Disability care

Types of disability

Assessing range of function

Communication difficulties

 

• Find out how your practice accesses interpreters. Language interpreter services are free across Australia: the patient needs to be registered, which you should talk through with your registrar as a process. b) Sign language interpreter services are not free: the patient needs to apply to the NDIS to access (and pay through their NDIS plan for) sign language interpreters, which can be quite an expensive service and cannot be easily arranged at short notice. There is a National Relay Service that does video consults, but that’s of more relevance to Telehealth than in-practice consultations.
• Ask the patient how they prefer to communicate. a) Carers might have strategies to help with communicating, especially with non-verbal patients. b)Remember that many deaf people are very skilled at lip reading, but don’t assume.
• Speak as they would to anyone else of that age and gender.
• Speak directly to the patient.
• Use appropriate volume.
• Observe for verbal and non-verbal cues.
• Listen
• Check they have been understood
  NOTE: Masks with clear plastic across the mouth are available to assist with lip reading – it is worth checking if these are on hand in your practice before seeing a patient with communication difficulties

The GP’s role in NDIS

The resources provided for GPs by the NDIS are readily available on the NDIS website.
•The GPSA Teaching Plan: Adults with Disabilities adds additional resources to these in a succinct, user – friendly format.

The NDIS role in patient’s disability care

Applying for the NDIS

When applying for their NDIS package and subsequent reviews / amendments, the patient needs to consider their needs in terms of three types of supports:

• Core – Supports enabling participants to complete ADLs, work towards their goals, and meet their objectives. eg: personal care assistance.
• Capital – Investments made to support participants, such as assistance technologies, equipment or home and vehicle modifications.
• Capacity building – Supports that enable participants to build their independence and skills, for example exercise physiotherapy.

These supports are viewed by the NDIS through the lens of their relevance to the participant’s stated goals and objectives, for example:

• To live independently.
• To develop meaningful relationships.
• To communicate better so they can buy their own groceries.

Tips for registrars helping new applicants with the NDIS process

1. Ask the patient to nominate them as their “Lead Health Professional”.
   – The GP will still never receive any reports, but
   – This does ensure that involved therapists can see who the GP is which can help with communication.
2. Always be very clear about how the patient’s condition affects their “functional ability”.
   – The NDIS is rejecting applications that include elements they think could be covered by a GPMP/ TCA or a hospital allied health program: it is crucial to make a clear distinction between the medical condition (not covered by NDIS) and how that medical condition is affecting the patient’s function and stopping them from achieving their objectives and living the best life possible.
3. Tell the patient to be specific and think as broadly as possible.
   – I.e. “wheelchair maintenance” and “measuring & fitting” for a new powered wheelchair can be >$30,000.

Providing the required evidence for NDIS

For each functional domain, the patient provides evidence of the disability and:

1. Impact and severity.
2. Patient capacity to manage.
3. The expected duration.
4. What your patient requires to manage their disability
   i.e. suggested equipment and supports.
5. If and how quickly your patient is deteriorating in their
   level of function.

NOTE: GPs can summarise, or attach existing medical reports, from specialists or allied health.

Writing for the NDIS

A useful tool to refer to when addressing the evidence needed to meet NDIS requirements, “GP Statement of Evidence”, can be found on the website of NDIS provider Inclusion Melbourne   NDIS providers have developed some really useful tools to aid the GP in translating their medical terminology into the language the NDIS needs at the other end.

If registrars detect and signs of abuse or neglect in their patients, below are some key contacts for referrals:

Complaints about an NDIS provider

• The Commissioner has the power to:
  – Request further information from a person or body
  – Apply for and execute search warrants to collect evidence as part of an investigation
  – Request compulsory attendance at meetings and the production of relevant documentation
  – Conduct a public enquiry if this is in the public interest.
  Following an investigation, further action may be taken. This could be making an application to a court or tribunal. The intention is always to improve the safety of the adult and uphold their rights.

Concerns about abuse or neglect:

• National Disability Abuse & Neglect Hotline
  1800 880 052
  “The Hotline works with callers to find appropriate ways of dealing with reports of abuse or neglect through referral, information and support. The Hotline will remain impartial – and does not take sides and does not advocate on anyone’s behalf.”
• Immediate concerns about violence or crime
  – Police – 000

Medical and social history registrars should  ask about

Health care checklist for an adult with developmental disability

Points for registrars to discuss with individuals living with a disability

While a health assessment for people aged 45–49 years (inclusive) who are at risk of developing chronic disease can be billed just once, a health assessment for people with an intellectual disability can be billed and done annually*.

Case conferencing teams must include a GP and at least two other health or community care providers, one of whom can be another medical practitioner. Each team member should provide a different kind of care or service to the patient.

*It is important to complete regular health assessments for patients living with a disability each year.

Example:

Billing per year for patient with an intellectual disability: