Presented by Gill Clarkson, Cara Lockie and Sarah Moyle Resilience and Sustainability in Equipment and Modification Service (EMS) Provision Presented by Gill Clarkson, Cara Lockie and Sarah Moyle

The role of the EMS provider Enable NZ and accessable are contracted by the Ministry of Health to: Manage a capped budget (currently $56 million per annum; 64% Enable NZ, 36% accessable) Facilitate the provision of equipment, housing modifications, driver assessment, vehicle purchase and/or modification Manage the repairs, maintenance, return, refurbishment and disposal of equipment Manage complaints and uphold a complaints procedure Advise EMS Assessors regarding EMS criteria and process

How Nurturing and Enabling Resilience and Sustainability relates to EMS

Sustainability The term sustainability is derived from the Latin sustinere (tenere, to hold; sub, under). Sustain refers to an ability to "maintain", "support", and "endure". [Wikipedia]

[Wikipedia]

Economic and Social Sustainability: Guiding Principles of EMS Funding (sect 1.2) Equipment and Modification Services aim to: Support people with disabilities and their families to live as independently and safely as possible Make a significant contribution to enabling people with disabilities to participate (if they want to) in activities inside and outside, the home and in their local communities. The Ministry of Health is not able to provide funding to meet all of the needs identified by disabled people, their family or whanau. To assist with the fair allocation of resources there is access criteria in place that guides the provision of Equipment and Modification Services.

Sustainability of a Solution This is about sustainability at the Micro [individual] level Refers to Future Proofing of a solution: The ability of something to continue to be of value into the distant future; that the item does not become unusable or obsolete . . . . due to social and environmental change [Wikipedia]

Resilience Social sciences Resilience (organisational): the ability of a system to withstand changes in its environment and still function Psychological resilience: an individual's ability to adapt in the face of adverse conditions [Wikipedia]

https://www.linkedin.com/pulse/6-domains-resilience-jurie-rossouw

Bringing it Together According to Wikipedia . . . Sustainability can also be defined as a socio-ecological process characterized by the pursuit of a common ideal. An ideal is by definition unattainable in a given time and space. However, by persistently and dynamically approaching it, the process results in a sustainable system

Professional resilience in disability support: Micro – advocating for individual needs Meso – advocating for extra resource & innovation to meet the needs of a specific group / set of needs Macro – Advocating for [socially, economically and environmentally) sustainable change in national disability support systems/structures

Resilience on a micro and meso level: [Wikipedia] Psychological resilience, is an individual's ability to adapt in the face of adverse conditions [Merriam-webster Dictionary] adapt means to adjust, accommodate, conform or reconcile to bring one thing into line with another.

Relationships Your Assessment = 1:1 (Micro) Holistic assessment of need; identification of the optimal solution; discussion about all options If the person decides to seek EMS funding = 1:1:Many (Macro) Restrictions in place to manage fair and ethical allocation of scarce resource; if optimal solution can’t be provided for then you need to promote consideration of alternative solutions and/or funding options. You may also record unmet needs so that as OT/Professionals we may work together to advocate for new or cheaper technology, alternative solutions and more funding

“Us and Them”??? EMS Advisors share the same professional values as EMS Assessors and we must strive to work as part of a team

EMS as it is: Stats, Common Issues and Questions

EMS Advice – areas we cover MOH link - https://www.health.govt.nz/our-work/disability-services/contracting-and-working-disability-support-services/equipment-and-modification-services Walking and standing – adults and paediatrics Wheeled mobility and postural management (wheelchairs, buggies, restraints, lying, sitting, standing) Personal care/Household management equipment Vehicle purchase and modifications contributions Housing modifications Challenging behaviours Communication assistive technology Hearing assistive technology Vision assistive technology (low vision)

ENZ – some stats

ENZ stats

Vehicles ENZ - 2016/2017 financial year

Vehicles ENZ - 2017/2018 financial year

accessable stats

accessable stats

accessable stats

accessable stats

Commonly asked questions Job seeking – does this meet criteria? Still at school under 16 years – but soon to turn 16 years old Still at school age 16+ Tertiary study

Commonly asked questions (cont) 6 year time frame Door sill covers Seating for the able bodied person/non disability related modifications What constitutes evidence for [self] ‘employment’

Common Issues for EMS funding Already modified vehicles Capped funding Liaison with the wheelchair assessor Quotes from the modifier Car seat and a vehicle modifications .

Case study - growth, is this a disability? Family with English as second language Lottery grant approval for funds towards vehicle purchase with intent for MOH funded mods Mods approved despite concerns from the EMS Advisor re: sustainability Result - second mods requested within 4 years

Summary The EMS budget is capped Long term, future proofed solutions need to be sought This is a complex niche within EMS funding We share the same values as the assessor group We need to be resilient, and to work together to achieve the best possible outcomes.