Posts by Rosemary McDonald
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Hard News: From Zero: The Meth Episode, in reply to ,
Without re listening to the interview...it seems that the funders (the DHBs via the Ministry of Hell) think that funding a 12-16 week course is the best practise so they want to fund only 12-16 week courses. Those doing the work say that funding an initial 4 week course might very well be best practise, rather than signing someone up to months of rehab.
I think the drop out rate is higher for the longer courses, and a shorter course with very good on going community support has a higher success rate.
Services providers would need funding to actually collect evidence to support this.
Later, I will listen again...but I think that is the gist.
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Hard News: From Zero: The Meth Episode, in reply to ,
And regards funders requiring rehab operators to demonstrate best practice. What’s the problem with that?
The problem is that the funder's idea of what is 'best practise', differs from what the operators have learned is 'best practise'.
And the funders don't listen to what the operators are saying.
And its all pretty damn depressing, especially when addicts can avoid jail. There's a window when someone is confronted with the reality of their problem and willingly seeks help. The help has to be available...
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Hard News: From Zero: The Meth Episode, in reply to Russell Brown,
So....with even the Constabulary coming on board with the 'help not hound' message for those with addictions, one would have thought that the Government would have ensured that the funding was in place to provide addiction services with a proven track record of the desired 'outcomes'.
Not so...with not only funding being harder to secure, but funders demanding that addiction treatment providers follow what they (the funders) consider 'best practise', not what the providers have found actually is more effective.
Kathryn Ryan interviews two addiction services providers, both who express their measured frustration at the "perverse incentives" that could "do more harm than good."
And the Funder?
Ultimately....this sorry lot...
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Access: Some aspects of New Zealand’s…, in reply to Hilary Stace,
I didn’t get an invitation to the launch. Rosemary, did you?
The (recently instituted) Interweb Generated Guffaw of the Day Award to you Hilary!
(And here's me hoping that you got an invite and would tell us what they dished up for breakkie.)
I am pretty sure that the CEO of the Counties/Manukau District Health Board will have made sure that Peter and my names are on the Master List of Persons Not To Be Allowed To Attend On Threat Of Trespass for gala Launches of Government Disability Related Initiatives.
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On this Day...Disability Pride Day and the day that the New New Zealand Disability Strategy is launched in a dawn breaker at parliament, I am heartened by the interview with Chief Ombudsman Peter Boshier on Natrad this morning.
In my opinion, the New Strategy is exactly what the Government ordered.
Aspirational happy clappy twaddle with no clear direction and certainly little in the way of actual facts.
According to the blurb...NZ is doing just fine with meeting the requirements of the UNCRPD and reports from the UN monitoring committee will be acted on.
Hah! Rubbish.
And I feel Peter Boshier obviously sees this, as this morning he gave us directions to his Office if we want the Government to meet its obligations under the Convention.
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More from NZ Doctor....http://www.nzdoctor.co.nz/news/2016/november-2016/29/disabled-by-a-system-straw-men-and-short-straws.aspx
(okay, maybe the link won't work because of login requirements...but if a technomoron like me can get in...;-)
This is a very good piece.
Wellington GP Anne-Marie Cullen says talking to parents of disabled children and young people leaves her “shocked at the lack of supports”.
Dr Cullen wants to see a drastic overhaul of services to make them more straightforward and bring them under one state agency.
For people with very high and complex needs, the disability sector and Ministry of Health-led new direction of “choice and control” is not going to work, Dr Cullen says.
“This choice thing is a nonsense, and it is to the detriment of our most vulnerable.
Actually, a seriously good piece of work, with quotes from Coleman, Toni Atkinson (head honcho at the Misery of Health Disability Support Services), Esther Woodbury from DPA and Garth Bennie from the New Zealand Disability Support Network.
There is also a brief outline of the life and death of Nicholas Owen, whose parents...
...planned a gradual transition for their multiply disabled son Nicholas from living at home to living in residential care.
It was to start with three days a week. In part, this was respite for his parents. “We were getting exhausted, quite frankly, and we needed a break,” Mr Owen says.
“We thought, he can’t live at home forever, and he was the right age (19) to be learning how to live more independently.”
