Disability Support Services - moh.govt.nzFILE/DisabilitySupportServices.pdf · Part 1: Background 1...

Disability Support Services

Increasing participation and independence

Published in August 2002 by the Ministry of Health

PO Box 5013, Wellington, New Zealand

ISBN 0-478-25523-3 (Book) ISBN 0-478-25524-1 (Internet)

This document is available on the Ministry of Health’s website: http://www.moh.govt.nz

Contents

Executive Summary v

Part 1: Background 1

Population profile of people with disabilities 1 What are Disability Support Services? 2 How are DSS accessed? 3 History of DSS 4 Funding and expenditure 6

Trends in DSS expenditure 6

Part 2: Wider Influences on Future DSS 9

Impact of human rights and other philosophies 9 Focus on intersectoral approaches and the NZDS 10

The New Zealand Disability Strategy 10 Office for Disability Issues (ODI) 11 Development of an intersectoral framework to achieve equity and coherence 11 Pathways to inclusion (vocational services) 11

Other pressures on DSS 12

Part 3: Improving How We Operate: Strategic Direction 13

Separating DSS planning and funding 14 Responding to the NZDS 14

Balancing national consistency and more flexible approaches 15 Individualised funding options 16

Moving to a greater focus on outcomes and participation 17 Improving information data systems 17 Developing research and evaluation capacity 17 Balancing habilitation, rehabilitation and participation, against support 18 Managing demand and expenditure 19 Future funding issues 20 Ensuring there is a quality assurance framework for all services 22 Developing workforce capacity and skills 23 Improving disability sector capacity, skills and viability 24 Key issues 24

Disability Support Services: Increasing participation and independence iii

Part 4: Current Directions and Initiatives 26

Achieving successful independent living 26 Balancing safety and the right to risk 27 Beyond deinstitutionalisation 28 Seeing that health and support needs are met, and ensuring good linkages and co-ordination across health services 29 Seeing that vocational needs are met 30 Better intersectoral relationships, planning, funding and assessment 30

Equity and service challenges 30 Culturally appropriate services 31 Responding better to age-stage needs 32 Initiatives for specific high-need disability groups 34

Part 5: Key Decisions in the Next Three Months 37

Appendix A: Summary of Current Disability Support Services (DSS) 39

iv Disability Support Services: Increasing participation and independence

Executive Summary Disability Support Services (DSS) are a range of support services for people with disabilities and their families and whänau. The Ministry’s current direct funding role in relation to DSS contrasts with most other Vote: Health-funded services, which have been devolved to District Health Boards (DHBs). Based on decisions made by Cabinet in July 2001, DSS for people 65 and over will be separated from DSS for people under 65. DSS for older people is planned for devolution to DHBs after 1 July 2003, subject to a Cabinet decision based on DHBs proving capability to provide an integrated continuum of care for people 65 and over. Future funding and planning options for DSS for people under 65 will be further considered from July 2004; the Ministry will continue to fund these services pending any changes resulting from this work. The Ministry has established a number of strategic directions and priorities for the next three years. These include:

• separating the two funding streams for the different age groups, and creating viable arrangements (including the transition of DSS for older people) around these funding streams, so that the vision for older people (in the Health of Older People Strategy) and the strategic direction for younger people are established

• enhancing its strategic direction for younger people with disabilities – future directions will be based on the New Zealand Disability Strategy (NZDS), Ministry of Social Development-led work on equity of access and coherence of services for people with disabilities, and viable arrangements for DSS for younger people with disabilities ensuring there is a greater focus on outcomes, and increasing participation and independence, and working intersectorally

• ensuring that, throughout this transition, ‘business as usual’ service provision and improvements to the national consistency of services and policies occur, so there is as little disruption as possible to people with disabilities.

Achieving successful supported community living, improving services and reducing equity and service gaps, guided by the NZDS and within a carefully managed budget, will all contribute to this.

Disability Support Services: Increasing participation and independence v

Part 1: Background

Population profile of people with disabilities

One in five New Zealanders has a long-term disability or impairment.

Statistics New Zealand’s 2001 New Zealand Disability Survey established that 743,800, or one in five New Zealanders, have a long-term disability or impairment.1 While this is a high figure, not all people are eligible for, or need to receive, DSS funded by the Ministry of Health (eg, some people may be eligible for support from sources such as ACC). According to the Disability Survey, disability increases with age. Eleven percent of children (0–14 years) have a disability, compared with 13 percent of adults aged 15–44 years and 25 percent of adults aged 45–64 years. However, more than half (54 percent) of people aged 65 years and over report having a disability. The majority of people with disabilities have more than one disability or impairment. Physical disabilities are the most common, with 66 percent of people over 15 reporting a physical disability. Sensory disabilities are the next most common (42 percent). Only 5 percent of people reported having an intellectual disability, although the support needs level of this group is higher on average than for the other main groups.2 Significantly, 43 percent of the adult population with disabilities are moderately limited by their disabilities and require special equipment related to their disability or some assistance with daily living from families or whänau, or support services, while 15 percent are severely limited and require daily or constant assistance. This compares with 1996–97 when 28 percent of the same age group reported they were moderately limited, and 12 percent had severe limitations.3

1 This represents an increase of 41,800 people since the first Statistics New Zealand

Disability Survey in 1996–97. Statistics New Zealand Disability Survey 2001, May 2002.

2 People with intellectual disabilities had the highest level of disability requiring assistance (DRA) to disability ratio of any group, according to analysis of the 1996–97 Disability Survey by the Ministry of Health and Health Funding Authority (1998).

3 Between the two surveys, the proportion of people reporting a mild limitation and no need for assistance decreased from 61 to 42 percent.

Disability Support Services: Increasing participation and independence 1

Only 4 percent of people with disabilities (27,300) live in residential facilities such as aged care facilities or community homes for people with disabilities under 65; the remaining 96 percent live in households in the community. For Mäori, while overall disability rates are the same (one in five), in younger age groups they tend to be higher, reflecting earlier onset of disabling and age-related conditions for Mäori than for others in the population. One-third of Mäori aged 45–64 years reported a disability compared to one-quarter of the total population in this age group. Sixty-one percent of Mäori aged 65 and over reported a disability, compared with 54 percent of the total population in this age group. Approximately 28,100 Pacific peoples with a disability live in New Zealand and one in seven Pacific peoples report having a disability. Further analysis of statistics relating to both Mäori and Pacific peoples is required, as there is also some evidence to suggest a level of under-reporting.

What are Disability Support Services?

DSS are predominantly community-based and delivered by private and not-for-profit providers.

The Ministry of Health currently funds a range of Disability Support Services (DSS) for people with disabilities of all ages, to increase their independence and participation. Families and whänau may also receive support. DSS constitute a complex and individualised range of services, ranging from home-based support to residential support services. (For more information, see Appendix A.) DSS are predominantly community-based and delivered by private and not-for-profit providers. Providers vary in size from large national providers such as IHC, to small owner-operated local enterprises. In response to policy and contracting changes, only a small proportion of services are now provided by hospitals, although these account for a significant portion of DSS expenditure. While the Ministry of Health is the predominant government funder of DSS, other support services are funded through agencies such as the Ministry of Education, ACC and the Ministry of Social Development’s Work and Income New Zealand. There are strong intersectoral linkages between many of these services, and boundary tensions can result.

2 Disability Support Services: Increasing participation and independence

DSS are largely funded from tax revenue, but consumers pay part charges for some services. They do not pay for services such as needs assessment and service co-ordination, or personal care services. DSS are generally free for children up to the age of 16 or until they qualify for an Invalids Benefit. Access without charges on some services depends on income and asset levels. Support from not-for-profit organisations, or Lottery Grants Board and charitable funding, may supplement services funded by the Ministry of Health.

How are DSS accessed? A person with a disability must meet the Ministry’s definition of disability; that is, be assessed as having either a physical, intellectual, sensory, psychiatric or age-related disability, or a combination of these, where the disability is likely to: • continue for a minimum of six months • result in a reduction of independent function to the extent that ongoing

support is required. This definition of disability now needs amending and updating (see Part 4, p. 29–30 for reasons.) Once eligibility for DSS is established, three interlinked processes form the basis for access to specific publicly funded DSS (the DSS Framework). The Ministry of Health funds these processes within a ring-fenced4 budget, and requires auditable boundaries between them.

• Needs assessment: this identifies and prioritises all of a person’s care and support needs (including needs that may be met by other agencies), irrespective of funding constraints and availability of services.

• Service co-ordination or planning: this identifies the most appropriate services and support options to meet assessed needs and outcome goals, within available funding. It may require prioritising access to some funded services through means testing based on assets and/or income, or using particular criteria to determine waiting times for some services. The service co-ordinator may assist people to access support from other services.

• Provision of services: generally this is in the form of an individual support package of services for the person with the disability, and their family where appropriate.

4 The DSS ringfence refers to a separate DSS Non-Departmental Output Class (NDOC).


The Ministry also funds community-based agencies to provide disability information and advisory services separate from the needs assessment and service co-ordination (NASC) process.

History of DSS

The DSS reforms between 1993 and 1997 led to significant gains in some areas, and far more people received DSS than in the past. However, a high degree of unmet need was highlighted.

Current DSS responsibilities are the result of legislative, policy and funding decisions made between 1993 and 1997.5 Under the New Zealand Public Health and Disability Act 2000, the Ministry nationally purchases DSS, with most contracts being administered by four regional offices.

1 Prior to 1993, arrangements for publicly funded DSS were confusing, with multiple funding streams across a number of government agencies, ad hoc policy and service development, and a multiplicity of service providers.

