:format(webp))
Dear DSC, As a provider delivering Core supports in a regional area, we've had mixed messages about whether we can deliver supports when a participant is in hospital. The participant has requested it and the hospital are happy for us to. But a local NDIA rep says it’s against the rules. We've scanned the NDIA Operational Guidelines but struggled to make sense of it. What services can we deliver in hospital?
This is a situation that many providers will have been in before. Spending time in hospital is (unfortunately) part of life and for people with disability it’s even more of a common occurrence. It’s completely reasonable that a person would want familiar, trusted supports when they are spending time in hospital. But as your experience with the NDIA representative shows, the guidance for providers has been less than consistent over the past few years.
The answer to your question depends on the type of support being delivered. So, let’s look at what rules apply for different support types.
But first, there are some key documents you need to be aware of:
- The Applied Principles and Tables of Support (APTOS) is one of the key ways that the NDIA determines how it’ll work with the mainstream health system (and other mainstream systems). Hospital services are a mainstream health service.
- Operational Guidelines are one of the ways the NDIA communicates to the world what they will and won’t fund. The Operational Guideline for Disability-related health supports is most relevant here.
Personal care supports
The APTOS clarifies that NDIS supports are not intended to replace clinical services while the person is in hospital. Fair enough. The Operational Guidelines also say most supports in hospital should be covered by hospital staff. This is important because we don’t want a system where the quality of someone’s health services is determined by the size of their NDIS Plan.
Supports for people with complex communication and behaviour concerns
But APTOS also says that NDIS funds can be used if the person in hospital has complex communication needs or challenging behaviours. But there are no definitions provided of what is considered complex communication or challenging behaviours. So, you’ll need to work out with the person if they meet these requirements.
Support Coordination and Psychosocial Recovery Coaching
This doesn’t matter much for your situation, Dear Reader, but generally, Support Coordination and Psychosocial Recovery Coaching are fine to deliver while the person is in hospital (especially if they are helping prepare for discharge).
Training for hospital staff
The Operational Guidelines also state that NDIS funds can be used to provide training and guidance to hospital staff when a participant is in hospital. If this can be done before a person’s hospital stay - all the better!
Contradicting advice
We know some NDIA staff have been giving advice that seems to be in contradiction to the APTOS guidelines. There are even staff threatening compliance action against providers if they find out that supports were delivered in hospital, even those that are related to complex communication or challenge behaviours (as per the APTOS).
Making the situation even more complicated - we very often hear that health service staff will request that a provider comes in and supports the person. This is particularly so for health services in regional areas where staffing is often threadbare, let alone having staff members with expertise in disability support.
Tips for navigating the interface
There are a few things you can do to protect yourself and support the person you’re supporting:
- If the NDIA representative says no supports at all can be delivered in hospital, politely ask them where it says that in the NDIS Rules, APTOS, Operational Guidelines, and any other documents that govern how the Scheme works.
- Outline and align the scope of the services that you want to deliver in terms of supporting a person with complex communication needs or challenging behaviours, as per the APTOS requirements.
- Sometimes it’s easier to let the health system and the NDIA fight this out amongst themselves, especially if it’s the health staff contacting you asking for support workers to come in. Escalate to more senior leaders in the health service and get them on your side. Every health service has an established complaints management system, and these processes are often useful for getting the people in a room that can find a quick solution. So, make sure you know the complaints processes for your local hospitals and health services.
- Front-load supports where you can. The NDIA says that NDIS funding can be used for training and preparing health service staff. So, in cases of planned hospital stays, do the work beforehand and bill it to the person’s plan - with their agreement, of course.
Unfortunately, there’s no golden ticket answer to your query. Usually a mix of negotiation, empathy, clear and firm communication and a willingness to be flexible will be the best course of action. Speak softly and carry a big APTOS-shaped stick.
Do you have a question that you want answered by one of our NDIS whizkids? Submit them here.
