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Purpose of this support material
This resource supports occupational therapists (OTs) engaged by WorkSafe, WorkSafe authorised agents and self-insurers to complete a Household help services needs assessment (HHSNA).
It outlines the following.
- The intent and scope of a HHSNA.
- Expectations for assessment practice and recommendations.
- How to support workers with independence and reablement.
- How to complete the assessment using WorkSafe’s HHSNA form.
- How to align recommendations with Victorian legislation and WorkSafe guidelines.
This resource will also help OTs to explain the assessment to workers.
Reference to WorkSafe throughout also includes WorkSafe’s authorised agents and self-insurers.
Purpose of the assessment
A HHSNA is a functional assessment of a worker’s capacity to manage common household tasks after a work‑related injury or illness. These tasks include cleaning and gardening, including one‑off annual tasks.
The assessment identifies strategies to maximise and maintain a worker’s independence. This includes consideration of:
- self‑pacing strategies
- task modification
- gradual reduction of services
- the prescription and trial of adaptive household equipment, where clinically appropriate.
The OT’s recommendations will help agents determine if household help services and/or adaptive household equipment are reasonable and necessary as a result of the accepted compensable injury.
The assessment must be:
- completed by a WorkSafe‑registered OT
- conducted using WorkSafe’s HHSNA form
- returned to the worker’s agent.
Assessment referral process
If an agent determines a HHSNA is required, a referral will be issued. Referrals will include relevant claim details, any existing household help services, and identified safety risks.
Supporting documentation will typically include:
- Household help worker’s declaration form
- Treating health practitioner’s household help request form.
If the referral does not contain enough supporting information, additional information should be requested before it is accepted.
OTs are expected to review referral information carefully to determine if they are appropriately qualified to complete the assessment. For example, the referral may involve a complex mental injury claim. If they feel they are not qualified, the OT must notify the agent they are unable to accept the referral.
If available information indicates a worker is unlikely to be eligible for the requested services, the OT must consult with the agent before accepting the referral.
The assessment must proceed only when a clear and specific need has been identified and agreed.
Assessment form
OTs must use the approved WorkSafe HHSNA form to conduct the assessment. All sections and questions must be completed in full. If this is not possible, clear clinical reasoning must be provided as to why. Additional rows or information can be added where appropriate to support your assessment.
The HHSNA form must not be used for assessments relating to:
- home or car modifications
- personal or attendant care
- childcare
- community access
- equipment other than adaptive household equipment.
Assessment of equipment types other than adaptive household equipment must be completed using the Equipment prescription form and in line with the Equipment and related services guidelines.
Assessment of service types outside the scope of a HHSNA should be conducted using the appropriate WorkSafe forms (where available) and processes.
Refer to the relevant guidelines for details or contact [email protected].
How to use the form
The HHSNA form is provided as a Word document to optimise usability.
- Text boxes will expand when typing.
- Add additional rows in tables by using the ‘Tab’ key.
- Extend the length of tables by using the mouse.
Additional instruction and guidance has been included throughout the form.
Additional information that doesn’t fit into any section of the form can be included:
- on the final page in the text box for further comments
- as an attachment and noted in the ‘Enclosed attachments’ section.
Billing and fee schedules
HHSNA assessment
HHSNA item codes can only be billed when the approved HHSNA form is completed in full.
Assessments completed on custom or adapted templates will not be paid.
Adaptive household equipment
Equipment trials for adaptive household equipment conducted as part of the HHSNA are covered by the HHSNA fee.
The equipment prescription fee may be billed only where both:
- a separate trial and prescription are required
- approval has been provided by the agent.
The equipment prescription fee is not payable for form completion alone.
Adjustments requested by the agent or the WorkSafe Clinical Panel as a result of recommendations falling outside policy are covered by the initial assessment fee.
Roles
Occupational therapist
The OT’s role is to assess the worker’s functional capacity to perform household tasks. They must also provide clinically justified recommendations relating to:
- independence with household tasks
- household help services or adaptive household equipment related to the accepted compensable condition.
OT recommendations will inform agent determinations about what is reasonable and necessary to be funded under the scheme. They do not constitute approval for services or equipment.
The OT is responsible for contacting the worker to arrange the assessment.
Claims manager
The role of a case manager at an authorised agent, self-insurer, or WorkSafe is to determine eligibility and liability for funding of requested household help services and/or adaptive household equipment items.
They make this determination by considering the assessing OT’s recommendations alongside legislation and guidelines under the Workplace Injury Rehabilitation and Compensation Act 2013 and the Accident Compensation Act 1985.
The case manager is responsible for communicating this determination to the worker.
If a determination needs to be made by a specific date, claims managers should clearly communicate to the OT when the report is due. This will allow the OT to consider and plan for the worker’s availability, treater contact and recovery planning.
Communicating with the worker
Clear and consistent communication supports effective assessment and expectation management.
Workers should understand the following.
- The purpose of the assessment.
- The importance of functional observation.
- That OT recommendations do not guarantee service provision.
- That funding determinations are made by the agent in line with legislation and guidelines.
- That fees or co‑contributions may apply in some circumstances.
It is best practice for OTs to avoid sharing their recommendations with the worker before an agent determination. If discussion occurs, it is important the OT makes it clear to the worker that recommendations are subject to guideline consideration and determination processes.
Helping workers achieve independence
All HHSNAs must be completed with a reablement focus. This means prioritising assistance and strategies that support a worker to maximise their independence and gradually resume household tasks where safe and appropriate.
During the assessment, OTs should complete the following.
- Directly observe and assess a worker’s functional capacity, where safe to do so.
- Identify strategies to increase capacity.
- Explore opportunities for task modification.
- Consider the reasonable contribution of other household members including the reasonable redistribution of tasks. See the section, Reasonable contribution of other household members.
- Consider adaptive household equipment prescription to improve independence.
- Create a clear plan to build the worker’s capacity and reduce services over time.
- Contact the worker’s treating medical practitioner and/or therapy team. This may include the certifying practitioner, a physiotherapist and/or a psychologist.
- Discuss the Recovery and services plan with the worker and any relevant parties, such as the claims manager.
Household help should not be used as a sole motivator or incentive to return or remain at work. Household help can be used to assist someone when they are returning to work while they continue to build their capacity and return to duties. Services will be reviewed following a successful return to work to determine if services are still reasonable and necessary.
Conducting a Household help services needs assessment
Before the assessment
OTs will need to review the following before beginning an assessment.
- The referral, including the agent’s reason for requesting a HHSNA.
- The worker’s Household help workers declaration form. This provides information about the worker’s personal and social circumstances and their home.
- The treating health practitioner’s Household help request form. This provides previous capacity assessments, if any, and clinical rationale for services.
- WorkSafe’s Household help services guidelines.
- WorkSafe’s Equipment and related services guidelines.
- Clinical framework for the delivery of health services.
- Any additional documentation provided by the agent, as indicated on the referral form.
OTs should conduct their own risk assessment before attending the worker’s home.
Safety tips for a Household help services needs assessment
The safety of OTs and workers is WorkSafe’s upmost priority. The OT and the agent must work together to make sure it is safe and appropriate for an assessment to occur in a worker’s home.
OTs should consider the following.
- Review all referral information and consider if they are appropriately qualified to conduct the referred assessment. It is OK to not accept a referral.
- Speak to the case manager about any safety concerns. These may include, but not limited to, animals in the home, unsteady ground, hoarding, weapons in the home or a worker’s history of aggression or violence toward self or others.
- Make sure the agent has contacted the worker to explain the purpose of the assessment.
- Request additional support from the agent as appropriate, such as approval for 2 OTs to attend the home at the same time.
- Conduct a risk assessment before entering the home.
- Leave the property if it is unsafe to complete the assessment. If this occurs, the OT should contact the agent and document the reasons the assessment could not be completed in their report. The OT may also wish to debrief with a suitable colleague.
- Contact Emergency Services on 000 in case of emergency.
The assessing OT is strongly recommended to contact the appropriate treating providers before the assessment to make sure assessment is appropriate and safe. Treater contact is especially important for mental injury claims where a worker can feel vulnerable when it comes to their capacity to complete household tasks.
