What is PADP?
PADP is the NSW
Government’s Program for Appliances for
Disabled Persons.
It is meant to provide the
funds for the vital equipment necessary for maximum
independence and dignity for people with
disabilities to enable them to continue to live in
the community (avoiding institutionalisation) and
to reduce their dependency on others at home and at
work.
The PADP annual budget of $13
million is managed by Local Area Health Services
for the NSW Health Department. The program is meant
to assist adults and children with such
disabilities as cerebral palsy, spina bifida,
muscular dystrophies, multiple sclerosis, spinal
cord injury, and post polio. The program is meant
to provide a range of mobility aids ranging from
expensive items such as electric wheelchairs
through to custom made shoes.
The Problems
There is not enough money
allocated to the program. This has led to highly
restrictive means testing.
PADP funding has been
seriously eroded because:
- medical items such as
oxygen and CPAP machines (for sleep apnoea) have
been introduced into the program and now take up
more than 30% of the PADP budget;
- the pressure on hospital
beds and lack of hospital funding has meant that
more people are being discharged with supportive
equipment taken from PADP funding;
- the incidence of
disability has increased due to a lower
mortality rate;
- developments in
technology and design have resulted in more
sophisticated equipment, providing more
opportunities and a greater demand;
- funding for the program
has never been based on need but simply an
arbitrary allocation which has never been
enough.
In some cases people are told
the waiting list can be as long as 4
years.
Families already struggling
financially cannot cope with additional expenses
for necessary equipment and are forced to beg from
charities, service clubs and their local
community.
Families’ resources are
depleted by the costs associated with a disability,
and many families are forced into poverty because
of these costs.
There is confusion
over:
- eligibility criteria for
assistance;
- probability of assistance
(and time frame);
- ownership of
equipment;
- why legitimate concerns
have been constantly ignored over the last 12
years.
Lack of funding, fragmented
management and unclear guidelines have particularly
disadvantaged:
- people requiring complex
mobility aids and higher priced items such as
wheelchairs;
- children who are growing
and in need of continuing modifications;
and
- people in high population
growth areas.
The
(Mis)management
In addition to inadequate
funding, the program is restricted by:
- lack of a centralised
policy which results in crisis allocation and no
clear rational rationing and assessment
procedures. High need areas do not have the
budgets to support their demand;
- fragmented management and
discrepancy of the Program’s management
between different regions;
- outdated and
inappropriate guidelines e.g. where a family has
one working adult they are ineligible for PADP
irrespective of other disability-related
expenses or the number of children in the family
– this is inequitable;
- lack of accountability
– for money, equipment or returned
equipment (which is often left in
storage);
- areas with small budgets
are reluctant to spend on expensive items i.e.
wheelchairs;
- no consumer involvement
in policy development;
- difficulties in accessing
the program for disadvantaged persons e.g. poor
literacy skills, people from NESB;
- inadequate information
for people with a newly acquired disability, and
parents of children with a
disability;
- no independent complaints
mechanism available.
Essential Equipment for
People with Physical Disabilities
Needs vary according to age
and disability. For independence, some people may
need a range of equipment such as a motorised
wheelchair (which can cost up to $12,000), a manual
wheelchair (approx. $1250), a hoist, voice
synthesiser, computer, crutches, splints, calipers,
a shower chair ($1,000), custom made shoes or
incontinence products.
PADP guidelines allow for
most of these items (if funds are available in the
local area) with the exception of communication
devices and environmental control units.
Effects of Inappropriate
Equipment
Aids and equipment require
construction or modifications to suit individual
needs.
Inappropriate or ill-fitting
equipment can cause serious medical complications
(poor breathing & circulation, pressure sores,
curvature of the spine, pain, and contractures of
muscles) which can lead to hospitalisation and
increased disability.
As children continue to
develop until about 18years, they require
continuous minor modifications and adjustments to
equipment such as wheelchairs and standing frames
with annual refits for calipers, braces,
splints.
People with a degenerative
condition will also require regular modifications
as their condition progresses.
What Needs to be done with
PADP?
In consultation with the
disability sector, the scheme needs to be
restructured with a view to introducing centralised
management and accountability, clear eligibility,
prioritisation of funds and a proper complaints and
appeals mechanism.
The PADP budget needs to be
immediately doubled with funding requirements to be
reviewed annually on an on-going basis.
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