ABI: SLOW TO RECOVER PROGRAM AIDS, EQUIPMENT AND REPAIR POLICY

Transcription

1 ABI: SLOW TO RECOVER PROGRAM AIDS, EQUIPMENT AND REPAIR POLICY Acquired Brain Injury Slow To Recover Program 55 Buckingham Ave SPRINGVALE VIC 3171 Ph: Fax: Background Acquired Brain Injury is a major cause of disability. The Acquired Brain Injury: Slow to Recover (ABI: STR) program was established in 1996 for people with severe to profound acquired brain injuries, who were not eligible for compensation, or not accepted into traditional rehabilitation services. The ABI: STR program offers individually tailored, slow stream rehabilitation services to people with an acquired brain injury aged between 5 64 years. The program aims to support clients to reach their optimal level of independent functioning. ABI: STR is a state-wide program that is delivered through external contracted case management agencies, therapy support workers and therapy providers brokered through MonashHealth. The program is funded by the Victorian Department of Human Services and is governed by the Disability Services Act (2006). 2. Program overview The primary objective of the ABI: STR Program is to improve outcomes for clients with severe to profound acquired brain injury. On this basis, the ABI: STR Program can fund the reasonable cost of equipment to support and maximise a client s rehabilitation needs where this equipment will: Increase or maximise independence, or prevent deterioration of function and participation; Provide specialised seating systems to optimise and maintain postural control; Improve mobility; Enhance communication skills and / or communicative independence ; Swallowing management for transitional and independent feeding and minimise the risk of aspiration and choking; Pressure care management; Facilitate a return to vocational, educational, or recreational activities; Ensure a safe environment. 2.1 Eligibility criteria All clients on the ABI STR program are eligible to apply for equipment, have that equipment reasonably maintained, and have that equipment repaired, or replaced as appropriate. 2.2 Change in client status When a client is discharged from the ABI: STR program, they are no longer eligible to apply for new equipment through the ABI: STR program. They may, however, be able to apply for items through the State Wide Equipment Program (SWEP). \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 1

2 Following discharge from the ABI: STR program, clients have the following choices: a. Keep the equipment; however it will be their responsibility to fund the maintenance, insurance and repairs of the equipment *, or b. Return the equipment if they no longer have a need for it. The ABI: STR Program will be responsible for removing any unwanted equipment from the client. *NB: Clients may be eligible for equipment maintenance under SWEP Clients who move into a supported accommodation facility funded by the Victorian Department of Human Services will be able to keep their equipment. SWEP may fund the maintenance of this equipment. 3. Aids, equipment and home modifications provided by the ABI: STR program The ABI: STR program provides aids, equipment and home modifications that will support the client s rehabilitation needs, as outlined in Table Communication and cognitive equipment Rules specific to the provision of communication and cognitive equipment are as follows: High technology equipment High technological equipment refers to personal computers (PC or Mac), tablets and smart phones. It also refers to the electronic alternative augmentative communication systems (AAC) (E.g. Lightwriter). There are two main purposes for such equipment: 1. As an alternative or augmentation aid to the client s communication and / or cognition; 2. To use as therapy practise, as a textbook, or work sheets would be used. In such case, there must be a functional basis that carries over to the client s functional / participation goals. STR will fund the reasonable cost of: Specialist or adaptive software or peripherals required as a result of his/her ABI; Upgrades to the client's existing hardware and/or software that are required to run approved specialist or adaptive software or peripherals; Installation of the above noted computer hardware, software and peripherals, where it is not provided by the supplier and requires specialist knowledge to complete the installation. A client is eligible to receive high-technology equipment when: The client does not own or have access to such equipment that meets his/her needs, and A recommendation is made by a speech pathologist and / or occupational therapist, (in liaison with a clinical neuropsychologist, if relevant) with specialist knowledge and experience in the application of high technology equipment. The therapist must provide justification that such equipment will: o Increase the client's independence in communication, or o Enable the client to participate in social settings, work, or access education. STR will only fund ONE of PC or Mac-based computers and one of laptop, tablet or desk top; STR will fund minimum specification hardware, operating system and software; \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 2

