Case
Jordan needs to spend some time in hospital care while he has an operation. He’s concerned that the hospital staff will not understand how to look after his disability support needs. He asks us to give him funding for a support worker who is experienced with his disability, to help him at the hospital while he’s an inpatient.
Would we fund this?
No, we would not typically fund a support worker for Jordan while he’s an inpatient at hospital. This is because this support is likely to more appropriately given by the health system. It’s part of their universal service obligation to all patients, or as part of a reasonable adjustment required under disability discrimination law.
Why wouldn’t we fund this?
When working out whether a support is reasonable and necessary for you, we would look at the information you’ve given against the framework of our NDIS Funding Criteria.
Typically, we only fund supports that help you do everyday tasks that you can’t do because of your disability. This includes the services of a support or care worker.
We won’t fund supports that are more appropriately funded by another service, such as the health system. Ordinarily, a patient’s care in hospital is most appropriately provided by the hospital. This includes things like showering, bed transfers and pressure care.
We need to think about a number of things when we decide whether a support is most appropriately funded by us, rather than by the health system. One important point is that we are not responsible for services that aim to improve the health of Australians. This includes:
- allied health services (including acute and post-acute services)
- care in public and private hospitals
- pharmaceuticals (medicines)
- preventative health
- universal entitlements.
A hospital should also make reasonable adjustments to accommodate your specific disability needs. For example you might need extra daily care due to your disability, such as additional pressure care or help with showering while you’re an inpatient in a public or private hospital or health clinic. This care is likely to be a reasonable adjustment, and more appropriately provided by the health system, rather than by us.
Health services have an obligation to have ‘capabilities to meet the needs of people with disability’. This means that health services must meet the needs of people with disability including NDIS participants. If you need more care than what the health service or hospital usually provides, you should discuss it with the hospital or service so that they can make reasonable adjustments to make sure you get the care you need from them. Ordinarily, we wouldn’t fund this care, which means you can’t use your NDIS funding on supports that are provided in the hospital.
This also means we won’t generally fund the care and clinical services you need while you’re staying in a public or private hospital, or while you’re under the care of a medical or an allied health service (including acute and post-acute services).
What else do we think about?
The hospital is responsible for your care needs while you’re in hospital. This means it’s likely your support workers won’t be allowed to operate hospital equipment, or control how they support you in a hospital.
Also, your personal care needs can often change in hospital and your support workers may not be trained to change your support routine. This could put you at risk of getting inappropriate care. They’re also unlikely to be included in any hospital communications, nor aware of Work Health Safety arrangements of the hospital (including emergency management procedures). This could put both you and your support workers at risk. We can’t fund supports that are likely to cause harm to you or be a risk to others.
While we will not typically fund support workers to help you while you’re in hospital, we may fund reasonable and necessary supports to:
- give guidance and training for hospital staff working with you if you have challenging behaviours
- give specific training to help hospital staff communicate with you if you have complex communication needs.
Case example
Peta has cerebral palsy and is 22 years old. Peta needs full physical assistance for all care, and needs two carers using a hoist for all transfers as all of her limbs are affected. Peta is also nonverbal and uses a communication device.
Peta lives with her parents in the family home but has to go into hospital for up to two weeks for an operation on her ankles. As Peta has difficulty communicating with people, she’s concerned about staying in hospital. She wants the support workers that she knows and trusts to look after her personal care at all times while she’s an inpatient.
Peta’s parents are concerned about her vulnerability and the level of care she may receive in hospital. They ask us for additional funding to give Peta 24/7 support assistance while she’s staying in hospital.
When working out whether the funding for Peta’s 24/7 hospital support assistance is reasonable and necessary, the planner looks at the information provided against the framework of the NDIS Funding Criteria.
In doing so the planner thinks about whether the support:
- is most appropriately funded or provided by us, and not through other general systems of service delivery or support services that are offered:
- as part of a universal service obligation
- as part of a reasonable adjustment required under discrimination law.
- represents value for money in that the costs of the support are reasonable, in terms of the benefits achieved and compared to the cost of alternative support
- is likely cause risk to Peta or cause harm to others.
In Peta’s case the planner decides:
- the supports are more appropriately provided by the health system, not by us. This is because while Peta is in hospital, the hospital has a universal service obligation to give her the care she needs. The hospital is obliged to make reasonable adjustments to the way it usually does things to meet Peta’s disability needs. They must make sure she can access the hospital and receive quality care like everyone else. When working out which service system is appropriate, it’s important to remember that we are not responsible for services that aim to improve the health of Australians.
- it won’t be value for money for us to fund supports that the hospital already must provide under its universal service obligation, or as a reasonable adjustment.
Peta’s support workers may not be able to give appropriate care to Peta while she is an inpatient. This is because they’re unlikely to be allowed to operate hospital equipment, or control the delivery of her supports and care in that setting. Instead, the hospital is responsible for Peta’s care while in hospital, especially because her post-operative care needs are likely to be different from her normal care needs. Although having the same supports as usual is likely to be effective and beneficial for Peta’s mental wellbeing, her support workers are not hospital staff trained nor authorised to give care in the hospital environment, especially post-operative support. Doing so may put Peta and the support workers at risk.
Peta’s funding request is not assessed as reasonable and necessary and funding is not given for her 24/7 hospital support assistance. Instead, the planner highlights that to help with the concerns Peta may have about staying in hospital, she can use her existing supports to fund:
- her support coordinator to put her care provider in touch with the hospital to discuss Peta’s special disability support care needs while she’s in hospital (for example, sharing the care plan or communication plan)
- training for the hospital staff to help them communicate with Peta due to her complex communications needs
- an assessment of Peta’s care needs so that care plans (for example, 24 hour positioning plan, continence care etc.) can be developed and shared with hospital/health staff.
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