Supports in the time of COVID

Saying “COVID can’t get any worse than this” is a bit like saying “Macbeth” in a theatre – you’re just inviting the virus to unleash its wrath. And while things can certainly get worse, they are undeniably pretty bad at the moment.

The continuation of supports remains one of the biggest challenges for the disability sector. Many providers are increasingly worried about how they are going to continue delivering essential services with so many of their employees unable to work. Meanwhile, people with disability are anxious about what will happen with their disability supports if they or their regular support worker test positive for COVID.

But don’t worry – this isn’t just an article to tell you how bad things are at the moment. We do have some mercy. Instead, we are here to help you wade through the mountains of information out there and summarise what you need to know about:

• The NDIA’s response.
• Rules around disability workers and close contacts.
• Funding for rapid antigen tests (RATs).
• Providers’ legal responsibilities.
• Helpful resources.

There is also a rant about provider of last resort at the end, just because that issue deserves a rant. 

The information below is by no means a comprehensive list of everything out there. If you think we have missed anything important, please let us know at [email protected].

What is the NDIA doing?

We sent some questions to the NDIA about whose responsibility it is to ensure the continuation of essential supports during this crisis. Perhaps unsurprisingly, the NDIA’s position seems to be – without quite saying it outright – that it is a funding body and thus not responsible for ensuring that services are delivered.

The NDIA said participants who test positive for COVID should contact the healthcare system as their first port of call. While this is undoubtedly true, particularly if the person is unwell, it doesn’t really address the issue of how COVID-positive participants can continue to access their disability supports. The last thing the health system needs or has capacity to do right now is provide disability supports and hospital beds to people whose needs aren’t medical.

The NDIA also said that participants should contact their provider about “options for the continuing provision of services.” If they have concerns about funding, then they should contact the NDIA. In other words, funding is an NDIA responsibility, while the continuation of support is a market responsibility. And we all know how well leaving things up to an already stretched market went with RATs.

The NDIA also said that it had been supporting the market through a number of COVID measures, including

• Nearly $670 million in advance payments were made to NDIS providers at the start of the pandemic to ensure continuity of services to participants and their workforce;

• Engagement of a national provider to offer centralised support on workforce issues, and assist with advice on best practice in relation to Covid infection control.
• The NDIA has also supported participants, where appropriate, to work with their providers to access some supports and services through telehealth, to reduce risk of exposure to COVID-19.
• Sharing of data with states and territories to ensure continuity of supports.

The second point is particularly interesting – where on earth is this workforce support? It appears to be a reference to the participant contingent care support services program that will provide workforce guidance for providers and additional workers, “if available.” Alas, there is a catch – this program is only available to supported independent living (SIL) providers and presumably (though this is not 100% clear) only for the delivery of SIL supports, which excludes the overwhelming majority of NDIS participants. 

See also: Meeting workforce challenges by Rob Woolley

The NDIA also said that participants can access the following COVID supports, many of which have been in place since early in the pandemic:

• PPE (if reasonable and necessary).
• One-off deep cleaning if a support worker tests positive.
• Cleaning and high intensity supports for SIL participants.
• Meal preparation and delivery for eligible participants until 28 February 2022.
• More flexibility on low-cost AT.

On January 24th, the NDIA also announced that participants can use their Core funding to purchase RAT tests for themselves or their support workers, if they are necessary to receiving reasonable and necessary support.

There are also payments available to eligible providers to support participants and workers to get vaccinated and boosted.

See also: Information Guide for Participants by Todd Winther

Rules around disability workers and close contacts

The rules around workforce and close contacts seem to be changing every five minutes, so providers also need to ascertain whether their support workers can legally do a shift. On 13 January, the National Cabinet agreed that disability support workers and other essential workers who are close contacts can continue working if they:

• are asymptomatic.
• obtain a negative RAT test on day one and every second day until day six (thus the biggest challenge is sourcing RATs).