3 When determining funding for equipment, ABI STR will take into consideration any same type of equipment that is already owned by the household High Technology Equipment Upgrades STR will only fund an equipment upgrade if such an upgrade: results in the client s increased independence in its use and the current equipment no longer maximises the client's independence in communication / cognition, or; is as a result of the client having achieved a goal and requires upgraded equipment to further his / her rehabilitation requirements; is necessary for the continued use or serviceability of the equipment; STR will not pay for upgrades to a client s computer equipment to run programs which are the client s preference, and are not required as a result of his / her ABI; Where equipment (e.g. tablet, Smart phone) will not be used entirely for rehabilitation purposes, the client will be requested to contribute towards the purchase of such equipment Internet access STR will only pay for internet access if it is to allow the client to access education or work remotely, and if the client does not have current access to the internet. STR will consider internet access for social interaction if the client resides in a remote location from his / her social contacts and internet access is the recommended method of social interaction. 3.2 Wheelchairs Clients may be eligible for funding for both a manual and a power wheelchair, subject to appropriate clinical justification. Such requests will require review by the ABI: STR Clinical Advisory Team. The replacement of a powered or manual wheel chair will be considered after a minimum of 5 years, or subject to reassessment. 3.3 The ABI: STR program will not fund the following: Equipment where there is no published evidence in a recent peer-reviewed journal that the equipment is safe and effective; Aids and equipment that are standard household or personal items (for example, washing machines, clothes dryers, clothing, etc.) and generally regarded as community norm for the person or their family to purchase. Aids and equipment that do not support rehabilitation needs (e.g. Continence aids, domiciliary oxygen, lymphoedema compression garments, wigs). The SWEP program should fund these items. \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 3

4 Equipment where there is no clear benefit to the client; Equipment for a person other than the client; Equipment for a condition that existed before the ABI, unless it has been exacerbated by the ABI; Internet subscriptions see exceptions above; Computer games or peripherals, games consoles or games controllers (e.g. joysticks or steering wheels); Commercial software where alternative software that can perform the required function is available without cost (e.g. Avast antivirus, AbiWord/OpenOffice, etc.); Additional cost of software, hardware or peripherals where this is the client's personal preference and not required to maximise a client's independence, e.g. a mirrored hard drive, LCD monitors, graphics, sound and video cards, speakers, port replicators, secondary equipment for desktop setup, backup memory, backup power sources, multifunctional devices and laptop carry bags; Additional cost of software upgrades where this is the client's personal preference and not required to ensure that the client's computer remains serviceable or maximise a client's independence; The cost of consumables such as ink, paper, blank media, etc.; The cost of an additional phone line for internet access. 4. Roles and responsibilities 4.1 Monash Health (ABI: STR program) Responsibilities ABI: STR funds the cost of assessments conducted by the specialised therapists for the purpose of aids, equipment or home modification prescription. Assessments are funded in accordance with the ABI: STR fee schedule as part of the clients rehabilitation program; To ensure that the ABI STR clients details including name and residential address, are current. (This is made possible by the clients case managers providing relevant updates); To analyse requests for aids, equipment, vehicle and home modification assessments regarding the suitability, cost effectiveness, justification of the recommended aids and equipment and obtaining advice or clarification as required; Ensure that referring therapist has determined that the client has the cognitive, physical and psychological ability to operate the aid, equipment, vehicle or home modification safely and effectively. Seek appropriate professional advice (e.g. from the ABI STR Clinical Advisory Team) to review assessment if required; \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 4

5 Ensure that purchasing of aids and equipment is based on assessed need and urgency of application. That is, have a prioritisation process in place. Coordination and/or communication with the therapist making the request, as well as the client s case manager regarding the provision of aids and equipment between all parties and ensuring that the clients kept informed of the progress in supply; The ABI STR Program: Will own the equipment while the client is on the ABI STR Program; Is responsible for the insurance and; Will fund the reasonable cost of servicing and repair of the equipment; May dependent upon the circumstances fund one replacement piece of equipment if it becomes irreparably damaged. Will ensure that the aid or equipment is delivered to the clients nominated address, by keeping a current client database. 4.2 Therapists / equipment prescribers Therapists and other specialist prescribers are responsible for providing assessments and recommendations in the relevant categories of aids and equipment (see Table 1.0). Prescribers of equipment are expected to: Complete aids and equipment applications in accordance with the ABI: STR program guidelines and professional practice; Source and supply quotations for aids, equipment and non-urgent repairs; Establish that the client and/or their carer have the cognitive, language and physical ability to operate the aids, equipment or home modification safely and effectively; Ensure that the client is agreeable and motivated to use the equipment and has trialled the equipment where possible; Provide a detailed report, using the ABI: STR aids and equipment application form, including the detailed specifications, recommendations and justification for the most appropriate and cost effective aids, equipment or home modification for the client. This report must also include details of the recommended supplier, and a written quote for the aids, equipment or home modification; Be available to discuss the assessment report and recommendations with representatives of the ABI: STR program and amend the recommendations where appropriate; Inform the client of possible alternatives to the recommended aid or equipment, and advise the client of the possibility of being provided with a reissued aid or equipment item; \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 5

