In earlier editions of PULSE,1 we have discussed the National Disability Insurance Scheme (NDIS) and its possible impact on the health industry. In this edition, we revisit the NDIS in light of recent Coroner’s Court findings relating to the death of a child with complex high needs whilst in respite care provided under the Home and Community Care (HACC) Program.2 The findings provide useful guidance for organisations planning for the commencement of the NDIS.

HACC and NDIS

HACC is jointly funded by the Commonwealth and Victorian governments. HACC services are provided to elderly and young people with moderate to profound disabilities.3 HACC services provide support and maintenance to people in the community who would otherwise be unable to care independently for themselves, enabling them to continue living at home.

The NDIS will be implemented from July 2019 and is anticipated to cover approximately 100,000 Victorians aged 0– 64.

Management of the HACC Program will be split from July 2015. Services for people aged 65 and over will be directly managed by the Commonwealth Government and services for people under 65 will be funded and managed by the Victorian Government until the NDIS is in full operation.

The case of Felix Hua

Felix Hua was a 14 year old child with severe autism, no functional communication and little understanding of what was going on around him.

He was primarily cared for at home by his family but commenced regular respite care after being assessed by the local council. His respite care was outsourced by the council under contract to a care organisation. The care organisation provided the majority of its services to the elderly, but also provided services to younger people with disabilities.

On 30 May 2009, while in respite care, Felix was left unsupervised for a short period of time. He wandered off and could not be found despite extensive local searches. His body was later found in a river only a short distance from where he was last seen. Cause of death was confirmed as drowning.

The Coroner identified a number of issues relating to Felix’s care which are applicable to other care organisations providing services under the HACC Program, or plan to provide those services through tender.

Learnings from the Inquest

The following take-outs from the Coroner’s findings may provide useful guidance for organisations which currently provide, or plan to provide, care services to both the elderly and young people under the NDIS:

  1. Organisations should ensure that manuals or the like include appropriate guidance and information relating to the complexities and differences in providing respite care to a child with a disability, as opposed to an elderly person requiring home or other personal care services.
  2. Organisations should review and ensure that their human resource governance structure includes checking mechanisms to enable timely identification of training needs or other problems.
  3. Organisations should review and consider staff competencies with reference to the clients with whom they work. Where a client presents with particularly complex, challenging or high level needs, specialist skills may be required in addition to the requisite basic set of skills. This may be comprised of formal education and qualifications such as a Certificate III or IV in disability care. The competency of staff members providing care to children with particularly high needs should be properly documented.
  4. Organisations should ensure that children with disabilities have regular review of their cases, particularly as they experience ongoing and predictable developmental changes which in turn, change their care needs and may also alter their risk assessment. If care is contracted to another service, the contractor should initiate the review.
  5. Where an assessment of risk is needed, the assessment process should be conducted by a properly informed and qualified risk assessor with the particular child’s needs in mind.
  6. Care organisations should be guided by the outcomes of the Community Care Common Standards quality review, which will occur in a three year cycle (currently due July 2014) and the updated HACC Program Manual. They should also keep abreast of developments during the transition to the NDIS.

Comment

Organisations that provide services under the HACC program must comply with its service standards. Where services are provided to both the young and the elderly it is essential to bear in mind that these are two very distinct client groups and policies and procedures need to adequately recognise this.

This brings significant challenges for organisations to ensure they do not fall short of expected standards. The onus is on organisations to ensure they have the capability to provide services to both client groups in a way that is targeted towards each service user’s needs.