Thread by @PWDAustralia

Good morning!

The #DisabilityRC will be kicking off in 5 minutes.

We'll be tweeting along all day using the hashtags:
#Covid19 #DisabilityRC

If you would like to avoid the content, we suggest muting these hashtags.

You can also watch along here: disability.royalcommission.gov.au

If you missed yesterdays hearing, here's some articles covering the discussion around education, isolation, and emergency planning:

theguardian.com/australia-news…

aap.com.au/disability-inq…

canberratimes.com.au/story/6885813/…

sbs.com.au/news/disabilit…

We've started with the first witness, Professor Anne Kavanagh.

She is the Chair of Disability and Health at the University of Melbourne.

#Covid19 #DisabilityRC

Eastman begins by asking for some background on COVID-19.

Prof. Kavanagh explains the virus is new and can cause very severe illness. Public health responses are necessary to avoid the spread of this virus.

#Covid19 #DisabilityRC

We need a consistent approach across the population for avoiding contact and further spread.

Everyone in the population needs to participate in prevention.

#Covid19 #DisabilityRC

There is a higher degree of risk for people with disability whe contracting the virus.

People with disability face a greater impact from the public health measures put in place to stop the spread of the virus.

This risk is even higher in group homes.

#Covid19 #DisabilityRC

One of the key issues Prof. Kavanagh has higlighted is the slow response from the government on issues for people with disability.

Kavanagh has highlighted a total of 6 key issues.

#Covid19 #DisabilityRC

The health sector was underprepared to deal with the health needs of people with disability.

Kavanagh was involved in writing a statement of concern, she said this was prompted because of concerns around the lack of response.

#Covid19 #DisabilityRC

A second statement of concern was released, which highlighted the need and called for an expert advisory committee to guide the public health response for people with disability.

#Covid19 #DisabilityRC

The Commonwealth subsequently started an expert advisory committee to develop a health care plan for the needs of people with disability.

#Covid19 #DisabilityRC

One of the tasks of the committee is the implementation of the plan.

Prof Kavanagh has previously said that the plan does not go far enough for people with disability living in congregate settings.

#Covid19 #DisabilityRC

Kavanagh raised concerns about a lack of clarity in the implementation of the plan, noting several gaps where it was unclear where the responsibilities lie.

She notes issues like sick leave for the workforce, rules around PPE, and more.

#Covid19 #DisabilityRC

Kavanagh says she wants government bodies across state and commonwealth levels to work together.

"It's a complex situation, but people with disabilities require all parts of government to work closely together."

#Covid19 #DisabilityRC

The escalation in Victoria resulted in a third statement of concern.

There were a number of recommendations which address the issues around responsibility.

#Covid19 #DisabilityRC

These included reaching out individual households, accessible testing for people with disability, and provisions for disability services.

There needed to be detailed emergency planning.

#Covid19 #DisabilityRC

"You can't have a one-size fits all approach"

#Covid19 #DisabilityRC

Outreach needs to be proactive and accessible. This includes reaching out to individual households, not just publishing materials.

#Covid19 #DisabilityRC

The second key issue highlighted by Prof. Kavanagh:

the availability and transparency of data.

Eastman asks a series of questions, including if we knew how many people with disability have been infected or died from COVID. Kavanagh says we dont know.
#Covid19 #DisabilityRC

The only data available is through the NDIS Quality and Safeguards Commission.
This data wouldn't include people who use non-NDIS service providers, or are not on the NDIS.

#Covid19 #DisabilityRC

Chair Sackville asks why data is so important.

Prof Kavanagh says without data we don't know the scale of the problem, how it's transmitting. Particularly in the workforce and in group homes.

It's important for us to understand what's happening

#Covid19 #DisabilityRC

Kavanagh also says it's an accountabiltiy issues, and is needed to protect people with disability.

#Covid19 #DisabilityRC

The third key issue is the response from the NDIA and the NDIS Quality and Safeguards Commission.

This includes concerns around whether they were equipped to deal with a public health response.

Kavanagh says they wee not equipped.
#Covid19 #DisabilityRC

The approach from the Quality and Safeguards Commission could have been more directive for service providers in continuing their services.

The commission did reach out to services, but services were able to decide their own course of action.

#Covid19 #DisabilityRC

"There needed to be much more guidance and working with providers to think of other ways to provide support"

#Covid19 #DisabilityRC

The fifth key issue was around workforce.

A survey in June found that a quarter of people in the disability support workforce had not done basic infection control training.

50% of those that did get the training wanted more.

#Covid19 #DisabilityRC

This training covered basic infection control, such as basic personal hygiene and physical distancing.

#Covid19 #DisabilityRC

Much of the workforce also wanted more testing available. They weren't recognized as an essential workforce so were not prioritized.

The workforce was worried about contraction, and also spreading the virus.

#Covid19 #DisabilityRC

The survey found that 90% were not able to maintain physical distancing while providing support.

53% would provide support with close contact physical tasks, like brushing teeth.

64% of disability support workers had received or purchased PPE.
#Covid19 #DisabilityRC

For a significant amount of the workforce, they had to provide their own PPE including gloves and masks.

