Guidelines for levels of attendant care for people who have spinal cord injury and can claim under the New South Wales Motor Accidents Scheme

Transcription

1 Guidelines for levels of attendant care for people who have spinal cord injury and can claim under the New South Wales Motor Accidents Scheme

2 March 2002 ISBN X Published by Motor Accidents Authority of New South Wales Level 22, 580 George Street, Sydney 2000 Phone: Fax: TTY: Designed and produced by Designate

3 Contents Introduction 2 Methodology 2 Working Party Members 3 General Information 4 Definition of attendant care 4 Issues to consider 5 Abilities, assistance and support required for the following levels of injury Cervical 1-3 (C1-C3) Ventilator Dependant 6 Cervical 4 (C4) 8 Cervical 5 (C5) 10 Cervical 6 (6) 12 Cervical 7-8 (C7-C8) 14 Thoracic 1-4 (T1-T4) 16 Thoracic 5-9 (T5-T9) 18 Thoracic 10 Lumbar 1 (T10-L1) 20 Lumbar 2 Sacral 5 (L2-S5) 22 Factors that may change an individual s level of attendant care support 24 APPENDIX Equipment 26 1

4 Introduction One of the objectives of the NSW Compulsory Third Party (CTP) personal injury insurance scheme is to provide appropriately for the future needs of people who have been injured in a motor vehicle accident and have ongoing disabilities. Section 45 of the Motor Accidents Compensation Act 1999 gave the Motor Accidents Authority (MAA) the responsibility to develop guidelines for the appropriate treatment, rehabilitation and attendant care of people injured in a motor vehicle accident. The MAA, therefore, undertook to develop guidelines recommending the level of attendant care services for people who sustained a spinal cord injury in a motor vehicle accident. In the Motor Accidents Scheme approximately 0.2% of claimants sustain a spinal cord injury. The Motor Accidents Authority Claims register shows that attendant care costs account for approximately 20% of spinal cord injury costs. From July 1989 to December 2000, of the $8.4 billion paid out in claims, spinal cord injuries account for $425.8 million (5.1%). It is beneficial to all to ensure that this payment is spent appropriately to meet the reasonable and necessary care needs of people with a spinal cord injury. The aim of these Guidelines is to provide assistance to those assessing both the current and future care needs of people who sustain a spinal cord injury in a motor vehicle accident and can claim under the Motor Accidents Scheme. These Guidelines do not intend to set a minimum standard of care. Individual circumstances will need to be taken into account when assessing a person s care needs. Methodology The MAA convened a working party with representatives from a range of organisations with experience in assessing the needs of people with a spinal cord injury and in delivering attendant care services. The role of the working party was to develop guidelines on the level of attendant care it was reasonable to expect CTP insurers to consider under the Motor Accidents Scheme. Existing guidelines were reviewed by the working party, in particular Outcomes Following Traumatic Spinal Cord Injury: Clinical Practice Guidelines for Health-Care Professionals, Paralyzed Veterans of America, The recommendations in these Guidelines for the levels of attendant care for people who have a spinal cord injury and can claim under the Motor Accidents Scheme are based on information provided and the consensus opinion of the members of the working party. These Guidelines do not specifically relate to the attendant care needs of children. The level of care recommended in these Guidelines is the level the typical person with a spinal cord injury requires living independently in an appropriately modified environment. The person may live alone or with other people. Each person will need to be assessed to determine if there are any factors that would put the person outside the range of the typical person with a spinal cord injury for example age or co-existing injuries. A list of factors that may change a person s level of attendant care support are on pages 24 and 25 The Guidelines do not cover a person living in institutional care, e.g. nursing home or a person who has other significant disabilities e.g. brain injury. The recommendations made in this document refer to the total hours of care required by the person with that level of injury. Gratuitous or informal care that may be provided by family & friends has not been included into this figure. Whether the level of care recommended is actually provided by a paid carer from an Attendant Care agency or paid/unpaid from family and personal networks should be negotiated between all parties. 2

5 Working Party Members Nicola Bell Tina Bidese Suzanne Boyle Paul Caleo Chris Campbell Stella Engel Wendy Harris Paul Heath Dougie Herd Jenny Hinton Suzanne Lulham Daria McIntosh Terri Mears Barbara Merran Sharon Mooney Suzanne Pierce Jenny Phuong Sue Rutkowski Chris Seidel Debbie Solomon Graham Wilson OT Australia, NSW Motor Accidents Authority The Law Society of NSW Home Care Service of NSW Spastic Centre Prince Henry & Prince of Wales Hospitals Spinal Cord Unit PARAQUAD Department of Ageing, Disability and Home Care Strategic Policy Planning and Funding Directorate Physical Disability Council of NSW Moorong Spinal Unit, Royal Rehabilitation Centre Sydney Motor Accidents Authority Australian Quadriplegic Association Northcott Society Southern Cross Community Healthcare Insurance Council of Australia Department of Ageing, Disability and Home Care Home Assistance 'N Domestic Support (HANDS) Royal North Shore Hospital Spinal Unit Motor Accidents Authority Physical Disability Council of NSW PARAQUAD 3

