We can help pay for supported accommodation when a client has:
- sustained a transport accident injury which precludes them from returning to their pre-accident/pre-injury or illness accommodation; and
- been assessed by an appropriate therapist and/or multidisciplinary team as requiring supported accommodation services or by an Aged Care Assessment Team (ACAT) as requiring care and supported accommodation in an Aged Care Facility/Nursing Home/Hostel.
We can help pay the reasonable costs of supported accommodation services under section 60 of the Transport Accident Act 1986 (the Act) where the client requires residence in a supported accommodation facility on a permanent or semi-permanent basis in order to meet their care and support needs as a result of a transport accident injury.
We will periodically review a client's entitlement to supported accommodation to ensure that the level of support and services remain reasonable for the transport accident injury and remains payable under the Act.
Supported accommodation services
Supported accommodation is a model of care that responds to the needs of clients who have multiple physical, sensory and/or cognitive disabilities arising from their transport accident injury which impacts significantly on their capacity for independent living. The care provided may relate to physical assistance and/or assistance required to address cognitive and psychological issues.
There are four types of supported accommodation: Shared Supported Accommodation (SSA), Supported Residential Services (SRS), Residential Aged Care (RAC) and Group Homes.
We can help pay for supported accommodation services where the services:
- are identified as being the most appropriate and enabling response to a client's clinically justified care and support needs,
- optimise functional independence and actively support the client to achieve their independence goals (see information on the Independence model),
- are provided in a way that is consistent with the Clinical Framework for the Delivery of Health Services, and
- are delivered using a client centred approach.
Supported accommodation services may provide personal care, domestic and community services, supervision, nursing care, or a combination of all of these.
Supported accommodation facilities should offer:
- a separate bedroom;
- a 'home-like' environment with furnishings;
- standard equipment appropriate to the client's care and support needs;
- varied meal choices with high nutritional value;
- appropriate staffing to meet all personal care needs of the client;
- supervision and/or nursing care relevant to the needs of the client; and
- accommodation that is clean, hygienic and kept in good repair.
The accommodation service should endeavour to maximise a client's personal dignity, choice, independence, functional skills and capabilities and should encourage and facilitate his/her participation in social and community activities.
The choice and location of a supported accommodation facility is made by the client. The client will consult with their representative (if applicable), treating team, supported accommodation service providers and Aged Care Assessment Team (ACAT) (if required) in making their decision. See also the Client Information sheet entitled, Choosing a Shared Supported Accommodation Service.
We can consider engaging a TAC-approved case manager to facilitate admission into a supported accommodation facility in circumstances where a client requires additional support to source and choose a supported accommodation facility.
In these guidelines:
- Supported Accommodation refers to the following four accommodation facility options available:
- Shared Supported Accommodation (SSA).
- Supported Residential Services (SRS) within the meaning of section 5 of the Supported Residential Services (Private Proprietors) Act 2010.
- Residential Aged Care (RAC).
- Group Home (within the meaning of Section 3(1) of the Disability Act 2006 and formerly known as Community Residential Unit (CRU)).
- Shared Supported Accommodation (SSA) facilities provide care and support for people with disabilities. They are houses with paid carers that may provide personal care, nursing, rehabilitation, housekeeping, meals and laundry services, provided within a shared care model, 24 hours a day, 7 days a week.
- Supported Residential Services (SRS) facilities are private businesses that provide accommodation and personal care for people who do not demonstrate the ability to return to living independently. SRS facilities vary in the services they provide, the people they accommodate and the fees they charge. Services may include assistance with personal activities of daily living (showering, personal hygiene, toileting, dressing, medication), domestic activities of daily living (preparation of meals, laundry) and community activities of daily living as well as physical and emotional support. Some SRS facilities also provide nursing or allied health services.
These facilities do not receive Government funding but must be registered with the Victorian Department of Health (DOH) as a SRS and remain compliant with the criteria for registration.
- Residential Aged Care (RAC) facilities (also referred to as Aged Care Facility/Nursing Home/Hostel) provide care and support services to people who are no longer able to care for themselves or be cared for by others in their own homes. Care is provided under the Commonwealth Aged Care Act 1997 and facilities must be certified by the Commonwealth as a Residential Aged Care (RAC) service. There are two types of residential aged care:
- Low level care refers to the provision of suitable accommodation and related services which includes laundry, meals, cleaning and personal care services such as bathing, dressing and toileting assistance.
- High level care refers to accommodation and related services which includes personal care services, nursing care and equipment.
For more information on eligibility of clients entering into Residential Aged Care facilities, access the Department of Health website.
