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Advice from the Disability Service Directorate

ARCHIVED Addtional Information from Enable New Zealand and Accessable On: Advice from the Disability Service Directorate of the Ministry of Health dated 26th August 2004

Based on Specialised Assessor feedback to Enable New Zealand and accessable, we are providing comment, clarification and information regarding the changes in policy and process as advised by the Disability Service Directorate of the Ministry of Health in their document.

Ministry of Health Approved Changes to ESS Management

Point 1
accessable and Enable New Zealand be given the mandate to manage the budget on a month by month basis.

Point 2
In the Ministry of Health regions to which Enable New Zealand delivers services, the delegation to Specialised Assessors for purchasing equipment and housing modifications up to the value of $500 is permanently withdrawn and henceforth all applications for equipment and housing modifications be subject to the completion of an application.

Flow charts for the respective processes are attached. If the request is similar to but not Common List the Specialised Assessor should comment briefly on why a Common List item will not meet the essential disability related need.

Applications for new, reissued, and common list equipment should be made on the Equipment Application Form (Version: Specialised Assessor Equipment Manual. April 2001). A brief sentence in the rationale section is all that is required. Enable New Zealand will seek further information from the Specialised Assessor if necessary.

Applications for housing modifications continue to be made on the Housing Modification form Version May 2003

Point 3
No retrospective funding be approved for any applications, unless approved by the Ministry.

Point 4
Enable New Zealand and accessable to be given full authority to review the priority rating allocated to all applications.

Point 5
The process for accessing funding for high cost /complex housing modifications and personal care equipment will more actively involve the NASC providers.

Enable New Zealand and accessable are required by the Ministry of Health to seek assurance that consideration is not only given to attainment of outcomes but also effective resource allocation.

Where applications are lodged for high cost housing modifications and personal care equipment, Enable New Zealand and accessable will seek evidence of meaningful liaison with NASC. This will include, but is not limited to, all applications where the value is likely to exceed $10,000.00. The following information is an essential requirement for these applications.

  • Documented support that the proposed solution is essential to enable the client to remain in their home
  • Support that the proposed care environment is likely to be long-term and that the care resources required to support the person in their home are likely to be sustainable
  • The other options considered
  • Reasoning supporting the long-term cost-effectiveness of the proposed solution.

The timing of the liaison with NASC is important. In order to fully consider the options for long-term care, liaison with NASC should occur at the beginning of the assessment process. Currently it is more usual for a Specialised Assessor to send the completed application for the equipment or housing modification to NASC for endorsement and by this time it is generally too late for the NASC to be able to meaningfully discuss the proposed equipment or housing modifications as the clients expectation of receiving that particular solution is already in place.

Enable New Zealand and accessable do not require liaison with NASC for ALL personal care or housing modification applications.

Enable New Zealand and accessable will be looking for meaningful liaison on applications for those clients with a disability for which it may be difficult, for both safety and care reasons, to continue to support in the community long term.

In addition Specialised Assessors may seek to liase with NASC if they consider it will support their application as outlined in the following insert
Using the Priority Guidelines
Any application which does not meet specific prioritising criteria, but which the specialised assessor believes is deserving of higher priority, should be discussed with the local NASC provider. A joint decision may then be made to raise the priority. This decision will be based on issues relating directly to the person's disability and the impact for them and their caregivers if the environmental support service is not made available within a certain time frame.

The criteria for prioritisation guidelines DO NOT over ride existing eligibility criteria.

Point 6
Any Priority 1 (P1) applications that have not come to charge within six months of being approved will be voided and the process for approval will have to be completed again if the person still requires ESS. The only exception to this will be for those applications where there is an issue to be resolved and/or needs have changed since the original application and/or there has been some communication between the Specialised Assessor and Enable New Zealand or accessable.

If approval has been given by Enable New Zealand or accessable for the release of funding for equipment or housing modifications and this has not resulted in either an invoice or further information from the Specialised Assessor outlining the delay, the application will be abandoned after six (6) months. A new application would be required after 6 months where it is established by a Specialised Assessor that the client has an essential disability related need for ESS.

Point 7
The process for driving assessment is retained within the ESS budget. The process as used in the Auckland region be adopted by Enable New Zealand (ie That all referrals are treated as applications and come to Enable New Zealand to be approved in the context of access and eligibility criteria and according to the priority guidelines).

