We are in the midst of a once in a generation change in the way health, disability and aged care services are delivered. Essentially this is a shift from block funding to a client-directed care model, with funding tailored to meet the individual’s specific needs. This shift is most noticeable at the moment in the NDIS and My Aged Care.
This represents a great new opportunity for OTs but inevitably such change gives rise to problems. OTA seeks to identify these problems and propose solutions.
National Disability Insurance Scheme
While the NDIS represents an historic opportunity to ensure certainty of support for some of Australia’s most vulnerable people, the rollout of the scheme has been less than ideal. OTA members and their clients report long and frustrating delays in the approval of plans and, as a knock-on effect, long and dangerous delays in the delivery of supports, including vital assistive technology.
OTA continues to advocate forcefully in this space, proposing constructive solutions to the many problems besetting the scheme.
Along the way there have been some important wins.
In early 2018, the Independent Pricing Review commissioned by the National Disability Insurance Agency (NDIA) recommended significant cuts in the fees paid for most NDIS services. A tiered pricing structure, based around the highly problematic concept of the client’s “complexity”, would have seen some services attract payments of as little as $110 per hour. OTA played a leading role in vocal and protracted efforts to overturn a proposal which threatened the viability of OTs’ businesses and was potentially disastrous for their clients. As a result of these efforts, the federal government announced in April 2019 that the hourly rate paid by the National Disability Insurance Agency (NDIA), would rise from $179 to $190 per hour, to take effect from 1 July.
Given the demands of military service, both physical and mental, a sizeable proportion of Australian veterans require the services of occupational therapists—clinicians who help our veterans participate in meaningful and productive activities. While occupational therapists derive enormous professional satisfaction from working with veterans and war widows, their work has become increasingly difficult to sustain.
This is because remuneration for such work has, in effect, been frozen for nearly twenty years by successive Australian governments. Rather than addressing these concerns, the 2018-19 federal budget included funding cuts of more than $40 million from allied health services over the following four years.
Those experienced occupational therapists still doing veterans work, do so at a loss; they only keep doing it out of loyalty to longstanding clients and by cross subsidies from other work.
If the exodus of experienced occupational therapists from The Department of Veterans’ Affairs (DVA) work is to be staunched, the federal government must act now to ensure the provision of occupational therapy services is, at the very least, sustainable.
It should be a source of national shame that clinicians with longstanding relationships with wounded, disabled and ageing veterans are having to cut these ties because the Australian Government is unwilling to provide fair compensation for their services. And it is unconscionable that the 2018-19 budget requires those clinicians still doing this work, but at a loss, to endure at least a further three years without a real increase in pay.
As part of its ongoing efforts to correct this injustice, OTA has launched a standalone website, OTs for Veterans, to raise awareness of the issue and involve OTs, veterans and their carers in our campaign to ensure fair pay for OTs working with veterans and war widows. As our campaign states, this is not the way a grateful nation treats the people who treat its veterans.
As the Australian population ages, an increasing number of OTs will be working in the aged care sector. This might involve working in Residential Aged Care Facilities or working with people who have opted to stay in their own homes.
OTA is currently preparing submissions to several aged care related inquiries, most notably the Royal Commission into Aged Care Quality and Safety. We have also been very vocal supporters of falls prevention among the elderly, reminding governments and the private health insurance sector that every dollar invested in falls prevention returns multiple dollars in savings to our health system—most notably our public hospitals. And, most importantly, it enhances the safety and the quality of life of our elderly.
The role of occupational therapists in mental health service provision is longstanding and a core area of practice for occupational therapists dating back to the beginning of the profession. Occupational therapists work across the spectrum of mental illness, providing services to people with mild, moderate and severe mental health conditions. They deliver services to people with relatively common conditions such as anxiety disorders, as well as more severe conditions that require targeted interventions, such as psychosis and trauma-related disorders.
Occupational therapists provide strengths-based, behaviourally-oriented and goal-directed services to improve mental health and wellbeing, and to help a person access personally relevant and valued roles in life.
OTA has recently redoubled its efforts to raise awareness of the role of OTs in mental health, making numerous submissions to reviews of mental health services and funding.
A network of 31 Primary Health Networks (PHNs) has been established across Australia by the federal government, with a view to increasing the efficiency and effectiveness of medical services for patients and improving coordination of care. As part of the PHN project, the government is also piloting Health Care Homes, a single point of multi-disciplinary care for those with chronic disease. These are based at general practices.
As the PHNs are at various stages of development, and the Health Care Home pilot is being reassessed by government, OTA is obliged to play something of a wait and see role. Having said that, we continue to advocate across all forums for a properly resourced commitment by governments at all levels to preventative care and the principle of wellness. And in the case of those with chronic disease, we argue that it is imperative this be managed in a more effective, evidence-based way.
We continue to remind government that occupational therapists, with their expertise in functional assessment and helping people to achieve practical goals, must be an integral part of primary care teams.