6 Ensure that training is provided to the client and/ or their carer(s) and / or therapy support worker(s) in the safe use of the aid or equipment. Monitor and organise ongoing maintenance and repair of the equipment, while the client is under their care. Individual discussions may need to take place if the therapist, who prescribed equipment, discharges their client, while the client remains on the STR program. 4.3 Clients Clients who are issued with aids and equipment under the ABI: STR program are responsible for: General upkeep, care (including appropriate storage)and cleaning of equipment; Keeping the details of the warranty; Refraining from inappropriate use of, or modification to, items supplied; Not putting any member of the public at risk through the inappropriate or negligent use of the aid or equipment; Providing a non-refundable contribution to the cost of the aid, equipment, or home modification, where these exceed the maximum specification outlined in the ABI: STR aids and equipment guidelines (e.g. smart phone or tablets that exceed the 16 GB cap; bathroom modifications for aesthetic purposes, or where the equipment has dual usage, part of which is not for rehabilitation). 5 Priority of access The ABI STR Program will ensure that clients most in need are supported and prioritised. Once a client s application has been received and deemed eligible under the ABI: STR aids and equipment guidelines, the application will be prioritised in accordance with the following (reworded from the SWEP Guidelines): Risk management approach to prioritisation In order to consider the potential implications of non-provision of equipment to eligible clients, a risk management approach to prioritisation has been developed, based on the AS/NZS ISO 31000:2009 Risk Management Principles and Guidelines. Risks to clients based on potential consequences, or Implication of non-provision are assessed in a context of relative likelihood, providing a structured way to communicate urgency of need, and articulate a reasoned approach to priority of access. It must be noted, however, that ABI STR clients deemed not at risk, but rather with potential to benefit, will also have access to equipment, but may be regarded as low priority and placed on a waiting list. Articulation of risk is only intended to guide the ABI:STR Program as to the level of urgency. Paradigms of priority assessment There are three paradigms used within the above framework that are considered within a high urgency category. These paradigms, which have equal weighting, are paraphrased as: 1. Safety Issues. These are issues which threaten the physical safety of the client and/ or their support people in their daily lives. 2. Independence issues. These are issues which threaten the capacity for clients to live independently in their community. \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 6

7 3. Health Maintenance Issues. These are issues which threaten the psychosocial well-being of clients and / or their support people. Likelihood and Consequence Within a risk management framework, anaylsis of potential risks must be undertaken in a context of consequence severity and likelihood. Incremental levels of outcome severity are defined, and the likelihood of that outcome if equipment is not provided for clients within a timeframe can be identified by the requesting therapists. By analysing the potential risk within the three risk paradigms, the ABI STR program may ensure those who require equipment (or repairs) urgently are readily identified, while equipment / repair provision continues to be provided to all eligible clients in an equitable manner. The MonashHealth Risk Management Risk Matrix consequent Implementation Tool and Likelihood Measures appear in the tables below. These have been adapted from the AS/NZS ISO 31000:2009 Risk Management Principles and Guidelines. This matrix should be used when assessing urgency of need, and allows for clarity and transparency around the timing of equipment provision following request. Risk Rating = Likelihood x Consequence Likelihood Consequence Insignificant Minor Moderate Major Catastrophic Almost Certain M (19) H (12) H (9) E (4) E (1) Likely M (20) M (17) H (10) E (5) E (2) Possible L (23) M (18) H (11) H (8) E (3) Unlikely L (24) L (21) M (15) M (13) H (6) Rare L (25) L (22) M (16) M (14) H (7) \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 7

