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Needs assessment

Getting the right NASC assessment

Getting NASC & SLI information for disability residents

Communication breakdown leads to pressure sores

Speaking up brings changes for others

Prompt action by advocate helps wheelchair user

ACC doctor tries to ignore a consumer

The importance of continuity

Involvement in annual review process

Being included in meetings regarding your own future

Waiting list for home help

Empowering carers to advocate more effectively

Poor communication and support from Needs Assessment Service Co-ordination Agency

Communication problems with a needs assessment agency

Getting the right NASC assessment

Needs Assessment and Service Coordination Service ~ Right 4 ~ appropriate standards ~ Right 5 ~ effective communication ~ assessment & care planning ~ Autistic Spectrum Disorder

The mother of a young boy with high disability needs contacted the advocacy service about her concerns. She spoke English as a second language and had difficulty communicating with the Needs Assessment and Service Coordination Service (NASC) regarding her son's needs assessment and care planning. She had approached them a number of times raising her concerns, but with no success. She was obviously frustrated by the lack of progress.

After considering her options she decided to lodge a formal complaint in regard to her son's additional condition (presumed to be Autistic Spectrum Disorder).  She wanted this to be identified, his needs to be reassessed and responded to properly. She also raised issues about the quality of her son's previous assessment and the standard of care provided over the last two years. 

The advocate gave consistent support throughout the process which was prolonged due to the necessity of ongoing communications. The NASC were finally able to offer a positive resolution by appointing a new needs assessor who reviewed the consumer's case, recognised the core issue, assigned him to the right team, and upgraded the scale of his care coordination plan to meet his full needs. 

When all the above outcomes were achieved, the mother was both excited and delighted. She wrote an email to acknowledge the advocate's help:

"I want to thank you for your help. Finally my son is under the right team now. They have also referred him to other support services. I am happy with their services. Appreciate your efforts and patience. You have helped to make this happen. Again, THANK YOU".

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Getting NASC & SLI information for disability residents

Needs Assessment and Coordination Service ~ Supported independent living ~ Right 6 ~ Fully informed

A married couple living in residential care said they had not been informed of the result of their Needs Assessment and therefore did not know the level of support hours that had been allocated. They also wanted information on the option of Supported Independent Living.

At the request of the consumers an advocate contacted the NASC who arranged a review assessment for both of the consumers. At the time of the assessment the consumers were both given information on options of support and assessed for the number of support hours that they would need. They were also given information on Supported Independent Living.

The consumers were happy with the outcome of their NASC assessment and getting the information they had requested enabled them to look at other options for their future.  

They thanked the advocate for supporting them through the process. 

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Communication breakdown leads to pressure sores

Occupational Therapy ~ Right 4(4) ~ Services that optimise quality of life

A consumer contacted an advocate after getting pressure sores from sleeping in her wheel chair. She couldn't get in and out of her hospital bed as it was too high.

She had left several messages for the occupational therapists to contact her as she wanted someone to visit her and suggest ways she could transfer to and from the bed. The consumer believed the lack of response from the occupational therapists was because they had argued during a recent admission to hospital. The advocate assisted the consumer to write a letter of complaint, in which the consumer also included a message about wanting to restore the relationship.

The occupational therapists contacted her as soon as they received the letter and apologised for the breakdown in communication. They explained that the argument had no relation to her ongoing care and support, and it was just a matter of messages not being passed on. A few days later an occupational therapist visited her and organised a new bed. The consumer felt a lot better about what had happened and the future picture was brighter now that she was confident to voice her opinions without fearing any adverse consequences.

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Speaking up brings changes for others

Home Support Services ~ NASC assessment ~Right 4~ consistent with needs ~ Right 5~ effective communication ~ Right 6 ~ fully informed

The mother of a young disabled child contacted the advocacy service for help to get the service her child was entitled to. Many months had passed since the needs assessment, and a referral had been sent to a home support agency for support hours, but no service had been provided. After considering her options she decided to contact the NASC Service Coordinator to request a different agency to provide the service.

She also wanted to use the support of the advocate to pursue the option of writing to the home support agency so they would know about her distress at the failure to provide any support services or communication.

As a result of her letter she received a written apology from the agency. They advised that as a result of her complaint they were making changes to their communication processes so this situation would not occur in the future.

The child's mother told the advocate that although the situation had been difficult for her, and she had moved to a different home support agency, she was pleased that speaking up had resulted in changes so this situation would not happen to other families referred to that agency.

