Housing for People with an Acquired Brain or Spinal Injury: Mapping the Australian Funding Landscape

This research aimed to synthesize housing supports funded by 20 major insurance-based schemes for Australians with an acquired brain injury (ABI) or spinal cord injury (SCI). Publicly available grey literature (i.e., primary information from respective scheme websites) was systematically reviewed and compared. There were notable differences between the different scheme types (disability vs. workers compensation schemes) and across different States. Collectively, scheme funding was more likely to be focused on housing infrastructure and service delivery, than on tenancy support. Australians who are least likely to benefit from the current funding context are those whose home cannot be reasonably modified, are wanting to build or purchase a new home, do not have suitable, alternative short- or long-term housing options if their current home is not feasible, require support to maintain occupancy of their home or financial assistance to move into a new home, may benefit from case management services, family supports, and assistance animals, and/or cannot afford their rent or home loan repayments. Several interactions, inconsistencies, contradictions, and gaps that warrant further attention were also revealed. This review has highlighted the need for policy makers to provide transparent information about housing entitlements for individuals with ABI or SCI, and their families. A unified, evidence-based framework to guide the funding of housing and housing support services may increase the consistency of interventions available to people with ABI or SCI and, therefore, improve outcomes.

findings will enable comparison of funded supports across the diverse schemes, and on a national scale, to inform future decision making in this area.

Method
A scoping review of available information was systematically conducted. The scoping review method is considered appropriate for addressing broad research questions and when assessment of study designs and quality may not be required [34]. In accordance with the methodological framework described by Arksey and O'Malley [34], five key steps were completed: (1) identify the research question/s; (2) identify relevant literature; (3) study selection; (4) chart the data; and (5) collate, summarize and report the results. Each step is described below.

Step One: Identify the Research Question/s
To address the review aim, the following research questions were proposed: 1.
What do the major Australian insurance schemes fund in relation to housing for a person with ABI or SCI? 2.
What individual factors impact on the availability of housing supports in each scheme (i.e., type of injury and level of severity; person's age; location; family contexts; existence of other mental or physical health conditions)?
For the purpose of this review, funding related to housing was broadly defined as funding that supported people to live as independently as possible in their home and participate in their community. This definition included funding for infrastructure (e.g., home modifications), tenancy (e.g., assistance with rent or mortgage repayments), and service delivery (e.g., attendant care; assistance with accessing and participating in the community) [3]. Funding for hospital or medical care, rehabilitation services, and vocational and educational support services (including travel to any such services) was beyond the scope of the current review. Funding related to living outside of Australia, financial assistance in the form of regular payments (e.g., income supplement), or historical compensation arrangements (e.g., superseded legislation) were also out of scope.

Step Two and Step Three: Identify Relevant Literature and Study Selection
The relevant Australian schemes were first identified and their websites were systematically searched for relevant information. Sources of information reviewed included: • Information detailed on scheme websites; • Online information sheets and resources produced by scheme authorities (e.g., fact sheets, policy statements, and scheme guidelines); • Scheme annual reports; • Case studies provided by each scheme; and • Relevant State and Commonwealth legislation referred to by schemes.
To provide an analysis of the existing funding context, and how national and interstate insurance schemes interact, only current information detailed on scheme websites and resources published after the introduction of the National Injury Insurance Scheme in 2016 (e.g., legislation; annual reports) were reviewed. No other limitations were applied to the searches.

Search Strategy
The search strategy and data extraction process employed in this study was "systematic, transparent and reproducible" [35]. Two researchers independently and systematically searched the scheme websites in June 2018 for relevant information. All sources of information were noted, and the details of relevant sources of information were recorded for further examination and data extraction (a record of resources reviewed is available at: https://research-storage.griffith.edu.au/owncloud/index.php/s/b58U Yegujruvsd5). Only information that addressed the research questions was included in the review. Any discrepancy between the two researchers was discussed with a third researcher to achieve consensus.

Step Four: Chart the Data
Data extraction was performed independently by two researchers. A standard data extraction form was used to provide consistency and structure to the data extraction process. Data extracted from relevant sources included: (a) scheme title; (b) the national or interstate focus of the scheme (and Australian State/Territory of relevance, if applicable); (c) citation details; (d) funded housing supports in relation to infrastructure, tenancy, and service delivery; and (e) influencing individual factors, as available. Any discrepancy between the two researchers was reconciled by mutual agreement with a third researcher.

2.5.
Step Five: Collate, Summarize and Report the Results A narrative synthesis was used to describe the data extracted from the relevant sources. The data was synthesized at the level of: (a) individual funding schemes; (b) collective national and State/Territory-based schemes; (c) housing funding contributions (e.g., infrastructure, tenancy, and service delivery supports); and (d) an overall summary. Quality appraisal of data sources was not relevant for this scoping review [34].

Results
This review identified 20 major insurance schemes across Australia that currently provide housing-related funding to people with ABI or SCI. This included four national schemes (i.e., the NDIS, Seacare, Comcare, and the Department of Veterans' Affairs [DVA] Compensation Scheme) and 16 State/Territory-based schemes inclusive of the NIIS and workers compensation schemes. CTP insurance schemes (where still occurring across Australia) were not included in this review since most individuals seriously injured in a motor vehicle accident (post-2016) will access housing or housing support through a lifetime care insurance scheme such as NIIS. Although CTP schemes (common law compensation payments) have historically included a component for housing modifications and care to live independently, they now predominantly focus on funding non-housing related supports for individuals with serious ABI or SCI (e.g., economic loss; expenses for treatment related to the person's injury; pain and suffering). Table 1 provides an overview of the funding contributions of the 20 relevant schemes in relation to three main categories of housing support (i.e., infrastructure, tenancy, and service delivery) following ABI or SCI. Particular infrastructure, tenancy, and service delivery supports that are funded (or not funded) by respective schemes, as well as demographic factors that may influence the availability of funding to individuals, are outlined following this summary. Scheme funding contributions toward housing supports did not differ between ABI and SCI conditions.

Housing Infrastructure Funding
In relation to housing infrastructure, funding across the 20 schemes related to seven subcategories. These subcategories included home modifications, new builds owned by individuals, homes purchased by individuals, consumables and equipment, vehicle modifications, and short-and long-term accommodation. Table 2 provides a summary of particular infrastructure supports funded (or not funded) by the schemes and highlights the differences between schemes based on publicly available information. Investment in housing infrastructure varied dramatically with a focus on supporting individuals to remain living in their current housing rather than move into another home that might better address the person's needs. For example, all 20 (100%) schemes funded home modifications (although the type and extent of modifications financed differed across schemes) whereas only three (15%) schemes contributed funding for new builds owned by individuals, one (5%) scheme supported the purchase of a new home owned by individuals, and six (30%) schemes provided funding in relation to other long-term housing options.     [41,73] None identified from publicly available information.
None identified from publicly available information.
Home purchases (owned by individuals)

(5%)
The person's main dwelling must be unable to be reasonably modified [45] and the unit must only include facilities specifically utilized by the person which cannot be accessed or modified within the main dwelling [80].
A reasonable amount toward the purchase cost of a semi-detachable portable unit [62] A contribution to, or payment of, the full purchase price of a main residence [51].
Not applicable.    Accommodation where the need is not due to the person's injury [39] In relation to short-term accommodation while modifications are completed, one (not all) schemes: • specified time restraints for the funding provided (e.g., short periods of up to 14 days at a time; a maximum of 6 months) [49,57] • will fund short-term accommodation only for the first home modification [39,57] In relation to short-term, transitional accommodation, one (not all) schemes: • specified time restraints for the funding provided (e.g., 18 months after first being discharged from hospital or respite care) [51]  Most schemes did not report elements relating to long-term accommodation that would not be funded (i.e., it is unknown whether funding caveats exist).
Only one scheme specified funding limitations. In relation to SDA: • Personal support costs (such as those provided through SIL) that are assessed and funded separately would not be funded [46,49] • Accommodation costs where these are not linked to a person's disability or where specialist accommodation with integrated supports is not required would not be funded [46,49] None identified from publicly available information. access to a client-centred model of support that promotes independence. In relation to supported residential services [127]: • a housing model that provides assistance with showering, personal hygiene, toileting, dressing, meals, and medication. Some supported residential services also provide nursing or allied health services.
In relation to shared supported accommodation (i.e., group home): • houses with paid carers that provide personal care, nursing rehabilitation, housekeeping, meal and laundry services. There may also be a sleepover facility for staff [128,129] [127,130] Note. Data obtained from publicly available information. Since the level of detail provided in each scheme's public documents and the extent of infrastructure supports funded by each scheme varied dramatically, the information presented in this Table reflects the most accurate representation possible. Additional differences in funding across the schemes may be identified if/when further details about funded infrastructure supports are provided by each scheme.