6 General Information CTP insurers are obliged to pay for treatment, rehabilitation and attendant care on an as incurred basis once they have admitted liability on the claim. However, the insurer is only obliged to pay for treatment, rehabilitation and attendant care costs that are reasonable and necessary, properly verified and relate to the injury resulting from the motor vehicle accident (section 45 of the Motor Accidents Act 1988 and section 83 of Motor Accidents Compensation Act 1999). People who have been injured have a responsibility to mitigate their loss such as undertaking a rehabilitation program or pursuing alternative employment opportunities. What is reasonable and necessary depends on the individual s specific circumstances. These Guidelines will assist this decision making. Definition of attendant care Attendant care assists people with disabilities to perform tasks they would normally be doing for themselves. Attendant care services aim to provide assistance to people with everyday tasks and includes, for example, personal assistance, nursing, home maintenance and domestic services. They enable individuals to live independently in the community. Attendant care services may include: Personal assistance: Duties may include assistance with personal care e.g. feeding, drinking, toileting, personal hygiene, grooming and dressing and personal administration e.g. personal correspondence. Domestic services: Includes cooking, cleaning, shopping and similar tasks involved in the everyday operation and maintenance of a household. Community access: Includes social and avocational activities and facilitation of community access through transport and mobility. Home nursing: Includes those direct care tasks requiring specialised skills, training or experience of a Registered or Enrolled Nurse or an Assistant in Nursing. Gardening / home maintenance services: Includes the performance of routine garden/home maintenance for the purpose of upkeep and to ensure safe and easy access for the individual. Child care services: Involves the supervision of children for the purpose of ensuring their welfare in the absence of a parent, guardian or other suitable carer. Educational support: Includes those services required to allow the person injured (both children and adults) to enter and remain at school or other educational facility. Vocational support: Includes those services required to assist the person injured maintain employment. Respite care: Respite is for either the person injured or their family and can be provided at home or in a separate location for the person injured. 4

7 Issues to consider There are a range of factors that may change an individual s level of attendant care support. It is not possible to list all the factors that may impact on an individual s life, however, some of the factors are listed on pages 24 and 25. What is reasonable and necessary obviously varies from person to person. Factors that may be considered include the pre-existing lifestyle of the person injured and the availability and cost of new technology. It is important that if the person s circumstances change that there is an easy mechanism for reassessment. Requests for changes in levels of support should be accompanied by a documented assessment justifying the request. The category of respite care does not include emergency care, e.g. if there is the need to recall a personal assistant due to a bowel accident. Emergency care should not have a limit, however, if emergency support hours are high, it is an indication that a reassessment may be required as support hours being provided in another category may be inadequate. There is a close relationship between levels of care and prevention of health problems that if left undiagnosed can lead to an increase of care. Although not a category of attendant care, consultants, for example spinal advisers and health management assessors, can assist in managing medical problems and therefore reduce potential additional attendant care costs. Occupational Health and Safety requirements, e.g. lifting equipment, must be provided and are considered necessary to maintain the typical level of care and not factors that will decrease care hours. Some industrial awards impose a minimum number of hours a carer can be employed per shift. Aggregating care time over more than one person or grouping several smaller tasks to make up the minimum time may be appropriate. In some cases however, especially in rural areas, the minimum award hours may have to be allocated regardless of the assessed time for the support task. Home Nursing has a very broad definition. It would be appropriate to designate the nursing qualifications required on a task basis, to ensure that it is understood that certain levels of training are mandated by the nature of the activity, e.g. the necessity of a Registered Nurse for some wound dressing procedures. There may be times when personal care duties may also include some simple household activities that can be undertaken in conjunction with personal care, e.g. soaking/washing personal clothing items after a bowel accident. There may also be times when the person injured decides, for convenience or to reduce the number of carers coming into their home, to combine some personal assistance, domestic assistance and community access tasks. It can not, however, be assumed that certain tasks will be combined. The combining of tasks must be negotiated between all parties. The maintenance and replacement of equipment has not been addressed. All requests for new equipment and maintenance should be evaluated against the documented assessment of need. 5

