1 Non CAEP Funded Assistive Equipment and Technology in Western Australia Project Report Background The Independent Living Centre of WA (ILC) is a non-government, not-for-profit, community based information and advisory service for people with disabilities and the frail aged, their families and carers. The service enables people to get information on and trial a range of equipment and assistive technologies. The ILC also informs consumers and others in the disability sector about the provision of equipment and funding options. The avenues for consumers to acquire equipment are diverse and varied and can be confusing. Similarly, opportunities to return and reissue equipment are often unclear and inconsistent. The ILC receives many requests from consumers who want to purchase second hand equipment or who want assistance to sell or otherwise dispose of equipment no longer needed. It is recognised that although equipment provided through the Community Aids and Equipment Program (CAEP) can be accounted for via e-CAEP, there is no equivalent system in place to track equipment funded from other sources. As the ILC believed that this situation warranted investigation, an application to Disability Services Commission (DSC) for funding was submitted. The ILC gratefully acknowledges the DSC for the Disability Industry Plan Seed Grant which subsequently funded this project. The project was carried out from February 2008 to January 2009. Purpose of Project ♦ To identify and seek agreement on the issues affecting the sector associated with provision of non CAEP funded equipment to consumers. ♦ To develop recommendations that will guide the sector’s future strategic planning in effective information pathways, systemic management and reissue of non CAEP funded equipment.
Transcript
1
Non CAEP Funded Assistive Equipment and Technology in Western Australia
Project Report
Background The Independent Living Centre of WA (ILC) is a non-government, not-for-profit, community based information and advisory service for people with disabilities and the frail aged, their families and carers. The service enables people to get information on and trial a range of equipment and assistive technologies. The ILC also informs consumers and others in the disability sector about the provision of equipment and funding options. The avenues for consumers to acquire equipment are diverse and varied and can be confusing. Similarly, opportunities to return and reissue equipment are often unclear and inconsistent. The ILC receives many requests from consumers who want to purchase second hand equipment or who want assistance to sell or otherwise dispose of equipment no longer needed. It is recognised that although equipment provided through the Community Aids and Equipment Program (CAEP) can be accounted for via e-CAEP, there is no equivalent system in place to track equipment funded from other sources. As the ILC believed that this situation warranted investigation, an application to Disability Services Commission (DSC) for funding was submitted. The ILC gratefully acknowledges the DSC for the Disability Industry Plan Seed Grant which subsequently funded this project. The project was carried out from February 2008 to January 2009.
Purpose of Project ♦ To identify and seek agreement on the issues affecting the sector associated
with provision of non CAEP funded equipment to consumers.
♦ To develop recommendations that will guide the sector’s future strategic planning in effective information pathways, systemic management and reissue of non CAEP funded equipment.
2
Project Methodology Mapping Of Existing Systems in Western Australia Information was obtained from ten organisations in WA during the first half of 2008 on equipment provided to consumers by funding other than CAEP. This information was gathered via face to face interview and/or by the completion of electronic templates. The templates listed different types of equipment and included questions regarding volume and location of equipment, funding sources, ownership and maintenance procedures. Systems Research Eastern States Information was gathered from organisations in other states and territories on models of practise in the provision of equipment. In the first instance, the relevant state government funded equipment scheme was identified for each state and territory and then some baseline information was obtained on the scope of each program. Organisations in each state that provide equipment in addition to the state government programs were identified and surveyed as to their equipment provision practices. When available, written samples of policies and practices were obtained. This part of the project was undertaken mid 2008. Sector Wide Consultation A sector consultation with wide representation of stakeholders was held at the ILC on November 12, 2008. The purpose of the consultation was to clarify and seek agreement on the issues associated with non CAEP funded equipment provision. An external facilitator was used to ensure objectivity and to assist the group to develop and prioritise recommendations for the future.
