LIST OF ABI Acquired Brain Injury AT Assistive Technology COAG Council of Australian Governments DSO Disability Service Organisation DSS Department of Social Services ILC Information, Linkages and Capacity Building ISP Individual Support Package MS Multiple Sclerosis NDIA National Disability Insurance Agency NDIS National Disability Insurance Scheme NDS National Disability Strategy PEG Percutaneous Endoscopic Gastrostomy RAC Residential Aged Care SSA Shared Supported Accommodation YPIRAC Younger People in Residential S
IMPLICATIONS In the absence of other alternatives, these research findings point to the benefit in maintaining small-scale shared residential settings beyond NDIS transition as one of a range of possible options for this cohort. Stemming from these research findings, there are five key implications for full Scheme design: The health and disability interface for NDIS participants with complex healthcare needs to be recognised and coordinated Scheme participants, family members and NDIS planners and support coordinators require education and capacity building to understand and effectively plan for the complexity of supports required by this group in order to influence outcomes Lifetime care and outcomes will be improved with early intervention within an insurance model approach, through engagement during the planning process, at the point of entry to RAC, or in alternative accommodation models such as SSA There is a need for skilled coordination of supports, delivered by appropriately trained or experienced practitioners working across health and disability, to ensure a holistic response to the needs of people at risk of entry to RAC or long term inpatient hospital admissions Participation and individual outcomes can be enhanced through moves from RAC to small-scale, well located and designed supported accommodation, however there is more work to be done to build the social and economic participation of people with disability and complex health needs. These implications provide directions for the full NDIS roll out for this particular target group, which has relevance for other Scheme participants living with a range of disability types.
of progress towards goals often the result of significant injury or acquired disability. It may be that these supports are not funded by the NDIS, however agreements with Health about the roles and responsibilities, and effective coordination across both sectors is required to maximise results. This should not be negotiated as needs arise but planned and proactive where possible, consistent with the insurance model. THERE IS A NEED FOR SKILLED COORDINATION OF SUPPORTS the identified importance of an effective health and disability interface for this target group, and the complexity of their needs, specific attention and approaches to pre- planning, planning, coordination and implementation of NDIS supports in a timely manner will be pivotal. This coordination will allow participants to receive timely access to the equipment and supports they require to achieve a level of social and economic participation aligned with their goals and aspirations. Such coordination will also ensure that secondary conditions relating to the functional disability are accommodated or addressed via the application of customised equipment and supports. The need for coordination of support to implement packages under the NDIS has been recognised in the new support clusters definition and pricing framework published recently27, which state, ‘Higher intensity complex support coordination may be paid where a participant requires assistance from a support worker with additional qualifications and experience relevant to the participant’s complex needs. If such support is provided or guided by a health professional because of the needs of the participant, the health professional rates apply for that support’ (p.6). The NDIA defines support coordination as ‘assistance to strengthen participants’ abilities to coordinate and implement supports and participate more fully in the community’ (p.6). Given the complexity of support needs of the participants in the SSAs surveyed in this study, and the responsiveness required to review the needs of this population over time, ongoing coordination of support or timely and responsive review of NDIS is expected to be higher or more frequent for this target group than other Scheme participants. ‘Specialist support coordination’ is likely to be a necessary support required within an NDIS plan for a majority of this target group, not an exception.
ASSISTIVE TECHNOLOGY MUST BE HARNESSED WITHIN AN NDIS TO IMPROVE OUTCOMES Survey results indicate that residents of SSA experience a range of disabilities, and resulting complex care needs, that necessitate the timely supply of customised assistive technology (AT) solutions. Sixty five percent of the group had access to mobility equipment and 50% to home automation or environmental control AT provided through the SSA provider, whilst 43% had mobility equipment and 13% had environmental control AT sourced externally. Beyond the traditional AT items necessary for this group, such as motorised and manual wheelchairs, hoists and showering aids, the development of smartphone and tablet technology has diminished the gap between specific and mainstream technology28. This has created the opportunity for people with disability and their families to access mainstream technology options. The desirability and perceived social acceptance of these mainstream options increase potential for more integrated lives. Current and emerging technology offers the real potential for people with significant and permanent disability to live with the level of independence or autonomy that many of us take for granted29, and could change the way supported accommodation is delivered to residents. However, it should also be noted that this group may experience potential barriers to assistive technology uptake and ongoing use, which may include low income, limited support available to build technology usage and skill development, and impaired cognitive communication ability28. The level of knowledge of both NDIS participants and planners regarding assistive technology needs and opportunities may influence participants’ potential to apply assistive technology solutions within goal setting. A number of the people in this study’s target group do not have the cognitive and or communication capacity to indicate their preferences regarding assistive technology options. They may not have natural supports available to them to assist. Information and resources to gain knowledge on possible assistive technology solutions will need to be developed and made accessible to NDIS participants and families. Planners will also require knowledge in this area to be drawn upon during a planning process. This will ensure that technology is harnessed in useful way within an NDIS to build the social and economic participation of people with disability and also has the real potential to influence Scheme costs. Some NDIS participants and support networks will require peer support, training and/or intermittent input to harness the full capability of technology supplied, and avoid technology abandonment29. This should also be