8 Cervical 1-3 (C1-C3) Ventilator Dependent Abilities and assistance required Respiration Ventilator dependent, inability to clear secretions and intermittent suction required. Ventilator is necessary, however portable ventilator will attach to back of chair. Oxygen and humidification are also required. Mobility / movement Varying quality of limited active head and neck movement. Total assistance required with transport. Total assistance required for all transfers including use of a hoist with 1-2 assistants due to the complexity of the support equipment and the need to monitor the person s body position. Possible ability to manoeuvre motorised chair with chin control or other adaptive device. Personal Total personal assistance required. Range of abilities from limited to good use of mouth stick for computers, keyboards, telephones, turning pages and environmental controls. Range of assistance required from total assistance to independent in communication depending on workstation set up and equipment availability. Domestic Total assistance required with domestic duties. Equipment See pages 26 to 27 6

9 Level of support required Personal assistance 168 to 189 hours per week Total assistance required with personal care. Level of care based on 24 hour active care plus additional 2 hours (am) and 1 hour (pm) for assisting with showering, hoist etc. Where the person is not medically stable, Registered Nurse care 24 hours a day, 7 days a week is required. If the person is medically stable, Registered Nurse care 24 hours a day, 7 days a week is optimal. However, there may be some circumstances where this level of care is not necessary or is unavailable. If the person is medically stable, care could be provided by a carer with a range of qualifications, training and skills appropriate to the person s individual needs. The decision on the qualifications, training and skills of the carer is to be made by the treating team. There may also be situations where 24 hour Registered Nurse care is not available, e.g. in rural and remote areas. The treating team will need to decide the level and type of nursing care that is appropriate, including access to emergency nursing and monitoring of care provided. Reassessment by the treating team of the level and type of care needs to be done on a regular basis. Support arrangements should always be negotiated with the family as they may wish to have some family time with minimal staff disturbance. The personal assistant requires qualifications, training and/or the skills required for the specific task, e.g. changing dressings, ventilator care, suction etc. Domestic services 21 to 28 hours per week At this level of injury, it is not appropriate to assume that a personal attendant will also undertake domestic duties. The person injured requires a personal attendant in their close proximity to ensure safety. An example would be if the person injured developed a sputum plug or went into spasm. Immediate assistance would be required which would not be possible if the personal attendant was doing other domestic tasks, e.g. hanging out the washing. There may however be negotiated times between the person injured and their personal, domestic and community access assistants where there is some sharing of tasks to allow a more flexible routine or to limit the number of support staff coming into their home. Community access 7 to 10 hours per week The 7 hour lower range can be interpreted as an hour a day for transport including medical and other personal appointments, e.g. hair dresser, lawyer. The other hours are highly variable depending on the individual s age, past social habits and the amount of support the actual activity requires, e.g. playing cards, fishing, drinking with friends. Home nursing Not applicable, as nursing is covered under personal assistance with 24 hours Registered Nurse care a day (or as assessed by the treating team). Gardening/home maintenance services 0.5 to 2 hours per week The lower range of hours may be expected for a person living in a home unit. Although they will not require hours for gardening, there would still be the need for minor home maintenance. Respite care Not applicable as hours covered in personal assistance and domestic services. Childcare services, educational support and vocational support The categories of child care services, educational support and vocational support have not been allocated a range of support hours. The support requirements in these categories are very specific to an individual s circumstances and should be based on an assessment of the individual s needs. 7

10 Cervical 4 (C4) Abilities and assistance required Respiration Able to breath without a ventilator. Low endurance and may require assistance to clear secretions. Mobility / movement Total paralysis of trunk and lower extremities. No elbow, wrist or finger movement. Can move head and neck, some movement of shoulders and will usually have control of neck muscles. Total assistance required with transport. Total assistance required for all transfers including use of a hoist with 1-2 assistants due a range of factors including the weight of the person and spasms. Total assistance required for manual wheelchair. Can use chin control for motorised wheelchair on flat ground and ramps of low gradient. Hoist necessary for positioning in a vehicle. May require arm supports and wrist/hand splints. Personal Total personal assistance required. Range of abilities from limited to good use of mouth stick for computers, keyboards, telephones, turning pages and environmental controls. Range of assistance required from total assistance to independent in communication depending on workstation set up and equipment availability. Domestic Total assistance required with domestic duties. Equipment See page 27 8

