Support for disability care

The COVID-19 initial assessment and management pathway includes information about vulnerable risk factors. This pathway is part of the COVID-19 suite of pathways.

Need a login? Request access here or contact info@healthpathwaysmelbourne.org.au

The Australian Department of Health has established the COVID-19 Health Professionals Disability Advisory Service.

Health professionals can access this service by calling 1800 131 330 from 8:00am to 9:00pm, Monday to Friday.

The service provides specialised advice to health professionals responsible for the medical care of people with disability diagnosed with COVID-19 or experiencing symptoms.

This service is in place until 17 November 2020.

The Commonwealth Department of Health has published the following fact sheet:

• Fact sheet: Information for primary health care services supporting people with disability

This fact sheet provides information and guidance for primary health care staff and services, including GPs, who are providing care to people with intellectual or developmental disability during the pandemic.

People with disability may prefer to be tested at home due to impaired mobility, social anxiety, or difficulty travelling to you or other testing services. If these patients want to get tested at home, they may be able to access the Victorian Department of Health and Human Services (DHHS) Call-to-Test service:

Accessing the service

People with disability and their carers can:

• Call DHHS on 1800 675 398 and select Option 9.
• Alternatively, call the Disability Information Helpline on 1800 643 787 and explain that they need an at-home test.

More information

• DHHS: Call-to-Test service
• Easy Read information for patients

According to the Australian Human Rights Commission’s Guidelines on the rights of people with disability in health and disability care during COVID-19:

• nearly one in five Australians have a disability (around 4.4 million people)
• prevalence of disability increases with age. Around 3.7 per cent of children aged 0-4 have a disability, and this increases to 84.6 per cent of people aged 90 years and over
• the NDIS provides funding to support eligible people with permanent and significant disability – around 460,000 Australians.

The statistics are clear: most GPs will regularly see patients who have disability. These include physical, sensory and intellectual disabilities, as well as psychosocial disabilities arising from a mental health condition.

The Australian Human Rights Commission has published an easy read version of its guidelines. These documents include practical examples and are recommended reading for anyone who cares for people with disabilities, including GPs, nurses and disability support workers.

The guidelines highlight:

• that it may be necessary to treat people with disability differently to those without disability and to acknowledge their differences (rather than ignore them). Care providers need to make reasonable accommodations to enable equality of opportunity – not merely equality of treatment
• that people with disability experience significant disadvantage in accessing health services for many reasons, including unconscious bias and communication barriers. Delayed diagnoses and misdiagnoses of health problems can occur when health professionals make assumptions that a patient’s symptoms are related to their disability, rather than exploring alternative causes.

Disability care is a broad area that includes physical, sensory and intellectual disabilities, as well as psychosocial disabilities arising from a mental health condition. There are many relevant pathways on HealthPathways Melbourne that can be found using the search function. Key pathways include:

• Health assessment for people with an intellectual disability
• National Disability Insurance Scheme
• Early Childhood Early Intervention
• Disability parking
• Carer resources and support services
• COVID-19 initial assessment and management
• Orthotics referrals
• Community transport
• Multi-purpose taxi program
• Special needs dentistry referral
• Disclosure of domestic and family violence
• Developmental concerns in school children (not adapted for Melbourne)
• Intellectual disability in adults – genetics (not adapted for Melbourne)

Need a login? Request access here or contact info@healthpathwaysmelbourne.org.au

People with disability are at increased risk of poor mental health, abuse and violence during COVID-19. This is due to increased social isolation, potential disruption of services and support groups, and anxiety and stress.

The following services and resources are available:

• View mental health services available in the North Western Melbourne Primary Health Network region during COVID-19
• Australian Department of Health: Information for health and mental health workers supporting people with disability
• Victorian Department of Health and Human Services: Mental health resources
• Counsellors are available on the Disability Information Helpline, which helps support people with disability during COVID-19
• Psychosocial Support Services and services available through the NDIS (see below)

As vulnerable members of our community, people with disability are at increased risk of abuse and violence at home and during care. This is especially true during COVID-19, which has meant increased time spent at home with family and increased stress within the home.

