Case
Nigel is an NDIS Participant who lives permanently in a residential aged care facility. He asks for extra funding for a support he needs. The aged care facility does not provide the support and Nigel needs it due to his disability support needs.
Would we typically fund this?
We may fund Nigel’s additional supports if they specifically relate to his disability. He needs to support his request with evidence, which we assess against the NDIS Funding Criteria to work out if the support is reasonable and necessary. Residential Aged Care facilities are expected to give NDIS participants the same supports they give to residents who do not have a disability.
Why would we fund this?
If you permanently live in a residential age care facility, you may be eligible for extra supports in addition to those that all aged care residents would normally receive. This includes supports such as additional daily living or personal care supports. You need to give us evidence from a suitably qualified therapist to explain why the level of care you get from the aged care provider doesn’t meet your disability support needs. The Aged Care provider should also give us information on the amount of support it provides so we can assess what extra support may be reasonable and necessary.
To work out whether a support is reasonable and necessary for you, we look at the information you have given us again the NDIS Funding Criteria.
What else might we fund?
We assess NDIS funding for participants living in residential age care using the same criteria as we assess participants not living in residential age care. This includes funding for disability specific supports that other aged care residents would not normally receive, such as:
- assistive technology specific to their needs
- behaviour intervention
- social and community participation.
This ensures that participants who have a plan and live in residential aged care facilities have comparable levels of NDIS support as participants living in the community.
Case example
Rajni is 62 and had a stroke that severely affected his left arm and leg. If he tries to hurry through tasks or is rushed, he has uncontrollable tremors and can become upset and confused. He becomes particularly distressed and agitated when he has to bath in a shower bed. Rajni requires some level of support for all of his daily care needs.
Rajni’s therapist recommends he receive funding for behavioural support to ensure proper measures are in place to reduce his distress. The therapist also recommends we provide Rajni with customised equipment so he can feed and shower himself without risk of injury to himself or others.
Rajni’s nominee sends the therapist report to us, requesting funds to:
- cover the cost of his behavioural support program
- modify his room so he can feed and shower himself.
When working out whether the funding for Rajni’s supports are reasonable and necessary, his planner looks at the information provided against the NDIS Funding Criteria. The planner considers whether:
- Rajni needs the supports solely and directly as a result of his disability needs
- behavioural therapy will be, or is likely to be, effective and beneficial for Rajni with regard to current good practice
- the cost of the modifications are value for money when compared with other supports available to Rajni for day-to-day living
- it’s more appropriate for other general systems of support to fund the support.
In Rajni’s case, the planner decides that:
- he needs the supports solely and directly as a result of his disability needs, for his mental confusion, behavioural impacts and functional impairment of his left arm and leg
- behavioural therapy will be, or is likely to be effective and beneficial in helping Rajni manage his mental confusion and behavioural issues, and it is the responsibility of the NDIS to fund these reasonable and necessary supports
- shower modifications will be, or are likely to be, effective and beneficial for Rajni as they will increase his independence and they represent good value for money as they will be of long-term benefit
- the modification to allow Rajni to feed himself without a care worker is a support that all age care residents would normally receive, that we already fund the through the cross-billing arrangements with Department of Health.
The planner concludes the:
- behavioural therapy and shower modifications are reasonable and necessary and we approve funding
- modifications so Rajni can feed himself are not reasonable and necessary, we decline extra funding for the support we already fund the through the cross-billing arrangements with Department of Health.
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