Assistive Technology within the NDIS – ARATA’s NDIS Policy Statement

participation through technology

Assistive Technology within the NDIS

ARATA’s NDIS Policy Statement

Assistive technology (AT) practitioners provide • Urban/rural/remote – solutions for urban areas professional advice to consumers to ensure will often need to be different for rural and the best AT solution. AT practitioners include remote locations occupational therapists, rehabilitation engineers, • AT delivery will be different for children, adults physiotherapists, speech pathologists, prosthetists, and older people and must be responsive to orthotists and suppliers. changing needs and goals To deliver these solutions efficiently, the NDIS • A national accreditation system for prescribers must incorporate an effective national AT system. and suppliers

• A national training and mentoring program to fill Key factors for an effective AT system: gaps in workforce capacity and develop efficient

• Consumer control and choice is central to support networks in rural and remote regions for the process skilled practitioners

• Cultural shift from short-term AT device • Consumer-led evaluation and research to improve provision to individualised AT solutions which processes will deliver an innovative NDIS. maximise participation and minimise long-term health problems and costs

What is an assistive technology solution? Assistive Technology (AT) refers to aids An individually tailored combination of AT and equipment. AT can be anything from a together with assessment, trial and adaptation, simple device in the kitchen to a wheelchair home modifications and personal support. or a computer application. See www.at.org.au

Introduction

The Australian Rehabilitation and Assistive Technology Background Papers were developed from a national Association (ARATA) is committed to ensuring that the consultation with ARATA members and other key National Disability Insurance Scheme (NDIS) provides stakeholders, and draws on their substantial expertise. assistive technology that achieves good outcomes for Assistive technologies, home and vehicle modificationsconsumers that are timely, efficient and affordable. are vital and cost-effective strategies for minimising ARATA is a national organisation established in 1993. barriers and enabling a wide range of outcomes Members include AT professionals (occupational therapists, including autonomy and independence in activities in physiotherapists, rehabilitation engineers, etc); AT suppliers the home, getting out and about in the community, and consumers. This Policy Statement and associated communicating with others, and participation in education and employment and community activities.

The NDIS as proposed by the Productivity Commission

In 2011 the Productivity Commission proposed some basic Underpinned by structures for the NDIS including: • Control and choice by people with disabilities, with Three tiers decisions based on their goals and aspirations and outcomes evaluated accordingly

1. The whole Australian population to be insured, to

• Assistance provided will be what is ‘reasonable and minimise impact of disability and maximise inclusion necessary’

2. Information, referral, web services and community • Current annual funding of over $7b will need to engagement, targeting 4m people with disabilities and increase to $13.5b 800,000 primary carers Functional roles

3. People receiving funding support from NDIS, targeting approximately: • Governing Board and National Disability Insurance Agency (NDIA) (a) 330,000 people with intellectual, physical, sensory

• Disability Support Organisations (intermediaries for and psychiatric disabilities; people with disabilities if they choose to use them to (b) 80,000 for early intervention; broker services, manage services, planning etc)

  • Disability Service Providers (NGO, government, for- (c) a small but unknown number of others optimally

profit, individuals, specialist services, etc) to supply supported; and coordinate services (d) some carers

• Government disability and mainstream services outside NDIS

1. AT and people with disability People with significant levels of disability targeted The World Health Organisation defines AT as: ‘an in the top tier of NDIS will usually be reliant on AT umbrella term for any device or system that allows with some using up to eight different devices often individuals to perform tasks they would otherwise be in combination. Provision of AT through the NDIS unable to do or increases the ease and safety with must focus on the functional impact of impairments which tasks can be performed’. AT encompasses a wide on an individual, rather than on diagnostic range of items and the AT Pyramid below illustrates categories, age, or other criteria. this variety. Modifications to the home and vehicles are also an essential part of AT solutions for many.

