How to get funding for SIL with a Spinal Cord Injury | MyCareSpace

Spinal Cord Injury - How to Get Funding for Supported Independent Living (SIL)

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Funding for support in your NDIS Plan with a Spinal Cord Injury (SCI)

Support can be funded in your NDIS plan in a variety of ways. You can have funding for drop-in support, support to engage in the community, support based at home for all of your activities, support at a day program etc.

To be eligible for funding for support, you must meet the NDIS eligibility criteria. This resource focuses on Supported Independent Living (SIL) and the eligibility requirements for SIL.

Due to high support needs, SIL is typically required in the home for participants with complex spinal cord injuries.

 

Supported Independent Living (SIL) Eligibility

The NDIS has eligibility criteria that must be met by the funding for any support to be included in your NDIS plan. This includes SIL.

You are required to demonstrate eligibility for SIL before receiving funding for your in-home support needs.

SIL is typically funded for those who require support for:

  • 24 hours per day, 7 days per week, including overnight support.
  • Of these 24 hours , you require active or direct support for 8 hours or more.

The support you require must relate directly to your diagnosis of spinal cord injury and any other co-occurring conditions recognised by the NDIS.

If you do not require such a high intensity of support, SIL might not be the right model of care for you. Consider exploring drop-in supports, or Individualised Living Options (ILO).

 

Is Supported Independent Living (SIL) Reasonable and Necessary?

Eligibility for SIL must meet the NDIS reasonable and necessary criteria. The reasonable and necessary criteria involve definitions and rules set by the NDIS which they must consider when approving or declining funded supports.

The NDIS will consider the following when approving or declining SIL:

1. Goals

SIL will assist you to pursue and achieve the goals in your plan.

2. Social & Economic Participation

SIL will assist you in undertaking activities to facilitate your social and economic participation.

3. Value for Money

The SIL model of care requested represents value for money. This means the cost of the recommended SIL supports is considered reasonable relative to both the benefits achieved and the cost of alternative supports.

4. Effective and Beneficial

SIL will be effective and beneficial for you. This means it will meet your needs related to your spinal cord injury. Your lived experience in previous SIL settings or short-term accommodation (STA) will help to justify this requirement.

5. Reasonable Expectations for Your Family and Informal Supports

Funding of SIL takes account of what it is reasonable to expect families, carers, informal networks, and the community to provide. The NDIS the availability of existing supports, and what must be provided by a SIL provider, in order for your needs to be met.

Spinal cord injury can result in a lifelong physical, cognitive, and emotional difficulties. You can also experience a wide range of co-occurring conditions. The impact of your disability and secondary health conditions can be used to justify how it is not considered reasonable to expect family members to cater to your support needs over the long term.

6. Related to NDIS & Your Disability

SIL is most appropriately funded or provided through the NDIS, instead of another funding body available. This means the need for SIL relates directly to your disability and your in-home support needs.

 

The NDIS also considers what other supports you require in your home, and how these supports will all work together to ensure SIL is the most appropriate support.

For an easy-to-understand breakdown of reasonable and necessary from MyCareSpace, see here.

 

What does the NDIS consider when approving funding for Supported Independent Living (SIL)?

The NDIS considers a range of factors when determining if SIL is reasonable and necessary to fund for you. Considerations include:

  • your current situation, goals, and aspirations
  • where you live now and your future home and living goals
  • your independent living skills and potential to build on these
  • supports you need to achieve your home and living goals
  • information about your day-to-day support needs
  • any alternative home and living options

This is outlined in the SIL Operational Guidelines from the NDIS.

The NDIS will review any reports from allied health professionals or providers that are submitted to them as part of your application for SIL. 

The most sought-after assessment is a Functional Capacity Assessment, completed by an Occupational Therapist (OT). Following the assessment, the OT will prepare a Functional Capacity Assessment Report that also includes recommendations specific to SIL.

The NDIS do not provide a template for therapists to complete a SIL report. Each OT provider has their own template and assessment process. For this reason, it may also be called a:

  • Supported Independent Living Assessment
  • Support Needs Assessment
  • Home and Living Assessment
  • Housing Assessment

 

What is a Functional Capacity Assessment?

A Functional Capacity Assessment is an in-depth assessment completed by an Occupational Therapist with you in your home. The assessment addresses every aspect of your day-to-day life and involves an in depth analysis on how you perform a task and if you require support, what this looks like.

A report is completed following the assessment which outlines your daily life, and difficulties experienced related to your disability and support needs.

The report includes recommendations for NDIS support and services you require to address any challenges and goals you wish to achieve.

 

How does a Functional Capacity Assessment for SIL differ from a standard Functional Capacity Assessment?

A quality assessment completed by an OT for SIL should include specific details and recommendations regarding your support needs across all of your daily activities and routines. Across every activity you engage in, the report should provide detail on:

  • The ratio of support required (how many people are involved in your care)
  • The intensity of support required (the type of care quality necessary based on your needs)
  • The best context for this support to succeed (the model of care best suited to you - who you live with, where you live etc.)

The report should include details on what support you require across the day and overnight. The report must refer to your informal supports (family and friends), and how they are unable to meet all of your daily living needs, which means that SIL is necessary for you.

The report should reference SIL eligibility, which includes the reasonable and necessary criteria, as discussed above.

When working with an OT for a SIL assessment, it is important to feel assured that they are skilled in this area and are confident in recommending SIL for you. If they determine SIL may not be the best support model for you, they should discuss this with you during or following the assessment, particularly if they anticipate the NDIS will be unlikely to approve SIL funding. 

Remember, ultimately the decision to approve and decline SIL is the role of the NDIS. The role of the OT is to present evidence of your disability and provide recommendations, concerning relevant legislation so that the NDIS can decide funded supports.

 

How can I get a Functional Capacity Assessment for SIL?

To find an Occupational Therapist who is experienced in completing a Functional Capacity Assessment for SIL for people with spinal cord injury, reach out to our Connections Team. This FREE service can connect you with an OT in your area.

Request a SIL Assessment for Spinal Cord Injury

 

Submitting evidence to the NDIS for SIL

Once your Functional Capacity Assessment has been completed and you have your report which includes recommendations for SIL, you may consider what other evidence is required to submit to the NDIS.

The more justification you provide that illustrates your support needs and need for SIL, the more evidence the NDIS has available to consider when approving SIL in your NDIS Plan.

Other information prepared by family members, carers, or yourself may help communicate your needs, and how insufficient access to support may impact your health, well-being and quality of life. This is often described as an Impact Statement, which you can learn more about here.

The final step is to prepare and submit a Home and Living Request.

 

Submitting a Home and Living Request for SIL

To request SIL funding, you are required to submit a Home and Living Request. This involves preparing a supporting evidence form which you can find here.

The form can be completed and submitted in one of the following ways:

The form will help participants to select the correct option based on their current needs

 

If you have a Support Coordinator, they can assist you in completing and submitting the form by one of the following methods:

  • Via email to: enquiries@ndis.gov.au
  • Via mail to: NDIA, GPO Box 700, Canberra ACT 2601
  • In person at your local NDIS or partner office. 

 

Ensure the submission also includes the Home and Living Form, as well as any reports prepared by yourself, carers or health professionals. This includes the OT Functional Capacity Assessment with Recommendations for SIL.

The NDIS will review all documents provided to decide whether to fund SIL. You will typically be informed of their decision via email. If SIL is approved, this will likely result in the generation of a new NDIS plan. If SIL is declined, you will be offered the opportunity to have this decision reviewed.

 

How do I find a SIL provider in my area?

When SIL is approved in your plan, you will be provided with a sum of funding for SIL in your Core Support budget.

You are not automatically allocated to a Provider and have choice and control over which provider you engage with for SIL.

Need help finding a SIL provider? Get in touch with the MyCareSpace Connections Team for assistance navigating the NDIS and finding a SIL provider in your area.

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