Responsibility for service funding was principally divided between the then Department of Health, and the Department of Social Welfare (DSW). While some welfare assistance derived from the Social Security Act 1964 (notably the rest home subsidy), the enactment of the Disabled Persons Community Welfare Act (DPCWA) in 1975 established a range of community support programmes for people with disabilities, their families and support agencies. Some programmes were demand-driven, others had capped funding.

2 As a result of New Deal announcements,6 between 1993 and 1995 most DPCWA programmes and related DSW responsibilities were progressively transferred and consolidated under the regional health authorities (RHAs) and Vote:Health, and DSS funding was ring-fenced. The aim of the reforms included ensuring people had access to appropriate responsive services of an acceptable quality; promoting rehabilitation; and shifting the basis of access to services from nationally specified ‘entitlements’ to individually assessed needs. Intersectoral issues requiring further work were identified.

5 The Health and Disability Services Act 1993 provided the legislative basis for DSS until

the New Zealand Public Health and Disability Act 2000 was passed. 6 The New Deal: Support for Independence for People with Disabilities, Ministers of

Social Welfare and Health, 1992.


The DSS reforms led to significant gains in some areas, and far more people received DSS than in the past. However, the requirement that all people accessing DSS services have a comprehensive needs assessment raised expectations that needs would be met, and identified a much higher degree of unmet need than expected. Demand for most services has exceeded available funding, and this has constrained the ability to develop innovative services and address service gaps.

3 In 1997, the then government announced the decision to create one funding agency, the Health Funding Authority (HFA). Improving the nationwide consistency of services and service improvements became important priorities for DSS, as well as putting funding management strategies in place.

4 In 2000 the Government made the Ministry of Health responsible for leading the development of the New Zealand Disability Strategy (NZDS) and overseeing its implementation. The NZDS aims to reduce barriers to participation faced by people with disabilities in their communities.

5 In July 2001 the Government decided that:

• planning and funding for DSS for people aged 65 and over would be separated from that for younger people with disabilities. The proposal to devolve DSS funding and planning for older people to DHBs is dependent on DHBs demonstrating capability to provide an integrated continuum of care for this population group7

• funding and planning for DSS for younger people would remain with the Ministry, pending further analysis of options for meeting their needs, and development of a strategic direction before July 2004.

On 1 July 2002 responsibility for advising on disability issues and leadership and monitoring of the NZDS shifted to the Ministry of Social Development’s Office of Disability Issues. To reflect this change, the Disability Issues Directorate within the Ministry of Health has become the Disability Services Directorate (DSD).

The wider implications of these decisions are currently being worked through. (For further discussion, see Part 3, pp.13–14.)

7 The integrated continuum of care for older people spans health promotion, disease

prevention, treatment, rehabilitation and support services.


Funding and expenditure

Ringfenced funding for DSS is now 19.5% of total Vote:Health.

Expenditure for DSS over the years reflects strong external demand pressures as well as internal efforts to manage and constrain budget growth, and some changes to the way funding statistics are drawn up.8 Ringfenced funding budgeted for DSS is 19.5% of Vote:Health ($1.346 billion GST inclusive in 2001/02). The proportion of Vote:Health ring-fenced for DSS has declined in recent years as a result of funding for younger people with psychiatric disability9 being transferred out of the ringfence to mental health. There have been other minor transfers from the ringfence.

Trends in DSS expenditure Excluding psychiatric disability, actual DSS expenditure increased steadily from 1995/96 to 2001/02 by between 2.5 and 7 percent each year, reflecting strong demand pressures.

8 See the Ministry of Health’s Health and Independence Report (2001) for a full

discussion on the growth of expenditure on specific DSS since the consolidation of services under Vote:Health.

9 Psychogeriatric services have remained part of DSS in some regions (Central and Southern).


Figure 1: DSS expenditure, 1995/96 to 2001/02 ($000)

$-

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

DSS expenditure $1,012,614 $1,077,433 $1,139,387 $1,174,450 $1,256,802 $1,300,901 $1,315,079 1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02

Note: DSS attract different GST rates. The average GST rate (for all services) for 2001/02 is 11.4%. The same GST rate has been applied to previous year figures to arrive at GST-inclusive figures. The 2001/02 expenditure figure is subject to audit. Increased expenditure from 1996/97 onwards reflects changes in prices, demographics and technology. Service volume increases (especially in areas such as home-based support), and some recent price increases (in particular for aged residential care services) have also been key drivers. Approximately 88% of DSS expenditure in 2001/02 went on five main service areas:

• residential care for older people, and for people with intellectual, physical or sensory disabilities

• home-based support

• environmental support

• carer support such as respite care

• assessment, treatment and rehabilitation (AT&R).


Figure 2: DSS expenditure by service area, 2001/02 forecast

Residential care56% Other

12%

Home-based support10%

Environmental support5%

Carer support5%

Assessment, treatment and rehabilitation

12%

Note: the percentages shown in the above graph are similar to those of previous years. DSS funding for people age 65 and over is estimated to be up to 65% of total DSS funding ($875 million for 2001/02), while non-age-related funding is currently estimated to be about 35% ($471 million). Reliable information on the exact proportion between aged and non-aged DSS expenditure will not be available until August 2002.


Part 2: Wider Influences on Future DSS

DSS are significantly influenced by overseas and societal trends, and developments in other services and sectors, including: • the impact of human rights and other philosophies • an increasing emphasis on intersectoral approaches and the NZDS • other pressures, such as the ageing of the population.

Impact of human rights and other philosophies New Zealand’s disability sector has expressed a strong commitment to human rights in recent decades, and has actively advocated that people with disabilities should enjoy the same human rights as all other members of society. Vigorous disability rights and advocacy movements, and support for the social model of disability,10 have resulted. In 1993 the New Zealand Human Rights Act (HRA) for the first time included people with disabilities. An amendment in 2001 means that from 1 January 2002, government activities are also subject to the HRA under a Bill of Rights Act standard. Including DSS within a human rights framework presents a number of challenges.

• Access to and the nature of particular DSS may be differentiated on the basis of disability type, and current access criteria are sometimes not evidence-based. In addition, the Ministry of Health’s definition of disability is based on a much narrower definition than that used by the HRA. In the coming years access to some DSS and the definition of disability will need to change, to bring them more into line with the HRA.

• The HRA, the recent HR Amendment Act and the NZDS (with its underpinning rights-based philosophy) highlight a tension between the concept of rights-based access to services, and operating DSS and other government-funded services within budget constraints.

10 The social model places disability within its social context, and focuses on the

relationship between people with impairments and their social environment, and on removing barriers to participation in that environment.


Principles of inclusion and normalisation have also had a major impact, and provided philosophical justification for deinstitutionalisation. There is now a realisation that living in the community by itself does not necessarily guarantee full inclusion. Increasingly, people with disabilities are asserting their right to speak for themselves, rather than have family members or providers speak for them. DPA (New Zealand) Inc. provides a national ‘voice’ for people with disabilities.11 A separate carers rights movement has also emerged (there is an active Carers New Zealand organisation). In addition, there is a national Disability Sector Chief Executive Officers Group, and disability providers have their own network in Auckland.

Focus on intersectoral approaches and the NZDS There is widespread demand for a more holistic/ integrated/ co-ordinated and intersectoral approach to providing disability services.

The New Zealand Disability Strategy

Underpinning the NZDS is a vision of ‘a society that highly values our lives and continually enhances our full participation’. The NZDS provides a framework to address disability issues across agencies, policies, services and legislation.

Governments around the world are actively working to bring leadership, direction and vision to disability services. One of the main mechanisms has been through developing a national disability strategy. Following its election in 1999, the New Zealand Government made a commitment to develop a national strategic plan to eradicate barriers to community participation faced by people with disabilities. Guided by a Disability Sector Reference Group, and after extensive consultation with people with disabilities, their families and whänau, and the wider disability sector, the New Zealand Disability Strategy (NZDS) was launched in April 2001. The NZDS has 15 objectives and 113 associated actions. The Government expects the vision of the NZDS to be achieved over an extended period. The NZDS represents a strong commitment to human rights, empowerment, participation and inclusion. There is also an emphasis on partnership based on the Treaty of Waitangi, and in a broader sense between government, communities and support agencies. 11 DPA (NZ) Inc is the national assembly of people with disabilities.


The NZDS provides a framework to address disability issues across agencies, policies, services and legislation.

• All government departments from 2002/03 have to develop annual implementation plans, against which their progress in meeting the objectives and action areas contained in the NZDS is measured, and reported to Parliament.12

• While sectors such as local government are not required to develop implementation plans, they are strongly encouraged to implement the NZDS within their own organisations and sectors. Activities such as building compliance activities of local government have a major impact on the everyday lives of people with disabilities.

Office for Disability Issues (ODI) The ODI was established within the Ministry of Social Development (MSD) to be the lead agency for the NZDS and provide policy advice and ministerial support to the Minister for Disability Issues on disability issues, from 1 July 2002. This role includes being the lead agency for strategic and intersectoral disability policy.

Development of an intersectoral framework to achieve equity and coherence When the NZDS was launched, the Government announced that the Ministry of Social Policy (now MSD) would lead a review of the nature and extent of government-funded support and services provided for people with disabilities, including their families and whänau. A report to the Minister for Disability Issues in the second half of 2001 noted the ad hoc development of policies and services to date and the related lack of intersectoral strategic policy direction and co-ordination. It recommended how this could be improved, and that further work be led by MSD.

Pathways to inclusion (vocational services) There have been ongoing concerns expressed by people with disabilities and providers at the lack of opportunities to participate in employment and community activities, and a lack of clear policy and funding direction. The roles of the different government agencies involved have also been unclear.

12 These reporting requirements for the Minister for Disability Issues are specified in

section 8(4), NZPHDA 2000.


