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.