Tenancy Funding
In relation to tenancy, funding across the 20 schemes related to three subcategories that focused on supporting individuals to find, move into, and/or maintain occupancy of a private or rental home. These subcategories included rent assistance, support obtaining and/or maintaining a tenancy, and relocation costs. Table 3 provides an overview of tenancy-related support funded by respective schemes. Only one (5%) scheme reported the availability of funding for rent assistance, and six (30%) schemes reported the availability of support to move into another home. There was no mention of assistance with mortgage repayments for individuals who were injured after purchasing their home or people with ABI or SCI wanting to enter the property ownership market. There was a general lack of publicly available information regarding tenancy funding, which is likely problematic given the increased risk of individuals with ABI or SCI residing in unsuitable residential environments or housing that is not their preferred option [23], together with the potential for individuals to have low income following injury [29][30][31] and thus not be in a strong position to change their housing situation. None identified from publicly available information. Other costs associated with the end of a tenancy that are a condition of the lease (e.g., advertising costs associated with breaking a lease, steam cleaning of carpets or cleaning a property at the end of a tenancy) [56] Note. Data obtained from publicly available information. Given the limited detail provided in each scheme's public documents about funded tenancy supports, the information presented in this Table reflects the most accurate representation possible. Additional differences in funding across the schemes may be identified if/when further details about funded tenancy supports are provided by each scheme.

Service Delivery Funding
Service delivery funding across the 20 schemes related to six subcategories that focused on supporting individuals to live an ordinary life once established in their home. These subcategories included attendant (personal) care, household services, community access and participation, case management services, family supports, and assistance animals. Table 4 provides a summary of particular service delivery supports funded (or not funded) by the schemes and outlines the differences between schemes based on publicly available information. The majority of schemes provided funding for attendant (personal) care (n = 17; 85%) and household services (n = 17; 85%). Fewer schemes supported individuals to access and participate in their community (n = 11; 55%), increase the capacity and capability of informal supports such as the person's family (n = 11; 55%), and increase the person's independence through assistance animals (n = 4; 20%).   Household services can be provided on a short-term basis (e.g., while the person is recovering from surgery) or for a longer period to support the person's ongoing requirements [148] • Necessary and reasonable support services to assist an injured person with parenting or caring responsibilities to carry out their responsibilities [136] In relation to firewood provision: • Short-term assistance with firewood up to a specified maximum amount [  In relation to firewood provision and heating alternatives: • The cost of State Forest licences required to collect firewood or permits which the person did not hold before the accident [95,111] In relation to household services for children with injury: • services in place of ordinary parenting duties, or for age-appropriate services that parents ordinarily use (e.g., babysitters, nannies, childcare costs or out-of-school-hours care) [ In relation to transport:

Differences across Schemes (if Applicable)
In relation to community-based grants: • funding to organisations, groups, and private companies for activities and services that improve the health and wellbeing of people with disability [165] In relation to community awareness initiatives, funding may be available to: • Assist organisations to adjust to the specific needs of their member with an injury where that adjustment is not part of their universal obligations under reasonable adjustment [166] • Support organisations to increase their awareness of the needs and desires of people with disability, and explore strategies to assist them to address simple improvements that may be needed to their facilities to enable access and participation by people with disability [167] In relation to transport: [49,67,75,158,160,161,164,168] • Travel for the person with disability (not otherwise specified) • Supports that enable the person to build capacity to independently travel One scheme will fund advocacy support while at least one scheme does not [170,171]   • it can be demonstrated that respite will enhance the functioning of the family unit and enhance sustainability of the regular care or support routine [39] • respite services may be provided to someone who is a carer of an entitled person; an entitled person who is a carer; or a self-carer (otherwise not defined; for residential respite only) [110] In relation to specialist behavioral intervention support: • the person displays significantly harmful or persistent behaviours of concern [175] In relation to training: In relation to respite services: [39,67,82,91,110,122,129] Supports that are funded under the community services system, even if the system does not provide them.
Community services system includes: [175] • general family support and counselling, parenting skills programs, and family relationships services • all aspects of the statutory child protection system • arranging out of home care for children subject to child protection orders (including making these arrangements sustainable for children with disability) • guardianship arrangements for people under the age of 18 years In relation to people with injury who have caring responsibilities, childcare that: [147] In relation to respite services, only one scheme specified a limit (i.e., number of hours or days in a calendar year) that an eligible person may apply for respite [110] In relation to an injured child: • Some (not all) schemes will fund reasonable expenses of school holiday programs or childcare [39,56,127,136,138,144,147] In relation to people with injury who have caring responsibilities, only one scheme specified the following eligibility criteria to access childcare services: • the training will assist the person and their family to achieve greater independence and/or cohesion, and it represents a cost-effective option [136] In relation to people with injury who have caring responsibilities, to access childcare services: • the person cared for a child or children before their accident (or was pregnant at the time of their accident) and is now unable to care for them due to their injuries [51,147,176 In relation to specialist behavioral intervention support: [175] • highly specialized intensive support interventions to address significantly harmful or persistent behaviours of concern • the development of behaviour support plans that temporarily use restrictive practices, with intention to minimize use of these practices In relation to training: [136,175] • training for immediate family members or people who live with the person in matters related to caring for a person with disability (particularly when equipment, medical aids, or manual handling may be required) • training for carers and others in behaviour management strategies required due the person's disability In relation to people with injury who have caring responsibilities: • specialist assistance in the home (not defined) may be provided to strengthen the sustainability of informal supports [175] • is performed by family and friends (except for registered childcare) • is not related to the accident injuries • not done personally by the injured person before the accident (unless the person was pregnant at the time of their accident) • the person requires childcare services in order for them to receive or attend medical or rehabilitation treatment for their injury [51,176] • to access registered and in-home childcare services specifically, all other forms of childcare have been explored and deemed inappropriate and the family lives in a rural or remote location [51,176]  • reasonable costs of childcare services (i.e., funding for the amount of time that the person would have been providing care for the child or children but is now unable to do so due to the accident) [51,176,177] • when the parent is unable to access or secure a place in approved childcare, an Authority may pay for registered childcare such as a nanny or au pair [177] Assistance animals 4 (20%) Required as a result of accident injuries [178] Suitably trained Guide and Assistance Dogs for people with visual or hearing impairments. Funding may include the dog, harness, training, freight, accommodation during training, and veterinary costs when needed [136,179] • The use of an assistance animal to restrain a person outside of an approved behavioural support plan [180] • Feeding, grooming and general day-to-day maintenance costs of an animal [178,180] • Ongoing veterinary costs once the animal has retired from service [178] One scheme will not fund: • the purchase, transport, or upkeep of dogs to assist with the management of symptoms of mental health conditions such as PTSD, anxiety, or depression "until sound evidence exists" [181] • additional training (animals provided are expected to be fully trained) [178] Note. Data obtained from publicly available information. Since the level of detail provided in each scheme's public documents and the extent of service delivery supports funded by each scheme varied dramatically, the information presented in this Table reflects the most accurate representation possible. Additional differences in funding across the schemes may be identified if/when further details about funded service delivery supports are provided by each scheme. GP = General practitioner; PTSD = post-traumatic stress disorder.