3
Mapping of Existing Systems in WA At the commencement of this project, organisations in the disability sector that provide equipment from funding other than CAEP were contacted and invited to participate. The ten organisations that agreed to participate were then surveyed to obtain information on what equipment they provided and how this was managed. Information was provided by the following organisations: ♦ Association for the Blind ♦ Rocky Bay Inc ♦ The Centre for Cerebral Palsy (TCCP) ♦ Nulsen Haven ♦ Multiple Sclerosis Society (MS Society) ♦ Motor Neurone Disease Association of WA (MNDAWA) ♦ Brightwater at Home service ♦ Silverchain ♦ Centre for Inclusive Schooling (CIS) ♦ Medical Physics and Engineering RPH The first six are disability specific, member organisations that primarily provide equipment to their members. Brightwater and Silverchain provide equipment when necessary as part of specific program delivery eg EACH packages, Palliative care. Similarly, CIS provides equipment for use at school by students with disabilities to enable them to participate in the education process. Medical Physics and Engineering RPH is a state-wide speciality service that encompasses Health Department, CAEP and other funding sources to provide assistive technology to meet communication and environmental control needs. Equipment Types The following types of equipment and assistive technology were selected for organisations to report on: ♦ Adjustable Beds – bed equipment and pressure relieving mattresses ♦ Manual Handling- including hoists, slings ♦ Mobility – walking aids and wheelchairs (manual and electric) ♦ Seating –specialised chairs, electric lift chairs ♦ Hygiene ♦ Communication ♦ Transport ♦ Small Aids – dressing and eating
4
Table 1: Types of Equipment Provided By Organisations in WA with Some Examples of Volume
Beds & Bed Equipment
Manual Handling
Mobility Seating Hygiene Communication Transport Small Aids <$100
Association for the Blind
35 video magnifiers
Rocky Bay
50 electric
beds
TCCP
Nulsen Haven
140 eating aids
MS Society
10 scooters
MNDAWA
10 electric
beds
36 electric lift chairs
Brightwater
Silverchain
133
alternating air overlays
CIS
120 mobile
hoists
Medical Physics RPH
5
Processes Asset Management and Tracking of Equipment Most of the organisations surveyed managed their equipment loans in house. Those that did not were Brightwater at Home services (BHS) which is fully outsourced (see below) and MNDAWA which is partially outsourced eg communication and environmental control items managed by Medical Physics and Engineering RPH.
Previously BHS purchased their own equipt for issuing but storage and cleaning of same were major problems. To address these issues, BHS contracted a supplier to provide a full equipment supply and asset management service. The BHS staff requests equipment for an individual client by email to the supplier. The supplier delivers requested item(s) directly to BHS client. The supplier collects equipment when no longer required, services and cleans equipment i.e. full rental service. The equipt that is issued to BHS clients can be from the supplier’s general rental equipment pool or could be specific items that have been purchased for supply to BHS clients only e.g. commodes, floatation chairs. Half of the organisations surveyed used an Access database to manage their equipment loans. Two organisations used an Excel spreadsheet system and the remaining three relied on entries in individual client files.
Several of the Access database users reported that it was working well for them eg Medical Physics RPH and CIS. Others found it less effective due to a lack of resources to input data eg MNDAWA. Those using Excel spreadsheets found them time consuming (eg TCCP – as additional to e-CAEP and other internal systems) and less effective (eg MS Society “feel as if items are getting lost”). The organisations where individual client files are the only record of the provision of non CAEP funded equipment noted that it was very time consuming to report; was inconsistent (different staff recording differently) and was often reliant on a few staff members retaining the history “in their heads”. Regardless of the type of system in place and the number of equipment items being managed, all of the organisations in this survey reported that tracking of equipment was a significant issue for them. A common situation is that equipment is provided to the client on the basis that it is returned when no longer required however this is not routinely followed up by the provider.
6
Funding Sources Most of the organisations surveyed identified multiple funding sources for their equipment purchases. All of the disability specific organisations had some capacity to access funding for equipment. This was either through targeted fundraising, general donations, grants or through approaches to service clubs and other charitable trusts. Changes in funding were noted by some organisations eg historically Rocky Bay has directly funded adjustable beds for clients. In the past year, Rocky Bay did not have funding available and 6 clients successfully sought funding from different charitable trusts. The TCCP has a coordinated approach to fundraising for equipment. All funding requests are processed by the TCCP fundraising department so they can be coordinated and prioritised. Clients are required to make a financial contribution to the cost. Costs are on a sliding scale, depending on means, with a minimum 10% contribution (unless undue hardship). If an individual family or TCCP client wants to pursue their own fundraising opportunities then, for clarity, this is done completely separately of TCCP. All organisations reported receiving donations of equipment when no longer needed by someone regardless of how originally funded eg an individual may have purchased from their own funds and then donates later. Sometimes these donations are made with stipulations that need to be managed when equipment is reissued. For example, that the equipment may only be reissued to another client with a particular diagnosis or for a child. Other non CAEP equipment funding sources identified included: ♦ Department of Veterans Affairs ♦ Lotterywest Disability Equipment Grants ♦ Equipment for Living Grants (one off programs) ♦ EACH packages ♦ Health Department ♦ Department of Education and Training Thus, the potential is there for an individual client to have multiple items of equipment all from different funding sources.