Enable New Zealand Driving Vehicle Assessment process

Driving Vehicle Assessment (DVA) (September 2004)
A DVA is required in some cases before a person is allowed to drive after the onset of a disability. e.g. a person may have had a stroke but recover sufficiently to return to work. However, there may be a concern about the person's ability to drive safely within the LTSA definitions.

A DVA is also required when a person is applying for funding to purchase a Vehicle and or a Vehicle Modification. The funding is managed by Enable New Zealand on behalf of the Ministry Of Health (MoH)

An application for a DVA must be forwarded by a Specialised Assessor [not the Driving Assessment Service] and contain the following:

1. An application form signed by the person with the disability and a Specialised Assessor.

The Specialised Assessor does not have to be a person with Driving Assessment skills and could be an Occupational Therapist or a Physiotherapist who has had contact with the person.

2. A brief assessment or a letter detailing the essential need for the DVA.

Rationale is:
To return to full time employment, full-time tertiary education or voluntary work (greater than 20 hours/week). If the application is also for a Vehicle Purchase or Modification, proof of full time education or employment is required.

3. A Medical Certificate form completed by a Doctor involved in the client's care.

4. A copy of the person's driving licence and notification as to any previous LTSA stand-down from driving

5. The name of the Driver Assessment Service chosen by the Specialised Assessor and/or the person, and the anticipated cost of the assessment.

6. The completed Priority Guidelines as per the Specialised Assessor Manuals

When the application has been received by Enable New Zealand, and approved by the Professional Advisor, the application Priority Guidelines are reviewed and the application is given the relevant priority. Very rarely would a DVA meet the P1 Priority Guidelines. The application is placed on the waiting list and the relevant letters sent to the Person and the Assessor.

As soon as the funding is available for the application to proceed, the Service application form is photocopied by Enable New Zealand and sent to the chosen Driver Assessment Service with the Service approval letter.

The Driver Assessment Service will contact the person and make an appointment. On completion of the Service, an invoice and Driving report is forwarded to Enable New Zealand for payment.

There is no funding available for a person to achieve a NZ Drivers License. All aspects of this process are the responsibility of the client.

Where a person has never driven before, they must hold at least a Learners Driving Licence. An on-road assessment is at the discretion of the chosen Driver Assessment Service.

On completion of the DVA and where the Driver Assessment Service believes that the person is not safe to drive or that there should be a restriction on the conditions of their driving, the Driver Assessment Service will provide these details to the LTSA.

Purchase and/or Modify Vehicle
If the DVA has been completed in order to fulfil the requirements for an application to purchase and/or modify a vehicle, the report from the Driver Assessment Service may be used as the application forms. This is used in conjunction with the application sent by the Specialised Assessor.

If the application for the Vehicle Purchase and/or Modification meets the criteria and is approved by the Manager, it will be placed on the waiting list according to the Priority Guidelines. A letter outlining the approval and the waiting list is sent to the Specialised Assessor and the person.

Driver Assessment Service Employs a New Zealand Registered Occupational Therapist who is registered with Enable Information as a Specialised Vehicle Assessor.

Point 8
Individuals (children) will not usually be eligible for more than one seating system and/or mobility base at any one time and that funding for car seats be provided to meet safety needs only (as distinct from positioning requirements). This can be reviewed on a case-by-case basis where there are safety issues identified.

Individuals will not usually be eligible for more than one seating system and/or mobility base (in this context mobility base refers only to the base to which a seating system attaches) at any one time (Note: a person who qualifies for a powered wheelchair may also have a backup transit wheelchair where it is assessed as being essential by the Specialised Assessor).

Funding for car seats will be provided to meet safety needs for travel in the vehicle only (as distinct from positioning requirements), where the person meets the Ministry of Heath access and eligibility criteria.

Point 9
Funding for one standing frame only will be approved at any one time.

Note that the existing criteria for accessing Ministry of Health funding for standing frames still applies. The existing definition for this accreditation area is inserted below:

Section 8.6 Standing Frames (STD)
The provision of equipment to encourage and promote the maintenance of functional posture, skeletal and spinal integrity and/or the potential for walking.

In most cases standing frames are a therapy intervention. Where the standing frame will promote the ability to maintain a functional posture during skeletal development, funding will be provided (Specialised Assessor Equipment Manual, July 2000, p.17).

Point 10
The priority guidelines will be rigorously applied and all applications for wheelchair/seating systems for people in hospital and rest home level aged residential care will be treated as priority two (on the basis that care to manage pressure care, safety, mobility and socialisation is funded by bed/day rate paid to residential care providers).