To address these issues, in September 2001 the Minister for Disability Issues and the Associate Minister of Social Services and Employment released Pathways to Inclusion, the vocational strategy for people with disabilities, and announced that the Disabled Persons Employment Promotion Act 1960 (DPEP Act) would be repealed.13 Under the vocational strategy, MSD (Work and Income New Zealand) is responsible for providing better-quality outcome-focused employment and training opportunities, and community participation activities, for people with disabilities from 16 to 65 years of age. Work and Income is also committed to building sector capacity and service quality. The strategy has implications for the Ministry of Health and DHBs to work through during the strategy’s implementation period. (See Part 4, p.25 for further discussion on these implications.)

Other pressures on DSS • Improved technology and medicine have meant there are now more people

of all ages surviving, often with complex disabilities, and requiring a high level of support.

• An ageing population is leading to increased numbers of frail older people, and increased numbers of older people who slowly begin to require more support to live independently in their homes.

• Increasing participation of women in the paid workforce has increased home-based support and respite demands, and carer, family and whänau expectations that they should be paid to provide care, as well as trained and supported.

• Reforms of the 1990s made new demands on and stretched the New Zealand DSS provider sector to the point where some agencies have questioned their long-term viability.

13 The Department of Labour was responsible for developing the vocational strategy.


Part 3: Improving How We Operate: Strategic Direction

Guided by the NZDS and the Ministry’s key overall directions, over the next two years the Ministry’ work on DSS will focus on: • managing the separation of funding and planning of DSS for people 65 and over

from that for younger people, and the proposed devolution of DSS for older people to DHBs

• developing a strategic direction for younger people with disabilities • improving the national consistency of DSS services • managing DSS funding and prioritisation.

Key policy and services directions include: • responding more appropriately, holistically, intersectorally and flexibly to: – ‘age-stage’, and to disability-specific needs of people with disabilities – Mäori with disabilities – Pacific people with disabilities – families and whänau of people with disabilities • involving people with disabilities in policy making and service management at

every level, and in evaluation of their services and supports, as well as families and whänau when appropriate.

In July 2001 Cabinet made a series of decisions that set an agenda for change for DSS.

• Planning and funding for DSS for people aged 65 and over will be separated from that for younger people with disabilities. The decision to separate DSS for older people recognises that disability in older people is generally related to deteriorating health, and that older people’s support needs are closely entwined with their health needs.

• Devolution of funding and planning of DSS for older people to DHBs will be dependent on DHBs demonstrating capability to provide an integrated continuum of care (devolution is subject to a further Cabinet decision).

• Funding and planning for DSS for younger people will remain with the Ministry, pending further analysis of options for meeting their needs. This decision reflected concern from the disability sector that DHBs would not understand disability issues as they are identified in the NZDS, and that this could lead to the inappropriate medicalisation of services for this group.


Implementation of the Health of Older People Strategy, launched in April 2002, is closely linked to the decision to separate out DSS funding for older people. This strategy provides a vision for the future for older people, and the changes necessary to achieve it. In order to provide stability and certainty within the health and disability sector, in June 2002 Ministers agreed that the Ministry will retain responsibility for DSS for younger people for the next two years, until a strategic direction and definitional boundaries for future DSS are agreed. Any recommendations on major structural reform will not be made before July 2004. This will not prevent continued service development, and improvements and initiatives in specific areas, occurring in the meantime.

Separating DSS planning and funding Splitting the planning and funding functions of DSS into two groups – people aged 65 and older, and younger people with disabilities – is a challenging and complex task, with widespread implications. Boundaries and definitions have been developed to guide the separation of DSS for older people (over 65) from DSS for younger people (under 65). These include principles for funding for ‘grey areas’, such as services for people under 65 who develop disabilities that are more closely related to the ageing process, and for those over 65 with lifelong disabilities that are not necessarily related to age. There are risks to be managed by the funders. There is a need to ensure equity of access to DSS across the funding streams, maintenance of good sector relationships, and sufficient human resource capability throughout the period of change. There are also further issues to be resolved regarding any future boundary between DHB services for people 65 and over and DSS for those under 65.

Responding to the NZDS The NZDS is influencing every level of DSS policy, funding and service development. The Ministry’s regional offices are beginning to develop local responses to the NZDS, and to look at ways of encouraging people with disabilities to be involved at all levels of ‘organisations, whether as service-users, staff or in governance and management positions’ (NZDS Objective 5.1). Regional offices have employed a number of people with disabilities to implement the NZDS.


In working to the NZDS, some difficult issues have to be worked through; for instance:

• formal governmental accountabilities may inhibit full involvement of people with disabilities in some areas

• the emphasis on increasing participation14 creates additional pressures to broaden access criteria; for example, for environmental support services and in other areas. Resolving environmental support services issues will have implications for the respective roles and funding responsibilities of the Ministry and the Lottery Grants Board (LGB).15

Balancing national consistency and more flexible approaches A clear message from the NZDS and consumer feedback is that DSS policies, services and access criteria need to be more nationally consistent, while systems such as NASC need to be more flexible and responsive to needs. The following three elements form separate parts of the work programme.

• The policies and processes underpinning the DSS framework will be reviewed, so that there is more equitable access to services.

• The Ministry is currently making efforts to put all DSS on to the Nation-wide Services Framework (NSF), to ensure greater consistency across funding approaches and service provision.

• The Ministry is also working to ensure its needs assessment and service co-ordination model is flexible and responsive, and to look at how these processes can be co-ordinated across agencies to benefit individuals with disabilities. A model of improved intersectoral assessment and co-ordination of services for people with disabilities under 65 will be trialled.16

14 ‘Participation’ has been a goal for some time for some existing DSS service

specifications and policy documents. 15 The Individuals with Disabilities Subcommittee of the LGB provides discretionary

funding for mobility and communication equipment, to enable independence and community participation. LGB funding is under extreme pressure, and LGB has signalled it wants to cease funding, and for the Ministry of Health to assume these funding responsibilities. This issue will be taken into consideration in the second stage of the Environmental Support Services review, to begin in November 2002. The second stage will review access and eligibility criteria.

16 Developing and trialling this model is part of a three-year Ministry-led research project funded through the Ministry of Research, Science and Technology’s Cross Departmental Research Pool.


The current NASC-based model can respond well to needs but is considered an unnecessary layer of bureaucracy by some consumers and their families. Many Mäori and Pacific people and their whänau in particular are uncomfortable with the current system, and either avoid it or do not know how to access and use it, so that many needs go unmet. Ways of being more responsive to individuals, family and whänau, cultural, and disability-specific needs are being developed. For some people, individualised or direct funding appears to offer a workable alternative. The Ministry will further explore direct-funding options, and will contribute to the MSD-led review of family care payments. The existing NASC model does not easily cope with people whose needs are complex, variable and require intensive case co-ordination across a number of agencies and sectors. Many people with multiple disabilities and challenging behaviour fall into these categories. The Ministry currently funds a small number of people to receive Flexible Support Funding. Funding may begin at a very high level (and cover intensive case co-ordination), then over time, as the person becomes more settled, reduce. Evidence suggests that these flexible models have good outcomes and should be expanded.

Individualised funding options Individualised or direct funding is the provision of cash, tax credits or cash vouchers or other forms of transfer direct to people with disabilities to purchase and arrange their own care. Individualised funding appears to enable successful supported independent living for some people. The Ministry is currently undertaking a review of the largely ad hoc individual funding arrangements it has with some people and, in some cases, their families. The aim is to put in place a coherent, fair and national framework, with protection for the consumer, the staff they employ and the Ministry. People have moved to these arrangements for a variety of reasons. In most instances people are directly managing their home-based support funding with little difficulty, and evidence suggests that it is not a more expensive option. This finding is similar to findings from overseas, where individualised funding in one form or another has existed for 30 years, and has become widespread in the last 10 years.


Moving to a greater focus on outcomes and participation At a system level (as well as at an individual level) difficult funding, policy and service decisions have to be made. There is a need to develop outcome measures for DSS, so that the quality and effectiveness of service funding and provision can be monitored. A systematic way of measuring client satisfaction is also required. Worldwide, there is a move to try to develop workable disability and rehabilitation outcome measures that apply across a diverse range of services and disability and age groups, and reflect the outcomes sought by clients. Research, including a literature review, is part of the Ministry’s under-65s work programme, and will include looking at outcome measures and how they can be applied.

Improving information data systems Developing an efficient DSS information data system is a high priority. The new system needs to provide timely and accurate information on service provision and consumer characteristics. It also needs to: • interface well with wider Ministry information technology developments • support improved internal and intersectoral policy development and service

planning. Until now, DSS has been hampered by the lack of an integrated and reliable data system. The Disability Survey provides a useful broader snapshot in time, but cannot replace a regular data system.

Developing research and evaluation capacity Historically, there has been a limited research or evaluation capacity to support:

• the development of DSS and other disability services and an appropriate knowledge base

• evidence-based DSS decision-making at the individual, services, funding and strategic policy levels

• the development of quality outcome measures that contribute to effective evaluation, and help to chart progress in achieving the goals of the various key strategies.


More disability research and evaluation has taken place overseas. While the Ministry will continue to draw on relevant international sources (especially from countries such as the US and Britain), at other times this is not appropriate due to New Zealand’s unique population, demographic and historical profile and services mix. It will be important to develop research and evaluation capacity for DSS. The Ministry’s success in its bid to the Ministry of Research, Science and Technology to lead a three-year research project will support and encourage the development of this capacity. The Ministry is also co-ordinating a steering group overseeing further analysis of the 2001 New Zealand Disability Survey.

