Guidance Material for an Occupational Therapist · PDF fileCompleting a Victorian WorkCover...

Guidance Material for an Occupational Therapist

Completing a Victorian WorkCover Authority

Household Help (Occupational Therapy) Assessment

Guidance Notes for an OT’s completing a HH (OT) Assessment

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Copyright not enforced

“The information contained in this publication is not subject to copyright. The Victorian WorkCover Authority encourages the free transfer, copying and printing of the information in this publication if such activities support the purposes and intent for which the publication was developed.”

Currency

“This publication is current as at 1 January 2004, and replaces and supersedes all previous versions of this publication.”

First published November 2003


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Table of contents EXPLANATION OF TERMS 4 INTRODUCTION 5 Defining Household Help 6 The Household Help Occupational Therapy Assessment 6 Using this guidance material 7

SECTION 1: POLICIES AND ADMINISTRATION RELEVANT TO CONDUCTING A HOUSEHOLD HELP OCCUPATIONAL THERAPY ASSESSMENT Eligibility criteria 9 Professional conduct 9 Privacy 9 Occupational Health and Safety 10 Schedule of fees 10 Invoice Requirements 10

SECTION 2: PROCEDURES FOR COMPLETING ASSESSMENTS Household Help (OT) Assessment request process 13 Expected timeframes for actions 14 Conducting the assessments 15 Completing the report 15

SECTION 3: GUIDANCE NOTES FOR COMPLETING TOOL AND REPORT 17 ATTACHMENT 1: PROFORMAS Attachment 1.1 Household Help (OT) Assessment TOOL 40 Attachment 1.2: Household Help (OT) Assessment REPORT 48 Attachment 1.3: Agent Household Help (OT) Assessment Request Proforma 53 Attachment 1.4: Example Medical Release Authority 54

ATTACHMENT 2: EG HOUSEHOLD HELP (OT) ASSESSMENT REPORT 54 ATTACHMENT 3: CONSULTATION/ BIBLIOGRAPHY 60


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Explanation of Terms

Authorised Agent (agent) Means a person appointed under Section 23 of the Accident Compensation Act 1985 to be an authorised agent of the Authority. The agent manages claims on behalf of the Victorian WorkCover Authority. References to Authorised agents in this document are not relevant where the employer is self insured.

Case Manager Means a Case Manager employed by an agent.

Current work capacity In relation to an injured worker, means a present inability arising from an injury such that the injured worker is not able to return to his or her pre-injury employment but is able to return to suitable employment.

Household Help

Household Help is a ‘personal and household service’ within the meaning of section 5(1) of the Accident Compensation Act 1985.

Household Help service In a WorkCover context household help refers to the provision of assistance (housework / gardening labour hire services) for injured workers with basic, routine, common housework and gardening tasks in their home.

Household Help also refers to (authorised) occupational therapy services, provided (at the request of an agent) by an Occupational Therapist (registered by the Victorian WorkCover Authority) in order to maximise an injured worker’s independence with Household Help activities.

Household Help (OT) Assessment

Means a Household Help (Occupational Therapy) Assessment. A Household Help (OT) Assessment is WorkCover’s customised household help assessment format for use by Occupational Therapists (approved as a service provider with the Victorian WorkCover Authority) to assess an injured worker’s functional capacity in regard to household help activities.

Independent medical examination

Means a medical examination under Section 112 of the Accident Compensation Act 1985

Injury Means an injury within the meaning of Section 5 of the Accident Compensation Act 1985.

IMA (Injury Management Advisor)

Means an Injury Management Advisor employed by an agent.

Injured worker (worker) Means workers who have incurred an injury or disease at work and have entitlement to workers compensation under the Accident Compensation Act 1985 in respect of that injury or disease.


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'Medical Release Authority' Means a release by a worker, or the agent of the worker,

to allow a health professional to make information or records relating to that worker available to the Occupational Therapist undertaking the Household Help (OT) Assessment.

No current work capacity In relation to an injured worker, means a present inability arising from an injury such that the injured worker is not able to return to his or her pre-injury employment and is not able to return to suitable employment.

Occupational Therapist

Means an Occupational Therapist who has occupational therapy qualifications approved by the Victorian WorkCover Authority.

Reasonable Cost Guidelines (RCG)

Means the maximum costs (hourly payment rates) that WorkCover have determined as reasonable payment for a Household Help service.

Return to work plan Means the individual written plan for returning an injured worker to work required under Part VI (Section 156(2)) of the Accident Compensation Act 1985 (the Act), where the worker has no current work capacity within the meaning of the Act in respect of the injury for a period or periods that total 20 or more calendar days.

Treating practitioner Means the medical practitioner treating the worker, or the medical practitioner or other provider who gives the certificates of capacity to the worker. This includes a medical practitioner, registered physiotherapist, registered chiropractor or registered osteopath.

Victorian WorkCover Authority (VWA)

Means the Victorian WorkCover Authority in accordance with the Act.

WorkCover certificate Means a medical certificate required under Section 103(1)(b) of the Accident Compensation Act 1985 to accompany a claim for compensation.


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Introduction

This guidance material has been developed by the Victorian WorkCover Authority to assist Occupational Therapists completing a WorkCover Household Help Occupational Therapy (OT) Assessment for an injured worker (worker) under the WorkCover scheme and should be read in conjunction with the Accident Compensation Act 1985 (the Act) and Household Help “Agent Advisory Material”. Defining Household Help Section 99(1)(a) of the Act provides that if an injured worker has an injury which entitles them to compensation, then the Victorian WorkCover Authority, or a self insurer and the employer, is liable to pay as compensation the reasonable costs of medical and like services, which includes personal and household services. In a WorkCover context, household help refers to the provision of assistance for injured workers with basic, routine, common housework and gardening tasks in their home. In addition, household help refers to (authorised) occupational therapy services, provided (at the request of an agent) by an Occupational Therapist (approved by the Victorian WorkCover Authority), in order to maximise a worker’s independence with Household Help activities. By this, the Authority aims to deliver Household Help services that are appropriate for the worker’s injury, stage of recovery (including their physical rehabilitation program) and household circumstances. The service provision strategy is therefore designed to deliver appropriate short-term assistance in the acute post injury (or post surgery) period, and where recovery or functional restoration is prolonged, or functional incapacity is permanent, delivering services that maximise a worker’s return to independence with household tasks. Household Help Occupational Therapy Assessment To support appropriate Household Help service delivery strategy, the Victorian WorkCover Authority has developed a professional assessment tool and report format for Occupational Therapists to use in assessing a worker’s Household Help needs and recommending appropriate strategies for maximising a worker’s independence with household activities. A request is made by the agent (and in some circumstances the treating medical practitioner) to an Occupational Therapist in order to assist with identifying strategies to maximise and maintain a worker’s independence in completing household help tasks by: • Re-educating and training the worker in adaptive housework/gardening methods; • Assisting the worker to find ways to compensate for any functional limitations by

the use of adapted techniques, and/or equipment; and • Recommending external household help services where independence cannot be

maintained.


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Recommendations detailed in the Household Help (OT) Assessment will assist the agent to make consistent, sound and proper decisions regarding a worker’s entitlement and eligibility for a Household Help service, based on their assessed needs and individual circumstances. Using this Guidance Material This guidance material is divided into three sections. Occupational Therapists should familiarise themselves with each section to ensure they meet the Victorian WorkCover Authority’s requirements and obligations when conducting a Household Help (OT) Assessment. Section 1 details the general administrative policy in relation to conducting an assessment for the Victorian WorkCover Authority. Section 2 details the procedural requirements specific to conducting a Household Help (OT) Assessment. Section 3 contains Guidance Notes on using the Household Help (OT) Assessment Tool and completing the Report; as well as templates for both.


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Section 1

Household Help (OT) Assessment: Standards and Approvals Eligibility criteria 9 Professional conduct 9 Privacy and confidentiality 9 Occupational Health and Safety 10 Schedule of fees 10 Invoice requirements 10


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1.1 Eligibility criteria It is mandatory for an Occupational Therapist conducting the assessment to:

• Be a qualified Occupational Therapist (OT) who is a member of (or eligible for membership with) OT AUSTRALIA;

• Be approved by the VWA as an authorised 'Medical & Like Services" Provider; and

• Have completed WorkCover’s Household Help (OT) Assessment training. 1.2 Professional Conduct

An Occupational Therapist must conduct themselves at all times in accordance with their Professional Code of Ethics. The role of an Occupational Therapist is to undertake a Household Help (OT) Assessment that is of high practitioner quality and to provide a report that is entirely impartial, objective and contains recommendations that are based on the agent’s liability and the worker’s assessed needs and relevant WorkCover considerations.

An Occupational Therapist must:

• Only accept a request if their workload permits them to conduct the assessment and submit the report within agreed timelines;

• Conduct the assessment conscientiously, expeditiously and in a proper, professional, legal and business-like manner;

• Exercise standards of diligence and care normally exercised by similarly qualified persons in the performance of comparable work;

• Inform the agent of any non-cooperation by the worker; and

• Take due regard of the extent of relevant Victorian WorkCover Authority considerations in each case.

NOTE: In accepting a request to conduct a Household Help (OT) Assessment the Occupational Therapist agrees to the guidelines and standards outlined in this Guidance Material.

1.3 Privacy

Occupational Therapists are subject to the Privacy Act 1988 (Cth), the Health Records Act 2001 (Vic) and other legislation and ethical codes that apply to Occupational Therapists, when treating and assessing patients on a day to day basis. When an Occupational Therapist undertakes a WorkCover Household Help Occupational Therapy (OT) Assessment for a WorkCover claimant, the VWA requires an Occupational Therapist to comply with these existing privacy obligations in relation to handling a claimant’s personal and health information. It is VWA policy that authorised agents provide a copy of the OT report to the claimant when they advise the claimant of their decision on service provision.


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1.4 Occupational Health and Safety

An Occupational Therapist is responsible for developing and implementing safe work practices that in no way adversely affect the health and safety of themselves or others. 1.5 Schedule of fees for assessments An Occupational Therapist is able to use the following schedule of codes and fees when completing Household Help (OT) Assessments (as at 1 July 20031):

Code Description Fee Effective

MX36 ADL001

ADL Assessment – Insurer Requested (maximum 5 hours) ADL Assessment – GP Referred

$84.69 p/h $84.69 p/h

1 July 2003 1 July 2003

Services include:

¬ Liaison with the agent, worker & their treating health practitioner. ¬ Conducting the assessment ¬ Travel costs ¬ Education (where appropriate) ¬ Report preparation

NOTE: Additional reimbursement for travel may be granted in exceptional circumstances. The Occupational Therapist should discuss these circumstances with the authorised agent and seek approval prior to undertaking the assessment.