Worker history
The purpose of this section is to provide context and allow the worker to tell their story. Here, the OT can include the worker’s:
- current and past symptoms
- previous household help services
- return to work history.
Non-compensable, pre-existing or age-related health conditions
WorkSafe will not pay for services related to non-compensable injuries or illness, including age-related decline. Similarly, WorkSafe will not pay for increases in service provision required because of changes in capacity related to non-compensable, pre-existing or age-related conditions. In these circumstances, workers may be eligible for assistance through other government or community services. These may include My Aged Care or local council supports.
Home environment
- Residential address at the time of injury
WorkSafe considers the size and nature of worker’s residential address at the date of injury when assessing if household help services are reasonable and necessary. The OT should outline this information if the worker has moved since their injury or illness.
If a worker relocates to a different residential address following their injury, WorkSafe will not pay for increased service costs as a result of relocation.
- Providing photos of the home environment
Photos provide valuable context for the case manager about the home environment. The OT should seek permission from the worker to photograph their property and home environment for the purpose of this assessment.
Pre-injury capacity and supports
- Pre-Injury household activities and tasks
In this section, the OT should list the household activities or tasks performed before the worker’s injury or illness and who was responsible for the tasks.
WorkSafe will pay for household help services only for household tasks the worker performed themselves before their work-related injury or illness. WorkSafe will not pay for services that were already being provided by paid or purchased services before the injury or illness. For example, if the worker had a cleaner or gardener pre-injury.
The assessing OT can add more rows to this table if required.
- Current supports being provided to the worker
The OT should list here the informal and formal supports being provided to the worker following their injury or illness and who is now responsible for these tasks. For example, Task: vacuuming, Frequency: once a week, Persons responsible: cleaner, Finance type: WorkSafe.
- Barriers to household members and other informal supports
The OT should document any barriers to other household members or other supports completing household tasks. See the section, Reasonable contribution of other household members.
- Reasonable contribution of other household members
Household help services funded under the WorkSafe scheme are not intended to replace the ordinary responsibilities of other household members. Neither are they intended to maintain pre‑injury household standards or arrangements. A full replication of pre‑injury arrangements is not an entitlement under the scheme.
Before household help services are considered or continued, the reasonable contribution of other household members toward household task completion must be explored. If a worker is unable to perform household tasks due to a compensable injury, adult household members are expected to contribute to the running and maintenance of the household to the extent that it is safe and reasonable.
Paid household help services should only be considered after both:
- reasonable redistribution of tasks has occurred
- occupational therapy strategies to maximise the worker’s independence have been implemented, including:
- adaptive household equipment recommendation
- task modification
- self‑pacing and scheduling strategies across the day or week.
WorkSafe expects that the following will occur.
- Tasks may be redistributed among household members.
- Household routines may be modified.
- Expectations about frequency of task completion, methods and standards may be adjusted where safe and reasonable.
Full‑time employment or study or a combination of both by another adult household member is not a sufficient reason for an inability to contribute to household tasks.
If household members can reasonably increase their contribution to the completion of household tasks, this must be considered in preference to ongoing household help services.
WorkSafe will not pay for services that extend to other adult household members. For example, cleaning that relates solely to a spouse or adult household member, even if the worker performed those tasks pre‑injury. Similarly, WorkSafe will not pay for services that address the injury, illness or physical restrictions of household occupants other than the worker.
If other household members are unable to make a sufficient contribution to household tasks, or there is residual unmet need, occupational therapy intervention to maximise the worker’s independence must occur before household help service provision.
- Functional assessment
A functional assessment involves direct observation of the worker performing household tasks, where it is deemed safe. Where direct observation is not possible, the OT must document how capacity has been determined. For example, worker reported, treating practitioner input.
Workers may be cautious due to pain or fear of aggravation. OTs should balance safety with the need to observe functional performance sufficient to determine reasonable and necessary supports. It is also important for workers to understand the importance of engaging in the assessment. They should also understand that if they do not participate safely, it may be difficult to determine what services are reasonable and necessary.
- Patient reported outcome measures
The first principle of the Clinical Framework outlines the importance of measuring and demonstrating the effectives of treatment and services through use of outcome measures.
