The National Disability Insurance Scheme is a new era in the way people with disabilities are supported across Australia. The structure 'supports' for each individual focuses on their goals. 'Goals' determine the activities participants want to engage in and how they want their lives to look like. While a small number of people with disability need care (usually referred to high needs - assisting with bathing, toileting, feeding, communication, medications, budgeting, behavioural and household management.) the majority of participants only need assistance with some areas of daily living such as housework, communication and medication.
By focusing on ability not disability, we are moving away from a system of 'care' to a system where families and individuals are fully engaged in the planning of their 'supports'. Some individuals will be able to engage at higher levels than others; and some will need the support of family, (unpaid) carers and guardians. Where a person is under the adult guardian then the ndia will most likely manage their plan.
Every plan starts with participants and their families choosing their ndis goals; In day to day language, this is 'the activities they want to engage in' The plan also decides who will be responsible for ensuring the participants plan is administrated correctly. This will either be the person themselves, a third party or the ndia. Regardless of how the plan is administrated the participants all have the same choices when it comes to their support structure; support providers; suppliers; therapists, programs, early intervention and support workers.
Unless a person is living in full time supported accommodation government agencies (or providers) are no longer responsible for 'the care' of a participant. In many cases the terms 'care' and 'duty of care' are being confused. While both terms have a legal responsibility attached to show 'due care' at all times and undertake risk management procedures, only those under taking a 'care/guardianship role' can make decisions on behalf of participants.
All others providing supports or guidance to individuals with disabilities must show 'due care'. Let us explore one example of how service providers must show 'due care'. As part of my ndis plan I access physiotherapy, recently I had a fall and injured my hand. Before continuing on with my exercise program my phyiso required medical clearance from my GP. This required an x-ray. Neither my GP or physio have made any decisions on my supports, they can only guide and support me to achieve my ndis goals.
I may need further tests before together we come up with an action plan to achieve my goals. Both have met their legal requirements under their respective duty of care. So those employed in the disability sector need to ensure their 'duty of care' policies are around risk management and not decision making. This is a difficult transformation to make.
In the main, front line workers are referred to as key workers; support workers; lifestyle support workers or personal care attendants. The general community and some in the disability sector still refer to these employees' as 'carers'. While some aspects of 'care' may be required by participants and families, such as personal care, financial or medications supervision. These staff are still not 'carers' in the traditional sense of the word.
The ndis nor refers to a participants 'support network' in terms of 'informal supports' and 'formal supports'; both types of supports have a role to play in enabling and empowering participants to achieve their goals. Here we have another change in the front line workers role. We have moved away from having a care giver role to one of enabling people with disabilities to do what they can.
For me through physio and medication I am now able to walk unaided again. Previously support workers have encouraged me not to walk to prevent falls. However in terms of osteoporosis we know weight bearing exercise is in my best interest. The ndis takes a more proactive approach to long term disability support. In the main the disability sector struggles with these concepts.
My supports look very different to what they looked like pre-ndis. I now directly engage my support workers and self-mange my ndis plan through a plan manager. The role of a plan manager is not to decide who supports me; what aids I will purchase from a given supplier, but pays my invoices on my behalf and assists with reporting to the ndia. This is something most providers do not understand and filters down to services and suppliers who support me.
This relates back to how the ndis views 'supports' as 'informal supports' and formal supports. "Informal supports" are usually provided by family members, guardians and friends. These are natural supports we all have. They may come through school friendships; fellow students; work collages; sporting or social groups or business relationships. In the main our informal supports are unpaid.
However a participant may have a member of their informal support group who has a legal care role in their life. This is usually a parent or a sibling but not always. These care givers are either 'carers and/or legal guardians', who have legal responsibilities in decision making on behalf of the participants. Not all participants will have carers or guardians as they move in to adulthood. People with disabilities who do not require care or legal support are known as 'self-carers'. This is another term the general community struggles with.
Not only am I a self-career but I also run a small business and book keeping, paying invoices and wages is part of my work day. Thus the ndia decided I could self-manage my plan with minimal risk to my well-being and themselves. This is the type of risk management ndis support providers still see as their role.
Much of this 'risk management' is more about ensuring their own survival and economic security in a market driven environment, without clients or participants direct service providers have no income. So many are still struggling to find that balance. Part of the answer was attaching quotes to service agreements. A service agreement spells out the rights and responsibilities of both parties. The quote then forms part of ndis plan budget and a service booking is made ensuring the participant has the funding to pay for the services to be provided under that agreement.
When a service agreement is worth tens of thousand of dollars this is understandable. However where this involves a amount under $100 then neither the participant or provider/supplier want the effort of a service agreement, but my wheelchair tires still need replacing. Like many people who self-manage a issue arises when a provider can not put the invoice through the ndia portal and the participant is reliant on a planner to pay. I found out the hard way that a planner can withhold funds, even when there is over $100 000 sitting in my plan.
These are the daily frustrations of those who self-manage. Providers want us to make payments under their terms and conditions. Their need to self-protect and protect participants leaves participants without equipment and supports or out of pocket.