Demographic Influencing Factors
Demographic factors that influenced the general provision of housing-related funding for Australians with ABI or SCI were identified using the publicly available eligibility criteria. These demographic factors included the person's age, gender, location, culture, degree of functioning, intrinsic characteristics, whether the person is in receipt of external compensation, and whether the person has a pre-existing medical condition or comorbidities. These influencing factors raise several challenges because unbiased and reliable assessment is so complex. Table 5 provides a summary of these influencing factors.

Age
The person's current age and age at the time of injury [137] For children with ABI or SCI [39,56,94,132,136]: • There is an expectation that parents will provide substantial care and support for children;

•
Funding may be provided if the child's care needs are due to their disability and substantially greater than those of other children of a similar age (note that scheme authorities will consider what is reasonable support for parents and other family or community members to provide in light of the support parents have to provide the child generally, even with disability); • The extent of any risks to the wellbeing of the child's family members or carer/s (how risks are defined and assessed not explained); and • Whether the funding or provision of the support for a family would improve the child's capacity or future capacity (i.e., independence), or would reduce any risk to the child's wellbeing (how independence and risks are defined and assessed not explained) For adults with ABI or SCI [76]:

•
The extent of any risks to the wellbeing of the person arising from the person's reliance on the support of family members, carers, informal networks and the community (how risks are defined and assessed not explained); • The suitability of family members, carers, informal networks and the community to provide the supports that the person requires (e.g., age and capacity of the person's family members and carers, including the extent to which family and community supports are available to sustain them in their caring role); • The intensity and type of support that is required and whether it is age appropriate for a particular family member or carer to be providing that care (how this is assessed not explained); • The extent of any risks to the long-term wellbeing of any of the family members or carers (e.g., a child should not be expected to provide care for their parents, siblings or other relatives or be required to limit their educational opportunities; other risks not defined); and • The extent to which informal (unpaid) supports contribute to or reduce a person's level of independence and other outcomes (how this is assessed not explained) Gender Whether supports provided are gender appropriate for a particular family member or carer to be providing that care [76] Locatio Price limits differed across Australian states/territories [49] Urban/regional/rural areas: • Price limits differed between urban and remote/very remote areas (to accommodate additional service delivery costs) [49,51,176] • Available wheelchair accessible public transport in the person's local area (e.g., buses, trains) or any public transport (e.g., limited in regional areas and often no public transport in rural areas) [137] Culture Recognition that a person's cultural background may influence their choices for supports [137], but no explanation of how schemes actually respond to different cultural needs

Degree of functioning
The person's diagnosis, progress of recovery, and prognosis [39,43,56,58 How these tasks are assessed were not explained.
Whether the person has reached maximum medical improvement [182]. How this is assessed was not explained.