- Group Home (within the meaning of Section 3(1) of the Disability Act 2006) and formerly known as Community Residential Unit (CRU) is a residential service that provides housing for four to six residents with support provided by rostered staff. In most cases, clients will not be eligible for a Group Home unless their primary disability existed before the transport accident injury.
- Daily Living Expenses (DLE) also known as the basic daily fee or the basic daily care fee are a client's expenses associated with accommodation, as well as food and household items, power, water and other utility services, and room temperature control expenses that are incurred when living in a supported accommodation facility.
Shared Supported Accommodation (SSA)
This section communicates expectations of the delivery of SSA services. It has been created to reduce risk and ensure compliance with TAC legislative requirements. The setting, ongoing review and maintenance of expectations contained here will promote consistency, efficiency and transparency across the delivery of services.
This section should be read in conjunction with the Attendant care policy which provides information about our expectations for the delivery of care to clients who live in a private home. This care is paid for as part of a 24 hour shared care model in an SSA facility.
What we can pay for in relation to SSA
We can help pay the reasonable costs of care in SSA in accordance with our fee arrangements with residential care providers. We pay for SSA services to be provided as a 24 hour shared care model. This means that the SSA provider must have an appropriate level of staffing to ensure the care required by the client can be delivered across the full 24 hour period.
We will consider paying for clinically justified specialist equipment in a SSA facility for specific use by a particular client with the consent of the owner of the facility. Such equipment must be prescribed by a treating health professional and approved by us. It is expected that all SSA facilities will comply with local planning regulations by providing an appropriate and safe level of access for clients.
The SSA provider can charge the following for a client:
- Daily Fee (Daily Bed fee) - We can help pay a Daily Fee specified for a client in a SSA residence. The Daily Fee covers the costs of providing the shared care services to the client over the 24 hour period. It is expected that the Daily Fee will be sufficient to cater for the client's support needs within a shared care model. The Daily Fee includes, but is not limited to, the following irrespective of frequency:
- Personal care, showering, bathing, dressing, grooming.
- Toileting, bladder and bowel care.
- Daily stretches, walking program (as directed by the recommending health professional).
- Meals/feeding/PEG feeds.
- Participation in domestic activities such as meal preparation, shopping, laundry.
- Participation and inclusion in structured activities within the house.
- Supporting and facilitating a client's accessing of the community, such as supporting clients to complete shopping tasks.
- Assistance with planning and organising of activities, appointments, including assisting the client to attend regular GP visits.
- Behavioural management (as directed by the recommending health professional).
- Monitoring and administering medication.
- Fitting and using aids, orthotics and appliances, hearing and communication devices.
- OHS requirements for transfers and mobility.
SSA providers must ensure they are willing and able to meet the client's support needs within the Daily Fee before agreeing to accept a referral and that the required level of care is provided routinely on an as needs and ongoing basis.
- Daily Living Expenses (DLE) are a client's expenses associated with accommodation including rent, food and household items, power, water and other utility services. The client may be required to contribute to their DLE.
- Holding Fee - We will pay a Holding Fee where a client is on Planned Leave. Planned Leave means a period during which a client will not be living at a 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 (i.e. Christmas).
- Residential Program Establishment Fee is designed to ensure that an Independence Support Plan and appropriate services are established for a client. The Independence Support Plan must clearly outline the support and supervision that will be provided to assist a TAC client to maximise their independence.
We will only pay the Residential Program Establishment Fee if we have received our client's Independence Support Plan no later than 15 business days after the services start and the Provider has developed a TAC Client Specific Training Program (if required).
The provider must give us a full or partial refund of the Residential Program Establishment Fee if it decides to stop providing services to a TAC client within three months of the services starting. We will make the decision about whether the Provider must pay a full or partial refund.
- TAC client death - We will pay the Daily Fee for two weeks after a TAC client's death. We are not required to pay an Additional Fee or a Daily Living Expenses Fee. The Provider must notify us of a client death before the end of the business day.
- Staff Training - We can help pay the reasonable costs for an allied health or other medical professional to provide client specific training to SSA staff. This is paid according to the fee schedule for the relevant health professional.
We may consider paying for additional attendant care for a client to supplement support provided under the 24-hour shared care model, and when support is required in addition to the activities listed under the Daily Bed Fee. This additional attendant care must be approved by the TAC coordinator, be considered reasonable and be clinically justified in writing by an appropriate health professional. Approval for additional attendant care will be for a time-limited period only, following which a further request for appropriate clinical justification may be required.
It may be reasonable to review whether the care needs of the client can be met within the 24-hour shared care model or whether alternative living arrangements may be more suitable for a client whose needs have permanently changed.
We will not pay for SSA staff to be trained according to our minimum requirements. These costs are the responsibility of the SSA provider.
Who can provide SSA?