7
Ownership of Equipment The information obtained from all organisations supported the general principle that the ownership of equipment items is determined by the source of funding. In terms of the six disability organisations that directly fund equipment for their members, the organisation usually retains ownership of that equipment, even though an individual client may have use of the item indefinitely. Some exceptions to this were identified by Nulsen Haven. These included electric lift lounge chairs and some communication aids funded by Nulsen Haven but owned by individual residents. Nulsen Haven also funds numerous specialised eating aids and other items costing less that $100.00 that are given to the individual residents and replaced as needed. When an individual client or family funds the equipment they have ownership of the item. Other circumstances where the individual client owns the (non CAEP funded) equipment items include equipment funded by: ♦ Equipment for Living Grants ♦ Lotterywest Disability Equipment Grants ♦ Charitable trusts eg beds supplied to Rocky Bay clients ♦ Donation eg when MS Society has equipment donated, such as beds and
electric lift lounge chairs, they in turn usually pass it onto one of their members who needs the same.
Equipment supplied to individuals by state or commonwealth government departments remains the property of that department eg Department of Veterans Affairs, Health Department, Department of Education and Training. Equipment supplied to an individual via their care package provider remains the property of that provider even though the funding originates from state or commonwealth government. Maintenance of Equipment In general, the owner of the equipment is financially responsible for equipment repairs and maintenance. Some exceptions were evident eg The Centre for Cerebral Palsy (TCCP) retains ownership of TCCP funded equipment but the individual who has been provided with the equipment is responsible for arranging and funding repairs and maintenance. Another variation was identified eg by Nulsen Haven, where equipment was owned by an individual but maintenance was funded via CAEP even though the item itself was not CAEP funded. Some of the organisations had the capacity to carry out equipment repairs and maintenance in -house eg TCCP and Rocky Bay. The remainder utilised equipment suppliers and/or other contractors eg Technology Assisting Disability WA (TADWA). For Brightwater at Home Services, repair and maintenance was
8
included in the asset management contract with the supplier. A reported benefit of this system was access to 24 hour assistance. Little or no scheduled and routine equipment maintenance was being undertaken by any of the surveyed organisations. In terms of reissuing equipment, most of those surveyed expressed safety concerns regarding serviceability and liability for equipment. These concerns frequently led to returned equipment being stored rather than reissued. Equipment Storage All of the organisations surveyed indicated that storage of equipment was a significant problem for them. The only exception was Brightwater at Home services (BHS) because they now outsource this. However, storage difficulties experienced previously were one of the reasons they changed their system. Insufficient space for equipment was the main problem identified by all organisations because their facilities had not been designed to provide equipment storage and/or they have outgrown the space available. This has resulted in some organisations using multiple locations for storage at their own site and in some cases at off site locations. This makes equipment issue and reissue not only more time consuming eg having to travel back and forth from storage sites but also adds to the already challenging task of tracking equipment. Due to lack of suitable storage spaces, some equipment was being stored in inappropriate locations eg service reception area and staff offices. In some cases the storage areas were also potentially hazardous due to overcrowding, poor lighting and inadequate ventilation. Cleaning and infection control was also identified as a significant factor in equipment storage. Most of the organisations had no staff resources for cleaning of equipment and thus returned items were often stored without being cleaned. Some utilised volunteers to clean equipment. Some reported that the problem was compounded by lack of information on how to clean certain items and what cleaning products could be used safely. Medical Physics at RPH noted that a lot of communication devices had specialised cleaning protocols due to the nature of materials and also the type of usage eg cross contamination risk in sip and puff operated items.
9
Delivery of Equipment Practices varied between organisations in terms of delivery of loan equipment. For some, it was part of the loan agreement that the client or their family arranged for collection of the equipment (eg MNDAWA). For others, the equipment was delivered by health professional staff as part of their clinical service, for example, when training is provided (eg Medical Physics RPH, MS Society). For Brightwater at Home Services, delivery and collection of equipment is included in their service agreement with supplier. Rocky Bay highlighted specific issues in relation to the delivery and collection of adjustable beds i.e. couriers not always equipped to handle them necessitating the use of furniture removalists with two staff. This leads to high delivery costs not factored in to the original funding obtained to purchase the beds.
10
Eastern States Systems Research Having considered the provision of assistive equipment in WA from funding other than CAEP, a review was undertaken of the situation in the eastern states. Each State and Territory has its own version of CAEP, ie a state government funded scheme which operates to provide essential equipment to its residents. These schemes were noted as a reference point. Non government organisations in each state that provide equipment from other funding sources were then identified and contacted to provide information on their systems and practices. Information was obtained by telephone and/or electronic survey from a representative sample of 10 such organisations across Australia (see Table 2). The following information was gathered and is detailed in Table 3. ♦ Type of equipment provided ♦ Asset management and tracking systems ♦ Funding sources and eligibility criteria ♦ Ownership and maintenance of equipment ♦ Cost to client ♦ Length of equipment loan ♦ Storage and delivery ♦ Equipment reissue and decommissioning practices Practices Many of the equipment provision practices of the eastern states organisations were similar to those in WA. Some of the notable differences included: ♦ Single equipment store used by state government equipment scheme and
non government equipment providers eg Domiciliary Equipment Service and Novita (SA), ACT Community Options uses ACTES store (ACT). In Tasmania, MS Society clients can choose to ‘donate’ equipment to the state CES. CES then takes ownership of the equipment and is then responsible for its maintenance, reducing the cost to the client. It can be reallocated to another client (not necessarily with MS) when the client no longer requires it.