Intrinsic characteristics
The person's attitude, motivation, perceived control in life, positive self-image, coping style, and adjustment to disability may influence their personal resources and thus influence their need for support [112,137] Whether the person is in receipt of external compensation If the person is in receipt of external compensation which is intended to be used to pay for supports of a kind which a scheme would ordinarily fund, the compensation is taken into account when determining the type of supports and amount of funding the relevant scheme will provide [38,76] Whether the person has a pre-existing medical condition or comorbidities
Note. Data obtained from publicly available information. Since the level of detail provided in each scheme's public documents and the extent of housing supports funded by each scheme varied dramatically, the information presented in this

Discussion
This scoping review aimed to synthesize the publicly available information about housing supports funded by the major Australian insurance schemes for people with ABI or SCI. Funded supports related to housing were compared across the diverse schemes, and between different Australian States and Territories, to produce an overall snapshot that would inform future decision making in this area. The extent of missing information across the schemes made it difficult to draw firm conclusions.
There were notable differences in available information across the different schemes. For example, the disability-related schemes (i.e., NDIS and NIIS schemes) generally provided more information about funded housing supports for people with an ABI or SCI than the workers compensation schemes. This finding is not surprising given the focus of disability-related schemes on supporting individuals to live ordinary lives compared to the particular focus of workers compensation schemes in assisting an injured person to return to work. The extent of missing information from the workers compensation schemes makes it difficult to confirm the range of housing supports likely to be funded by these schemes for people with an ABI or SCI. It is important to note that there is strong research evidence regarding the role of suitable housing and transportation systems in supporting return to work following an acquired injury; particularly since inadequate transportation has been identified as a significant barrier for return to work and individuals with ABI or SCI may participate in home-based employment [1,[183][184][185][186][187]. Since participation in work is considered an important indicator of social integration [186,187], and being employed is associated with increased self-esteem, socialization, physical activity (and therefore fewer medical treatments), adjustment to injury, life satisfaction, wellbeing and financial independence [186][187][188][189], an expanded focus on housing in all schemes might, therefore, be justified.
At a national level, the NDIS and all Victorian schemes provided more information about funded housing supports for people with an ABI or SCI compared to other national schemes (Seacare, Comcare, and the DVA scheme) and the remaining State and Territory schemes. It is important to note that the amount of information available does not correlate with the most comprehensive housing support. Rather, this finding suggests that people with ABI or SCI who are eligible for funding through the NDIS or Victorian schemes (and their families) may be more informed about their housing entitlements, and thus in a stronger position to advocate for appropriate housing supports.
There were also notable differences among the housing infrastructure, tenancy, and service delivery supports that were funded across the schemes. Funding was focused predominantly on housing infrastructure and service delivery, rather than tenancy support. For example, funding across the 20 schemes was consistently provided for home modifications (n = 20; 100%), consumables and equipment (n = 19; 95%), vehicle modifications (n = 18; 90%), attendant (personal) care (n = 17; 85%), and household services (n = 17; 85%). Less funding was provided for new builds (n = 3; 15%), home purchases (n = 1; 5%) and rent assistance (n = 1; 5%) with two, four, and seven schemes specifically stating that they would not fund these housing supports. However, it is important to note that these three supports had a high rate of missing information. That is, information was missing from more than 50% of schemes where the identified housing supports were not mentioned in any public documents, so it was not clear whether the respective schemes provided funding for these supports or not. Additional housing supports with high rates of missing information included short-term accommodation (information missing from 12 [60%] schemes), long-term accommodation (n = 14; 70% schemes), support obtaining and/or maintaining a tenancy (n = 14; 70% schemes), relocation costs (n = 14; 70% schemes), case management services (n = 16; 80% schemes), and assistance animals (n = 16; 80% schemes). Given the extent of this missing information across the 20 major insurance schemes, the nature of support for individuals with ABI or SCI to find short-or long-term accommodation, move into their new home, retain their home, and manage their community services and supports remains unclear.
Australians with ABI or SCI who are most likely to benefit from the existing schemes are those who reside in a home that can be modified and have access to attendant (personal) care, household services, and community access and participation support (although this does not guarantee that the modifications undertaken or support provided will meet all of the person's needs). People least likely to benefit from the current funding landscape are those whose home cannot be reasonably modified, are wanting to build or purchase a new home, do not have suitable, alternative shortor long-term housing options if their current home is not feasible, require support to maintain occupancy of their home or financial assistance to move into a new home, may benefit from case management services, family supports, and assistance animals, and/or cannot afford their rent or home loan repayments. These are concerning findings when considering the pre-existing personal factors (e.g., debts associated with higher education; potentially low amounts of savings) and post-injury personal factors (e.g., low income due to limited or no participation in work; high housing costs associated with disability) that are commonly experienced by people with ABI and SCI [29][30][31].