8 L Low Risk H High Risk M Medium Risk E Extreme Risk Likelihood measures: 6 Pricing, quotes and invoicing Due to the nature of the clients on the ABI STR program, many of the larger pieces of equipment (e.g. wheelchairs) will be highly specialised for the particular client. It is therefore not realistic to define upper price limits in those circumstances. Some items such as ipads, have a recommended retail price, which is what the ABI STR program will fund. The number of quotes required will be in line with: a. Two quotes for each item $2000; b. Three quotes for each item >$2001. c. For specialised equipment only available from one supplier, one quote will be accepted. Where the equipment quoted is fit for purpose and of sufficient quality, the quote of lesser value will be selected; The contractors / supplier of specifically modified aids and equipment should be specialists in their area. Clients may make a non-refundable contribution to fund equipment costs over that of the lesser quote. 6.1 invoicing Once a piece of equipment has been purchased, or an item repaired, the person / business who provided the equipment or service should send the invoice to: strequipment@monashhealth.org or ABI: STR program, Level 1, 55 Buckingham Ave, Springvale, Vic \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 8

9 The invoice MUST state the following: - Client s name - Req number - the item(s). The invoice amount must be equivalent to the amount funded in the approval letter by the ABI STR program. 7 Grievance processes and dispute resolution 7.1 Non-approved Equipment and Pricing Appeals Appeals regarding equipment prescribing, provision or funding will be resolved in line with the ABI:STR appeal process ABI: STR Appeals Procedure This procedure relates to the provision of clinical services including equipment and direct service provision. Grievances arising from payment issues or other contractual matters should be considered under the appropriate grievance process. In recognition that recommendations and decisions made by the Clinical Advisory Team, or recognised proxy may substantially change the range and nature of services provided to clients of the program an appeals process has been established which may be accessed by: 1. ABI:STR Clients ( Clients ), or 2. Carers of Clients, or 3. Family of Clients, or 4. Case Managers, and 5. Service Providers. This appeals process is in addition to external complaints mechanisms available through the Disability Services Commissioner, and the Department of Human Services. This appeals process must be read in conjunction with existing complaints procedures. Effective communication remains the key to reducing the need to activate appeals processes. Effective formal and informal communication must take place at all stages of the client s journey through services Communication Processes 1. Ongoing informal communication between Clinical Advisory Team clinicians, clients, case managers and service providers 2. Formal communication to client / family with cc to case managers and services providers (as appropriate); a. following on from case review at Clinical Advisory Panel meetings, b. where an appeals process has been activated by client, family or carer 3. Formal communication to case managers and services providers (as appropriate); a. where there has been a request for variation / equipment 4. All formal communications which include decisions / recommendations must be supported by clear rationale and justification. 5. All formal communications must be signed by the Program Manager, or Director if the Program Manager is not available. \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 9

10 7.1.3 Appeal levels ABI:STR Clients ( clients ), carers of clients, family of clients, case managers, and / or service providers providing services to clients are able to make application to access the appeals process. There are three levels of appeal available to applicants. These are outlined below. All appeal applications must be made in writing (assistance may be given to applicants who have difficulties with communication) and sent to the ABI STR Program Manager. Applications must be accessed under level 1 before being escalated to level 2. Level 3 occurs independently of Monash Health, however information gathered through investigations may assist in any investigation initiated at level 3. Level 1 internal review Applicant to provide details of appeal in writing to the Program Manager. The applicant is invited to contribute any additional information in support of their application and make comment on any information. Program Manager to instigate a review of the decision / recommendation. Program Manager to confirm or amend decisions / recommendations. Outcomes of the review are to be communicated in writing to the applicant. If applicant is not satisfied with the outcome the application must be escalated to Level 2. Level 2 program independent medical review Details of application, and relevant clinical information to be provided to the (Medical) Director Rehabilitation and Aged Care Services Medical Director for review Decisions / recommendations confirmed, amended or rejected Outcomes of the review are to be communicated in writing to the applicant. If applicant is not satisfied with the outcome the application must be made aware of external complaints mechanisms available under Level 3. Level 3 External complaints mechanisms Complainant access external complaints mechanisms independently of Monash Health \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 10

