[2021] AATA 378
General information, not legal advice.
Administrative Appeals Tribunal of Australia
2021-02-26
Original judgment source is linked above.
(a) it enabled the Applicant and his wife to spend more time with their daughter and daughter-in-law who worked in the practice, and see their grandchild who they could babysit for their daughter-in-law when she was at work;
(b) it enabled the Applicant to be close to the Royal Adelaide Hospital and reduce travel time to the hospital for treatment; and
(c) it was more conveniently situated to permit the Applicant a wider range of social and community activities with better disability infrastructure.
The Applicant's daughter agreed with that proposal.
(a) to be supported to complete daily tasks as independently as possible;
(b) to be supported to obtain necessary assistive technologies to enable the Applicant to live as independently as possible; and
(c) to be assisted to identify and source home modifications required to enable the Applicant to live independently.
[The Applicant] requires seating services to be of equal height, use of weight-bearing supports to grasp with his upper limbs (e.g. grab rails) and use of slide board or stool to bridge the gap and provide additional stability during transfers.
[The Applicant's] transfers, and sitting balance, have been impacted by the Left amputation progressing from below knee to above knee. [The Applicant] is currently less stable and has reduced capacity to correct his positioning when he becomes unsteady in sitting or during transfers. When his Left stump was below his knee, he was able to grasp the underside of seat services to increase his stability and support dynamic balance. Following the above knee amputation on his Left, [the Applicant] no longer has the ability to grip and stabilise his position on his Left side using his stump. [The Applicant's] safety in sitting is also influenced by the depth of the seat he is using....... [the Applicant] is at an increased risk of falling from his seat when he leans or reaches forwards due to the change in his centre of gravity.
When [the Applicant] is able to wear one or two lower limb prosthetics, his sitting balance is increased.
(a) a stairlift was not considered suitable because:
(b) A platform stair lift was not suitable because:
(a) there was direct access between the home and the garage. The garage was undercover with level flooring, adequate lighting and was the safest location for the Applicant to transfer in and out of his motor vehicle, whether he was walking with prosthetics or mobilising in his wheelchair;
(b) the lift enabled the Applicant to use any method of mobility, including his powered wheelchair and manual wheelchair using prosthetics with walking sticks. There was no requirement to transfer on and off a platform or seat;
(c) the Applicant would be able to use a lift independently without the need for support to participate in community activities and events, which would assist in achieving his goals.
Statement of LH (the Applicant's wife) dated 14 June 2020
it was also suggested that we slow down the build so the NDIS approval comes through before we spend the money. Installing a lift could be problematic, but we were encouraged to include it in the home modifications.
due to lack of communication and delays in making decisions, it has become more difficult for [the Applicant] to achieve his goals. He wants to walk, but it has been seriously delayed! He wants to move to a house which caters for his needs in an environment that is safe, but can't!
She expressed her anger and dissatisfaction with the way that she and the Applicant had been treated, the "red tape" involved in the process and the distressing impact that the system has had upon her which is ongoing.
Undated Statement of SH (the Applicant's daughter)
He applied for new legs and modification to the building. He was told that his plan had "place holder" amounts and that when quotes were submitted, they will be assessed and he would have an outcome in regards to home modifications and legs, we assumed that this would be in a reasonable time.
Dr Cafaro Report dated 17 July 2020 and Addendum Report dated 17 August 2020
will benefit from the provision of the most essential human requirements, those being safe and appropriate housing, access to equipment which has been deemed both by myself and his specialist Orthopaedic surgeon essential to his recovery and the ongoing support of his physical and emotional well-being. He must have housing and a residence which can accommodate full-time wheelchair use and not be a hindrance on his recovery and care providers...... [The Applicant] requires the ability to conduct his normal life in an environment which is accessible to a heavily physically disabled person requiring a wheelchair full time and the expectation is on the NDIA to accommodate those humane requirements.
would be able to manage independently in regards to his wheelchair transport if his residence, facilities and supports were amenable to this, which unfortunately they are currently not. This is hampering his recovery and worsening his overall condition; both physical and emotional.
(a) The lift gave the Applicant independence. It would enable LH to visit her sister in Brisbane which she was currently unable to do. The lift meant the Applicant did not need others present with him. The platform stair lift and stair chair lift were not options, the latter because the risk of falling remained.
(b) The lift gave the Applicant the ability to interact socially, to go to the shop and would enable him to exercise and improve his psychological health.
(c) The lift represented value for money. The stair chair lift seat was not safe and, albeit the platform stair lift may be possible, there was an issue with the structure of the building and the position of the bottom of the staircase proximate to the front door.
(d) The Adelaide premises, being in the city, enabled the Applicant to have closer access to others, including the Royal Adelaide Hospital.
