Participants with a degenerative condition

When we say degenerative condition we mean a disease or condition with progressive and irreversible loss of function. This means the things you can do change and your ability to do tasks declines over time.

Case example

Neil is 43 years old and lives with his wife and 12 year old daughter in a home they own. Neil lives with primary progressive multiple sclerosis and has high physical support needs due to his degenerative condition.

Neil’s plan includes funding for up to 6 hours support each day to help him with his self- care. Neil’s motor control, memory function and bladder and bowel control is getting worse. He is experiencing problems with his balance, problem solving and concentration as well as fatigue and heat sensitivity. He needs extra help with his personal care and mobility in his home. Neil also needs help so he doesn’t wander from home and to safely transfer in and out of bed and his wheelchair.

Neil’s goal is to be as independent as possible in his home and community. Neil’s allied health practitioners have completed an updated functional capacity assessment. The assessment shows Neil now needs more help with all his bathing, dressing and eating activities. It recommends extra support because of his neuropsychological function, like help to remember to turn off the stove.

The report recommends a hoist to assist with Neil’s transfers and modifications might be needed to make sure his home is accessible now and in the future. A second person is needed to help with his transfers to make sure he and his carers are safe.

Would we fund this?

Yes, we could fund rental of a hoist while a more permanent solution is investigated. We could also fund more personal care supports and 2 people to help with Neil’s transfers while we investigate if modifications might be needed to Neil’s home:

  • so he can remain in his home
  • so he can function safely in his home
  • to help maximise his independence and his functional skills.

Why would we fund this?

To decide if a support is reasonable and necessary for Neil, we think about the information he has given us against the NDIS funding criteria.

For us to fund more supports for Neil it must meet the all of the NDIS funding criteria. It must:

  • help Neil to pursue his goals  to remain at home and be more independent
  • help Neil improve his social and work activities 
  • not generally be something that could be given by Neil’s family or friends 
  • will be, or is likely to be effective and beneficial  in helping Neil
  • be value for money, which means that the costs of the increased support, is reasonable when comparing the benefits it will give, versus the cost of alternative supports . We think about whether the increased supports achieve the same independence and functional outcomes for Neil as alternative available supports.
  • be something we are responsible for providing. 

What else do we think about?

When we decide whether we should fund these supports for Neil, we think about:

  • his supports as a total package. Equipment or assistive technology may be needed to help with his personal care for example
  • other options like flexible equipment rental or supports to build Neil’s capacity to stay at home
  • if it’s appropriate for informal supports to provide personal care
  • if the extra support for Neil’s personal care will make sure Neil is safe in his home
  • Neil’s future needs and whether he can stay in home in the long term. We may need to fund home modifications for Neil in the future. 

The planner decides:

  • providing additional personal care to Neil is not the responsibility of his family and friends so increases the hours of personal care in Neil’s plan to 8 hours a day
  • to include funding for a 2:1 ratio of supports in his plan for 3 hours a day for his safe transfers
  • a package of flexible equipment rental is cost effective for Neil’s immediate support needs, and as his needs change
  • to include funding for an OT assessment to explore whether any home modifications would support Neil to remain in his home in the future
  • to schedule regular check-ins with Neil to make sure his current plan has the right supports as his needs change.

When we create a plan we must think about supports as a total package of supports. To help us to do this we use the principles we use to create your plan.

For more information, refer to:

This page current as of
4 October 2022
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