Attendant care provider guidelines

These guidelines should be read in conjunction with the information at Working with the TAC.

We can help fund attendant care for eligible clients to assist their rehabilitation and maintain activities of daily living. Attendant care services may include physical assistance or prompting with personal care such as showering, dressing and eating and assistance with therapy programs developed by health professionals. It may also include support to access the community for activities such as shopping, banking, employment and education.

We consider the need for attendant care services on a case by case basis. Support services are tailored to the individual, delivered in the right place at the right time. They enable clients to participate in valued social and economic roles and to live as independently as possible. We expect all disability support providers to uphold the principles of person-centred practice and to support clients in a manner that maintains their dignity, privacy and wellbeing.

Who can provide attendant care?

We can help fund disability service providers to deliver individual support to clients in their homes, in supported accommodation settings and in the community. Service providers must adhere to our Attendant Care policies and employ support workers who meet the minimum care standards specified in our Independent Review against Quality Standards (IRQS).

What we can pay for

We can pay the reasonable cost of attendant care services, with approval, when required as a result of an accepted transport accident injury.

We can pay the reasonable cost of attendant carer travel when accompanying a client to a transport accident injury related hospital, medical or rehabilitation appointment. Our approval is required before travel can be paid for a carer.

The agency will need to submit a Support Plan that details the attendant care program expected to best meet the client’s individual support needs.

Daytime support

We can help pay for daytime support for clients who require active provision of attendant care that is classified as:

  • Personal care: physical assistance with daily living tasks, as directed by the recommending occupational therapist/other allied health professional. Includes the provision of domestic services by the attendant carer in downtime between provision of personal care.
  • Therapy support: assists the client to actively participate in goal directed home or community based rehabilitation activities where the support is necessary 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.
  • Community access: assists and supports the client to undertake community activities, as directed by the recommending occupational therapist.

Overnight support

Support is available for clients who require assistance during their usual period of sleep, either in their home or at an approved location. Overnight support is usually provided in the form of an inactive, sleepover shift, however some clients may require active support during the shift. TAC approval is required for all overnight support.

Inactive sleepover shift

An inactive sleepover shift is an 8 hour shift provided overnight in the client’s home. The support worker may sleep during the shift, but will respond to the client’s personal support needs if required, for example to assist with toileting.

Inactive sleepover shifts usually commence at 10pm through to 6am the following morning, however commencement times may vary to suit individual client preferences.

Inactive sleepover shifts include one hour of unscheduled active support, measured in 30 minute increments.

Active support

Active support means the support worker stays awake and works with the client on planned or scheduled activities. Examples of activities considered to be active support include, but are not limited to the following;

  • Assistance with personal care such as toileting and continence management
  • Medication and pain management
  • Managing spasms, turning and repositioning
  • Assisting ventilated clients who require suctioning
  • Assisting clients in altered states of consciousness
  • Assisting clients with medical needs requiring frequent attention
  • Activities to reduce behaviours of concern, including implementing strategies identified in a client’s positive behaviour support plan.

Transitioning from a sleepover shift to active support

If a client unexpectedly requires more than one hour of active support during an inactive sleepover shift, the additional active support hours will be paid at the appropriate hourly active support rate for weekdays (Monday to Friday) or weekends (Saturday or Sunday) or applicable public holiday rates.

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 active overnight support rates. The change of hours is managed as a variation via the TAC’s Care On Line system. An example of weekday billing when transitioning from inactive to active support is provided in the table below.

The TAC may request supporting documents from services providers to demonstrate the time and tasks undertaken during active support hours, particularly when transitioning from an inactive sleepover shift to active support. A task log template has been developed for this purpose and is available from the TAC client’s Support Coordinator or our website.

Billing example for transitioning from sleepover shift to active support (IRQS providers)

Active hours within an inactive sleepover shift

Billing codes*

Example for weekday rates for IRQS providers (2021-2022 rates)

0 – 1

Bill at inactive sleepover shift rate AT0025

$215.48

1 – 2

Bill at inactive sleepover shift rate AT0025, plus 1 hour at AT0025 Weekday Active Overnight Care hourly rate or

AT0020 for Saturday or Sunday rate

$215.48

+  59.80

$275.28

2 - 3

Bill at inactive sleepover shift rate AT0025, plus 2 hours at AT0025 Weekday Active Overnight Care hourly rate

or AT0020 for Saturday or Sunday rate

$215.48

59.80

+  59.80

$335.08

3 - 4

Bill at inactive sleepover shift rate AT0025, plus 3 hours at AT0025 Weekday Active Overnight Care hourly rate

or AT0020 for Saturday or Sunday rate

$215.48

59.80

+  59.80

59.80      

$394.88

4 - 5

Submit COL variation to deduct sleepover shift and claim 8 hours at AT0025  Weekday Active Overnight Care hourly rate or AT0020 for Saturday or Sunday rate

$59.80

X   8

$478.40

5 - 6

Submit COL variation to deduct sleepover shift and claim 8 hours at AT0025  Weekday Active Overnight Care hourly rate

$59.80

X   8

$478.40

6 - 7

Submit COL variation to deduct sleepover shift and claim 8 hours at AT0025  Weekday Active Overnight Care hourly rate

$59.80

X   8

$478.40

7 - 8

Submit COL variation to deduct sleepover shift and claim 8 hours at AT0025  Weekday Active Overnight Care hourly rate

$59.80

X   8

$478.40

*Adjust for relevant active support rate, weekend rates if working on a Saturday, Sunday or public holiday

For the relevant rates, please refer to the Attendant care (IRQS) fee schedule or the Attendant care fee schedule.

