How NDIS providers can implement comprehensive health assessments for participants

In 2019, the Scoping review of causes and contributors to death of people with disability in Australia was released.

The review, commissioned by the NDIS Quality and Safeguards Commission, sought to “obtain an Australia-wide perspective on the prevalence of, and factors contributing to, the deaths of people with disability.”

The need for such a review was clear.

For almost a decade, Australians have been hearing that compared to the general population, people with disability experienced worse health outcomes and higher rates of avoidable deaths.

But with the responsibilities of public health and disability services in a state of flux after the rollout of the NDIS, figuring out a clear path of action was anything but simple.

Fortunately, recognising the sector’s need for clear, actionable advice, the NDIS Quality and Safeguards Commission used the 2019 scoping review to develop a series of Practice Alerts to help providers better meet the healthcare needs of NDIS participants.

In this article, we’ll provide an overview of the Comprehensive Health Assessment Practice Alert.

As Melbourne’s leading doctor and nurse led NDIS provider for people living with disability and high medical needs, the team at SeenCare is uniquely well-placed to provide real-world advice on this important topic.

Not only will we unpack everything you need to know about health assessments for people with disability. We’ll also include practical tips for how providers of any size can implement the recommendations detailed in the comprehensive health assessment practice alert.

A Snapshot of Health Outcomes of Concern

A strength of the scoping review of causes and contributors to death of people with disability in Australia is that it was able to quantify the key health outcomes of concern for people with disability.

Below is an overview of 10 key conclusions drawn from the summary of findings after analysing the circumstances of death among 901 people with disability across Australia:

1. The median age at death was 20-36 years lower than that of the general Australian public
2. An “overwhelming majority” of deaths reviewed involved people with intellectual disability
3. High levels of co-occurring mental health concerns were common
4. The “vast majority of people who died experienced multiple physical health problems”
5. Dental and swallowing problems necessitating mealtime support were frequently observed
6. A high number of people required communication and/or mobility support
7. High rates of polypharmacy (multiple prescribed medications) were noted, along with “psychotropic medications in the absence of a diagnosed mental illness”
8. Vaccination rates, such as for influenza and pneumococcal, were low
9. Information on the date of the last comprehensive health assessment was missing for a “significant minority”
10. More than half of people who died were outside a healthy weight range, with weight and exercise monitoring status unknown for many

Other noteworthy points include:

• Most deaths (59%-71%) were unexpected
• Respiratory disease was the leading cause of death, followed by epilepsy, heart disease and cancer
• “Unnatural or external causes of death accounted for 5%-8% of all deaths, with the vast majority of these being related to accidental choking
• Concerns were raised about service providers failing to proactively manage ongoing health risks (eg, healthy lifestyle support, chronic disease management)
• Disability support staff had difficulty telling the difference between an urgent and non-urgent medical situation

Why Comprehensive Health Assessments?

If wondering how to tackle the list above makes you feel a little overwhelmed, join the club!

With the issue of improving health outcomes for people with disability cutting across so many different areas—and involving both disability service providers and healthcare professionals—it’s difficult to know where to start.

However, for many reasons, increasing the use of comprehensive health assessments is the logical place to start.

Let’s explore why…

What is a Comprehensive Health Assessment?

Many of us (particularly those who’ve reached middle age) are familiar with health checks.

Depending on your age, gender and health status, your GP is likely to recommend a schedule of checkups designed to catch any issues of concern early and prevent avoidable health issues.

A comprehensive health assessment for a person with disability is no different.

According the NDIS Quality and Safety Commission’s practice alert:

“The completion of a regular comprehensive health assessment for people with disability improves detection of health needs, enables active management of those needs, and significantly reduces health risks and poor health outcomes.

Regular comprehensive health assessments have been shown to prevent illness and maintain the health and wellbeing of people with disability. These outcomes are a result of identifying unmet health needs, preventing disease, engaging in regular health care and improving communication with the GP.”

A health assessment on its own won’t guarantee a person with disability receives the healthcare they need. However, it will help to identify any specific issues of concern relevant to the individual. Plus, it starts a dialogue between the disability service provider and the participant’s GP.

As we’ll detail in the following section, this dialogue is equally as important as identifying health issues.

Health Risks for People with Disability

There are several underlying factors behind the poor health outcomes experienced by people with disability in Australia.

The comprehensive health assessment practice alert calls these “risks of health problems for people with disability.”

The risks identified are:

• “Some people with disability may not be able to communicate when they feel unwell or experience pain. They may communicate in ways that are specific to them, and not well understood by others
• A person’s symptoms or behaviours are attributed to their disability and, as a result, they do not receive appropriate health assessments or treatments
• A mix of individual, medical, communication and social problems. These may be due to disability, health conditions that run in the family, poor nutrition, inappropriate accommodation, abuse and neglect, homelessness, inadequate preventative health care or treatment
• Lifestyle factors, such as obesity, physical inactivity, isolation, smoking and alcohol intake”

Key Messages from the Practice Alert

After identifying the health risks for people with disability, the comprehensive health assessment practice alert details strategies to address each one.

