Case
Helen is a paraplegic with limited mobility. She has recently developed a number of pressure sores which, due to her disability, are chronic and likely to take months to resolve. Helen asks us to fund the wound care supports her doctor has recommended.
Would we fund this?
Yes, we would typically fund wound care supports for participants with chronic wounds such as pressure sores. This cost is likely to meet our funding criteria. You will need to provide a wound care plan from your doctor or care nurse. This plan includes details of wound care supports your need to support your disability-related injury.
Why would we fund this?
To work out whether a support is reasonable and necessary for you, we look at the information you give us against the NDIS Funding Criteria.
You need to give us a wound care plan which details what supports your doctor recommends for your disability support needs. We use this to work out whether the wound care supports are more appropriately funded by us, rather than the health system. We would be the most appropriate funding body if the wound care supports relate to your ongoing disability care needs and let you go about your daily life.
This wound care plan needs to include an assessment and diagnosis confirming your wounds are chronic, in that they won’t heal, will heal slowly or will heal but reoccur. Chronic wounds are those that have not healed after three months. It also needs to show the wounds relate to your ongoing disability support needs.
The plan needs to give us information about:
- a wound care or pressure injury management program that includes the details of the consumables you need for treatment
- wound prevention management including recommendations of assistive technology options
- planning and support care, defining the frequency and level of care needed required to support your wounds.
What else do we think about?
We won’t fund wound management supports that do not relate to your disability. The health system is responsible for such things as:
- wounds being treated in the hospital, a clinical setting, including at home, or while in custody.
- the early treatment of wounds, such as acute wounds.
We won’t fund consumables, such as dressings, antiseptic cream and medical tape to treat such things as minor cuts and grazes that do not require medical support. We see these as a day-to-day living cost.
We may consider funding for a support worker to help you treat an acute wound, if:
- due to your disability, you can’t treat yourself, for example you may not have the mobility you need to apply dressings to a deep cut to your foot
- you also don’t have access to clinical support through the health system to help you. In this case, we would not fund the dressings and related consumables as these are the health system’s responsibility.
Case example
Mark has a spinal injury and has no mobility in his legs. He recently had an accident while in his kitchen and severely burnt his arm. Mark spent six nights in hospital while the burn was treated and dressed. During this time Mark also developed a number of pressure sores as he was unable to shift his position regularly using his uninjured arm and being on heavy pain support medication.
On discharge from hospital, Mark’s doctor gave him a wound treatment plan. The plan explained:
- Mark’s burn is acute and likely to heal in 8 to 12 weeks
- his burn dressings will need to be changed weekly for about 4 to 5 weeks
- Mark’s pressure sores are deep and chronic and, even with care support, will most likely to take months to resolve
- the range of consumables, such as dressings Mark will need to treat his burns as well as the chronic pressure injuries
- Mark’s at-home care needs, including how often a nurse will need to visit to treat his wound and make sure his pressure injuries don’t get worse.
Mark sends the wound treatment plan to us, asking for funded supports to cover the cost of his wound care support. He stresses that due to his limited mobility he will need at-home nursing support.
When thinking about whether funding to manage Mark’s wounds and buy the wound care consumables is reasonable and necessary, the planner considers several things:
- Does Mark need help to manage his chronic or acute wounds, because his disability limits his capacity to treat them himself?
- Is the NDIS, rather than Medicare, the Pharmaceutical Benefits Scheme or other health system options, the most appropriate funding body?
- Are the quotes for the items listed in the treatment plan value for money? Are there other consumables or supports which would achieve the same outcome at a lower cost.
The planner assesses Mark’s funding request and approves funding for all the items listed in the wound care plan relating to the extended management of his chronic pressure sores. This includes the cost of two visits a week from a home-care nurse to dress his wounds and prevent his injuries from escalating.
The planner declines funding for the consumables specific to Mark’s acute burn injury. These are more appropriately funded by Medicare and the health system.
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