SSA services can only be provided by a TAC authorised/approved and registered provider. Refer to the list of SSA providers. Supported accommodation services must be approved by us in writing before the client takes up residency.
An SSA provider must meet the registration criteria and agree to the terms and conditions of providing disability services detailed on our website.
The minimum requirements for staff providing care to clients in an SSA are demonstrated competency in areas relevant to the needs of clients including:
- first aid,
- Zero Tolerance to Abuse,
- AFAC fire safety training,
- food safety,
- manual lifting, and
- infection control.
Staff must also complete a client specific training program where required as a result of a client's specialised support needs.
TAC registered providers must have and use:
- A complaints process and notify us within 48 hours days of receiving a TAC client complaint. The provider must also notify us if they cannot resolve a client or other stakeholder complaint within 14 calendar days from the date the complaint was made.
- A fully documented Incident Reporting Procedure. The provider must notify us of all serious incidents involving clients before the end of the business day after the serious incident occurs.
Information we need to consider paying for SSA
Approval of SSA may form part of the independence planning process for clients with a severe injury.
Approval in writing is required for all other clients. We require an initial request for SSA services from the client or the client's family, treating medical practitioner or health professional.
We may request completion of one of the following reports from an appropriately qualified therapist/treating team before deciding whether to pay for SSA services:
- Functional Independence Assessment (FIA)
- Functional Independence Review (FIR)
- Residential Functional Independence Review (Residential FIR)
Letters of recommendation from relevant treaters will also be considered.
Supported Residential Services (SRS)
What we can pay for in relation to SRS
We can help pay the reasonable costs of care in SRS accommodation in accordance with our fee arrangements with the individual residential care provider. We will consider paying for specific equipment in a SRS for use by a particular client with the consent of the owner of the facility. It is expected that all SRS facilities comply with the relevant supported accommodation residence requirements.
Who can provide SRS?
SRSs are granted a certificate by the Department of Health allowing them to provide accommodation services under the Supported Residential Services (Private Proprietors) Act 2010. SRS providers must meet the supported accommodation criteria listed above and:
- employ a qualified personal care coordinator who coordinates care for all residents;provide at least one staff member for every 30 residents;
- allow for extra staff to provide adequate levels of care for residents; and
- provide sufficient staff (at least one) on site overnight to ensure the safety of residents and respond to their needs.
For more information access the Supported Residential Services page on the Department of Health website.
Information we need to consider paying for SRS
Approval of SRS for clients with a severe injury may form part of the independence planning process in consultation with the TAC coordinator and the clients treating occupational therapist/medical practitioner.
Approval in writing is required for all other clients before they reside in a SRS. We require an initial request for supported residential services from the client or the client's family, treating medical practitioner or health professional.
We may request completion of one of the following reports from an appropriately qualified therapist/treating team before deciding whether to pay for SRS:
- Functional Independence Assessment (FIA)
- Functional Independence Review (FIR)
- Residential Functional Independence Review (Residential FIR)
Letters of recommendation from relevant treating providers will also be considered.
We will ask the proposed SRS provider for information about their services and fees before deciding whether the service can be approved for the client. The Supported Residential Services (Private Providers) Act 2010 requires a 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 us.
Fees payable for SRS
We can help pay the reasonable costs of SRS fees and charges as specified in the residential and services agreement between the owner of the facility and the client.
These fees and charges include the DLE component associated with accommodation including rent, food and household items, power, water and other utility services. The client may be required to contribute to their DLE.
Residential Aged Care (RAC)
What we can pay for in relation to RAC
We can help pay the reasonable costs of a client's Residential Aged Care (RAC) accommodation.
Who can provide RAC?
RAC must be approved by the Commonwealth Department of Social Services (DoSS) (formerly by the Commonwealth Department of Health and Ageing) and also be accredited by the Aged Care Quality and Safety Commission. A client must be assessed by an Aged Care Assessment Team (ACAT) as eligible to receive that type of care for the approved provider to be eligible to receive subsidies.
Contact the Commonwealth Respite and Carelink Centre on freecall 1800 052 222 for information about aged care homes in your area.
Information we need to consider paying for RAC
We require an initial request for RAC from the client or the client's family, treating medical practitioner or health professional.
We require a completed:
- ACAT assessment before a client can enter RAC; and
- an Aged Care Funding Instrument (ACFI) before we will pay for services.
Approval of residential aged care services for clients with a severe injury may form part of the independence planning process for applicable clients.
Fees payable for RAC
The fees are determined once the RAC facility assesses the resident's care requirements and submits an ACFI to the DoSS. The DoSS calculates the fee subsidies in accordance with the ACFI form which would normally be paid for by the DoSS. The fee 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.
