian Government’s Aged Care Quality and Safety Commission.

In relation to supported accommodation services, the TAC cannot pay for:

• Supported accommodation services for a person other than the injured client.
• Supported accommodation services for a condition that existed before a transport accident injury or that is not as a direct result of a transport accident injury.
• Supported accommodation services that are not consistent with the level of care that a client requires as a result of their transport accident injury.
• Supported accommodation services that do not have the required accreditation/registration specific to that setting type (as specified by the TAC in this policy).
• Related costs such as rent, accommodation bonds and rates.
• The physical building development or maintenance.
• Room temperature controls/air-conditioning, unless deemed medically necessary and approved as reasonable by the TAC.
• Capital expenses.
• Extra services (e.g., dry-cleaning, hairdressing, paid TV, room upgrade).
• Care provided to a client in the client's private home.
• Care provided in hospital.
• Additional attendant care to provide physical assistance or prompting with personal care tasks. This type of support should be included in the Aged Care Funding Instrument subsidy level determination.
• Supported accommodation services provided outside the Commonwealth of Australia.
• Treatment or 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.

Also see general items the TAC cannot pay for.

Before seeking TAC funding for Residential Aged Care fees, a client will need to establish their eligibility for a Commonwealth subsidised place in an aged care facility. To do this a client can apply for an eligibility assessment on the My Aged Care website. Once a client has an aged care assessment outcome, they can send this to their TAC claim manager. The claim manager will then advise the client if the TAC can contribute to the costs of their aged care support. The TAC will directly pay the Aged Care provider for costs in line with the fees determined by the Australian Government.

The TAC requires an initial request for RAC from the client or the client's family/advocate, treating medical practitioner or health professional. The TAC requires a completed:

• ACAS assessment before a client can enter RAC; and
• A letter of fee determination from the Commonwealth Government which includes an Australian National Aged Care Classification (AN-ACC) subsidy calculation.

If a TAC client is required to complete a means assessment before entering a RAC, this form should be returned by the client to Services Australia (previously known as Centrelink) or the Department of Veterans Affairs (DVA), whichever is applicable to the TAC client.

All RAC providers must be accredited by the Australian Government’s Aged Care Quality and Safety Commission.

Supported accommodation services can support TAC clients with services that fulfil the following conditions:

• Are required as a direct result of a transport accident injury (not for a pre-existing condition).
• Are safe and effective.
• Promote recovery, functional independence, or self-management.
• Are reasonable.
• Comply with all responsibilities relating to the profession or service.
• Comply with all relevant legislative requirements, including the Transport Accident Act 1986, the Health Records Act 2001, the Disability Act 2006, the Income Tax Assessment Act 1997 and the Charter of Human Rights and Responsibilities 2006.

The TAC can only pay for services provided by Residential Aged Care facilities that are accredited by the Australian Government’s Aged Care Quality and Safety Commission. This helps ensure that clients receive a standard of care that is high quality and aligned to government standards.

The TAC must be provided with a copy of the AN-ACC letter from the Department of Health, Disability and Ageing (DOHDA) or Services Australia sent to the RAC facility setting out the fee subsidies applicable to the client. It is the RAC facility's responsibility to contact the DOHDA to have the subsidies reviewed if it does not agree with them.

Australian National - Aged Care Classification (AN-ACC) subsidy: Whilst awaiting the AN-ACC rating for new residents the RAC provider may charge the TAC the interim or AN-ACC default rate, determined by the DOHDA. The TAC will provide back payment to the facility for the shortfall once the correct AN-ACC subsidy rate has been established. Alternatively, a RAC provider can wait for the AN-ACC level determination and invoice the TAC for back payment.

Following a client’s move into supported accommodation, the TAC may contact the supported accommodation provider or treatment team to discuss the client’s progress or request an assessment, to make sure that:

• The client has all the appropriate support they need.
• They are getting proven, evidence-based treatment and not receiving treatment that is not helping them recover.
• They are moving towards getting their life back on track or being able to live as independently as possible.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

2. Reasonable

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable. The TAC may accept part or full liability for a client’s RAC fees in relation to their transport accident injuries

The TAC will pay RAC fees and supplements at the rates determined by the Commonwealth Government. The TAC does not have control over the calculation of the fees or subsidies for clients in RAC facilities.

3. Clinical justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:
  • results in a measurable benefit to the injured person.
  • reflects the adoption of a biopsychosocial approach.
  • empowers the client to self-manage their injury.
  • has goals focused on optimising function, participation and return to work and health.
  • is based on the best available research evidence.
• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions maybe more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan. Please refer to Treating clients with severe injury or permanent disability section above.
• The treatment or service should be discontinued and the client discharged when either:
  • the client can independently manage their recovery,
  • the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
  • there is no measurable benefit on outcome measure scores from continued treatments or services.

4. Outcome focused

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.