However, staff are only allowed to go to work. Outside of work, they must quarantine until getting a negative test on day six or seven. So, they still can’t go to parties or for a drink at a mate’s house.  

While this is certainly one way to deal with the workforce crisis, I can’t imagine many people with disability who are vulnerable to serious illness will be thrilled by the idea of receiving support from people who have recently been close contacts. As always, keeping open lines of communication will be crucial in these circumstances.

Going on a RAT hunt

Finding and funding RATs remains one of the sector’s biggest challenges. Disability service providers are competing with other industries for the limited supply of RATs, not to mention the 25 million people across the country, many of whom are desperate to get their hands on some.

If you do manage to obtain a RAT, there are a couple of funding options available for people with disability. NDIS participants can claim from their CORE budget for RATs for themselves or a support worker, if the test is necessary for the delivery of a service. SIL providers can claim up $12.50 for a test that is necessary for the delivery of a support. The National Cabinet has also agreed that concession card holders can access up to 10 free tests over three months. However, that avenue will not be available until 24 January.

Providers’ legal responsibilities

We also put questions to the NDIA about the legal responsibilities of providers. The Quality and Safeguards Commission responded that “Registered NDIS providers are responsible for ensuring they have plans in place to ensure business continuity and continuity of critical supports for participants, including during the COVID-19 pandemic.” It also directed providers to support material on its website and to the Emergency and Disaster Management Practice Standard. 

Importantly, if the COVID pandemic substantially impacts a provider’s ability to continue to deliver services, the provider needs to notify the Commission using this form. 

See also: Quality and Compliance Obligations by Rob Woolley

See also: Contractor Legal Obligations by Jess Quilty

Resources to get you through

 When governments fail to step up to a challenge, it is up to the rest of us to make a bad situation work. But we’re all exhausted and stretched to the limit at the moment. Thus, it is more important than ever to lean on the resources that some amazing people have developed to support you:

• Late last year, a group of top-notch Support Coordinators published a kit of COVID resources that we cannot recommend highly enough. It includes a practical checklist, tools for record keeping, state-based emergency information, and more. While it is targeted at Support Coordinators, many of the resources will be useful for all providers.

• The Growing Space has developed a guide to making a Covid Ready Kit for NDIS participants.
• DSC has made our support worker Supporting People to Stay Infection Free and Safe Waste Management eLearning modules available for free. 

• IDEAS has collated a bunch of Easy Read Resources on COVID-related topics.
• The Black Dog Institute has developed free resources to help people manage stress and anxiety during COVID.

• Now is a good time to support people in developing a health passport for hospital visits. There are a number of resources available to help with this, many of which have been collated by the Summer Foundation  and IDEAS. Hospitals probably won’t care what template you use, and some of the options include:§  Admission 2 Discharge resources.§  Julian’s Key Trial by the Government of Queensland.§  The Government of South Australia developed a My Health Information template. It has been taken off the website, but you can still find it on the Growing Space's page. §  Bendigo Hospital’s passport.§  The Department of Health’s Companion Card Information Sheet.

Provider of last resort, wherefore art thou?

It’s hard to know how to end an article about COVID without resorting to platitudes like “stay safe out there” that we are all completely sick of. So instead, let’s finish on a rant about provider of last resort.

To be fair on the NDIA, it can’t make a workforce appear out of thin air, certainly not one that is properly trained with the appropriate security checks. What all this highlights is the need to plan ahead, to assume there will be a crisis (particularly when a global pandemic was declared over 18 months earlier), and to put appropriate measures in place.

Since the NDIS’s inception, the NDIA, the Commonwealth government, and states and territories have been consumed by a game of “bags not me” when it comes to provider of last resort. While this is impacting all of us now, many participants have long been feeling the effects of the absence of a back-up option for when the market can’t or won’t deliver a support. What COVID has highlighted is that provider of last resort can no longer be treated as a niche issue. It is essential to the health and safety of nearly all NDIS participants.