Patient-reported outcome measures (PROMs) are validated questionnaires. They measure a person’s perception of their health, symptoms, quality of life, and daily functioning. Poor or low PROM scores do not mean a worker is more likely to receive household help services. Rather, they provide meaningful information about how a worker’s injury or illness impacts them.
The OT may administer any clinically indicated PROM or risk measure. Some examples include:
- Patient Specific Functional Scale (PSFS)
- Upper Extremity Functional Index (UEFI)
- Lower Extremity Functional Scale (LEFS)
- Modified Bartel Index
- Lawtons Domestic ADL Assessment
- Oswestry Disability Index (ODI)
- Falls Risk Assessment Tool (FRAT)
- Depression Anxiety and Stress Scale 21 Item (DASS-21).
The assessing OT can also record PROM scores previously reported by other providers and/or assessments in this section and make comment on any measurable changes in reported capacity.
In this section, the OT should directly observe a worker completing household tasks to understand their functional capacity. This includes activities such as vacuuming, washing clothes.
For each task, the OT should note if the worker was observed participating and if not, how the information was sourced. For example, directly observed or reported by worker or treating health practitioner.
- Functional capacity and mental injuries
Mental injuries can influence a worker’s mood, behaviour and executive function, and can make them feel overwhelmed when it comes to organising and completing household tasks. While a worker may have the physical capability to perform household tasks, they may struggle because of their work-related mental injury. Coordinating an approach with the treating health providers, such as psychologists and GPs, are critical to make sure workers feel safe, meet goals and rebuild their capacity.
The assessing OT should comment on a worker’s:
- presentation (of self and home)
- mood
- participation
- pre-existing capacity
- barriers to task completion, for example, lack of motivation.
It is important that people living with a mental injury are encouraged to engage in household tasks and self-care. If they have been receiving household help services, a graded return to tasks may be appropriate to make sure workers can manage themselves and their homes.
- Environmental and personal barriers to independence
Environmental factors include the following.
- The attitudes of others. For example, family, community, cultural group, colleagues.
- The availability of communication support. For example, interpreters or culturally appropriate resources.
- The availability, proximity, and accessibility of services, including rehabilitation services.
- Family expectations.
- The physical environment.
Personal factors may include the following.
- The ability to communicate.
- Beliefs and values.
- Culture.
- Engagement in the rehabilitation process.
- Education.
- Health literacy.
- Life roles, for example, parent, worker, student, friend.
- Motivation and self-efficacy.
- Incidental observation and other commentary
There may be discrepancies between the worker’s reported function or function reported by other treating practitioners and what the OT observes during the assessment. Workers may be guarded in their movements out of fear of pain and avoidance as well as day to day fluctuations in capacity and anxiety about the assessment.
Where information in supporting documentation is incorrect or no longer accurate, this should be documented and interpreted using clinical reasoning, recognising recovery progression, variability, and psychosocial influences. For example, worker’s capacity has improved post-surgery since the initial household help request.
Services and recovery plan
- SMART goals
SMART goals align with Principle 4 of the Clinical Framework – Implement goals focused on optimising function, participation and return to work.
- Goals should be developed in conjunction with, and agreed to by, the worker.
- Goals should be functional and SMART: specific, measurable, achievable, relevant and timely.
Progress toward goal achievement should be regularly assessed and goals reset or modified as necessary.
- Services and recovery plan for long-term injuries
Some workers may have been receiving household help services for a long time and be used to these services. It’s important for workers to safely engage in their household tasks with a sense of purpose and capability.
SMART goals are always relevant and necessary to achieve optimal recovery outcomes. This includes workers with long-term injury and/or service provision. Consider exploring short-term and achievable goals that will support worker empowerment. These goals should be developed and implemented in collaboration with treating health practitioners.
Goals promote independence, improve function and participation, and prevent the worker from significantly deteriorating from their current level of function.
SMART goals can focus on:
- participation in routines
- energy conservation
- quality of life.
Example SMART goal: Over the next 3 months, the worker will actively plan and prioritise vacuuming and mopping tasks and participate in these activities within their physical tolerance.