Where providers that managed risks they too experience delays in payment for services. It is hard to get your head around how in an electronic age of money transactions that a payment or an invoice can take months. A more transparent way to undertake translations is needed. The first time I know of a problem is when an unpaid invoice turns up in my inbox.
All others providing supports or guidance to individuals with disabilities must show 'due care'. Let us explore one example of how service providers must show 'due care'. As part of my ndis plan I access physiotherapy, recently I had a fall and injured my hand. Before continuing on with my exercise program my phyiso required medical clearance from my GP. This required an x-ray. Neither my GP or physio have made any decisions on my supports, they can only guide and support me to achieve my ndis goals.
I may need further tests before together we come up with an action plan to achieve my goals. Both have met their legal requirements under their respective duty of care. So those employed in the disability sector need to ensure their 'duty of care' policies are around risk management and not decision making. This is a difficult transformation to make.
In the main, front line workers are referred to as key workers; support workers; lifestyle support workers or personal care attendants. The general community and some in the disability sector still refer to these employees' as 'carers'. While some aspects of 'care' may be required by participants and families, such as personal care, financial or medications supervision. These staff are still not 'carers' in the traditional sense of the word.
The ndis nor refers to a participants 'support network' in terms of 'informal supports' and 'formal supports'; both types of supports have a role to play in enabling and empowering participants to achieve their goals. Here we have another change in the front line workers role. We have moved away from having a care giver role to one of enabling people with disabilities to do what they can.
For me through physio and medication I am now able to walk unaided again. Previously support workers have encouraged me not to walk to prevent falls. However in terms of osteoporosis we know weight bearing exercise is in my best interest. The ndis takes a more proactive approach to long term disability support. In the main the disability sector struggles with these concepts.
My supports look very different to what they looked like pre-ndis. I now directly engage my support workers and self-mange my ndis plan through a plan manager. The role of a plan manager is not to decide who supports me; what aids I will purchase from a given supplier, but pays my invoices on my behalf and assists with reporting to the ndia. This is something most providers do not understand and filters down to services and suppliers who support me.
This relates back to how the ndis views 'supports' as 'informal supports' and formal supports. "Informal supports" are usually provided by family members, guardians and friends. These are natural supports we all have. They may come through school friendships; fellow students; work collages; sporting or social groups or business relationships. In the main our informal supports are unpaid.
However a participant may have a member of their informal support group who has a legal care role in their life. This is usually a parent or a sibling but not always. These care givers are either 'carers and/or legal guardians', who have legal responsibilities in decision making on behalf of the participants. Not all participants will have carers or guardians as they move in to adulthood. People with disabilities who do not require care or legal support are known as 'self-carers'. This is another term the general community struggles with.
Not only am I a self-career but I also run a small business and book keeping, paying invoices and wages is part of my work day. Thus the ndia decided I could self-manage my plan with minimal risk to my well-being and themselves. This is the type of risk management ndis support providers still see as their role.
Much of this 'risk management' is more about ensuring their own survival and economic security in a market driven environment, without clients or participants direct service providers have no income. So many are still struggling to find that balance. Part of the answer was attaching quotes to service agreements. A service agreement spells out the rights and responsibilities of both parties. The quote then forms part of ndis plan budget and a service booking is made ensuring the participant has the funding to pay for the services to be provided under that agreement.
When a service agreement is worth tens of thousand of dollars this is understandable. However where this involves a amount under $100 then neither the participant or provider/supplier want the effort of a service agreement, but my wheelchair tires still need replacing. Like many people who self-manage a issue arises when a provider can not put the invoice through the ndia portal and the participant is reliant on a planner to pay. I found out the hard way that a planner can withhold funds, even when there is over $100 000 sitting in my plan.
These are the daily frustrations of those who self-manage. Providers want us to make payments under their terms and conditions. Their need to self-protect and protect participants leaves participants without equipment and supports or out of pocket.
Where providers that managed risks they too experience delays in payment for services. It is hard to get your head around how in an electronic age of money transactions that a payment or an invoice can take months. A more transparent way to undertake translations is needed. The first time I know of a problem is when an unpaid invoice turns up in my inbox.
We know good business relationships are built on open communication, in a market driven economy when communication brakes down customers take their business elsewhere. This is something the disability sector can learn from the business sector. Everyone makes mistakes and their is nothing wrong with admitting to them. Its when you deliver excuses or try to cover up errors that business relationships breakdown. Where there are service agreements and penalties if participants op out, they feel trapped and controlled.
Under a system designed to focus on the participants anytime a provider or supplier puts their needs before providing due supports rists in a breakdown of ndis principles. This is not the ndis fault but a sectors determination to keep control. The challenge to all of us is are we able to communicate openly and honesty to try each other to make transactions in a honest manner. If we are not the system will again fail those it was designed to support.
This is such a well written article and describes what is happening now and where faults lie. It also points out how well this new system can work if everybody understands the participants have a right to having full choice and control. Thsnks for this great article
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