For a complete overview please refer to the full document. However, we’ve provided a summary of the key points below.

After each point, you will also find practical implementation tips.

These tips are based on the SeenCare leadership team’s 54 years of combined experience in the healthcare and disability sectors.

Identifying and addressing symptoms early

Picking up early on changes like weight loss or gain, a sudden change in eating habits, breathlessness, fatigue and expressions of pain means medical care can be accessed early to prevent an illness from getting worse.

Where a symptom of concern is noted, it’s essential to seek input from a GP as soon as possible.

Practical implementation tips

• Doing this well requires mutual trust between participants and staff
• Support staff may require additional training to understand and identify symptoms
• It’s best practice to have an individual plan for monitoring any specific symptoms of concern
• Having a supervisor or senior staff member to seek advice from is important. At SeenCare, we’ve embedded registered nurses on our team, so disability support workers can quickly and easily get advice on a participant’s health symptoms

Undertaking a regular comprehensive health assessment

According to the practice alert:

A comprehensive health assessment involves the participant and GP discussing and reviewing the participant’s medical history, current health problems, medications and any lifestyle risks.

The GP will, based on health information and physical examination, recommend what the participant requires for good health and wellbeing. The GP will also recommend and refer the participant for relevant preventative health care such as regular screening for serious conditions. For example: skin cancer checks; breast and/or or bowel cancer screening.

It is recommended that people with disability have a comprehensive health assessment at least once every 12 months.

Practical implementation tips

• If a participant’s GP seems hesitant to undertake a comprehensive health assessment, you can advise them there is a specific item in the Medicare Benefits Schedule item for a Health assessment for people with intellectual disability
• A structured approach and fillable form are also available for health assessments for people with disability via the Department of Health and Aged Care. This can be useful if you (or the GP) aren’t sure where to start and/or want a guided process to gather information and write out a healthcare plan
• Don’t leave scheduling the health assessment up to the GP. Make booking and supporting the participant to engage in the assessment part of the disability support plan

Developing a healthcare plan

An essential, yet often overlooked part of a comprehensive health assessment is the healthcare plan.

There is no set way the healthcare plan needs to be developed. But at a minimum, the GP, disability services provider and the participant should have a clear idea of any actions requiring further attention (like referrals, tests or further appointments).

Practical implementation tips

• It’s best practice to write the healthcare plan out, identifying who is responsible for each action, with a timeframe specified for each one. This can be done by the GP, disability support worker or the participant
• Get everyone to agree to the plan before it is completed
• Incorporate the healthcare plan into a participant’s disability support plan

Being proactive with chronic illness

Chronic disease is the biggest killer in Australia, contributing to 9 out of every 10 deaths.

Preventive healthcare and lifestyle factors (like getting enough exercise and eating a balanced diet) can reduce the risk of developing chronic disease. Once chronic illness is present, a proactive approach to monitoring symptoms and managing the disease can improve outcomes.

Proactively managing chronic illness includes things like regularly taking medications, keeping an eye on health markers (like blood pressure or blood sugar levels) and seeing healthcare specialists when required.

This approach is often called chronic disease management.

Practical implementation tips

• Chronic disease management can be thought of as a combination of medical and lifestyle interventions. For people with disability, it tends to work best when healthcare professionals and disability support staff work collaboratively with a person-centred approach
• Having a good working relationship with a participant’s GP is helpful. At SeenCare, we have partnerships with a small group of GPs who have agreed to bulk-bill our NDIS clients.
• Primary Health Networks (PHNs) can be a great resource if you are having trouble finding healthcare support for people with disability. They fund a variety of programs, like mobile vaccination clinics for vulnerable people (including those with disability).

Healthcare Is Everyone’s Business

The practice alerts published by the Quality and Safeguards Commission highlight a change in direction recently confirmed in the 2023 NDIS Review—Healthcare for people with disability is now considered everyone’s business.

This likely won’t come as a surprise to most providers. But as is often the case with policy changes, results on the ground can often lag behind decisions made at the National level.

Perhaps one of the biggest challenges is that disability support providers have been required to take on a substantial amount of additional responsibility, in a workforce that traditionally has not been trained in the provision of healthcare supports.

Whilst we acknowledge there will be an element of new skill development during this transition, we believe that disability support workers already possess many of the foundational skills to support people with disability to improve their health.

Communication assistance, advocacy, supported decision making, person-centred care, assistance with daily life and helping individuals to set goals and achieve them are all fundamental strengths of disability providers.

At its core, this is what the practice alert on comprehensive health assessments prescribes to improve health outcomes for people with disability. And we are confident NDIS providers will rise to the challenge and contribute to progress on this important issue.

SeenCare delivers a unique model of integrated health and disability care to NDIS participants with high medical needs living in Melbourne. To find out more or enquire about a referral, please contact one of our friendly staff members today.