♦ Intranet database register of all equipment provided and requested regardless
of funding source (NSW Spastic Centre). This quantifies equipment need and provides data to apply for funding to meet unmet needs.
♦ On line ordering system for standard equipment, dispatched across state
(SA). www.des.domcare.sa.gov.au
11
Table 2: Eastern States Government Equipment Schemes and Non Government Organisations
State State Government Scheme Non Government Organisation Providing Equipment
ACT ACT Equipment Scheme (ACTES) Community Options
NSW NSW Health – Program of Appliances for Disabled People (PADP)
NSW Spastic Centre
QLD Medical Aids Subsidy Scheme (MASS)
Muscular Dystrophy Association of Queensland (MDAQ) Cerebral Palsy League of Queensland (CPLQ)
SA Domiciliary Equipment Service Independent Living Equipment Program (ILEP)
Novita Children’s Services The Multiple Sclerosis Society of South Australia & Northern Territory
TAS Community Equipment Scheme (CES)
Neuromuscular Alliance of Tasmania - includes Motor Neurone Disease, Muscular Dystrophy, Spina Bifida, Huntington’s Disease and Multiple Sclerosis Associations. Cerebral Palsy Tasmania -
VIC Victorian Aids and Equipment Program (VAEP)
Motor Neurone Disease Association (MNDA VIC)
NT The Territory Independence and Mobility Equipment (TIME)
NT Carers Association
12
Table 3: Non Government Organisations in Eastern States and Territories
ACT and NSW Organisation
ACT Community Options
Co-ordinates services for people who are frail aged or have a disability and their carers to enable them to continue living at home.
NSW Spastic Centre Provides services and equipment to children and adults with cerebral palsy and allied conditions.
Types of Equipment Provided
◊ Beds, hoists and air mattresses – post discharge from hospital (short term)
◊ Mobility equipment (if not eligible via ACTES) ◊ Children’s seating ◊ Hygiene equipment ◊ Car restraints and other transport aids ◊ Small aids for Community Options clients
only (under $100) ◊ Hire costs for equipment trial
◊ Manual Handling ◊ Pressure management ◊ Mobility ◊ Seating ◊ Hygiene ◊ Communication ◊ Transport ◊ Small aids ◊ Treatment – eg orthotics, splints, lycra garments
How Equipment
is Funded Discretionary funds
Fundraising – approx $500 000 per year for equipment for children. Also applications to trusts and funds (eg Variety).
Who Owns Equipment
Client Permanent loans are owned by client. Short term loans by Spastic Centre. Families usually return equipment to Spastic centre if no longer needed.
Cost to Client and Time Limits
No cost. Short term post hospital discharge. Long term if in community.
No cost apart from maintenance once warranty ceases. Sliding scale token payment for short term loan equipment. 3 month limit for high tech equipment.
Maintenance of Equipment
Short term loan equipment is maintained by Spastic Centre. Client responsible for maintenance of permanent loans as per written agreement, unless financial hardship demonstrated.
Storage and Delivery
Stored with ACTES equipment.
Most sites have dedicated storage areas within facility and some also use shipping containers to store large items. Drop off by therapist or courier paid for by Spastic Centre.
13
Any Other Issues
Some agencies in ACT spend big at end of financial year if they have surplus funds so equipment is not based on need. Identified concerns regarding liability and responsibility for equipment function. Legal issues have increased OHS practices. Preference is for individual agencies to have their own discretionary funding to purchase equipment.
Equipment register logs all applications made by therapists for equipment regardless of funding source. This quantifies the equipment need as well as lobbying for more funding to meet the unmet need. PADP waitlist – Can be over 12 months, depending on lodgement area. Car modifications - Identified a gap in who will fund this. Previously funded by the NRMA foundation but this was discontinued some years ago.
14
QUEENSLAND
Organisation Muscular Dystrophy Association of Queensland
(MDAQ) Cerebral Palsy League of Queensland (CPLQ)
Types of
Equipment Provided
Varies depending on donations. At time of review had: ◊ Manual handling equipment ◊ Pressure management ◊ Mobility aids ◊ Hygiene equipment ◊ Transport ◊ Small aids
No beds, seating or communication aids at present.
