For Health Professionals

For Professionals managing patients with IDA hospital admission for a person with an intellectual disability (ID) can be a confusing and frightening experience resulting in behaviours that are difficult to interpret and manage. The capacity of staff to be able to communicate with the person may be limited. These factors increase the risk that a hospital admission could result in missed diagnosis, inefficient use of resources and an increased length of stay, miscommunication, disjointed discharge planning and disconnection with community resources leading unplanned re-admissions.

Poorer health outcomes and negative hospital experiences for people with ID living in supported accommodation has been reported by NSW Ombudsman (1) and the NDS have reported high rates of adverse outcomes (2) in addition people with ID and their carers have told us that they often feel ignored and disrespected when in hospital.

The positive or negative experiences that a person with ID experiences in a NSW hospital depends largely on effective communication between disability support staff, the disability team leader, hospital staff and community based health services.

The Admission2Discharge (A2D) Together folder was created to facilitate timely transfer of relevant and current information to enable hospital staff to meet the needs of people with ID and thereby improve their hospital journeys and health outcomes.

Access A2D Together Folder Resources
Access A2D Together Folder Training

Disability Reform

Disability reform is being undertaken across NSW and Australia. This includes the implementation of the National Disability Strategy (NDS), the National Carers Strategy (NCS), NSW Disability Inclusion Action Plan (DIAP), the rollout of the National Disability Insurance Scheme (NDIS) and the devolution of Aging, Disability and Home care (ADHC), Family and Community Services (FACS).

The Admission2Discharge Project has been developed based on disability inclusive practices and supported by a range of international, national and local conventions and policies.

Some of the most significant of these are listed below.

The United Nations Convention on the Rights of Persons with Disability

The Convention is intended as a human rights instrument with an explicit, social development dimension. It adopts a broad categorization of persons with disabilities and reaffirms that all persons with all types of disabilities must enjoy all human rights and fundamental freedoms. It clarifies and qualifies how all categories of rights apply to persons with disabilities and identifies areas where adaptations have to be made for persons with disabilities to effectively exercise their rights and areas where their rights have been violated, and where protection of rights must be reinforced.

Australia has ratified both the agreement and the protocol. This means it must be incorporated in our laws.

Click here to read more

As a result of signing the United Nations Convention on the Rights of Persons with Disability, Australia has reviewed the outcomes for people living with a disability in Australia. This resulted in the implementation of Disability Reform, the Australian National Disability Strategy, and the development of the National Disability Insurance Scheme (NDIS).

Click here for more about the NDIS.

The Disability Inclusion Act 2014

Reform in NSW has included the enactment of the NSW Disability Inclusion Act, 2014. As a result of this change, NSW has developed the NSW Disability Inclusion Plan in 2015.

The plan is the NSW Government’s commitment to identifying and breaking down the barriers which prevent those with disability from enjoying the same opportunities and choices as everyone else. The plan has four focus areas that are aimed at creating long term change and require consistent efforts from government and the wider community. The focus areas are:

  1. Developing positive community attitudes and behaviours
  2. Creating liveable communities
  3. Supporting access to meaningful employment
  4. Improving access to mainstream services through better systems and processes

NSW Health Disability Inclusion Action Plan 2016-2019 

NSW Health has developed the NSW Health Disability Inclusion Action plan (DIAP) to ensure the NSW Health system provides equitable and dignified access to services and employment for people regardless of disability. This plan is part of a broader NSW agenda to improve the lives of people with disability and moves us closer to a fully inclusive society for all.

More information is available on the NSW Health website here

A hospital admission for a person with an Intellectual Disability can be a confusing and frightening experience resulting in behaviours that are difficult to interpret and manage by staff who don’t know the person.

This increases the risk that the patient’s presentation could result in missed diagnosis, escalation of behaviours of concern, inefficient use of resources, and increased length of stay, miscommunication between multidisciplinary teams, disjointed discharge planning and disconnection with community resources that could lead to unplanned readmission.

The People with disability and hospitalisation: Challenges and opportunities in NSW, the NDS Background Paper produced by the National Disability Services NSW in April 2014, highlighted these issues.

The NSW Ombudsman is required by law to review the deaths of people with disability in residential care in NSW, and make recommendations to reduce preventable deaths. This is the eighth report to Parliament on reviewable deaths, and focuses on deaths in 2012 and 2013.

As a result, Health policy and guidelines have been developed to improve outcomes for people with a disability when in hospital. These include:

The aims of the guideline are to ensure that staff working in hospitals and disability accommodation support services are aware of their respective roles and responsibilities to people with disability before, during and after transfer of care from hospital and to provide a framework for best practice for health care staff and disability support staff/nurses.

The guideline outlines steps to ensure the admission and discharge process is as seamless as possible, and contains tools to assist with the planning for hospital admission for people with a disability, including the Hospital Support Plan and a decision making escalation process.


Another tool which can assist in the transfer of personal information is TOP 5 which identifies and shares specific, unique strategies to help settle, calm, and personalize care for a person with intellectual disability who may have limited communication and/or challenging behaviours.

Agency for Clinical Innovation Intellectual Disability Network

The Intellectual Disability Network is working to improve the care and health of people with intellectual disability across all ages by providing clinical leadership, research and education as essential elements to enhance the capacity of primary and secondary health services.