Considerations

• How can RAC enable the client to undertake activities that support participation in valued social and economic roles?
• What is the client’s long term accommodation goal and how will the client’s current living situation support them to get their lives back on track.
• How will the client’s transition to the RAC contribute to what they want to achieve and their current goals.
• How can it be ensured that the RAC enables increased participation in activities of daily living and work that are important to the client.

Under the Transport Accident Act 1986, the TAC is unable to pay for the physical building and maintenance of the accommodation itself or the “bricks and mortar”. People with extreme functional impairment and/or very high support needs may be eligible for Specialist Disability Accommodation (SDA) funding with the National Disability Insurance Scheme (NDIS) for this purpose. See NDIS SDA webpage for further details.

This policy refers to the delivery of shared care support while residing in a NDIS funded Specialist Disability Accommodation (SDA) property.

To be considered for approval, a client’s need for SDA must be:

• Directly related to their transport accident, and
• Due to the severity of the injuries/ impairment and the resultant need for high levels of care and/or accessible living environment.

Clients must have NDIS SDA funding approved to be eligible for the TAC to consider funding for the reasonable costs of care within this type of supported accommodation as a result of the client’s transport accident injuries.

If a client is an inpatient in hospital and there is yet to be a decision on a NDIS SDA application, the TAC may consider the funding of temporary shared supported accommodation if it is demonstrated that:

• All inpatient rehabilitation goals have been achieved.
• The hospital has recommended the person is safe for discharge.
• A continued hospital admission has resulted in detriment to the person’s mental and/or physical wellbeing.

In instances where a client has NDIS SDA funding approved and is residing in a SDA property, the TAC can pay for the reasonable costs of care within the shared supported accommodation as a result of the client’s transport accident injuries. This may include:

• Daily support fee.
• Daily living expenses.
• 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 is based on clinical recommendations by a health professional
• If a client has SDA approved for a single dwelling and is NOT sharing care with other residents, the TAC may fund the reasonable attendant care support required to live independently based upon the Occupational Therapy assessment.

• Directly to the service provider, when the client has given the service their TAC claim number.
• The client can pay for the service and then using myTAC, send a copy of their receipt to TAC for reimbursement.

The TAC won’t pay for services that:

• Do not treat, or are not related to, a client’s transport accident injuries.
• Are not reasonable, necessary or appropriate.
• Are not clinically justified, safe and effective.
• Supported accommodation providers that do not have the required accreditation/registration specific to Specialist Disability Accommodation.
• Incidental items that may be provided to clients as part of their stay. This includes upgrading a standard room type and other services clients might request where there is no clinical need for the request that relates to the client’s transport accident injuries.
• Supported accommodation services for a person other than the injured client.
• Supported accommodation services for a condition that existed before a transport accident injury or that is not as a direct result of a transport accident injury.
• Supported accommodation services that are not consistent with the level of care that a client requires as a result of their transport accident injury.
• Supported accommodation services that do not have the required. accreditation/registration specific to that setting type (as specified by the TAC in the guidelines).
• Related costs such as rent, accommodation bonds and rates.
• The physical building development or maintenance.
• Room temperature controls/air-conditioning, unless deemed medically necessary and approved as reasonable by us.
• Capital expenses.
• Extra services (i.e. dry-cleaning, hairdressing, paid TV, room upgrade).
• Care provided to a client in the client's private home.
• Care provided in hospital.
• Additional attendant care services for the facilitation of community access and participation where approval has not been given by us.
• Supported accommodation services provided outside the Commonwealth of Australia.
• Treatment or 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.

Also see general items the TAC cannot pay for.

Providers of SDA properties must meet the TAC’s Shared Supported Accommodation Property Enrolment requirements for each SDA property in which shared support is provided.

The property where shared support is delivered must also meet the TAC’s Shared Supported Accommodation Property Enrolment requirements for each property in which shared support is provided.

SDA properties where shared support is delivered must also be enrolled with the TAC and meet the TAC’s Shared Supported Accommodation Property Enrolment requirements.

Supported accommodation services can support TAC clients with services that fulfil the following conditions:

• Are required as a direct result of a transport accident injury (not for a pre-existing condition).
• Are safe and effective.
• Promote recovery, functional independence, or self-management.
• Are reasonable.
• Comply with all responsibilities relating to the profession or service.
• Comply with all relevant legislative requirements, including the Transport Accident Act 1986, the Health Records Act 2001, the Disability Act 2006, the Income Tax Assessment Act 1997 and the Charter of Human Rights and Responsibilities 2006.

For specific registration requirements to be eligible SDA provider, please refer to NDIS SDA dwelling enrolment and vacancies.

Clients must have NDIS SDA funding approved to be eligible.

For details about authorisation, monitoring and how the TAC makes decision, please refer to strategic supported accommodation policy.  The main criterion is that the client must have NDIS SDA funding approved to be eligible.