- Treater contact
Conversations with the worker’s treating health practitioners are an important component of supporting the worker to meet their functional goals. Having the entire treating team support their journey toward independence in the home can help reduce worker anxiety and build their confidence and capacity for non-household related tasks.
Getting in touch with providers can be difficult. It is recommended the assessing OT contact the treating health practitioner prior to the assessment to set a time to discuss its outcomes.
Two attempts at contact is reasonable. If the OT is unsuccessful in speaking with the worker’s treating health practitioner, the assessment recommendations can be emailed or faxed to them.
The OT may also request a case conference with the case manager and treating health practitioner to discuss HHSNA outcomes.
- Summary of recommendations
The appropriate boxes should be checked based on the recommendations of the OT. These should be drawn from the recorded assessment observations. Where appropriate, more than one recommendation type can be selected.
The summary of recommendations is not a guarantee of provision or non-provision of services.
Clinical justification helps agents to determine if provision or non-provision of services and/or adaptive household equipment is reasonable and necessary. OTs should provide as much information as possible.
- Adaptive self-management techniques or strategies
Remaining active and undertaking household tasks may improve a worker’s recovery and independence. These tasks can include physical activity, routine planning and executive function. Adaptive self-management techniques or strategies should be considered and explored in preference to ongoing paid services.
- Informal supports
Informal supports can include household members who live with the worker or other family and community members. These people can support the worker with their household tasks while they recover. See the section, Reasonable contribution of other household members.
- Adaptive household equipment
For information on equipment, refer to the WorkSafe Equipment and related services guidelines.
If the worker's injury means they cannot return to completing household tasks as they did pre-injury, adaptive household equipment may be considered to help them maximise their independence. This is in accordance with the Household help services guidelines.
Types of adaptive household equipment include the following.
- Household cleaning equipment, such as a stick vacuum or steam mop.
- Lightweight gardening equipment, such as a battery powered mower or trimmer.
It is expected that supply of adaptive household equipment will replace or reduce the need for WorkSafe funded household help services. Where a graduated reduction of services is indicated, the prescribing health professional must document a plan to reduce services over a defined time period. This must include a graded activity program, outcome measures, complexities/barriers, and defined review points. This plan should be developed in consultation with the worker’s treating team and submitted to the agent for approval.
WorkSafe will generally not pay for, or partially pay for, the following adaptive household equipment.
- New equipment where the worker’s existing household equipment will meet the need.
- Household equipment required regardless of the work-related injury or illness.
- Any running costs, related consumables or spare parts.
- Maintenance, repairs or replacement.
- Equipment supply cost for any secondary residence or holiday home.
- Equipment supply cost where the worker moves to a new property post-injury which requires additional maintenance to their pre-injury residence.
- Any upgrades to, or superior models of, equipment where the base or standard model meets the worker’s injury-related functional requirements.
- Equipment model considerations
In cases where the assessing OT believes the base model of equipment is not clinically sufficient, justification and reasoning must be provided. This justification must explain how the item relates to the work-related injury and/or illness and why superior item features or functions are necessary to meet the worker’s needs. This will be considered when determining liability for the model type. For example, WorkSafe may not pay for upgraded long-stick vacuums with specific attachments or auto-empty dustbins if the base model meets the worker’s injury-related functional requirements.
Workers are required to contribute to non-standard or above-base model equipment item costs, where the base model meets the worker’s injury-related functional requirements. It is recommended this is discussed with the worker before assessment recommendations are finalised.
- Trials of adaptive household equipment
Trialling equipment is important to ensure it is safe for the worker to use. It can also make sure the worker feels confident using the equipment.
Trials of adaptive household equipment can occur within the HHSNA assessment or as a separate trial, depending upon the type of equipment and the clinical appropriateness.
If a trial is deemed unnecessary or inappropriate, the clinical rationale for not trialling the equipment should be documented on the HHSNA form.
Trials may be completed at the supplier store or within the worker’s home.
It is expected that prescribing therapists conduct trials of items available from WorkSafe contracted equipment suppliers before recommending any items from a non-contracted supplier.
Recommendations for items from non-contracted suppliers must include clinical justification of why WorkSafe contracted equipment supplier products did not meet the worker’s needs, and why the alternate item is clinically necessary. Details of the WorkSafe equipment contracted suppliers are available from WorkSafe’s website.
