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August 02 2011 - Update

ARCHIVED Managing EMS Budget in the 2011 - 2012 year


The EMS budget for the Enable New Zealand region has returned to its baseline after two years of additional funding being made available to clear all wait lists. This funding was only available till the end of June 2011. Based on current trends the anticipated volumes of applications for funding for equipment and housing and vehicle modifications in the 2011/12 year are forecast to exceed the available budget. Therefore in order to manage demand and remain within budget we need to make some changes to how applications are managed.

The following steps effective from 1 August, are being taken to ensure that the available budget goes to those people in greatest need of this support in the most fair and transparent manner.

1. MoH List Equipment

All MoH List Equipment applications will continue to be processed on receipt.

2. Priority 1 and 2

All applications for EMS funding will be considered to be Priority 2 and will be processed in date order as budget allows. Applications for complex items of equipment or housing modifications which are assessed to require immediate action – i.e. Priority 1 funding - should be prepared and managed using the following process.

Priority 1 applications will be considered where this is supported by the Professional Advisor or Clinical Leader (or other delegated professional), at the assessment service. Such applications must be forwarded by email to the following address:

The request must note the reasons for Priority 1 (see the indicators for Priority 1 below). Priority 1 applications will be processed within four weeks of receipt and will gain funding as quickly as possible.

Please note this in effect takes over the old ‘urgent’ process which will cease as of the date of this communication.

Indicators for P1

The person has a documented history of safety issues which will imminently affect the health and safety of themselves or their unpaid support people:

  • Damage to skin integrity for people using a wheelchair or who are immobile in bed and have no support to re-position.
  • History of falls.
  • Challenging behaviour. 
  • Skeletal integrity.

The required equipment solution is essential to enable the person to undertake the role as a Main Carer of a dependent (parenting):

  • Communication with the dependent person.
  • Oversight of the person.

The person has a progressive condition and is experiencing a sudden change in needs which impacts on their ability to communicate.

The person lives alone and has no other support people to assist undertaking activities of daily living or retain mobility around their home.

The person is under 16 years old and unable to continue with school attendance and their education, and the item of equipment has 50% or more approved funding from the Ministry of Education.

And in addition to one or more of the indicators above the person cannot afford to pay for the solution themselves.

3. Assessor Access to Stores

The Assessor Access to Stores in Hamilton, Palmerston North and Christchurch will increase to 5 days per week Monday to Friday: 10am -12 midday and 1.30 - 3pm

4. Reissue MOH List Equipment

EMS Assessors are reminded they are able to reissue MoH List Equipment items that are returned to their services as per this process:Reissuing Equipment - Enable New Zealand Region

5. Stores Contact

A project is underway to pilot a process where EMS Assessors can directly call a Stores Technician to seek out a specific item of equipment from the available items in Store. This will then be issued to the client on receipt of an application. Progress re this pilot and its roll out across all areas will be updated in late August.

6. High Cost Personal Care Equipment

Applications which contain a request for a high cost personal care equipment solution will be reviewed by a panel at Enable New Zealand. Initially the threshold for the high cost personal care item will be $5,000, (although this may lower in the future).

The review panel will include the Enable New Zealand Professional Advisors and Procurement Team. There will be additional rigor required re the justification for the equipment option and the procurement team will also seek additional suppliers who may have a competing, more cost effective product, details of which will be discussed with the EMS Assessor.

Please note this process does not include wheelchairs, powered wheelchairs or communication equipment.

7. Return of Equipment Items

Work is underway to advertise and promote with the general public, the need to return equipment to Enable New Zealand.

Where Enable New Zealand has a physical Store presence it is requested that EMS Assessors encourage clients and their family to drop equipment back at Enable New Zealand rather than incur freight costs for picking items up.

8. Equipment Specifications

Specification forms are being developed for certain items of non MOH List Equipment. This would mean that items such as a hoist would be described as being within certain key specifications –i.e. weight capacity, width, cradle type. Any hoists in the Stores that meet or exceed those key specifications will be provided.

This allows older items which are not currently available on the New Zealand market to be reissued more easily.

Items for ‘or similar’ specifications:

  • Hoists.
  • Wheelchair Backs.
  • Wheelchair Cushions.
  • Mattresses.

9. Wet Area Showers (WAS) Threshold

Review of EMS expenditure across each District Health Board areas highlights some interesting statistical information, especially when comparing against population percentages in each District Health Board. Some areas have significantly lower volumes of housing modifications, specifically bathroom/toilet modifications than their population would suggest might have been requested whilst others have notably higher volumes. District Health Board’s often make the case that they are serving a unique client group – e.g. more older people retire into the area, lower socio economic, poor housing stock, a lot of children with disabilities etc. However the varying volumes of applications in different areas do seem to reflect the difference in practice and paradigm that EMS Housing Assessors might apply to the notion of ‘need’ for modifying a bathroom or for finding other solution.

Wet Area Showers are often provided to minimise risk of falls or caregiver injury. Evaluation of the reality of that risk, or whether that risk is eliminated with the installation of a Wet Area Shower is difficult to measure with no validated tool in place to assist in assessment. There is also no standard or clear methodology for evaluating/determining when a bathboard, stripwashing, swivel bather etc. are not viable options for people. There are clients at each end of the spectrum for whom it is easy to identify the need to for a Wet Area Shower, but there appears to be a significant variation in how that “need” is determined and how other options are assessed and considered.

There appears to be an understanding that bathroom modifications need to consider the potential long term needs. As an example, there is little point removing a bath and installing a shower cubicle, when the shower cubicle itself might become difficult to use at some future point particularly when the cost of installing a Wet Area Shower is similar. However if the person could get by using rails and bathboard, or a shower over the bath, then there is no need to consider a Wet Area Shower as the best long term solution.

NB: Work to develop a set of assessment guidelines to assist EMS Assessors to determine the threshold of need at which a Wet Area Shower should be considered is being progressed by Enable New Zealand.

10. Clients Given the Option of Self Funding

EMS Assessors must advise the client that where their application does not meet P1 requirements, there is potentially a wait for available funding the length of which is currently not known. This gives them the opportunity to consider their options and the potential to self fund the solution.

11. Review of Application Patterns

Enable New Zealand will be reviewing application statistics in relation to the population served for Assessment Services and will be providing feedback to the Ministry of Health, Assessment Services and individual EMS Assessors (particularly on specific patterns that raise concern).

This shift in focus from examining individual file applications to a more strategic analysis of patterns of application generation will become more of a focus for the Professional Advisors at Enable New Zealand.

Feedback will be provided to the general EMS Assessor community via the Disability Funding website.

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