On-call support

The on-call service is an alternative to 1:1 attendant care for clients who require occasional or ‘just-in-case’ assistance at night and / or during the day. It is a collaborative service between a monitoring service and an attendant care call-out service. The service is designed to operate 24 hours per day and 7 days per week.

Shared support

We can help pay for shared support, an attendant care service provided to two or more people – at least one of whom is a client – at the same time or as part of a small group. Shared support can be for a one off event or for regular attendance at a community group/recreational activity.

This service may be provided:

  • when two or more clients requiring attendant care services live together
  • where there is a particular activity that more than one client can engage in together, such as a concert or holiday

Training for attendant care support workers

We can help pay for training for an attendant care support worker if a client requires tailored support above the minimum care standards specified in IRQS and the training is not general in nature, such as familiarization with the client’s care plan.

We take into consideration a range of factors to determine if a training request is reasonable including:

  • the recommendations of treating health professionals
  • the type of training and frequency
  • the number of carers, including group training and hours required
  • options to deliver the training, for example face to face, carer manual, video

IRQS minimum training requirements for support workers

Service providers are responsible for ensuring support workers meet the following minimum requirements and for ensuring that competence in these requirements is maintained over time.

  • CPR
  • First aid - anaphylaxis
  • Food safety
  • Infection control
  • Manual Handling
  • Australasian Fire and Emergency Services Authorities Council (AFAC)  Fire Safety Awareness Training
  • Administration of medication
  • Understanding Abuse – Zero Tolerance

Requesting training for an attendant care support worker

Client specific training for attendant care support workers is usually requested by a member of the client’s treating health team. Whilst service providers and clients may request training for attendant care, it must be supported by clinical evidence from the client’s treating team.

How often will the TAC fund training for attendant care support workers?

We will work with providers to ensure training is reasonable and reflects the client’s needs. Frequent requests for training that are not in response to a change in a client’s health status or care needs, such as high staff turnover, may be an indication that the client’s care program is not optimal and should be reviewed.

In some instances there may be a need for more frequent training of attendant care support workers to ensure they have the appropriate skills to support clients. For example, to apply positive behaviour supports for clients in line with behaviour support plans or when new equipment or requirements are introduced for clients with complex or changed health conditions.

Who can deliver training for attendant care support workers?

Training is usually delivered by a member of the client’s treating health team, such as an occupational therapist, speech therapist or neuropsychologist. In some cases clients may have a detailed care manual or behaviour support plan containing key training material or guides. Clients and their treating health team may also prepare demonstration videos as an adjunct to these guidelines.

The Program Establishment Fee

We provide funding to service providers when establishing a care program for a new client. The funds assist in the recruitment and induction of attendant care support workers to their employer as well as development of care plans and rosters. It does not include client specific training.

Sole Support Worker Arrangements

The disability sector recognises that a client’s vulnerability may be increased when they receive support in their own home by the same and sole support worker for an extended period of time.  This risk is further increased when the client lives alone. The TAC expects that all clients are offered and provided supports and services by multiple support workers where possible.  Should sole-support worker arrangements be in place, the attendant care provider is responsible for ensuring the appropriate arrangements for initial and ongoing risk assessments and monitoring of quality and safeguarding oversight are in place. The TAC expects that in-home reviews with these clients is completed at least every six months.

Family and friends as paid support workers

The TAC does not support the employment of family members as paid support workers. This is intended to help preserve family relationships and to avoid conflicting responsibilities.

The term "family member" in this Provider Guideline is used to represent a person who is identified by the client as a member of their family, or part of their close personal support network. This could include but is not limited to an immediate or non-immediate family member, partner, household member, friend and/or legal guardian.

In some circumstances, it may not be possible to find suitable support workers for a client because of their location or exceptional support needs. An attendant care provider may consider employing a family member as support worker for short-term employment of up to three months, while other appropriate support workers are sourced. This arrangement may be extended beyond three months when the provider requires additional time to find an appropriate support worker. The attendant care provider must ensure that the family member is eligible to provide support in accordance with these guidelines.

The above approach to employment requests applies to any new employment of family members, even if they are currently or have been previously employed by another provider.

Prior to considering employment of a family member, the client or their team will need to provide evidence to the attendant care provider to demonstrate that all other avenues of sourcing non-family paid support have been explored and exhausted.

The TAC can pay for services to assist a client in finding suitable support workers, such as a Case Manager.

The attendant care provider is to advise the TAC of employment of a family member as paid support worker upon their commencement to any TAC funded program within 10 working days. The attendant care provider is responsible for communicating their decision regarding the family member’s request for employment to the client and/or the family member.

Paid attendant care provided by family members should not replace usual parental or caregiver responsibilities.

Existing arrangements involving family members

Existing arrangements will be reviewed individually and on an ongoing basis by the TAC, to ensure each client is receiving safe and quality care. Where possible, it is recommended that external support workers be introduced to the program. The TAC expects that the employment expectations below are met by existing family members employed by IRQS-registered providers.

Apart from the position on employing family and friends as paid support workers, all other expectations within this guideline apply to all support workers.

TAC’s expectations

All family members providing paid attendant care supports and services must be employed by a TAC IRQS-registered attendant care provider and meet all of the employment requirements of that provider.

It is the expectation of the TAC and responsibility of the attendant care provider to manage the family member’s employment like any other employee. This is to ensure the TAC client (the client) is receiving quality and safe supports and services, aligned to clinical need, best practice and industry standards.

The TAC expects the following is adhered to by the family member “employee” and all other employees of the attendant care provider “employer”:

  • The employer is to ensure the employee has demonstrated the competency to complete the role
  • The employee is to disclose the nature of the relationship with the TAC client to their employer
  • All standard employment requirements of the IRQS registered provider are met, managed by the employer as per usual processes. This includes but is not limited to:
    • Support worker screening as per the provider’s process and IRQS registration requirements (such as Police Check)
    • Attend and complete all mandatory training expected by the TAC and the employer (as listed above)
    • Undergo and meet supervision requirements of the employer
    • Adhere to any and all reporting requirements of the employer (such as duty sheets)
    • Adhere to all policies and procedures of the employer (such as manual handling, professional conduct)
    • Adhere to the relevant OHS/WHS regulations in your State/ Territory which includes reporting to the employer if an employee is not fit to complete usual duties
    • The TAC expects work hours are completed in line with the relevant Industry Award, ensuring only “ordinary work hours” of up to 38 hours per week are completed
    • The employee is subject to full requirements of the Disability Service Safeguards Code of Conduct (Code) if operating in Victoria, and all other State and Federal Codes of Conduct relevant to the provider in each State and Territory
    • An employment agreement must be signed between the employee and employer, to confirm the employment requirements align with standard conditions of employment
  • An employee must provide care in line with a client’s agreed Support Plan
  • The employee is to encourage a client’s independence and pursue recommended opportunities for independence building where possible, as recommended by a suitably qualified health professional
  • The attendant care provider must make reasonable attempts to arrange at least one other independent support worker to be employed on the program, to avoid care being provided solely by the family member(s)
  • The employer should complete a risk assessment prior to commencement of an attendant care program, to ensure a safe working environment with risk mitigation plan exists
  • Should a client or employee be dissatisfied with the attendant care service/support that is being provided, this should be discussed directly with the attendant care provider
  • The client and employee are to agree to regular program reviews, aligned to the attendant care provider’s processes. The TAC expects that this is completed in-home at a minimum of every six months. This is to ensure the program is being delivered in line with the client and employer’s expectations, to ensure the client is consulted where possible and to discuss progress in seeking alternative support workers
  • The client and employee are to agree to the TAC conducting a formal review of the attendant care program, at least annually
  • The attendant care provider should follow their own policies and procedures for supporting clients and responding to potential or actual abuse, neglect, exploitation and preventable injury
  • The attendant care provider is to contact the TAC should concerns exist or the need for a formal review of support be indicated

TAC’s role

The TAC will keep track of the program and expects reasonable progress is being made towards sourcing suitable independent support workers. The TAC can pay for additional support for the client to find support workers if required, such as case management services. The TAC may seek information from this provider regarding activities to source alternative support workers.

The TAC’s funding of care arrangements are subject to review at any time, should the TAC not be satisfied that the above requirements have or are being been met. The TAC may request information from the attendant care provider to demonstrate adherence to the above requirements.

The TAC will review the overall attendant care program annually or more frequently if required, to ensure the program continues to be clinically justified and is providing the best possible support and service for the client. The TAC will make decisions regarding attendant care hours based on clinical justification.

Other things to note

If your client has a severe injury, the discussion, referral and approval of services may form part of the independence planning process between the client's treating team and our TAC coordinator.

If your client already has an individualised funding package, attendant care services may be included as part of that.

How much we can pay

We can pay for services in line with our Attendant care fees.

What we cannot pay for

We cannot pay for:

  • shadow or supernumerary shifts
  • personal or incidental expenses, including meals
  • attendant care services for a person other than the injured client
  • general training to meet the minimum requirements of IRQS provider registration
  • training that is not specific to the needs of the client
  • training that is not approved by us prior to being conducted
  • training that is not supported by clinical evidence

Also see general items we cannot pay for.

For more information

Access our policy for Attendant care.