Implications
Several important implications emerged from this comparison across schemes, including the identification of interactions, inconsistencies, contradictions, and gaps. This review has highlighted several interactions that complicate the funding provided by schemes. For example, schemes will only provide funding for housing supports that are disability-related (e.g., the result of the person's accident). Funding will not be provided if the person's medical condition or comorbidities are pre-existing. How the connection between the person's medical condition or comorbidities and the person's accident is defined, determined, and judged by scheme authorities (i.e., what constitutes a medical condition or comorbidity; whether delayed onset is considered) was not explained within public documents. This ambiguity represents a major grey area within scheme funding guidelines. For instance, fitness declines rapidly for people with SCI [190] and chronic illness is experienced at a high rate in ABI and SCI populations, however onset might be delayed [191,192]. The absence of clear guidelines surrounding the person's medical condition and comorbidities places the person at risk of piecemeal, rather than holistic, support. Likewise, whether funding is provided for pre-existing conditions or comorbidities that are exacerbated as a result of the person's accident was not clarified. In addition, some schemes specified funding restraints that interact with external services (e.g., the provision of short-term accommodation for a specified time period while home modifications are completed). Whether the timeframes indicated are variable in response to external constraints (i.e., builders; building conditions; supply and demand) was not clear. Interactions within and across schemes, and also with external services and programs, differed across the schemes which can create discrepancies, confusion, and gaps.
The inconsistencies identified within and across schemes represent inequitable access to housing support. For example, some schemes fund partial or full costs for the provision of home exercise/gym equipment, climate control, and travel to recreational activities while other schemes do not fund these supports. How schemes decided supports like these are not disability-related, and therefore not funded, remains unclear. Deterioration following ABI and SCI can be reduced by exercise [193,194], complications caused by temperature regulation deficits within the ABI population can be minimized by climate control [195], and engagement in recreational activities following ABI and SCI can enhance the person's psychosocial wellbeing and improve quality of life after injury [196,197]. Inequitable access to housing supports such as these can lead to disparity of outcomes. Indeed, national schemes such as the NDIS were intended to remedy previous inconsistencies between schemes and jurisdictions. In particular for people with ABI and/or SCI, how individuals acquired their disability determined the level of compensation they received more than how severe the person's disability was. The NDIS was intended to supersede this previous funding context, and provide need-based support, but the process is ongoing and far from straight-forward.
Several contradictions within and across schemes were also identified. For example, repair and/or replacement of home modifications, equipment and vehicle modifications may be funded by schemes, however the cost of insurance for these supports may not be funded. This paradox is interesting given that insurance may reduce the cost of repair or replacement. Similarly, cosmetic and personalized fittings not deemed 'reasonable and necessary' (in relation to home modifications) are not funded by schemes, which contradicts the personalized and person-centered philosophy held by most schemes. How the boundary between personal preference and 'reasonable and necessary' is defined and enacted upon remains unclear. Additional contradictions within and across schemes may result in disincentives to improve one's situation. For instance, assistance animals are highly trained disability support services that enable people with disabilities to safely and independently participate in daily activities [198]. Investment in assistance animals may replace the need for a funded support worker, however only four (20%) schemes provided funding for this support according to public documents. An expectation of at least one of these four schemes is that the assistance animal is fully trained, and so additional training is not funded. However, specific training is likely needed to suit the home and needs of the person, highlighting further contradictions by the schemes. This review has also revealed a number of gaps that warrant further attention. These gaps may be characterized by a lack of a preventative approach (e.g., housing supports that promote ongoing rehabilitation or reduce decline or deterioration over time, such as swimming pools, hydrotherapy pools, spas, gym memberships and home modifications to support the natural ageing process of an individual, are not funded), and little recognition of broader social determinants of health [1] and health promotion [199] as an integral component of lifestyle (e.g., hobbies or personal lifestyle interests and housing supports that enable people to increase control over, and improve their health, such as case management services that assist the person to make informed decisions and exercise choice and control, are not funded by the majority of schemes). Systemic gaps were also identified. For example, many and various housing supports that were identified as being the responsibility of other departments and systems and thus not funded by the respective schemes (e.g., specific equipment; school teacher aides; hospital and GP visits; transport infrastructure including road and footpath infrastructure; homelessness prevention and outreach; access to temporary and long-term housing for people who are homeless or at risk of homelessness) may contribute to people with ABI and SCI 'falling through the cracks'. This review has also highlighted a lack of recognition of change over time. Funding for some housing supports (e.g., further modifications to the same vehicle) may only be provided where there are 'unforeseen and significant changes to the person's needs'. However, how 'unforeseen' and 'significant' is defined was not described in any public documents, and whether deterioration or ageing are considered 'unforeseen' remains unclear. Additional complex concepts specified within scheme public documents with no clear understanding of how these concepts are assessed and acted upon include 'age appropriate', 'no clear benefit', and 'maximum medical improvement'. This ambiguity may lead to funding decisions that are based on subjective judgements which could be potentially biased, stereotyped and not well-assessed at any one point in time.