When conducting a trial, the OT must make sure the worker has either used the equipment, a comparable type of equipment or that their capacity can be reasonably determined through observation of similar movements. For example, push and pull motions with stick vacuum and broom are similar.
Heavy weight gardening equipment is not considered adaptive household equipment and requires a separate trial and equipment prescription form.
Automated cleaning and gardening equipment and high value items may require a clinical panel review.
Ride-on-mowers and related equipment items are not considered adaptive household equipment and require a separate process for trial and approval including ride-on-mower equipment prescription form. For information on ride-on-mower assessment and prescription, refer to the equipment and related services guidelines.
Household help service provision
- Make recommendations within guidelines
OTs are required to provide clinically justified recommendations that are aligned with WorkSafe’s guidelines. This ensures recommendations are appropriate, support clear decision making, and avoid the risk of unintentionally misleading workers about service entitlement.
- Recommendations must be related to a work-related injury
WorkSafe can pay the reasonable costs of household help services a worker needs as a result of a work-related injury or illness under the Victorian workers compensation legislation.
The treatment or service must meet the following criteria.
- Be clinically justified, safe and effective.
- Be likely to achieve measurable improvement in a person’s functioning.
- Promote progress toward a person’s functional independence, participation and self-management.
- Be for rehabilitation purposes for a work-related injury only.
- Be delivered in line with the Clinical Framework.
- Reasonable household help services
Household help services should be recommended in 6 to 12 week blocks, with opportunities for building capacity and reducing services, where appropriate.
For housework and cleaning, 1 to 2 hours a fortnight may be reasonable. This is unless additional time is requested with justification on the referral form.
Lawn mowing and edging, and primary garden tasks should be considered for fortnightly service during summer (1 October – 31 March) and monthly service during winter (1 April – 30 September).
For primary gardening tasks, an hour in addition to lawn mowing and edging services can be considered.
Reasonable garden maintenance relates to land immediately surrounding the property, including nature strips. Generally, WorkSafe will not pay for garden maintenance to the property outside of the immediate vicinity.
One-off cleaning and gardening can be considered for the following.
- Additional annual cleaning tasks such as cleaning exhaust fan, oven, light fixtures, window cleaning and thorough floor cleaning.
- Light pruning of trees.
- In fire prone or regional areas, general clearing of garden debris around the immediate vicinity of the house.
WorkSafe will not pay for one-off cleaning and gardening. Thos includes the following.
- Other services that would require a professional to complete, for example, decluttering, solar panel cleaning, vacate cleans, chimney cleaning and arborists.
- Home or furniture maintenance, including cleaning of drapes, blinds or carpets.
- Property maintenance or repair, including painting, watering, fertilising, applying pesticides to gardens, or maintaining paving.
For the full list of what WorkSafe will and will not pay for, refer to Household help services guidelines.
- Requests outside of assessment scope or WorkSafe guidelines
An assessing OT may notice a worker may benefit from household support services or equipment not covered in the scope of the HHSNA referral. This can be documented at the bottom of the report. The OT should also raise the matter with the worker’s case manager.
If a worker asks for a service or equipment item outside the scope of the referral to be reviewed during the assessment, the OT should advise them to speak with their case manager and treating health practitioner.
Report recommendations must align with WorkSafe’s guidelines. If an OT’s report recommendations are repeatedly outside of guidelines, they may be referred to the WorkSafe Clinical Panel for review.
Support for occupational therapists
- WorkSafe Clinical Panel
WorkSafe Clinical Panel provides advice to WorkSafe and agents on claims and policies. The Panel may contact OTs to provide coaching on assessment expectations.
- Clinical Panel Support Services
The support service is available to provide clinical advice. OTs can engage in peer-to-peer discussions about available treatment and services.
- Clinical framework for the delivery of health services
OTs conducting assessments for WorkSafe are expected to adhere to the principles outlined in the Clinical framework for the delivery of health services. These principles are endorsed by professional bodies, including Occupational Therapy Australia (OTA). They guide evidence-based, goal-oriented, and client-empowering practices.