Advice Support Tool
FOI 23/24-1328
Theme: Continence Sub-Theme(s):
References: [include any relevant referenced documents]
NDIS Act 2013 Section 34 1. (a) - (f) and 2. NDIS Support for Participant Rules 2013 SOP _DisabilityRelatedHealthSupports.docx Continence Supports | NDIS
Continence Assessment
DOCUMENT 8
Note: All criteria need to be met for the supports to be funded through the NDIS.
| Criteria for reasonable and necessary supports | Is criteria met? | Considerations (including evidence used) |
|---|---|---|
| 34.1(a) Enabling the participant’s goals and objectives (supports will assist the participant to pursue the goals and objectives in their plan) | & Yes O No | The participant may not have a specific goal regarding incontinence, however, consider how the management of urinary and faecal incontinence may underpin and assist the participant to pursue their stated goals. For example, goals around increased independence and community access may be achieved if provision of appropriate continence consumables and formal support are provided to ensure appropriate management and containment resulting in maintaining health, wellbeing and dignity. |
| 34.1(b) Assist the participant’s social and economic participation (supports will assist the participant to undertake activities to facilitate their social and economic participation ) | & Yes O No | Continence management will result in appropriate and socially acceptable strategies in place to ensure that the participant’s urinary and fecal incontinence is appropriately managed, and their dignity preserved. This in turn increases the participant’s opportunities to be included and to participate in social and economic opportunities. This may include the provision of continence consumables and formal supports if the participant is unable to independently manage their incontinence. |
| 34.1(c) Value for money (supports represents value for money, ie the costs of support are reasonable, both in | & Yes | Has there been a Continence Assessment by an independent or hospital-based Continence Specialist |
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of alternative support)
Consider NDIS Support for Participant Rules 2013 Part 3.1 (a) - (f);
Are there any expected changes to the participant’s circumstances in the next 1-2 years that may make it inappropriate to fund the requested equipment or modifications?
If yes, have comparative costs of purchasing or hiring the equipment or modifications been provided?
Are there comparable support options which would achieve the same outcome at a substantially lower cost? What alternative supports were considered?
Is there evidence that the support will substantially improve the life stage outcomes and be of long-term benefit to the participant?
Is there evidence that funding support is likely to increase independence and reduce funded support costs in the long-term?
Is there evidence the support will increase the participant’s independence and reduce the participant’s need for other kinds of supports?
Consider the primary purpose of support and if any additional or non-standard features have direct functional outcomes that will reduce funded support needs.
Is there evidence the quoted support cost is comparable to expected cost of same kind of supports? Consider NDIA benchmark pricing guide and PANDA tool.
Criteria for reasonable and necessary Is criteria Considerations (including evidence supports met?
| terms of the benefits achieved and the cost | O No ——> | nurse? NOTE a product recommendation from a nurse employed by the manufacturer of continence consumables is not a continence assessment.
Has the participant been using the suggested continence consumables for some time and the request is to continue with these consumables? If yes, then typically we should consider that the consumables meet the needs of the participant.
Has the assessor considered any likely changes i.e., are the individual needs stable? Participant’s continence consumable needs may change over time and though many participants use the same consumables for many years it must not always be assumed that they remain the most effective and beneficial or best value for money.
Have comparable continence consumables been explored and reasons outlined why they could not achieve the same outcome at a substantially lower cost? All consumables should be clinically indicated by the functional need this may include higher cost consumables such as hydrophilic catheters for Clean Intermittent Self-Catheterisation (CISC).
Does the continence consumable reduce the reliance on formal and informal support? For example, this may influence the type of continence pad suggested or a request for waterproof linen which only requires a wipe over rather than full wash when contaminated.
For newly suggested consumables — has a trial been completed? If so, what was the trial result? Or is the request to fund a trial? This is particularly important for higher cost consumables such as Transanal Irrigation (TAI) — typically the TIA may be effective but is not always tolerated by the participant, so a trial
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| Criteria for reasonable and necessary supports | Is criteria met? | Considerations (including evidence used) |
|---|
is necessary before funding a full years’ worth of consumables.
Is the suggested consumable required due to the participants functional impact? E.g., is a more expensive catheter required due to the participant’s anatomical requirements, or their reduced dexterity or are bariatric sized pads required due to obesity? Less standard consumables are typically more expensive but may be reasonable and necessary to fund due to participant individual need.
In some circumstances lower cost consumable alternatives may achieve the same outcome. For assistance with considering if an item is value for money please refer to Continence Consumables NIB743 11.08.2023.docx — consider pricing of the same consumables from a different service provider. Consumables can be bought from different shops/providers.
If the participant is unable to manage their incontinence independently, they may rely on informal/formal support. The level of Core DA support provided is typically included within the provision of personal care however, consideration must be given to providing support throughout the day/night, at home and in the community to ensure appropriate level of incontinence management, skin integrity maintenance and participant dignity.
34.1(d) Support is effective or beneficial for the participant
(supports will be, or are likely to be, effective for desired effect and beneficial for the participant, having regard to current good practice)
Consider NDIS Support for Participant Rules 2013 Part 3.2 and 3.3
What are the expected benefits of the support provision?
✓ Yes | O No —
Has the participant been using the suggested consumables for some time? Or has a trial been completed? Or is the request to fund a trial of high-cost consumables? For example, Transanal Irrigation (TIA). This evidence will outline that the suggested consumables provide appropriate containment or management of urine and faecal matter without leaks and that a pad has the appropriate capacity.
