NDIA Accountability Project

Impact of NDIS transition on assistive technology provision for people with spinal cord damage

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Assistive Technology Submission

Submission due 14th September 2018

Response for Spinal Life Australia - Allied Health Team

Address : 109 Logan Road Woolloongabba 4102 Ph: 3391 2044

Summary

Spinal Life Australia is Queensland’ s leading provider of advocacy, therapy and supports for people with spinal cord damage. For over 50 years, our organisation has focussed on assisting people with spinal cord damage to rebuild their lives and regain their independence after sustaining this permanent disability.

With offices in Brisbane, Cairns, Townsville Rockhampton, Bundaberg, Toowoomba and now in Perth, Western Australia, our Allied Health Services team whose qualifications include Occupational Therapy, Physiotherapy, and Registered Nurse provide services in the core areas of:

  • access to expertise and funding including assistance with applications for government concession and subsidy schemes to buy and modify private vehicles, prescribe aids and equipment, and help with modifications in the workplace;
  • specialist personal advice and assessment including bowel, bladder and pressure advice and management, home modification assessments and designs, workplace assessment and driving assessments;
  • mobility, seating, and equipment solutions including seating and postural assessments, trial and prescription of aids, disability specific technology and equipment that improves independence and lifestyle in areas such as mobility pressure care, continence, personal care, transfers and environmental controls, and hand splinting.

Spinal Life’s therapists has been involved and had experience with Assistive Technology and NDIS since January 2017 across, Toowoomba, Ipswich and now Greater Brisbane. Prior to that Townsville colleagues within the service have been working as a provider in the NDIS from July 2016.

Reason for Submission

As part of the committee’s role to inquire into the implementation, performance and governance of the National Disability Insurance Scheme (NDIS), the committee will inquire into and report on the provision of assistive technology with reference to

a. The transition to the NDIS and how this has impacted on speed of equipment provision; b. Whether the estimated demand for equipment to be sourced through the assistive technology process in each roll out area was accurate; c. Whether market based issues impact the accessibility, timeliness, diversity and availability of assistive technology;

Response to Submission

a. The transition to the NDIS and how this has impacted on speed of equipment provision;

Significant delays in equipment provision

  • First to get a plan; waiting for plan meeting and waiting for provision of plan.
  • On boarding, assessment and prescription at service level at SLA can take between 2 weeks to 2 months, but the process of approval takes a further 3 to 12 months. There is then time to order/ delivery.
  • Report writing into the AT templates is arduous, not intuitive or user friendly. IT review urgent. Does not impact timeliness of reporting, but creates administration complexity and duress for clinicians.
  • Second quotes not appropriate, doesn’t achieve better outcomes. There are delays with obtaining second quotes (Expensive powerchairs, Home modifications, also it is unclear what is the trigger) Second quote is unrealistic for complex AT, as investment of second provider/supplier with participant and prescriber must be scheduled at additional prescriber cost. The quotes can’t be guaranteed to be like for like. This could also change the script, due to differences in trial equipment and decisions involved during the second assessment/evaluation/prescription. An oversight used by the federal EAF - Employment Assistance Fund is to obtain a powerbase comparative price to validate/authenticate the high cost component of the quote.
  • Main delay is having report read, interpreted, approved, because of lack of professional knowledge of persons reviewing the report. A clinician’s oversight is recommended.
  • Reporting involves some clinical language, however, additional writing is necessary to explain in layman’s terms for the reviewer.
  • Lack of clear process for providers/ suppliers to raise invoice/place equipment orders following approval. Often participant doesn’t know either. Too often left with prescriber to mediate between participant and supplier, a role the LAC should undertake to coach both participant and providers.
  • Where there is an Initial rejection, prescriber assists client to lodge a first review/appeal, and then assists participant prep for tribunal, and attendance.
  • Lack of transparency about what AT participants can and can’t apply – No listing of AT that is IN or OUT so LACS encouraging prescribers to pursue items they know will be rejected. Lead on the participants. Time and $ wasting. Erodes relationship with prescriber.
  • Fixed times to delivery, so no control of this. Delays to approval can be better managed.

