State-based aids and equipment programs
Despite there being an assumption that an individual’s assistive technology needs can still be dealt with at the state level, existing state-based aids and equipment programs currently fall well short of people’s needs.
Long waiting lists can prevent people from accessing support when they need it.
Key policy and program issues can be summarised as follows:
- Most state-based programs remain grossly underfunded. There has been no commitment to growth to keep up with the increasing costs of assistive technology. Using Queensland as an example, we know that funding for the state-based Medical Aids Subsidy Scheme (MASS) has not been increased since 2008. In fact, funding for the scheme has actually decreased because there is an expectation that it will no longer service people who are eligible for the NDIS. We know that aids and equipment programs in other states have followed similar trends.
- People accessing state-based programs are still expected to make a significant, and often prohibitive, financial contribution towards the cost of their assistive technology.
- Many people accessing state-based programs continue to be plagued by long waiting lists. This prevents them from accessing support when they need it most; with a person’s assistive technology needs often having changed significantly between the date of prescription and receipt of the technology that has been recommended.
- People accessing state-based aids and equipment programs do not have the same level of choice and control that is afforded to participants under the NDIS. There are a range of approved products that can be funded under each program. As such, not all equipment that is required by people with disability can be funded.
- People living in residential aged care are unable to access assistive technology under existing state-based aids and equipment programs. There is currently no other pathway available to provide people living in care with the specific equipment they need.
- Some state-based programs prevent people from accessing funding if they are already in receipt of, or on the waiting list for a home care package.xiii Unfortunately, Home care packages also fail to provide timely or appropriate access to assistive technology.
Case study: Amir
Amir is in his early 70s. He sustained a spinal cord injury 42 years ago and needs a new power drive wheelchair to help him get around. His chair is his primary mobility device, and he cannot access his community without it. He also needs to sit in it for most of the day, so it has to be customised to provide him with an appropriate level of comfort and prevent him from developing potentially serious or fatal pressure wounds.
Amir needs a chair with customised seating, power seat functions and customised chin control. This chair has been priced at $32,000. Unfortunately, Amir is only eligible to access a subsidy of around $15,000 under the Queensland state-based aids and equipment program. This leaves him with an out of pocket expense of around $17,000 which he cannot afford.
Case study: Sandra
Sandra is a 38-year-old woman who lives in Victoria. She has an incomplete spinal injury as a result of a horse-riding accident she was involved in several years ago.
Sandra spent her first 3 and a half years post-spinal injury without NDIS funding after being rejected for the scheme several times. She relied largely on hand-me-down assistive technology, including a second-hand walker from a friend’s Mum and an old manual wheelchair from a friend with footrests taped on with gaffa tape. These solutions did not meet her needs and she found herself not joining in on social activities, outings with her family or doing any hobbies because she was so exhausted after getting around at work.
Sandra couldn’t afford the allied health services she needed to learn to use her mobility equipment appropriately. This led to misuse and fatigue. She also had to pay for all repairs and maintenance on her assistive technology herself. This often meant that she went long periods without being able to get around while she saved up for the repairs that were needed.
Sandra received funding for her intermittent (single use) catheters through the Victorian State-Wide Equipment Program and the Federal Continence Aids Payment Scheme. She was unable to access funding for the self-lubricating catheters that best met her needs though and had to make do with a cheaper model instead. She suffered from frequent urinary tract infections as a result.
After several rejections, Sandra was eventually accepted onto the NDIS. As an NDIS participant, she can finally afford the mobility supports she needs to achieve her work and personal life goals. she also now has a catheter that better meets her needs, and her health has improved as a result.
Sandra worked out that she had been paying about $30,000-$40,000 per year out of her own pocket for assistive technology and related allied health supports before she was accepted into the NDIS. In order to meet these costs, she was required to go without other services and supports She needed to make ends meet and cut down in other areas of her and her family’s life.
Sandra knows how the systems outside the NDIS are failing people with disability, because she’s experienced things from both sides. While she is grateful for the fact that she now has better access to services under the NDIS, she knows there are many people who are still excluded who cannot get the help they need.