Balancing habilitation, rehabilitation17 and participation, against support For a number of reasons – including limited funding, a lack of specialised rehabilitation personnel and insufficient development and co-operation in and between some rehabilitation providers and services – the Ministry has paid more attention to providing support than to habilitation or rehabilitation and participation goals. At times this has created avoidable long-term dependence on support services, especially for adults.18 Reviews of rehabilitation by two Ministry regional offices will help to address some of these issues. Part of the Ministry’s work programme will look at how an individual outcome focus can be encouraged. This will require working across DSS and health services, as well as across other government agencies and the wider sector, to determine the best way to ensure habilitation and rehabilitation are underlying principles, where this is appropriate. Moving to a greater focus on habilitation and rehabilitation has other implications. More investment in individuals may be required in the short term to prevent long-term dependence, and access and eligibility criteria may have to be reassessed.

17 Habilitation refers to services for people who have never lived independently and

focuses on development of skills to achieve independence. Rehabilitation focuses more on goal-centred restoration, or relearning of skills to resume a former role.

18 There has been more of a focus on habilitation and rehabilitation, and goal setting for children, through DSS Child Development Services, Special Education and DHB Paediatric Services.


Managing demand and expenditure DSS demand-driven expenditure accounts for around 75 percent of all DSS expenditure, so managing demand for DSS is important. In December 2001 a confirmed three-year funding path (2002/03–2004/05) was agreed for Vote:Health, and this provides an incentive for managing future DSS demand.19 The Ministry is improving its budget forecasting and prioritisation processes in order to improve its total budget management and manage demand for DSS. Service prioritisation processes and the following core business activities guide expenditure decisions:

• improving data collection, integrity and information systems

• maintaining a risk management system

• implementing more robust and consistent budget forecasting methodology

• implementing more equitable and nationally consistent access and eligibility criteria, so that services can be targeted effectively

• introducing nationally consistent guidelines for needs assessment and service co-ordination agencies, to ensure equity for individuals, regardless of geographic location.

Prioritisation of services is central to the NASC process. Prioritisation is required when there are budget constraints, and ensures an affordable service mix is made available. The Ministry is continuing to develop prioritisation methodologies, processes and tools for DSS, so that DSS are delivered through a transparent, effective and fair prioritisation approach. Prioritisation decisions can be unpopular and contested, and prioritisation is not an easy process to apply, either by NASCs or accredited equipment assessors. NASCs are now given more guidance and training to help them make difficult individual prioritisation decisions. In most instances, keeping people safe, enabling people to live at home, and children’s needs are given a high priority. Developing the DSS prioritisation system is a key issue for the next three years. During this period, wider government decisions on prioritisation emerging from MSD-led work may need to be taken into account. Human rights considerations are already having an impact.

19 The New Zealand Public Health and Disability Act 2000, section 3(2), requires that

services outlined within the Service Coverage Agreement are available and provided within existing resources.


Future funding issues While the current three-year funding path provides funding certainty over the period to 2004/05, and the Ministry expects to be able to manage DSS expenditure within available funding in 2002/03, there is likely to be more pressures on funding in the following years. A number of medium- to long-term challenges facing DSS funding are discussed below.

Impact of the transition project The Ministry is working through the process of splitting DSS funding, in preparation for devolution of DSS for older people to DHBs.

Pricing pressures Although the Government agreed to price increases for the aged residential care sector, many other major DSS areas have not had price increases for some time, and some providers have signalled that they have viability concerns. The Ministry’s ability to make any new price increases between 2002/03 and 2004/05 will be very limited.

Population-based funding There are implications for the Ministry in gradually moving to a population-based funding arrangement for DSS, over four to six years. This shift parallels DHBs shifting to population-based funding. The Northern and Midland regions over time will gain funding, while the other two regions stand to lose in a relative or actual sense (depending on how funding weights are shifted, and over what period). A priority is ensuring that actual services are disrupted as little as possible. Moving to population-based funding should improve national consistency in access to services.

Decisions on income and asset testing Means testing of older people is considered discriminatory under the Human Rights Act in that older people are disadvantaged in comparison to younger people who access residential services. The policy must now be re-examined in the light of human rights considerations. Younger people are not required to use their resources in accessing residential support, although they forfeit any benefit (eg, the Invalids Benefit).20

20 They are able to retain a small part of their benefit as a personal allowance.


Policy work began in 2001/02 to change the current means-testing regime faced by older people or those ‘like in interest’. ‘Like in interest’ refers to people aged 50–64 who are single or widowed, and with no dependants, who are assessed as ‘like in interest’ to an older person (eg, they have early-onset dementia). People 65 and over or those ‘like in interest’ who have been assessed as requiring residential care indefinitely are currently means tested to determine whether they are eligible for the Residential Care Subsidy. Detailed policy decisions have not yet been finalised on removing asset testing for older people requiring residential care. Income testing would continue as the way for people to contribute to the costs of their long-term care. Further work on income and asset testing (as it applies to other DSS services) is also required as part of reassessing access criteria for all DSS services. Currently, people who meet the access and eligibility criteria for a vehicle and vehicle modifications grant, and for home modifications costing over $7900, may be income and asset tested.

Impact of other policy changes A number of possible or already signalled policy changes could have significant fiscal implications for DSS in the coming three years. Any new arrangements put in place for DSS must be based on carefully managing any further fiscal exposure of the Ministry or DHBs, in the light of the requirements of the Public Finance Act 1989.21 These possible changes include:

• changes to the Ministry’s definition of disability (see discussion pp. 29–30)

• introducing more flexibility into DSS funding arrangements (eg, expanding individualised funding for individuals with disabilities and families providing care), which could have an impact on DSS funding and operational arrangements, although the exact nature of this impact is not yet clear

• fiscal implications could arise from changing income and asset-testing regimes for DSS services other than aged residential care (the budget implications of changes to asset testing for aged residential care have already been signalled).

21 The Ministry cannot incur a deficit under this Act.


Ensuring there is a quality assurance framework for all services The Health and Disability Services (Safety) Act 2001 (HDSSA) introduced a new regulatory environment that aims to ensure appropriate safety and quality improvement measures are in place, particularly in hospitals and residential care. The application of the HDSSA does not yet extend to community-based care and other more informal settings, although an enabling clause allows the quality and safety framework to be gradually extended to these services once analysis of the costs and benefits has been undertaken, standards are in place and stakeholders have been consulted. The new approach requires that all services currently covered by this regime (hospitals, rest homes and homes for people with disabilities) comply with sector-developed service standards. Services will be independently audited against these standards, and services must be compliant with the relevant standards before the Director-General will consider certifying those services. All aged and residential care covered by the new legislation must comply with all the Minister-approved standards, including the Health and Disability Sector Standard, by October 2004. Services that have not achieved certification by this date will be legally unable to deliver services. The extension of the new safety and quality improvement environment to all DSS services is seen as strategically the best mechanism to ensure consistent quality, regardless of which agency provides funding in the future. To extend in this way – especially to cover services provided in homes and other community settings – will require balancing safety, quality, and ‘duty of care’ obligations, and quality of life and quality of care. The Ministry and ACC are working with Standards New Zealand to develop a standard for home and community-based support services, which will be gazetted under the Health and Disability Services (Safety) Act after the requisite analysis is complete and stakeholders have been consulted. Compliance timeframes for this standard have yet to be set. In time, as new standards are developed and service areas such as home-based support come under the legislation, funders such as the Ministry should have a declining need to monitor provider compliance against contractual specifications.


Developing workforce capacity and skills The DSS reforms of the last decade and the expansion of services and service types have highlighted urgent and complex workforce issues. For example, the workforce includes paid support workers who are unregulated and low paid, as well as families and other informal or unpaid carers. Both these groups have limited training and support opportunities. Many DSS workforce issues are closely linked to quality and safety issues (for both clients and workers22). Future developments will need to take into account the increased emphasis on responding intersectorally to workforce issues facing DSS and health services, as well as education and social services. Linking with the intersectoral Tertiary Education Strategy will be important. The Health Workforce Advisory Committee (HWAC) is currently developing a draft discussion document summarising the committee’s position on ‘Building the Health and Support Workforce Capacity For People Who Experience Disability’. Shaping the future DSS workforce needs to give consideration to:

• all health professionals being responsive to the needs of people with disabilities

• clearly defining the roles and functions of the health and support workforce

• identifying the levels of skill, knowledge and experience required by both professional and non-professional workers

• ensuring education, training and development opportunities exist to meet service standards and defined competencies (where appropriate)

• developing flexible career structures which allow people to move between different roles and functions within the workforce

• ensuring there are linkages – including training, supervision and monitoring – across the professional and non-professional workforces

• responding to the different needs of Mäori through building the capacity of the Mäori disability workforce

• responding to the different needs of Pacific peoples through building the capacity of the Pacific peoples disability workforce.

22 For example, the Department of Labour’s Occupational Safety and Health Service is

initiating discussion around the steps that can be taken to prevent harm to careworkers.


The Ministry’s work programme includes the Clinical Training Agency undertaking a stocktake of the DSS workforce to inform DSS workforce developments over the coming years, and a series of training programmes, covering: • needs assessors and service co-ordinators • informal carers • accredited assessors of environmental support services • community support workers working with people with autism spectrum

disorder • care co-ordinators and care managers who will work under the Intellectual

Disability (Compulsory Care) legislation. Work on draft competencies for health and disability workers has commenced, but will not be completed until after the home and community-based support standard has been finalised.

Improving disability sector capacity, skills and viability Building and sustaining capacity and a sufficient choice of providers for consumers, as well as quality services, is another major challenge for DSS. The prospect of multi-year DSS funding gives providers better funding security as a basis for future planning. Historically, because government has part-funded some DSS, providers have sought support from private or charitable organisations, or a number of contracts from different agencies to cover the full costs of a service. This can lead to providers having to juggle a range of contract requirements and relationships, in some cases to support one relatively small service. In recent years, charitable funding has also become more difficult to obtain, and prices for services rarely increased from the mid-1990s until recently, when there have been price increases in some areas.