11 Level of support required Personal assistance 49 to 91 hours per week Total assistance is required with personal care. The upper range allows for 24 hour care when combined with domestic services and an inactive sleepover. When 24 hour care is provided, additional care hours will not be necessary for community access. A person with this level of injury is usually living with someone in attendance. However, if they are not living with someone in attendance, then the maximum level of adaptive environmental equipment is necessary including access to vital call and environmental control systems. Domestic services 18 to 21 hours per week The range at this level includes total assistance with washing and ironing, shopping etc. There may be negotiated times between the person injured and their personal, domestic and community access assistants where there is some sharing of tasks to allow a more flexible routine or to limit the number of support staff coming into their home. Community access 7 to 10 hours per week The 7 hour lower range can be interpreted as an hour a day for transport including medical and other personal appointments, e.g. hair dresser, lawyer. The other hours are highly variable depending on the individual s age, past social habits and the amount of support the actual activity requires, e.g. playing cards, fishing, drinking with friends. Community access hours will only be necessary if 24 hour care is not provided by other categories. Inactive sleep-over 56 hours per week Sleep-over means a continuous period during which an employee is required to sleep at the workplace and be available to deal with any urgent situation which cannot be dealt with by another worker or be dealt with after the end of the sleep-over period. (Defined in the Social and Community Services Employees (State) Consolidated Award.) Some individuals may prefer not to have an inactive sleep-over. If so, vital call, full environmental control for lights/tv, air conditioning, etc. would need to be fully operational and the person able to independently access a drinking system overnight. Home nursing 0.5 hours per week The allocation of 0.5 hours a week is not an indication that home nursing will be required weekly, rather it is to allow home nursing on an as-needed basis up to approximately 26 hours a year. Gardening / home maintenance services 0.5 to 2 hours per week The lower range of hours may be expected for a person living in a home unit. Although they will not require hours for gardening, there would still be the need for minor home maintenance. Respite care Not applicable as hours covered in personal assistance and domestic services. Childcare services, educational support and vocational support The categories of child care services, educational support and vocational support have not been allocated a range of support hours. The support requirements in these categories are very specific to the individual s circumstances and should be based on an assessment of the individual s needs. For example, if eight hours educational/vocational support is required at an education facility or work then it is likely there will be a reduced need for domestic meal preparation during the day when lunch is bought or taken as a packed lunch. A reduction in domestic hours could then be made for when the person is assisted with meal breaks at the education facility or work. 9

12 Cervical 5 (C5) Abilities and assistance required Respiration Low endurance and may require assistance to clear secretions. Mobility / movement Total paralysis of trunk and lower extremities. Can move head and neck with fair to good shoulder control. Some movement in elbow and forearm. No wrist or finger movement. Total assistance required with transport. Able to use motorised wheelchair with hand control. Range of assistance required from total to some assistance with manual chair with capstans, pushing uphill, downhill, rough surfaces and outdoors. Rarely able to drive motor vehicle but possible with appropriately modified vehicle, adaptive equipment and assistance with transfer and positioning chair. Total assistance is necessary for transferring to and from chair/bed/vehicle. Splints or palmer bands may be needed for any activity needing hand or digital grip. Personal Total personal assistance required for bowel/bladder management, bathing/showering and lower body dressing. Some to total assistance required with upper body dressing. Range of assistance required from total to some assistance for grooming with adapted equipment. Total assistance required with bed/wheelchair transfers and some assistance in positioning with equipment. Total assistance required for food/meal preparation and cutting food. Range of assistance required from some assistance to independent in eating with equipment/splints. Special equipment ergonomically designed may be required. Range of assistance required from total assistance to independent in communication depending on workstation set up and equipment availability. Can, with adaptive equipment/devices, turn pages and use computers, keyboards, telephones and environmental controls. Domestic Total domestic assistance required. Equipment See page 28 10

13 Level of support required Personal assistance 42 to 49 hours per week Total assistance required with personal care. A person with this level of injury is usually not living without someone in attendance. However if they do the maximum level of adaptive environmental equipment is necessary including access to vital call and environmental control systems. Domestic services 18 to 21 hours per week The range at this level includes total assistance with tasks such as washing, ironing and shopping, etc. Community access 7 to 10 hours per week The 7 hour lower range can be interpreted as an hour a day for transport including medical and other personal appointments, e.g. hair dresser, lawyer. The other hours are highly variable depending on the individual s age, past social habits and the amount of support the actual activity requires, e.g. playing cards, fishing, drinking with friends. Inactive sleep-over 56 hours per week Sleep-over means a continuous period during which an employee is required to sleep at the workplace and be available to deal with any urgent situation which cannot be dealt with by another worker or be dealt with after the end of the sleep-over period. (Defined in the Social and Community Services Employees (State) Consolidated Award.) Some individuals may prefer not to have an inactive sleep-over. If so vital call, full environmental control for lights/tv, air conditioning, etc. would need to be fully operational and the person able to independently access a drinking system overnight. Home nursing 0.5 hours per week The allocation of 0.5 hours a week is not an indication that home nursing will be required weekly, rather it is to allow home nursing on an as-needed basis up to approximately 26 hours a year. Gardening / home maintenance services 0.5 to 2 hours per week The lower range of hours may be expected for a person living in a home unit. Although they will not require hours for gardening, there would still be the need for minor home maintenance. Respite care 0.5 to 1 hour per week Respite care may be required if the person takes respite in an environment that is less accessible than their home and needs personal, domestic or community access assistance. This would be only for the time they are away from home and the number of respite hours additional to their existing personal assistance, domestic assistance and community access hours would be low. An allocation of 0.5 to 1 hour a week is not an indication that respite will be used each week, rather it is a range of support hours a year that can be used on an as-needed basis. Childcare services, educational support and vocational support The categories of child care services, educational support and vocational support have not been allocated a range of support hours. The support requirements in these categories are very specific to the individual s circumstances and should be based on an assessment of the individual s needs. For example, if eight hours educational/vocational support is required at an education facility or work then it is likely there will be a reduced need for domestic meal preparation during the day when lunch is bought or taken as a packed lunch. A reduction in domestic hours could then be made for when the person is assisted with meal breaks at the education facility or work. 11

