BPA

BPA stands for user-controlled personal assistance and is an equality tool for people with functional variations. BPA is a fantastic service for both children, young people and adults. There is no lower age limit and no diagnosis requirements either - it is the need for help that is decisive.

BPA was established as a right in 2015. Entitlement means that everyone who needs and qualifies for BPA is entitled to it.

Who is entitled to BPA?

A prerequisite for having the right to BPA is that the child has a claim to the necessary health and care services from the municipality. There is also a need for an adult, usually a parent or someone else in the child's network, to act as supervisor for the scheme.

• The need for help must be at least 32 hours per week.
• Help needs of between 25 and 32 hours per week will also be entitled to BPA, unless the municipality can document that such organization will be significantly more costly.
• You must have a need for more than 2 years, and be under 67 at the time of application.
  

What can you get organized as BPA?

• Personal assistance
• Practical assistance and training
• Support contact
• Relief
• Continuous night watch
• Simple healthcare

In practice, this means that you can apply for BPA lessons for assistance needs beyond the needs of other children of the same age without functional variations. If there is a need for continuous assistance during the night, e.g. where a child needs to be looked after during sleep and there is a continuous need, i.e. it cannot be remedied with point-by-point services, then you can also apply to have this organized as BPA.

Health services are not covered by the right. Although healthcare services cannot be required to be organized as BPA, it will often be appropriate, and in accordance with the intention of the scheme, for the municipality to include healthcare services in the BPA scheme if this is justifiable and the family wishes it.

You can read two examples of getting health care included in BPA here.

The right to BPA also includes relief for parents with children under the age of 18 living at home. Read more about relief here.

If the total number of hours for all the services the child receives and/or needs exceeds 25-32 hours a week on average, then the child has the right to have those services organized as BPA. Examples of such services can be support contact, organized free time services, free time contact, respite care, home care, care allowance and other assistance. It is also possible to have BPA even if you have e.g. home care next door. What is important is that the right to BPA comes into force when the services' total hours exceed 25-32 hours a week. This means that the hours you continue to have organized outside BPA must also be included.

What if you do not meet the requirement of 25 hours a week?

There is nothing to prevent the municipality from granting BPA even if the number of hours is less than the requirement of 25-32 hours. 

Due to the fact that it is not rights-based, it can be difficult to get BPA granted when the number of hours is lower than the official requirement of 25-32 hours. It can also be difficult to get the municipality to grant enough hours so that it exceeds the requirement. Many municipalities often point out that practical assistance is a parental responsibility and not a municipal responsibility, so it becomes important to justify the scope and show the difference from a family without children with a variety of functions. 

You can read an example of a BPA arrangement with a lower number of hours here.

Parents of children with a long-term and increased need for assistance should apply for BPA, despite a number of hours under 25, because:

• BPA creates more predictability and freedom for the whole family.
• The child has fewer carers to deal with.
• Parents themselves choose who will be employed and thus who fits best with the child.

How to apply for BPA

BPA must be applied for at your municipality.
If you have coordinator, you can ask if the coordinator can help with the application. The social worker at the hospital/habilitation can also be asked.

You can either apply electronically or find an application form that you can print out on the municipality's website. If it is difficult to find or to know how to do it, you should contact the municipality. The department that deals with such applications is often called the service and coordination office, the child and family service, ordering office, administrative office, application office or allocation office (Dear child has many names!), but it is also possible to call the switchboard to be forwarded to the right place.

Documentation you must include in the application is a doctor's certificate from the child's doctor in the specialist health service or another responsible doctor, and possibly certificates from relevant agencies/professionals around the child.

It is recommended to attach a descriptive day clock (day wheel). Download examples of how to write a circadian clock below. We have also attached an empty template that you can use to fill in.

It may also be a good idea to illustrate the hours that are needed by "dividing them up" categorically. Below you can download a template for calculating hours, which you can attach to your application.

This template gives the municipality a simple and realistic picture of the need. The template is made in addition to the 24-hour clock and application. The needs must therefore be described in more detail in the 24-hour clock and application, while the template is used for short and concrete examples.

This is a template if you already have a decision on BPA (or other services):

This is a template for first-time applicants:

Below is an example of completing the template:

Worth remembering

• BPA is a right, not something the municipality can opt out of.
• Try to include good examples and descriptions of situations where BPA would have been useful.
• A "golden rule" for the assessment of health care in BPA is that if parents can perform the health care after training from health personnel, then BPA assistants can also do this.
• The municipality is allowed to take its own share for the part of the BPA decision that is given as "practical assistance". The municipality is still not allowed to demand a deductible for relief. This means that if BPA is given as relief to parents, they cannot claim a deductible even if the tasks involve practical assistance. If you as a family need help for practical assistance (e.g. cleaning) as a relief measure, the municipality will not take an out-of-pocket share for this.
• When people over 18 who still live in the same house as their parents receive practical assistance, the deductible must only be calculated based on the income of the person receiving the assistance. Parents' or siblings' income shall not be included. 

