The National Disability Insurance Scheme (NDIS) provides individualised support for people with disability, as well as their families and carers. For Australians with a permanent and significant disability, aged under 65, the NDIS will provide the reasonable and necessary supports they need to live an ordinary life (1). An individual may meet the disability requirements if: they have a permanent impairment or condition which substantially reduces their ability to participate effectively in activities or perform tasks without assistance from other people or assistive equipment; and their impairment affects their capacity for social and economic participation; and they are likely to require support under the NDIS for their lifetime (2). Not all people with a disability will become NDIS participants. Only those who meet the access criteria will become a participant and receive an individualised plan (1).
For the purposes of becoming a participant in the NDIS the focus of 'disability' is on the reduction or loss of an ability to perform an activity which results from an impairment. The term 'impairment' commonly refers to a loss of, or damage to, a physical, sensory or mental function. The narrower definition of 'disability' employed by the NDIS seeks to target those people with disability who have a significant impairment to their functional capacity. This functional definition of disability focuses on outcomes for people with disability that are in the most need (3).
Consideration of lymphoedema as a disability meeting the specific NDIS requirements will need to occur on a case by case basis. Many individuals may live with and manage lymphoedema as a chronic condition without meeting the disability requirements. For others, the impact of their condition will result in the aforementioned criteria being met. For instance, managing an individual’s increase in swelling following an episode of lower limb cellulitis is likely to be considered a health issue and by itself would not qualify the individual to become an NDIS participant. But if persistent limb swelling prevented the individual from participating in everyday activities without assistance from others (or without the use of equipment), as well as affecting their ability to participate in social and economic roles for their lifetime, then an application for funding under the NDIS should be considered.
The NDIS allows for flexibility in the therapeutic management of participants with lymphoedema. A participants plan ideally allows for both allied health consultations along with garment provision (equipment). According to the National Disability Insurance Authority (NDIA), reliance on commonly used items by itself will not result in a substantially reduced functional capacity to participate effectively or completely in an activity. Commonly used items include glasses, walking sticks, bathroom grab rails, dressing aids etc. In considering the role played by home modifications and equipment, the NDIA will consider specific needs arising from the prospective participant's impairment, and whether those needs are met (or need to be met) through the use of specialist disability aids and/or equipment.
Such items would generally be specifically designed to assist in increasing the functional capacity and participation of people with disability and be formally prescribed by a medical practitioner, specialist clinician or allied health professional such as an occupational therapist, physiotherapist (3). It is therefore important that the treating therapist be able to demonstrate how the compression garments increase the participant’s functional capacity and participation.
Each participant will have a plan with specific goals. All lymphoedema treatment and garmenting under the NDIS should be demonstrably meeting or helping to meet the participant’s individualised goals. Further details regarding service provision, participant plans and your role as a therapist can be found within the NDIS provider toolkit (4). Each NDIS fund (plan) requires management by someone/s. This can be the person themselves or a nominee, a registered plan management provider or through the NDIS agency itself. The NDIS was set up to allow individuals to access therapists of their own choosing. Participants are able to exercise choice in selecting their providers (therapists). It is only when a participants funding is managed by the Agency that the supports must be provided by a registered provider of supports (5). Registered providers are individuals or organisations that are registered with the NDIA to deliver a support or a product to a participant in the NDIS.
Information about the NDIS is regularly changing and being updated. It is important to review this information regularly to remain up to date with developments
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