When an NDIS participant is hospitalised, questions often arise about whether the NDIS will cover the costs of additional support services during their stay. Understanding the distinctions between the responsibilities of the NDIS and the health system is crucial to managing expectations and ensuring that necessary support is provided.
Case Scenario: Jordan’s Concern
Jordan, an NDIS participant, needs to undergo surgery and is worried that the hospital staff may not be adequately equipped to manage his disability support needs. He requests funding from the NDIS for a support worker experienced with his disability to assist him during his hospital stay.
Would the NDIS Fund This?
In general, the NDIS would not fund a support worker for Jordan while he’s an inpatient at a hospital. The reason is that the support Jordan needs is more appropriately provided by the health system. Hospitals have a universal service obligation to provide care to all patients, including those with disabilities, and they must also make reasonable adjustments as required under disability discrimination law.
Why Wouldn’t the NDIS Fund This?
The NDIS has specific criteria to determine whether a support is considered reasonable and necessary. Typically, the NDIS funds supports that assist participants with everyday tasks they cannot perform due to their disability. However, when it comes to healthcare, the NDIS generally does not fund supports that are more appropriately provided by another service, such as the health system.
Hospitals are responsible for the care of patients, including those with disabilities. This includes tasks such as showering, bed transfers, and pressure care. The NDIS does not cover services that aim to improve the health of Australians, such as:
- Allied health services (including acute and post-acute services)
- Care in public and private hospitals
- Pharmaceuticals (medications)
- Preventative health measures
- Universal healthcare entitlements
Additionally, hospitals are required to make reasonable adjustments to accommodate the specific needs of patients with disabilities. For example, if a patient requires additional pressure care or assistance with showering due to their disability, the hospital is responsible for providing this care as a reasonable adjustment.
What Else Does the NDIS Consider?
When determining whether to fund a support service for an NDIS participant in the hospital, the NDIS considers several factors. One key consideration is that the NDIS cannot fund supports that might cause harm to the participant or pose a risk to others.
Hospitals are responsible for managing the care of patients, and support workers may not have the training or authorisation to operate hospital equipment or adjust support routines in response to changing care needs. This could potentially result in inappropriate care or safety risks for both the participant and the support workers.
While the NDIS does not typically fund support workers to assist participants during a hospital stay, it may consider funding reasonable and necessary supports to:
- Provide guidance and training for hospital staff working with participants who have challenging behaviours.
- Offer specific training to hospital staff to help them communicate with participants who have complex communication needs.
Case Example: Peta’s Hospital Stay
Peta, a 22-year-old with cerebral palsy, requires full physical assistance for all care, including the use of a hoist for transfers and the use of a communication device due to her nonverbal status. Peta lives with her parents but needs to be hospitalised for two weeks for an ankle operation. Concerned about her vulnerability and communication challenges, Peta and her parents request additional NDIS funding for 24/7 support assistance during her hospital stay.
NDIS Decision-Making Process
To assess whether funding for Peta’s hospital support assistance is reasonable and necessary, the NDIS planner evaluates the request against the NDIS Funding Criteria, considering the following:
- Appropriate Funding Source: The NDIS considers whether the support should be provided by the NDIS or through other service systems. In Peta’s case, the planner determines that the hospital, under its universal service obligation, is responsible for providing the necessary care, including making reasonable adjustments to meet Peta’s disability needs.
- Value for Money: The planner evaluates whether the requested support represents value for money, considering the costs of the support versus the benefits achieved and compared to the cost of alternative supports. Since the hospital is already obligated to provide the necessary care, funding additional support would not represent value for money.
- Risk Considerations: The planner assesses whether the support might pose a risk to Peta or others. In this case, Peta’s support workers may not be trained or authorised to provide care in a hospital setting, especially post-operatively. This could create risks for Peta and the support workers.
Based on these considerations, the NDIS does not approve funding for Peta’s 24/7 hospital support assistance. Instead, the planner suggests alternative supports that Peta can use her existing NDIS funding for, such as:
- Having her support coordinator connect her care provider with the hospital to discuss her specific disability support needs (e.g., sharing her care plan or communication plan).
- Providing training to hospital staff to help them communicate with Peta due to her complex communication needs.
- Conducting an assessment of Peta’s care needs to develop and share care plans (e.g., 24-hour positioning plan, continence care) with hospital staff.
Key Takeaways
Understanding the boundaries between NDIS funding and health system responsibilities is crucial when navigating support services for NDIS participants in hospital settings. The NDIS focuses on funding supports that help participants with everyday tasks related to their disability. However, when it comes to healthcare, the health system generally bears the responsibility for providing necessary care, including making reasonable adjustments for people with disabilities.
NDIS participants and their families should engage with hospitals and health services to ensure that reasonable adjustments are made to accommodate disability-related needs during a hospital stay. In situations where additional support is needed, participants can explore using existing NDIS funding to coordinate care and provide necessary training to healthcare staff.
For more detailed guidance, participants can refer to the NDIS Operational Guideline on Disability-Related Health Supports and the NDIS Guideline on Reasonable and Necessary Supports. These resources provide valuable insights into how the NDIS assesses funding requests and what supports are considered reasonable and necessary.
In summary, while the NDIS plays a vital role in supporting participants with their disability-related needs, it is essential to understand that healthcare, particularly in hospital settings, falls under the responsibility of the health system. By working collaboratively with both the NDIS and healthcare providers, participants can ensure they receive the appropriate care and support during their hospital stay.