The couple clearly communicated with the provider the routines required to keep their son safe at all times of the day and night, and stayed in regular contact.
Nicholas died in care after about a year. It has left the couple feeling betrayed, Mr Owen says.
Awaiting the inquest next month, he says serious events carry no financial penalties, so care homes have no incentive to provide a high standard of care.
(my bold)
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Service Providers struggle to make a profit out of disabled clients with high and complex needs...
Contract prices do not reflect the costs of meeting the Government’s service requirements, Dr Bennie says. This is most acutely felt for people with the highest and most complex needs, and he worries a tragedy is simply waiting to happen.
“For example, there can be a considerable period of delay between taking [such a client] and a funding package being agreed. There is usually no retrospective payment and, as soon as they start making progress, the funding gets trimmed.”
One provider recently had $200,000 taken out of funding packages for a number of clients.
Neglect, abuse sometimes happens
When poorly resourced, providers can have difficulty managing clients with challenging behaviours, Dr Bennie says. He admits neglect and abuse sometimes happen.
Some providers are turning high-needs people away rather than bear all the risks and responsibilities, Dr Bennie says.
Funding affects both quality and wages, he says. “We recognise support workers are grossly underpaid (on average, $17 an hour).”
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There is a difference between ‘seclusion’ and ‘respite’. The latter is when a student needs some time away from others. Autistics of all ages frequently suffer from sensory or social overload, and need somewhere to rest and recuperate. This means a space which is quiet, separate from others, preferably with comfortable furniture, and which can, if necessary, be darkened.
Thank you, thank you for clearly and decisively clarifying the difference between 'seclusion' and 'safe/respite' rooms. I fear that the latter will be flushed along with the dirty water of the former.
And....I am hoping that you, or others with similar lived experience, have been engaged by the Ministry of Education as consultants...visiting schools and helping teachers and students better manage meltdowns.
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Access: How many agencies does it take…, in reply to Angela Hart,
If he didn’t have a partner……
He'd be in a spot of bother.
However, after Christchurch, Civil Defence did get together with the necessary groups to formulate a disability specific 'disaster preparedness' plan.
Much of it is about planning and networking, but also about building resilience and self sufficiency. (I know the latter is relative and objective...but it does make sense for the person with the disability to lead their own survival plan.)
Actually, quite a commonsense document.
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Access: Help needed! Deciphering the…, in reply to linger,
Re: core staff costs – my best guess is that the intended calculation is, roughly, (number of assessed support hours) x (number of people required simultaneously), possibly also with some fudge factor for (specialised-skill-dependent payscale required). Which, at least dimensionally, makes some sort of sense.
Unless one needs two staff on duty at the same time to complete cares.
One might be assessed as needing, say, two hours for shit, shower, shave dressing and installation in one's wheeled mobility device.
It used to be the case that if one required two people to manage transfers (from bed to commode and from commode to bed and finally bed to wheelchair once robing is complete) then the formula would go something like...two x two hours = 4 hours of personal care. The allocation of Hours is based on ONE staff performing cares...if two are needed they won't double the core hours. So if you need two staff...you end up with half the actual hours of care. One or more of the 'sh s" will have to be done another day.
One of the usual reasons for having two staff (other than situations of extraordinary behavioural issues) is when the 'authorities' insist that all transfers are done using a hoist. For many people who need full assist transfers, hoists have inherent risks which might be mitigated by having two people doing the work. The Miserly refused to double the PC hours under these circumstances....yet...Contracted Providers can refuse to provide care unless a hoist is used...even if this is against the wishes of the person being hoisted. This was one of the examples given in the HRRT hearing for the Family Carers Case, and one of the reasons why sometimes it is out of necessity, as well as choice, that family provide some or all of the care. The Mystery of Health system (and I balk at calling it a 'system') has little if any flexibility...and is designed by people who don't have a clue about the lived reality.
ACC, in their Infinite Wisdom (actually a real fear of having their arses sued for not providing a safe level of care the entitled client needs) has written in their Guidelines that in some cases two carers will be required for hoist transfers and that this should be factored into to the overall allocation.