Preventing new entries to Residential Aged Care (RAC) requires information and education at the coalface of discharge planning, and liaison roles that oversee the transition of supports between sub-acute health and the community.

People with complex support needs leaving sub-acute services require flexible and responsive supports that can respond to changes in a timely way. Their needs may change rapidly, requiring input from both health and disability providers, especially in the period immediately after discharge.

The NDIS and health systems need to work more closely together to ensure that when a young person is ready to leave hospital they can return to the community as quickly as possible, rather than being discharged into aged care.

Diverting young people away from aged care and back into the community faster will result in positive health outcomes and long-term savings to the NDIS as the physical and mental deterioration associated with aged care admission will be prevented.

State and federal governments should declare that fixing the hospital discharge pathway is a strategic priority of the NDIS. This would involve the following actions:

  • The Disability Reform Council to establish a group of experts that reports back with a strategic plan to addressing the health-disability interface, including discharge planning, access to slow-stream rehabilitation and clinical services in the community.
  • Develop working arrangements between the NDIA and hospital and Aged Care Assessment Teams to ensure young people in hospital are ready for discharge, are immediately provided with an NDIS plan to return to the community and not discharged into aged care. This must include consideration of whether an additional discharge planning role is needed to make sure young people in hospital do not fall through the cracks or suffer from blame and cost shifting between NDIA and hospitals.
  • The NDIA must review its internal access request and planning processes to ensure that these requests are processed quickly, particularly when individuals are stuck in hospital or at risk of entering aged care.
  • The state and federal governments must ensure that young people in hospital at risk of aged care become participants immediately by amending the Facilitating Participants Plans rule and associated phasing schedule for the NDIS to allow immediate access.
  • The NDIA and the Department of Health should report publicly on the number of young people who have entered aged care in sites where the NDIS is operating and this should be considered regularly by the Disability Reform Council as part of the NDIS performance framework.


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