Spotlight issue: Supporting people with intellectual disability from admission to discharge
People with intellectual disability may be at risk of poor health outcomes when admitted to an acute care setting, whether through an emergency admission or planned admission.2,20,27 The lack of reasonable adjustments to effectively communicate with people is a safety and quality risk.
Women, children and young people, Aboriginal and Torres Strait Islander people, culturally and linguistically diverse people and LGBTQI+ people with intellectual disability are at higher risk of poor health outcomes.
Many people with intellectual disability have experienced or are at risk of abuse, neglect, domestic violence, homelessness, contact with the criminal justice system and stressful encounters with health services.[71] Understanding and preventing these experiences is part of improving health outcomes.[72]
Important NSQHS Actions
| Action 5.12 | Clinicians document the findings of the screening and clinical assessment processes, including any relevant alerts, in the healthcare record. |
|---|---|
| Action 5.13 |
Clinicians use processes for shared decision-making to develop and document a comprehensive and individualised plan that: … d. Commences discharge planning at the beginning of the episode of care. |
| Action 5.27 | The health service organisation that admits patients overnight has systems for the preparation and distribution of food and fluids that include nutrition care plans based on current evidence and best practice. |
Strategies for improvement
Strategies to support Actions 5.12, 5.13d and 5.27 include:
- Understanding that people with intellectual disability may have unmet healthcare needs, specific disability support needs or clinical risks relating to their condition or intellectual disability. Identifying and recording these will facilitate a safer admission
- Collecting information from the person and their family, supporters or guardian ahead of time for planned admissions. If the person with intellectual disability cannot communicate their needs, a family member or NDIS disability support worker will be able to provide this information. Information to collect includes:
- How much assistance with daily activities does the person require?
- What support is needed for the person to understand what is happening to them and how to navigate an unfamiliar environment?
- Does the person require referral to a dietician, speech therapist or occupational therapist to assist with safety and quality during the period of admission?
- What are the person’s communication needs?
- What is the best emotional and behavioural support? This may include familiar phrases, music, photos, daily routines, and visits from significant others that can assist the person to manage the stress of a hospital admission.
- Does the person have any cultural safety needs?
- What is the person’s living situation? For adults, what is the role of the family or NDIS service providers in the person’s life, especially in health care including managing medication?
- How will the person be supported to make informed decisions and consent to their health care?
- For children or young people, how is key health information being shared with the parents or guardians?
What is the best way to communicate with family, supporters or guardians throughout the admission?
- Collaborating with the person, their family, supporters or guardians to plan the person’s transition from hospital to home. This includes ensuring:
- Clear details about the environment or setting the person is being discharged to. Is it a disability residential accommodation, their own home or home with family?
- The person and their family, supporters or guardian have a sound understanding of the person’s healthcare needs, medication and follow-up requirements after discharge
Determining whether clinical support can be provided by the hospital as part of recovery at home. This can include allied health or nursing supports as part of rehabilitation, or hospital in the home programs.
Resources
- Metro South Health Disability Nurse Navigators support people with intellectual disability during hospital admission and work closely with the person’s general practitioner and NDIS provider to ensure that supports are in place on discharge.
- National Disability Services Ready to Go Home Resources
- NDIS Quality and Safeguards Commission Practice Alert: Transitions of care between disability services and hospitals
- The NSW Health Responding to Needs of People with Disability during Hospitalisation Policy Directive sets out guiding principles for responding to the needs of people with disability including reasonable adjustments, person-centred services, accessibility and communication.
- The Western Australia Department of Health Disability Health Framework 2015–2025 provides direction for the Department and its partners on policy development and service delivery, to achieve improved health outcomes for people with disability.
- The NSW Agency for Clinical Innovation NSW Intellectual Disability Network works to improve the experience and delivery of health care for people with intellectual disability through clinical leadership, research and education.
- The Centre for Developmental Disability Health supports mainstream health service organisations in building their capacity to address the health needs of adults with intellectual and associated developmental disabilities.
- The Mater Intellectual Disability and Autism Service is a Queensland state‑wide service that supports health practitioners and service providers to improve the health and wellbeing of adults with intellectual and neurodevelopmental disability.
- The Specialist Mental Health Intellectual Disability Service is a Queensland state-wide service providing consultation and liaison service to help people with intellectual disability and those who may have or are diagnosed with mental health disorders to achieve better health outcomes.