New plan to protect people with a disability during the pandemic

Minimising sickness and death amongst people with a disability, sharing information on the specific coronavirus risks for disability, and guiding action for the sector.
 
Those are the goals of the Federal Government’s new Management and Operational Plan for COVID-19 for People with Disability (the plan).
 
The plan is a living document that will be updated periodically as new evidence emerges, in line with the Australian Health Sector Emergency Response Plan for Coronavirus.
 
It addresses a range of factors that need to be considered in managing and preventing the transmission of COVID-19, such as poor health literacy, the reliance on close contact with carers and support workers, having a compromised immune system, and the presence of multiple underlying health conditions.
 
In Australia, more than 4.4 million people live with a disability, equating to almost one in five.
 
Associate Professor Robert Davis, Chair of the RACGP Specific Interests Disability network, has praised the overall plan, after recently taking part in a Roundtable review of the document.
 
But he believes there is a lack of emphasis on the role of GPs, which is a particular concern given they are the frontline response of this health crisis, especially for people with disabilities who can often find emergency centres overwhelming.
 
‘Most of what will need to happen is at the primary healthcare level, and that’s GPs,’ Associate Professor Davis said.
 
‘It’s very important that the Government engage with the RACGP about this. The college has the capacity to operationalise and distribute information about the plan and provide education as well. With this particular issue, they really need to engage with GPs.’
 
Associate Professor Davis told newsGP Australia’s ability to flatten the curve should help to ensure the health and disability sectors are well-prepared. But a lack of personal protective equipment (PPE) is concerning GPs, given that people with disability are often reliant on close contact with carers and support workers, or live in group residential settings.
 
‘We’ve seen overseas that people who are in residential support have been affected. [By] living in close proximity and being dependent on others to provide various supports, they can have the virus brought into their houses more so than people who can also isolate more effectively,’ Associate Professor Davis said.
 
‘The plan recognises the need for PPE, but it’s one thing to recognise the need, and another to get PPE out there where it’s needed.
 
‘People with disabilities spread right through the community and the people that support them are not necessarily connected to the health services or health system. So it’s going to be a challenge for the government to provide [for], or be aware of, the people who need PPE and when they need it.’
 
Meanwhile, stringent social distancing measures, while necessary to keep people safe, can have consequences for people with disability when it comes to mental health, and in some instances, create the potential for greater risk of abuse, neglect and exploitation.
 
Associate Professor Davis says when it comes to this cohort, greater flexibility is sometimes needed.
 
‘I have had patients that have really, really been affected by being locked in and not having the access that they used to have,’ he said.
 
‘For example, a group of people with autism having a daily routine and having some sort of predictability in what's going to happen is very important. They may have been going out for various programs with multiple people and that’s been shut down overnight.  
 
‘If they’re living in a support accommodation with other people with disability then if they don’t have enough staff available it’s very hard for one person to go out one-on-one and to leave the rest behind.’
 
At his practice, Associate Professor Davis said he has needed to write letters of support addressed to police for patients going on longer drives as part of management for their disability.
 
‘Some people with autism particularly, they find sitting in the car is quite soothing. They might be 15 kilometres from home, and the police are concerned about what they are doing out,’ he said.
 
‘So there are particular issues where we need a bit of flexibility in terms of interpretation of what's going on. I think there’s a degree of anxiety from support staff of being in a situation where they’re seen to do the wrong thing. So sometimes they just need that extra bit of support.’
 
The expansion of telehealth has been particularly useful for GPs checking in on patients with disability, for which the logistics can be complicated, while reducing the risk that can come with travelling to and from a clinic for a face-to-face consultation.
 
‘Telehealth is sometimes a bit more useful for this population, frankly, because often when GPs do see someone it’s not only the person they have to see, but it’s one or two carers, or the carer and their family member as well,’ he said.
 
‘So to get all those people in the one place is sometimes difficult, but not so hard when you have a teleconference facility.’
 
While Associate Professor Davis applauds the Government for recognising the impact of the pandemic on people with disability, he says there is still a way to go when it comes to the plan’s operational aspects.
 
‘When you look at what they’ve written, there is a lot of planning and to-dos there. But you can understand given the speed at which COVID-19 has impacted on our community,’ he said.
 
The RACGP has more information on coronavirus available on its website.
 
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