What can I spend my funding on?

This is probably the question we get asked the most! What’s included or excluded from Support at Home funding has more grey areas than clear black or white.

So, let’s start with what we know, the purpose of the Support at Home Program (SaH) is to deliver care and services that help older Australians to live independently in their homes for as long as it is safe to do so.

The care and services provided need to meet the care needs set out in their My Aged Care Support Plan and Care Plan. These are based on the needs identified by the Aged Care Assessment Team (ACAT) when first entering the SaH program.

What do we know about allowable expenditure?

Although there is some uncertainty, the Department of Health and Aging is very clear on stating that Support at Home funding:

• Is not a source of extra income to be used for everyday items and costs.
• Is only for expenditure directly linked to aging (for example, expenditure related to a Chronic Disease is not allowable).
• Is not for expenses that all Australians have.
• Must be considered an acceptable use of a government subsidy that is funded through taxpayers’ money.
• Saving up for items at the expense of the delivery of care and services is not allowed.

In addition, all Support at Home spending:

• Must be within the limits of the budget and the scope of the Program.
• Must only benefit the care recipient directly, funds cannot be spent on or seen to be benefiting the carers or family members.
• Cannot be for expenditure that is already covered by another government scheme.
• Must be documented in both the care plan and the budget.
• Must be agreed upon in advance of making the expenditure.

There are six. They apply to every client and every provider.

1. Your care plan and budget are the agreement: We set them with you and send them to you. If a service or item is in your approved plan and budget, we pay for it. If it isn’t, we don’t.
2. Ask your Care Advisor before anything new starts: We add it to your plan and budget first. Equipment also needs a written recommendation from an occupational therapist or other qualified health professional before you buy or hire it.
3. Providers register before their first visit: We check their insurance and screening before they start. We don’t pay for visits made before registration.
4. Invoices must be complete: Each one needs the date, the time and what was done. Support workers also add a shift note for each visit. We don’t pay incomplete invoices. We can’t pay invoices that reach us more than 60 days after the quarter ends.
5. Anything arranged outside your plan is a personal cost: That includes services, equipment and reimbursements we haven’t approved first.
6. Tell your Care Advisor when things change: A hospital stay, a fall or a new health problem means your plan needs updating.

Speak with your Care Advisor and obtain confirmation before ordering an item, paying a deposit or arranging a new service.

Provide a description of what you need, why you need it and the expected cost. Your Care Advisor will explain whether additional information is required and notify you of the outcome.

Speak with your Care Advisor and obtain confirmation before ordering an item, paying a deposit or arranging a new service.

Provide a description of what you need, why you need it and the expected cost. Your Care Advisor will explain whether additional information is required and notify you of the outcome.

If we determine that the expenditure is not in scope for the package, we will discuss the reason why with you. We can also provide a written explanation of why the item was rejected.

If you are not satisfied with this outcome you may wish to seek assistance for dispute resolution from an independent advocacy service. The Aged Care Advocacy Service accepts enquiries at www.opan.com.au or 1800 700 600.

Should you wish to appeal the decision or make a complaint, contact the Aged Care Quality and Safety Commission:

https://www.agedcarequality.gov.au/

The Commission’s telephone number is 1800 951 822.

Allowable expenditure is one of the biggest minefields for approved providers. There is always new information and clarifications on inclusions/exclusions being released.

Different providers adhere to the expectations to varying degrees, meaning that there are discrepancies between what clients have approved with different providers.

Even with the same provider an item that was approved in the past, may no longer be approved.

Allowable expenditure is one of the biggest minefields for approved providers. There is always new information and clarifications on inclusions/exclusions being released.

Different providers adhere to the expectations to varying degrees, meaning that there are discrepancies between what clients have approved with different providers.

Even with the same provider an item that was approved in the past, may no longer be approved.

You can carry the greater of $1,000 or 10% of your quarterly funding into the next quarter. However, your quarterly budget is not designed to build an unrestricted savings balance for expensive purchases.