The AT Complexity Pyramid

CustomLow volume; Increased

made  high cost                                                                                               complexity;

higher risk

Customised AT

(e.g. ultralight wheelchair)

Combinations of specialised and / or mainstream (e.g. computer with adapted keyboard & mouse, height adjustable kitchen cabinets & benches)

Off the shelf specialised (AT) (e.g. standard wheelchair, refreshable brailler, grab rails)

Low

High volume; complexity;

low cost                          Mass produced consumer products                             lower risk

(e.g. non-slip mat, phone)

A) The AT process The AT process will vary with each person in relation to • Routine/scheduled maintenance the overall complexity, risk, urgency and costs of the • Routine/scheduled reviews and evaluation AT involved. Key determinants will include the person’s • Repairs as needed choices, goals and aspirations, domestic and community • Replacement as scheduled/needed environment, whether they live in urban, rural or remote • Software and peripheral upgrades areas, and level and type of disability. Structural elements that also require careful For the NDIS AT system to deliver timely, effective and cost consideration include: efficient assistance, careful consideration is required of both

• workforce and accreditation the overall AT delivery (see dot points below) and overlying

• funding and decision making authority incorporatingstructural issues. Key steps in the AT process include: consumer control and minimisation of delays

• Information

• rural and remote provision

• Referral for AT needs assessment

• evaluation and innovation

• Initial AT assessment and prescription (prescriber with • different processes for high volume/low cost/low risk funding authority)

supply versus low volume/high cost/high risk supply

• More detailed assessment/fitting/customisation as

• linkages to other AT-related sectors such as education, required employment, health and aged care.

• Trialling (as required), and final selection/selection refinement These and other issues are outlined below, and are

• Purchase/reissue described in more detail in the Background Papers.

• Supply and delivery (including assembly/installation/check To deliver the greatest efficiency and outcomes, the NDIS fitting & customisation if required) must cover all that is within the AT Complexity Pyramid, in

• Training consumer, family, paid staff in use of equipment line with international standards (in particular ISO 9999).

B) Funding reasonable and necessary solutions AT funding must also include the ‘soft technology’ aspects (b) medical health products (such as oxygen, glucose of AT. Soft technology includes all the skilled input into testers etc) should be funded through healthcare provision essential elements of the AT system including information, arrangements; assessment, trialling, fitting, review and maintenance. At the higher end of AT complexity, this can be 15-30% of the (c) AT that is primarily necessary for major life roles (such as overall AT costs. education or employment) should be funded in cooperation with the respective agencies responsible for those Rather than lists of ‘eligible’ AT items which form the portfolios; and basis of most current government funded AT programs based on gatekeeping and rationing, the NDIA should rule (d) ‘mass market’ items such as mobile phones and certain items ‘out’ (such as oxygen, continence or medical computers (including connection costs) – when they are an consumable items). A cost effective long term approach essential part of an overall AT solution – should be funded to meeting an individual’s reasonable and necessary by the NDIS at 50% which recognises their mixed consumer requirements demands innovation and flexibility in finding product and specific AT use and value. the most appropriate solution. Other agencies (e.g. education, employment services, ARATA proposes that the NDIS should manage the funding health) may have specialist advisors to assist in prescription of all AT for those in the Scheme, including funding and implementation of AT primarily for their area, but the provided through NDIA and through other government funding mechanism should be coordinated through the program sources. Most AT should be funded from within NDIS. The NDIA should negotiate to have direct access to or the NDIS with the following exceptions: hold the funds from these agencies to minimise transaction (a) consumable items (such as continence aids) should costs, reduce complexity of access for people with disability largely continue to be funded separately to (durable) AT; and promote holistic service planning and provision.

C) Consumer control and choice The NDIS AT system must acknowledge and support the those with deteriorating function) require timely, diversity and skills of people with disability. This will and sometimes pre-emptive, access to AT advice include the person’s culture and language, their location and solutions, in line with the emphasis on early (including remote), their life stage (e.g. growing intervention. For example MND Victoria is currently children), and their lived experience of disability and AT. funded to run its own AT program, which provides both rapid response and the capacity to reissue equipment People with disability possess a range of knowledge and efficiently. The NDIA needs to identify and develop such experience of AT. Some will require extensive support innovative and flexible systems to optimise its success and training if they have a newly acquired disability, across the Australian disability population. while others with extensive AT experience will only require a brief discussion with an AT professional to The NDIS should include within its broader consumer verify their AT decisions. To promote both consumer education and training, strategies to increase the control and choice as well as systemic efficiency ARATA understanding of AT by consumers. For example the proposes that, depending on each person’s AT needs, NDIA, disability support organisations and disability service providers should recognise the importancediscretionary funding of up to $1000 annually is part of employing increasing numbers of skilled peopleof their approved service plan. This will enable people with disability in their organisations to facilitatewith disability to directly purchase any necessary AT communicating and mentoring with clients. Creatingitems, particularly high volume/low cost items and more accessible working environments is an importantinvolvement of AT professionals in these decisions will first step. Fundamentally the strategies shouldbe encouraged but not required. encourage consumers to take a more central and People experiencing frequent or rapid change in their informed role in choosing their AT professionals and disability and/or their environment (e.g. children, service providers, as well as their AT solutions.