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Prompt action by advocate helps wheelchair user

Occupational therapy ~ Wheelchair user ~ Right 4 ~ Appropriate standards consistent with needs ~ Right 5 ~ Effective communication

A woman contacted the advocacy service for support for her son. He is a wheelchair user and had been waiting a very long time for a replacement chair. The assessment by an OT to look at why his current chair was causing extreme pain in his lower back requiring pain relief determined a new chair would be ordered,

The consumer confirmed he was unhappy with the extensive delay in receiving a new chair as well as the lack of any communication about when he could expect to receive it.

After considering their options, they decided to forward their concerns to the provider, via the advocate. Following the provider's investigation into the matter, the consumer received a written response advising an administration error had occurred and an urgent request to the wheelchair centre had been made. The OT personally contacted the consumer and apologised.

Within a few days the consumer received his modified wheelchair and equipment to support him with his back pain. He said he feels more comfortable and his back has improved dramatically.

After many months of the consumer being in pain, feeling frustrated and ignored by more than one provider, the advocate was able to support and assist him to have his complaint taken seriously resulting in a speedy and satisfying conclusion to the matter.

The consumer and his family were very complimentary of the service provided by the advocate and said they will not hesitate to recommend the service to anyone in the future.

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ACC doctor tries to ignore a consumer

ACC doctor ~ Assessment ~ Right 1(1) ~ Respect ~ Right 10 ~ Right to complain

The consumer, an elderly lady, was referred by ACC to a doctor who told her during the consultation that she was "grinning like a stupid monkey". She found his attitude, comments and language offensive and contacted the advocacy service for help to complain about his conduct. The advocate advised the consumer of her options and she opted for help to draft a letter to the doctor. In the letter she requested an apology as well as acknowledgement that his behaviour had been inappropriate.

After a lengthy wait with no response, the consumer asked the advocate to phone the doctor to find out when she could expect a response. The doctor advised the advocate that because he had seen she was copied into the consumer's letter he did not have to respond. The advocate advised him of the role of the advocacy service, his right 10 obligations and requested he respond directly to the consumer.

Rather than respond to the consumer as requested, he emailed his response to the advocate. The advocate again contacted the doctor and requested he respond directly to the consumer, which he finally did.

The advocate contacted the consumer to check she had received the response. She had and while partially satisfied she decided not to take the matter further.

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The importance of continuity

NASC ~ Residential home ~ Privacy ~ Continuity ~ Complaint resolution agreement form

A resident from a disability home rang an advocate in a very upset state. He kept repeating that respect for his privacy had been ruined. The consumer had a disability that could make him difficult to understand. He suggested the advocate speak to the manager of the home, as he said she could explain what had happened and he trusted her.

It turned out that a NASC staff member had given the consumer's details to someone who had identified themselves as an advocate for people with mental health issues. The consumer's consent was not obtained prior to the information being supplied. When the "advocate" became unwell, personal information about the consumer was posted to the many service providers in the region. Once the NASC discovered what had happened they contacted the consumer to let him know. They also gave him the contact details for the local health and disability advocate.

Although the issue is one of privacy, the advocate already had an established relationship with the consumer through regular visits to the home. She felt the continuity of her assistance along with his difficulty communicating was more appropriate than referring him to another agency that would not be able to assist in person. The advocate supported him at a meeting with the NASC Manager who explained to him what actions had been taken. These included the staff member being disciplined as well as the consumer being sent a written apology.

The consumer was pleased he was able to give clear instructions about what he wanted. As some actions were to take place after the meeting a complaint resolution agreement form was completed. This included a plan that required the manager to keep him informed throughout the process. The consumer felt good about this as he had something to take away and knew that every effort was being made to put things right. He was also really happy to have had the support of an advocate he knew.

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Involvement in annual review process

A disabled consumer wanted to know why neither he nor his caregiver had been consulted in his annual review process. He queried why after a hospital admission his allocated hours on discharge were initially reduced and only reinstated when he questioned this decision.  His attempt to address his concerns via his support agency had not been responded to.

After discussion with an advocate the consumer requested support to put his concerns in writing, seeking an explanation, an apology and acknowledgement that urgent reassessment of his care might be required. In his letter he requested a meeting with the providers, his caregiver and advocate.

His request for a meeting was acted on and as a result he received an immediate increase in carer hours in acknowledgement that his care needs had increased. They were unable to explain why his hours following hospital discharge had been cut, as the facilitator in charge had left their employment.