◊ Communication devices ◊ Environmental control units ◊ Switch access ◊ Seating ◊ Power mobility ◊ Xsensor Pressure Mapping System
How Equipment is Funded
Fundraising (call centre and events), bequests, donations Fundraising, donations
Who Owns Equipment
MDAQ purchase and own equipment – once no longer needed it is returned to MDAQ and re-issued.
Technology Unit has an equipment loan pool library for CPLQ clients to trial. This equipment pool includes a range of communication devices, computer access equipment, Environmental Controls, seating, power wheelchairs and integrated controls. All equipment owned by CPLQ Technology Unit.
Cost to Client and Time Limits
Client can choose to pay percentage of cost or become a member for $25.
No cost if client of CPLQ. Fee for service access to Technology Unit equipment pool and Therapy consultations. 2- 4 weeks hire period, can be extended if needed.
Maintenance of Equipment
MDAQ funds all maintenance. Client signs agreement that it is their responsibility to notify MDAQ immediately if equipment is damaged.
Annual budget for equipment maintenance but usually insufficient. Annual recall of all equipment (approximately 500 items) for safety testing. All equipment is checked prior to loan.
15
Storage and Delivery
Most equipment is in clients home. Main office is located in an industrial area where they have a storage facility. MDAQ pays for delivery – often get discounts or no charge for delivery as they are regular customers.
Storage is on site – always looking for ways to store equipment more efficiently. CPLQ has an internal transport network which services most of SE QLD. No direct cost if equipment sent using this transport network. All CPLQ centers (including technology unit) pay an annual fee to maintain CPLQ transport network. For clients and CPLQ service centers outside this network the Tech Unit will pay for courier one way, it is the responsibility of the client or local CPLQ service centre to pay return freight
16
SOUTH AUSTRALIA
Organisation SA - MS Society
Novita Children’s Services
Types Of
Equipment Provided
The list varies depending on what is donated and what is needed for clients at that time – “basically it is luck of the draw”.
◊ Switches ◊ Standing frames ◊ Positioning wedges ◊ Small aids
All other equipment provided through ILEP, Variety or Lions children’s mobility fund.
How Equipment is Funded
◊ Grants ◊ Donations ◊ Fundraising ◊ Bequests
Novita – fundraising, including bequests. They also assist families to access other sources of funding eg:
◊ Australian Lions Children’s Mobility Foundation (walkers) ◊ Variety (AFO’s and other) ◊ Special Education Resource Unit (SERU - equipment in
schools) ◊ Inclusion Support Program (child care services) ◊ Compensable funds used, if eligible
Clients have the option to self fund but this is relatively rare.
Who Owns Equipment
MS Society owns most of the equipment. Exceptions include powered items eg scooters, electric wheelchairs, hoists etc where equipment is owned by client as maintenance cost is too high for MS society. Client must sign “equipment transfer and legal liability waiver form”
Ownership dependent on funding source.
Maintenance of Equipment
Client signs “Equipment agreement form” which states that the client is responsible for maintenance. In actuality most clients contact MS Society for assistance. MS Society approaches Disability SA to fund the repairs. If unsuccessful, MS Society usually funds.
The owner funds maintenance. All recycled equipment is cleaned and safety checked before re-issued.
17
Storage and Delivery
Storage is often difficult; use storage sheds on premises or leave in therapy areas. Some equipment is delivered by volunteers using an MS Society car. Heavy equipment sent via courier paid by MS Society. Items may be delivered or collected by clinical staff when visiting client. Sometimes the family will pick up and/or return items.
Novita has a central equipment store for specialized items and paediatric sized equipment. The government agency Domiciliary Equipment Service (DES) stores more standard, adult sized items for equipment for all eligible clients across the state (adults and children). A courier service delivers equipment and the cost is covered by government or Novita depending on where it is delivered from.
Any Other Issues
Cleaning of equipment is outsourced prior to reissue. Do not have the resources to check equipment regularly but as the client has signed the agreement form they have some responsibility. May incorporate MS Society equipment pool with DES to improve access to equipment. This could be financially advantageous but have some concerns eg many MS clients require equipment prior to being eligible for DSA registration, or need equipment quickly. These issues are currently being negotiated and need to be clarified before MS Society will relinquish equipment pool.
Novita has fairly autonomously managed children’s equipment funding in the past. There is a statewide government initiative looking at a single equipment scheme across the state which will have implications for how Novita manage children’s equipment, including funding. So far things have progressed very positively and waiting to see the implications of this major policy change. Vehicle modifications – Identified a gap in service. Currently apply to Variety if families are unable to self fund.