People have also been unable to leave home due to restrictions and reduced privacy may mean they are unable or unwilling to reach out for support. GPs should be conscious that assessing domestic violence through telehealth is difficult because they can’t be sure who else is around during the telehealth conversation.

The following services and resources are available:

• HealthPathways Melbourne: Family violence assessment and referral information
• North Western Melbourne Primary Health Network: Family violence
• 1800RESPECT: Information about violence against people with disability
• 1800RESPECT: The Disability support toolkit provides frontline workers with resources to help support people with disability who have been affected by violence and abuse
• RACGP White Book: People with disabilities (including abuse and violence)
• Relationships Australia Victoria: Disability Counselling and Support for people who have experienced violence, abuse, neglect and exploitation, and those affected by the Disability Royal Commission

The National Disability Insurance Scheme (NDIS) is a new way of providing individualised support for people with permanent and significant disabilities. People need to meet certain eligibility requirements to qualify for support under the scheme. Examples of disability given by the NDIS include physical disability, intellectual disability, and functional impairment resulting from a mental health condition.

The NDIS aims to provide support that fulfils each individual’s needs, such as home modifications, personal care, mobility aids and development of skills to help a person become more independent. It will also fund allied health and other therapy needed because of a person’s disability (such as behavioural therapy or speech therapy) but it is not intended to replace health or other public services.

GPs can assist by identifying patients who are likely to be eligible for the NDIS, directing them to current NDIS information and supporting them to apply. GPs can provide crucial evidence for patients’ access request forms when they apply to join the NDIS.

The Brotherhood of St Laurence is both the Early Childhood Early Intervention partner (for children 0-6 years old) and the Local Area Coordinator (for people over 7 years old) for the north western Melbourne region. The Brotherhood’s role is to work with individuals with disability to identify their support needs, apply to the NDIS, develop and use their NDIS plans, and link them to support and services.

Note that many people with disabilities are unable to access NDIS support as they may not meet the strict requirements (there are an estimated 4.4 million Australians with a current disability; around one in 10 are supported by the NDIS).

• HealthPathways Melbourne: NDIS
• More information about the NDIS and the GP’s role is available on our website
• RACGP guide for GPs to support their patients accessing the NDIS
• Design for life – Journal article about the GP role in helping patients access the NDIS
• Practical NDIS resources developed by GPs

New Psychosocial Support Services are now available and can provide functional support to people with severe mental illness who are ineligible for NDIS services. These services are commissioned by North Western Melbourne Primary Health Network (NWMPHN) with funding from the Australian Department of Health.

Psychosocial Support Services can assist people to participate in their community, manage daily tasks, secure stable employment and housing, and connect with family and friends. They can help support people who are not eligible for NDIS supports.

Psychosocial Support Services use an evidence-informed, non-clinical approach. They provide support at the times when it is most needed and are flexible, timely and assist recovery. The length of support can range from eight weeks to a maximum of 12 months. Services can be one-to-one or group support. There is no requirement for a person to have a mental health plan.

Support can include the development of learning strategies and skills to help a person:

• identify their strengths
• build resilience
• achieve their goals
• find people to help them improve their wellbeing
• connect with family or their community
• improve their physical health
• enjoy a full and vibrant life.

To be eligible for our Psychosocial Support Services a person must:

• live, work or have connections to the North Western Melbourne Primary Health Network region
• experience severe mental illness
• not be supported by the NDIS through an Individual Funded Plan
• not be receiving supports through the state-funded Early Psychosocial Intervention Support Response (EIPSR) or be clinically case-managed through Area Mental Health.

Anyone can refer to the service, including GPs. People can also self-refer.

See ‘Providers’ below for information on how to refer.

The following organisations provide Psychosocial Support Services in the North Western Melbourne Primary Health Network region:

Neami National provides services in northern Melbourne, including the local government areas of Darebin, Hume, Moreland, Yarra, Melbourne, Moonee Ponds and Macedon Ranges.

Contact number: 1300 052 588
Referral form

More information is available on the Neami National website.

cohealth provides services in western Melbourne, including the local government areas of Brimbank, Melton, Maribyrnong, Wyndham, Moorabool and Hobsons Bay.

Contact number: 03 9448 6880
Referral form

More information is available on the cohealth website.

Visit our System of Care search tool for more information on Psychosocial Support Services and other mental health services.

This includes ensuring you have:

• accessible car-parking spaces
• doorways wide enough to allow wheelchair access
• ramps/lifts/single-storey facilities
• accessible toilet facilities
• appropriate infection control procedures that still allow people to use mobility aids if needed.

Also consider supporting patients to access community transport or multi-purpose taxi programs if eligible.

This means ensuring you have:

• a wide range of times available and/or longer opening hours which suit both the patient and their carer or support person if they have one
• ‘double’ appointments to ensure that complex needs can be explored and to allow people enough time to communicate their story
• a choice of in-person, telephone and telehealth appointments.

For telehealth, note that:

• • Medicare subsidies for telehealth have been extended until 31 March 2021
  • each person is different and has different needs
  • those with mobility issues or anxiety about being out in public may prefer telehealth appointments
  • others, such as people with cognitive or communication impairments, may not be suited to a telehealth-type setting. See below for more information on telehealth consultations for people with disability.

Keep the following in mind when using telehealth or virtual consultations to manage patients with disability.

Assessment

Consider if your client can interact safely in this medium. Consider:

• suicide/mental health risk (for example – if the patient becomes distressed and hangs up)
• physical conditions
• if family violence is present, and if the perpetrator could be in the area, where the patient is having telehealth contact.

Access

Consider everything needed to interact technically in a telehealth consultation, including:

• access to a private space
• Wi-Fi, a working device and enough data
• computer literacy
• spyware not installed on their device (if in a family violence situation).

Availability

Assessing availability needs to be done as part of an initial assessment, but also needs to be performed on a per-session basis.

Preparation prior to session

When preparing for a telehealth or virtual consultation:

• think about things like the privacy of your space, especially if you are working from home
• check the settings of your telehealth software and turn off things you don’t want to use
• ensure the meeting is not being recorded
• if you share your screen, make sure you don’t have private information displaying.

Beginning and during a session

When starting a session:

• check you are talking to the intended client
• check their environmental safety (for example, make sure they are not driving).

Remember that telehealth and especially virtual consultations can be fatiguing. Consider making the session short. It’s likely you will also have to ask more questions, as you can’t rely as much on visual cues —especially over the phone!

Ending a virtual consultation

• Ensure that you end the meeting for all participants: don’t just leave the meeting yourself.

A decision tool is available to help clinicians and consumers decide together when telehealth is a safe and effective option for care. The tool was developed in partnership between the Victorian Department of Health and Human Services and clinical experts and is suitable for all primary health care providers. It is available on the Safer Care Victoria website.

• Appropriate use of interpreters, including Auslan for those who are deaf or hard of hearing. It is important not to make assumptions about a person’s ability to ‘get by’ without the use of interpreters. Informed consent is a duty of care issue. Visit HealthPathways Melbourne for more information on interpreter and translation services.
• Availability of printed information, including information in languages other than English, information in Easy Read and pictorials.
• You may need to take more time to explain something. Consider the best way to communicate with your patient if they have a different way of communicating.
• Use the teach-back method to check if someone has understood something:
  • This resource is specifically about using teach-back with interpreters, but it also explains what teach-back is
  • This video has a demonstration of the teach-back method

• Clear signage
• Well-trained staff who understand the needs of people with disability
• Friendly attitudes
• Allowing people enough time, and trying not to rush people through appointments
• Making patients feel important, listened to and respected
• Accommodation of certain needs. For example: providing a separate quiet area (where possible) to someone with disability who suffers from anxiety in busy unfamiliar spaces, or allowing a family member to accompany them as their support person.