Unless your registered provider purposely closes your funding the rolled over money will not be available for 70 days from the end of the prior quarter to ensure that all expenses have been processed.

Eligible equipment and home modifications generally use the Assistive Technology and Home Modifications scheme, known as AT-HM and is not constrained to the ongoing funding quarters.

• Bathing, showering, personal hygiene and grooming, assistance with cutting fingernails or with washing/drying hair.
• Toenail-cutting services delivered through a podiatrist.
• Dressing and undressing, and using dressing aids.
• Toileting.

• Assessment for and, if required, providing disposable pads and absorbent aids, commode chairs, bedpans and urinals, catheter and urinary drainage appliances and enemas.
• Assistance in using continence aids and appliances and managing continence.
• Assessment by a Continence Nurse.
• Some carpet cleaning in the case of severe incontinence.
• Toilet raiser seat, toilet surround with supporting recommendation.
• Washing machine and dryers can be considered ONLY for severe and permanent incontinence, as per the definition used by the Continence Aids Payment Scheme. Supporting documentation is required.

• Respite care delivered in the home.
• Assistance to access support services to maintain personal affairs.
• Emotional support including ongoing support in adjusting to a lifestyle involving increased dependency and assistance for the care recipient and carer, if appropriate.
• Providing 24‐hour on‐call access to emergency assistance including access to an emergency call system if the care recipient is assessed as requiring it.
• IT training in using a computer or mobile phone.
• Communication including assistance to address difficulties arising from impaired hearing, sight or speech, or lack of common language, assistance with the fitting of sensory communication aids, checking hearing aid batteries, cleaning spectacles and assistance in using the telephone.
• Encouragement to participate in social and community activities that promote and protect the care recipient’s lifestyle, interests and wellbeing. Activity must be linked to aging i.e. attending Men’s Shed, Senior Citizen membership, day programs. Note supplies to participate in the group activities are not allowable.
• Support for care recipients with cognitive impairment, including individual therapy, activities and access to specific programs designed to prevent or manage a particular condition or behaviour, enhance quality of life and provide ongoing support.

• Nursing, allied health and therapy services: Gap payments for Allied Health services on private health insurance are NOT claimable through the package. Allied health services must be related to age related functional decline, rather than chronic illness and providers must meet their respective accreditation and registration requirements and operate within the scope of practice of their particular regulated or self-regulated body. Services include:
  • Aboriginal & Torres Strait Islander Health Worker
  • Dietitian or Nutritionist
  • Exercise Physiology
  • Occupational Therapy
  • Art therapy
  • Chiropractic
  • Diversional therapy
  • Music therapy
  • Optometry
  • Orthoptics
  • Orthotists/prosthetists
  • Osteopathy
  • Rehabilitation counselling
  • Physiotherapy
  • Podiatry
  • Psychology
  • Social Work
  • Speech Pathology
• Chinese Medicine and Acupuncture therapy can be included if supported by a recommended by a suitably qualified medical professional (e.g. a GP) and delivered by an Australian Health Practitioner Regulation Agency (Ahpra) registered Chinese medicine practitioner.
• Psychology visits are payable AFTER Medicare funded visits through a Mental Health Care Plan have been exhausted. Any GP can refer you to the Mental Health Care Plan program.
• Nursing: wound care management, medication administration, general health and other assessments.
• General Health and other assessments.
• Other clinical services such as hearing and vision services.
• Access, referral to other health and related services, or health practitioners.
• Providing bandages, dressings, and skin emollients.
• Medication management.
• Pill dispensers, pill lock boxes and Webster packs.
• Rehabilitative support, access help; to meet a professionally determined therapeutic need.
• Blood pressure monitor (with GP supporting recommendation).
• CPAP/BIPAP: CPAP machines are typically funded under state and territory specialised aids and equipment schemes. The care recipient’s treating medical practitioner is responsible to support them to access these schemes. However, in some jurisdictions, CPAP machines are not subsidised, or are only subsidised in specific circumstances. As the Australian Government does not fund, or partially fund, access to CPAP machines, the provider can consider funding this service, but only after they have tested and confirmed whether state/territory schemes can cover the cost.
• Remedial Massage for an age-related condition must be delivered by a suitably qualified professional, e.g., physio, remedial massage, osteo or massage therapist.
• Natural therapies, including:
  • Pilates (only when sessions are supervised by an exercise physiologist or physiotherapist)
  • Tai chi (only when sessions are supervised by a Chinese Medicine Practitioner, exercise physiologist or physiotherapist)
  • Yoga (only when sessions are supervised by an exercise physiologist or physiotherapist)
• Consultation/tests/surgery with medical practitioners (GPs and specialists) for a private appointment (i.e. not covered by MBS) with a GP to meet evidence requirements for the dementia and cognition supplement and oxygen and enteral feeding supplements.

• Wound care management, including nursing services.
• Pressure relieving cushion and mattress.
• Skin creams, body wash and ointments for the management of age-related skin integrity, which is defined as assistance to maintain clean and intact skin. This includes providing bandages, dressings, and skin emollients that are prescribed by relevant health professionals or medical practitioners. Skin emollients include lotions and oils, such as Alpha Keri Bath Lotion, QV Bath Oil and Hamilton Skin Therapy Oil.
• Adult wipes (not baby wipes).
• Rinse-free foam such as Remedy Phytoplex (by Medline), rinse free cleanser (comes in a spray for hair, and a foam for body).

• Providing crutches, quadruped walkers, walking frames, walking sticks and wheelchairs (items must be suitable, safe and a recommended item). You can read more on assistive technology and equipment purchases in our AT-HM guide.
• Providing mechanical devices for lifting, bed rails, slide sheets, slide boards, sheepskins, tri-pillows, and pressure relieving mattresses.
• Mobility, transfer (including in and out of bed) e.g. hoist.
• Ramps (fixed and portable) and grab rails.
• Crash and sensor mats, walking belts, hip protectors.
• Car transfer aid/ handy bar.
• Small aids to assist in activities of daily living, such as jar openers, long handed sponges, dressing aids.
• Assistance in using the above aids.
• Falls Assessment administered by a Registered Nurse.
• Hydrotherapy or exercise classes delivered by an Exercise Physiologist or Physiotherapist.
• Custom made or medical grade shoes, supported by Podiatrist recommendation.

Transport and personal assistance with shopping, visit health practitioners, emotional support, social support and attending social activities.

Cabcharge (not rideshare services such as Uber) can be used for accessing local aged care transport needs: medical appointments, age related social activities, religious activities, shopping.

Private Transport costs for KMs, may be allowable in extenuating circumstances, such as living in a remote area (MMMs 4-7), with no other transport options available. To be discussed with your Care Advisor and a budget set.

Specialised and complex equipment that is generally adjusted to suit the care recipient’s individual support needs requires a recommendation from an appropriate health professional. It is important to make sure the equipment is supplied and set up correctly to avoid any risk of injury. Self-diagnosed or non-evidence-based items are not allowable. The cost of the assessment can be included in the package.

Not everything recommended by the Occupational Therapist (OT) is an allowable HCP expenditure item. An OT can identify strengths and difficulties and will help the client work out practical solutions to develop, recover, improve, as well as maintain the skills needed for daily living and working. This may include modifying an activity or an environment, recommendation, customisation and oversight of equipment provision. They use a range of specific therapeutic procedures to enhance performance such as wound care management, techniques to enhance sensory, perceptual, and cognitive processing, and manual therapy technique skills.

We refer to the Enable NSW Professional Criteria for Prescribers for guidance on who can prescribe different types of equipment. A GP is not qualified to recommend equipment.

