Respite care policy
The Victorian Workcover Authority (VWA) will pay the reasonable cost of Respite Care Services which are required as a result of a work-related injury or illness.
- What are Respite Care Services?
- Who is eligible for Respite Care Services?
- When will the VWA pay for Respite Care Services?
- Are there additional expenses the VWA will consider?
- How much Respite Care Services will be provided?
- When will the VWA not pay for Respite Care Services?
- Is prior approval required for the payment of Respite Care Services?
What are Respite Care Services?
Respite Care Services are services provided to assist workers with a work-related injury or illness who are being cared for at their place of residence (e.g. by family or household members) by giving workers and carers a short term break from their regular support routine. Respite care can be provided within a worker’s place of residence (e.g. by an attendant carer) or externally (e.g. accommodation facility such as an aged care facility, supported residential services (SRS), shared community housing, or a day program).
Respite Care Services are intended to assist the continuation of the primary informal support relationship between a carer and an injured worker whilst giving both the opportunity to rest and have a break
Who is eligible for Respite Care Services?
To be eligible for consideration of Respite Care Services, an injured worker, as a result of their work-related injury or illness, must:
- have a substantial physical, psychological, cognitive or sensory disability which was sustained as a result of a work related injury or illness
- require a significant level of ongoing daily/personal support, eg. hygiene, mobility, supervision etc.
- have a family or household member who provides to the worker a significant level of ongoing daily/personal support
- have been assessed by an occupational therapist and/or multi-disciplinary team, as requiring respite care.
When will the VWA pay for Respite Care Services?
Upon request by a medical practitioner, the VWA will consider paying the reasonable cost of Respite Care Services as follows:
- up to a maximum of 28 days of respite care during any one calendar year
- additional respite care beyond 28 days in exceptional circumstances (e.g. for a worker requiring significant daily support provided solely by family or voluntary carers or where the carer is elderly/infirm)
- the worker to attend an accommodation facility (e.g. group home, aged care facility) or day program
- additional support required to facilitate attendance at external respite care including travel and attendant carer costs
- attendant care to be provided to a worker in their usual residence.
Are there additional expenses the VWA will consider?
Whilst an injured worker is receiving respite care services in an accommodation facility such as an aged care facility, SRS, shared community housing or participating in a day program, the VWA may consider authorising payment of the cost of attendant care services as well as the accommodation costs.
How much Respite Care Services will be provided?
The amount of respite care to be provided in any given calendar year is to be determined after considering the following:
- the ongoing support needs of the worker
- the reasonableness of the amount of respite care requested taking into account the ongoing support needs of the worker
- the type of activities undertaken within a worker’s approved support program or individual plan if participating in the Community Integration Program
When will the VWA not pay for Respite Care Services?
The VWA will not pay for:
- services that are required for an injury, condition or circumstance existing before the work related injury was suffered
- services that are not required as a direct result of the work related injury
- the respite carer undertaking additional duties not directly related to the support of the worker, e.g. household tasks or care of other family members
- normal daily living costs incurred whilst the worker receives external respite care such as accommodation costs (rent, utilities payments) and food additional to that provided as part of the respite care
- additional costs incurred as a result of the injured worker, family or carer choosing a respite care option which offers a higher level of support than is required to meet the injured worker’s needs, e.g. a worker who requires low-level support (group home) wanting high-level support (nursing home)
- respite care provided by a family or household member residing in the same household as the worker.
Is prior approval required for the payment of Respite Care Services?
Prior written approval for Respite Care Services is required. Request for the provision of Respite Care Services must come from a Medical Practitioner.