14 Cervical 6 (C6) Abilities and assistance required Respiration Low endurance and may require assistance to clear secretions. Mobility / movement Total paralysis of trunk and lower extremities. Can move head and neck with good shoulder control. Some movement in elbow, forearm and wrist. Total assistance for floor to chair transfer. Range of assistance required from some assistance to independent with wheelchair to bed and bed to commode transfer. Minimal assistance required with other transfers. Independent with standard arm control motorised wheelchair on all surfaces. Independent using manual wheelchair on even surfaces. (Sometimes requires capstan knobs on hand rims). Range of assistance required from total to some assistance with manual wheelchair outdoors. May choose to use a motorised wheelchair with handcontrol for long distance travel. Minor assistance may be required with applying adaptive bands although this may not be necessary when using appropriately engineered bands. Palmer bands needed for writing, typing, grooming, feeding etc. Can drive an appropriately modified vehicle using hand controls but may require assistance and aid with transfer in/out vehicle and loading/unloading chair. Personal Total assistance required with bowel care. Range of assistance required from total to some assistance with bladder care and bladder care equipment. Emptying own leg bag may be possible but usually requires assistance. Range of assistance required from total to some assistance with lower body bathing and lower body dressing. Some assistance required with upper body dressing. Range of assistance required from some assistance to independent with bathing upper body and grooming using adaptive equipment. Total assistance needed with cutting food. Independent eating with adaptive equipment. Independent in communication depending on workstation set up and equipment availability. Domestic Can prepare basic meals using adaptive equipment. Requires assistance with other meal preparation. Total assistance required with all other house cleaning and domestic duties. 12 Equipment See page 28

15 Level of support required Personal assistance 28 to 35 hours per week On average, 4 hours a day is usual, however there are some circumstance where the upper range will be necessary, for example where assistance with bladder care does not fit into a 4 hour-a-day routine. Domestic services 18 to 21 hours per week A break down of the hours could be interpreted as 2 hours a day meal preparation (assuming breakfast is independent), 3 hours shopping, 4 hours cleaning, washing, ironing and other domestic duties a week. More assistance is required with washing and ironing than C7-C8. Community access 7 to 10 hours per week The 7 hour lower range can be interpreted as an hour a day for transport including medical and other personal appointments, e.g. hair dresser, lawyer. If a person has a fully modified vehicle that they can access and drive independently then transport hours would be reduced. The other hours are highly variable depending on the individual s age, past social habits and the amount of support the actual activity requires, e.g. playing cards, fishing, drinking with friends. Home nursing 0.5 hours per week The allocation of 0.5 hours a week is not an indication that home nursing will be required weekly, rather it is to allow home nursing on an as-needed basis up to approximately 26 hours a year. Gardening / home maintenance services 0.5 to 2 hours per week The lower range of hours may be expected for a person living in a home unit. Although they will not require hours for gardening, there would still be the need for minor home maintenance. Respite care 0.5 to 1 hour per week Respite care may be required if the person takes respite in an environment that is less accessible than their home and needs personal, domestic or community access assistance. This would be only for the time they are away from home and the number of respite hours additional to their existing personal assistance, domestic assistance and community access hours would be low. An allocation of 0.5 to 1 hour a week is not an indication that respite will be used each week, rather it is a range of support hours a year that can be used on an as-needed basis. Childcare services, educational support and vocational support The categories of child care services, educational support and vocational support have not been allocated a range of support hours. The support requirements in these categories are very specific to the individual s circumstances and should be based on an assessment of the individual s needs. For example, if 8 hours educational/vocational support is required at an education facility or work then it is likely there will be a reduced need for domestic meal preparation during the day when lunch is bought or taken as a packed lunch. A reduction in domestic hours could then be made for when the person is assisted with meal breaks at the education facility or work. 13