We do not have control over the calculation of the subsidies for clients in RAC facilities. All care fees and supplements will be paid at the levels prescribed by the DoSS and listed in the Residential Care Manual as applicable to the particular facility and care level.
We must be provided with a copy of the ACFI letter from the DoSS sent to the RAC facility setting out the fee subsidies applicable to the client. It is the RAC facility's responsibility to contact the DoSS to have the subsidies reviewed if it does not agree with them. For more information on fees, subsidies, supplements and indexation please refer to the Aged care fees and charges information on the Department of Health website.
A resident may be eligible for Government assistance with the costs of their accommodation. An assets assessment will be undertaken to test a person's eligibility for assistance. Centrelink and the Department of Veterans Affairs (DVA) undertake assets testing of new residents entering residential care facilities. A person requiring an assets assessment will need to complete a Request for an Assets Assessment form and submit it to Centrelink or the DVA (in the case of veterans).The Request for an Assets Assessment form is distributed by ACATs. Call the Aged Care Information Line on 1800 500 853 for more information.Fees and charges will be as advised by the DoSS and agreed to by us.
The subsidy is composed of a number of smaller subsidies, based on the resident's care requirements, financial status, and the facility's payroll tax status, funding and location. The subsidy components are:
- Aged Care Funding Instrument (ACFI) Subsidy (previously known as the Resident Classification Scale (RCS) Subsidy pre 20 March 2008). The ACFI subsidy was introduced on 20 March 2008. There are 64 levels for ACFI. The ACFI subsidy is broken up into three care domains, Activities of Daily Living (ADL), Behaviour Supplement (BEH) and Complex Health Care Supplement (CHC).
- Transitional Supplement, Concessional Supplement or Accommodation Supplement Only one of the above three charges would be paid by us for a client depending on their assets (usually for residents with very few assets) and when they entered residential care. These charges are determined by Centrelink or the Department of Veteran Affairs (DVA).
- Payroll Tax is paid by TAC to facilities that have a payroll tax liability. The facilities are required to complete work for the DoSS to receive this tax.
- Enteral Feeding Supplement is payable on behalf of residents who are enterally fed. There are two rates, bolus and non-bolus, which will be listed separately on the letters sent by the DoSS.
- Oxygen Supplement is payable on behalf of residents who require additional oxygen. Unlike all of the other supplements, the oxygen supplement is calculated on a monthly rate, not a daily rate, because oxygen tanks are fully filled for use by one resident and are completely emptied before reuse by another resident. This will be listed separately on the letter from the DoSS.
- Daily living expenses fee (also known as the basic daily fee, the basic daily care fee, the client personal contribution or daily client contribution) is payable by all residents that enter residential care. Currently the client pays after 18 months post discharge from hospital a $10 contribution towards this fee and the balance is paid by us. It goes towards rental, food, utilities and similar expenses. The daily living expenses fees increase twice a year in line with the aged care pension.
- Accommodation Charge or Bond - Residents may be asked to contribute towards the costs of their accommodation in a residential care facility by paying an accommodation charge or accommodation bond. We can help pay the reasonable costs of the accommodation charge but not the accommodation bond.
- Respite Supplement is used for short term bursts of less than 30 days (same as the TAC funded respite service). The respite supplement operates in a similar manner as the ACFI subsidy, applying to all residents receiving respite care. The respite supplement is calculated in two parts, the respite subsidy and the respite supplement. It is broken down into separate categories.
- Extra Services Fees - Should a client in an Aged Care Facility choose extra services such as hairdressing, massage or dry cleaning, the client will be responsible for these costs.
Residential Care Entry Package
Clients and their families may obtain a Residential Care Entry Pack which provides an application form and information booklet about applying for a place in an aged care home. The application form can be downloaded and instructions for printing can be found on the Department of Health website.
Please be aware that responsibility for aged care and ageing recently moved to the Department of Social Services. Ageing and aged care content on the Department of Health and Ageing's website will be progressively published on the DoSS website.
Responses to requests
We will respond to written treatment and service requests as per the TAC Service Charter.
A supported accommodation services request may be reviewed by the TAC Clinical Panel to assist the TAC to make a decision on a request for supported accommodation services. The Clinical Panel may contact the requesting health professional or supported accommodation service provider to seek further information and/or discuss the proposed services before making a recommendation about the request. We will respond to the request after they have received the Clinical Panel's recommendation.
What we cannot pay for
In relation to supported accommodation services, we 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
- related costs such as rent, accommodation bonds and rates
- room temperature controls/air-conditioning, unless deemed medically necessary and approved as reasonable by us
- capital expenses, such as periodic payments in Residential Aged Care (RAC) facilities
- extra services (i.e. laundry, dry-cleaning, hairdressing)
- 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.