Can you choose your own physiotherapist on Support at Home?

You can ask for one, and the program has a name for it. Nominating a physiotherapist from outside your parent’s provider is a third-party worker arrangement, and it is set out in the Support at Home rules rather than being a favour you are asking for. Two things come with it: the provider has to agree, and it may add an overhead capped at 10% of the service cost.

What usually happens instead is that nobody raises it. The care partner says physiotherapy is in the support plan, somebody from the provider’s own allied health team turns up, and because they turned up it never comes up that there was a decision to make.

What does the government actually say?

The Department of Health’s page on self-management by Support at Home participants is where this lives. It names the arrangement:

Some participants prefer to choose their own workers, including workers from different organisations (for example, a gardener). These are called third-party workers.

And it lists “choosing or coordinating services, according to their needs and budget” as one of the self-management activities an older person can take on, alongside managing their own workers and paying invoices themselves. So the structure assumes some participants will want a say in who comes into the house.

Can the provider say no?

Yes, and it is worth knowing that before you ring. The same page is written to providers and is direct about it:

You and the participant should agree on any self-management activities or third-party workers. You should make this clear in their care plan.

As the provider, you must meet all regulatory obligations and requirements, including when third parties deliver services. If you can’t meet these requirements, do not agree to a third-party worker arrangement.

So this is a request the program is built to accommodate, not an instruction you can issue. What a provider is checking is whether it can still stand behind the care: registration, insurance, notes, incident reporting. Ask the question as an administrative one and you will usually get an administrative answer. We would like X to provide her physiotherapy. What do you need from them to set that up? On our side the answer is a service agreement, an AHPRA registration number and a certificate of currency.

What does it cost to use an outside physiotherapist?

Nothing out of pocket for the physiotherapy itself. It is clinical care under Support at Home, so it carries no participant contribution whoever delivers it.

There is one cost specific to the choice, and almost nobody mentions it:

You can charge an overhead if a participant wants to use a third-party worker. This covers additional costs associated with these arrangements. Overheads are capped at 10% of the actual cost of the third-party service, which you must include in the final service price.

That comes out of her quarterly budget rather than her pocket, and it is not automatic. Ask whether the provider intends to charge it and at what rate, so you can work out what the budget actually holds. While you are asking: for ongoing services, 10% of the quarterly budget is deducted for care management before any of it reaches a service.

Why bother, if someone is already turning up?

Because the allocation is the service. Ask a provider whether the same physiotherapist will come every week and you will usually get a careful answer, because a roster cannot commit to it. That is not anybody behaving badly, it is how rostering works.

What it costs your parent is the thing you most wanted and are least likely to get told about: somebody who has seen her often enough to know what normal looks like for her, and who would therefore notice her slipping. That takes one physiotherapist over months, not a sequence of competent strangers. It is the one part of the arrangement you cannot buy back later, which is why it is worth a phone call now rather than after six months of visits.

What should you ask before you agree?

• Who is coming, and will it be the same person each week?If the answer is “one of our physios”, that is the roster answer.
• What will you charge her budget for this? Covers the third-party overhead and anything else going on the invoice.
• What happens on the other six days? The home program, and whether anybody follows it up, is where most of the progress comes from. A weekly visit with nothing attached to it is one day out of seven.
• What do I get told, and when? Ask for the real answer rather than the brochure one. Ours is a quarterly update, formal or informal, plus Jimmy on email whenever you want him in between.

How do you set it up?

1. Get physiotherapy named in her support plan. It has to be in the plan to be funded, and it is rarely offered unprompted. Say what has changed and when: the fall in June, the hand on the furniture, the two weeks in hospital in August. Care partners act on specifics. What a home visit involves is worth reading first, so you can describe what you are asking for.
2. Tell the provider who you want, and ask what they need. The care partner is meant to write self-management and third-party arrangements into the care plan, so ask for it to go in there.
3. Let the two of them do the paperwork. We invoice the provider directly, so nothing lands on your kitchen table. Ask and Jimmy will tell you exactly what we send and who we send it to.

If your parent came across from a Home Care Package, what Support at Home changed for Home Care Package clients covers the funding side in more detail, and the two-minute falls-risk check asks the same eight questions we ask at a first assessment. Or email info@jxphysio.com.au and ask Jimmy how we would go about it with her provider.