b.

whether the estimated demand for equipment to be sourced through the assistive technology process in each roll out area was accurate;

  • Significantly underestimated demand, and complexity of AT.
  • Existing equipment often old, poorly maintained for a range of reasons, such as: The equipment item(eg. bed) was not part of previous scheme (eg. MASS) or client’s were ineligible for equipment (Working) or client’s doing their best to be independent of government support.
  • There are limited resources for urgent equipment to manage breakdown of equipment, substitute hire items

c.

whether market based issues impact the accessibility, timeliness, diversity and availability of assistive technology; Delays in orders and “shopping around” impacts supply companies and builders, they have now pushed to be funded for their assessment time.

  • Engaging providers/suppliers who meet NDIS guidelines (eg registered providers/suppliers).
  • Many builders will not undertake any NDIS work reducing pool of options for choice for participants.

d.

the role of the NDIA in approving equipment requests; AT reports should be overseen by competent AHPs with experience in the disability sector, relevant to that AT (eg. Mobility)

  • NDIS processes are eroding our professional integrity and clinical expertise
    • Asking us to work outside of the AHPRA guidelines
    • Eroding client relationships – NDIS blames prescriber when advising participants of rejections.

e.

the role of current state and territory programs in the assistive technology process;

  • MASS had resources in both equipment provision, refurbishment, timely repairs and clinical oversight for prescriptions which is no longer being accessed by NDIS. They also could provide for trial equipment and urgent issues of pressure cushion and mattress replacement to prevent hospitalisation.
  • This is an under-utilized resource of expertise and physical, maintenance and rehab tech resources.

f.

whether the regulatory frameworks governing assistive technology are fit-for- purpose, AHPRA regulation of OT and PT as prescribers is a strong and effective body.

  • Too many and lack of transparency
  • Open to interpretation by every participant and LAC
  • Block to discharge of Spinal Injuries Unit, PAH - refer to report on costs incurred by Qld Health, when NDIS - Prevents rehabilitation access for traumatic spinal injury.

  • Lack of understanding that disability esp. SCI can lead to health issues, and they cannot be separated. The govt prog NDIS/ Qld Health needs collaboration on working with this.

  • Rehabilitation Engineering expertise unavailable – formerly from MASS g. OTHER ISSUES

  • No provision for AT failure that has catastrophic consequences for SCI individuals, eg. seat cushion causing pressure areas, hoist failures. No means to currently highlight requests as urgent

  • Unrealistic estimates of how long AT lasts and the poor undermaintained quality of the longstanding equipment with a participant that needs replacement

  • LAC and Planners lack of understanding of AT issues.

  • Participants having to attend AAT to obtain basic equipment related to their disability

  • Lack of understanding between what health issues are linked to their disability and are not stand alone health issue experienced by an able bodied person.

  • AT templates- currently only complex home mods template allows for photos to be imported into the word version. Urge that all AT templates should allow for this.

  • Electronic submission portal to allow for tracking of application- participants invariable contact prescriber for a progress report as their calls to their local area office to request an update go unanswered. LAC’s or NDIS Planners drawing on personal/lived experience when discussing a participant’s AT equipment/accessories within an AT Application – eg: “I personally find frogs legs on my wheelchair to be useless so why is this reasonable or necessary”

  • The NDIS AT Template does not allow for Spell check. The PDF document appears to send in an editable format. This is not ideal.

  • NDIA have been asking Prescriber’s for dollar figures on how a recommended AT equipment item prescriber had requested would save the NDIA in “care hours” for example. We are not accountants, and should not be expected to be keeping abreast of the latest hourly rates of personal care workers. We cannot on the contrary assign a dollar figure to what could be a saving of 10’s of thousands of dollars or more preventing an inpatient hospital admission caused by a serious pressure with the same recommended AT equipment. The NDIA Template does not reflect the questions that the planners are asking the prescribers – just like this example.