Case example
Due to his disability Ivan needs a medical or specialised bed. He also wants to get the bed upsized to a queen so that he can continue to sleep in the same bed as his partner.
Would we typically fund this?
No, we would not typically fund this. When we assess whether funding for a medical or specialised bed is reasonable and necessary, funding is typically approved for a king single sized bed. This is because it’s considered the sufficient size bed for an adult participant. The need for the upsized bed is not related to Ivan’s disability needs.
Why wouldn’t we fund this?
A bed is a piece of household furniture that’s found in most homes and used by the majority of Australians. Household furniture that most people are likely to have, is considered a day-to-day living cost. Unless the need for the furniture is due to your disability support needs, we can’t fund it.
To work out whether a support is reasonable and necessary for you, we consider the information you’ve given us against the framework of the NDIS Funding Criteria.
We look whether:
- the need for a type of bed is entirely as a result of your disability
- there’s enough justification for why a king single sized bed isn’t suitable for your disability needs
- there’s evidence on how the larger bed or mattress will potentially reduce the long-term cost of your other supports, for example you may need less home care support hours
- the bed is most appropriately funded by us, and not another mainstream service such as the health system
- it’s reasonable to expect families to fund the cost of upsizing the bed or buying a companion bed.
What else do we think about?
We won’t fund extra items that don’t relate to your disability. However, you may choose to pay extra from your own money if you would like to have:
- a larger bed, for example upsizing from the king single to a queen sized hi-low bed with the same specifications
- a particular brand, model or design of bed that otherwise has the same purpose
- add-on special features not related to your disability needs (e.g. Hypoallergenic)
Case example
Vidisha has been diagnosed with multiple sclerosis. She has reduced bed mobility, which means she often needs help to get in and out of bed. Due to discomfort, she finds it easier to breathe if she sleeps with her upper body at an angle rather than flat. Vidisha is married and lives with her partner. They currently share a queen sized bed together.
Vidisha applies for funding of a queen size Hi Lo bed. She supports her funding request with a letter from her therapist. The therapist recommends a Hi Lo bed to ease Vidisha’s sleeping problems and minimise risk when she’s getting in and out of bed with help.
When working out whether the funding for the queen size Hi Lo bed is reasonable and necessary, the planner looks at the information Vidisha has given against the framework of the NDIS Funding Criteria.
The planner takes into account whether the queen size bed:
- is required for Vidisha’s disability
- will reduce her need for disability supports or additional supports
- is a day-to-day living cost that is due to, or caused by, Vidisha’s disability support needs
- is something that is reasonable to expect the family to fund.
The planner also looks at factors such as:
- whether the requested bed will achieve what the therapist suggests, and whether there should be a trial of the bed to find out
- the cost of the queen size vs the king single bed and whether other options, such as leasing the bed and mattress, are better value for money
- whether other support options such as customised foam wedges to prop her up during sleep, could have the same effect
- whether the features of the requested bed will support Vidisha’s disability needs significantly better than the base model.
In Vidisha’s case, the planner assessed that:
- a Hi Lo bed to let Vidisha sleep in a semi-reclined position to help her breathing, is solely and directly as a result of her disability support needs
- a Hi Lo bed is effective and beneficial for Vidisha’s disability support needs, and value for money over other supports
- a king single Hi Lo bed is suitable for her disability needs, is more cost effective, and will get the same result in meeting her disability support needs, as a queen size Hi Lo bed
- as the purpose of upgrading to a queen sized Hi Lo bed was to share the bed with her partner, the cost of the queen sized bed is a day-to-day living cost that isn’t caused by Vidisha’s disability support needs.
- funding the king single bed takes into account what is reasonable to expect the NDIS to provide, while funding the queen bed is not.
Vidisha’s request for a queen size Hi Lo bed didn’t meet the reasonable and necessary requirements, including being value for money. Instead, a king single Hi Lo bed was a reasonable and necessary support and would be funded by the NDIS. The planner explained to Vidisha that she could upgrade the bed to a queen size if she decides to pay the extra from her own money.
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