1.6 Invoice requirements Invoices should include: • An Occupational Therapist’s details including: Name and Victorian WorkCover

Authority Health Services Medical and Like Provider number • ABN (Australian Business Number) • Invoice number and/or date of invoice • Worker’s name, claim number and date of injury (where a claim number is

unknown include the worker’s date of birth) • Employer’s name • Dates of service • Item code • Description of each service • Fee charged for each service All accounts must be submitted to the agent on completion of authorised services, or at intervals negotiated with the agent. NOTE: The Victorian WorkCover Authority will only pay for services with prior approval, and where services have been rendered (consequently non attendance and cancellation by workers will not be paid). However, in exceptional circumstances

1 Rates are subject to indexation. Refer to the Victorian WorkCover Authority website for current rates at: www.workcover.vic.gov.au


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occupational therapists may negotiate with Agents in respect to their individual circumstances. Invoices should be forwarded to the postal address of the agent as detailed on the website www.workcover.vic.gov.au.


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Section 2

Procedures for completing Household Help (OT) Assessments

2.1 Household Help (OT) Assessment request process 13 2.2 Expected timeframes for actions 14 2.3 Conducting the assessments 15 2.4 Completing the report 15

This section should be read in conjunction with:

Attachment 1.1: Household Help (OT) Assessment TOOL 40 Attachment 1.2: Household Help (OT) Assessment REPORT 48 Attachment 1.3: Agent Household Help (OT) Assessment Request Form (To be forwarded to the Occupational Therapist by the agent) 53 Attachment 1.4: Example Medical Release Authority 54


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2.1 Household Help (OT) Assessment request process

The agent will complete a Household Help (OT) Assessment request for both initial and review assessments. NOTE: In some circumstances a request may come from the treating medical practitioner. An Occupational Therapist must use the Household Help (OT) Assessment Tool and Report when completing these assessments. The Occupational Therapist must ensure that they have prior written authorisation from the agent prior to commencing any services regardless of the source of the request. When conducting a review assessment, an Occupational Therapist must focus on identifying and assessing changes to the worker’s medical, functional and household status and make recommendations accordingly. Additional information may be provided by the agent to assist the Occupational Therapist to complete an assessment. An Occupational Therapist must seek a copy of any previous Occupational Therapy assessment reports from the agent. If the agent does not provide a copy with the original request, it is suggested that the Occupational Therapist contact the agent. The following are examples of documents that may be provided by the agent if available and relevant to the assessment being requested:

• Worker’s WorkCover Claim Form;

• Household Help request – treating medical practitioner advice;

• Household /Gardening Tasks – Service Authorisation List;

• Previous (most recent) Household Help (OT) Assessment report(s).

• Previous Activities of Daily Living Assessments;

• Relevant sections of the most recent treating medical (or other) practitioner or independent medical examiner reports; and

• If services are requested in conjunction with the worker’s return to work, a copy of the employer’s most recent ‘Return to Work Plan’ and ‘Offer of Suitable Employment’ document and relevant associated approved occupational rehabilitation provider reports.


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2.2 Expected timeframes for actions

The flow chart below details the timeframes for key actions to be completed by an Occupational Therapist. NOTE: An Occupational Therapist should negotiate any variations with the agent.

Timeframe Proformas to be used

Request Process – An Occupational Therapist must:

Once a request for a Household Help (OT) Assessment has been received from an agent:

Contact agent & complete the following: • Accept/ reject request dependent on ability to complete assessment & report within required time. • Discuss request. • Clarify scope of Assessment.

• Contact injured worker to book time to complete Assessment.

• Explain Assessment process. • Conduct Assessment.

• Contact treating medical practitioner. • (other treating health practitioner optional).

• Complete Assessment Report and forward this to request source eg agent.

• Close file unless otherwise

advised by agent.

2 days

7 days

7 days

2 days

* Household Help (OT)

Assessment Tool

* Household Help (OT)

Assessment Report


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2.3 Conducting the assessment

The Household Help (OT) Assessment must be completed by an Occupational Therapist at a worker’s home. The Occupational Therapist must:

• Utilise the Household Help (OT) Assessment Tool to complete the assessment;

• Fully consider the scope of the assessment provided by the agent;

• Obtain a detailed verbal history from the worker relevant to the assessment;

• Determine the worker’s functional abilities with respect to their request and its relationship to their compensable injury;

• Provide the worker with education to maximise their independence in performing housework and/or gardening tasks;

• Contact the treating medical practitioner to discuss the assessment and seek further medical information; and

• Where appropriate contact other relevant parties for information eg treating health practitioner (physiotherapist, chiropractor etc).

2.4 Completing the report

The Household Help (OT) Assessment Report proforma must be used by an Occupational Therapist to complete the final report following the assessment. When writing the report, an Occupational Therapist must:

• Relate recommendations and the report to the specific scope of the request;

• Complete all relevant sections of the report eg where a section is not relevant, specify this by marking it as “not applicable”;

• Ensure final reports are typed, of high quality and error free;

• Be objective;

• Be signed and dated by the Occupational Therapist who completed the assessment; and;

• Submit the report to the agent. NOTE: the agent will read the assessment and make a decision on entitlement to Household Help services. When notifying the worker in writing of a decision, the agent will forward a copy of the Household Help (OT) report recommendations to the worker and the worker’s treating medical practitioner.

NOTE: Household Help (OT) Assessment reports not completed to the agent’s satisfaction (due to not meeting requirements as set out in this Guidance Material) may be returned to the Occupational Therapist for amendment at the therapist’s expense.


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Section 3 Guidance on completing the Tool and Report 3.1 How to use the guidance notes for completing the Tool and Report 17 3.2 Section on ‘Background Information’ 17 3.3 Section on ‘Assessment Scope’ 18 3.4 Section on ‘Assessment Checklist’ 19 3.5 Section on ‘Recommendations’ 20 3.6 Section on ‘Opinion regarding request for Household Help Services’ 24 3.7 Section on ‘Recommended Services to Maximise Independence’ 25 3.8 Section on ‘Recommended Review Date(s) for Services’ 27 3.9 Section on ‘Recommended Equipment to Maximise Independence‘ 28 3.10 Section on ‘Recommended adaptive techniques to Maximise Equipment’ 28 3.11 Section on ‘Documents Reviewed’ 28 3.12 Section on ‘Medical Information’ 29 3.13 Section on ‘Liaison with the Treating Medical Practitioner’ 30 3.14 Section on ‘Reported Pre-injury Function for identified task(s)’ 31 3.15 Section on ‘Reported Post-injury Function for identified task(s)’ 31 3.16 Section on ‘Task(s) currently completed by Household Help Services’ 32 3.17 Section on ‘Current Presentation’ 32 3.18 Section on ‘Observations and correlation between observed and reported

data’ 34 3.19 Section on ‘Personal/Household Circumstances’ 34 3.20 Section on ‘Details of the Home Environment 35 3.21 Section on ‘Summary of Tasks and Relevant Comments’ 36 3.22 Section on ‘Additional Comments’ 37 3.23 Section on ‘Sign off’ 38

This section should be read in conjunction with:

The VWA Agent Advisory Material (website to be included when available) Attachment 1.1: Household Help (OT) Assessment TOOL 40 Attachment 1.2: Household Help (OT) Assessment REPORT 48 Attachment 1.3: Agent Household Help (OT) Assessment Request For (To be forwarded to the Occupational Therapist by the agent) 53 Attachment 1.4: Example Medical Release Authority 54 Attachment 2: Example of a completed Household Help (OT) Assessment Report 55


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3.1 How to use the guidance notes for completing the Tool and Report The Household Help (OT) Assessment Tool and Report are almost identical in content therefore an Occupational Therapist can utilise the following section for guidance on using both the Tool and Report proformas when completing an assessment. Information in italics denotes additional comments to further assist an Occupational Therapist in completing an assessment and report. This information is not included in the Household Help (OT) Assessment Tool and Report proforma and is provided as a guide.

3.2 Section on ‘Background Information’ This section contains basic background information relating to the assessment. General considerations for an Occupational Therapist are as follows: • An Occupational Therapist must complete all sections. • Most of the information can be obtained from the documentation sent by the

agent. Incomplete details can be obtained from the worker. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

BACKGROUND INFORMATION:

DATE OF ASSESSMENT: The date the assessment is conducted

WORKER: Include first and last name

CLAIM NUMBER: The worker’s claim number

MANAGING AGENT: The agent managing the claim

DATE OF INJURY: The date the compensable injury occurred

TYPE OF INJURY: Provide brief details on the type of injury eg fractured left arm

DATE OF BIRTH: The worker’s date of birth and age (at time of assessment)

GENDER: Note whether male or female

CURRENT WORK STATUS: Indicate whether the worker is at work (including days/hours)/or not at work

CURRENT MED. CERT.: Use current work capacity or no current work capacity

EMPLOYER: Detail the name of the injury employer

PRE-INJURY POSITION: List the worker’s pre-injury position/job title

REQUEST SOURCE: Specify who made the request for the assessment, title and organisation

DATE REQUEST RECEIVED:Specify the date the request was made

DATE OF REPORT: The date the assessment report was completed PRESENT (AT ASSESSMENT): List all people present at the assessment including titles


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3.3 Section on ‘Assessment Scope’ This section contains information relevant to the assessment scope. General considerations are as follows: • Occupational Therapists must complete all sections; • The Occupational Therapist should be able to obtain most of the background

information for an assessment from documentation sent by the agent. Any incomplete details can be obtained from the worker.

NOTE: If the worker reports additional issues during the assessment that are not within the scope of the assessment (as agreed with the agent), the following is recommended: • The worker should be instructed to discuss these issues with their treating

medical practitioner; • These should be verbally discussed with the agent following the assessment; and • These issues should be detailed in the ‘Additional Comments’ section and no

further actions should be taken unless authorised by the agent. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

ASSESSMENT SCOPE:

Initial Assessment - No Previous Household help Services Initial Assessment – Household Help services in place however no previous Assessment Review Assessment- Previous Occupational Therapy assessment conducted, recommendations made and implemented. Requires review of progress and Household Help services.

The worker "has requested" or "is receiving" Household Help services for [housework and/or gardening] due to difficulties with [detail identified tasks that have resulted in the request for services] • Select the appropriate response depending on the request made by the agent. • Detail the tasks as reported by the agent. • If this is a review assessment, document any previous strategies or education received to

assist in maximising independence. In response to this formal request, a Household Help (OT) Assessment was conducted to evaluate the worker’s ability to perform the above listed tasks and to maximise their independence in these tasks. The worker is currently receiving [detail service(s), service provider, when services commenced, hours, frequency, whether paid for by worker or authorised by the agent or funded through other means]. • Indicate any services the worker is currently receiving and who pays for these services eg

the worker, the agent or funded through other means (eg Veteran’s Affairs etc).


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3.4 Section on ‘Assessment Checklist’ This section contains prompts to ensure that an Occupational Therapist explains key information to the worker prior to conducting an assessment i.e. this occurs following arrival at the worker’s home. Key considerations include: 3.4.1 Medical Release Authority When the injured worker completes a WorkCover “Workers Claim Form” to claim for workers compensation, they sign their authority to release medical information. This provides authority for “any person who provides a medical service or a hospital service to me in conjunction with the injury to which this claim relates, to give information regarding the service relevant to this claim to the Victorian WorkCover Authority, my injury employer, my employer’s WorkCover Agent, or a Conciliation Officer upon request from any such person while that person is responsible for administering or conciliating this claim” If the treating practitioner requests the worker’s signed consent before they will speak with you, request that the Agent forward a copy of the worker’s Authority to the treating practitioner. To avoid any delays which may be associated with requesting the Agent forward the worker’s Authority, you may wish to consider obtaining your own medical authority from the injured worker. All such Authorities should be brief and specific to the work injury. (An example of an authority to release medical information is provided in Attachment 1)

3.4.2 Authorisation of recommendations An Occupational Therapist is advised wherever possible, not to discuss any potential recommendations for Household Help service provision with the worker as this may result in false expectations regarding outcomes of their request. If a worker requests information on potential recommendations, the Occupational Therapist should advise the worker that they are not at liberty to discuss this information. However, the occupational therapist can advise that the agent will provide a copy of the OT report with the agent decision letter. It is accepted that in some instances, an Occupational Therapist may need to discuss possible options with the worker and treating medical and/or health practitioner. It must be stressed that an Occupational Therapist must advise the worker that any options discussed are not approved and are subject to agent review and authorisation. 3.4.3 Clarifying assessment scope An Occupational Therapist must explain to the worker that only tasks identified within the scope of the assessment will be assessed. For example: • An agent may report that a worker is having difficulty with household tasks due to

back pain and has requested household help services for issues with cleaning. The worker may then report difficulty with dressing at the assessment. This is considered outside the scope of the assessment, and as such, no recommendations regarding this issue should be included in the report.


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Reference to the worker’s reported difficulties (with dressing in this case) may be included in ‘additional comments’ at the end of the report following prior discussion with the agent.

*Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

ASSESSMENT CHECKLIST

Explain the scope of the assessment to the worker, for example: "The scope of this assessment is to determine your ability to perform the above listed tasks

and to maximise your independence by assisting you to find ways to compensate for any functional limitations by use of adaptive technique, assistive equipment, re-education and training in adaptive house work /gardening methods”.

Ensure the worker understands that the agent makes all decisions on recommendations i.e. the worker must be clear that the Occupational Therapist’s recommendations are subject to agent authorisation.

Ensure only the tasks relating to the assessment scope are observed and assessed.

3.5 Section on ‘Recommendations’ This section contains information to assist an Occupational Therapist in identifying recommendations that maximise a worker’s independence in performing house work and/or gardening tasks and assist the agent to make a decision regarding a worker’s entitlements. An Occupational Therapist is encouraged to contact the agent if they require further guidance in understanding specific legislation and/or relevant guidance material as it relates to individual cases. 3.5.1 Identifying appropriate recommendations

An Occupational Therapist must ensure that:

• Recommendations have regard to the VWA Agent Advisory Material; • Recommendations are clear and concise; • Recommendations are easily understood by those without medical qualifications; • Maximising independence is a critical component of the assessment and the

provision of household help services should only be recommended where eligibility is established and no other options exist; and

• That all information obtained from the assessment is reviewed and the following factors considered when formulating recommendations.

• Injury/Medical status:

1. Is the request solely related to the compensable injury? What is the contribution of other medical illness/conditions?

2. Are the type of tasks and the frequency requested consistent with the injured worker’s current medical status and functional capacity (tasks able and not able to be performed)?

3. Is the requested duration of service consistent with the anticipated duration of the worker’s functional incapacity?


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• Rehabilitation Status: 1. Is the request related to returning/maintaining the injured worker at work? 2. Is there a return to work plan? Is the request (type of service, frequency and

duration) consistent with the worker’s work capacities and their return to work plan?

3. Have strategies to increase independence with tasks been considered? 4. Has equipment/aids to increase independence with the tasks been considered? 5. Consider a graded return to independence with household tasks program.

• Household circumstances: 1. Consider the pre and post injury size of the house/garden & its specific

configuration (i.e. number/type of rooms) 2. Consider the number of occupants and their ages.

• Personal/Family circumstances: 1. Identify the household tasks that would normally be performed by the worker

versus those of the family/household members. 2. Are the requested services (housework/gardening tasks) for the injured worker? 3. Consider the self funded pre-injury household services (i.e. cleaner, lawn mower). 4. Consider the reasonable contribution of family members and other household

occupants in undertaking or assisting with household tasks.

3.5.2 Explanatory information (Agent Advisory Material) An Occupational Therapist should consider the Agent Advisory Material (an excerpt has been outlined below): Household Help should generally be provided in a rehabilitation framework with a primary focus on assisting the injured worker to maintain their independence with routine household tasks, or return to independence with the tasks as soon as is possible. As the type and frequency of service provision a worker may require is expected to change and/or reduce as the worker’s recovery or adaptation to their residual capacities progresses, short-term service provision should include a step down and transition period and long-term service authorisation requires regular re-assessment to determine the worker’s household help needs. The provision of Household Help services to an injured worker must be based on their assessed needs and should consider their individual circumstances in relation to:

• The nature of the worker’s injury (medical evidence) and their physical rehabilitation program. The worker’s physical rehabilitation program may require them to remain active and undertaking household tasks may be appropriate. (This should be confirmed with the treating medical practitioner).

For example:

o A worker may be unable to lift their arms beyond shoulder height, therefore

tasks within shoulder range should still be able to be undertaken by the worker. Only tasks above shoulder height, such as hanging out washing could be precluded, and in the absence of a family member to assist with this task, Household Help (Occupational Therapist services to maximise independence may be appropriate.

o In the acute (0-4 weeks) and sub acute (4-6 weeks) and chronic (6 weeks

plus) phases following a strain/sprain injury, workers are encouraged to stay active and mobile1.

1Victorian WorkCover Authority Sprains/Strains - Continuum of Care Model


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• The relationship of the injury to the services requested.

o The presence of other medical conditions (pre/post injury) and family members circumstances (i.e. family members may impact upon the injured worker’s abilities to complete household tasks. The contribution of these conditions or circumstances is relevant when determining the extent of WorkCover’s liability. Note: The worker may be eligible for additional assistance through community agencies or their local council for services relating to their non-compensable injury or family circumstances.

o The nature of the injury (i.e. upper/lower limb) and its specific functional

limitations (i.e. sitting/standing tolerances) should be explored in relation to the type and amount of assistance sought.

§ For example: Ironing can be undertaken while seated to compensate

for limited standing tolerance or fatigue, work methods can be changed or re-organised to self pace the activity throughout the day i.e. smaller amounts of ironing self paced over the day/week.

• The household tasks performed by the worker pre-injury,

o Household help services are primarily related to providing assistance for the

injured worker and related to the tasks the worker undertook pre-injury (in their pre-injury home). Household help is not provided to complete all the tasks the worker undertook pre-injury, only those relating to the basic, routine, common domestic tasks the worker undertook that would be considered essential for running the household.

Whilst the worker may be eligible for assistance with household tasks, family members are expected to contribute to the household tasks and provide assistance to the injured worker prior to WorkCover Household Help service provision being considered.

• For example: If the injured worker undertook all housework and/or gardening in their

home pre-injury and was no longer able to undertake housework / gardening (or particular housework / gardening tasks) due to their injury they may be eligible for assistance for those tasks they can no longer do (occupational therapy assistance to maximise their independence with the task(s) or where this is not possible, (and based on likely duration of service provision), provision of a Household Help (labour hire) service. However, family members would be expected to undertake (or contribute to) the household tasks the worker is unable to perform before the worker is eligible for assistance.

• WorkCover housework services only extend to replacing a worker’s labour in the home for

routine, common, basic housework tasks (refer housework/gardening tasks authorisation reference lists) associated with maintaining themselves, and dependent children (and not other adult members) in the home.

o In considering a worker’s individual circumstances in relation to their obligations

to / for other family/household members. Assistance may only extend to providing assistance for housework tasks for a child (or children) residing in the home who was dependent upon the worker (and incapable of doing the task(s) themselves) undertaking the task(s) on their behalf pre-injury (such as cleaning the child’s bedroom, bathroom or toilet, doing the child’s laundry & essential ironing). And, in such cases there are no other adults (18 years and over) residing in the home to undertake the tasks for the child (or children).

§ NOTE: No services would be provided while the injured worker was

absent from the home, i.e. if the injured worker was away for a holiday.


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o If the worker did not undertake the tasks pre-injury then it must be as a direct result of their injury (and an associated change in their circumstances) that has made the provision of these services necessary.

§ For example: An injured worker resided with their parents prior to

their injury and did not undertake any household tasks & post injury they are a paraplegic/ABI impaired and are living semi-independently and now request gardening and housework assistance. In this instance Household Help services may be appropriate.

• The size and condition of the injured worker’s home/garden (pre-injury).

o The size of the home/garden (number of bedrooms/bathrooms, land size)

should be considered in relation to the type and extent of services requested. The worker’s home at the time of the injury (pre-injury) is the relevant home/garden to consider in this instance. If the worker has relocated as a direct result of the injury i.e. to directly offset the effects of the injury (i.e. wheelchair access required & pre-injury home unable to be modified) the new residence may be appropriate to consider.

o The condition of the home and its impact on the type or level of services

requested; For example the state of floor coverings could effect the time taken to vacuum.

• The equipment available to the client in the home/garden to complete the tasks.

o Consider what equipment is currently in use in the home/garden. Is it

appropriate given the worker’s injury for the tasks to be undertaken – how were the tasks undertaken before the injury? Could the worker undertake the task if modified equipment were provided? (i.e. replacing the use of a broom and dust pan for sweeping floors with a carpet sweeper could make a worker independent with this task).

• The injured worker’s pre-injury household arrangements.

o The worker’s pre-injury situation should be taken into consideration when

determining liability. Rooms not utilised (i.e. bedrooms, bathrooms, formal dining) will not be cleaned.

§ For example: If a worker paid for Household Help (indoor or outdoor)

prior to the injury, WorkCover may only be liable for any increase in services required due directly to the effects of the compensable injury.

• An injured worker who paid for lawn mowing services pre-injury

would not be eligible for assistance with this task post injury.

• The extent of contribution or assistance available from family members. The reasonable contribution of all household members in completing the household tasks (or assisting the worker to complete the tasks) must be considered. WorkCover expects that household members will assist with the running and maintenance of a household. Household Help housework services only extend to replacing a worker’s labour in the home for routine, common, basic housework tasks associated with maintaining themselves in the home and do not extend to other adult family members. For example, WorkCover would not pay for essential ironing of a spouse’s clothes, even if the injured worker did this ironing pre injury.


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• Assistance can only extend to providing assistance for housework tasks for a child (or children) residing in the home who were dependent upon the worker undertaking the tasks on their behalf pre-injury, who are unable to do the tasks themselves - such as cleaning a bedroom, bathroom/toilet, laundry & essential ironing). And, in such cases there are no other adults (18 years and over) residing in the home to undertake the tasks for the child (or children).

o WorkCover does not consider it unreasonable for a child (aged 8 –15) or

youth (15-18 years), to contribute to “light” housework or gardening such as making their own bed, clean/tidy & vacuum their bedroom, undertake small amounts of sweeping (inside and outside), dusting or vacuuming in other areas of the home (or to expect older children (13 years and older) to contribute to meal preparation and laundry) - up to several hours over the week.

o The ability/maturity of the family/household member to undertake the task

without risk to their health (i.e. manual handling) or safety considering the judgement to be exercised and equipment to be used must be paramount i.e. household appliances, kitchen utensils & garden implements (such as a lawn mower - the manufacturer’s instructions regarding equipment should provide a guide) and adult supervision is also recommended.

o In the absence of family members or their ability to make a significant

contribution; occupational therapy services to maximise the worker’s independence through adaptive techniques and/or equipment or changes to work methods i.e. self-pacing tasks throughout the day must be implemented prior to (labour hire) service provision.

3.6 Section on ‘Comments’ In this section an Occupational Therapist must indicate whether (based on the outcome of the assessment) they believe the provision of household help services or OT education are required to assist in maximising a worker’s independence in the performance of their house work and/or gardening tasks. The Victorian WorkCover Authority research on community standards in relation to housework and gardening is reflected in the Reasonable Cost Guidelines. Therefore, in making recommendations for service provision the Occupational Therapist should have regard to the Reasonable Cost Guidelines (RCG) as outlined in the agent Material with due consideration given to the extent and frequency of services requested to ensure they are within the RCG. NOTE: It is considered that any provision of Occupational Therapy education would result in a reduction or cessation of existing services. In most cases, training in use of common adaptive techniques or suggested assistive equipment would be completed at the time of the assessment and further education would not be required. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

COMMENTS

• The Occupational Therapist provides a brief summary of recommendations and other relevant background information.


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• eg “The Occupational Therapist recommends a graded cessation over 3 months given that the worker has demonstrated a capacity to perform the tasks and the other adult occupants could reasonably be expected to assist in housework”.

3.7 Section on ‘Recommended Services to

Maximise Independence’ This section contains information to assist an Occupational Therapist in identifying recommendations that maximise a worker’s independence in performing housework and/or gardening tasks that in turn will assist the agent in making decisions regarding a worker’s entitlements. Recommendations for services must identify a time-limited period that includes any adjustment for anticipated recovery/improvement, accommodate a plan for returning a worker to independence and a date for review. Given that the type and frequency of service provision a worker may require is expected to change and/or reduce as the worker’s recovery or adaptation to their residual capacities progresses, short-term service provision should include a step down and transition period and long-term service authorisation requires regular re-assessment to determine the worker’s household help needs. When recommending a graded cessation or reduction in services, the Occupational Therapist should detail the reasons in the report. This will assist the agent to explain and inform the worker as to why services are being reduced. The following examples are taken from the Agent Advisory Material in assisting to identify appropriate timeframes for household help service recommendations:

• For severe/complex injury Eg. Quadriplegia, severe acquired brain injury and where

further functional restoration was unlikely and the worker had been assisted to regain maximum independence the maximum authorisation period would be 12 months.

• For stable injuries where occupational therapy services have maximised independence but additional household help services are required, the maximum authorisation period would be 12 months however reviews may be required due to changes in household circumstances (i.e. changes to - children’s age, address, marital status) or entitlement (i.e. entitlement to weekly benefits may cease).

• For more recent injuries, where progressive physical recovery is anticipated, or occupational therapy services are expected to improve independence reducing levels of service provision should be built into service authorisation. In these cases more frequent review of service authorisation would be required i.e. 3 monthly.


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RECOMMENDED SERVICES TO MAXIMISE INDEPENDENCE • The Occupational Therapist selects the most appropriate option from the following

selection and provides relevant detail of the proposed recommendations eg see below.

PROVIDE INITIAL SERVICES/GRADED CESSATION • This box is ticked when the Occupational Therapist recommends a graded reduction in

services until they are ceased.

Service/Task Week No: Hours/ Mins Frequency (eg housework/ (Include graded reduction (eg 1.5 hours) (eg monthly) gardening) plan where applicable eg Vacuuming, eg Week 1-4 eg 2 hours eg fortnightly mopping/ sweeping floors, eg Week 5-8 eg 2 hours eg monthly dusting eg Week 8 onwards eg 2 hours eg cease

REDUCTION • This box is ticked when the Occupational Therapist recommends that the service is

reduced and then maintained at a specified level. Service/Task Week No: Hours/ Mins Frequency (eg (Include graded reduction (eg 1.5 hours) (eg monthly) Housework /gardening) plan where applicable eg eg Mowing lawn & eg Week 1-4 eg 2 hours eg Fortnightly weeding eg Week 5 onwards eg 2 hours eg Monthly

MAINTAIN CURRENT SERVICES • This box is ticked when the Occupational Therapist supports the current level of service.

Service/Task Week No: Hours/ Mins Frequency (eg housework / (Include graded reduction (eg 1.5 hours) (eg monthly) gardening) plan where applicable eg Mowing lawn & eg n/a eg 2 hours eg Monthly weeding


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EDUCATION • This box is ticked when the Occupational Therapist believes that the worker will benefit

from education to maximise their independence. In most cases this would be provided at the time of the assessment however, for complicated long term cases, this may be warranted (there is an expectation that this would result in a reduction or cessation of services).

Service/Task Week No: Hours/ Mins Frequency (eg housework / (Include graded reduction (eg 1.5 hours) (eg monthly) gardening) plan where applicable eg Occupational Therapy eg n/a eg 2 hours eg One off session Education

NO SERVICES • This box is ticked when the Occupational Therapist believes that the worker is not entitled

to services. No other information is therefore required in this box.

3.8 Section on ‘Recommended Review Date(s) for

Services’ The report should provide rationale for the recommended review period, i.e. the Occupational Therapist reports that the worker’s medical condition is not expected to improve for 6 months and a further Household Help (OT) Assessment is recommended at that time. In any case where the Occupational Therapist is recommending ongoing household help service provision, the OT must specify a service review date. The agent will consider this review date in setting the maximum authorisation period for service delivery.

• For severe/complex injury (ie. Quadriplegia, severe ABI) where further functional restoration is unlikely and the worker has been assisted to regain maximum independence, the maximum review period would be 12 months.

- However, even in these cases, the OT should consider whether other factors, such as changes in household circumstances (recovery of a sick spouse), may make a shorter review period more appropriate;

• For more recent injuries, where progressive physical recovery is anticipated, or occupational therapy services are expected to improve independence, a shorter review period would be more appropriate (eg. 3 months).


RECOMMENDED REVIEW DATES FOR SERVICES Service Timeframe Action for review For cessation/ review Of services Eg Gardening eg cessation of eg agent to review need for ongoing services in 8 weeks services (eg agent discussion with

treating practitioners etc.)


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3.9 Section on ‘Recommended Assistive Equipment to Maximise Independence’

This section contains information to assist an Occupational Therapist in identifying recommendations that maximise a worker’s independence in performing housework and/or gardening tasks through use of equipment. An Occupational Therapist is required to: • List the equipment required; • The strategies recommended to maximise independence; • The impact on any household help service provision; and • Supplier and equipment cost details (if known). *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

RECOMMENDED ASSISTIVE EQUIPMENT TO MAXIMISE INDEPENDENCE: Equipment/ Strategy for Impact on need for services Supplier Aid independence eg long eg enables worker eg eliminates need for service eg note supplier, handled toilet to clean toilet without provision to clean toilet item, code, cos t brush needing to bend the lower back

3.10 Section on ‘Recommended adaptive techniques to Maximise Independence’

In this section, an Occupational Therapist is required to detail adaptive techniques that maximise a worker’s independence in completing household tasks and expedite their ability to resume the identified tasks. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

RECOMMENDED ADAPTIVE TECHNIQUES TO MAXIMISE INDEPENDENCE Task Adaptive Technique Impact on need for services eg mowing eg use of self-pacing to complete task eg mowing services ceased

3.11 Section on Assessment Information Supporting Recommendation


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3.12 Section on ‘Documents Reviewed’ In this section, an Occupational Therapist is required to document details of any reports and/or documents that the agent or other parties have provided to assist with completing the assessment and report. It is expected that Occupational Therapists have reviewed this guidance material and the VWA Agent Advisory Material specific to Household Help and Gardening. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

DOCUMENTS REVIEWED Guidance Material for Occupational Therapists on completing Household Help (OT) Assessments. • VWA Agent Advisory Material • [Name], [Title], [Organisation] report dated [Date of report]. • [Name of practitioner], [Medical certificate], [Date of issue]. • There is no need to provide any details on content of reports in this section.

3.13 Section on ‘Medical Information’ In this section, an Occupational Therapist is required to complete relevant information regarding the worker’s current medical status. This information may be obtained from the worker, their treating medical and/or health practitioner (TMP/THP) and/or from any documentation provided by the agent. An Occupational Therapist must document where information was obtained eg the treating medical practitioner or worker. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

MEDICAL INFORMATION Topic Comments Reported by:

Brief history of injury List briefly how the injury occurred. Detail whether

reported by TMP or Worker Diagnosis List the worker’s work related medical diagnosis and whether this corresponds to the injury for which liability was accepted Prognosis List the worker’s prognosis including long term and short- term implications of diagnoses in relation to the worker’s ability to manage the specific household tasks. eg the worker may have a musculoskeletal disorder of the back which is unlikely to improve and hence the worker may not be able to bend. Surgery List any surgery the worker has undergone related to the compensable injury including the date of the surgery and outcome.


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Treatment List any treatment the worker is currently attending for their work related injury.

Medication List details of the worker’s current medication in relation to their work injury. Medical restrictions List details on the worker’s current medical restrictions and likely duration. Current symptoms Document details in regards to the following - The location of the pain, eg the lower back - A description of the pain, eg sharp - The frequency of the pain, eg constant - Aggravating factors, eg bending - Effect of house work /gardening tasks on pain Other non work related medical conditions: An Occupational Therapist should ask the worker if they have any non work related conditions that could affect their ability to manage the specific tasks.

3.14 Section on ‘Liaison with Treating Medical Practitioner’

In this section, an Occupational Therapist is required to detail information obtained from the Treating Medical and/or Health Practitioner. It is mandatory for an Occupational Therapist to liaise with the worker’s treating medical practitioner to discuss information relevant to the assessment. It may be appropriate for an Occupational Therapist to also contact the worker’s treating health practitioners (eg physio etc.) to obtain further information. NOTE: In circumstances where contact with the TMP is repeatedly unsuccessful, the OT should document all attempts made and inform the Agent of this difficulty. When contacting the Treating Medical or Health Practitioner, an Occupational Therapist should obtain the following information: • Confirm the worker’s diagnoses and prognosis; • Confirm medical restrictions in regard to the identified house work and/ or

gardening tasks; • Discuss factors limiting the worker’s ability to be independent in housework

and/or gardening; • Discuss whether there are medical illnesses/medical conditions or other

circumstances; • Discuss if the request is related to returning/maintaining the worker at work; • Discuss if strategies to increase independence with tasks has been considered; • Discuss if equipment to increase independence with the tasks has been

considered; and • Discuss if a graded return to independence with household tasks has been

considered. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

LIAISON WITH TREATING MEDICAL PRACTITIONER (contact is mandatory)


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Name Date of contact Comments

eg Dr Brown eg 13/ 6/03 eg Dr Brown stated that the worker should avoid bending and twisting for the next three months.

3.15 Section on ‘Reported Pre Injury Function for identified task(s)/Issues’

In this section, an Occupational Therapist is required to detail information from the worker with regard to who performed the identified tasks prior to their injury. An Occupational Therapist must document:

• The household help task(s); • Who performed the task(s) prior to the injury (This could be either the worker or

someone else eg the worker’s partner, relative, private cleaner or gardener); • If someone other than the worker performed the task(s), provide information on

why the worker is now seeking assistance with this task(s); and • Any comments explaining further clarification of tasks completed. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

REPORTED PRE INJURY FUNCTION FOR IDENTIFIED TASKS(S)/ISSUES Task Did worker Comments: Did the worker perform task? perform task? eg mowing eg no eg her husband mowed the lawns and she normally performed the weeding

3.16 Section on ‘Reported Post Injury Function for identified task(s)/Issues’

In this section, an Occupational Therapist is required to detail information from the worker regarding who is currently performing the identified tasks (post injury). An Occupational Therapist must document: • The identified household help task(s); • Who performed the task(s) post injury (this could be either the worker or

someone else eg the worker’s partner, relative, private cleaner or gardener); • If someone other than the worker is performing the task(s), provide information on

why the worker is now seeking assistance with this task(s); • Why the worker believes that their injury now limits their ability to undertake the

identified tasks; • If the worker is unable to undertake the identified tasks, can another household

member assist? Indicate reasons why/why not; • Whether there has been any change in the size of the task since the injury, (eg

more household tasks if the worker has moved to a larger house); and • Any comments explaining further clarification of tasks completed.


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Where appropriate, an Occupational Therapist must assess the workers ability to perform the task and where possible provide education on adaptive techniques, use of any assistive equipment etc. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

POST INJURY FUNCTION FOR IDENTIFIED TASK(S) Task Is worker currently Comments: Is the worker performing task? performing task? eg mowing eg no eg the neighbour is currently completing this task. The worker was able to use their current mower given that they were able to avoid bending and twisting demonstrated during the assessment

3.17 Section on ‘Task(s) currently completed by Household Help Services’

In this section, an Occupational Therapist is required to detail information from the worker regarding any household help services currently authorised by the agent. An Occupational Therapist must document: • The household help task(s) being completed; • The current level of servicing including the task(s) performed by the service

provider (eg cleaning the bathroom) and the duration and frequency of the task; and

• Any comments regarding further clarification of tasks completed eg start date of services (either exact date or estimate eg 6 months).


TASKS CURRENTLY COMPLETED BY HOUSEHOLD HELP SERVICES Task Hours/ Mins Comments Frequency eg Vacuuming eg weekly eg The provider vacuums all floors once a week

3.17 Section on ‘Current Presentation’ In this section, an Occupational Therapist documents the worker’s current presentation as relevant to the identified task(s). In some cases it maybe appropriate to document details regarding a worker's general daily activities other than the identified tasks. For example, information on other tasks, such as driving and shopping may assist the Occupational Therapist in assessing the worker’s functional tolerances.


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CURRENT PRESENTATION (comment as relevant to identified tasks):

Title Comments (Reported / Observed)

Height The Occupational Therapist should document the worker’s height (usually reported by worker). Make note of any impact of this on the identified tasks.

Weight The Occupational Therapist should document the worker’s weight either by

asking the worker, weighing the worker or describing the worker’s build, eg light build. Make note of any impact of this on the identified tasks.

Range of movement/Hand dominance

The Occupational Therapist should ideally formally assess the worker’s range of movement for relevant joints relevant to the identified issues. An Occupational Therapist should only note any observed impairment.

Make note of any impact of this on the identified tasks. Sitting tolerance/ Standing tolerance/ Walking tolerance/ Lifting Capacity

The Occupational Therapist may assess the worker’s functional tolerances in several ways including:

- Informal/formal observation during the assessment, eg. the worker was able to sit for 45 minutes continuously during the assessment

- Through feedback from the worker’s Treating Practitioners. - Asking the worker to report their current tolerances - The Occupational Therapist should note how the information was collected,

eg the worker reported that they can walk for twenty minutes, the worker’s Physio reported that the worker is able to walk for 30 minutes on the treadmill.

Make note of any impact of this on the identified tasks. Endurance The Occupational Therapist should make note of any issues regarding the

worker’s general endurance/activity tolerance. This information can be gathered by formal and informal observation and in discussion with the worker and their Treating Practitioners.

Make note of any impact of this on the identified tasks. Ability to perform other tasks (not included in assessment scope)

The Occupational Therapist should comment on the worker’s participation in other daily tasks not included in the assessment scope eg other personal and domestic tasks, driving, social activities, sport etc. This may be useful when correlating the observed and reported data in the next section. eg if a worker is able to mow lawns, then it is likely that they would be able to complete the task of vacuuming using self pacing. This may therefore not require household help to complete this task.

Psychological issues The Occupational Therapist should comment on any relevant psychological

issues. 3.19 Section on ‘Observations and correlation

between observed and reported data’


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In this section, an Occupational Therapist details observations made of the worker during the assessment and the correlation of these observations with other information i.e. such as feedback from the treating medical practitioner, relevant to the identified tasks. An Occupational Therapist is expected to comment on: • The worker’s presentation (as relevant to the identified tasks) as observed

formally and informally during assessment; and • The correlation between the worker’s observed presentation/status and as

reported by the worker, treating health practitioners and Independent Medical Examiners etc.

An Occupational Therapist must critically analyse the information collected and objectively comment on the correlation of this data. The source of the data includes:

• Formal observation of the worker; • Informal observation of the worker; • The worker’s self-reported current status relevant to the identified tasks; • The worker’s current status as reported/documented by the treating health

practitioner relevant to the identified tasks; and • The worker’s current status as documented in the request documents/reports

relevant to the identified tasks. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

OBSERVATIONS AND CORRELATION BETWEEN OBSERVED AND REPORTED DATA eg During the assessment the worker reported that they were unable to bend their lumbar spine due to pain and when contacted by the Occupational therapist, the treating medical practitioner stated that the worker should avoid bending. In correlation with this during the assessment the worker tended to squat when reaching items below waist level, hence avoiding bending their Lumbar spine.

3.2 Section on ‘Personal/Household Circumstances’ In this section, an Occupational Therapist is required to document details of the worker’s current social circumstances. This information is crucial to the Occupational Therapist’s understanding of the worker’s current support networks and to assist with identifying possible assistance that may be available with identified tasks the worker is unable to perform. The agent advisory material specifies, ‘the reasonable contribution of all household members in completing the household tasks (or assisting the worker to complete the tasks) must be considered. WorkCover expects that household members will assist with the running and maintenance of a household. Household Help housework


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services only extend to replacing a worker’s labour in the home for routine, common, basic housework tasks associated with maintaining themselves in the home and do not extend to other adult family members.’ Occupational Therapists are prompted to comment on other family members that may have a disability or illness only where relevant, for example where the disability of family members precludes them from making a contribution.


PERSONAL HOUSEHOLD CIRCUMSTANCES

Topic Comments

Detail relationship status of worker eg married Ability of occupants to assist eg Husband able to contribute to household tasks with household tasks Detail number and age of children eg two children aged 8 and 16. Detail other people living in the house eg the worker’s mother-in-law currently lives with the not included above. worker’s family in the fourth bedroom Detail other people who provide assistance eg since the injury, the worker has paid the in tasks but do not live at the house neighbour’s teenage son to mow the lawns every

fortnight. Detail house members who have a eg the worker’s mother-in-law has dementia and disability or illness? (Where relevant although independent in personal care tasks, she is ie. If impacts upon the worker’s need for unable to assist with the domestic tasks. services) If so, detail level of assistance, frequency/by who.

3.21 Section on ‘Details of the Home Environment’ In this section, an Occupational Therapist is required to document information on the home environment as relevant to the scope of the assessment. This includes details of the worker’s home environment (prior to the injury if different from the current home/the size of the home/land, general information on the number of rooms, general state of the home etc). The Occupational Therapist is required to document the equipment the worker used prior to the injury and comment on whether this equipment is safe and appropriate. The Occupational Therapist is also required to document any assistive equipment that the worker may have purchased or has been provided in the past. If the worker has existing assistive equipment then the Occupational Therapist should document who funded this item(s), if it was recommended in a previous Occupational Therapy assessment and whether the item is used by the worker. This information is crucial in assisting an Occupational Therapist to understand the worker’s individual needs within their home environment. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

DETAILS OF THE HOME ENVIRONMENT


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Topic Comments Pre-injury Home (if relevant) Has there been a change in the worker’s home environment eg Yes since the injury? If yes detail changes eg Prior to the injury the worker lived in a one bedroom flat Current Home

Home Type eg. Ground floor unit

Number of bedrooms eg 2 bedroom

Number of bathrooms eg 1 bathroom

Number of living areas eg 1 combined lounge/ dining area

Type of flooring – carpet / tiles eg carpet in bedrooms, tiles elsewhere

Access to home eg 1 step at front and rear

General presentation eg Neat, tidy home

Size of Garden eg Small garden with a grassed area at front and rear.

