Submission regarding issues, implementation and performance experienced as an NDIS participant

Background Information

I am a person who uses a wheelchair for mobility due to spinal injuries. I am also a Carer for my husband who requires a high level of support due to his disability and a Planner for the National Disability Insurance Agency (NDIA).

2015

Prior to the NDIS, my husband and I were both receiving government funded support. Part of the support included Home Modifications to support us both to maintain our independence.

An Occupational Therapist completed a report making recommendations.
The OT made recommendations and identified many high-risk concerns.
Identifying the need for an accessible bathroom,
A fixed Ramp alongside the side of our property which would provide wheelchair access via a glass sliding door.
The report was submitted to Central Coast Community Connections.
The report identified that the Home Modifications were complex and required approval from a board.
I was advised that I would be required to self-fund 30% of the final cost of the Home Modifications.
I was also advised that there was an option to agree to a payment plan.

Late 2015

I was advised that NDIS had started to roll over clients from government defined programs. I submitted both of our application forms to become NDIS participants.

Several months had passed where I was waiting for the board to approve funding for the home modifications. My husband and I had received a letter from NDIS stating that we both had meet access to become NDIS Participants.

I advised Central Coast Community Connections that we both had received information from NDIS advising that we both meet access to apply to become NDIS participants. This information was also shared with the OT.

May 2016

I was advised that the board had approved the funding for the Home Modifications. I discussed several options with the OT agreeing to self-fund the 30% of the Home Modifications. I could not wait any longer.

I contacted Central Coast Community Connections advising that I would agree to self-fund the 30% contribution of the Home Modifications.

July 2016

I was advised that Central Coast Community Connections had exhausted all of their funding for Complexed Level 3 Home Modifications.

The OT and builder from Central Coast Community Connections were both aware of the urgent need for the Home Modifications. Both advised there was funding available for level 2 Complex Home Modifications. They both spent extensive time/resources attempting to bring the quotes under the level 3 Complex Home Modifications.

September 2016

An LAC called to make a time to collect information to develop our NDIS Plans. Our Plans were built and approved in October identifying the need for urgent Home Modifications.

October 2016

I commenced employment as a planner for the NDIA. My OT submitted reports advising of the high risk identified without Home Modifications. The original OT reports and building quotes from Central Coast Community Connects were submitted to NDIS.

January – February 2017 Still awaiting approval from NDIS. I rang NDIS to be advised that no one had read the reports. I was then told that my OT would need to resubmit his report on the correct templates etc.

February 2017 We self-funded Home Modifications to Bathroom as I was really concerned about the real risk of not being able to maintain my independence, dignity and employment at the NDIS.

June 2017 I eventually received a reply notification that the NDIS has received my request for Home Modifications advising that some of the recommendations from the OT could be approved.

Insert from letter At this time, based on the evidence provided in your therapist’s report, we are not satisfied this support represents value for money. The cost of the support must be reasonable compared with the benefits achieved and the cost of other similar support. This requirement is outlined in section 34(1)(c) of the National Disability Insurance Scheme Act 2013. NDIS will not fund a higher cost modification where the same benefits can be achieved through a lower cost alternative. The option of a platform lift at the front entrance needs to be fully explored before we are able to consider the deck and ramp. Reasons for requesting funding for a ramp instead of a platform lift must relate to your disability rather than being based on your preference alone. If you choose to proceed with construction of the deck and ramp, NDIS may consider contributing an amount equivalent to provision of the lower cost alternative eg installing a platform lift. In this instance, a separate quote prepared by the builder can be submitted to NDIS for consideration. If approved, these costs will be paid to the builder upon satisfactory completion of the deck and ramp.” NDIS would be happy to consider a revised home modifications quotation if you decide to proceed. As we discussed, it is generally expected that any proposed home modifications will be suitable for your long term needs. For this reason, any future requests need to include all the modifications you require for your current dwelling, as it is unlikely that NDIS will approve modifications at a later date unless it can be demonstrated that there have been unforeseen and significant changes in your level of function.

I attempted to explain to the planner the benefit of a ramp and requested a different planner who was familiar with the needs and requirements of a person with reduced mobility and the need to use a wheelchair. This request was ignored.

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I advised my OT of the outcome of the request for Home Modifications. My OT also advised me that there was a new process for submitted Complex Home Modifications. My OT and builder meet with me at my home to discuss the Home Modifications for the ramp and Laundry and to prepare a quote for a platform lift at the request of the NDIA. New report was rebuilt and submitted to the NDIS. I was advised by my planner that she would review my request when she returned from leave. Following reviewing the reports, I was advised that the request for Home Modifications was above benchmark and the Planner was required to go to the Technical Advisory Team (TAT) for recommendations and approval.

September 2017 I submitted a complaint to the Agency requesting a planner from outside of the region. I mentioned in the complaint my concern about the impact of the whole process potentially having a negative effect on my professional working relationship.

I have regained employment and assisting with one of the key drivers of the Agency, Economic Participation. I am unsure how long I continue in my employment, caring role and being a valuable member of the Community.

Recent updates December 2017 On the 20th of November I received a phone call from a Service Delivery Manager advising of the outcome from the Technical Advisory Team (TAT) not to fund the requested ramp. On the 22nd of November I was required to advise my Team Leader that I was required to go on extended leave due to stress associated with being a participant of the NDIS. I have requested further information in reference to the advice but have been experiencing great difficulty in receiving this information. I am sure you can appreciate this information is required to assist me in moving forward. I am in desperate need of Home Modifications.

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