Advice for Providers on level 4 requirements, specialist advice, legal interventions …

Please find some guidance below from MoH regarding the challenges related to maintaining individuals in services during the requirements of Alert Level 4 for COVID-19.

Alert Level 4 requirements

As of midnight Wednesday 25 March 2020, everybody needed to be at the place where they could best be supported during the Alert Level 4 lock down period. This means people in residential services are required to stay there for the full duration of the COVID-19 Alert Level 4 restrictions.

In the event of an outbreak

In the event, that a person in a residential service is tested positive for COVID-19, then that person will remain in the home in isolation (see requirements for barrier nursing) and the entire group will be isolated. No one will be pre-emptively moved out of the home. Clinical support will be provided to the home at the time. In this event, please notify the Healthline immediately on 0800 358 5453.

Where individuals fail to meet the Alert Level 4 requirements

It is likely that some people will have difficulty with the COVID-19 restrictions. Disability support service providers may find that they have an increase in people experiencing challenging behaviour. Explore has particular expertise and experience in delivering practical advice and support to whânau, children, adults, support workers and organisations. The Ministry of Health and Explore have agreed Explore will change the way they deliver specialist behaviour support while we are in Alert Level 3 or 4 for COVID-19.

Residential support services needing specialist advice

Since 27 March 2020, disability residential support service providers have been able to directly contact Explore for immediate wellbeing and behaviour support advice, support, risk assessment and safety planning from Explore Behaviour Specialists by calling 0800 000 421. Providers will not need a referral from the NASC to access these services,

People being supported at home needing specialist advice

From midday Wednesday 1 April 2020, Explore will provide immediate wellbeing and behaviour support advice, support, risk assessment and safety planning to anyone eligible for disability support services through Disability NASC. People will not need a referral from the NASC to access these services, however, people will need to advise Explore who their NASC is.

Disabled people, their whânau and support workers can contact Explore directly by calling 0800 000 421.  From Monday 6 April 2020 these hours will be extended to 8am- 8pm.

Should individuals continue to experience difficulty with the COVID-19 restrictions and choose to leave the residential service (or visit others outside their bubble), it is important that staff try and retrieve them as quickly as possible. As soon as staff note a person is absent from the premises, they will make every effort to check their immediate vicinity. This can be physically in terms of their immediate environment but also things like phoning friends and family and likely places they may have gone to.

When individuals return to the premises, they will not be able to re-enter your service ‘bubble’ if they have been exposed, or potentially exposed or in close contact with others. In this event you will either have to isolate them in part of your service or relocate them to an empty home, cabin, hotel or alternative. You may find as a service that you have a single address to do this and we know that many providers have prepared themselves with self-isolation areas. You will have also received extensive advice from the Ministry regarding the management of this so we will not duplicate that information here.

You may feel that in order to manage the situation that you need to increase staffing or even consider the use of security guards. Please talk to your portfolio manager in the first instance about the possibility of additional resources to support this to occur.

Legal interventions

If an individual is not under existing legal orders, then they have freedom of movement under usual circumstances. This means legal provisions in the Mental Health (Compulsory Assessment and Treatment) Act 1992 and the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 will not be available as a lawful way of responding to the current situation. We also cannot detain people unlawfully by placing them in a secure setting in order to manage them. This situation requires the utilisation of relational security through staffing supervision.

In some situations where people continue to refuse to abide by the requirements of Level Four there are wider legal means that can be used. These are described under the Health Act 1956 and relate to “Where individuals are deliberately not complying with expectations that they quarantine themselves”. The Health Act allows for an order to be made on a case by case basis, by one of the national Medical Officers of Health based within the Ministry. These situations will be considered and triaged based on risk. The Health Act can be used to require people to go into quarantine or to undergo testing, but it cannot compel them to accept treatment. The Act also does not provide authority to hold them in a secure facility, where they are not subject to existing legal orders.

Should an order be made it can require an individual to be in a specific place such as their home and the order can be both directed to them and enforced by the police. It is likely also that the police may deal with situations where disabled people are treated the same as other members of the public in relation to not abiding by the requirements of Level Four such as arresting and detaining people. Just to emphasise again the use of legal interventions should be considered a last resort. Please let us know if you need additional help or support should you be struggling with a situation currently. The following table may help you to problem-solve in the situation, in terms of an escalation of actions.

Provider is seeing an increase in challenging behaviour in terms of individuals struggling to comply with the Alert Level 4 isolation requirements.Contact Explore Behaviour Support on 0800 000 421
Provider is experiencing non-compliance with Level 4 requirements as individuals continue to be challenged by the current situation.Provider to attempt to retrieve the person safely. Provider to notify health line and report to Ministry as a critical incident. If unable to retrieve the person then the police are to be notified. The person will not be able to re-enter your service ‘bubble’ if they have been exposed, or potentially exposed or in close contact with others. If retrieved the provider may consider the need for increased staffing and/or the use of security guards.
Person continues to leave the service despite increased staffing and/or behavioural interventions. Police have intervened and returned the person on a number of occasions.Provider to talk to the Ministry of Health as to whether the person’s inability to abide by the L4 requirements would mean that an order under the Health Act 1956 may be required.
Person continues to leave the service despite the use of a Health Order.Provider to advise the police that the order has been breached. The police will take action as per the requirements of the Health Order.
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