Neurone Disease (MND) and Multiple Sclerosis Associations (MS)
The Neuromuscular Alliance Tasmania (NMAT) is an alliance of Tasmanian not for profit organisations that support people who have chronic progressive neuromuscular conditions.
CP Tasmania - Equipment and Technology Library (ETL)
Equipment provided for use at school by students with a disability.
Types of Equipment Provided
MD Have assisted with funding towards the following items:
◊ Manual Handling ◊ Beds and Pressure management ◊ Mobility ◊ Seating ◊ Hygiene ◊ Transport
Adult onset MD clients usually have equipment needs met through health system, with the exception of electric wheelchairs. Most equipment requests for pediatric clients. HD
◊ Beds and Pressure management ◊ Mobility ◊ Seating ◊ Communication ◊ Small aids
SB
◊ Manual Handling eg hoists, slings
◊ Manual Handling eg hoists, slings; slide sheet; walk belts; wheelie stools for carers
◊ Beds and Pressure management eg adjustable bed-rarely
◊ Mobility eg manual wheelchairs-occasionally, strollers; a variety of walking aids
◊ Technology eg computer hardware; software; peripherals; switches and mounts
◊ Small aids-fixed and height adjustable writing slopes
19
◊ Beds and Pressure management eg adjustable bed, alternating air mattress overlays
◊ Mobility eg electric wheelchairs, manual wheelchairs, pushers
◊ Seating cushions ◊ Hygiene eg commodes ◊ Communication computers ◊ Transport eg. Wheelchair carrier, wheelchair restraints
system ◊ Small aids (items under $100)
MND Communication : Lightwriters & scanners or similar. Sundry equipment in circulation that was purchased more than 5 years ago – gradually being written off. Have ceased issuing any equipment except for communication aids for the past 5 years. Do still have other equipment such as hoists, wheelchairs and electric lift armchairs out on loan but haven’t purchased any more. MS Depends on what is required. Only occasionally provide equipment.
Eligibility: For equipment loans and trials-any disability; for technology loans-those students defined by Dept of Education, as having severe physical or severe and multiple disabilities. The service is statewide and available to all school sectors-government, catholic and independent.
How Equipment is Funded
◊ Grants ◊ Donations ◊ Fundraising ◊ Bequests
State and commonwealth government grants mostly from education but administered by state Department of Health. Grants applied for biannually via a tender process. Occasionally charitable funding has been sought.
Who Owns Equipment
MD – Client ownership. Often is returned by family when no longer needed. The association does not encourage this as find it very difficult to pass on used equipment unless have someone in need at the time of return.
CP Tas
20
HD – Association ownership. SB – Client ownership. MND – Association ownership. We require a health professional referral and usually loan the item to the client and expect the HP to issue it and provide monitoring. MS - Client owns the equipment or it is ‘donated’ to the state Community Equipment Scheme (CES). This allows for reissue to another client (not necessarily with MS) when the client no longer requires it
Cost to Client and Time Limits
MD - The client must be a financial member of MDATas (Fee is $10 ) No time limits. HD – No cost or time limits. SB – Cost is negotiated on an individual basis but generally client pays 40%. No time limits. MND – No cost or time limit (ongoing monitoring). MS – Cost is negotiated on individual basis. No time limits.
No cost to client. A student may use an item until they no longer need it. Ongoing review of need is done by teachers and health professionals. Reviews are also done when student’s transition between schools. All items must be returned on leaving school.
Maintenance of Equipment
MD – Client responsible for maintenance by written agreement. A client may apply to the association for funding for repairs and maintenance but this given lower priority than others needing equipment to be purchased. HD – Association maintains equipment. Association accepts responsibility except when equipment is in a residential care facility and then responsibility of the facility. SB – Client responsible for maintenance unless financial hardship. Equipment provided is always new and under warranty. MND – Association maintains equipment. MS - Client responsible for maintenance if has ownership of item. When ownership of equipment is transferred to CES then CES responsible for cost of maintenance.
All items must be returned to the ETL for maintenance. Repairs are done on site by tradesmen associated with Dept of Health or outsourced to appropriate tradesmen. Items are checked by a maintenance officer when they come in and go out. If under warranty, they are repaired via the supplier. Other work is outsourced to tradesmen, using genuine parts if possible. Only a few items are custom made, and items are rarely modified. CPTas carries appropriate insurance. The ETL is currently upgrading its maintenance systems in recognition of the issues in this area.
