IPC Guidance for Alert Level 1

The Ministry of Health has released new Infection Prevention and Control (IPC) guidance for Alert Level 1 in health and disability settings.  Thank you to all who have contributed to the development of these documents. This guidance should be used in conjunction with your organisation’s IPC guidance, where available. The documents are available on the […]

Alert Level 2 guidance

Please find attached Alert Level 2 guidance for disabled people, their family, whānau and aiga.

While this guidance is current as at 21 May 2020, the rules around Alert Level 2 may change, particularly for gatherings. For the most up to date guidance, please see: health.govt.nz/COVID19-disability or covid19.govt.nz.

Clinical guidance to health professionals

Please find below a link to the clinical guidance that the MoH has developed (with the Donald Beasley Institute) for health professionals responding to patients with an intellectual disability. Whilst it has been developed within a COVID-19 context, it obviously has a much broader application.

They are also developing similar guidelines for autistic people.

Advice for Health Professionals

MoH Alert Level 2 Guidance

Covid-19 (MoH)

Please go to the Ministry of Health website which is constantly updated for information on Covid-19. This is where you will find information specifically for disabled people and their family and whānau as well as links to accessible formats. Information on the website includes Covid-19 assessment and testing and so much more …
·        Extending your bubble and keeping safe
·        Services that can be delivered safely at Alert Level 3
·        Respite options during Alert Level 3
·        Visiting a family member in residential care
·        Guidance for people who employ their own support workers
·        Looking after your wellbeing
·        What to do if you do not feel safe in your home
·        Getting food and medicines
·        Total Mobility … and much, much more

Information from MSD on medical certificates, disability allowance, additional funding …

The Ministry of Social Development (MSD) has made some temporary changes to document requirements as part of the COVID-19 response. The changes are helping to make things easier for people and ensure they continue to receive support during this time.

Here is an overview of some key changes they’ve made:

No medical certificate renewals for existing clients

People already getting Jobseeker Support, Sole Parent Support or Supported Living Payment don’t need to provide another medical certificate. They’ll continue to be paid as normal. This includes the Work Capacity Medical Certificate.

No medical certificates for new clients

For now, MSD won’t ask people to go get a medical certificate if they have no other reason to consult a health practitioner.

However, if someone already has a medical certificate, MSD will use this in their application.

When a person doesn’t have any of the usual medical verification (for example a Medical Certificate or Specialist reports), MSD will look at other options like granting an Emergency Benefit so they can still get support.

Temporary changes for Disability Allowance

People applying for the Disability Allowance for the first time, or an existing client with a new or increased costs, won’t need to provide receipts or invoices to verify these costs.

They also won’t need to provide a medical certificate to verify their eligibility and costs.

However the eligibility criteria for Disability Allowance haven’t changed so applications for items such as unfunded medications or services will need evidence of essential need to qualify for assistance.

Deferring reviews

For now, there will be no annual reviews (for example for Disability Allowance or Child Disability Allowance) or social housing reviews. This means if someone

would normally have a review, they won’t need to do anything – they’ll continue getting paid.

More information

The best place to go for the latest information on ways MSD can help is their website. Go to www.workandincome.govt.nz.

MSD makes additional funding available …

The Government has made additional funding available to support the wellbeing of disabled people including people with health and mental health conditions by trying to limit the impacts of anxiety and loneliness during the Covid-19 response. This funding is to enable organisations to continue providing support during alert level 4, alert level 3 and any periods of self-isolation.

How can the funding be used?

Organisations can use the funding to:

  • employ additional staff to provide regular support to disabled people and their families/whanau. This support can be provided through a variety of channels including face to face (for essential service providers and following Ministry of Health Guidelines) email, Facebook, texts or phone calls
  • develop resources to provide activities for people at home. This can include setting up and managing private Facebook groups, developing YouTube videos, video conferencing, creating and sending hard copy activity packs, sending art supplies and supporting the develop of peer support networks. We’ve pulled together some ideas from MSD funded providers and have attached them to this email.

Who is the funding for?

Priority will be given to funding organisations supporting disabled people including people with health or mental health conditions who:

  • live alone
  • live with family/whanau
  • are in Contract Board
  • live in a flat; or
  • live in rural or isolated areas

Funding amount

If your application meets the funding criteria you will receive a one of payment of $18,500. You may receive more if you are supporting a large number of people in the priority groups. The funding will be paid as a lump sum.

Reporting

You will be asked to provide a brief report detailing how you have used the funding in early July.

How to apply:

Complete the attached form and send it to participation_inclusion_services@workandincome.govt.nz. We will review your application and get back to you if we need more information.

Information on Family Funded Care

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.

IssueAction
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.

General information to the disability community (including PPE and building your bubble)…

We hope you and your whānau are safe and taking care of each other. This is a significant time for us in Aotearoa – and all over the world. I know that this is causing concern and anxiety in our community.

I want to reassure you that our small and passionate team are working hard with champions in the disability community to keep you all healthy and safe.

Below is information about changes we’re making to support you, and updates from the Ministry.

Message on Personal Protective Equipment from the Ministry of Health

We know you have lots of questions about Protective Equipment, so below is all the information we have.

Current demand for personal protective equipment (PPE) is unprecedented. The Ministry recognises this is causing concern among the increasing number of staff being brought in to help manage the COVID-19 outbreak. Measures to address immediate needs, which include a limited urgent release of equipment and accompanying guidance, will be announced within 24 hours. These measures are in addition to a longer term solution which is also being worked through. The safety of staff is a top priority as we work through this fast-evolving and challenging time.

Information for Disability and Aged Care Providers

We’ve got an update for Disability and Aged Care Providers on:

·        Essential services

·        Changes for disability and aged care services under alert level 4

·        Coordinating with your DHB or NASC

·        Supporting people who are more at risk of Covid-19

·        Supporting people with confirmed or suspected Covid-19

·        Personal protective equipment (PPE)

·        Going to work

·        Advice for employers.

Read the full update on our website – Update for Disability and Aged Care Providers on Alert 4.

Essential workers letter

We have developed a template for essential workers. You can download this as soon as it’s on our website: https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-novel-coronavirus-information-specific-audiences/covid-19-disability-support-and-residential-care-providers

Build your bubble

We’ve made a video about how you can build your bubble. Please share this with people you know!

Making information accessible

We’re working with specialist advisors from the disability community to ensure that information the Ministry and Covid-19 teams are sending out, is accessible to everyone. As you can appreciate, this takes time. While this is a huge priority for us, we ask that you be patient as we work hard to get everyone the information they need.

What we’re working on

We’re working on a number of tasks that we’ll keep you updated on as we progress. This includes:

·        Paying residential family carers under Funded Family Care policies
·        Supporting your wellbeing with a phone line for specialist behavioural advice for disabled people, whānau and residential providers

Adri Isbister, Disability Directorate, MoH (Deputy Director-General, Disability)