Implications for Consumers and Policy Makers
The interactions, inconsistencies, contradictions, and gaps revealed by this review highlight several opportunities for consumers and policy makers. Individuals with ABI or SCI, and their families, may use this information to inquire about particular housing supports they may need to live as independently as possible at home and participate in the community, and that have not been mentioned in their respective scheme guidelines, fact sheets, or other public documents. The findings of this review may therefore empower individuals and their families to pursue information about housing supports they may be entitled to, in order to improve their housing situation. For policy makers, this review has highlighted equality issues that must be considered and acted upon, particularly if individuals with ABI or SCI are unable to access the housing support they require from other government or non-government schemes. In addition, the identification of missing information across the schemes by this review represents an opportunity for all schemes to provide transparent information about housing entitlements for individuals with an ABI or SCI, and their families. The development and communication of a unified, evidence-based framework for housing support that is tailored to ABI and SCI, and incorporates a lifelong rehabilitation approach that recognizes broader social determinants of health [1] and health promotion [199] as an integral component of lifestyle, may inform future decision making in this area. There is now adequate evidence to refute the notion of a recovery plateau following ABI and SCI, and thus great hope for long-term neurological recovery [200][201][202][203][204][205]. Such an approach would likely improve housing outcomes for consumers. Lastly, people with ABI and/or SCI are considered to be among the most supported people with disability in Australia due to their often high level of support need, and so the nature of housing support provided, and information available, for the many other disability types ought to be explored.

Limitations and Future Research Directions
The findings of this review must be interpreted in context of its limitations. First, the review findings reflected information made publicly available through each scheme's official website. This included the availability of the resources themselves, as well as the breadth and depth of information provided in each resource. The potential of missing information was identified in relation to several schemes, meaning that the findings reflected only the available data. Despite this limitation, Arksey and O'Malley [34] argued that scoping reviews are often broad in scope and can identify gaps in knowledge requiring further examination. The findings of this scoping review can, therefore, inform subsequent investigations, including examination of: (a) actual housing funding across the schemes in comparison to policy; (b) decision-making processes that translate policy into housing provision and service delivery; and (c) the impact, utility and benefit of funded housing supports for individuals with ABI or SCI to inform future policy. The knowledge generated through this research could inform future, evidence-based decision making in this area.

Conclusions
This scoping review evaluated the publicly available information about housing supports funded by major Australian insurance schemes for people with an ABI or SCI. The 20 schemes included in this review were four national schemes (i.e., the NDIS, Seacare, Comcare, and DVA Compensation Scheme) and 16 State/Territory-based schemes inclusive of the NIIS and workers compensation schemes. This research highlighted distinct differences between the 20 schemes in terms of the level of detail available in their public documents, the extent and type of housing support each scheme would fund, and the demographic factors that influenced the availability of particular housing supports.
The interactions, inconsistencies, contradictions, and gaps revealed by this review highlight several opportunities for consumers and policy makers. There is a need for transparent information about housing entitlements for individuals with an ABI or SCI, and their families. There is also a need for policy makers to investigate ways in which different elements of their schemes interact with or contradict other elements or with other schemes, creating disincentives, discrepancies or gaps. The development and communication of a unified, evidence-based framework for housing support that is tailored to ABI and SCI may improve housing outcomes for consumers.
Author Contributions: C.J.W. led this body of work. J.C. and K.K. collected the data. C.J.W. synthesized the data with assistance from J.C., K.K., and E.K. C.J.W., J.C., and K.K. prepared the manuscript with revisions from E.K.
Funding: This work was supported by the Motor Accident Insurance Commission (MAIC) in Queensland and instigated by the National Injury Insurance Scheme Queensland Agency (NIISQ-A). MAIC and NIISQ-A have had no involvement in the conduct of this research or the writing of this article.

Conflicts of Interest:
There is no actual or potential conflict of interest that could inappropriately influence, or be perceived to influence, this work.

National Schemes
At a national level, the National Disability Insurance Scheme (NDIS), administered by the National Disability Insurance Agency (NDIA), provides lifetime support for eligible Australian residents under the age of 65 years with permanent disabilities, their families and their carers.
Several national workers compensation schemes also exist. Seacare, which is overseen by the Seafarers Safety, Rehabilitation and Compensation Authority, provides workers compensation to seafaring employees and appropriate third parties. Comcare is a no-fault workers compensation scheme that provides a range of payments and supports to eligible employees of the Commonwealth Government agencies and statutory authorities, the ACT government and corporations or authorities who have been granted a licence to self-insure. Current or former members of the Australian Defence Force with injuries caused by their military service may also be eligible for compensation under the Military Rehabilitation and Compensation Act 2004, including income payment for periods in which they are unable to work, payments for medical treatments and rehabilitation, and permanent impairment compensation.