Key issues The key issues for improving how the Ministry operates include:

• managing and balancing critical, often conflicting, pressures on DSS (eg, increasing the focus on habilitation and rehabilitation and participation) within a constrained budget

• along with other government departments and DHBs, implementing the NZDS – including working in partnership with people with disabilities, and with consumer and provider groups


• balancing consistency and flexibility – a flexible, responsive (individual) needs-based system does not necessarily sit well within a highly structured system, which seeks to give certainty to individuals and their families. The current model can also be culturally insensitive in not funding whänau

• balancing control for the funder, and maximum control for the client and/or family or whänau

• ensuring the future viability of DSS, whatever the model or whichever the funder

• developing a quality framework for all services – not just residential services

• improving workforce competencies and skills, as well as sector competencies, skills and viability.


Part 4: Current Directions and Initiatives

Work currently being undertaken by the Ministry aims to: • enable people to live in the community with quality of life and dignity, and

maximum independence and participation • ensure equity of access to DSS (regardless of which agency is responsible for

different age groups), including cultural equity • ensure continuous service improvements, including directing effort to filling

critical service gaps.

Achieving successful independent living Independent living opportunities for people with disabilities have grown in the last decade. More people are being supported to live with a degree of independence (or interdependence) and dignity in the community. Home-based support expenditure more than doubled in the five years between 1995/96 and 2000/01, with expenditure rising from $52.5 million to $105.5 million. This increase reflects specific strategies to support people with disabilities in their own home (rather than residential care), when this is an appropriate and safe option. Groups experiencing the benefit of this growth include:

• older people – it is estimated that 75 percent of clients receiving home-based support are older23 and that those who enter residential care are generally the ‘older older’24 with a higher level of support need

• increasing numbers of people with high and complex disabilities, many of whom are children; high support packages (some costing over $200,000 per year) may be required, including services such as home help, personal support, respite care and equipment

23 46% of 75–84-year-olds and 57% of those 85 years and over live at home with some

assistance (Statistics NZ Disability Survey 2001). 24 Of those who enter residential care, 27% are aged 85 or more, compared to 5.9% of

those aged 75–84 (Statistics NZ Disability Survey 2001).


• people with intellectual disabilities, both those resettled into the community as well as those who have never been institutionalised; many people have high support needs and require a high level of ongoing support, which is provided by agencies such as IHC.

The Ministry is currently carrying out a comprehensive review of home-based support services because of the critical role they perform, with a view to developing a more strategic and integrated approach to their planning and delivery. Some of the issues likely to be considered in more depth during the home-based support services review are discussed below. Some of the strategic preconditions for success (eg, workforce and provider skills and capacity) have been discussed in previous sections.

Balancing safety and the right to risk Most people with disabilities want to live in the community as independently and for as long as possible. However, some people with disabilities are assessed as needing more assistance than they are willing to accept. Needs assessors and providers of service face having to weigh up their duty of care responsibilities with encouraging the autonomy and decision-making of clients. Developing a better home and community-based support standard25 and a more comprehensive quality and safety assurance framework should ensure that the medical model and the social model (which stresses the right to be self-determining) are seen as complementary rather than mutually exclusive options. Equally, the family caregiver may oppose a move to supported independence or sustaining independence when the person with a disability and their needs assessor support it. The rights and views of carers also may have to be weighed.

25 The Ministry developed Standards for Home Based Services in 1995 which will be

replaced with the new joint Ministry and ACC home and community-based support standard.


Beyond deinstitutionalisation Twelve institutions for people with intellectual or psychiatric disabilities have closed since 1987, and approximately 3700 people with intellectual disabilities have moved to community-based services. Resettlement plans have recently been approved and are now being implemented for the remaining two large institutions for people with intellectual disabilities: Kimberley Centre, Levin, and Braemar Hospital, Nelson.26 Creating a meaningful life in the community presents a challenge to services and the wider community, as well as to people with disabilities and their families. The process of gaining agreement from Kimberley Centre families showed the fears and doubts some had about the Government’s long-term commitment to supporting residents in the community. The Kimberley deinstitutionalisation process continues to attract a high level of media and political interest, and the Kimberley Parents and Friends Association expects the Minister to have a high level of interest and oversight in the project. The NIMBY (not in my back yard) syndrome of some local areas and councils demonstrates that fear, stigma and lack of disability awareness still exist in the community. For full inclusion to take place, educational and other management strategies as well as advocacy, have to be built (and costed) into the process. There are also other issues around deinstitutionalisation, including the following.

• The living situations of other groups, such as people under 65 with physical disabilities, may not be appropriate. Many lived in hospital wards until they closed, and left without a formal deinstitutionalisation process with funding attached. Some moved with a high support package directly into homes in the community if accessible housing could be secured. Others, because of a shortage of community housing and other supports, were shifted into aged care facilities such as rest homes. The Ministry is budgeting to provide more age-appropriate alternatives. Solutions often involve working with agencies such as the Housing NZ Corporation.27

26 Resettling Kimberley residents is expected to take three years; Braemar’s resettlement

requires less time. 27 Housing NZ Corporation received additional funding for community housing for

disadvantaged groups, such as people with disabilities, in the 2002/03 budget.


• There is an ongoing high demand for supported community living places. This demand is hard to meet because of the lack of skilled support staff, as well as cost factors. Parents may no longer feel they can cope at home with their son or daughter with high support needs as they reach adulthood, or as they (the parents) age. ‘Lifetime planning’ would enable support systems to respond more effectively to these needs.

Seeing that health and support needs are met, and ensuring good linkages and co-ordination across health services DHBs are committed to population health approaches and to achieving improved outcomes and participation. There is also an expectation that the balance of services will move towards early intervention and approaches that minimise the need for care. Like the rest of the population, people with disabilities require access to good health services, and overall could benefit from a preventive population health approach. However, some people – especially those who will always be high users of health services – consider their ability to benefit from this approach may be compromised by their pre-existing disabilities, and need assurance that their access to health services will be ‘without discrimination’.28 Another critical issue will be clarifying which groups make up ‘younger people with disabilities’ eligible for DSS, and the range of DSS they can access. The current definition of ‘disability’ is outdated with regard to people with psychiatric and neurological disabilities, for example, and once DSS funding is split, ‘age-related’ will not be part of the definition. However, some flexibility must be maintained to take account of the needs of groups that may be affected by the new older people/younger people divide, such as:

• people with a long-term disability who turn 65 but do not have a disability associated with the ageing process

• people under 65 who have health and disability support needs that are similar to those more commonly experienced in old age.

It is important that DHBs and the Ministry work together to ensure that all groups have access to a continuum of care that spans both health and DSS services. All prioritised health and disability needs should be met. 28 NZDS Objective 7.9: ‘Ensure that disability services do not perpetuate the myth that

disabled people are ill, while recognising that disabled people do need access to health services without discrimination’.


Seeing that vocational needs are met Under the vocational strategy (see Part 2), the vocational interface between Work and Income and Health/DHB-funded services will be clarified over the strategy’s five-year implementation period. The transition of responsibility at age 65 for those who no longer want to work will also be clearer. The Ministry funds vocational services for people with intellectual disabilities of any age who have been resettled into the community, and day activities, generally for older people. The Ministry’s commitment to resettled people with intellectual disabilities has meant they have often enjoyed higher levels of service than other people.

Better intersectoral relationships, planning, funding and assessment A factor critical to the success of community living is better intersectoral linkages (see Part 2, pp. 10–11). To succeed, social services such as health, disability support, child and youth protection, justice, income support and education need to engage in joint planning, especially to manage services as people make the transition from one service or sector to another. Mainstream services, such as public transport, also play an important part and need to provide accessible services and supportive infrastructure. The annual NZDS implementation process should, over time, improve relationships, understanding and the integration of services. Specific intersectoral initiatives, such as the MSD-led Intersectoral Strategy for Children and Young People with High and Complex Needs, have proven successful when policies and procedures are properly implemented.

Equity and service challenges A recent stocktake of DSS policies and services highlighted existing service gaps, some historical in nature and others of more recent origin, which have significant equity implications. While there have been some new local and national initiatives, overall the Ministry has been limited in its ability to effectively tackle some of these gaps for a number of reasons, such as demand pressures and the complexity of the issues. A mix of legal, ethical and human rights, cultural, intersectoral and funding issues often has to be worked through before practical solutions can be found. Developing strategic directions for the future, in the context of the NZDS and as part of the Ministry’s work programme, will need to continue to give a high priority to addressing key gaps.


Culturally appropriate services It is difficult to accurately state the level of access to DSS of Mäori, Pacific peoples or people from other cultures.29 It is known that Mäori, and Pacific peoples access DSS less than other people with disabilities. One of the main reasons for this is that until recently many DSS providers have not met the cultural needs or expectations of Mäori or Pacific peoples.

Mäori Guided by the Government’s commitment to the Treaty of Waitangi and to fulfilling its obligations as a Treaty partner, the Ministry is in the final stage of developing a Mäori Disability Action Plan (MDAP). The MDAP aims to meet the needs and aspirations of Mäori with disabilities in planning, developing and funding DSS. The NZDS,30 He Korowai Oranga: the Mäori Health Strategy Discussion Document, and the more recent Te Puawaitanga: Mäori Mental Health National Strategic Framework, provide the basis for the MDAP.31 The MDAP has strong links to the NZDS and other health strategies, as Mäori have a holistic view of health and disability. The Ministry is currently developing three-year regional MDAP implementation plans, guided by the MDAP’s five goals. These goals are to promote:

• participation of disabled Mäori – work is under way nationally and locally to improve participation (eg, through holding consumer hui/forums in all regions and working with DPA and its Mäori caucus)

• partnership development with Mäori – most localities are actively developing new partnerships with Mäori organisations, or building on existing arrangements such as with the Ministry’s Treaty-based partners Tihi Ora and Tainui; partnerships with iwi Mäori health services support the Maori holistic view of health and wellbeing

• developing services for Mäori – there has been considerable work to address service gaps; for example, Mäori Deaf services and trilingual training have been developed, as have the infrastructure and capacity of Ngäti Käpo o Aotearoa, for käpö (blind) Mäori; Mäori provider and workforce development is a high priority

29 This is partly due to poor ethnicity statistics. Ethnicity of clients is not always given, or,

if given, may not be accurately coded. 30 Notably, ‘Promote the participation of disabled Maori’ (Objective 11, NZDS). 31 Other recent strategies are also referenced and taken into account; eg, Ngä

Whakatätaka (Mäori Health Action Plan), and the Health of Older People Strategy.


