Community nursing services – general information

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DVA funds community nursing services for eligible DVA Veteran Card holders to meet their assessed clinical needs.

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Community nursing services

DVA funds approved Community Nursing (CN) providers to deliver clinically required nursing and personal care services to eligible DVA Veteran Card holders. This includes:

  • assessing client needs and developing a care plan
  • providing care to meet assessed clinical needs
  • re-assessing needs over time and updating the care plan as necessary
  • working with other health care providers as required. 

This care is to help clients maintain independence and receive the care they need to remain at home.

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Who can provide community nursing services

DVA funds approved CN providers to deliver services to eligible DVA Veteran Card holders.

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Who can access community nursing services

To receive community nursing services for an assessed clinical need, a client must have either a: 

If a client has a Veteran White Card, DVA will fund CN services if the care they need is due to an accepted service-related injury or condition.

If a client has a Veteran White Card, contact DVA to determine if the client can receive DVA funded CN services before providing care to the client.

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Refer a client for community nursing services

Which clients need a referral

All clients need a written referral if they are either:

  • new to receiving community nursing services
  • have been out of care from a CN provider for over 28 days
  • at the end of each continuous 12 month period of care. 

Upon receiving a written referral from an authorised referrer, a CN provider must:

  • assess the client's clinical nursing and personal care needs
  • provide services to meet their clinical and personal care needs that are within the scope of the CN Program.

Who can refer clients

To provide community nursing services to a client, a written referral must come from an authorised referral source, which can be a:

  • general practitioner (GP)
  • treating medical practitioner in hospital
  • hospital discharge planner
  • nurse practitioner specialising in a community nursing field.

Referrals should be sent directly to a CN provider and not to DVA. 

Community Nursing referral template

Written referrals can be made by completing the D9389 Community Nursing Referral form and sending it directly to a contracted Community Nursing provider.

The Panel of Providers page lists approved CN providers for each state and territory.

Alternatively, the written referral can be provided using the authorised referrer’s own letterhead or referral document.

Note: The client’s GP is to have ongoing clinical oversight of the client’s care.
 

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Coordinated Veterans’ Care (CVC) Program

The CVC Program is a proactive coordinated care program. It aims to improve participant quality of life and decrease the risk of unplanned hospitalisation. 

The role of a Community Nurse in the CVC Program

Where a GP does not have access to a practice nurse, they may choose to work with a CN provider to deliver the care coordination element of the program. The role of the Community Nurse in this situation is to coordinate care for the CVC participant, and be in contact with the client's GP regularly.

A CN provider must receive a written referral from a GP requesting the provider to deliver CVC coordination services to an eligible client. Referrals are valid for 12 months and monthly updates are required to be provided to the GP. 

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2022 Feedback Survey

In 2022, a survey of a sample of CN clients and their carers was conducted. A summary of the results is now available.

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Protective Factors Study

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