• Consider making medicines easier to access. For example: by sending a digital script straight to the pharmacy after a telehealth consultation.
• Ensure you help transmit health information to others involved in COVID-19 prevention, testing and treatment if necessary, and if given patient consent.

The following resources will help primary care providers support people with disability during COVID-19.

• 1800RESPECT fact sheet: Working with people with disability

Supported Residential Services are privately operated residential homes where people with disability receive accommodation and support for daily activities.

Residential care includes group homes and respite services, usually with fewer than six residents, and Supported Residential Services that accommodate 10–80 residents.

The potential for COVID-19 to spread in these facilities and cause outbreaks and associated poor health outcomes is high, similar to the potential in residential aged care facilities. This is due partly to:

• communal living
• the requirement for close contact with personal care workers who support residents with daily living activities such as feeding, bathing and getting dressed
• a highly mobile workforce of personal care workers, who come into contact with vulnerable people across homes and services.

In addition, some people with disability have other chronic conditions or weakened immunity, making them vulnerable to severe COVID-19.

People with disability may also face difficulties implementing safety measures such as social distancing and wearing a mask, and basic hygiene such as washing hands.

The Victorian Department of Health and Human Services has a strategy in place that involves assessment of local Supported Residential Service providers by community health services (cohealth and IPC Health). This involves the review of systems and procedures and planning for a safe environment for residents should a COVID-19 outbreak occur. Planning involves infection control, prevention and preparedness strategies, outbreak management plans and recovery plans.

The aim is for residents to be able to remain in their home if they need to quarantine and self-isolate, unless they need to move for health reasons. However, relocation and repatriation of clients may be required in some circumstances. This is due to the complexity of the client cohort, as well as difficulties presented by shared facilities and the capacity of providers to prevent and respond to COVID-19 outbreaks.

This template assists with recording the needs of individual residents. It may be shared with services involved with working with the facility to prevent and respond where residents are exposed to COVID-19.

• Supported Residential Services – COVID-19 Resident Information (.docx)

We recommend the following courses for GPs:

• NDIS access and psychosocial disability for clinicians – developed by Transition Support Project
  • Aims to provide GPs with knowledge about the role of clinicians in identifying people who are likely to be eligible for NDIS support, and how to provide helpful evidence to support their application.
  • This training takes 30-40 minutes to complete.
• GP clinical audit to improve the assessment and management of behaviours of concern in people with intellectual disability
  • Takes 6 hours
  • Qualifies for RACGP QICPD Category 1 = 40 points

The following webinars are available to watch on demand:

• Navigating delayed childhood development, ASD and ADHD (15 August 2020)
• Hearing loss, cognitive impairment and hearing aid solutions (delivered by Royal Victorian Eye and Ear Hospital – 16 June 2020)
• Sudden loss of vision (delivered by Royal Victorian Eye and Ear Hospital – 18 August 2020)
  

The RACGP has a Disability Special Interests Group. Visit the RACGP website for more information on joining the RACGP to gain free membership of this group.

The following resources and support are available for disability support workers in the NWMPHN region during COVID-19:

DHHS: Disability services sector

This page includes information for people working in disability residential services and people who work in the community. It also includes information about PPE.

DHHS: Community services

This page includes:

• eLearning for community service workers including disability support workers. There are three free short (20-minute) eLearning courses available about staying safe from COVID-19including:
  • COVID-safe for residential carers
  • PPE for community workers
  • use of P2/N95 masks.

• PPE for providers of Supported Residential Services and disability group homes (how to use PPE, how to request it, and FAQs)
  Engaging interpreters during COVID-19 if the client speaks another language.

Australian Department of Health: COVID-19 resources for disability services