Cutting the costs of incontinence

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Written by Bernie Riley, PCFA General Manager of Supportive Care Programs

If you have incontinence and need continence products, you might be eligible to a government subsidy known as the Continence Aids Payment Scheme (CAPS).  

In this article we’ve included a breakdown on the eligibility criteria and how you can access the CAPS scheme and other state and territory subsidies.

Many of men and their families may be aware of the Federal Government  subsidy scheme called the Continence Aids Payment scheme (CAPS).

The current CAPS yearly payment rate is up to $650.40. The CAPS team is part of Services Australia and operates from 8.30am to 5pm (AEST) Monday to Friday you can call them on 1800 239 309. 

You need to meet all the eligibility requirements to get CAPS. The basic requirements are that you:

• have permanent and severe incontinence
• have an eligible neurological condition or eligible other condition that is the cause of your permanent and severe incontinence
• be 5 years or older
• be an Australian citizen.

You may not be able to get CAPS if you don’t meet eligibility.

You will also need Registered health professionals who can confirm your condition and assist you with completion of the CAPS scheme forms. These include:

• general practitioner (GP)
• continence nurse
• registered nurse
• physiotherapist
• occupational therapist
• Aboriginal health worker
• medical specialist.

In general men who have severe and permanent incontinence after radical prostatectomy are deemed to have a Category 7 Eligible Neurological condition and do not need to be a concession card holder.

You may also be eligible though if you have a non- neurological condition other than a total removal of the prostate.  However, you must also have a Centrelink or DVA pensioner concession card.

These non-neurological conditions do include- problems which could be caused by prostate cancer or its treatments- that is, under Category 8- prostate cancer, a radiation damaged urethra or bladder or rectum, incontinence caused by Transurethral Resection of Prostate (TURP), urethral stenosis, bladder neck or muscle dysfunction and several others are all eligible conditions.

If you are DVA eligible White and Gold card holders you may be eligible for two years supply of continence aids before needing to be reassessed for eligibility under the Department of Veterans affairs Rehabilitation Appliances Program (RAP).

Additional to this there may be state based subsidies that require further assessment to access and enable an increase in funding for those eligible. In some cases, those who exhaust the funding available through CAPS may be eligible for further subsidy or supply of continence aids through these state-based schemes. In many cases men will have to be referred to a continence service or be further assessed, but the financial assistance can be worth it if $650 does not cover the cost of continence supplies necessary. In some cases, the state-based scheme will supply a range of continence aids or supplies which are prescribed by the continence service you may be assessed by. PCFA’s Telenursing Service or The Continence Foundation can help you understand access to these programs.

Here’s a quick breakdown of some additional State-based information:

In Victoria there may continence aids for eligible people through the State-wide Equipment program (SWEP), more specifically their Continence Aids program (CA). People may be eligible for additional catheters, drainage bags, bottles, washable bedding and chair pads, washable briefs and pads, but does NOT cover disposable pads or pants.  SWEP has contact line 1300 747 937.

In NSW, ENABLE NSW may offer additional supply of incontinence products for those men who have exhausted the funding provided by CAPS. Men will need to be assessed by a nurse with specific training in prescribing the most suitable product for each person’s needs. You may need to be referred to such a specialist on your area. You can find a local specialist through the Continence Foundation of Australia’s Service Directory or by calling them.

In QLD, men may be eligible for supplies of continence aids through the Medical Aids Subsidy Scheme (MASS). Again assessment and prescription by an appropriately trained health professional is essential.

In SA, no state-based subsidy exists beyond that available through CAPS, DVA or the NDIS.

In Tasmania, The Tasmanian Department of Health and Human Services operates the Community Equipment Scheme (CES). Continence supplies (available from Independence Australia) of up to $1000 per year are available for eligible clients who pay half the costs of supplies received. People who are eligible for CAPS or DVA continence assistance will not be eligible for this scheme.

In WA, men may be eligible for further assistance through the Continence management and support scheme (CMASS). The Silver Chain Nursing Association delivers the Continence Management and Support Scheme (CMASS) at clinics through Western Australia. Specialist nurses provide assessment and advice on how to best manage and improve your bladder or bowel condition. If continence products are required, Silver Chain can assist with accessing a subsidy of up to $490 per year through Independence Australia.

In NT, the Disability Equipment Program (DEP) may provide eligible men with assistance after CAPS funding is exhausted. At this time an assessment is undertaken, and frequency of supply will be based on manufacturers’ guidelines. DEP may fund up to a monetary ceiling of $1500

In ACT the ACT Equipment scheme (ACTES) does not provide a subsidy for men access funding through CAPS.

Other subsidies
If you are likely to benefit from pelvic floor exercises then the cost of visiting  a pelvic floor physiotherapist can also be subsidised with a Chronic disease management plan . You may wish to discuss this with your GP to make these arrangements and arrange a referral.

You can locate a locally based nurse through either of the below locators:

1. Continence Australia- where you can narrow the search to a pelvic floor physiotherapist or continence nurse in your area or
2. Australian Physiotherapy Association (APA) 
   Find a physio: https://choose.physio/find-a-physio

Some men also prefer to try a range of products before buying in bulk. Companies such as PCFA Partner TENA offer delivery of a range of sample incontinence. There are a range of other companies who also provide this service

People seeking any further information could call PCFA’s Telenursing Service on 1800 22 00 99 to chat with the team about their options. We’re here to help!