2. Accreditation and the AT workforce There are currently no national accreditation structures have been proposed by the sector but have not progressed for AT practitioners or suppliers involved in assessment, in the absence of a national approach to funding, prescription, customised fitting, repairs/maintenance. The accreditation and links to salary. NDIS should facilitate the establishment of accreditation As part of the development of the NDIS it will be essentialfor practitioners, and suppliers which recognises both to undertake some scoping work on the AT workforceincreasing levels of competency and the different fields of capacity and structure, including a gap analysis. Specialpractice (e.g. wheeled mobility & seating, remote service consideration should be given to approaches that encouragedelivery etc.) Such accreditation, in concert with service skilled practitioners to work in rural and remote Australia. Aorganisation certification, will be essential to providing a tiered approach to practitioner expertise should encouragehiqh quality, timely and cost-efficient AT system. collaboration and mentoring between practitioners in Many skilled practitioners and suppliers underpin Australia’s specialist centres and community based generalists and current efforts in AT provision. While there is a need for the full utilisation of linked information resources (e.g. more professionals with enhanced training in AT, the current the Independent Living Centres, accredited suppliers) and training/mentoring opportunities, career pathways, and increasingly available information and communication remuneration hinder this. This makes it difficult to attract technologies such as the National Broadband Network. and retain skilled personnel across the sector from basic This will be particularly important for people with disability technical and support staff through to expert professionals. and AT professionals without local access to particular AT Programs of training/mentoring and career development expertise or advice that might be required (e.g. rural and remote consumers).

3. A consistent and coordinated national NDIS AT system ARATA proposes the establishment of a coordinated Using a collaborative approach the NDIA should national NDIS AT system. Internationally, national work with consumer, carer, professional and industry systems that integrate local generalist assistance associations on key national AT issues including: with regional secondary and national tertiary centres • simplification and optimisation of systems, of expertise maximise the capacity to achieve good documentation and regulation to achieve outcomes for people with disability in a way that is efficiencies and cost savings for all; accessible, cost effective and efficient.

• AT lifecycle management, including extended While existing state/territory systems have elements warranty and preventive maintenance into of similarity, their operations are quite different and purchase price; most have a culture founded on rationing, short- • reuse, recycling and refurbishment; term decisions and with limited capacity to address • provision of appropriate solutions (product, supply holistic need. The National AT System must facilitate and preventive maintenance) into rural and remote delivery of AT solutions (as part of a suite of supports) settings (e.g. a standardised battery charger, or targeted at achieving the consumer’s goals. The NDIA standardised front castor). itself should lead in creating an accessible workplace, including the built environment and information and In summary a national NDIS AT system will enable: communication technology (ICT). The sector-wide • effective oversight and integration within influence and cost efficiencies to be gained under the NDIS; the NDIS will not materialise if each state/territory • the flexibility to pool similar challenging settings operates separate funding and delivery systems. across the country (eg remote) under specialist support teams and protocols;The new AT system should embed purchasing contract and supply chain arrangements that deliver: • efficient action on key issues such as workforce,

  • holistic, long-term and goal focused selection accreditation and quality, processes and logistics;

and use; • greater industry influence and support for product

• responsiveness and timely provision of solutions and service innovation; (including replacement); • a focal point for collaboration with other key

• competitive pricing including ‘whole of product life’ portfolios such as education, employment, health costs (e.g. durability and maintenance); and aged care; and

• quality benchmarks (e.g. product standards); • the collection of national data for review/evaluation

• research and innovation. and engagement in participatory/inclusive research.

This position statement is underpinned by the ARATA Making a difference with AT papers:

• Advisory Group Paper: The Economic Potential of AT solutions
• Expert Working Group Paper 1: Assessment and Eligibility
• Expert Working Group Paper 2: Control and Choice
• Expert Working Group Paper 3/4: Workforce and Quality

ARATA (Australian Rehabilitation and Assistive Technology Association)

is a non-profit membership organisation of practitioners and consumers passionate about enhancing the lives of people with disability (and people of all ages) through the best use of assistive technology.

ARATA contact information:

c/- Technical Solutions Australia, 109 Ferndale Rd, Silvan Vic 3795

website: www.arata.org.au

www.arata.org.au