Navigating the NDIS - For Participants and Healthcare Professionals
Published on the 09 July 2019
Published on the 09 July 2019
The following topics will be covered:
The National Disability Insurance Scheme (NDIS) is a government-led initiative, intended to support Australians who are living with an intellectual, physical, sensory, cognitive and/or psychosocial disability (Australian Department of Human Services 2019).
Support offered by the NDIS can be in the form of anything from services information, to financial and aide assistance, to linking individuals to support groups.
The NDIS is designed to help eliminate barriers to living a fulfilling and productive life for around 460,000 Australians (under the age of 65) who are living with a permanent and significant disability and to provide them with the necessary supports required (Australian Department of Human Services 2019).
This is achieved by providing information and connecting people to services in their communities such as doctors, sporting clubs, libraries and schools, as well as information about what support is provided by each State and Territory government (Australian Department of Human Services 2019).
The NDIS is not to be confused as a replacement of the Disability Support Pension – this pension still provides income support through Centrelink to people aged 16 to 65 who are unable to work as a result of their disability (Australian Department of Human Services 2019).
The NDIS does, however, offer additional funding to meet the particular special needs of a person with a disability, such as to buy a wheelchair or have assistance at home (The Conversation 2016).
The NDIS was created in response to a 2011 Productivity Commission report in Disability and Care that found disability services, as they were in 2011, were:
The commission suggested a system of flexible individual funding packages that could be accessed to purchase disability supports (The Conversation 2016) hence the implementation of the nation-wide service.
The National Disability Insurance Agency (NDIA) is the independent government organisation that administers the NDIS.
The NDIA makes decisions regarding whether someone is eligible to become an NDIS participant and, if so, how much funding they are entitled to. This is based on legislation called the NDIS Act 2013 that details which supports and services the NDIS will fund (Australian Department of Human Services 2019).
The term ‘insurance scheme’, is intended to reflect the intention of the NDIS, which is to take ‘a lifetime approach’, providing support where needed and investing in people with disability early on to improve their outcomes later in life (Australian Department of Human Services 2019).
The NDIS has rolled out in all States and Territories except Western Australia, which is scheduled to be in operation by July 2020 (Australian Department of Human Services 2019).
The NDIS funds a range of supports and services, including areas such as:
In order to be considered reasonable and necessary, a support or service must:
For healthcare professionals: although GPs and healthcare professionals are not required to make referrals, at times they may need to provide some direction and guidance regarding the steps required to access the NDIS.
For participants: do not hesitate to ask a trusted healthcare professional for assistance in applying, make sure your intentions and goals are clear and understood.
For healthcare professionals: you may be needed to support a patient in submitting an NDIS Access Request form. It is important to note that you must have the person with a disability with you while you complete the form (Summer Foundation 2018).
For participants: ensure that you are overseeing this process or are with a trusted person who can oversee it with you.
The current Access Request form requires the participant (with a healthcare professional’s assistance) to address the following points:
The Summer Foundation has provided a resource to help clarify the Access Request Form process for both participants and healthcare professionals (see Additional Resources).
An individual can lodge an access request over the phone by calling the NDIA on 1800 800 110 between 8 a.m. and 8 p.m.
If the individual’s application is accepted, a planning conversation will then be held with an NDIS representative about the person’s life situation, current supports and hopes for the future (Australian Department of Human Services 2019).
If aged 7 and above, one of the NDIS’ partners may deliver local area coordinator (LAC) services, which involves linking a potential participant to the NDIS and to supports in their area (Australian Department of Human Services 2019).
If the individual is eligible for an NDIS plan, a LAC will talk to them to learn about their current situation, supports, and goals to help develop their plan. Note that LACs cannot approve an NDIS plan (Australian Department of Human Services 2019).
Access those links here: https://www.ndis.gov.au/applying-access-ndis/how-apply/get-help-applying
For healthcare professionals: you may need to assist a patient with creating an NDIS plan. A plan is intended to aid the NDIA in gaining an understanding of a participant’s support needs. The planning process can also involve family, carers and significant others (Australian Department of Human Services 2019).
For participants: your plan should outline your short-term and long-term goals – made as specific as possible. Goals are milestones you want to achieve with support from the NDIS as well as other supports and services. (Australian Department of Human Services 2019).
Goals might include becoming more independent, getting a job, learning new skills, enrolling in an educational course, engaging with their community, or improving their relationships and making friends (Australian Department of Human Services 2019).
It is ideal that the planning process is led by the participant (to the extent they want to) and from there, an individualised plan is devised (Australian Department of Human Services 2019).
Potential participants must make considerations such as:
They also need to consider:
The Summer Foundation has provided a resource to help clarify the Planning process for both participants and healthcare professionals (see Additional Resources).
Healthcare professionals are able to carry out the following tasks:
For more information, please see the NDIS’ Information for GPs and health professionals, available at: https://www.ndis.gov.au/...information-gps-and-health-professionals.
The evidence you supply to support an NDIS Access Request must relate to the patient’s primary disability, which has the greatest impact on the life of your patient. Any additional evidence relating to other disabilities that may affect your patient and the impact they have on their functional capacity will also be accepted (Australian Department of Human Services 2019).
A patient may need you to provide evidence that:
It’s important to link the impact of the disability on the patient’s day-to-day function in areas such as:
Individuals who receive allocated funding can select a registered service provider to manage and provide support. Alternatively, they can self-manage and negotiate the supports specified in their confirmed plan, including employing support workers (The Conversation 2016).
In many cases, family members can assist heavily on the participant’s behalf. Numbers indicate that only 7% of participants choose to self-manage their funds, while 35% combine self-management and agency management and 58% are fully agency-managed (The Conversation 2016).
As a healthcare professional, your compassion, professionalism and guidance can greatly help to facilitate a patient’s NDIS journey.
As a prospective participant of the scheme, remember that you do not need to navigate the NDIS on your own; there are individuals, communities, agencies and resources readily available to you.
It does not need to be thought of as a daunting process.
Australian Department of Human Services NDIS General Information: https://www.ndis.gov.au/
Australian Department of Social Services Health Related Supports: https://www.dss.gov.au/sites/default/files/documents/06_2019/attachment-drc-communique-fact-sheet-health-related-supports.pdf
Creating an NDIS Plan with The Continence Foundation: https://www.continence.org.au/pages/ndis-participant-.html
The Conversation ‘Understanding the NDIS’ series: https://theconversation.com/au/topics/understanding-the-ndis-28996
Summer Foundation ‘How To Fill Out the NDIS Access Request Form’: https://www.summerfoundation.org.au/wp-content/uploads/2018/04/How-to-fill-out-the-NDIS-Access-Request-Form.pdf
Summer Foundation ‘Sample Plan’:https://www.summerfoundation.org.au/ndis/developing-an-ndis-plan/
Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date.