16 Cervical 7-8 (C7-C8) Abilities and assistance required Respiration Low endurance and may require assistance to clear secretions. Mobility / movement Paralysis of trunk and lower extremities. Can move head and neck with good shoulder control. Full elbow movement. Moderate to full arm, wrist and finger control. C7 has movement in thumbs. Assistance required with floor to chair transfers. May require supervision or be independent in transferring to and from level surface with aid of transfer board. Independent using manual wheelchair on indoor surfaces and level outdoor terrain, possible also to mount kerb. Range of assistance required from some assistance to independent with manual wheelchair on uneven surfaces. Independent using motorised wheelchair on outdoor surfaces. May choose to use a motorised wheelchair with hand-control for long distance travel. Can drive an appropriately modified vehicle using hand controls. Independent with transport if able to transfer, load and unload wheelchair. Some people will require assistance with transfer and loading/unloading wheelchair. Personal Some to total assistance with bowel care given limited upper body movement and the existence of other factors (age, health, strength). Independent to some assistance required with bladder care. Independent in upper body, showering/bathing and dressing, may require some assistance in lower body showering/dressing. Independent in grooming. Independent in most other activities with minimal use of adaptive equipment. Domestic Independent with light meal preparation and light house duties. Range of assistance required from total to some assistance with complex meal preparation, heavy housework and home maintenance. Other domestic duties possible if living in an appropriately designed/modified house. Equipment See page 29 14

17 Level of support required Personal assistance 14 to 21 hours per week Although 2 hours in the morning and 1 hour in the afternoon has been allocated, this may vary on a day-today basis with some days requiring more, e.g. bowel care days and others less. Domestic services 14 to 21 hours per week A break down of the hours could be interpreted as 2 hours a day meal preparation (assuming breakfast is independent), 3 hours shopping and 4 hours cleaning, washing, ironing and other domestic duties a week. Less than 2 hours meal preparation may be required some days if lunch is prepared before or purchased while out. Community access 0 to10 hours per week The lower range only applies to individuals who are independent in transfer and bladder care. This figure includes transport assistance. Although some individuals may be independent with transfer and wheelchair loading/unloading and able to drive an appropriately modified vehicle there is still an allowance of 7 hours a week assistance with transport. Assistance with transport will still be necessary for those who do not have a licence and/or do not have access to an accessible vehicle. A reduction in transport assistance would be justified if the person had an accessible vehicle and was an independent driver. The other hours are highly variable depending on an individual s age, past social habits and interests, e.g. playing cards, fishing, drinking with friends. Home nursing 0.5 hours per week The allocation of 0.5 hours a week is not an indication that home nursing will be required weekly, rather it is to allow home nursing on an as-needed basis up to approximately 26 hours a year. Gardening/home maintenance services 0.5 to 2 hours per week The lower range of hours may be expected for a person living in a home unit. Although they will not require hours for gardening, there would still be the need for minor home maintenance. Respite care 0.5 to 1 hour per week Respite care may be required if the person takes respite in an environment that is less accessible than their home and needs personal, domestic, or community access assistance. This would be only for the time they are away from home and the number of respite hours additional to their existing personal assistance, domestic assistance and community access hours would be low. An allocation of 0.5 to 1 hour a week could be interpreted as 26 to 52 hours a year. Childcare services, educational support and vocational support The categories of child care services, educational support and vocational support have not been allocated a range of support hours. The support requirements in these categories are very specific to the individual s circumstances and should be based on an assessment of the individual s needs. For example, if educational and vocational support hours are required at an education facility or work then it is likely there will be a reduced need for domestic meal preparation during the day when lunch is bought or taken as a packed lunch. A reduction in domestic hours could then be made for when the person is assisted with meal breaks at the education facility or work. 15

18 Thoracic 1-4 (T1-T4) Abilities and assistance required Respiration Respiratory muscle function abnormal. Compromised respiration capacity and endurance. Mobility / movement Lower trunk paralysis and total paralysis lower extremities. Limited upper trunk stability. The lower the level of injury the greater the balance. Full upper extremity control and hand function. May require assistance with floor to chair transfer due to limited upper body balance and movement. May require supervision or be independent in transfer with sliding board or other aids on level surface. Independent using manual wheelchair. May choose to use a motorised wheelchair hand-control for long distance travel. Can drive an appropriately modified vehicle. Independent with transport if able to transfer, load and unload wheelchair. Some people may require assistance with transfer and loading/unloading wheelchair. Personal Minimal support in personal care is required if the person has no other complicating factors, e.g. health, weight, or other disability and living in an appropriately modified environment. Domestic May need assistance with heavy housework and home maintenance. Other domestic duties are possible if the person is living in an appropriately modified environment. Equipment See page 29 16