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Criteria for reasonable and necessary supports
| Criteria | Is criteria met? | Considerations (including evidence used) |
|---|---|---|
| How will effectiveness of achieved outcome be measured? | For skin integrity consumables — the aim is to clean the skin, protect the skin from damage and restore skin to its natural balance. Has the participant been using the suggested consumables for some time? Or has there been a trial completed? This will demonstrate that skin integrity has been maintained and the incidence/risk of Incontinence Associated Dermatitis (IAD) has been reduced. If skin integrity issues are present how are the requested consumables going to be effective and beneficial in lowering the risk? And how will this be measured i.e., is a wound assessment by a Wound Specialist nurse required to complement the continence consumables request? It is important to consider multiple requests for skin care consumables as they may provide a duplication of support. Typically, we only want one product each to clean, protect and restore. | |
| When will effectiveness of achieved outcome be achieved? | ||
| Are there other supports required to achieve or maximise the reported support outcomes for participant? |
Are the continence consumables compatible with the environment where they will be used? E.g., it would be reasonable and necessary to include some hand sanitizing gel for a participant managing incontinence while accessing community as there may not be access to hand cleaning facilities.
If the participant is unable to manage their incontinence independently, they may require informal/formal supports to assist with toileting, personal care including catheterization/complex bowel care and skin care to manage the risk of integrity issues.
34.1(e) Support coordinates with but does not replace informal support
(funding or provision of supports takes account of what it is reasonable to expect families, carers, informal networks and the community to provide)
Consider NDIS Support for Participant Rules 2013 Part 3.4
Typically, if a child requires support to manage their incontinence this would remain a parental responsibility. However, as the child gets older it may not be socially or culturally acceptable for the parent to be providing such support e.g., a single male parent providing continence support to a 12yo
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Criteria for reasonable and necessary supports
| Criteria | Is criteria met? | Considerations (including evidence used) |
|---|---|---|
| 34.1(f) Support is most appropriately funded by the NDIS (supports are not more appropriately funded or provided through other general service systems or universal service obligations Consider NDIS Support for Participant Rules 2013 Schedule 1.) | XX Yes / O No | If the participant is an inpatient (hospital) it is deemed the responsibility of the health system to provide continence products during the hospital stay. Discharge planning may request continence consumables be funded for use in the community. Evidence will be provided by the hospital nursing/Continence Specialist. If the incontinence is new, trials may have been undertaken during the hospital stay and training will have been provided. Incontinence must be directly linked to the disability otherwise the health system will provide continence consumables for use upon discharge into the community. |
Is the requested consumable a treatment which is not funded by NDIS? E.g., laxatives, enemas? These may be available on the PBS, or the participant may need to purchase them privately.
As per Continence Supports | NDIS, typically if a child has incontinence issues NDIS may fund consumables after age 5yo however in rare situations NDIS may fund continence supports for children younger than 5yo for disability related medical conditions.
Where the participant resides in an Aged Care Facility the Aged Care Quality of Care Principles (2014 legislation - Quality of Care Principles 2014 (legislation.gov.au)) Part 2 Care and services — to be provided for all care recipients who need them, 2.1 (b) includes the provision of managing incontinence.
Free stoma appliances and products are provided by Stoma Appliance Scheme (health) Stoma Appliance Scheme | Australian Government Department of Health and Aged Care
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Criteria for reasonable and necessary supports
| Is criteria met? | Considerations (including evidence used) |
|---|---|
| X Yes | Support will not cause harm (Supports will not be funded if it is likely to cause harm to the participant or pose a risk to others, or the support would be contrary to a law of a jurisdiction). Consider NDIS Support for Participant Rules 2013 Part 5.1 and 5.3 |
| O No -> | Once a trial has been undertaken any risks will have been identified and alternative supports suggested. With any invasive procedure there is a level of acceptable risk of harm such as a much higher risk of anatomical damage or infection with catheter insertion or skin integrity issues including IAD due to the exposure of skin to acid in urine and faeces — therefore the aim is to minimize the risk of harm as it will never be completely excluded. |
Support is directly related to the participant’s disability
(supports will not be funded under the NDIS if they do not relate to the participant’s disability or are day-to-day expenses or income replacement)
Consider NDIS Support for Participant Rules 2013 Part 5.1 and 5.2
| & Yes | Have the continence consumables been recommended to address the functional impacts (incontinence) associated with disability for which the participant has gained access to the scheme? — check Disability tab in CRM. For example, 64yo participant meets access for anxiety and PTSD and they are diagnosed with stress and urge incontinence — this is not likely to satisfy this criterion. Incontinence is not a typical functional impact of psychosocial disabilities and stress/urge incontinence is common in the aging population. | | O No | |
Support does not duplicate other supports
| & Yes | This section refers to the support being duplicated under other funded sources from NDIS — it is not. |
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Criteria for Reasonable and Necessary Supports
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| Criteria for reasonable and necessary supports | Is criteria met? | Considerations (including evidence used) |
|---|---|---|
| (supports do not duplicate other supports delivered under alternative funding through the NDIS such as Information, Linkages and Capacity Building (ILC) funding.) | ⬜ No → | referring to other mainstream services. |
Consider NDIS Support for Participant Rules Part 5.1
Are all of the above criteria met for all supports?
☑ Yes ?
⬜ No →
Version Control
| Version# | Status | Date | Modified by | Brief Description of Modification |
|---|---|---|---|---|
| V1.0 | Cleared | 29/08/2023 | NIB743 | Production of initial V1.0 |
| V1.0 | Cleared | 05/09/2023 | JIF775 | Transferred to Key Advisor Advice Resources repository |
Note: Document uncontrolled in hard copy
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