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 will often need to be different for rural and remote locations

AT delivery will be different for children, adults and older people and must be responsive to changing needs and goals
A national accreditation system for prescribers and suppliers
A national training and mentoring program to fill gaps in workforce capacity and develop efficient support networks in rural and remote regions for skilled practitioners
Consumer-led evaluation and research to improve processes will deliver an innovative NDIS.

What is an assistive technology solution?

Assistive Technology (AT) refers to aids An individually tailored combination of AT 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 decisions based on their goals and aspirations and Three tiers outcomes evaluated accordingly

Assistance provided will be what is ‘reasonable and

The whole Australian population to be insured, to necessary’ minimise impact of disability and maximise inclusion • Current annual funding of over $7b will need to increase to $13.5b
Information, referral, web services and community Functional roles engagement, targeting 4m people with disabilities and • Governing Board and National Disability Insurance 800,000 primary carers Agency (NDIA)

Disability Support Organisations (intermediaries for

People receiving funding support from NDIS, targeting people with disabilities if they choose to use them to approximately: broker services, manage services, planning etc) (a) 330,000 people with intellectual, physical, sensory • Disability Service Providers (NGO, government, for-
and psychiatric disabilities; profit, individuals, specialist services, etc) to supply
and coordinate services (b) 80,000 for early intervention; • Government disability and mainstream services outside NDIS (c) a small but unknown number of others optimally supported;

1. Assistive Technology and people with disability

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

                   The AT Complexity Pyramid

                                         CustomLow volume;
                                      made  high cost
                                                                                            Increased
                                                                                                  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; 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 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 These and other issues are outlined below, and are refinement described in more detail in the Background Papers.
Purchase/reissue
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 of AT. Soft technology includes all the skilled input into essential elements of the AT system including information, asessment, trialling, fitting, review and maintenance. the higher end of AT complexity, this can be 15-30% of the overall AT costs. with the respective agencies responsible for those Rather than lists of ‘eligible’ AT items which form the basis of most current government funded AT programs based on gatekeeping and rationing, the NDIA should rule out certain items (such as oxygen, continence or medical consumable items). A cost effective long term approach to meeting an individual’s reasonable and necessary requirements demands innovation and flexibility in finding the most appropriate solution. Other agencies (e.g. education, employment services, ARATA proposes that the NDIS should manage the funding of all AT for those in the Scheme, including funding provided through NDIA and through other government program sources. Most AT should be funded from within the NDIS with the following exceptions: (a) consumable items (such as continence aids) should largely continue to be funded separately to (durable) AT; (b) medical health products (such as oxygen, glucose testers etc) should be funded through healthcare provision arrangements; At (c) AT that is primarily necessary for major life roles (such as education or employment) should be funded in cooperation portfolios; and (d) ‘mass market’ items such as mobile phones and computers (including connection costs) – when they are an essential part of an overall AT solution – should be funded by the NDIS at 50% which recognises their mixed consumer product and specific AT use and value. health) may have specialist advisors to assist in prescription and implementation of AT primarily for their area, but the funding mechanism should be coordinated through the NDIS. The NDIA should negotiate to have direct access to or hold the funds from these agencies to minimise transaction costs, reduce complexity of access for people with disability 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 discretionary funding of up to $1000 annually is part discretionary 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, prescription, customised fitting, repairs/maintenance.

The 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 increasing levels of competency and the different fields of capacity and structure, including a gap analysis. Special consideration should be given to approaches that encourage delivery etc.) Such accreditation, in concert with service organisation certification, will be essential to providing a tiered approach to practitioner expertise should encourage hiqh quality, timely and cost-efficient AT system.

collaboration and mentoring between practitioners in specialist centres and community based generalists and the full utilisation of linked information resources (e.g. the Independent Living Centres, accredited suppliers) and increasingly available information and communication technologies such as the National Broadband Network. This will be particularly important for people with disability and AT professionals without local access to particular AT 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.

While existing state/territory systems have elements At lifecycle management, including extended of similarity, their operations are quite different and warranty and preventive maintenance into most have a culture founded on rationing, short- purchase price; term decisions and with limited capacity to address • reuse, recycling and refurbishment; holistic need. The National AT System must facilitate • provision of appropriate solutions (product, supply 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 underpended by

  the ARATA Making a different 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