On-Call Service. June Definitions. Background. Guidelines for providing on-call services to injured workers

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1 On-Call Service Guidelines for providing on-call services to injured workers June 2014 The WorkSafe Agent (the Agent) can pay the reasonable costs of an on-call service for eligible workers when required as a result of a work-related injury or illness under Victorian workers compensation legislation (the legislation). The Agent will periodically review a worker s entitlement to on-call services to ensure that the service remains reasonable for the work-related injury or illness and is payable under the legislation. Background The on-call service offers an alternative to an attendant carer providing attendant care services in a worker s home. It can provide remote 24-hour monitoring of a person who may require assistance with non-emergency medical or personal care needs. The worker is provided with a pendant or device to trigger a phone call to a monitoring service, which then initiates contact with the worker to assess appropriate support. Once an assessment is made, the monitoring service will then contact one or more of the following: emergency services, the worker s nominated contact person (i.e. family/friend), and; an on-call attendant care agency (during the day and/or night). A worker may need an on-call service to: support their ability to live independently in their own home, or provide intermittent or occasional support needs This policy must be read in conjunction with the: Policy for Attendant Care. Policy for Equipment and Related Services. Definitions Attendant care is a support service provided to a worker at home or in the community to promote their independence and enable them to participate in all aspects of their lives, in accordance with the Attendant Care Policy. An attendant carer is a person who is appropriately trained and employed by an attendant care agency to provide attendant care services in a way that promotes independence and functional skills. A call-out is a minimum of 2-hours of active door-to-door service paid at the personal care hourly rate. A daytime on-call service is the on-call attendant care service which can be provided from the hours of 7am to 11pm, 7 days a week. A keysafe refers to a safe that is mounted outside the home. A medical alert device is a medical alert bracelet, pendant, vial of life and/or wallet card that a worker wears or keeps, with details of their medical, supervision, and emergency instructions. A monitoring service is a personal alarm and monitoring system comprising: a personal alarm which can be worn as a necklace pendant, watch or belt clip. A special sensitive button or blow switch can be used where a Note: This policy is a guideline issued by WorkSafe Victoria under Victorian workers compensation legislation in respect of the reasonable costs of services, and services for which approval should be sought from the WorkSafe Agent or self-insurer (as the case may be) before the services are provided. <Insert key code>

2 worker has limited or lack of muscle coordination a receiver unit and the required components that are plugged into the worker s telephone line (some monitoring services allow for units that do not require a telephone line) - this allows the signal to be received from the pendant and automatically dials the monitoring centre the monitoring station, which provides the 24-hour monitoring service Royal District Nursing Service (RDNS) Response Service - this service only applies to workers who have no nominated emergency contacts. An on-call service is a remote service for workers who require a low level of care during the day and/or overnight, but do not require an attendant carer to be constantly present and/or sleep over in their home. This service comprises two components: the monitoring service and the attendant care service. When a call is triggered the monitoring service will contact the worker first to establish which of the following calls will be made to provide appropriate support: contacting the worker s nominated contact person (for example neighbour or family member), or arrange a call-out for an attendant care service to provide personal care within a 30 minute period (such as personal hygiene), or arrange for an emergency response (such as police, ambulance or fire). An overnight on-call service is the oncall attendant care service which can be provided from the hours of 11pm to 7am, 7 days a week. Eligible workers are workers who have been approved by the Agent as eligible for the on-call service due to the severity of their work-related injury or illness Guidelines What can the Agent pay for in relation to an on-call service? The Agent can pay the reasonable costs of an on-call service for a worker where it is: medically necessary due to a work-related illness or injury identified as being the most appropriate and least restrictive response to a worker s needs requested by a medical practitioner and/or treating therapist. The Agent will consider whether the injured worker is suitable for the on-call service overnight and/or during the day, dependent on the worker s individual care requirements. Workers may be eligible for on-call services if: they have the physical and cognitive capacity to operate a personal alarm and to decide when it needs to be activated they live alone or live with someone who is unable to provide assistance they are not at risk of a medical emergency that may prevent them from using the service. For example, an injured worker with epilepsy or unstable diabetes may not be suitable for a personal alarm as they may be unable to activate the alarm due to seizure or hypoglycaemia they have identified independent living as a goal they receive, or request to receive attendant care services and require minimal or no assistance during the day and/or through the night

3 their need for care can be reduced with the provision of appropriate equipment. For example, a worker who previously required active attendant care for turning during the night is provided with an appropriate pressure care mattress and now only requires overnight on-call attendant care for personal care. Where a worker is eligible to receive oncall services, the Agent can pay the reasonable costs of: equipment provided by the on-call service in order to provide the service, such as personal alarm receivers, pendants and keysafes (including installation, delivery, transport and maintenance). the monitoring station the RDNS response service for workers with no nominated emergency contacts on-call attendant care provided as a support response, including a call-out fee where an attendant carer is required between the hours of 11pm-7am. A call-out includes a minimum of 2-hours of active door-to-door service paid at the personal care hourly rate. The Agent can also pay the reasonable costs of an ambulance and any hospital services required as a result of the workrelated injury or illness when the monitoring service deems this to be the most appropriate support response. Keys need to be made available to the nominated contacts or to the response service via a keysafe so that they can enter the home Who can provide the personal alarm and monitoring service? The monitoring service can only be provided by a 24 hour call service that provides monitoring equipment and services in accordance with Australian Standard Personal response systems, and is registered and approved by WorkSafe to provide this service to workers. Who can provide on-call attendant care? On-call attendant care in response to a monitoring service request must be provided by an attendant care agency that is registered and approved by WorkSafe to provide on-call attendant care services to workers. What information does the Agent require to consider paying for on-call services? Prior approval in writing from the Agent is required. The Agent requires a written request from the worker s medical practitioner and assessing or treating therapist confirming that an on-call service is appropriate for the worker s work-related injury or illness. In deciding whether the costs of on-call service are reasonable, the Agent will consider: the worker s pre-injury functional ability the estimated costs of the monitoring system the level of support within the household (excluding medical alert devices). When will the Agent respond to a request? Within 10 working days of receiving the on-call service request, the Agent will advise whether: the request has been approved the request has been denied, or further information is required to make a decision. Where further information is required, the Agent will advise whether the request has been approved or denied within 10 working

4 days of receiving the additional information. What are WorkSafe s invoicing requirements? Refer to the How to Invoice WorkSafe guidelines. What fees are payable for an on-call service? The Agent can pay the reasonable costs of an on-call service. In relation to an on-call service, what won t the Agent pay for? The Agent will not pay for: treatment or services for a person other than the worker fees associated with cancellation or nonattendance treatment or services provided outside the Commonwealth of Australia without prior written approval from the Agent treatment or services provided by telephone or other non-face-to-face mediums. Further information Contact the referring Agent, info@worksafe.vic.gov.au or refer to: How to Invoice WorkSafe WorkSafe Policy for Attendant Care WorkSafe Policy for Equipment and Related Services WorkSafe s Online Claims Manual Medicare Benefits Schedule (MBS).

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