Health Support of People with Disabilities in South Australia

Abstract

Over the last 2 decades, South Australians who live with severe and/or profound disability have been afforded greater support to enable them to lead good-quality lives in the general community. South Australia has been progressively dispensing with institutional accommodation in favor of various supported accommodation options within the community. This commitment has been coupled with investment in a community-based health support program.

Community-based health services have been oriented to enable individuals with disabilities, along with their parents and carers, to self-manage health conditions associated with their disabilities and to minimize the level of intervention required by health professionals. This has culminated in the inter-agency development (involving government and non-government agencies) of a health support program that is responsive to the needs of individuals, underpinned by a clear state-wide policy with procedures and guidelines.

The health support program is available to individuals of all ages who have a range of health conditions that are most likely to be associated with profound or severe disability, i.e. impairments that limit mobility or impede independence in daily self-care (these conditions include cerebral palsy, autism, brain injury, paralysis, multiple sclerosis, epilepsy, diabetes mellitus, and the full spectrum of syndromes diagnosed at birth). The program involves individuals with disabilities, their families and carers, personal care workers, and health and education professionals. The key program facilitators are registered nurses from the South Australia Royal District Nursing Service, the Children, Youth and Women’s Health Service, and the Community Accommodation and Respite Agency. Anecdotal evidence suggests that the program has been effective in minimizing unnecessary admissions to hospital, enabling children to be included in mainstream education settings, and managing the impact of health needs on people’s daily lives.

Not all people with a disability have high health needs. The Health Support Program distinguishes three levels of client need, the planning and intervention required for each level, and the nature of practitioner qualifications required for the planning of health support. The program provides support that is categorized as level 3 and could be managed in the community by a care worker who has been trained and competency assessed by a registered nurse to undertake complex health activities.

The program complements mainstream health services by maximizing the opportunity for people with disabilities to manage their conditions without unneccessary hospitalisation or undue health professional intervention in their daily lives.

Appendix

1. Case Study

1.1 Support Level 3 Client

An 11-year-old child with spina bifida, asthma, diabetes, hydrocephalus managed by ventriculoperitoneal shunt, poor weight gain, and epilepsy, is living at home with her parents and siblings, attends a local primary school and uses center-based respite one weekend per month.

1.2 Health Assessment

The registered nurse receives a referral from the Respite Agency.

The registered nurse liaises with the family and reviews the child’s existing CYWHS healthcare plan developed by their registered nurse, and the DECS School Support Plan developed by their pediatrician.

The registered nurse undertakes both a health support and an environmental risk assessment to determine the support needs required during respite, and evaluates the School Support Plan for its applicability in the respite setting.

Liaison with allied health specialists/health professionals is undertaken as necessary, and as an outcome of the assessment, it is determined that the client requires level 3 support. A healthcare plan is developed that is specific to the client’s needs within the respite service environment.

The registered nurse notifies the referring agency of the following:

• support needs and appropriateness of care worker support, and any training and competency assessments required;

• environmental considerations;

• additional support needs for medication management;

• the need to refer this child to a speech pathologist for the development of ‘safe eating and drinking guidelines.’

1.3 Education and Training

The registered nurse receives a request from the Respite Agency to conduct competency-based training and assessment of three care worker staff, who work weekends at the Respite Service, to support this client.

The registered nurse verifies that the three care workers have a current Senior First-Aid Certificate and that they have completed pre-employment training in basic health support and disability awareness.

The registered nurse conducts training on cerebral shunt management and diabetes management, and ensures reviews of training for asthma and epilepsy management provided by the agency (should be covered by first-aid qualification) are performed.

The training is completed with competency-based assessments for blood glucose monitoring, administration of midazolam, and monitoring of the shunt.

All training is related to the healthcare plan developed by the registered nurse, and the client’s individual needs. Written copies of all health-related procedures are provided to the care workers and they are instructed to follow procedures without deviation. Contingency planning, including trouble-shooting strategies, are documented in the client’s healthcare plan, and each care worker is made familiar with this plan.

The registered nurse advises the care workers of the successful or unsuccessful outcome of the competency assessments, as well as the provider agency or agencies.

1.4 Supervision

All care is provided in accordance with the training received and as per the healthcare plan document whilst the client attends the respite service. An identified ‘manager’ is made available to care workers should they need support. The care worker also has knowledge of appropriate community resources to assist with health support trouble-shooting.

The care worker is provided ‘indirect’ supervision by the registered nurse in relation to questions regarding their competency or the client’s healthcare plan.

The client and their family/guardians know to contact the respite service should the support needs of the client change – or if they have any concerns or comments about the level of health support provided.

1.5 Accountability

The registered nurse remains accountable for:

• the risk assessment undertaken on behalf of the referring provider agency;

• all training and competency assessments provided;

• notifying the referring provider agency of training and assessment outcomes;

• ensuring effective and timely communication of the above.

The respite service remains accountable for:

• the health support service provided;

• the staff employed and the outcomes of all support provided;

• ensuring that the client has a current healthcare plan, and that all changes to support requirements are referred to an appropriate health professional.

1.6 Delegation

Registered nurses are accountable for their own decisions and actions in relation to delegation to a care worker. The registered nurse is responsible and accountable for undertaking a risk assessment in the planning and implementation of care. The registered nurse is accountable to follow the Nurse Board ‘Delegation of Care Standards.’