He received a letter of apology which detailed that when his twelve-month review was undertaken he and his carer would be consulted, that additional hours would be required due to the degenerative nature of his condition and that staff would have refresher training on following review process policies and appropriate contact with clients of the Support Service provider. The consumer was extremely happy with the outcome.

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Being included in meetings regarding your own future

A consumer was unhappy he had been asked to attend an assessment meeting at short notice which did not give him any time to prepare, discuss it with staff or to have a support person present despite his request to have support.

After discussions with an advocate a meeting was organised with the management of the residential service. The following outcomes were agreed:

• A support person will attend with the consumer at all needs assessments. Information will be provided in a timely manner allowing the consumer to prepare and discuss the material with staff or a support person.
• A support person will be present to discuss his goals/life plan and when a meeting organised by residential services involves him. Information will be provided prior to the meeting giving the consumer opportunity to prepare.
• If a support person is not available the meeting is to be rescheduled.   

The manager of residential services undertook to re-iterate to the consumer their agreement and commitment to these outcomes, and the consumer was happy with this.

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Waiting list for home help

An elderly gentleman contacted advocacy as he has had no contact from the Needs Assessment Service (NASC) for over 14 months. He had written to them a year ago but did not receive a response. He wanted to know his position on the waiting list for home help as he had had a lower spinal collapse. He had also had a heart attack not long after he sent the letter and informed the advocate that the NASC was not aware of this.

The advocate contacted NASC. The elderly man advised that he was now receiving one hour per week home help, and was very happy with this outcome.

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Empowering carers to advocate more effectively

A woman who supported a man who had a physical and intellectual disability contacted advocacy with written authorisation from the man to speak about his situation. His overall needs were complex, and he lived at home with a number of support services including personal care and domestic assistance. He had ongoing concerns that his quality of care was being compromised by inconsistency of care and an unavailability of carers. He had recently had a fall that resulted in hospitalisation. He wanted to return home but the hospital clinicians were not keen on this.

The support person used advocacy to clarify her questions and to gain encouragement to ask them. She wanted to know what was required in the needs assessment process before changes in disability support services could occur, how needs are determined in the assessment process and who ultimately decides what the needs of the person with the disability are. She also wanted to know how clinical recommendations fit into the assessment process and how other non-hospital clinical opinions could be included.

The second issue was the man's long-term concern about having more direct choice in caregivers. It was suggested that she ask about all available funding possibilities including any discretionary funding.

Ultimately, there was a further review by a needs assessor. The disabled man signed the assessment, agreeing to the needs identified. The support person supported the man through the needs assessment process and found out about individualised funding which allowed more autonomy regarding funding including direct hiring of staff.

The man continues to live at home and is now able to choose the people he wants to care for him through an individualised funding package.

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Poor communication and support from a Needs Assessment and Service Co-ordination service

The family of a consumer with cognitive deficits contacted advocacy for assistance.  The consumer lived with his extended family, and as he tended to make poor social choices, his family had legal guardianship. Despite frequent calls by members of the family to the local Needs Assessment and Service Co-ordination service (NASC) they got no response and as a result the consumer and his family received very little support.

The family tried to cope with very little support but became so 'worn out' they sought the help of their local advocate to meet with staff of the NASC agency.

Their complaint highlighted the following issues:

• Poor communication from NASC.
• Lack of information about disability support options.
• Lack of timeframe for supports to be commenced as well as a lack of follow-up to ensure they were in place.

At the meeting, support options and outcomes were discussed. Although the NASC staff agreed to keep the family informed, the advocate had to chase them up on a regular basis to make sure information was provided and appropriate disability supports were put in place to ease the stress for the family.

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Communication problems with a needs assessment agency

NASC agency ~ Needs assessment ~ Effective communication ~ Timely response ~ Self-advocacy

A mother contacted the advocacy service as her request to the local needs assessment agency had not been acted on. She had asked for an assessment for her younger son and an update on support services for her older son. Despite making these requests on a number of occasions, there had been no response and the information had not been provided.

She stated she wanted clear and honest responses from the NASC agency with communication and support provided in a timely manner. 

After discussing her complaint with an advocate, she wrote to the NASC agency outlining her complaint and asking for a meeting with a manager to discuss her concerns and a way forward.  Although she used the advocate to prepare for the meeting, she had other support available at the meeting and felt able to advocate on behalf of her sons.

At the meeting, the NASC manager personally undertook to ensure that appropriate service provision was in place for the two children and that all future communication with the family would be open, honest and timely.