Supplements under home and residential care packages – are you eligible?

05 Aug 2013

The Living Longer Living Better (LLLB) reforms announced in April 2012 provided that from 1 August 2013 new supplements would be available in the Home Care Packages Program and Residential Care for the:

  • Dementia and Cognition Supplement in home care;
  • Dementia and Severe Behaviours Supplement in residential care; and
  • Veterans’ Supplements in home care and residential care for service related mental health conditions.

The final guidelines outlining the eligibility criteria have now issued.  Approved providers are able to claim supplements on top of the basic subsidies for care recipients provided the recipients meet the relevant eligibility criteria.

Home care

The funding will be provided for dementia care in all levels of Home Care, as well as for veterans with a mental health condition associated with their service.

Home Care Program package recipients may attract either:-

  • the Dementia and Cognition Supplement; or
  • the Veterans’ Supplement

You can never claim both.

The supplement rate is 10% of the basic subsidy amount payable for each of the 4 Home Care levels as outlined in the following table:

Home Care Package Level 1 Level 2 Level 3 Level 4
Home Care Package basic subsidy $20.55 $37.38 $82.20 $124.95
Dementia and Cognition Supplement (10%) $2.06 $3.74 $8.22 $12.50
Veterans’ Supplement (10%) $2.06 $3.74 $8.22 $12.50

The supplement will be calculated daily and paid to the Approved Provider on a monthly basis.

Residential care

Dementia and Severe Behaviours Supplement

The Dementia and Severe Behaviours Supplement in residential care provides funding for those residents with severe behavioural and psychological symptoms associated with dementia or other conditions.

Funding is provided on top of the basic subsidy delivered through the Aged Care Funding Instrument (ACFI) in recognition that the ACFI funding does not fully capture the cost of care needs of residents exhibiting these severe and complex behaviours.

Eligibility

The resident must:

  • have a relevant medical diagnosis; and
  • an Assessment of Severe Behaviours and Psychological Symptoms (using the ‘Neuropsychiatric Inventory – Nursing Homes’ (NPI-NH) assessment tool).  The NPI-NH assessment must be carried out by a registered nurse, clinical nurse consultant, nurse practitioner or medical practitioner and must be completed within the previous three months for payments to commence.

Approved Providers will be required to review a resident’s eligibility for the supplement every 12 months from the date of eligibility.

An assessment cannot be undertaken in the first 7 days of care.  In addition, an application to obtain the supplement cannot be submitted to DOHA inside the first 28 days of care.  If the application is accepted, Approved Providers will have their payments backdated to the shorter of:

  • the date of eligibility; or
  • a maximum of 56 days from receipt of a valid application.

This means you should lodge your application as soon as possible after the first 28 days to ensure you receive the supplement for the entirety of the time that the resident is in your care.

Process:

  1. Enter care
  2. Day 7- Day 28 
  3. Day 56 - Settle in NPI –NH Assessment Apply to DHS and payments commence from date of entry

Veterans’ Supplement

Approved Providers of residential care may also receive a Veterans’ Supplement to facilitate access to residential care for veterans with service related mental health conditions.  This is to ensure their service related mental health condition does not act as a barrier to accessing appropriate care.

Eligibility

All veterans who have an accepted mental health condition that the DVA has determined as related to their service will be automatically eligible to attract the supplement.  There is no requirement for any ongoing assessment of eligibility.

Approved Providers do not need to submit a claim for the Veterans’ Supplement.  DVA and Department of Human Services will match information to determine eligibility, but it would always be safest to confirm that your records match theirs.

Where a veteran meets the criteria for both the ‘Veterans’ Supplement’ and ‘Dementia and Severe Behaviours Supplement’, they may attract both supplements.

This is another step forward in what be a long journey into the reform of the care for the ageing population in Australia.