Supporting Australians living with disability during COVID-19

13 minute read  09.04.2020 Penny Eden, Emily MacDonald, Sacha Shannon, Michael Thomas
The public health emergency created by COVID-19 has changed the way all Australians live their lives. Adjusting to social distancing and home confinement as our 'new normal' will be especially challenging for some parts of the community.

In particular, Australians living with disability and those in supported accommodation will find it challenging. We consider how the public health Directions affect people living with disability and persons residing in social housing operated by registered NDIS providers.

Providers who operate and manage supported accommodation must take proactive steps to support their participants during this period and respond to the associated risks.

Stay-at-home directions for all Australians

On 29 March 2020, the National Cabinet issued guidance recommending that all Australians stay home unless they are required to leave their home for:

  • Shopping for essential food and necessary supplies;
  • Medical or health care needs, including, including compassionate requirements;
  • Exercise in compliance with the public gathering requirements; and
  • Work and study if you are unable to work or learn remotely.

States and Territories implement directions with no specific directions in place for specialist disability services

As at 8 April 2020, Queensland, New South Wales, Victoria and Tasmania have operationalised the National Cabinet's guidance by introducing directions issued pursuant to public health legislation (together, the Directions). These Directions require people to remain in their primary residence and impose significant penalties for non-compliance. The other States and Territories have implemented directions which, although they do not prevent persons from leaving their primary residence, do place restrictions on gatherings at both public and private premises, limiting gatherings to between two and 10 persons, depending on the jurisdiction (together, the Gathering Directions).

The Directions include necessary exemptions to accommodate the needs of people living with disability, including for example, exemptions to allow a person to be visited and assisted by a person who is not a member of their household but is a carer or a support person, and an allowance for persons with disabilities to receive more than two visitors at their place of residence, where the visitors are carers or support persons. Similarly, disability services are expressly excluded from the operation of the Gathering Directions, in order to ensure that persons living with disability continue to be permitted to receive the care and support they require.

The consequences of the Directions are serious for all Australians and will continue to have a dramatic impact on our day-to-day lives. With no specific directions in place impacting specialist disability accommodation, this update considers how the Directions will nonetheless affect those living in shared accommodation, in particular people living with disability and residing in social housing operated by registered NDIS providers (social housing).

State Governments introduce Care Facilities Directions in Victoria

On 7 April 2020, the Victorian Deputy Chief Health Officer introduced Care Facilities Directions. These directions extend the restrictions previously placed on aged care facilities to other care facilities, including disability residential services, specialist disability accommodation and supported residential services. The direction prohibits visitors to care facilities, except where the visitor is a worker, a prospective resident (or their companion) or visits for the purposes of providing care and support. A resident may only have one care and support visitor each day and the visit must be for less than two hours. The direction also lists excluded persons who must not enter a care facility, which includes those who have travelled outside Australia within 14 days of the proposed visit, has a fever or respiratory infection or has had contact with a known case of COVID-19. Under the direction, providers must take all reasonable steps to ensure compliance with the prohibition on visitors. The penalty for non-compliance by providers is 600 penalty units, $99,132.

Also on 7 April 2020, the Queensland Minister for Communities and Minister for Disability Services and Seniors, Coralee O'Rourke announced a partnership between the Queensland Government and the Community Recovery Hotline to support Queenslanders with disability to access food, household items and medications.

We expect that the ways in which state Governments support people with disability will continue to develop over the course of the pandemic and that more specific measures will continue to be introduced in ways that mirror the developments in Victoria.

The Royal Commission issues a statement of concern for the disability sector

The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (Royal Commission) has issued a statement of concern about the impact that the pandemic will have on people with disability. The Royal Commission has identified access to health care, essential support services, accessible information, access to food and nutrition, employment and income security and reduced oversight in close residential settings as key areas of concern for people with disability during the pandemic.

In relation to reduced oversight in close residential settings, the Royal Commission has stated that the Directions may have the unintended consequence of reduction of formal oversight mechanisms (such as Community Visitor Schemes) and informal oversight provided by family, friends, supporters and advocates. The Royal Commission's view is that with the decrease of oversight comes an increase in the risk of violence, abuse, neglect and exploitation. In most jurisdictions, calls for specific support for the disability sector have gone unanswered. Unlike the aged care sector, there have been no directions issued specially in relation to the needs of people living with disability or disability service providers except for in Victoria.