Does worker own safe and appropriate standard equipment? eg Worker borrowed neighbours mower If no what did they do use before their injury. Does the worker currently have any assistive equipment? eg Worker has a long handled dustpan & broom

3.21 Section on ‘Summary of Tasks and Relevant

Comments’ In this section, an Occupational Therapist is required to summarise the identified tasks and provide specific comments (as relevant to the scope of the assessment) following consideration of a range of factors (detailed below). *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

SUMMARY OF TASKS AND RELEVANT COMMENTS Review all information obtained from the worker and assessment, treating medical and/or other practitioners and other relevant parties (eg. agent).

All recommendations must be completed in consideration of the following: Injury/Medical status: Is the request solely related to the compensable injury? What is the contribution of other medical illness/conditions? Are the type of tasks and the frequency of services requested consistent with the injured worker’s current medical status and functional capacity (tasks able and not able to be performed)? Is the requested duration of service consistent with the anticipated duration of the worker’s functional incapacity? Rehabilitation Status: • Is the request related to returning/maintaining the worker at work? • Is there a return to work plan? Is the request (type of service, frequency and duration) consistent

with the worker’s work capacities and their return to work plan? • Have strategies to increase independence with tasks been considered? • Has equipment/aids to increase independence with the tasks been considered?


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• Consider a graded return to independence with a household tasks program. Household circumstances: • Consider the pre and post injury size of the house/garden & its specific configuration (i.e.: number/

type of rooms). • Consider the number of occupants and their ages. Personal circumstances: • Identify the household tasks that would normally be performed by the worker versus those of the

family/household members. • Are the requested services (house work tasks/ gardening tasks) for the worker? • Consider the self funded pre-injury household services (eg cleaner, lawn mower). • Consider the reasonable contribution of family members and other household occupants in

undertaking or assisting with household tasks.

SUMMARY OF TASK(S)

Upon completion of the Household Help (OT) Assessment the following is noted:

Task Comment

eg vacuuming eg Worker paid for a private cleaner prior to their injury. On assessment worker was unable to perform the task due to a non work related cardiac condition. Worker reported they are unable to continue to afford to fund this service. eg mowing eg On assessment it is the Occupational Therapist’s opinion that

the worker should be able to manage this task through use of standard equipment and self-pacing. The Occupational Therapist provided the worker with education on self-pacing during the assessment and demonstrated adaptive techniques to ensure the worker avoids bending and twisting their back while performing this task.

3.22 Section on ‘Additional Comments’ In this section, an Occupational Therapist is provided with the opportunity to list other issues that may have arisen during the course of the assessment however were not relevant to the scope of the assessment and therefore not formally assessed. For example, a Household Help (OT) Assessment is completed due to a worker’s reported difficulty with household tasks following back surgery and a request for assistance with household tasks. The worker may then report difficulty with dressing at the assessment. This is considered outside the scope of the assessment, and as such, recommendations regarding this issue are not included in the report. Reference to the worker’s reported difficulties (with dressing in this case) may be included in this section. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

ADDITIONAL COMMENTS:

? (detail any additional comments. Write N/A if this section if not required)


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eg During the assessment the worker reported that they are currently having difficulties with personal care tasks and believe they will benefit from the installation of rails in the shower to increase their safety. Following discussion with the agent, the Occupational Therapist recommends that an Activity of Daily Living (ADL) Assessment be conducted to maximise the worker’s independence and safety in the performance of their personal care tasks.

3.23 Section on ‘Sign off’ In this section, an Occupational Therapist provides information on contact details. *Below is an example of how this section appears in the Tool & Report proforma (includes additional guidance notes).

This report has been completed for the consideration of the agent. If you wish to discuss this report or require additional information, please contact the author on [enter phone number]. Yours sincerely [Enter name] Occupational Therapist B. App. Sc. (O.T.), [Enter other qualifications as applicable] [Enter organisation] cc: [Enter name, address]


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Attachments

Attachment 1: Proformas Household Help (OT) Assessment TOOL 40

Household Help (OT) Assessment REPORT 48 Agent Household Help (OT) Assessment Request Form 53 Example Medical Release Authority 54

Attachment 2: Example of a completed Household Help (OT) Assessment Report 55 Attachment 3: Consultation 60 Bibliography 60


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WORKCOVER HOUSEHOLD HELP (OCCUPATIONAL THERAPY) ASSESSMENT TOOL

BACKGROUND INFORMATION DATE OF ASSESSMENT: WORKER: CLAIM NUMBER: MANAGING AGENT: DATE OF INJURY: TYPE OF INJURY: DATE OF BIRTH (AGE): GENDER: CURRENT WORK STATUS: Not at work At work: Days/Hours_____ CURRENT MED. CERT.: Current Work Capacity No Current Work Capacity

EMPLOYER: PRE-INJURY POSITION: REQUEST SOURCE: Name: Organisation: DATE REQUEST RECEIVED: DATE OF REPORT: PRESENT (AT ASSESSMENT): Worker Others (if applicable) Occupational Therapist ASSESSMENT SCOPE

Initial Assessment - No Previous Household help Services Initial Assessment - Household Help services in place however no previous Assessment Review Assessment- Previous Occupational Therapy Assessment conducted, requires review of status

Tasks to be assessed: Housework Gardening Detail the identified tasks as reported by the agent: (Note: only assess tasks reported by the worker that are consistent with those detailed by the agent).

Currently receiving authorised Household Help services? No Yes If ‘Yes’, provide details in the following boxes: Type of service Service Provider: Hours/ frequency When did service start

Housework

Gardening ASSESSMENT CHECKLIST o Explain the scope of the assessment to the worker eg

“The scope of this assessment is to determine your ability to perform the above listed tasks and to maximise your independence by assisting you to find ways to compensate for any functional limitations by use of adaptive technique, assistive equipment, re-education and training in adaptive house work tasks/gardening methods”.

o Ensure that the worker understands that the agent makes all decisions on any recommendations.

o Ensure only tasks relating to the assessment scope are included in recommendations.


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DOCUMENTS REVIEWED (eg enter name, title, organisation, date of reports, documents etc)

• Guidance Material for Occupational Therapists on completing Household Help (OT) Assessments.

• VWA Agent Advisory Material on Household Help services.

MEDICAL INFORMATION (comment as relevant)

Topic Comments Reported by (TMP, Worker etc)

Brief history of injury

Diagnosis

Prognosis

Surgery (eg date, surgery outcome etc)

Treatment (eg type, goal, frequency, duration etc)

Medication

Medical restrictions

Current symptoms

Other non work related medical conditions

LIAISON WITH TREATING MEDICAL PRACTIONER (TMP) (contact with TMP is mandatory)

Name: (include name/ title)

Date of contact

Comments (eg does TMP support proposed recommendations)


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REPORTED PRE-INJURY FUNCTION FOR IDENTIFIED TASK(S)/ ISSUES

Task (Detail housework and/ or gardening tasks)

Did worker perform task? eg (yes, no, sometimes)

Comments: Is the worker able to perform the task? eg If yes/ sometimes, detail frequency completed, modified techniques/ equipment used etc. If no or sometimes, who else performed task/ how often etc? eg husband Detail start date & cease date of private services if relevant.

POST INJURY FUNCTION FOR IDENTIFIED TASKS

Task (Detail housework and / or gardening tasks)

Is worker currently performing task? eg (yes, no, sometimes)

Comments: Is the worker able to perform the task? eg If no or sometimes, assess the worker’s ability to perform task. Where possible provide education on adaptive techniques, assistive equipment. If no or sometimes, who else performs task/ how often eg children

TASKS CURRENTLY COMPLETED BY HOUSEHOLD HELP SERVICES Task (Details housework and/ or gardening tasks)

Hours /Frequency

Comments (eg details actual tasks completed/ start date of service etc)


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CURRENT PRESENTATION (comment as applicable to identified tasks):

Title Comments Reported (tick)

Observed (tick)

Height (note if relevant and if this impacts on ability to complete tasks)

Weight (note if relevant and if this impacts on ability to complete tasks)

Range of movement/ Hand dominance (if relevant)

Sitting tolerance

Standing tolerance

Walking tolerance

Lifting Capacity

Endurance (ie as it relates to activity)

Ability to perform other tasks (not included in assessment scope) eg other personal and domestic tasks, driving, social activities, sport etc

Psychological issues

OBSERVATIONS AND CORRELATION BETWEEN OBSERVED AND REPORTED DATA Detail comments: (eg formal and informal observation of the worker, self-reported status of the worker, reported status of the worker as reported by THP, medical reports etc)


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PERSONAL/HOUSEHOLD CIRCUMSTANCES

Topic Comments Detail relationship status of worker

Single Married De-facto Other

Ability of occupants to assist with household tasks.

Detail number & age of children & whether at home, school

Details other people living in the house not included above:

Detail other people who provide assistance in tasks but do not live at house.

Detail any house members who have a disability or illness etc? (Where relevant ie. if impacts upon the worker’s need for services). If so, detail level of assistance required, frequency/ by who.

DETAILS OF THE HOME ENVIRONMENT Topic (provide detail as applicable)

Comments

Pre-injury home (if relevant)

Has there been a change in the worker’s home environment since the injury? If yes, provide details

Current home

Type of home Single Double

House Unit Flat Other, provide detail: Number of bedrooms

Number of bathrooms

Number of living areas

Type of flooring carpet/ tiles

Access (internal /external / steps)

General comments on garden setup & size

Does the worker own safe and appropriate standard equipment? If no what did they do use before injury.


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Does the worker currently have any assistive equipment?

SUMMARY OF TASKS AND RELEVANT COMMENTS

Consider theses factors when commenting on tasks. Detail comments in the box below: • Injury/Medical status:

4. Is the request solely related to the compensable injury? What is the contribution of other medical illness/conditions?

5. Are the type of tasks and the frequency requested consistent with the injured worker’s current medical status and functional capacity (tasks able and not able to be performed)?

6. Is the requested duration of service consistent with the anticipated duration of the worker’s functional incapacity?

• Rehabilitation Status:

6. Is the request related to returning/maintaining the injured worker at work? 7. Is there a return to work plan? Is the request (type of service, frequency and

duration) consistent with the worker’s work capacities and their return to work plan?