Some residents of hospital and rest home level aged residential care units may be funded based on a different contract that does not cover the above level of provision. NASC will be able to inform you if this is the case. The application will need to clearly state the Residential Care contract that the person is funded by. In order for the application to be considered Priority One, it will need to detail other excluded options that could be used to meet the pressure care, safety, mobility and socialisation needs such as assisted changes in position.

This applies from 1 July 2004.

Point 11
TENS machines will no longer be funded through the ESS budget as they are now purchased through DHB pain management contracts.

Enable New Zealand and accessable will be responsible for repairing any TENS machines that we have issued.
When those TENS machines that have been issued by us are not repairable, we will write them off and will not provide a replacement. The client should be referred to their local DHB Chronic Pain Service for assessment.

Point 12
Generally, no funding approval for additional rooms will be considered, unless approved by the Ministry on a case-by-case basis.

Where an additional room is deemed to be essential to meet a disability related need, an application in principle should be made to Enable New Zealand or accessable.

Point 13
An area for fencing for safety will only be approved for a safe outdoor area as opposed to fencing entire back yards etc.

Enable New Zealand will adopt the guidelines used by accessable. Section 10.3; accessable Housing Manual

Current Manual Specifications. Fencing. Section 10.3; accessable Housing Manual
Fencing and/or gate will only be purchased in exceptional circumstances when the person is at risk of injury as a result of their disability.
The Specialised Assessor must consider the clinical aspects of the person's disability regarding future needs i.e. is this going to be a problem in a year's time?

NASC involvement in the housing modification process must be demonstrated in the application.

The Specialised Assessor needs to consider the following:
1. is the fencing essential to allow the person to remain in their home?
2. the needs of a child in comparison to that of any child without a disability i.e. any young child requires supervision and secure fencing
3. the type and durability of fencing provided when the child was under 5 or that provided for other children from the same family who are under 5
4. the clinical aspects of the person's disability regarding future needs i.e. is this going to be a long-term problem or will a behavioural programme meet the persons needs

  • Note 
    the fenced area must be the minimum to prevent risk or injury i.e. a small fenced area within the boundaries allowing for supervision
  • the most cost effective materials are to be used
  • existing boundaries including the house wall must be considered as part of the small fenced area
  • the responsibilities of the registered proprietor of the property and neighbour to provide fencing for their properties must be investigated

Data Gathering
Information gathered regarding fencing a safe play area for a child:

  • NZS4102 Safer house design, Section 2.3 Children's outdoor play spaces
  • No vehicle access is to be provided within a play area due to the risks of injury by vehicle
  • One gate is provided to access this outdoor area
  • The area must include access from the house
  • The area must be visible from the commonly used areas of the home eg, kitchen, living areas to allow for adequate supervision of the child
  • Barnados childcare; information from this organisation relates to pre-school children regarding their recommendation for a safe play area and is not practical for older children
  • Size of area to be determined but it is anticipated that it will be no larger than 80sqm or 40 lineal metres of fencing. (At least 1 wall of the house will form part of the boundary and existing fencing or barriers must be considered)

Point 14
With respect to rental accommodation, Enable New Zealand adopts practice as undertaken by accessable:

  • Assessing suitability of chosen accommodation
  • Assessing longevity of rental accommodation
  • Focus on reusable equipment stairs, low rise lifts.

In reviewing an application Enable New Zealand and accessable will look for evidence that the Specialised Assessor has an understanding of the issues created by modifications to a rental property.
Has the Specialised Assessor determined suitability of the rental accommodation? 
Has the Specialised Assessor gained any evidence that the rental is a long term option? 
What reusable equipment has been considered/trialled? 
What alternative lower cost alterations have been considered?

Point 15
If the home where a housing modification is required to meet the essential disability related needs of a person does not meet Territorial Authority compliance standard there is no approval for funding.

The intention of the Ministry of Health position statement is to provide Enable New Zealand and accessable with a means of declining funding towards house modifications where the house is clearly not in a fit state to modify.

