Disclaimer: This blog post is specific to Victoria in Australia, and the information I present here is subject to change at any minute as there are lots of stakeholders at play! Any quotation marks you see throughout this post are statements that have been directly taken from the respective website.
To the best of my knowledge, below is a break down of the financial supports available for people on home tube feeding in Victoria (and likely applicable to majority of other Australian states). For anyone working in this area or anyone with a home feeding tube, you know how complex this space can get but here we go…
What financial supports are available in Victoria for people with home feeding tubes?
- Australian Government Home Enteral Nutrition (HEN) Public Hospital Services
- National Disability Insurance Scheme (NDIS)
- Transport Accident Commission (TAC) – likely to exist in other Australia states too but under a different name.
- Department of Veterans’ Affairs (DVA)
- Australian Government Home Care Packages (HCP)
- Private insurance companies
Have I missed any?
What are the HEN Public Hospital Services?
In Victoria, people with home feeding tubes that are cared for by a public hospital get fully subsidised tube feeding formula, equipment, and healthcare professional support.
The Department of Health in Victoria has just recently updated their funding arrangements document. Click here if you want to read the document in full, and here are a few key points to take note of:
- To be eligible for a public hospital HEN service for tube feeding you must be:
- on commercial liquid formula (so not blenderised homemade formulas),
- a Medicare eligible patient who is registered with that public health service,
- agreeable for ongoing medical follow up at that public health service, and
- agreeable to your data being used to monitor and evaluate processes.
- If you are a private patient receiving treatment at a private hospital, you can move your care to be under a public health care organisation and be willing to have your medical follow up there to be able to access this subsidised funding. *The italicised is the sticky part for most people that have private specialists who they prefer to follow up with.
- For those with an NDIS plan, the public hospital HEN service is required to identify these NDIS participants and facilitate their move to NDIS funding to be used for their home tube feeding consumables and be followed up by “an NDIS-funded suitably qualified and competent clinician”. Double dipping is a no-go zone!
So what about the NDIS, how does it help people with home feeding tubes?
We recently contacted the NDIS and disseminated our findings in our fortnightly newsletter PUMP Issue 2 (subscribe to PUMP here). Click here to read it, but in short – the NDIS can fund everything from formula, to equipment, to dietetic and nursing consultations. As a clinician, you just need to write a really good advocacy letter requesting what is necessary, reasonable and will support the NDIS participants optimal health, wellbeing and independence.
Transport Accident Commission (TAC)
The TAC in Victoria covers all fees related to enteral feeding if the tube feeding is related to the client’s transport accident. So formula, a spare feeding tube, feeding equipment, and dietitian consultations would all be covered. Check out these two website pages, dietitian guidelines and supported accommodation provider guidelines. Of importance to note is that the TAC will not cover “food to be prepared for a soft diet or food that will be vitamised or thickened”; so people who choose to be on homemade blended tube feeding formula would not have their groceries subsidised.
Department of Veterans’ Affairs (DVA)
We emailed the DVA general enquiries email some questions about their funding for home tube feeding and here was the response:
- “Please see here for a General Overview of DVA’s Services”
- “Please see here our DVA Fee Schedules for what Services can be claimed”
“You may need to speak to our Rehabilitation Appliances Program Department to confirm what Equipment can be supplied. If you have any questions, please email us at generalEnquiries@dva.gov.au or call 1800 555 254”.
Their response may seem vague, but I can tell you from professional experience with some of my DVA clients, the DVA has covered everything from formula, to feeding equipment, and dietitian consultations.
Australian Government Home Care Package (HCP)
A HCP is an Australian Government funded initiative that provides support for older people who want to stay living at home. Eligibility is determined by a government body called the Aged Care Assessment Team (ACAT). There are several levels of HCP and depending on someone’s personal circumstances, they maybe expected to contribute to the cost of their care. Importantly, the HCP’s do cover:
- “Nutrition, hydration, meal preparation and diet: assistance with preparing meals, including special diets for health, religious, cultural or other reasons; assistance with using eating utensils and assistance with feeding”
- “Enteral feeding requirements”
Check this page out for more details.
Private Insurance Companies
Even though someone’s home tube feeding is often a life long “treatment” and is often highly linked to their primary medical diagnosis, I’m yet to have a win with making sure a client of mine is supported by their private health insurance which they’ve been paying for for years! It’s tricky and unfair! If anyone reading this has had a win with a private insurance company, please contact me!
Well this is pretty self-explanatory and it is no surprise that it will weigh super super heavy on someone’s bank account. I’ve done some math’s to help paint the picture. A typical person with a feeding tube on a daily basis may use: 1 bottle (1L) of formula, a feeding pump, two 60ml syringes, and 3 giving sets a day. That equates to ~ $50 / day. Over a year (365 days), that’s $18,250.
Need I say more?
Where to go for more information?
Besides the websites I have linked above, check out this study we published last year, covering the demographics of HEN services across Australia and New Zealand.
Flood C, Parker EK, Kaul N, Deftereos I, Breik L, Asrani V, Talbot P, Burgell R, Nyulasi I. A benchmarking study of home enteral nutrition services. Clin Nutr ESPEN. 2021 Aug;44:387-396. doi: 10.1016/j.clnesp.2021.05.007. Epub 2021 May 26. PMID: 34330495.
I hope this post has shed some light on what’s out there to support people (and the clinicians and carers looking after them) with feeding tubes.
In short, there is lots of red tape around the funding supports that are “available” making them attainable to some and impossible to reach for others. We need to do better. We need equity of care and support.
Happy reading and home tube feeding,