Eastman asks why there hasn't been a national response to provide guaranteed access to PPE for all disability support workers.

#Covid19 #DisabilityRC

The commission is adjourning for a short break due to some technical issues.

We'll be back in a few minutes (hopefully)

#Covid19 #DisabilityRC

and we're back!

@FBeaupert will be taking over live tweeting for the rest of the session.

#Covid19 #DisabilityRC

The Commission will be returning from lunch in a few minutes.

We'll be taking over the live-tweeting for the remaining sessions.

#Covid19 #DisabilityRC

We will now be hearing from Dr. Jason Agostino.

His statement is on behalf of @NACCHOAustralia as the Medical Advisor.

He is a General Practitioner and an epidemiologist.

#Covid19 #DisabilityRC

@NACCHOAustralia Mellifont asks about the increased risk that COVID poses for First Nations people.

The increased risks include increased spread and more severe illness.

#Covid19 #DisabilityRC

@NACCHOAustralia Rapid spread results from crowded housing from multigenerational households, as well as lack of access to resources like clean water.

First nations people are likely to face more severe illness from the virus due to chronic illness and other health risks.

#Covid19 #DisabilityRC

@NACCHOAustralia Talking about telehealth, Agostino says there is a lot of barriers for First Nations people to access telehealth.

Many people require more patient support that isn't available.

#Covid19 #DisabilityRC

@NACCHOAustralia Barriers include access to internet with good connectivity and bandwith, as well as accessiblity issues.

#Covid19 #DisabilityRC

Patient end suppport is best practice for people with disability. It supports safe and accessible care.

There needs to be new Medicare items to provide this patient support.

#Covid19 #DisabilityRC

There needs to be early on psychological support for people who are self-isolating. This includes culturally safe support for First Nations people.

We can not expect people to seek help themselves when there are so many barriers that exist.
#Covid19 #DisabilityRC

There's been an underappreciation of the expertise and efforts of NACCHOs in controlling the spread of the pandemic.

#Covid19 #DisabilityRC

First Nations communities were proactive in acknowledging and preventing COVID-19 in their communities, which has resulted in low rates of infection.

Agostino says that regardless, efforts must continue to communicate and prevent the spread of the virus.

Communication has worked well, community connectors and service providers have worked well to connect people with disability to the information they need.

Regardless, some messages aren't getting through and there needs to be localized and detailed info.

#Covid19 #DisabilityRC

Onto people refusing tests, Agostino mentions some people may be scared or uncomfortable with the testing process,

He mentions that clear communication with description, videos, and understanding how the test works would make people more comfortable.

#Covid19 #DisabilityRC

Sackville asks about the low rates of infection for First Nations people.

Agostino credits the actions of First Nations leaders and community members, as well as NACCHOs in preventing the spread.

#Covid19 #DisabilityRC

That wraps up the evidence from Dr. Agostino.

#Covid19 #DisabilityRC

The final witnesses appear on a panel, Claire Robbs and Andrew Richardson.

Robbs is the CEO of Life Without Barriers
Richardson is the CEO of Aruma.

Aruma and Life Without Barriers are both service providers.

#Covid19 #DisabilityRC

Robbs works with her national emergency response team to coordinate pandemic response.

This led to the creation of a helpline for people with disability.

#Covid19 #DisabilityRC

Translating and interpreting services are provided as needed for the call centre.

Mellifont asks whether this requires self-initiation for people from CALD backgrounds to access support.

Robbs says communication in other languages is available.
#Covid19 #DisabilityRC

Staff can request translated information for families that require.

Mellifont refers evidence from earlier this week, citing the need for tailored information and the need to ensure communications strategies are safe and ensure trust.

#Covid19 #DisabilityRC

Robbs says they understand the need for appropriate and safe responses, but they don't receive a lot of requests for this.

She says there is a lack of demand, and that this means they might take a different approach moving forward.

#Covid19 #DisabilityRC

Sackville asks Robbs to clarify who their clients are.

They mainly provide support for people with disability, largely adults with intellectual disability, They also provide support to older australians, refugees, foster care programs.

#Covid19 #DisabilityRC

Sackville asks about the number of COVID-19 cases present within Life Without Barriers.

At the beginning of the pandemic, 2 staff tested positive, with later 14 staff and several clients.

As of last night, 13 group homes have confirmed cases.

#Covid19 #DisabilityRC

When asked if the service providers create a specialized strategy for communication with First Nations community, Richardson says Aruma does not presently do that.

Robbs confirms that Life Without Barriers does provide specialized information.

#Covid19 #DisabilityRC

Robbs discusses the restrictions placed on services, particularly group homes.

There was a level of discretion for what restrictions could be places on people, depending on if they were at a higher health risk.

#Covid19 #DisabilityRC

Richardson discusses the same issue. They did not provide much discretion when it came to restrictions, but it varied depending on the service.

#Covid19 #DisabilityRC

Sackville asks Robbs about her statement, referring to people living in group homes.