• working intersectorally (eg, with Te Puni Kökiri and the Ministry of Education on specific projects)

• building the capacity and cultural competence of the Ministry’s Disability Services Directorate.

Existing DSS services provided to the general population have started to change, but progress is uneven. The cultural competence of services such as NASC, and of services in rural areas and for children, needs to improve.

Pacific peoples DSS for Pacific populations living in New Zealand and Pacific peoples’ understanding of disability rights are underdeveloped. The Ministry launched a Pacific Health and Disability Action Plan (PHDAP) in February 2002, which sets out a strategic direction for improving health outcomes for Pacific peoples and reducing inequalities between Pacific and non-Pacific peoples. The vision, principles and priorities form the basis for future Pacific health and disability support policy and support services. Priority 5 of the PHDAP is ‘to promote participation of disabled Pacific peoples’, and outlines key action areas for the Ministry over the next three years, including: • collect data and information on the support needs of Pacific peoples with

disabilities • increase access to quality support services • encourage Pacific communities to consider disability issues and

perspectives, and for this to be valued and considered in developing community-based disability support services.

Work is under way on these actions. Priority 5 of the PHDAP draws on Objective 12 of the NZDS. The NZDS refers to the need to support disability workforce development and training for Pacific peoples, by training Pacific peoples as providers of disability information and services for their local communities. This is starting to happen in Auckland.

Responding better to age-stage needs Responding better to ‘age-stage’ needs, including improved transitions between services, is a key driver of high-level Ministry and intersectoral policy and service development.


Children and young people While there are issues for all age groups, there are particular DSS issues for children and young people and their families and whänau.

• The complex developmental needs of children and young people with disabilities and associated family and whänau needs are not always well understood by mainstream children’s services, or DSS that cover all age groups. There are a small number of DSS solely for children with disabilities and their families.

• There is a shortage of professionals with appropriate child development skills, and of some services (eg, out-of-home respite for children with complex needs).

• Some services for children are not available in some areas, and access to a few services does not extend to children and their families.32

• There is a lack of child-specific DSS information. The Ministry is committed to ensuring that the specific needs of children and young people with disabilities and their families and whänau are considered at all levels of DSS policy and service development.

Older people Until at least 1 July 2003 the Ministry will continue to have responsibility for funding DSS for older people. Ensuring the continuity and improvement of services for older people over this time will be important, especially since DSS for older people are estimated to account for up to 65 percent of DSS funding. The following issues related to DSS for older people will have an impact in the next year.

• The adequacy of funding for the aged residential care sector will continue to be questioned.

• The shortage of registered nurses will affect rest home and continuing care hospital staffing.

• Services for people with dementia are underdeveloped. A Dementia Working Group reported in January 2002, and based on the report’s recommendations the Ministry has committed to a work programme over the next two years to improve dementia services.

• Active monitoring and auditing of rest homes can lead to closures of facilities, and this generates media interest and debate.

32 For example, vehicle and vehicle modification grants are not available to families with

children with disabilities, only to people with disabilities in post-compulsory education, training or employment.


Initiatives for specific high-need disability groups

People with autism spectrum disorder (ASD) Providing services to people with ASD highlights the difficulties of responding to the needs of people with extremely complex and life-long disabilities, which are only now beginning to be understood. The Ministry of Health-led Autism Services Intersectoral Working Group (ASIWG) was established in 1999 and has a focus on strategic management and professional development.33 It has established a number of projects that impact across all sectors. These include setting up:

• leadership forums and research seminars run by international experts

• training programmes for health and education professionals (eg, Massey University has a postgraduate Diploma in Autism, and the Ministry of Education has provided training for specialist teachers and teacher aides)

• Earlybird, a training programme that gives parents information about their child’s autism, and helps them to communicate and manage the behaviour of their children and access support

• recent initiatives to address regional services, and to look at research gaps. The Paediatric Society has been contracted to develop over the next two years an ASD Best Practice Guideline for professionals and social services agencies working with children and adults with ASD.34

People with sensory impairments There are significant technology issues, as well as competency, skill and workforce gaps, in the area of sensory services, especially for people with hearing impairments. Both technology and human resource needs are pressing, although there is probably less appreciation of the need to develop human resource supports. Many solutions require intersectoral solutions as needs straddle many different sectors. The Ministry works closely with the Ministry of Education in the area of

33 ASIWG was set up following an inquiry into the death of Casey Albury, and a Ministry

of Health-led review of services for people with ASD in New Zealand, established by the Director-General of Health, with support from other agencies.

34 The Guideline will cover evidence-based information and research to assist assessment and diagnosis, medication and therapy interventions, models for developing support services, supported and independent living options, and work and vocational opportunities.


sensory services for children, and a joint stocktake of services for children with sensory impairments has been completed and will inform further work. Issues to be resolved include the following.

• There is a lack of access to hearing aids. While fully funded hearing aids are free for children and targeted adult groups, other groups only receive a low level of subsidy (see Appendix A). The Ministry will address this issue in the context of its review of environmental support services (ESS).

• There are not enough qualified sign-language interpreters, lipspeakers and communicators for people with hearing impairments and Deaf people, nor enough deafblind interveners (guide helps). There are also not enough orientation and mobility instructors and other specialised services for people with visual impairments.

• Technology for people with sensory impairments is rapidly improving, but new technology is expensive. More work is needed to guide decisions on funding new technologies (and equipment services generally). Equipment access criteria inherited from the Disabled Persons Community Welfare Act 1975 do not reflect advances and the new opportunities they create. Work on access and eligibility criteria will occur as part of the ESS review.

• There is a shortage of culturally appropriate services. The Ministry of Health is funding the training of sign-language interpreters fluent in te reo Mäori, and te reo support services for Mäori with vision impairments. Equivalent services have not yet been developed for Pacific peoples.

The deafblind population has unique support needs, which are quite distinct from people who are Deaf or blind. The Ministry has been putting effort into ensuring that the needs of deafblind people are properly assessed, and mainstream services understand how to more appropriately support the needs of this group. The Ministry is committed to further work in this area.

People with intellectual disabilities charged with an offence: the Intellectual Disability (Compulsory Care) Bill In 1997 the Government decided that stand-alone legislation was required to provide for the compulsory assessment and care of people with an intellectual disability charged with, or convicted of, an imprisonable offence. This would close a legislative gap that had existed since 1992, when the new Mental Health (Compulsory Assessment and Treatment) Act excluded people with an intellectual disability who had been covered by the definition of ‘mental disorder’ in the Mental Health Act 1969.35 35 The Bill is associated with the Criminal Justice Amendment Bill (No.7), which provides

the legal mechanism to divert people to the proposed compulsory care regime.


The Bill, introduced to the House in October 1999, extended compulsory care to people who were not offenders but who exhibited behaviour that posed ‘a serious risk of danger to the health and safety of themselves or others’ (the non-offender population). The extent to which the Bill limited rights raised concerns, and in the face of opposition expressed to the select committee, the Government removed the non-offender population from the Bill and placed more emphasis on rehabilitation. The select committee reported the Bill back to Parliament in April 2001, retitled the Intellectual Disability (Compulsory Care and Rehabilitation) Bill. Little progress can be made until it is allocated a priority on the legislative programme of the incoming government. Meanwhile, service development for people expected to come under the legislation has proceeded. However, the delay in passing the Bill is of concern to providers, who have appointed new care co-ordinators and care managers required under the new legislation.36 Further briefings will be provided.

36 A diploma course in Care Management at the Auckland College of Education ends in

August 2002.


Part 5: Key Decisions in the Next Three Months The key decisions that need to be made, and the actions that need to be taken, in the next three months involve:

• determining a new legislative programme and order of priority for: – –

the Intellectual Disability (Compulsory Care and Rehabilitation) Bill removing asset testing for older people and those ‘like in interest’ requiring residential care (pending final decisions by Government)

• reporting back to the Ministers for Telecommunications and for Disability Issues on provision of TTYs37 by 30 September 2002, and on the provision of a telecommunications relay service by 30 October 2002

• providing a progress report back to the Minister of Health on DSS for younger people with disabilities in September 2002

• providing a draft Cabinet paper to relevant Ministers by November 2002, regarding approval to devolve DSS funding for people 65 years and over to DHBs from 1 July 2003.

37 TTYs are text telephones for people who are speech and/or hearing impaired and

Deaf.


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dina

tion

mod

el fo

r peo

ple

unde

r 65.

38

In

som

e ca

ses

peop

le w

ho a

re a

sses

sed

and

allo

cate

d a

pack

age

with

a c

erta

in le

vel o

f ser

vice

s m

ay c

hoos

e to

pur

chas

e ad

ditio

nal

serv

ices

. 39

Sup

port

Nee

ds A

sses

smen

t and

Ser

vice

Co-

ordi

natio

n Po

licy,

Pro

cedu

re a

nd In

form

atio

n R

epor

ting

Gui

delin

es (F

ebru

ary

2002

).

