Kia ora NZDSN Members
This week we take a look at planning for level 3, update you on various streams of work in progress and again ask for your feedback on issues that will help inform our work with government. This week’s regional network zoom sessions reported a noticeable change in mood from providers – exasperation, frustration and even anger about the lack of support from the Ministry. This stems from contradictory messaging along with constant delays in adequate communication and guidance from the Ministry around some critical issues – family visits and expanding bubbles under level 3, reimbursement for level 4 costs, PPE and returning workers under level 3.
Family visits and expanding bubbles
We were not impressed with the ministry’s initial guidance on this as it failed to acknowledge the complexities involved and the need to support providers to be taking a very cautious approach.
Guidance should be based on principles of open communication with families – acknowledging their desire to reconnect, but being very factual about the actual risks and difficulties of safely managing these and thus the need to adopt a very cautious approach – otherwise we run the risk of a very slippery slope in terms of the health and safety of everyone. Nor do we want declarations of ‘we are still in level 4 so no visitors.’ Most providers are adopting a visits by exception only and with clear protocols. We support this approach. Providers are very mindful of the diversity of peoples circumstances, even within the same house and the complexities that are involved. Attached is an example of a letter that one provider has written to families which we think strikes the right balance between acknowledging the wishes of families and people being supported alongside good employer obligations.
We have met with the Ministry to work through some more detailed guidance and support for providers and this should be available soon.
Personal protective Equipment (PPE)
Still a work in progress and relentlessly exasperating! And despite a lot of media attention. The failure to update guidance in a timely way to reflect disability sector concerns is very disappointing, especially under the more fluid level 3. Some areas are reporting improvements, but for others things are still problematic. We need specific feedback on where it’s not working for you – please contact us with details. We know that in many cases providing gloves and masks to all support workers who feel they need them to be comfortable in their work and reduce anxiety may put strains on the supply chain. Note that ordering operates on a two-week supply turn around, don’t order more than 2 weeks supply at a time. This quote may assist you in ordering the supplies that you may need: “This order is based on the HBDHB recommended stock levels per day, for residential services, of 2 of each item per staff on shift x the number of residents”.
Presentation to the Epidemic Response Committee.
This was an opportunity to highlight issues impacting the sector and the difficulty getting traction on disability specific issues within a Ministry that has core health matters as its main focus. This has often meant mixed messaging with communications and delays in decision making and guidance for the sector by DSS within the Ministry. We also made the observation that we do not want to lose some of the flexibility that has been enabled as we move out of the crisis.
This has all been a salutary reminder about why funding and policy responsibilities for disability need ultimately to shift out of the Ministry of Health. This is an idea that has been widely supported across the disability sector for many years, ever since it transferred to health in the early 1990s. Where it should go in the machinery of government has also been the subject of much discussion and hopefully the current crisis will spur some more focused attention on the issue along with some decision making. Suffice to say at this point – anywhere but the Ministry of Health!
Attached are the summary notes provided to the committee and a link to the video recording of the session:
Epidemic Response Committee Meeting held 22-04-2020
Infection Control Audits in Residential Services
This is beginning to sound a bit like a repeat of PPE in the sense that DHBs are adopting a variety of approaches and audit tools. While a checklist was developed to assist providers to prepare for the DHB audits some DHBs are apparently adapting the checklist as the audit tool itself. Again DHBs are often surprised by the scale and scope of disability services. There also appears to be a very short period for some between receipt of the checklist and the actual DHB audit. We are keen to hear your feedback on how the this auditing process worked for you. If you have any questions or concerns please contact rob.gill@health.co.nz
Wage and Leave Subsidies
Again, what you need to know:
- You can only apply for a wage subsidy if you can demonstrate that you have a 30% drop in revenue for a particular contract line. Most ACC contracts would be an example of this. This would not be the case for most DSS and MSD contracts because of the surety of continued contract funding.
- The essential workers leave subsidy is for those people you have had to stand down on extended leave because they are over 70 or have underlying at risk health conditions. We have been advising in the last two updates that you should be applying for this subsidy and you should really get onto this now as it is not paid retrospectively.
We realise that because the Ministry committed to meeting extra-ordinary funding of COVID related costs for the level 4 lock down period many of you did not initially apply for subsidies. One of the largest costs will be backfilling staff to fill those roles vacated by people stood down on leave, ensuring effective bubbles and for those staff who had to spend periods in isolation. The delays in a process for assessing and paying for these extra costs is frustrating and increasingly unacceptable. We have raised this in numerous forums and with Ministers repeatedly.
Returning Employees
For employees over 70 and those with underlying health concerns providers need some clear protocols in place around returning to work. We acknowledge that most providers have already fully explored remote/work from home options for these employees. Further guidance other than what is on the COVID-19 and Work Safe websites is not yet available. These workers are still being advised to stay at home and/or work from home if possible. Our broad guidance is to adopt a good employer approach that listens to people who want to return to their usual workplaces and does not place any pressure on them to return. For those who wish to return ensure that you are confident about their being asymptomatic and not living with people who are symptomatic and that you can safely manage any risks in the work setting. And of course apply for the essential workers leave subsidy if they remain at home on leave.
To assist you to assess risk and develop mitigation strategies we have attached some earlier guidance that was developed for DHBs. However, there are several caveats to bear in mind in using this resource: it may not still be current, it was developed for DHB/hospital settings and may not directly translate to a community context, but in the absence of detailed guidance from the Ministry it will give you some ideas to think about in assessing and mitigating risk for returning employees.
ODI Survey – how is life going?
There were over 1500 responses to the first survey. Attached is the introduction and link to the next one. We encourage you to complete it as this helps us move from anecdote to data. The first results will be available next week.
Regional Zoom Sessions
This week’s attendance across the country was well in excess of a hundred providers. Summary notes from last week are attached which includes links to additional information and resources. As we indicated in our introduction the has been a distinct shift in mood as exasperation grows about the quality of communications and delays in guidance on critical matters from the Ministry of Health.
For those in Auckland the experiment with 3 meetings in a week had mixed results with some double ups around content and issues discussed. After further discussion we have agreed to one separate meeting each for NASC and NZDSN. However, Mireille Vreeburg our NZDSN coordinator will attend both meetings so unresolved and residual matters can be taken into the NZDSN meeting – which will now revert to Wednesdays – and Garth Bennie will attend these. Mireille will be in touch with new Zoom invitations.
Here are the summary notes and links to information and resources from last week’s zoom sessions.
Kia tu tahi tatou
From the NZDSN team