21
Storage and Delivery
MD – No storage facilities. Pay for courier if necessary. HD – Association arranges delivery and pays for it. SB – If delivery is required then expense is shared by client and association. MND – Stored at association. Delivery arranged on individual basis. MS – No storage facilities. Equipment prescribed by relevant health professional and either delivered to client from CES of by supplier if new purchase.
On site. Always a problem as very few items can be stacked. It affects what can be purchased, and what is kept. Over the life of the ETL the total number and range of items has become fairly stable. Items not currently required are stored awaiting reissue. ETL has an agreement with a statewide freight company and pays for all deliveries. Most items are sent to the school within 2 weeks of the request.
Any Other Issues
All finding it increasingly difficult to fund the provision and maintenance of equipment. Lack of funding to maintain up to date loan equipment. An increase in requests for assistance at end of financial year when no funding available in government program. SB – A decrease in volunteers has reduced fundraising capability and therefore ability to assist members.
The service was set up in response to the needs of students with disabilities attending mainstream schools. It has had ongoing support from Department of Education. Uncertainty about accommodation and problems of lack of space.
22
NORTHERN TERRITORY
Organisation NT Carers Association
Types of
Equipment Provided
◊ Wheelchair ◊ Walkers ◊ Scooters ◊ Toilet seat, rails, bath chairs ◊ Occasionally lend lightweight wheelchair for outings ◊ Handybar for support workers to use with clients
How Equipment is Funded
Donated by clients.
Who Owns Equipment
Carers Association. .
Cost to Client and Time Limits
No cost to client. 3 monthly basis, although this is flexible eg client waiting for TIME equipment - usually takes 12 months.
Maintenance of Equipment
Outsource maintenance.
Storage and Delivery
Storage – shed. Clients pick up usually.
Any Other Issues
Conditions of use – client must agree to look after equipment and pay for any damage. Find it cheaper to maintain or repair equipment than pay for hire of equipment for client.
23
VICTORIA
Organisation Motor Neurone Disease Association of Victoria
Provides services to people with MND, their families, community workers and service providers.
Types of Equipment Provided
◊ Electric lift lounge chairs ◊ Electric adjustable beds ◊ Electric wheelchairs ◊ Hoists and slings ◊ Manual wheelchairs ◊ Mattress overlays ◊ Shower commodes ◊ Walkers ◊ Communication devices ◊ Respiratory aids
Over 1400 items of equipment in equipment loan pool. For some lower cost items the association has determined that it is more cost effective to purchase in bulk and provide items to individuals on a non – returnable basis. These include: Shower chairs, Over toilet frames, Shower stools, Bed cradles and Bed sticks
How Equipment is Funded
Recurrent and one off funding grants from state government.
Who Owns Equipment MNDA for equipment pool items. For non returnable items mentioned above the client has ownership. Cost to Client and Time
Limits No cost to client or time limits. Due to nature of condition tends to be self limiting loan period.
Maintenance of Equipment
MNDA funds all maintenance and repairs of loan items. In Victoria tagging of electrical equipment by a certified repairer is required by state law before any loan can be made.
Storage and Delivery
On and off site storage capacity. Use courier services in metro and regional areas for delivery. Agreements with regular courier drivers and companies had been successful in providing more sensitive service to clients. Difficulties with regional deliveries have been identified due to company requirements for all items to be wrapped and labeled. This is done at the pick up site or by the company for an additional charge. When equipment is being returned from regional areas this may need to be done by family members which can be difficult or distressing to manage.
24
Sector Consultation A sector consultation was held at the ILC on November 12, 2008. The purpose of the consultation was to clarify and seek agreement on the issues associated with non CAEP funded equipment provision. An external facilitator was used to ensure objectivity and to assist the group to develop and prioritise recommendations for the future. There were over 30 attendees representing a wide range of stakeholders, including: ♦ Silver Chain ♦ Association for the Blind of WA ♦ Disability Services Commission ♦ Independent Living Centre ♦ Rocky Bay Inc ♦ MS Society ♦ Technology Assisting Disability WA ♦ Therapy Focus ♦ The Centre for Cerebral Palsy ♦ Brightwater group ♦ Motor Neurone Disease Association of WA ♦ Centre for Inclusive Schooling ♦ Senses Foundation ♦ National Disability Service ♦ Perth Home Care Services ♦ Rehabilitation Engineering Clinic RPH ♦ Medical Physics and Engineering RPH ♦ Veterans Affairs ♦ Nulsen Haven ♦ Australian Huntington’s Disease Association ♦ Para Quad ♦ Health Department (representatives from Royal Perth, Bentley, Swan
Districts, and Armadale Hospitals) Program The participants were divided into small groups with even distribution of representatives from like agencies. At the start of the session, information was presented from the systems research in WA and the Eastern States. The groups then engaged in a series of exercises that facilitated the exploration of current practices, barriers, strengths and how access to non CAEP funded equipment could be improved.