8. Have strategies to increase independence with tasks been considered? 9. Has equipment/aids to increase independence with the tasks been considered? 10. Consider a graded return to independence with household tasks program.

• Household circumstances: 3. Consider the pre and post injury size of the house/garden & its specific

configuration (i.e. number/type of rooms) 4. Consider the number of occupants and their ages.

• Personal/Family circumstances: 5. Identify the household tasks that would normally be performed by the worker

versus those of the family/household members. 6. Are the requested services (housework/gardening tasks) for the injured worker? 7. Consider the self funded pre-injury household services (i.e. cleaner, lawn mower). 8. Consider the reasonable contribution of family members and other household

occupants in undertaking or assisting with household tasks.

Task Comment (include worker concerns/ therapist comments)


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ADDITIONAL COMMENTS

RECOMMENDATIONS: REQUEST FOR HOUSEHOLD HELP SERVICES RECOMMENDED SERVICES TO MAXIMISE INDEPENDENCE

Provide Initial Services/Graded Cessation Reduction Maintain current services Education No service

Service (housework/ gardening)

Week No. (Include graded reduction plan eg • Week 1-6 • Week 5-12)

Hours/ Mins (eg 1.5 hours)

Frequency (eg monthly)

RECOMMENDED REVIEW DATE(S) FOR SERVICES Service (housework/ gardening)

Suggested timeframe for cessation/review of services eg 3, 6, 12 week

Suggested actions for review (eg OT review assessment, agent review with treating medical or health practitioner (TMP/ THP), further medical assessment).

RECOMMENDED ASSISTIVE EQUIPMENT TO MAXIMISE INDEPENDENCE

Equipment (eg extra long handled toilet )

Strategy for independence (eg enables worker to clean toilet without bending)

Impact on need for services (eg eliminating need for service provision to complete task)

Supplier (supplier, item, code, cost)


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RECOMMENDED ADAPTIVE TECHNIQUES TO MAXIMISE INDEPENDENCE

Task (eg mowing)

Strategy for independence (eg use of self pacing to complete task)

Impact on need for services (eg cease lawn mowing assistance)


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WORKCOVER HOUSEHOLD HELP (OCCUPATIONAL THERAPY) ASSESSMENT REPORT

BACKGROUND INFORMATION

DATE OF ASSESSMENT: [Enter date of assessment]

WORKER: [Enter name]

CLAIM NUMBER: [Enter claim number]

MANAGING AGENT: [Enter managing agent]

DATE OF INJURY: [Enter date of injury]

TYPE OF INJURY: [Enter type of injury]

DATE OF BIRTH: [Enter date of birth] [Age in years: optional]

GENDER: [Enter whether male or female]

CURRENT WORK STATUS: [Enter work status ie at work, not at work]

CURRENT MED. CERT.: [Enter details ie CWC, NCWC]

EMPLOYER: [Enter name of employer]

PRE-INJURY POSITION: [Enter title of pre-injury position]

REQUEST SOURCE: [Name of referrer] [Title] [Organisation]

DATE OF REQUEST: [Date of referral]

DATE OF REPORT: [Date of report]

PRESENT (AT ASSESSMENT): [Enter name] [Title] [Enter therapist name] Occupational Therapist (OT) ASSESSMENT SCOPE

Initial Assessment: (No Previous Household Help services) Initial Assessment: (Household Help services in place however no previous OT Assessment) Review Assessment: (Previous OT Assessment conducted, requires review of status)

The worker [has requested or is receiving] Household Help services for [housework and/or gardening] due to difficulties with [detail identified tasks that have resulted in the request for services].

In response to this formal request, this assessment was conducted to evaluate the worker’s ability to perform tasks and maximise their independence in these activities.

The worker [is/ is not] currently receiving [detail service/s, service provider, when services commenced, hours, frequency, whether paid for by worker/ agent or funded through other means]. RECOMMENDATIONS: Following this [initial assessment/ review] of the worker’s ability to perform the identified tasks, the following recommendations are outlined below. (Note: Please refer to the body of the report for background information supporting recommendations).


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COMMENTS: [Detail a brief summary and provide any relevant information related to the recommendations listed below] RECOMMENDED SERVICES TO MAXIMISE INDEPENDENCE

Provide initial services/Graded Cessation Reduction Maintain current services Education No service

Service/Task Week No. (Include graded reduction plan).

Hours/ Mins Frequency

[housework/ gardening]

[e.g. week 1-6 week 5 -12]

[e.g.: 1.5 hours 1.5 hours]

[e.g.: fortnightly monthly]

RECOMMENDED REVIEW DATE(S) FOR SERVICES

Service Suggested timeframe for cessation/ review of services

Suggested actions for review

[housework/ gardening]

[e.g.: 3, 6, 12 months] [eg.: OT review assessment, IMA review with treating medical practitioner, further medical assessment]


Equipment / Aid

Strategy for independence

Impact on need for services

Supplier

[eg extra long handled toilet brush]

[eg enables worker to clean toilet without bending]

[eg eliminate need for service provision to complete task]

[Supplier, item, code, cost]


Task Strategy for independence Impact on need for services [eg: mowing] [eg: use of self pacing to

complete task] [eg cease lawn mowing assistance]


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ASSESSMENT INFORMATION SUPPORTING RECOMMENDATIONS DOCUMENTS REVIEWED

? [Name], [Title], [Organisation] report dated [Date of report]. ? [Name of Doctor/ Practitioner], [Medical certificate], [Date of issue]. ? “VWA Guidance Material for Occupational Therapists completing WorkCover

Household Help (OT) Assessments” (note: this is mandatory reference material). ? “VWA Agent Advisory Material” (note: this is mandatory reference material). MEDICAL INFORMATION

Topic Comments Reported by: Brief history of injury [Enter details] [eg: TMP, Wkr] Diagnosis [Enter details] Prognosis [Enter details] Surgery [Enter details eg date, surgery outcome etc] Treatment [Enter details eg: type, goal, frequency, duration] Medication [Enter details] Medical restrictions [Enter details ] Current symptoms [Enter details] Other non work related medical conditions

[Enter details eg: condition, history, functional implications]

LIAISON WITH TREATING MEDICAL PRACTIONER (TMP)(contact with TMP is mandatory)

Name: Date of contact

Comments

[eg: name, title] [Enter date] [eg: does TMP support proposed recommendations) REPORTED PRE-INJURY FUNCTION FOR IDENTIFIED TASK(S)/ ISSUES

Task Did worker perform task?

Comments: Is the worker able to perform the task? eg If yes/ sometimes, detail frequency, modified techniques/equipment used If no or sometimes, who else performed task/ how often etc? eg husband Detail start date & cease date of private services if relevant.

[Detail specific house work, gardening tasks]

[yes, no, sometimes]

[eg: Enter details]

REPORTED POST INJURY FUNCTION FOR IDENTIFIED TASK(S)/ ISSUES

Task Is worker currently performing task?

Comments: Is the worker able to perform the task? eg If no or sometimes, assess the worker’s ability to perform task. Where possible provide education on adaptive techniques, assistive equipment etc If no or sometimes, who else performs task/ how often eg children


[yes, no, sometimes]

[eg: Enter details]

TASKS CURRENTLY COMPLETED BY HOUSEHOLD HELP SERVICES

Task Hours/ frequency

Comments


[Enter details]

[Include relevant details ie start date of services, services provided]


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CURRENT PRESENTATION (comment as relevant to identified tasks)

Title Comments Reported Observed

Height [Enter details if relevant ie impacts on ability to complete tasks]

[ie: use 'X']

Weight [Enter details if relevant ie impacts on ability to complete tasks]

Range of movement/ Hand dominance

[ie as relevant to identified tasks]

Sitting tolerance [Minimum/ maximum limits] Standing tolerance [Minimum/ maximum limits] Walking tolerance [Minimum/ maximum limits] Lifting capacity [Enter details] Endurance [eg: activity tolerances] Ability to perform other tasks (not included in assessment scope )

[eg other personal and domestic tasks, driving, social activites, sport etc] ]

Psychological issues [Enter details] OBSERVATIONS AND CORRELATION BETWEEN OBSERVED AND REPORTED DATA [Enter details: formal & informal observations, self reported status of worker, THP opinion, medical

reports and documents etc] PERSONAL/HOUSEHOLD CIRCUMSTANCES

Topic Comments Detail relationship status of worker

[Enter details]

Ability of occupants to assist with household tasks

[Enter details]

Detail number & age of children [Enter details] Details other people living in the house not included above

[Enter details]

Detail other people who provide assistance in tasks but do not live at house

[Enter details]

Detail any house members who have a disability or illness etc? (Where relevant ie. if impacts upon the worker’s need for services). If so, detail level of assistance required, frequency/ by who.

[Enter details]

DETAILS OF THE HOME ENVIRONMENT

Topic Comments Pre-injury Home (if relevant) [detail if there has been any change in the worker's home

environment since the injury] Current home type [Enter details] Number of bedrooms [Enter details] Number of bathrooms [Enter details] Number of living areas [Enter details] Type of flooring carpet/ tiles [Enter details] Access to home [Enter details of internal and exteral access including steps] General presentation [Enter details eg presentation of house/ garden, garden setup] Does the worker own safe & appropriate standard equipment? If no, what did

[Enter details]


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they use before their injury? Does the worker have any assistive equipment?

[Enter details]

SUMMARY OF TASKS AND RELEVANT COMMENTS

Upon completion of the Household Help (OT) Assessment the following is noted: Task Comment [Detail issue]

[Worker's concerns] [Occupational Therapist's comments]

[Detail issue]


[Detail issue]


ADDITIONAL COMMENTS

[Detail any additional comments. N/a if not applicable]

This report has been completed for the consideration of the agent. If you wish to discuss this report or require further information, please contact the author on [Enter phone number]. Yours sincerely [Enter name] Occupational Therapist B. App. Sc. (O.T.), [Enter additional qualifications if applicable]

[Enter organisation] cc: [Enter name, address]


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WorkCover Household Help (OT) Assessment Request Form GOAL/EXPECTED OUTCOME OF SERVICE: Comments:

Total Approved Cost For Service period: $ Start Date: End Date: Case Manager Signature: Date:

PROVIDER DETAILS: CASE MANAGER DETAILS:

EMPLOYER DETAILS:

Name: Address: Phone: Fax: Email:

Agent: Case Manager: Title: Section: PO Box: Phone: Fax: E-mail:

Company: Contact: Title:

Address:

Phone: Fax: Email:

Services Requested: Code Authorised Cost

WorkCover Household Help Occupational Therapy Assessment $

WorkCover Household Help Occupational Therapy Education $

TOTAL $ CLAIMANT DETAILS: Name:

Address: Phone: Date of Birth: Male Female

Interpreter: Y N Language:

Claim No:

Occupation: Date of Injury:

Ceased Work Date:

Nature of injury: Current Segment: CP MDM LTM&RTW

TREATING MEDICAL PRACTITIONER Details:

PRE-INJURY HOURS:

Hours worked per week_____ Full-time Part-time Casual

*weeks in receipt of WC payments:_________

EMPLOYMENT STATUS:

Name: Clinic: Address: Phone: Fax:

Additional TREATING HEALTH PRACTITIONER Details:

Name: Clinic: Address: Phone: Fax:

q AT WORK, SAME PRE-INJURY HOURS q AT WORK, LESS PRE-INJURY HOURS q NOT AT WORK - DATE CEASED

_____________ q EMPLOYMENT TERMINATED

ATTACHMENTS: Medical Reports Current Medical Certificate

Claim Form(s)

Other Specify:

NOTE: This form should be completed by the agent. In the event that the agent gives you a request over the phone, the OT may complete this form.


