4.5.20.2 Agent reviews request

Once the Household help request: Worker declaration (worker declaration) and Request for household help services (HH request) forms have been received, the Agent should review them and determine the worker’s eligibility in accordance with the Household help services guidelines.

The documents received should be reviewed in conjunction with other information on file, including:

• the worker’s injury claim form and authority (section 6)

• the worker’s most recent certificate of capacity Ongoing certificate is issued for up to 28 days and can be issued by a: medical practitioner, osteopath, physiotherapist, chiropractor.

• treating health practitioner (THP Treating Health Practitioner) reports

• independent medical examination reports

• the worker’s most recent occupational rehabilitation report

• any previous OT Occupational therapy is a client-centred health profession concerned with promoting health and well being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to or are expected to do or by modifying the occupation or the environment to better support their occupational engagement . assessments

• the worker’s current living situation (i.e. other household members residing at premises)

• the worker’s expected recovery timeframes

• adaptive equipment needs or requests

• file notes on ACCtion/case notes on Novus.

Household help eligibility criteria

Agents must assess each request for Household help in line with the following eligibility criteria:

1. Request is for services WorkSafe can pay for under the Household help services guidelines.

2. Liability has been accepted for the injury the request for services relates to.

3. The requested services do not relate to pre-existing, non-compensable or age-related conditions.

4. The requested services are for the worker.

5. The requested services are for tasks the worker performed prior to their work-related An injury/disease is work related if it arose out of or in the course of employment and the scope of employment. injury or illness (not performed by other family members In relation to a work-related: • severe injury for which immediate inpatient treatment in hospital is received • eligible progressive disease • fatal injury a ‘family member’ means a partner, parent, grandparent, sibling or child of the worker or of the worker's partner. Note: this definition is not the same as a close family member. or purchased labour) and can no longer perform as a result of the injury/ illness.

6. The requested services relate to routine and essential tasks only, associated with the worker maintaining themselves in their primary residence.

Household help considerations

When considering whether the requested services are reasonable and necessary, the following should also be considered:

• Whether the services are clinically justified per information provided on the household help request form and Worker declaration.

  • Assess if the type, frequency and duration of services are reasonable in the circumstances, considering injury severity, recovery stage, home environment and available supports.

• Whether the need for requested services is a direct and current consequence of the accepted injury, i.e.

  • There is a clear link between the worker's present functional limitations and the requested services

  • The request does not reflect convenience, preference, or lifestyle maintenance rather than injury-related need.

• Whether other independents live at the worker’s address who can reasonably contribute to requested household tasks.

  • 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.

• The size of the worker’s home/garden at the time of the injury. WorkSafe will not fund additional service costs resulting from a worker relocating to new place of residence or larger property.

• Whether the supply of adaptive household equipment will replace or reduce the need for WorkSafe funded household help services.

• Whether the cost of the service is reasonable and in line with WorkSafe’s household help fee schedule.

Household help services should promote recovery and functional independence. They should be time-limited and regularly reviewed.

Household help services 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.

Household help requests that should be prioritised for review include:

• those associated with an acute injury (e.g. following emergency surgery or discharge from hospital)

• where the worker’s circumstances dictate some urgency (e.g. the worker has a significant incapacity, small dependent children and/or no family assistance etc.).

Approval of services

If requested services are considered reasonable and necessary, and less than 24 weeks of household help services have been provided to date, services may be approved in line with below.

Initial requests for short term services

Household help services can be approved for an initial period of 6-12 weeks to support a worker during their recovery.

Note: an OT household help services needs assessment is not required for the initial 6- 12 weeks of service provision unless it is difficult to determine if the requested services are reasonable and necessary based on information on file. Where surgery has been scheduled, Household help services can be arranged in advance.

An additional 6-12 weeks of household help services may be requested and considered for approval if it is identified by the worker’s treating health practitioner (THP) that further support is necessary during the initial 12-week period. A HH request form is required for each request for household help services. A worker declaration form is also required when it is not already on file from a previous request e.g. household help was approved following surgery or discharge from a hospital.

Agents should initiate an OT household help services needs assessment at 12 weeks of services. It is mandatory that agents complete the HHSNA referral form and provide this to OT to initiate a household help services needs assessment.

See: Arrange a household help services needs assessment

Initial requests for long term services

Initial requests for longer term household help services (approximately 6 months or longer) can be made where a worker’s injury requires a longer-term need for household help services. This may be applicable to workers with more severe and permanent injuries such as those eligible for the Community Integration Program (CIP Community Integration Program).

In this circumstance, the Agent should review the services in line with the below ready reckoner, and initiate a Framework OT assessment to review the worker’s ongoing need for household help services and establish strategies to promote worker independence.

See: Standard Household Help Ready Reckoner | Long Term Household Help Ready Reckoner

Subsequent requests beyond 24 weeks

Requests for additional household help services beyond 24 weeks (accumulated) should only be made in exceptional circumstances. For example, workers with severe and permanent injuries, such as those eligible for the Community Integration Program (CIP).

For all requests beyond 24 weeks (accumulated), Agents must:

• consider the need for longer term household help by reviewing appropriate supporting clinical information and rationale for services on file, including information provided on the HH request form and worker declaration.

• initiate an Occupational Therapy Occupational therapy is a client-centred health profession concerned with promoting health and well being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to or are expected to do or by modifying the occupation or the environment to better support their occupational engagement. (OT) household help services needs assessment, including a Functional Capacity Evaluation (FCE), to review the need for ongoing services.

Services may need to be approved while an OT household help services needs assessment is pending. If continuation of household help has been approved until the time of OT assessment, Agents should communicate to the worker that services beyond the OT assessment will only continue if appropriate for rehabilitation purposes and supporting independence.

Beyond 24 weeks of service provision, services should only be approved for a period of up to 12 weeks per request, unless the worker is significantly injured and requires longer term support.

After each 12-week period, the THP must submit a Request for household help services to the agent to request more household help services.

See: Household Help Services Needs Assessment

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