Points to consider to determine whether an existing house is substandard and/or unsuitable and therefore inappropriate include:

  • The existing house is in such a state of repair that major repairs and/or maintenance are required making it difficult to carry out the identified housing modification for the person with the disability.
  • The state of the existing house is such that it is considered to be detrimental to the health and safety of the person with the disability.
  • The Territorial Authority (Local Council) is unlikely to issue the Code Compliance Certificate on completion of the housing modification.
  • The number of people sleeping in the house exceeds the number permitted by the Home Improvement Regulations 1947 (copy available from Enable Information, CallFree 0800 17 1981)
  • It is the property owners responsibility to ensure that the existing house meets all the requirements for a habitable dwelling unit

It is important that if the existing house lacks any of the basic amenities relating to a safe, healthy and habitable dwelling unit under the Building Code it can be considered to be sub-standard. These requirements are based on the Building Code as they would apply to new building work and alteration and additions to an existing building. (Building Regulations 1992 1st Schedule)

  • Where the Specialised Assessor in concerned at the state of the house requiring modifications in terms of the above considerations, the application for Ministry of Health funding must include information relating to the standard of the existing house.
  • Any repairs and maintenance required to ensure that the house is suitable to be used as a habitable dwelling unit will need to be identified and remedied prior to Ministry of Health funding being approved.

Substandard Housing means Residential Housing that is less than what is required to conform with the quality or size expected for a safe, healthy and habitable house.

Amenities - means an attribute of a building which contributes to the health, physical independence, and well being of the building's users. (Building Regulations 1992 definition)

Point 16
No further funding approval given for housing modifications if the house is not readily and basically accessible.
NOTE: this information has since been updated. See 26 May 2005 - Update.

The Housing Manual describes that a housing modification must be essential for mobility into and within the home. This translates to mean external access into the home and internal access within the home. As such, Enable New Zealand and accessable have split the information required into 2 sections to provide clarity of decision making.

1. Access Into The Home
Considered to be access from the land/ground in the immediate vicinity of the dwelling into the home via an existing doorway.
Access modifications into the home may include:
a. The addition of external rails to existing steps where a permit would not have been required when the steps were installed
b. Conversion of steps to easy-steps
c. Installation of ramps (permanent or temporary)/low rise lifts/domestic passenger lifts
d. Widening of the door into the home

  • Only minor level linking works will be considered to provide an accessible link from the access modifications to a vehicle park
    eg; widening of an existing path that links to the vehicle parking would be considered where the path is no more than 5 metres in length
  • Only minor earthworks and/or retaining of land will be approved if required for the access modifications
    eg; minor preparatory work to level the ground is required prior to the access modifications.
  • Where the access requires use of adjacent land that is not part of the land owned by the registered property owner this will be considered as not being readily and basically accessible
    eg; where council land, neighbouring properties must be modified to provide access to the home, an application will not be approved
  • Where the property does not offer reasonable access from vehicle parking to the home, this will be considered as not being readily and basically accessible.
    eg; where the house is situated above or below the road level and there is no driveway access direct to the home
  • As part of the consent process there may be a requirement for a specialist report to be sourced from a consultant. Where the resulting report is unfavourable, the home may be considered as not readily and basically accessible
    eg; a Geotechnical report outlines the requirement for extra retaining of land to allow the modification to proceed.
  • Where a cable car or similar mechanical device as defined by the Building Act 2004 to traverse the ground between the home and vehicle is required for access into the home for the person with a disability, the home would not be considered readily and basically accessible.

2. Mobility Within The Home
Considered to be provision of essential access within the home through doorways or between levels and the provision of sufficient turning circles where a wheelchair is required for mobility.
Access modifications within the home may include:
a. The addition of internal rails to existing steps between different floor levels where a permit would not have been required when the steps were installed
b. Widening or removal of doorways
c. On a case-by-case basis - Removal of walls or alteration to corners of adjoining walls to provide greater turning circles
d. Wedge ramps or minor ramping for small stepped areas
e. Passenger lifts

  • Only minor wall alterations will be considered to provide adequate turning circles or direct line access between rooms
    eg; where a wall must be removed between the bathroom and toilet to provide adequate areas to mobility
  • On a case-by-case basis - Where a load bearing wall must be removed to provide adequate mobility, the home would not be considered readily and basically accessible
  • Only minor preparatory installation work will be approved where a passenger lift is required for essential access within the home
    eg; where a new space must be created within the home to install the lift, the home would not be considered readily and basically accessible
  • As part of the consent process there may be a requirement for a specialist report to be sourced from a consultant. Where the resulting report is unfavourable, the home may be considered as not readily and basically accessible

3. Notes
Where the registered property owner agrees to contribute the costs to ensure that the home is considered as readily and basically accessible, then an application will be considered for access modifications.

Prior to the access modifications the registered property owner is responsible for compliance with the current Building Code for the home as it is constructed.



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