NDIS 2018 Practice Standards – Amendments November 2021

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ACIA is a member of the NDIS Consultative Committee and was informed a few months ago of three new Practice Standards to be introduced early in the financial year. Unfortunately they have only been made available to us to distribute information today.
New Practice Standards: Mealtime Management and Severe Dysphagia Management
Following the delivery of Professor Julian Trollor and Dr Carmela Salomon’s report, one of the recommendations was to provide guidance and ensure compliance in relation to safe and quality NDIS provider and worker practice in the delivery of mealtime supports.
The NDIS Commission undertook consultation with the University of Technology Grant Co-Creation Advisory Panel (Panel) established for the Co-creating Safe and Enjoyable Meals for People with Disability and Dysphagia project funded through the Support for NDIS Providers grant program for their expertise, and the National Disability Insurance Agency (NDIA) in relation to categories of supports offered for mealtime and dysphagia management. Following these discussions it was determined that two new Practice Standards were required to set out service delivery and practice expectations for assistance provided to NDIS participants who:

  1. require support to consume food and liquid,
  2. experience severe dysphagia and require support to consume food or liquid.

The new Practice Standards are:

  • Mealtime Management (Practice Standard 26 A Core Module), with nine (9) associated Quality Indicators; and
    • Outcome: Each participant requiring mealtime management receives meals that are nutritious, and of a texture that is appropriate to their individual needs, and appropriately planned, and prepared in an environment and manner that meets their individual needs and preferences, and delivered in a way that is appropriate to their individual needs and ensures that the meals are enjoyable.
    • To achieve this outcome, the following indicators should be demonstrated:
      • Providers identify each participant requiring mealtime management.
      • Each participant requiring mealtime management has their individual mealtime management needs assessed by appropriately qualified health practitioners, including by practitioners:
        • undertaking comprehensive assessments of their nutrition and swallowing; and
        • assessing their seating and positioning requirements for eating and drinking; and
        • providing mealtime management plans which outline their mealtime management needs, including for swallowing, eating and drinking; and
        • reviewing assessments and plans annually or more frequently if needs change or difficulty is observed.
      • With their consent, each participant requiring mealtime management is involved in the assessment and development of their mealtime management plans.
      • Each worker responsible for providing mealtime management to participants understands the mealtime management needs of those participants and the steps to take if safety incidents occur during meals, such as coughing or choking on food or fluids.
      • Each worker responsible for providing mealtime management to participants is trained in preparing and providing safe meals with participants that would reasonably be expected to be enjoyable and proactively managing emerging and chronic health risks related to mealtime difficulties, including how to seek help to manage such risks.
      • Mealtime management plans for participants are available where mealtime management is provided to them and are easily accessible to workers providing mealtime management to them.
      • Effective planning is in place to develop menus with each participant requiring mealtime management to support them to:
        • be provided with nutritious meals that would reasonably be expected to be enjoyable, reflecting their preferences; and
        • if they have chronic health risks (such as swallowing difficulties, diabetes, anaphylaxis, food allergies, obesity or being underweight)—proactively manage those risks.
      • Procedures are in place for workers to prepare and provide texture-modified foods and fluids in accordance with mealtime management plans for participants and to check that meals for participants are of the correct texture, as identified in the plans.
      • Meals that may be provided to participants requiring mealtime management are stored safely and in accordance with health standards, can be easily identified as meals to be provided to particular participants and can be differentiated from meals not to be provided to particular participants.
  • Severe Dysphagia Management (Practice Standard 4A Module 1: High intensity daily personal activities), with five (5) associated Quality Indicators.
    • Outcome: Each participant requiring severe dysphagia management receives appropriate support that is relevant and proportionate to their individual needs and preferences.
    • To achieve this outcome, the following indicators should be demonstrated:
      • Providers identify each participant requiring severe dysphagia management.
      • With their consent, their individual severe dysphagia management needs are assessed by appropriately qualified health practitioners, including by practitioners conducting regular and timely reviews if needs change or difficulty is observed.
      • Each participant requiring severe dysphagia management is involved in the assessment and development of their severe dysphagia management plan. The plan identifies:
        • their individual needs and preferences (such as for food, fluids, preparation techniques and feeding equipment); and
        • how risks, incidents and emergencies will be managed to ensure their wellbeing and safety, including by setting out any required actions and plans for escalation.
      • Appropriate policies and procedures are in place in relation to the support provided to each participant requiring severe dysphagia management, including training plans for workers supporting them.
      • Each worker responsible for providing severe dysphagia management to participants has received training in managing their dysphagia. The training has been delivered by an appropriately qualified health practitioner or a person that meets the high intensity support skills descriptor for severe dysphagia management.

Implementation of the new Practice Standards will be supported by existing resources (for example, the Practice Alert for Dysphagia, Safe Swallowing and Mealtime Management), a transition period for existing registered NDIS providers, and a new online Worker Module focusing on supporting NDIS participants with eating and drinking.

New Practice Standard: Emergency and Disaster Management
A new Practice Standard will be introduced to assist in implementing the recommendations of the Royal Commission’s report on experiences of people with disability during the ongoing COVID-19 pandemic (‘Royal Commission report’).  The Royal Commission report recommended that ‘the NDIS Quality and Safeguards Commissioner should review the National Disability Insurance Scheme Practice Standards and National Disability Insurance Scheme Quality Indicators to ensure that they are appropriate for pandemics and other emergencies’.
The new Practice Standard is:

  • Emergency and Disaster Management, (Practice Standard 16A Core Module) with nine (9) associated Quality Indicators.
    • Outcome: Emergency and disaster management includes planning that ensures that the risks to the health, safety and wellbeing of participants that may arise in an emergency or disaster are considered and mitigated, and ensures the continuity of supports critical to the health, safety and wellbeing of participants in an emergency or disaster.
    • To achieve this outcome, the following indicators should be demonstrated:
      • Measures are in place to enable continuity of supports that are critical to the safety, health and wellbeing of each participant before, during and after an emergency or disaster.
      • The measures include planning for each of the following:
        • preparing for, and responding to, the emergency or disaster;
        • making changes to participant supports;
        • adapting, and rapidly responding, to changes to participant supports and to other interruptions;
        • communicating changes to participant supports to workers and to participants and their support networks.
      • The governing body develops emergency and disaster management plans (the plans), consults with participants and their support networks about the plans and puts the plans in place.
      • The plans explain and guide how the governing body will respond to, and oversee the response to, an emergency or disaster.
      • Mechanisms are in place for the governing body to actively test the plans, and adjust them, in the context of a particular kind of emergency or disaster.
      • The plans have periodic review points to enable the governing body to respond to the changing nature of an emergency or disaster.
      • The governing body regularly reviews the plans, and consults with participants and their support networks about the reviews of the plans.
      • The governing body communicates the plans to workers, participants and their support networks.
      • Each worker is trained in the implementation of the plans.

Additional Quality Indicators articulating emergency and disaster management elements have also been included across existing Practice Standards. These are summarised at Attachment 2.3.1.

Transition Arrangements
New providers applying for registration once the Rule is made will have no period of transition.
For existing registered providers, both new Core Module Practice Standards (Mealtime Management, and Emergency and Disaster Management), will have a transition period of 30 days once the Rules are amended to allow communication and adjustment to meet the new requirements.  The 30 day transition period reflects the intent of the new Practice Standards to manage risk to participants in relation to meals and emergency planning.
The new High Intensity Daily Personal Activities Practice Standard, 4A Severe Dysphagia Management, will apply on commencement.

NDIS Amendment
NDIS Amendment Guidelines


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