(e) The lift was effective and beneficial for the Applicant.
(f) The lift represented what was reasonable, when balanced with the expectation of family support, carers or other supports that may be available. The Applicant referred to paragraph 22 of his Statement of Facts, Issues and Contentions and to KLMN and National Disability Insurance Agency [2017] AATA 1815 at [44] and argued that, in respect of section 34(1)(e) of the Act, participant families should not be expected to pay for disability supports that meet the criteria of the Act. There are no other services to fund this reasonable and necessary support.
(a) represented value for money with no comparable supports;
(b) would improve the Applicant's life stage outcomes and add to his long-term benefit, including access to the community and increased independence with self-pride and a purpose in life;
(c) was cheaper in cost now than in the future and reduced the funding for supports in the long-term;
(e) was safe when compared to a stair chair lift and other options; and
(f) increased his independence and access to the community and would ensure less support from other support services and promote support that may be provided by other members of the family.
(a) a decision was made between the Applicant, his wife and his daughter well before funding was sought to install a lift; and
(b) the Applicant and SH were intending to complete work, including the lift, and financing it regardless of the outcome to the NDIA.
[19] Section 4 of the Act sets out 16 "general principles". The first role of these general principles in the legislative scheme is set out in s 4 (17), which provides:
It is the intention of the Parliament that the Ministerial Council, the Minister, the Board, the CEO and any other person or body is to perform functions and exercise powers under this Act in accordance with these principles, having regard to:
(a) the progressive implementation of the National Disability Insurance Scheme; and
(b) the need to ensure the financial sustainability of the National Disability Insurance Scheme.
[20] Thus, the role of the 16 general principles is qualified by decision-makers being required to take into account the two or more pragmatic considerations in s 4(17)(a) and (b).
Home modifications are changes to the structure, layout or fittings of the participant's home that are required to enable the participant to safely access and move around frequently used areas in their home as a result of their disability.
The Respondent submitted that the lift would not necessarily have been a required modification had appropriate consultation taken place. It is expected that a home modification would only be considered where the home to be modified is a participant's primary residence and the participant intends to remain living at the residence.
The Applicant is 65 years of age and intends to remain residing at the premises, but he has no interest in the property beyond the Granny Flat Agreement and that arrangement may change.
The Respondent repeated the earlier submission when referencing s 34(1)(c).
This, it was submitted, contemplated the NDIA's involvement in complex home modifications and that this matter was an example of such modification. In this matter, the NDIA has been removed from that process and cannot change the modifications.
The Respondent submitted that, albeit the property was purchased before the participant was granted access to the NDIS, there is an expectation that the NDIA will have the opportunity for some involvement in decision-making processes, and the NDIA was not afforded that opportunity in this matter where it may have been appropriate to do so.
capital building additions such as additions of rooms, stories or lifts or inclinators to allow access to multiple levels of a home or steep blocks of land.
That, it was submitted, was the kind of specific example, that will not be funded. However, when considering that funding, the Guidelines also require consideration of the following:
(a) whether other parts of the house can be reasonably organised as an alternative;
(b) whether alternative accommodation which is more accessible or more easily modified is available and the cost;
(c) whether there are compelling factors related to the participant... which makes moving premises unrealistic;
(d) the long-term cost benefits of alternative funded supports against the cost and benefits of the modification. The change of premises consideration did not apply in this matter_;_
(e) it is generally expected that the home modifications will be suitable for the participants anticipated long-term needs.
to the structure, layout or fittings of the participant's home that are required to enable the participant to safely access and move around frequently used areas in their home as a result of their disability.
When complex and extensive home modifications are being considered, the NDIA may also fund oversight by a project manager or independent building certifier to ensure compliance of the modifications and a qualified and experienced Occupational Therapist to certify the effectiveness of the modifications to meet the participant's goals and likely needs.
(8) People with disability have the same right as other members of Australian society to be able to determine their own best interests, including the right to exercise choice and control, and to engage as equal partners in decisions that will affect their lives, to the full extent of their capacity.
I certify that the preceding one hundred and seventy-one (171) paragraphs are a true copy of the reasons for the decision herein of Senior Member B J Illingworth
....................[SGND]................................
Mr Paul d'Assumpcao, National Disability Insurance Agency
[11] 378 ALR 449 [2020] FCAFC 70 at [143] - [153].
McGarrigle
National Disability Insurance Agency and Another
KLMN & National Disability Insurance Agency [2017] AATA 1815.
McGarrigle v National Disability Insurance Agency and Another [2017] FCA 308; (2017) 252 FCR 121.
Mulligan v National Disability Insurance Agency [2015] FCA 544; [2015] 233 FCR 201.
NDIA v WRMF 378 ALR 449; [2020] FCAFC 70.
(2017) 252 FCR 121