Inclusions:

• Falls alarm or falls detection watch is allowable (premium product at owners’ expense).
• An adjustable bed, electronically operated, bed with position adjustments to the backrest and leg rest area, and adjustable height. Single beds (including king single beds) are considered to be most appropriate as they allow for ease of access for attending health providers and carers, particularly nurses.
• A pressure relieving or hospital grade mattress.
• A companion bed refers to a non-adjustable detachable bed for partners, designed to be paired with an adjustable bed. The cost of a companion bed is considered a private expense.
• Shower stool/ wheeled commode.
• Handheld shower hose.
• Sit to stand/ recliner chairs.
• Over chair/bed table.
• Large print clocks, microwaves.
• Hearing aids: Only if the care recipient is not a pension concession card holder. A Home Care Package may cover (like for like) a typical hearing aid covered by Hearing Service Program (HSP). In all other cases hearing aids are an exclusion.

• Cleaning, making beds, dusting, oven or window cleaning, vacuuming and mopping.
• Personal laundry services, including laundering of care recipient’s clothing and bedding that can be machine-washed, ironing or arranging for dry-cleaning of care recipient’s clothing and bedding that cannot be machine-washed.

Meals, nutrition and diet

• Assistance with preparing meals including assistance with special diet for health, religious, cultural or other reasons.
• Assistance with using eating utensils and eating aids and assistance with actual feeding.
• Providing enteral feeding formula and equipment.
• Nutritional supplements and fluid thickeners as prescribed by a Dietitian or Speech Therapist.
• Consultation with a Speech Therapist, Dietitian or Diabetes Nurse.
• Meals: only meal preparation, packaging, and delivery are allowed (the ingredients are not allowable) at a rate of 70% of the full cost. Must be a ready-made nutritionally balanced meal for one ordered through a meal delivery company, not purchased from a Supermarket, takeaway, restaurant or food delivery services e.g., UberEATS. Limited to 7 of each of breakfast /lunch / dinners per week.

• Home maintenance, reasonably required to maintain the home and garden in a condition of functional safety and provide an adequate level of security, such as cleaning gutters.
• Light gardening such as:
  • maintaining access and egress pathways through a property
  • lawn mowing
  • weeding of established garden beds
  • yard clearance where there are issues of safety and access
  • essential pruning for access areas
• Minor home modification, if clinically justified, to improve safety and accessibility and promote independence. Minor home modifications could include:
  • lowering or removal of shower hobs
  • lowering kitchen bench tops
  • widening doorways and passages (e.g. to allow wheelchair access)
  • hand-held showers, sliding shower rails
  • removal of shower screens/doors and installation of weighted shower curtains
  • doorway wedges
• Minor home maintenance: maintenance activities that the care recipient previously did for themselves but can no longer do safely, for example:
  • cleaning gutters
  • changing light globes
  • fixing a broken door
  • working-at-height related repairs or cleaning for client health and safety i.e. gutters, roofs, windows, ceilings, and smoke alarm battery changes
• Minor plumbing includes changing a washer, unblocking a toilet, installing easy access taps, shower hoses or shower heads on a rail.
• Relocating power points, if directedly related to aging.
• Some carpet/ flooring replacements for functional safety may be allowable, discuss with your Care Advisor.
• Assisting the care recipient, and the homeowner if the homeowner is not the care recipient, to access technical advice on major home modifications.
• Assistance from support worker to organise belongings, including packing for a move.
• Advising the care recipient on areas of concern in their home that pose safety risks and ways to mitigate the risks.
• Remediation of hoarding, providing one-off decluttering/cleaning where it is required to ensure the safety of the care recipient and the home care worker entering the home.

Assistance and service dogs

• Service / Assistance Dog: A Home Care Package can assist with funding towards the ongoing cost of a Service/Assistance Dog (including a Guide Dog). The definition of assistance dog can be found at: www.healthdirect.gov.au/assistance-dogs. These costs include pet food, vet bills and essential grooming. If the client is walking their dog themselves, a support worker may accompany.

• Beauty therapy (e.g. manicures) and hairdressing. Note: transport for a hairdresser to provide home hairdressing may be allowable due to being bedbound, however the actual hairdressing cannot be funded.
• Wigs.
• Grooming devices e.g. electric shaver.
• Medicated skin creams and ointments, body wash, shampoo.
• Toilet Paper.

• Continence aids if a participant is in the CAPS program (HCP can fund these items once CAPS funding for the 12 months has been utilised).
• Sanitary pads

• Cost of entertainment activities, such as club memberships and tickets to sporting events.
• Travel and accommodation.
• Supplies to participate in any activity, e.g. gardening or craft.
• Meals during a social event or outing.
• Gym or pool memberships/access costs when not prescribed for aged-related functional decline and monitored by health professional operating within their scope of practice.
• Hobbies: any item that is essentially a personal hobby such as cameras, gaming device/ chairs, internet, club subscription, consumables etc.
• Gambling activities.

• Payment or gap payment for state/territory government funded programs, such as the Medical Benefits Schedule (MBS)/ Medicare or the Pharmaceutical Benefits Scheme (PBS) and/or aids and equipment schemes.
• Gap payments on Private Health insurance claims.
• Hospital costs, ambulance cover or private health insurance premiums.
• Dentures, dentistry and dental surgery.
• Prescription glasses, spectacles, contacts, eye tests, lenses and frames. Exception: specialised visual aids with an assessed care need regarding impaired sight.
• Prostheses (e.g. artificial limb).
• Diagnostic imaging, e.g. Xray or MRI.
• Specialist appointments.
• Natural therapies, including:
  • Alexander technique
  • Aromatherapy
  • Bowen therapy
  • Buteyko
  • Feldenkrais
  • Homeopathy
  • Iridology
  • Kinesiology
  • Naturopathy
  • Pilates (except sessions supervised by an exercise physiologist or physiotherapist)
  • Reflexology
  • Rolfing
  • Shiatsu
  • Tai chi (except sessions supervised by a Chinese Medicine Practitioner, exercise physiologist or physiotherapist)
  • Western herbalism
  • Yoga (except sessions supervised by an exercise physiologist or physiotherapist).
• Massage from a beautician/beauty therapist.
• Hearing aids available under the Hearing Services Program. Contact the Hearing Service Program for guidance on hearing aid replacement and delegate approval for non-standard hearing aids. Exception: if care recipient is not a pension concession card holder, in which case a HCP may cover (like for like) a typical hearing aid covered by HSP in this case only.
• Medications, vitamins and supplements, as well as items not covered by the PBS such as off-indication prescriptions, medicines not endorsed for listing by the Pharmaceutical Benefits Advisory Committee (PBAC) or medicines where the manufacturer has chosen not to list the product on the PBS.
• All medical services delivered by medical practitioners (as regulated by Ahpra’s Medical Board of Australia) are excluded in the HCP Program unless the purpose of the visit is to seek evidence for the dementia and cognition supplement, oxygen and/or enteral feeding supplements and the physician bills privately for the session.
• Psychiatry.

• Private transport-related costs including vehicle registration, vehicle repairs, vehicle insurance and fuel.
• Local transit costs of public bus, ferry or train fares.
• Gap payment when using the half price taxi scheme.
• Ride share, e.g. Uber.

• Non evidence based items.
• Gym equipment such as weights, bands, treadmills or exercise bikes.
• Gaming chairs.
• Massage table and guns.
• Air purifier.
• Diabetes related equipment.

• Purchase of food or drinks (including products like Sustagen), except as part of enteral feeding requirements.
• Vitamins, supplements and all medications (PBS or Non-PBS medications are not allowable).
• Take away food, premade meals from the supermarket, food delivery services e.g. UberEATS.

• Payment for permanent accommodation, including assistance with home purchase mortgage payments or rent, residential care (govt funded or privately funded).
• Moving costs.
• Home insurance, rates and household bills, such as water, sewage, phone, internet, gas and electricity costs.
• Televisions and streaming services (e.g. Netflix or foreign language TV channels).
• Purchase of toiletries, groceries, cleaning products.
• Whitegoods and electrical appliances (except items designed specifically for frailty such as a tipping kettle) including but not limited to air-conditioning, heating, fridges, stove tops, ovens microwaves, televisions, food blenders, clothes lines and vacuums.
• General mattress and frame for bed (exceptions for pressure relieving mattress or mattress/frame for an electrical adjustable bed or hospital bed).
• Home repairs/maintenance/specialist cleaning performed by a tradesperson or other licensed professional such as pest control, treatment of mould, steam cleaning of carpets and soft furnishings.
• Installation, replacement/repair /maintenance/servicing/professional cleaning of:
  • Water tanks
  • Solar panels
  • Fencing
  • Doors: internal, external or automatic
  • Gates
  • Roofs
  • Heating and cooling or hot water systems
  • Swimming pools
  • Power points (generally no)
  • Fridges
  • General household furniture or equipment.
• Home modifications or capital items that are not related to the care recipient’s aging-related care needs, for example:
  • Windows, roofs, pergolas, sunrooms, decking
  • Home modifications that don’t support ageing safely e.g., non-accessible bathroom and kitchen modifications; non-standard fittings in accessible bathroom modifications (e.g., mosaic tiles)
  • Home modifications requiring development applications
  • Major modifications, e.g. full bathroom renovation
  • Aesthetic modifications of any kind, (e.g. more expensive tile choices, heated towel rails or replacement of flooring) are excluded
  • Repainting the home
  • Major plumbing
  • Emptying of septic tank; remedying sewage surcharge (matter for water company/insurer)
  • Major electrical work, e.g., rewiring house
  • Replacement of entire floor and floor coverings throughout the home, some consideration can be given to safe passage for mobility equipment required or slip hazard reduction
  • Replacement of foundation e.g., concrete/cement slab
  • Significant changes to the floorplan of the home, such as adding a new bathroom or extension.
• Extensive gardening services such as:
  • Planting and maintaining crops, natives and ornamental plants
  • The installation and/or maintenance of raised garden beds
  • Compost heaps
  • Watering systems
  • Water features and rock gardens
  • Landscaping
  • Tree removal
  • Removal of garden beds
  • Removal of shrubbery (unless preventing safe access and egress)
  • Excessive gardening in areas not immediate to the home, access and egress
  • Green waste removal.
• Computers (desktop computers or laptops), ipads/tablets, home / mobile phones, e-readers, smart watches and similar.
• Home renovations, modifications or capital items that are not related to the care recipient’s care needs.
• Home maintenance services (such as those requiring a tradesperson) are typically the responsibility of the homeowner.
• Purchasing or replacement of fixtures, equipment or fittings that are considered basic accommodation responsibilities of the homeowner, tenant or landlord. This includes items such as security doors or cameras, flooring, painting, driveway maintenance, structural changes (i.e. moving walls or plumbing).
• Replacing gutters or flyscreens.
• Glass shower screens.
• Security related items such as doors, screens, cameras (external and internal), external lightning, doorbells.
• Complete re-concreting is out of scope, however it is allowable to replace a specific, limited area of problematic cracked concrete which poses a safety risk.

• Home Care Package Fees, i.e. basic daily fee, income-tested care fee and additional fees.
• Solicitors or accountants for maintaining care recipients’ personal affairs.
• Funeral costs and funeral plans.
• Cash payments or gift vouchers/cards, including online vouchers and coupons.
• Clothing including shoes.
• Pet care and associated costs such as walking (if the client is walking their dog themselves, a support worker may accompany), grooming, pet food; toys, bedding and boarding/pet sitter expenses, registration, vet bills, medication, insurance taxidermy, cremation.
• Service/s delivered by family members or live-in carers.
• Death Doula services.
• Case Management services.