Serv

ice

and

exam

ples

W

ho is

elig

ible

? W

ho p

ays

for w

hat?

(inc

ludi

ng

regi

onal

var

iatio

ns)

Cur

rent

and

futu

re d

irect

ions

Nee

ds a

sses

smen

t Pe

ople

of a

ll ag

es w

ho

mee

t the

Min

istry

’s

defin

ition

of d

isab

ility.

The

Min

istry

of H

ealth

fund

s ne

eds

asse

ssm

ent s

ervi

ces

from

co

ntra

cted

age

ncie

s. T

hey

are

free

to u

sers

. M

inis

try fu

ndin

g is

no

t ava

ilabl

e w

here

peo

ple

are

elig

ible

for d

irect

fund

ing

from

AC

C.

Evid

ence

-bas

ed g

uide

lines

for t

he

asse

ssm

ent o

f old

er p

eopl

e ar

e be

ing

deve

lope

d an

d ar

e du

e fo

r pub

licat

ion

in J

uly

2003

.

Serv

ice

co-o

rdin

atio

n or

pl

anni

ng

Anyo

ne w

ho h

as b

een

thro

ugh

a ne

eds

asse

ss-

men

t and

is a

sses

sed

as

requ

iring

a s

ervi

ce o

r pa

ckag

e of

ser

vice

s.

Thes

e se

rvic

es a

re fr

ee to

the

user

, with

the

exce

ptio

n of

peo

ple

elig

ible

for d

irect

fund

ing

from

AC

C.

As a

bove

.

Hom

e-ba

sed

serv

ices

Th

ere

are

incr

easi

ng n

umbe

rs o

f hig

h su

ppor

t pac

kage

s, in

clud

ing

for

child

ren.

Pers

onal

car

e (e

g, h

elp

with

dre

ssin

g, b

athi

ng a

nd

eatin

g)

Anyo

ne li

ving

in th

e co

mm

unity

who

has

bee

n as

sess

ed b

y th

e N

ASC

pr

oces

s as

bei

ng e

ligib

le

to re

ceiv

e th

ese

serv

ices

.

No

char

ge.

Ove

r the

pas

t dec

ade

ther

e ha

s be

en

an in

crea

se in

dem

and

by p

eopl

e w

ith

disa

bilit

ies

for i

ndiv

idua

lised

or d

irect

fu

ndin

g so

they

can

man

age

thei

r ow

n al

loca

tion

for p

erso

nal c

are

and

hous

ehol

d m

anag

emen

t.

Hou

seho

ld m

anag

emen

t (h

ome

help

) As

abo

ve, o

r the

prim

ary

care

give

r of s

omeo

ne

who

mee

ts th

e cr

iteria

.

No

char

ge fo

r peo

ple

who

hol

d a

Com

mun

ity S

ervi

ces

Car

d.

As a

bove

.

Serv

ice

and

exam

ples

W

ho is

elig

ible

? W

ho p

ays

for w

hat?

(inc

ludi

ng

regi

onal

var

iatio

ns)

Cur

rent

and

futu

re d

irect

ions

Car

er s

uppo

rt

Res

pite

car

e (p

rovi

ded

outs

ide

the

hom

e)

The

prim

ary

care

give

r of

som

eone

who

mee

ts th

e cr

iteria

.

A su

bsid

y is

pai

d bu

t doe

s no

t al

way

s co

ver t

he fu

ll co

st o

f the

se

rvic

e. T

he b

alan

ce m

ay b

e ‘to

pped

up’

by

the

fam

ily.

The

Min

istry

is a

ddre

ssin

g re

gion

al

disc

repa

ncie

s be

twee

n fu

ndin

g of

pa

ymen

ts fo

r for

mal

and

info

rmal

ca

rers

(‘fo

rmal

’ ref

ers

to o

rgan

isat

ions

, ‘in

form

al’ r

efer

s to

indi

vidu

als

who

may

be

fam

ily m

embe

rs b

ut n

ot th

e pr

imar

y ca

rer).

Car

egiv

er s

uppo

rt (p

rovi

ded

in th

e ho

me)

As

abo

ve.

As a

bove

.

Fam

ily a

nd w

häna

u C

arer

Su

ppor

t Pro

gram

mes

(th

ese

aim

to s

uppo

rt fa

mily

and

whä

nau

care

rs

by a

ssis

ting

them

to

impr

ove

skills

, by

impr

ovin

g th

eir

unde

rsta

ndin

g of

the

heal

th a

nd d

isab

ility

supp

ort s

yste

ms,

and

by

givi

ng o

ppor

tuni

ties

for

netw

orki

ng to

redu

ce

soci

al is

olat

ion)

Any

fam

ily o

r whä

nau

care

r who

pro

vide

s su

ppor

t for

a p

erso

n w

ith

a di

sabi

lity

who

mee

ts th

e M

inis

try’s

def

initi

on o

f di

sabi

lity.

No

char

ge.

Prog

ram

mes

are

co-

ordi

nate

d na

tiona

lly b

ut m

anag

ed b

y th

e M

inis

try’s

regi

onal

offi

ces.

Serv

ice

and

exam

ples

W

ho is

elig

ible

? W

ho p

ays

for w

hat?

(inc

ludi

ng

regi

onal

var

iatio

ns)

Cur

rent

and

futu

re d

irect

ions

Day

and

voc

atio

nal

serv

ices

Day

and

voc

atio

nal

serv

ices

(Wor

k an

d In

com

e N

ew Z

eala

nd

fund

s em

ploy

men

t and

tra

inin

g op

portu

nitie

s an

d co

mm

unity

par

ticip

atio

n ac

tiviti

es fo

r peo

ple

with

di

sabi

litie

s 16

–65

year

s of

ag

e)

The

Min

istry

fund

s da

y ac

tiviti

es, g

ener

ally

for

olde

r peo

ple,

and

day

and

vo

catio

nal s

ervi

ces

for

peop

le w

ith in

telle

ctua

l di

sabi

litie

s re

settl

ed in

to

the

com

mun

ity,.

Peo

ple

with

dis

abilit

ies

mus

t mee

t th

e M

inis

try’s

def

initi

on o

f di

sabi

lity,

and

be

asse

ssed

as

need

ing

serv

ices

whi

ch p

rovi

de

train

ing

oppo

rtuni

ties,

or

resp

ite c

are

for t

heir

prim

ary

care

rs.

In m

ost i

nsta

nces

ther

e is

no

char

ge.

Impl

emen

ting

the

Path

way

s to

In

clus

ion

voca

tiona

l stra

tegy

will

have

so

me

effe

ct o

n M

inis

try a

nd D

HB-

fund

ed s

ervi

ces

over

the

next

five

ye

ars.

Serv

ice

and

exam

ples

W

ho is

elig

ible

? W

ho p

ays

for w

hat?

(inc

ludi

ng

regi

onal

var

iatio

ns)

Cur

rent

and

futu

re d

irect

ions

Res

iden

tial c

are

Res

t hom

es (1

1,84

0 su

bsid

ised

clie

nts,

in

clud

ing

thos

e in

de

men

tia u

nits

, in

April

20

02)

Con

tinui

ng c

are

hosp

itals

(7

831

subs

idis

ed c

lient

s in

Apr

il 20

02)

Peop

le a

ged

65 a

nd o

ver,

or p

eopl

e ag

ed 5

0–64

w

ho a

re d

efin

ed a

s ‘lik

e in

ag

e an

d in

tere

st’ t

o an

ol

der p

erso

n, w

ho h

ave

been

ass

esse

d by

NAS

C

as re

quiri

ng re

side

ntia

l ca

re o

r hos

pita

lisat

ion

in a

co

ntin

uing

car

e fa

cilit

y.

If ol

der p

eopl

e (in

clud

ing

thos

e ‘lik

e in

age

and

inte

rest

’) ha

ve

inco

me

and

asse

ts, t

hey

pay

for

thei

r car

e up

to $

636

per w

eek

until

thei

r ass

ets

have

bee

n us

ed

up to

an

exem

pted

thre

shol

d.

Gov

ernm

ent p

ays

any

cost

s ov

er

$636

.

The

Gov

ernm

ent h

as in

dica

ted

its

inte

ntio

n to

rem

ove

asse

t tes

ting

but

reta

in in

com

e te

stin

g fo

r old

er p

eopl

e ac

cess

ing

resi

dent

ial c

are.

Th

ere

are

still

som

e yo

unge

r peo

ple

in

faci

litie

s fo

r old

er p

eopl

e, b

ut e

fforts

ar

e un

der w

ay to

mov

e th

em to

mor

e ag

e-ap

prop

riate

set

tings

.

Com

mun

ity g

roup

livi

ng

Gen

eral

ly p

eopl

e ag

ed

16–6

4 w

ith a

n in

telle

ctua

l or

phy

sica

l dis

abilit

y w

ho

have

bee

n as

sess

ed b

y a

NAS

C s

ervi

ce a

s re

quiri

ng c

are

in a

co

mm

unity

gro

up-li

ving

fa

cilit

y or

hom

e.

Youn

ger p

eopl

e ar

e no

t req

uire

d to

use

thei

r res

ourc

es in

ord

er to

ac

cess

resi

dent

ial s

uppo

rt,

alth

ough

they

forfe

it an

y be

nefit

(th

ey re

tain

par

t of t

heir

bene

fit

as a

per

sona

l allo

wan

ce).

Serv

ice

and

exam

ples

W

ho is

elig

ible

? W

ho p

ays

for w

hat?

(inc

ludi

ng

regi

onal

var

iatio

ns)

Cur

rent

and

futu

re d

irect

ions

Envi

ronm

enta

l sup

port

Acce

ss to

ser

vice

s is

prio

ritis

ed

and

peop

le m

ay b

e pl

aced

on

a w

aitin

g lis

t.

Man

y el

igib

ility

crite

ria d

eriv

e fro

m th

e D

isab

led

Pers

ons

Com

mun

ity W

elfa

re

Act 1

975

and

are

now

out

date

d.

Crit

eria

will

be re

view

ed a

s pa

rt of

the

seco

nd s

tage

of t

he E

nviro

nmen

tal

Supp

ort S

ervi

ces

Rev

iew

from

N

ovem

ber 2

002.

The

sys

tem

of

prio

ritis

atio

n is

als

o un

der r

evie

w.

This

is

a g

row

th a

rea

due

to in

crea

sed

com

mun

ity li

ving

and

tech

nolo

gica

l ch

ange

s.

Equi

pmen

t (in

clud

es, b

ut

is n

ot li

mite

d to

, eq

uipm

ent f

or th

e ho

me

and

mob

ility

equi

pmen

t.

Ther

e is

a s

epar

ate

serv

ice

agre

emen

t for

or

thot

ics

and

pros

thet

ics)

Peop

le w

ho m

eet t

he

Min

istry

’s d

efin

ition

of

disa

bilit

y an

d w

ho a

re

asse

ssed

as

need

ing

the

equi

pmen

t for

long

er th

an

six

mon

ths.

All e

ssen

tial e

quip

men

t for

ch

ildre

n is

free

. Es

sent

ial

equi

pmen

t for

per

sona

l use

is

also

free

for p

eopl

e re

ceiv

ing

a sp

ecia

l ben

efit,

or i

n ca

ses

of

hard

ship

. Pr

escr

ibed

am

ount

s of

di

spos

able

item

s ar

e fre

e, a

s ar

e ot

her i

tem

s, s

uch

as w

heel

chai

rs.

Som

e ite

ms

have

a m

axim

um

part

char

ge o

f $37

.

Impr

ovem

ents

to te

chno

logy

hav

e in

crea

sed

the

rang

e an

d co

st o

f man

y eq

uipm

ent i

tem

s. A

s te

chno

logy

im

prov

es, m

ore

wor

k is

nee

ded

to

guid

e de

cisi

ons

on fu

ndin

g ne

w

tech

nolo

gy.

Serv

ice

and

exam

ples

W

ho is

elig

ible

? W

ho p

ays

for w

hat?

(inc

ludi

ng

regi

onal

var

iatio

ns)

Cur

rent

and

futu

re d

irect

ions

Com

mun

icat

ion

aids

/ he

arin

g ai

ds

As a

bove

. H

earin

g ai

ds fo

r chi

ldre

n ar

e fre

e,

as a

re h

earin

g ai

ds n

eede

d fo

r ed

ucat

ion,

trai

ning

or

empl

oym

ent,

or fo

r prim

ary

care

rs o

f dep

ende

nt c

hild

ren.

Fo

r oth

ers

ther

e is

a m

axim

um

subs

idy

of $

89.1

0 (in

clud

ing

GST

).

The

max

imum

sub

sidy

has

bee

n se

t at

$89.

10 (i

nclu

ding

GST

) for

som

e ye

ars,

whi

le h

earin

g ai

ds c

ost f

rom

se

vera

l hun

dred

dol

lars

to s

ever

al

thou

sand

.

Gra

nts

for v

ehic

le

purc

hase

and

m

odifi

catio

ns

Peop

le w

ho m

eet t

he

Min

istry

’s d

efin

ition

of

disa

bilit

y; w

ho a

re

phys

ical

ly u

nabl

e to

use

pu

blic

tran

spor

t (re

gard

less

of w

heth

er it

is

ava

ilabl

e), a

nd w

ho

need

a v

ehic

le in

ord

er to

be

abl

e to

und

erta

ke

full-

time

empl

oym

ent,

or

full-

time

terti

ary

train

ing,

or

vol

unta

ry w

ork

with

a

reco

gnis

ed c

omm

unity

or

gani

satio

n.

The

Min

istry

pay

s up

to $

11,9

70

(incl

udin

g G

ST) f

or p

urch

ase

of a

ve

hicl

e, a

nd u

p to

$96

5 (in

clud

ing

GST

) for

any

veh

icle

m

odifi

catio

ns.

Inco

me

and

asse

t te

stin

g m

ay a

pply

.

Ther

e ar

e so

me

regi

onal

var

iatio

ns in

ac

cess

and

pric

es.

Thes

e ar

e cu

rrent

ly b

eing

add

ress

ed.

Serv

ice

and

exam

ples

W

ho is

elig

ible

? W

ho p

ays

for w

hat?

(inc

ludi

ng

regi

onal

var

iatio

ns)

Cur

rent

and

futu

re d

irect

ions

Hou

sing

mod

ifica

tions

Pe

ople

who

mee

t the

M

inis

try’s

def

initi

on o

f di

sabi

lity.

Alte

ratio

ns u

p to

$20

0 ar

e no

t co

vere

d. M

odifi

catio

ns c

ostin

g m

ore

than

$79

00 (i

nclu

ding

GST

) re

quire

inco

me

and

asse

t tes

ting

to d

eter

min

e co

ntrib

utio

n to

cos

t.

Artif

icia

l eye

s: $

150

per e

ye.

W

igs/

hairp

iece

s: $

400

for t

he fi

rst

wig

and

$18

0 pe

r yea

r for

the

next

two

year

s (a

ccum

ulat

ed if

no

t use

d ev

ery

year

). T

he th

ree

year

cyc

le th

en b

egin

s ag

ain.

Su

bsid

ised

item

s (a

rtific

ial

eyes

, bre

ast p

rost

hese

s,

and

wig

s)

Peop

le w

ho m

eet t

he

Min

istry

’s d

efin

ition

of

disa

bilit

y.

Brea

st p

rost

hesi

s: $

300

for t

he

first

pro

sthe

sis

and

$100

per

yea

r fo

r the

nex

t thr

ee y

ears

(a

ccum

ulat

ed if

not

use

d ev

ery

year

). T

he fo

ur y

ear c

ycle

then

be

gins

aga

in.

Ther

e ar

e re

gion

al v

aria

tions

in a

cces

s to

this

sub

sidy

. Th

ese

are

curre

ntly

be

ing

addr

esse

d.

Serv

ice

and

exam

ples

W

ho is

elig

ible

? W

ho p

ays

for w

hat?

(inc

ludi

ng

regi

onal

var

iatio

ns)

Cur

rent

and

futu

re d

irect

ions

Hab

ilita

tion

and

reha

bilit

atio

n

Asse

ssm

ent,

Trea

tmen

t an

d R

ehab

ilitat

ion

serv

ices

Peop

le a

sses

sed

as

need

ing

serv

ices

. Th

ese

serv

ices

are

mai

nly

prov

ided

in h

ospi

tals

, and

th

e m

ajor

ity o

f peo

ple

(app

roxi

mat

ely

80%

) re

ceiv

ing

serv

ices

are

ov

er 6

5.

Prov

ided

by

DH

Bs.

Serv

ices

are

fre

e to

use

rs e

xcep

t peo

ple

who

ar

e fu

nded

by

ACC

.

The

Min

istry

is re

view

ing

spec

ialis

t se

rvic

es fo

r old

er p

eopl

e, in

clud

ing

Asse

ssm

ent,

Trea

tmen

t and

R

ehab

ilitat

ion.

Chi

ld d

evel

opm

ent

serv

ices

C

hild

ren

and

youn

g pe

ople

ass

esse

d as

ne

edin

g se

rvic

es, w

hich

ar

e m

ainl

y ho

spita

l-bas

ed

and

mul

tidis

cipl

inar

y.

As a

bove

. In

crea

sing

dem

and

as m

ore

child

ren

and

youn

g pe

ople

with

hig

h ne

eds

live

in th

e co

mm

unity

.

Serv

ice

and

exam

ples

W

ho is

elig

ible

? W

ho p

ays

for w

hat?

(inc

ludi

ng

regi

onal

var

iatio

ns)

Cur

rent

and

futu

re d

irect

ions

Hab

ilitat

ion

or

reha

bilit

atio

n se

rvic

es fo

r bl

ind

and

visu

ally

im

paire

d pe

ople

Peop

le w

ho a

re

regi

ster

ed b

lind

and

who

ar

e un

der 5

or o

ver 1

6, o

r af

ter t

hey

have

left

com

puls

ory

educ

atio

n (w

ith s

ome

varia

tion

of

this

age

acc

ordi

ng to

in

divi

dual

circ

umst

ance

s).

Educ

atio

n is

resp

onsi

ble

for s

ervi

ces

betw

een

5 an

d 16

.

No

char

ge.

In 2

004

the

Min

istry

and

the

Min

istry

of

Educ

atio

n w

ill be

gin

join

t con

tract

ing

of

serv

ices

. Th

is s

houl

d re

duce

/elim

inat

e ga

ps in

ser

vice

s.

Dea

fblin

d se

rvic

es

Peop

le w

ith a

dua

l se

nsor

y di

sabi

lity.

Th

e M

inis

try a

lso

fund

s tra

inin

g fo

r pro

fess

iona

ls p

rovi

ding

de

afbl

ind

serv

ices

.

The

size

of t

he d

eafb

lind

popu

latio

n is

ye

t to

be d

eter

min

ed.

The

com

mun

icat

ion

and

supp

ort n

eeds

of

deaf

blin

d pe

ople

are

hig

hly

indi

vidu

al,

and

the

wor

kfor

ce to

sup

port

thes

e ne

eds

requ

ires

furth

er d

evel

opm

ent.

Disability Support Services - moh.govt.nzFILE/DisabilitySupportServices.pdf · Part 1: Background 1...

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Transcript of Disability Support Services - moh.govt.nzFILE/DisabilitySupportServices.pdf · Part 1: Background 1...