“No Man’s Land”: Review of Call to Action in Government Disability Services

An extensive review found ongoing problems with government-run disability care services come under the spotlight over allegations of neglect. Some patients were found to be suffering in “no man’s land” for months, with their dignity compromised and their risk assessments incomplete.

It outlines many shortcomings in the transition to work-from-home services, including protocol gaps and new complaints of “poor client hygiene” and “toxic leadership.”

A state-commissioned report released today calls for urgent improvements, and the government says they will be made.

The transition-to-home (T2H) program run by the Department of Social Services has been under scrutiny since last year. rear Indaily clarified the case of men – now known as Mr. D – was rushed from services to hospital in a state of neglect with a severely infected pressure ulcer.

a Subsequent gruesome investigation An independent health watchdog revealed “serious deficiencies” in his treatment, including having an infected pressure ulcer, appearing to be malnourished, and left in feces and urine for long periods of time.

T2H provides simple accommodation for homeless disabled patients who have been discharged from a long hospital stay.

It currently operates from two sites, Repat in Daw Park and St Margaret’s Rehabilitation Hospital in Semaphore.

Mr D resided in the now defunct T2H service at Hampstead Rehabilitation Centre.

The state government began an independent review of T2H after being elected in March, and today Social Services Minister Nat Cook announced those findings and pledged to take action to improve services. did.

A review conducted by Associate Professor Christine Dennis, a health expert at Flinders University, and Greg Addy, a disability and health advocate, found that none of the targeted NDIS standards of practice were fully met in T2H. I understand.

However, they were found to be “partially fulfilled” and the reviewer noted that none were rated as “unfulfilled”.

“If standards are ‘only partially met,’ the risk is currently low, but could worsen unless effective systems are implemented and monitored,” the report notes. increase.

The expected length of stay for patients at T2H is 90 days, but reports show that they stay an average of 207 days, with one client staying nearly 18 months, or 536 days.

“The need to address barriers to effective and timely discharge pathways is evident from the increase in long-stay outliers,” the review found.

Investigators are seeking a long-term strategic view of T2H.

“In our opinion, given the ever-increasing length of stay, there is a cohort of clients who remain very long-staying clients to ensure that their care and services maintain or redevelop their independence. It is important that the rights of people with disabilities continue to be upheld as we work to change policies, procedures or programs,” they found.

“T2H clients cannot live in ‘no man’s land’ as it can affect not only their functional decline but also their mental health and well-being.”

The report states that while T2H services at Repat are better than hospitals, they “compromise the privacy and dignity of clients.”

“Although living conditions in the St. Margaret family are of a very high standard, many shared rooms affect the privacy and dignity of the occupants,” the report notes.

According to the report, there were 1238 internally reported “incidents” at T2H from September last year to April this year, nearly half of which involved clients refusing medication.

From May of last year to April of this year, there were 1829 incident reports, including 27 related to nursing care.

Twelve NDIS standards of practice were assessed for compliance and rated as “partially met.”

They include Rights and Responsibilities, Risk Management, Quality Management, Incident Management, Support Delivery, and Professional Conduct Support.

The reviewers said staff raised concerns that clients become more vulnerable when large numbers of complex clients are grouped together.

“Despite raising these concerns, during the review it was found that management’s corrective actions in response to significant reports and investigations were consistent with appropriate timeliness and effective resolution of identified gaps and risks. It turned out to be missing,” they discovered.

The report states that T2H is “strongly supported by DHS’s comprehensive operations management system, but there are many gaps in key T2H operational protocols.”

“Some of these are currently being addressed,” it says.

The reviewers found the patient’s risk assessment to be ‘incomplete’.

“Intake assessments and checklists completed by staff are often incomplete, inconsistent, undated, and contain randomly written information in the margins of the templates,” they found.

According to reviewers, an internal audit report in May of this year found that only eight out of 20 client files reviewed had a risk assessment.

“Many other risk mitigation measures were not implemented according to the T2H policy in relation to completing a positive behavioral support plan and documenting substance abuse problems,” they found.

The report states that the understanding and application of T2H intake and eligibility criteria “remains an operational management concern.”

“The revised intake assessment and risk screening protocol is still in draft stage and requires many improvements to adequately address roles, responsibilities and well-defined processes,” it said.

According to the report, eight T2H contacts and complaints were made to the Health and Social Services Complaints Commission (HCSCC) in the past 12 months. clinical evaluation.

One complaint filed within DHS relates to “alleged toxic leadership.”

“[MySAFETY records]state that the complaint has been closed. but it doesn’t solve“We have no further information,” the report said.

Another complaint highlighted by reviewers was: NOTE: This client previously had him brought to the attention of the Adult Protection Unit (25 March – 12 March 2022) by SA Police.

“During conversations with the client’s partner, (he) stated that ‘repeatedly in vain attempts were made to address the matter before a police report was filed,'” the report said. ing.

The complaint said it was referred to the Incident Management Unit for further investigation with “a suspended staff member pending an investigation.”

DHS said Indaily No staff members are employed by the department today.

Social Welfare Minister Nat Cook said the government will use the findings of the review to hire additional staff, improve risk assessment and monitoring and provide ongoing worker training, including mental health first aid. said there is.

“I have long been concerned about aspects of the home transition. The complaints that have come to my attention before and after coming to government show that we need to do better. I did,” Cook said.

“I am working towards an ambitious future where NDIS participants will be discharged directly to their homes with adequate NDIS support in place, so there is no need for step-down services for discharging NDIS participants.

“T2H’s disability support workers deal with highly complex situations every day, and an independent review noted that they are ‘dedicated to the people they support’.

“We are confident that the actions we are taking to address the findings of the review will better support our staff in providing consistent, high-quality service.”

Cook said other actions in response to the latest review include:

  • Living environment audits based on best practice design principles
  • Create a memorandum of understanding between the Department of Human Services and SA Health to articulate governance and accountability
  • Introducing new referral and intake forms
  • Conduct both routine and “spot check” audits
  • Establish clearer contract terms for NDIS workers supporting onsite residents

Cook said one of the reviewers, Greg Addy, will be appointed to oversee the urgent remediation.

A department spokesperson said:.

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“No Man’s Land”: Review of Call to Action in Government Disability Services

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