In the process, you may come across statements from the municipality such as:

"It will be far too tiring for you to be a supervisor" 

"BPA is not for children" 

"What you need is something else"

"We do not find it appropriate to organize relief as BPA"

"Have you forgotten that you have a duty of care?"

"Your child can get after-school care"

Unfortunately, these are well-known statements from municipal authorities. This may be due to a lack of knowledge or bad attitudes, a lack of competence in BPA and legislation, the municipality's own interpretation of guidelines, misunderstandings about the parents' duty of care and the municipality's finances, etc.

Granted BPA, partially granted or refusal

Granted BPA means that you have received a decision on what you applied for. You are either entitled to the service from a date back in time, or from the day you receive the decision. 

Partially granted means that you have had parts of your application granted (e.g. you have applied for 40 hours of BPA per week, but the municipality believes that your child only needs 25 hours of BPA per week).

Refusal means that you have been refused the entire application.

We strongly recommend always complaining! Preferably with counterarguments and even more explanatory text about the child's needs. If you do not have a surplus, you can only complain about the decision itself and refer to the information in the application. If the municipality sticks to its decision, the appeal proceeds to The State Administrator. 

The municipality is obliged to give you a written decision (decision), whether you are granted, partially granted or refused BPA. The decision must be justified and must contain information about access to appeal: how to appeal, who handles the appeal, where the appeal must be sent and appeal options in the event of a new refusal (cf. the Administration Act). See our tips for writing a complaint here.

BPA suppliers

There are many BPA suppliers to choose from, and we have made a small list of advice for you that you can use as a starting point when choosing the right supplier for you. Read our advice here.
The municipalities have an overview of which companies supply BPA in their municipality.

In some municipalities it is not possible to choose anyone other than the municipality itself as supplier or only between a few suppliers (it must also be specified that even if the municipalities themselves organize BPA, the same rules and laws apply to them). 

The supervisor role

When there is a decision on BPA, the municipality allocates the number of hours and parents are usually supervisors for the scheme. This means that you yourself, often in collaboration with a BPA supplier, advertise positions, carry out interviews and select who is suitable to work with the child. It is one of the many advantages of BPA, namely being able to choose who will work for you.

It is important that the announcement is inviting and that the applicants get to know who the child is, what the child likes to do and some of the work tasks that are required for the child to have as independent a life as possible. It is common for the supplier to create the announcement so that it looks professional, but with the help of parents.
When you are ready to call in for an interview, it may be a good idea to sort the candidates, and preferably make a phone call to those who seem relevant in advance. It may be that you already realize on the phone that it will not be a "good match". At the interview, you can either appear together with the supplier, have it alone or have it together with an assistant from the BPA scheme. It is a good idea to have an "interview template" to follow. The supplier must have this available for you, but it is recommended that the template is designed for each individual and includes important questions for your child/family situation. You can choose to have many interviews in one day or spread it over several days. 

The supervisor sets up a duty schedule based on when the family needs the child to have BPA. The hours are granted as annual hours, which means that the hours can be allocated as needed within the year. In other words, you can have a lot of BPA in periods and less in others if you wish. 

In order to have a stable team around the child, it is important that as a supervisor you emphasize that the assistants should feel good about their work. You can get good follow-up from the BPA supplier you choose.

Legislation and guidelines

The Patient and User Rights Act

§ 2-1 d. Right to user-directed personal assistance 

"Persons under the age of 67 with a long-term and great need for personal assistance according to the Health and Care Services Act section 3-2 first paragraph no. 6 letter b have the right to have such services organized as user-directed personal assistance. The court includes relief measures according to the Health and Care Services Act § 3-6 first paragraph no. 2 for persons with parental responsibility for children under 18 living at home with reduced functional capacity. Health services in relief measures are not covered. The right also covers people over the age of 67 who, before reaching the age of 67, have been granted user-controlled personal assistance after the first sentence.

The right does not include services that require more than one service provider to be present or night services, unless the user has a continuous need for such services.

Long-term need in the first paragraph means need beyond 2 years.

High need in the first paragraph means a service need of at least 32 hours per week. Users with a service requirement of at least 25 hours per week still have the right to have services organized as user-directed personal assistance, unless the municipality can document that such organization will entail significantly increased costs for the municipality."

The Health and Care Services Act

§ 3-8. User-controlled personal assistance

"The municipality must offer personal assistance according to section 3-2 first paragraph no. 6 letter b, in the form of practical assistance and training, organized as user-directed personal assistance."

Circular about BPA

The Norwegian Directorate of Health's training manual on BPA