11 Table 1.0 Aids and Equipment available for provision under the ABI: STR program. Aids and Equipment Available Mobility aids and equipment Wheelchair- manual Including customisation and accessories Wheelchair- power Including customisation, accessories and power conversion kits Scooter Including customisation and accessories Gait aids: Sticks, crutches, 4-wheel frames and pick up frames Gait aids: Specialised or customised walking frames (e.g. Meywalker, Arjo Rehab Walker) Standing frames and tilt tables Bikes / trikes Specification All quotes to be submitted and assessed on an individual needs basis by the ABI STR advisory team For mobility only (not recreation) Type of assessment required May also require referral to ABI: STR Clinical Advisory Team for review Occupational Therapy and/ or Occupational Therapy and/ or Occupational Therapy and/ or Lifting and transfer aids and equipment Hoists: Mobile, overhead, standing Slings Transfer belts Transfer boards: Slide boards or swivel boards Occupational Therapy and/ or Occupational Therapy and/ or Occupational Therapy and/ or Occupational Therapy and/ or \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 11

12 Communication and cognition aids and equipment Electronic alternative augmentative communication systems (AAC) Speech pathologist and Occupational Therapist (for access to aid) and Neuropsychologist if relevant, OR assessment by Yooralla ComTec Computer tablet (e.g. IPad) Smart Phone Applications ( apps ) or computerbased programs / software to: a. be an alternative or augmentation to communication and / cognition; b. be used independently by the client as functional therapy practise Low-technology communication / cognitive equipment. E.g. large whiteboard and accessories; Customised communication books (e.g. via NECAS) - for AAC or rehab only - Recommended retail price (RRP) - Maximum 16Gb + WiFi - Must have trialled - for AAC or rehab only - RRP - Must have trialled - RRP - Requires referral to ABI: STR Clinical Advisory Team for review - Must have trialled Quotes and clinical rationale required Speech pathologist and Occupational Therapist (for access to aid) and Neuropsychologist if relevant Speech pathologist and Occupational Therapist (for access to aid) and Neuropsychologist if relevant Partly funded by client if partly for personal use. Speech pathologist and Occupational Therapist (for access to aid) and Neuropsychologist if relevant Speech pathologist and Occupational Therapist (for access to aid) and Neuropsychologist if relevant Switches for communication and / or environmental control Speech pathologist and Occupational Therapist (for access to aid) and Neuropsychologist if relevant, AND / OR assessment by electronic specialise such as Tecsol. \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 12

13 Personal care aids and equipment Commodes (bedside or shower) $3,400 Tilt in Space Wheeled Shower commode. All other styles of bedside commodes or shower commodes will be funded without a cap. Occupational Therapist Beds and pressure care aids and equipment specialised sleeping systems and Occupational Therapist pressure care equipment Bathroom Modifications Refer to Occupational Therapist Seating Day chairs Occupational Therapist / physiotherapist Recliner/ tilt chairs Including customisation and accessories Occupational Therapy / physiotherapist Household aids and equipment Trolleys (kitchen, laundry, general purpose) Reaching aids Adaptive kitchen aids: Kettle tipper Chopping board Jar/ bottle opener Specialised cups and straws (for dysphagia management) Specialised cutlery and plates (for independent feeding) Switches for environmental control Submit quotes for approval Quotes to be submitted and assessed on an individual needs basis by the ABI STR advisory team Quotes to be submitted and assessed on an individual needs basis by the ABI STR advisory team Quotes for these systems will be considered after clinical justification is reviewed by the ABI STR Clinical Advisory Team. Occupational Therapist Occupational therapist Occupational therapist Speech Pathologist Occupational therapist Occupational Therapist with speech pathologist if relevant. \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 13

14 Other Weights Splints and orthoses Serial Casting equipment Tilt tables Other requests must be submitted on an individual basis. Quotes to be submitted and assessed on an individual needs basis by the ABI STR advisory team Quotes to be submitted and assessed on an individual needs basis by the ABI STR advisory team Quotes to be submitted and assessed on an individual needs basis by the ABI STR advisory team Quotes to be submitted and assessed on an individual needs basis by the ABI STR advisory team Physiotherapist and / occupational therapist Physiotherapist and / or occupational therapist Physiotherapist and / or occupational therapist \ABI STR\ ABI STR Equipment\ABI STR_AIDS EQUIPMENT and repair policy_ Sept 2014.doc Page 14