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.