Recommendations for NDIS providers in the support, governance and management of disability services

The NDIS Quality and Safeguards Commission (NDIS Commission) developed the Quality Indicator Guidelines (Guidelines) as a measure of the quality and safety of NDIS registered disability service providers. The Guidelines set out the rights and responsibilities of participants and standards in relation to the provision of supports, governance and operational management.

It is important for NDIS providers to assess their approach to compliance and the additional steps required to ensure their services meet the standards set in the Guidelines, despite the challenges posed by COVID-19. The impacts of the guidelines are set out below.

Guideline 6: Person-centred supports

Each participant accesses supports that promote, uphold and respect their legal and human rights and is enabled to exercise informed choice and control. The provision of supports promotes, upholds and respects individual rights to freedom of expression, self-determination and decision-making.

To the extent possible, NDIS providers should ensure there is minimal disruption to the everyday delivery of NDIS supports and that care provided in social housing continues to further the goals set out in participants' NDIS plans. While there will be some necessary changes to supports during this time, providers should attempt to account for these and participants should be supported to understand the Directions and importance of compliance.

NDIS providers must consider how they will support the increased social and emotional needs of participants during this time and look for innovative ways to ensure that participants stay connected to their families, friends and services outside the home. This could involve interventions such as:

  • Ensuring there is adequate and appropriate access to technology in the home, for example telephones, iPads and computers that may be used to connect participants with their friends and family;
  • Ensuring there are activities and supports available within the home that are consistent with and support the goals set out in the participant's NDIS plan;
  • Where appropriate, allowing participants to continue with their daily routines and encouraging health routines and regular exercise; and
  • Engaging with participants to ensure they are continuing to work towards the goals set out in the participant's NDIS plan despite the stay at home directions, and are well supported and coping with the effects that COVID-19 has had on them.

In Queensland, registered NDIS providers, when performing functions for the State of Queensland, are expressly included within the operation of the Human Rights Act 2019, and accordingly must consider the human rights contained in that Act as part of their COVID-19 response. Similar express inclusions are not present in the equivalent human rights legislation in the Australian Capital Territory or Victoria. Registered providers in those jurisdictions should consider whether the equivalent human rights legislation applies to them, and if so, ensure that the human rights contained therein are being considered as part of responses to COVID-19.

We note that human rights are an inherent consideration, required under the Guidelines. Regardless of the operation of jurisdiction-specific human rights legislation, providers should consider human rights as part of their decision-making in managing and responding to COVID-19. Safety of those in your care remains the paramount consideration and it is likely that, to some extent, human rights may need to be limited in order to protect those in your care from the risks associated with the COVID-19 pandemic.

Guideline 8: Privacy and Dignity

Each participant accesses supports that respect and protect their dignity and right to privacy.

Except for limited circumstances, the Directions will result in all participants being confined to their home. There may be circumstances where a participant may leave their home, for example to access medical care or to exercise however, the reality is that there will be less 'comings and goings'. In practice, the Gatherings Directions will have a similar effect, through reduced out of home alternatives being open to participants. This will result in a significant disruption to daily routines and perhaps, result in group homes feeling more crowded than usual.

NDIS providers must keep this in mind and ensure that participants are aware of the 'house rules' and the expectations that participants may have of each other. This should form part of ongoing risk management to ensure all participants' rights to dignity and privacy are protected.

Guideline 9: Independence and Informed Choice

Each participant is supported by the provider to make informed choices, exercise control and maximise their independence relating to the supports provided.

The COVID-19 pandemic has resulted in tighter controls over the day-to-day lives of all Australians, resulting in a decreased sense of autonomy and freedom. NDIS providers will need to strike a balance between the public health and safety of the broader community and staff, and individual autonomy. Given the extent of the Directions, there may be circumstances where these two concepts will come into conflict.

NDIS providers must support participants to understand the changes and deal with the emotional impact of the changes. This could include:

  • Opening a dialogue between participants and/or their representatives about how the stay-at-home directions will affect them;
  • Implementing at home strategies to deal with disruption to other supports or activities which are no longer able to continue; and
  • Using technology to ensure participants remain connected to friends, family and the broader community during this time of social distancing.

Guideline 12: Risk Management

Risks to participants, workers and the provider are identified and managed.

The Royal Commission has identified the interplay between decreased formal and informal interactions and oversight and increased risk to people with disability. Participants living in group homes may be particularly vulnerable to COVID-19 due to pre-existing health issues, their relative inability to self-isolate and (in some circumstances) understand and maintain high standards of personal hygiene, as well as increased exposure due to the necessary flow of workers in and out of the group home. Providers should implement infection control measures and communicate with participants and workers about how they can minimise infection risks. Changes to environment and routine will also likely impact participants' general wellbeing.

Workers should be adequately resourced to deal with increased care needs and equipped to respond to specific concerns. Workers in the sector also face an increased risk of COVID-19. Providers should ensure workers are also appropriately equipped to prevent and handle a potential COVID-19 outbreak within group homes. This may include:

  • Mandating COVID-19-specific infection control and hygiene training for all workers;
  • Ensuring workers are trained in and supplied with personal protection equipment (PPE); and
  • Reminding workers of reporting and self-isolation requirements in the event of a suspected case of COVID-19.

In addition to increasing education for workers, providers should consider how to support their workers in dealing with COVID-19 related stress. Providers should maintain open lines of communication and where necessary, ensure employees have access to employee assistance programs. Providers must be conscious of how personal stressors may impact an employee's work and conduct regular internal quality reviews to monitor any changes in quality of care.

Guideline 18: Continuity of Supports

Each participant has access to timely and appropriate support without interruption.

The pandemic will create a range of resourcing challenges for providers, not least of which will be the likely spike in absenteeism of staff required to self-isolate or who face other personal stressors which affect their ability to work. Providers should assess whether they will be able to adequately address increased care needs with their existing workforce, and consider proactively sourcing and training new workers. High staff turnover and absenteeism may further exacerbate feelings of isolation and anxiety among participants. To the extent possible, providers should ensure new employees are integrated smoothly to avoid unnecessary disruption and maintain a sense of continuity of care and community.

Providers should also anticipate significant disruptions to their ordinary supply chains and also the supply of services that form part of participants' care plans. It is important to communicate with your suppliers about their business continuity plans and their ability to continue to provide resources and supports moving forward.

In addition to ensuring services are unaffected by the broader impacts of the pandemic, providers should also prepare for the possibility that a participant will test positive for COVID-19. As with any changes implemented as a result of the pandemic, providers should open a dialogue with participants or their representatives to explain what measures may be implemented in such an event, and how the service will minimise the impact of these measures on participants. This could include:

  • Providing a COVID-19 resource hub, where up to date information can be accessed by workers, participants and their families and representatives;
  • Providing 'debrief' opportunities and encouraging participants to engage with workers and discuss their concerns about COVID-19, the measures being implemented by the provider, and how these changes impact them; and
  • Where it may be necessary to relocate participants in the event of an outbreak, familiarising participants and/or representatives with this plan and engaging them in a dialogue about how to best support their needs during such a time.

Providers should be adequately resourced to deal with increased care needs and equipped to respond to specific concerns from the community and their workforce. Providers can anticipate that the ways in which state governments support people with disability will continue to develop over the course of the pandemic.

If you have any queries or require assistance in navigating these challenging times, please get in contact with us.

Contact

Tags

eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJuYW1laWQiOiJjZDkxMGVhZC00NzIzLTQ1NTktYTkyYS1jYTQwOWY5MjJlMTMiLCJyb2xlIjoiQXBpVXNlciIsIm5iZiI6MTczOTEzMzUzNywiZXhwIjoxNzM5MTM0NzM3LCJpYXQiOjE3MzkxMzM1MzcsImlzcyI6Imh0dHBzOi8vd3d3Lm1pbnRlcmVsbGlzb24uY29tL2FydGljbGVzL3N1cHBvcnRpbmctYXVzdHJhbGlhbnMtbGl2aW5nLXdpdGgtZGlzYWJpbGl0eS1kdXJpbmctY292aWQtMTkiLCJhdWQiOiJodHRwczovL3d3dy5taW50ZXJlbGxpc29uLmNvbS9hcnRpY2xlcy9zdXBwb3J0aW5nLWF1c3RyYWxpYW5zLWxpdmluZy13aXRoLWRpc2FiaWxpdHktZHVyaW5nLWNvdmlkLTE5In0.gWrM_e-1tPCILaWnmcKYGMzN9xYVt96fqMoOa4MNqJ0
https://www.minterellison.com/articles/supporting-australians-living-with-disability-during-covid-19