19 Level of support required Personal assistance 0 to 14 hours per week There is a wide variation in the level of personal assistance required for this level of injury. Generally, the higher level of support hours refers to the higher level of injury. Domestic services 5 to 14 hours per week The range of support hours is due to the large variance in function at this level of injury. The 14 hours a week would be required if the person injured had poor trunk control and poor balance. Domestic services include shopping. If assistance with shopping was required then the upper level of support hours would be necessary. Community access 0 to 7 hours per week This figure reflects transport assistance. Although some individuals may be independent with transfer and wheelchair loading/unloading and able to drive there is still an allowance of 7 hours a week assistance with transport. Assistance with transport is still necessary for those who do not have a licence and/or do not have access to an accessible vehicle. No transport assistance may be justified if the person had an accessible vehicle and is an independent driver. Home nursing 0.5 hours per week The allocation of 0.5 hours a week is not an indication that home nursing will be required weekly, rather it is to allow home nursing on an as needed basis up to approximately 26 hours a year. Gardening / home maintenance services 0.5 to 2 hours per week The lower range of hours may be expected for a person living in a home unit. Although they will not require hours for gardening there would still be the need for minor home maintenance. Respite care 0 to 1 hour per week Respite care may be required if the person takes respite in an environment that is less accessible than their home and needs personal, domestic or community access assistance. This would be only for the time they are away from home and the number of respite hours additional to their existing personal assistance, domestic assistance and community access hours would be low. An allocation of 0 to 1 hour a week is not an indication that respite will be used each week, rather up to 52 support hours a year can be used on an as-needed basis. Childcare services, educational support and vocational support The categories of child care services, educational support and vocational support have not been allocated a range of support hours. The support requirements in these categories are very specific to the individual s circumstances and should be based on an assessment of the individual s needs 17

20 Thoracic 5-9 (T5-T9) Abilities and assistance required Respiration Compromised respiration capacity and endurance. Mobility / movement Lower trunk paralysis, total paralysis lower extremities. Full upper extremity control. Full hand function. Fair to good upper trunk stability. The lower the level of injury the greater the balance. May require assistance with floor to chair transfer due to limited upper body balance and movement. Independent in chair transfer. Independent using manual wheelchair. Can drive an appropriately modified vehicle. Independent with transport if able to transfer, load and unload wheelchair. Some people may require assistance with transfer and loading/unloading wheelchair. Personal Minimal support is required with personal care if the person lives in an appropriate accessible environment and has no other complicating factors, e.g. health, weight, or other disability. Domestic May need assistance with heavy housework and home maintenance. Other domestic duties possible if living in an appropriately modified environment. Equipment See page 30 18

21 Level of support required Personal assistance There is a wide variation in the level of personal assistance required for this level of injury. Domestic services 0 to 10 hours per week 5 to 10 hours per week The range of support hours is due to the large variance in function at this level of injury. The 10 hours a week would be required if the person injured had poor trunk control and needed greater assistance with, e.g. heavy domestic duties and pushing and loading a shopping trolley. Community access 0 hours It was considered that assistance with transport would not be required at this level of injury. However, if the person could not transfer independently and either pull their wheel chair apart or use a car hoist then transport assistance may be required. Home nursing 0.5 hours per week The allocation of 0.5 hours a week is not an indication that home nursing will be required weekly, rather it is to allow home nursing on an as-needed basis up to approximately 26 hours a year. Gardening / home maintenance services 0.5 to 2 hours per week The lower range of hours may be expected for a person living in a home unit. Although they will not require hours for gardening there would still be the need for minor home maintenance. Respite care 0 to 1 hour per week Respite care may be required if the person takes respite in an environment that is less accessible than their home and needs personal/domestic/community access assistance. Respite support would also be necessary if the person injured is not independent with transport. This would be only for the time they are away from home and the number of respite hours additional to their existing personal assistance, domestic assistance and community access hours would be low. An allocation of 0 to 1 hour a week is not an indication that respite will be used each week, rather up to 52 support hours a year can be used on an as-needed basis. Childcare services, educational support and vocational support The categories of child care services, educational support and vocational support have not been allocated a range of support hours. The support requirements in these categories are very specific to the individual s circumstances and should be based on an assessment of the individual s needs. 19

22 Thoracic 10-Lumbar 1 (T10-L1) Abilities and assistance required Respiration Intact respiratory function. Mobility / movement Paralysis of lower extremities. Full upper extremity and good trunk control. (The lower the level of injury the greater the balance.) Full hand function. May require assistance with floor to chair transfer due to limited upper body balance and movement. Independent using manual wheel chair on indoor and outdoor surfaces. Independent in transfer and standing. Independent sit to stand. Independent sit to transfer Independent in driving an appropriately modified vehicle including loading and unloading wheelchair. Personal Minimal support is required with personal care if the person lives in an appropriate accessible environment and has no other complicating factors, e.g. health, weight, or other disability. Domestic May need assistance with heavy housework and home maintenance. Other domestic duties possible if living in an appropriately modified environment. Equipment See page 30 20

23 Level of support required Personal assistance 0 to 7 hours per week At this level the person injured is usually independent but may require up to 1 hour a day personal assistance, e.g. bowel/bladder care. A person with an injury level of T10 and below has been given a range of 0 to 7 hours a week of personal care support. If the person has poorly controlled neuropathic bowel dysfunction the upper level of 7 hours for personal care may be inadequate. Domestic services 3 to 10 hours per week The range of support hours is due to the large variance in function at this level of injury. The 10 hours a week would be required if the person injured had poor trunk control/balance and needed greater assistance with shopping, e.g. pushing and loading the shopping trolley and carrying and hanging washing. Community access Assistance with transport would not usually be required at this level of injury. 0 hours Home nursing 0.5 hours per week The allocation of 0.5 hours a week is not an indication that home nursing will be required weekly, rather it is to allow home nursing on an as-needed basis up to approximately 26 hours a year. Gardening / home maintenance services 0.5 to 2 hours per week The lower range of hours may be expected for a person living in a home unit. Although they will not require hours for gardening, there would still be the need for minor home maintenance. Respite care 0 hours Although no figure has been allocated to respite, some individuals may require respite hours if the person takes respite in an environment that is less accessible than their home and needs personal/domestic assistance. Respite support would also be necessary if the person injured is not independent with transport. This support would be only for the time they are away from home and the number of respite hours additional to their existing personal and domestic assistance hours would be low. Childcare services, educational support and vocational support The categories of child care services, educational support and vocational support have not been allocated a range of support hours. The support requirements in these categories are very specific to the individual s circumstances and should be based on an assessment of the individual s needs. 21

24 Lumbar 2-Sacral 5 (L2-S5) Abilities and assistance required Respiration Intact function. Mobility / movement Good trunk stability, partial to full control of the lower extremities. The lower the level of injury the greater the balance. Some hip, knee, ankle control and foot movement, may use option of kneeankle-foot orthoses. Full upper body control. Full hand function. May require assistance with floor to chair transfer due to limited upper body balance and movement. Independent in using a manual wheel chair on all surfaces. Independent in transfer and standing. With aids, independent to some assistance required in walking. Independent in driving an appropriately modified vehicle, including loading and unloading wheelchair. There is a very large range of abilities at this level from completely wheelchair dependant to being independent in walking. Even if the person can walk they will still have difficulty walking fast and need assistance with lifting objects. Personal Minimal support is required with personal care if the person lives in an appropriate accessible environment and has no other complicating factors, e.g. health, weight, or other disability. Domestic May need assistance with heavy housework and home maintenance. Other domestic duties possible if living in an appropriately modified environment. Equipment See page 31 22

25 Level of support required Personal assistance 0 to 7 hours per week At this level the person injured is usually independent but may require up to 1 hour a day personal assistance, e.g. bowel/bladder care A person with an injury level of L2-S5 has been given a range of 0 to 7 hours a week of personal care support. If the person has poorly controlled neuropathic bowel dysfunction, the upper level of 7 hours for personal care may be inadequate. Domestic assistance 3 to 10 hours per week The range of support hours is due to the large variance in function at this level of injury. The 10 hours a week would be required if the person injured had poor trunk control/balance and needed greater assistance with shopping, e.g. pushing and loading the shopping trolley and carrying and hanging washing. Community access Assistance with transport would not be required at this level of injury. 0 hours Home nursing 0 to 0.5 hours per week The allocation of 0.5 hours a week is not an indication that home nursing will be required weekly, rather it is to allow home nursing on an as needed basis up to approximately 26 hours a year. Gardening / home maintenance services 0.5 to 2 hours per week The lower range of hours may be expected for a person living in a home unit. Although they will not require hours for gardening, there would still be the need for minor home maintenance. Respite care 0 hours Although no figure has been allocated to respite some individuals may require respite hours if the person takes respite in an environment that is less accessible than their home and needs personal/domestic assistance. Respite support would also be necessary if the person injured is not independent with transport. This support would be only for the time they are away from home and the number of respite hours additional to their existing personal assistance, domestic assistance and community access hours would be low. Childcare services, educational support and vocational support The categories of child care services, educational support and vocational support have not been allocated a range of support hours. The support requirements in these categories are very specific to the individual s circumstances and should be based on an assessment of the individual s needs. 23

26 Factors that may level of attendant An individual s level of care will fluctuate. In most cases the change is not permanent and the support can return to the typical level indicated in these Guidelines. It is not possible to list all the factors that may impact on an individual s life and there may be times where additional or less support will be required due to factors that are not listed below. It is important that if there is a change in circumstances that there is an easy mechanism for reassessment of the person. Requests for changes in levels of support should be accompanied by a documented assessment justifying the request. 24