Queensland
In Queensland, people who sustain a serious injury in a motor vehicle accident may be eligible to receive necessary and reasonable lifetime treatment, care and support under the National Injury Insurance Scheme Queensland (NIISQ), which is implemented by the National Injury Insurance Agency Queensland. This no-fault scheme complements the existing Compulsory Third Party (CTP) scheme, providing support to people who may not have been eligible for support previously under the fault-based CTP scheme. People who sustain a serious injury resulting from a motor vehicle accident who are eligible to make a claim through the CTP scheme may receive compensation for general damages such as pain and suffering or economic loss, in addition to lifetime treatment, care and support through the NIISQ. The Queensland workers compensation scheme, WorkCover Queensland, will also engage the National Injury Insurance Agency Queensland to manage the treatment and support of eligible people who sustain serious injuries resulting from a workplace accident.

New South Wales
In New South Wales, the Lifetime Care and Support Authority (part of icare) is responsible for administering the no-fault Lifetime Care and Support Scheme, which funds treatment, rehabilitation and care for people who have sustained a severe injury as a result of a motor vehicle accident or workplace accident in New South Wales. Under the CTP scheme, people may be eligible for income and medical benefits regardless of fault, and people with serious injuries may also be eligible to claim compensation for economic or non-economic loss if they are able to prove that someone else was responsible for the accident that caused their injury. icare also provides workers insurance, and those who sustain severe injuries in the workplace may be eligible to receive payments through the icare Workers Care program.

Australian Capital Territory (ACT)
In the ACT, people who sustain a catastrophic injury as a result of a motor vehicle accident or workplace accident may be eligible for the ACT Lifetime Care and Support Scheme. This is a no-fault insurance scheme that provides eligible participants with long-term care and support. People seriously injured from a workplace accident may also be eligible for workers compensation for economic or non-economic loss, not including future medical expenses or support, which would be covered by the Lifetime Care and Support Scheme. Similarly, individuals injured in a motor vehicle accident and able to provide evidence that another person was at fault may be able to make a CTP claim for compensation for economic loss (e.g., lost wages) and non-economic loss (e.g., pain and suffering).

Victoria
In Victoria, the Transport Accident Commission is responsible for the no-fault Transport Accident Compensation Scheme, which covers long-term services and supports for people who have sustained serious injuries. Through the workers compensation scheme, WorkSafe Victoria, people who are seriously injured in workplace accidents may be eligible to receive payments for lost wages and superannuation, expenses for treatment related to their injury, permanent impairment benefits and may be able to claim for damages from their employer.

Tasmania
In Tasmania, people who have been seriously injured in a motor vehicle accident may be eligible to receive treatment and support, including long-term care, through the no-fault Motor Accident Insurance Scheme administered by the Motor Accidents Insurance Board. Through WorkSafe Tasmania, people who are seriously injured in a workplace accident (regardless of fault) may be entitled to receive weekly payments while unable to work, compensation for necessary and reasonable medical, rehabilitation and other expenses related to their injury, lump sum compensation for permanent impairment, and depending on fault may seek common law damages.

Northern Territory
In the Northern Territory, the Motor Accidents Compensation Scheme is a no-fault insurance scheme that provides a range of treatment and support for eligible people injured in motor vehicle accidents. People who are injured in a workplace accident may be entitled to compensation for weekly payments while unable to work, reasonable hospital, medical and rehabilitation treatment, and payments for permanent impairments.

South Australia
South Australia's no-fault Lifetime Support Scheme, administered by Lifetime Support Authority, provides treatment, care and support across the lifetime to individuals who sustain serious injuries as a result of a motor vehicle accident. Adults injured in a motor vehicle accident may be eligible for compensation through the CTP scheme if they are able to prove that their injuries are the fault of another driver. For people who are under the age of 16 when the injury occurs, compensation is available through the CTP scheme for treatment, care and support regardless of fault. ReturntoWork SA manages workers compensation claims in South Australia, providing income support and lifetime care and support for people who are seriously injured in a work accident.

Western Australia
In Western Australia, the Insurance Commission of Western Australia manages both the Catastrophic Injuries Support Scheme and the CTP scheme, which both provide lifetime care and support to eligible people who are injured in a motor vehicle accident. However, the CTP scheme is fault-based, so only people who can prove the fault of another driver are eligible for support through this scheme. Individuals must be unable to claim in the CTP scheme to be considered eligible for the Catastrophic Injuries Support Scheme. Compensation for economic or non-economic loss may also be claimed through the CTP scheme. Those seriously injured at work may be eligible for workers compensation through WorkCover WA, including compensation for loss of wages, reasonable medical, allied health treatment and workplace rehabilitation expenses, and some travel expenses related to the injury treatment.