25
Issues identified by Equipment Service Providers The organisations surveyed in WA and the eastern states identified a range of issues affecting the provision of equipment to their clients. Participants in the sector consultation reviewed and agreed on the impact of the identified issues. The group highlighted the challenges experienced by service providers in meeting their clients’ equipment needs. These are noted with each issue below.
SUMMARY OF ISSUES Asset Management and Tracking of Equipment ♦ Ownership of equipment varies across services ♦ Lack of labelling and coordination ♦ Inadequate systems and resources to manage same ♦ Lack of centralised database ♦ Consumer relocating within WA and interstate ♦ Not capturing information on unmet needs/trends
Reissue of Equipment ♦ Lack of data available on cost benefit of recycling vs new equipment ♦ Not clear who decides what should be reissued ♦ Lack of storage ♦ Inexperienced staff can lack confidence to reissue so purchase new Multiple Funding Sources ♦ Hard to navigate ♦ Funding gaps and restricted funding ♦ Duplication due to poor information sharing ♦ Multiple quotes required eg by charities – cheaper quote not always best
clinical option
Storage ♦ Limited space ♦ Universal problem ♦ Lack of collaboration or shared pooling across organisations and departments Delivery ♦ High cost ♦ Availability ♦ Installation of equipment, set up and training
26
Maintenance and Repair ♦ Costs and outsourcing ♦ Responsibilities not clear ♦ Disposal costs ♦ Abandonment and Theft ♦ Quality of repairs for items -no certification and determining fitness for reissue Safety ♦ Serviceability and liability ♦ Limited ability to modify equipment due to liability concerns Infection Control ♦ Time and cost ♦ May not happen ♦ Pest Control Consumer Eligibility ♦ Lack of information and education regarding eligibility, resources, processes
eg returning equipment once not needed ♦ Eligibility criteria focus on service/package provider and residential status
rather than on the person’s needs Consumer Satisfaction ♦ Response time ♦ Standard vs customised equipment ♦ Google area: high client expectations for expensive equipment ♦ Cost of some equipment items -what was luxury is now standard ♦ Cost to consumer variable and inconsistent across services ♦ Lack of collaboration between disability and health sectors Human Resources to Manage the Equipment ♦ Lack of staff resources impacts on all of the above ♦ Staff need to provide information to assist clients to investigate options ♦ Experienced staff needed to provide assessment for equipment. ♦ Prescribers’ vary in knowledge of what is available ♦ Country services have additional difficulties eg equipment for trial not
available
27
Where To From Here? In the last part of the sector consultation, each small group proposed ways that the identified issues could be addressed in order to improve practices. The documented suggestions were then viewed and prioritised by everyone individually. The following recommendations were developed from the individually prioritised suggestions. RECOMMENDATIONS 1. On - line database of equipment available for reissue and/or purchase. To promote interagency access to equipment and raise public awareness of equipment available. This could include: ♦ Consumer “for sale” of available second hand equipment ♦ Register for health services of surplus/spare/available equipment ♦ Search by criteria eg paediatric/ aged/adult ♦ Allow consumers (and others) to donate equipment Infrastructure and resource considerations: Initial funding would be required to establish a database as well as recurrent funding to maintain. A current example of this type of initiative is the service model established between TADWA and Therapy Focus in 2008 for the refurbishing and reissue of equipment. 2. Cost / Benefit analysis for all types of assistive equipment. To assist providers in deciding whether financially viable to reissue equipment items. Infrastructure and resource considerations: This could be done as a one off research project to obtain data that could be made available to the sector. 3. Fact Sheets available on - line with information on best practice guidelines for: infection control, care and maintenance of equipment. Include register of specialist prescribers. Infrastructure and resource considerations: This could be done as a one off project initially to determine what relevant data is already available across the sector and how to make it accessible at a central source. Further investigation would be required to meet identified gaps in data. Recurrent input would be required to maintain currency eg of specialist service providers.
28
4. Working party with state and commonwealth government involvement to look at: processes, eligibility, pathways and funding for need rather than specific item. Aim to remove barriers related to origin of funding and location of consumer eg Health Department vs Disability Services Commission, seamless transition of equipment with consumer from school to post school options. Infrastructure and resource considerations Interested stakeholders from all areas of the sector would need to be involved to achieve this goal. 5. On - line resource with information on all options and processes for equipment funding eg philanthropic and charitable trusts, including grant applications and tips for successful applications. Infrastructure and resource considerations This information is already available to some extent on the websites of the Independent Living Centre of WA and Disability Services Commission. Some one off resources would be needed to expand this information and make it easily available at one site.
