Case
Josie feels her disability means her mattress doesn’t suit her needs. She thinks a pressure or hygiene mattress would help her sleep better or more comfortably. It would also help her to more safely and independently manage her bed transfers.
Would we typically fund this?
Yes, we typically approve funding for a pressure or hygiene mattress if you need it because of your disability.
You will need to give us evidence or information that the mattress you want:
- relates to your disability
- is value for money compared with alternatives
- is effective and beneficial .
Why would we fund this?
Mattresses are a common item in Australian homes. Household items that most people are likely to have in their homes are unlikely to be disability-related supports. This means we are unlikely to fund them.
If, however, you need a particular item because of your disability support needs, then we may consider it a reasonable and necessary support. For example, you might need specialist furniture designed for people with disability, or regular furniture that can be modified to help you do everyday tasks.
When we work out whether a pressure or hygiene mattress is reasonable and necessary for you, we assess the information you give us against the NDIS Funding Criteria. You will need to give us evidence or information that shows the mattress is a reasonable and necessary support.
This means the evidence or information must show that you need the mattress as a direct result of your disability. This may include information, such as an assessment or report from a registered therapist about your disability support needs. We may already have some of this information.
You would also need to show that the mattress:
- is value for money , including information about the cost and benefits of the mattress and why cheaper alternatives are not fit for purpose
- is effective and beneficial , such as information that the type of mattress has worked for you in the past, or is designed to work for people with similar support needs to you
- will be installed correctly and operated safely operated to ensure it doesn’t cause harm to you or your carers.
In most cases, if we decide to fund a pressure mattress, we will also fund delivery and installation costs.
What else do we think about?
Your planner will determine if the mattress is a reasonable and necessary support based on the NDIS Funding Criteria.
The mattress must be ‘value for money’. When we think about the benefits and costs of the mattress, we consider:
- whether mattress will be effective and beneficial for you
- the costs and benefits of the mattress, including how long it is likely to last, compared with other supports that would achieve the same outcome.
- if mattress is likely to reduce the long-term cost of other supports, for example fewer home-care support hours
- whether it’s possible and more cost-effective to rent the mattress.
We won’t fund extra items that are not reasonable and necessary. You may choose, however, to pay out of your own pocket for:
- a particular brand, model or design of an item
- special features not related to your disability needs, for example hypoallergenic.
Case example
Sam has a progressive muscle weakness and degenerative spinal condition. He finds it hard to sit up from a lying position and needs help from another person to do so. He often wakes up because he is uncomfortable, and finds it easier to breathe if he sleeps with his upper body slightly elevated at an angle, rather than flat. He can’t independently shift his weight to reduce pressure. Sam needs to use a bed rail to roll to his side. His sleeping problems make him tired, which means it’s hard for him to do daily activities independently.
Sam applies for funding of a Hi-Lo bed with rails, and a gel-infused pressure prevention mattress. Sam supports his funding request with a letter from his therapist, which also recommends a gel-pressure prevention mattress. Sam’s therapist believes this mattress will make sleeping more comfortable for Sam, minimise the risk of pressure problems and reduce his sleeping problems.
Based on available information, the planner is satisfied the bed meets the NDIS Funding Criteria, including that it is related to his disability. She lists the make and model of the mattress and bed to be purchased and includes funding in Sam’s plan.
However due to the cost of the requested mattress, she needs more information to work out if the gel-infused pressure prevention mattress requested by the therapist is:
- value for money
- likely to be effective and beneficial in meeting Sam’s current and long-term pressure care needs.
There are different ways to provide the extra information needed for us to make a funding decision. Sam chooses to trial the mattress with the help of his therapist to show its effectiveness. Trials can typically be arranged with equipment suppliers at no cost. In Sam’s case, the mattress was available from the local supplier so Sam could try out the mattress for 10 days. The trial report showed that Sam was able to be able to move around the bed independently and sleep the entire night without interruption because he was more comfortable.
To work out whether the funding for the mattress is reasonable and necessary for Sam, the planner assesses the information provided against the NDIS Funding Criteria.
When deciding if the mattress is reasonable and necessary, the planner thinks about such things as whether:
- there is a cheaper pressure mattresses available with the same performance and function
- the mattress Sam’s therapist requests has higher functionality than the base model needed for Sam to achieve his desired outcome.
- other options, such as renting the mattress, are better value for money
- funding the mattress may reduce the cost of other supports in the long term.
She also considers information from the trial, current good practice, or other expert opinion to work out whether the mattress will achieve the desired option.
In Sam’s case, following the trial, the planner decides that the gel-infused pressure prevention mattress is value for money. The costs are reasonable relative to the benefits achieved. Cheaper options are:
- unlikely to meet Sam’s support needs or achieve the same outcomes
- not as safe when Sam’s transfers from a power chair
- not suitable.
In making her decision she notes that:
- the mattress will help Sam manage bed transfers and reduce the cost of other supports in the long term
- renting the mattress is more expensive than buying it
- the mattress will be effective and beneficial for Sam based on the therapist’s advice and the trial.
The planner assesses Sam’s gel-infused pressure prevention mattress as a reasonable and necessary support approves funding for Sam to buy the mattress. The planner also includes funding for mattress delivery and installation.
For more information, refer to: