Home modifications

PART 14 - Home modifications

This part of the Lifetime Care and Support Guidelines is issued under section 93 of the Lifetime Care and Support (Catastrophic Injuries) Act 2014.

To avoid requirements that might be unreasonable in the circumstances on any participant, the LTCS Commissioner may waive observance of any part or parts of these LTCS Guidelines.

Background

The LTCS Commissioner recognises that as a consequence of their motor accident injury, home modifications will be the preferred option for some participants to access their homes and live safely. Home modifications are considered in the overall decision making process regarding the living arrangements of the participant. In deciding the best residential outcome for the participant, the LTCS Commissioner will consider the participant's short and long term living arrangements, and all reasonable alternatives such as the provision and installation of equipment, and relocation to a more appropriate residence, as well as home modifications to an existing residence.

All home modifications require prior approval in writing by the LTCS Commissioner.

Policy

The LTCS Commissioner will fund the reasonable and necessary cost of home modifications for a participant who is residing in a new home or returning to their existing home for the long term, and the need for home modifications is related to the motor accident injury. 

Definitions

Home – a domestic structure which is a participant's usual place of residence, for example, a house or unit.

Home modification – modification to the structure, layout or fittings of a home where the motor accident injury restricts or prevents the ability to utilise the home's standard fittings or facilities. 

Relocation costs – costs directly related to moving from one home to another.

Rental property – a home lived in by a participant whereby rent is paid to a private owner, Community Services Directorate, or a community housing association.

  1. Consent

    2. The participant, wherever possible, should be involved in the decision making processes relating to their home modification and agree to any proposed modifications. Agreement and permission from the home owner must be obtained before the home modification process can proceed.

  2. Ensuring the home can be modified

    3. The LTCS Commissioner will first ensure that the participant's home is reasonably able to be modified. This will be assessed on several factors including but not limited to:

To ensure that the home is reasonably able to be modified, all proposed home modifications must be approved where necessary by relevant ACT planning authorities before any work may begin.

The LTCS Commissioner will not fund home modifications for any residence or property that constitutes, is likely to constitute, or will result in, an illegal structure. An illegal structure is one that is contrary to relevant building and construction codes or relevant ACT planning Guidelines, statutes and/or laws.

  • Assessment of the need for home modifications

    • The LTCS Commissioner will require a home assessment to be conducted by an occupational therapist with appropriate experience in home modifications. The assessment should include the participant's functional status and their proposed home environment. The assessment should identify environmental barriers relating to the motor accident injury, including all options to overcome these barriers. For example, any existing equipment and non-structural home modifications should be considered as an option if they enable an appropriate level of independence or safety for the participant and family.

    Recommendations for home modification as a preferred option must include clear clinical justification as to why home modifications are reasonable and necessary, and the feasibility of the proposed home modification compared with other alternatives such as relocation.

    The participant's need for home modifications is determined by the extent of physical injury and/or permanent loss of physical functioning and mobility that a participant has experienced as a result of their motor accident injury. The participant's need may also be determined by the extent of the participant's cognitive and/or behavioural impairment.

    Factors to consider when assessing a participant's need for home modifications may include:

  • Factors impacting upon whether home modifications are reasonable and necessary

    • Factors taken into account when deciding if a home modification is reasonable and necessary include:

    The LTCS Commissioner will assess whether home modifications are reasonable and necessary based on information contained in building modification project plans, reports from the home assessment completed by the occupational therapist, final modification costs and any other relevant information or reports.

    The LTCS Commissioner may approve home modifications in principle if final costs for modifications are being established. The LTCS Commissioner may delay definitive modifications where the participant's injury is likely to change or improve. In these circumstances the LTCS Commissioner may approve staged modifications to ensure the safety of the participant in the short term.

    4.1.    Modifications costing less than $11,100

    The LTCS Commissioner will fund reasonable and necessary home modifications that cost less than or equal to $11,100 (GST exclusive) irrespective of the type of residence or accommodation being modified, if the owner of the premises agrees to the proposed modifications and the home is able to be modified.

    4.2.    Modifications to a rental property

    The LTCS Commissioner will fund reasonable and necessary home modifications for participants in a private rental property or rental with family. The LTCS Commissioner will fund up to $11,100 in home modifications for every year of a guaranteed lease, if the owner of the premises agrees to the proposed modifications and the home is able to be modified.

    If the participant moves out of a private rental property, the LTCS Commissioner will fund the reasonable and necessary costs of returning a rental property to its former state, when the costs:

    For example, the LTCS Commissioner may fund the removal of grab rails, wedge ramps or replacement of a shower screen or hob at the end of a long-term tenancy.

    The LTCS Commissioner will only consider other costs relating to returning a rental property to its former state if they are reasonable and necessary, related to the motor accident injury and specifically requested by the owner, such as wear and tear to carpets as a result of wheelchair use.

    The LTCS Commissioner will not fund other costs associated with the end of a tenancy that are a condition of the lease, such as advertising costs associated with breaking a lease, steam cleaning of carpets or cleaning a property at the end of a tenancy.

    4.3.    Modifications to a home owned by the participant or their family

    The LTCS Commissioner will fund home modifications where:

    For participants living within the family home or who occupy their own home, the LTCS Commissioner may seek:

    Requests for home modifications that do not fall within the situations above will be considered on a case by case basis.

    4.4.    Transitional accommodation

    The LTCS Commissioner will fund the costs of short-term transitional accommodation in limited circumstances when a home modification is in process.

    Transitional accommodation is defined by the LTCS Commissioner as accommodation required when:

    The LTCS Commissioner will fund transitional accommodation for a maximum duration of 6 months. The LTCS Commissioner will only fund transitional accommodation for the first home modification.

    The LTCS Commissioner will consider funding the reasonable and necessary costs of transitional accommodation with regard to the following factors:

    The LTCS Commissioner will not fund:

  • Relocation if the home is not suitable for modification

    • If the home is unable to be modified, or if relocation is considered the most appropriate option, the LTCS Commissioner will fund the reasonable and necessary costs of:

    5.1.    Assistance to locate a suitable home for purchase

    If a participant's home is unable to be reasonably modified, or if relocation is the most appropriate option, the LTCS Commissioner may assist the participant to locate a suitable home for purchase by funding the reasonable and necessary costs of services to assist the participant to locate a suitable property. This will be considered where the participant is unable to look for alternative properties by searching the internet or liaising with real estate agents, or does not have family or friends to assist them locate a suitable property.

    5.2.    Changes of residence

    The participant and their family must consider the participant's individual needs as related to the motor accident injury, including current and expected function, prior to any change of residence. The LTCS Commissioner may fund professional assistance in order to identify suitable residential options for the participant and family.

    5.3.    Assistance when purchasing a new home

    When considering purchasing a home, the LTCS Commissioner expects that the participant will locate a property that does not require substantial modification, and the approximate cost of any home modification required will not be greater than $77,700. The LTCS Commissioner does not consider it reasonable that a participant with significant functional limitations chooses to move to a home where substantial modifications need to be undertaken to allow them to reasonably access the home.

    The LTCS Commissioner considers the approximate cost of home modifications will not be greater than $77,700 to enable the participant to access the following areas of the home:

    If the participant indicates a serious interest in purchasing a home and intends making an offer, the LTCS Commissioner requires a current building report or strata report (for units/townhouses) and pest report be provided to the LTCS Commissioner before purchase to ensure that the home is reasonably able to be modified. The cost of the building report or strata report, and pest report, will be reimbursed after the home is purchased.

    The LTCS Commissioner will not fund:

  • Service providers for home modifications

    • All home modifications funded by the LTCS Commissioner must be provided by an appropriately qualified licensed builder or trades person who holds current registration as a company or as a business/sole trader.

    The home modification must be in accordance with the quotation approved by the LTCS Commissioner and in accordance with the plans and job specifications submitted to the value of the approved quotation.

  • Additional work/cost-sharing

    • Modifications will be approved on an as-needed basis. A quotation is requested for works that are necessary for the proposed modifications. At times, the owner of the property, the participant and/or their legal representative or family member may request additional building works, or higher cost finishes because of aesthetic, architectural or other reasons, which are outside the scope of the LTCS Commissioner's funding. These works need to be quoted separately, agreed upon and the cost borne by the participant and/or property owner.  Any additional work should not affect participant access to or within the area being modified, or in any way adversely compromise the impact of any modifications that have been approved.

  • Home modification to a secondary home that is lived in concurrently

    • The LTCS Commissioner will fund the reasonable cost of basic access, for example, ramps, rails, doorway widening and minor bathroom modifications for a secondary residence which is lived in concurrently by a participant. For example, a participant who is a child may require a second home modification to stay at the residence of the parent who is not the primary carer, has joint custody or agreed regular overnight access visits in an agreement ratified by the Family Court or agreed to by both parents.

    If modifications to a secondary residence are requested, the LTCS Commissioner will consider the nature and extent of any previous home modifications approved by the LTCS Commissioner, along with the anticipated amount of time that the participant is expected to spend in the secondary residence and the potential benefit of modifying the secondary residence.

  • Subsequent home modification

    • The LTCS Commissioner recognises it may be reasonable and necessary to fund more than one home modification as the participant's circumstances change. Such circumstances may include, but are not limited to:

    If subsequent home modifications are requested, the LTCS Commissioner will consider:

    Funding available for subsequent home modifications will be considered in accordance with section 4 above.

  • Repairs and maintenance

    • The LTCS Commissioner will fund the reasonable and necessary cost of repairs and maintenance on home modifications funded by the LTCS Commissioner that are essential for participant access or safety. The LTCS Commissioner will consider funding the costs of repairs and maintenance for any additional wear and tear to a property that is a result of the motor accident injury, such as damage to floorboards from wheelchair use.

    If costs for home modifications were not funded in full by the LTCS Commissioner (for example, shared with the property owner), then the LTCS Commissioner will fund the cost of repairs or maintenance proportional to the original costs paid.

    The participant or property owner is responsible for any repairs and maintenance as a result of normal wear and tear (such as replacement of bathroom fittings/fixtures), for the upkeep of a residence (such as house painting) or maintenance of any additional works not funded by the LTCS Commissioner.

    The LTCS Commissioner will not fund:  

  • Room temperature control equipment

    • The LTCS Commissioner will fund the reasonable and necessary cost of room temperature control equipment if the participant is unable to self regulate their body temperature as a result of a motor accident injury, or if the lack of room temperature control causes secondary care complications.

    11.1.    Information required by the LTCS Commissioner

    For a participant with a complete spinal cord lesion at or above the level of T6, the LTCS Commissioner will fund the reasonable and necessary cost of the provision and installation of a reverse cycle air conditioner to provide heating and cooling. This does not require the certification of a medical specialist.

    For participants other than those who have sustained a complete spinal cord lesion at or above the level of T6, the LTCS Commissioner requires documentation that the participant has an impaired or absent ability to regulate their body temperature which will not resolve, or secondary care complications, including any clinical evidence such as documented changes in the participant's function in extremes of temperature. This must be certified by a suitably qualified medical specialist.

    11.2.    Areas of the home the LTCS Commissioner will fund room temperature control equipment

    Where the medical need for room temperature control equipment has been established, the LTCS Commissioner will determine the areas of the participant's home that it is reasonable and necessary to heat or cool, having regard to the following factors:

    In considering any requests to fund room temperature control equipment for areas other than the participant's home, the LTCS Commissioner will consider the following factors:

    The LTCS Commissioner will not fund:

    11.3.    Contribution to operating costs

    The LTCS Commissioner may contribute to the costs associated with the operation of room temperature control equipment. Operating costs may include the cost of electricity or gas and consumable items such as lubricating oil and filters.  The LTCS Commissioner will only consider a contribution to the cost of electricity or gas where an increase in the total consumption can be shown to relate directly to the running of the room temperature control equipment whether the equipment was purchased by the LTCS Commissioner or previously owned by the participant. For example, the participant is required to use the room temperature control equipment more frequently as a result of the injuries from the motor accident.

    The production of accounts or account summaries will be required to be provided for the LTCS Commissioner to identify the difference in pre- and post-accident electricity or gas costs, and to calculate payment for the amount of electricity or gas for which the LTCS Commissioner is liable. The LTCS Commissioner will calculate additional electricity or gas costs based on the increase in kilowatt hours or cubic metres multiplied by the cost per unit, rather than the gross dollar increase, which may be related to increases in other costs for which the LTCS Commissioner is not liable.

    The LTCS Commissioner will calculate the costs associated with the operation of room temperature control equipment by considering the following factors:

    Any change of domestic circumstances or prolonged absence from home will require a reassessment of the LTCS Commissioner's contribution rate to the operating costs.

    11.4.    Contribution to maintenance and repair costs  

    The LTCS Commissioner may contribute to the costs associated with the maintenance and repair of room temperature control equipment. Maintenance and repair costs may include servicing, preventative maintenance and repairs. The LTCS Commissioner will fund a contribution to the reasonable costs of servicing, preventative maintenance and repairs of room temperature control equipment.

    The LTCS Commissioner will negotiate this contribution having regard to the equipment to be operated, e.g. air-conditioner or heater and the number and size of rooms to be heated or cooled.

    Any change of domestic circumstances or prolonged absence from home will require a reassessment of contribution rate. To reimburse the approved contribution to gas or electricity costs, the LTCS Commissioner requires a copy of the gas or electricity account showing the calculation of cost for utility consumption and evidence of payment of the account.

    The LTCS Commissioner will not fund:

    Monetary amounts referred to in these LTCS Guidelines will be adjusted in accordance with movements in the determinations in force from time to time made by the New South Wales Treasurer applicable to non-economic loss payments under the NSW Motor Accidents Compensation Act 1999.

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