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WorkCover Household Help (Occupational Therapy) Assessment

Example MEDICAL RELEASE AUTHORITY

I _________________________________________________________

(Workers name)

of ________________________________________________________

(Workers address)

_____________________________________________________

Hereby give consent to my treating medical practitioner(s) providing

_____________________________________________________ (Occupational Therapist)

with information on my work related condition to assist with the completion of a WorkCover Household Help Occupational Therapy Assessment. I hereby give consent to the following treating health practitioner(s):

__________________________________________________________

(Medical Practitioner’s name)

__________________________________________________________

(Medical Practitioner’s address)

Phone:________________________ Fax:________________________ (Mandatory)

__________________________________________________________

(Treating Practitioner’s name)

__________________________________________________________

(Treating Practitioner’s address)

Phone:________________________ Fax:________________________ (If applicable)

Worker’s name:______________________________________________ (Please print)

Claim Number:______________________________________________

Worker’s Signature:_________________________ Date:____/____/____

Witnessed by:_______________________________________________

(Please print)

Witness’s Signature:_______________________ Date:____/____/____


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WORKCOVER HOUSEHOLD HELP (OCCUPATIONAL THERAPY) ASSESSMENT REPORT

BACKGROUND INFORMATION

DATE OF ASSESSMENT: 14/07/03

WORKER: Ms X

MANAGING AGENT: ABC

CLAIM NUMBER: 00 000 000

DATE OF INJURY: 12/01/03

TYPE OF INJURY: Lumbar disc bulge

DATE OF BIRTH: 00/00/48, Age: 55

GENDER: Female

CURRENT WORK STATUS: Not working

CURRENT MED. CERT.: No Current Work Capacity

EMPLOYER: SEW Inc

PRE-INJURY POSITION: Machinist

REQUEST SOURCE: Mr X, Case Manager, WorkCover Agent

DATE OF REQUEST: 10/07/03

DATE OF REPORT: 18/07/03

PRESENT (AT ASSESSMENT): Ms X (worker) X (Occupational Therapist) ASSESSMENT SCOPE

Initial Assessment no previous Household Help services. The worker has requested Household Help services for household help due to difficulties with the following tasks:

• Cleaning the floor including mopping and vacuuming • Cleaning the bathroom • Cleaning the toilet.

In response to this formal request, this assessment was conducted to evaluate the worker’s ability to perform these tasks and maximise their independence in these activities. The worker is currently receiving no Household Help services. RECOMMENDATIONS: Following this assessment of the worker’s ability to perform the identified tasks, the recommendations are outlined below. (Note: Please refer to the body of the report for background information supporting recommendations). SUMMARY OF RECOMMENDATIONS The Occupational Therapist does support the provision of Household Help services in the short term to assist the worker to recover from recent surgery. The Occupational Therapist also recommends that all going well, the worker should resume the identified tasks at the completion of this period through use of the


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assistive equipment and adaptive techniques as outlined below and as discussed with the worker during the assessment. RECOMMENDED SERVICES TO MAXIMISE INDEPENDENCE

x Graded Cessation Reduction Maintain current services Education No service

Service/Task Week No. (Include graded reduction plan where applicable)

Hours/ Mins Frequency

House work including, mopping and vacuuming the floor, cleaning the toilet and bathroom

1 – 4 5 – 8 Onwards

2hrs 2hrs Cease services

Weekly Fortnightly Cease services

RECOMMENDED REVIEW DATE(S) FOR SERVICES

Service Suggested timeframe for cessation/ review of services

Suggested actions for review

Housework 8 weeks Agent to contact worker and treating medical practitioner to review worker’s progress


Equipment / Aid

Strategy for independence

Impact on need for services Supplier

Extra long handled toilet brush

Enables worker to clean toilet without bending

Eliminate need for service provision for task

ACME Co

Long handled bath/shower scrubber

Enables worker to clean shower without bending

Eliminates need for service provision for task

ACME Co

Long handled dust pan and broom

Enables worker to clean spills without bending

Eliminates need for service provision for task

ACME Co


Task Strategy for independence Impact on need for services Vacuuming Worker to use existing

equipment by wrapping the vacuum hose around their body when vacuuming hence avoiding bending as demonstrated during assessment Worker to spread tasks across

several days hence avoiding increased discomfort

Eliminates need for service for task

Mopping Worker to spread task across several days using existing light weight mop and through application of technique to avoid bending and twisting as demonstrated during assessment

Eliminates need for service for task


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ASSESSMENT INFORMATION SUPPORTING RECOMMENDATIONS

DOCUMENTS REVIEWED ? Mr XY, Orthopaedic Surgeon, dated the 30/06/03 ? Dr General Practitioner, WorkCover Certificate,01/07/03. ? “VWA Guidance Material for Occupational Therapists completing WorkCover

Household Help (OT) Assessments” (note: this is mandatory reference material). ? “VWA Agent Practice Advisory Notes” (note: this is mandatory reference material). MEDICAL INFORMATION

Topic Comments Reported by:

Brief history of injury Fall at work. Immediately experienced lower back pain.

Worker

Diagnosis Lumbar disc bulge Worker Prognosis Surgeon has advised worker that they may be fit to

return to work within 6 to 12 months Worker

Surgery Laminectomy, 30/06/03. To be reviewed by surgeon in August 2003

Worker & TMP

Treatment Nil currently. Plans to commence physiotherapy in 8 weeks after review with surgeon

Worker & TMP

Medication Panadeine forte as needed Worker Medical restrictions Not to drive for 8 weeks

Not to lift Not to bend or twist Able to sit for short periods

Worker & TMP

Current symptoms Occasional lower back pain Worker Other non work related medical conditions

N/A Worker

LIAISON WITH TREATING MEDICAL PRACTIONER (TMP) (contact with TMP is mandatory)

Name: Date of contact Comments Dr General

Practitioner 15/07/03 treating medical practitioner supports provision of

household help service and strategies recommended to maximise the worker’s independence.

REPORTED PRE-INJURY FUNCTION FOR IDENTIFIED TASK(S)

Task Did worker perform Task?

Comments: Is the worker able to perform the task?

Cleaning floors, bathroom and toilet

Yes Worker performed all cleaning tasks prior to her accident

POST INJURY FUNCTION FOR IDENTIFIED TASK(S)

Task Is worker currently performing task?

Comments: Is the worker able to perform the task?

Cleaning floors, bathroom and toilet

No On assessment the worker was able to perform each of the tasks through education in adaptive techniques and use of assistive equipment, for details see recommendations. Husband previously completed task weekly.


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TASKS CURRENTLY COMPLETED BY HOUSEHOLD HELP SERVICES

Task Hours/ Mins /frequency

Comments

N/A CURRENT PRESENTATION (comment as relevant to identified tasks)

Title Comments Reported Observed

Height Average. X

Weight Medium build. X

Range of movement/Hand dominance

Unable to bend or twist due to pain. X

Sitting tolerance Limited to 5 minutes as per surgeon’s instructions. X

Standing tolerance 45 minutes. X X

Walking tolerance 30 minutes. X

Lifting Capacity Limited to light weights as per surgeon’s instructions. X

Endurance Reduced due to increased pain on activity. X

Ability to perform other tasks (not included in assessment scope)

Worker appears awkward in her movements when walking and transferring on and off the chair. Worker reported that they continue to drive in their local

area and perform the shopping, cooking and washing of the clothes and hanging them on the line.

X

X

Psychological issues

N/A X

OBSERVATIONS AND CORREATION BETWEEN OBSERVED AND REPORTED DATA Worker reported experiencing ongoing back pain that fluctuates depending on her activity level i.e.

the more she attempts activity, the greater her pain becomes. Worker appeared to move slowly and awkwardly when walking and transferring. The worker’s current presentation appears to be consistent with her recent surgery.

PERSONAL/HOUSEHOLD CIRCUMSTANCES

Topic Comments Relationship status of worker Husband

Ability of occupants to assist with household tasks

Husband is not available during the day to assist with tasks.

Number & age of children & whether at home, school or work

N/A

Other people living in the house not included above

N/A

Other people who provide assistance in tasks

N/A

Detail any house members who have a disability or illness etc? (Where relevant ie. if impacts upon the worker’s need for services).

N/A


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If so, detail level of assistance required, frequency/ by who DETAILS OF THE HOME ENVIRONMENT

Topic Comments Pre-injury Home (if relevant) N/A Current type of home Single storey house.

Number of bedrooms 3

Number of bathrooms 1

Number of living areas 2

Type of flooring carpet/ tiles Carpet with tiles in all wet areas.

Access (internal & external ie steps)

One threshold step at both the front and rear entrance. No internal steps.

General presentation/ size of garden

The home is located on an average sized suburban block and both the house and garden were well maintained

Does worker own safe and appropriate equipment? If no what did they use before their injury?

Yes

Does the worker currently have any assistive equipment?

No

SUMMARY OF TASKS AND RELEVANT COMMENT ISSUES

Upon completion of the Household Help (OT) Assessment the following is noted: Task Comment Cleaning floor

Worker reports being unable to complete task due to recent surgery. Occupational Therapist considers that the worker should avoid

task in the immediate future due to recent surgery Cleaning bathroom


task in the immediate future due to recent surgery. Cleaning toilet


task in the immediate future due to recent surgery. ADDITIONAL COMMENTS N/A This report has been completed for the consideration of the agent. If you wish to discuss this report or require further information, please contact the author on xxx Yours sincerely Occupational Therapist B. App. Sc. (O.T.)

Guidance Material for an Occupational Therapist · PDF fileCompleting a Victorian WorkCover...

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