He asks about placing restrictions on peoples homes, as some people with disability live in supported accomodation.

#Covid19 #DisabilityRC

Robbs clarifies that Life Without Barriers did not palce restrictions on people living in supported accommodation, only group homes.

#Covid19 #DisabilityRC

We've moved on to PPE. Richardson says they faced a lot of issues regarding PPE.
He said they had basic stocks as needed, so as the pandemic started they were unprepared.

They sought access to PPE through national or state medical bodies.
#Covid19 #DisabilityRC

High-grade PPE needs to be made available to disability support services.

The national stockpiles were made available to disability services much later than other essential services.
"they did not view disability services as essential services"

#Covid19 #DisabilityRC

Richardson says there was no clarity of information for disability organisations to receive a response when requesting PPE.

#Covid19 #DisabilityRC

Now discussing PPE training.

Robbs says they received alerts from the Quality and Safeguards Committee which included online resources for service providers.

Providers were all using different resources, and not all use competency checks.

#Covid19 #DisabilityRC

On community visitors, Robbs says some states moved their community visitor programs to online programs.

When asked about ensuring confidentiality and safety in the virtual setting, Robbs ensures there was measures taken to secure this privacy.

#Covid19 #DisabilityRC

Richardson agrees, and notes that community visitors also play a role in talking to staff and other members of the house, looking at dynamics.

#Covid19 #DisabilityRC

Mellifont asks about pandemic planning. Robbs notes that prior to March, their national emergency plan did not include a response to a pandemic.

She says there is an infectious disease plan, but it was not sufficient for COVID-19.

#Covid19 #DisabilityRC

Richardson says that Aruma also didn't have a pandemic plan in place prior to COVID-19.

They also built a specific pandemic response plan.

#Covid19 #DisabilityRC

When asked about whether either organization has ever been audited by any government body or agency regarding their pandemic plan, both witnesses respond no.

#Covid19 #DisabilityRC

Mellifont asks about whether the Quality and Safeguards Commission has followed up or provided guidance after the reporting of a confirmed case.

Both say that there has been no specific advice from any agency or department following an outbreak.

#Covid19 #DisabilityRC

Now discussing the work force. Both service providers faced challenges when dealing with a more fragmented and casualized work force, while also trying to provide flexible support and a large workforce.

#Covid19 #DisabilityRC

When asked what they would do different, Robbs says they would do more to communicate with people from CALD backgrounds.

She says they could have also done more consultation. with people.

She says they also could have used more nursing and health support.
#Covid19 #DisabilityRC

The same question to Richardson, he says they would work to refine their communications for CALD and First Nations people.

They also want to improve their consultation.

He says they're very happy with their rapid response process.

#Covid19 #DisabilityRC

Robbs talking about what she wants to see, highlighting the need for accessible and affordable PPE.

She also says there needs to be more support provided to providers, particularly guidance on how to handle the pandemic.

#Covid19 #DisabilityRC

Richardson says that the disability support sector is different to aged care, and needs to be differentiated as such.

He says it needs to be about choice, independence, and rights.

It involves health, education, community involvement, and much more.

#Covid19 #DisabilityRC

Richardson: disability services need to be considered essential.

This includes prioritizing these services for PPE, resources, testing, as well as guidance and advice.

#Covid19 #DisabilityRC

He says the NDIS is great, but a transactional model for essential human services breaks down during a pandemic and a new funding model is needed.

He also says people with disability need support to reintegrate into communities.

#Covid19 #DisabilityRC

Commissioner Bennett asks Richardson about restrictions on group homes during quarantine when there was no suspected case.

Richardson says yes and no, they placed restrictions in accordance with public health orders.

#Covid19 #DisabilityRC

Robb says that unless there was a confirmed case, there were no restrictions placed on group homes.

#Covid19 #DisabilityRC

Sackville raises the concerns of many people with disability about the over-casualized workforce

Aruma has 26% of it's group home workforce as casuals, with a turnover of 32% per year.

#Covid19 #DisabilityRC

When asked why the proportion of casual staff was so high, Richardson says it's hard to recruit people who want to do disability support.

He says they do regular reviews with their staff about progressing to permanent positions.

#Covid19 #DisabilityRC

Commissioner Bennett asks about the benefit of increasing the permanent part time workforce, giving more people access to benefits like sick leave.

Richardson says they now provide paid sick leave to many of their casual staff.

Sackville asks about the steps taken after confirmed cases.

Robbs says that they take steps from when someone first gets tested, including communicating with the people with disability in care about what will happen, what PPE looks like.

#Covid19 #DisabilityRC

Sackville asks about whether they have staff with specific training in assisting people with disability in these stressful situations.

Robbs says they have staff available, and encourage people to access them, particularly if they have to self isolate.
#Covid19 #DisabilityRC

Richardson says Aruma is more dependent on external supports for this, but they have a small in-house team that deals with anxiety arising from these situations.

#Covid19 #DisabilityRC

That concludes the proceedings for today.

The hearings well start back up tomorrow morning at 9:30am for the final day.

#Covid19 #DisabilityRC