Over the last 2 decades, South Australians who live with severe and/or profound disability have been afforded greater support to enable them to lead good-quality lives in the general community. South Australia has been progressively dispensing with institutional accommodation in favor of various supported accommodation options within the community. This commitment has been coupled with investment in a community-based health support program. Community-based health services have been oriented to enable individuals with disabilities, along with their parents and carers, to self-manage health conditions associated with their disabilities and to minimize the level of intervention required by health professionals. This has culminated in the inter-agency development (involving government and non-government agencies) of a health support program that is responsive to the needs of individuals, underpinned by a clear state-wide policy with procedures and guidelines. The health support program is available to individuals of all ages who have a range of health conditions that are most likely to be associated with profound or severe disability, i.e. impairments that limit mobility or impede independence in daily self-care (these conditions include cerebral palsy, autism, brain injury, paralysis, multiple sclerosis, epilepsy, diabetes mellitus, and the full spectrum of syndromes diagnosed at birth). The program involves individuals with disabilities, their families and carers, personal care workers, and health and education professionals. The key program facilitators are registered nurses from the South Australia Royal District Nursing Service, the Children, Youth and Women's Health Service, and the Community Accommodation and Respite Agency. Anecdotal evidence suggests that the program has been effective in minimizing unnecessary admissions to hospital, enabling children to be included in mainstream education settings, and managing the impact of health needs on people's daily lives. Not all people with a disability have high health needs. The Health Support Program distinguishes three levels of client need, the planning and intervention required for each level, and the nature of practitioner qualifications required for the planning of health support. The program provides support that is categorized as level 3 and could be managed in the community by a care worker who has been trained and competency assessed by a registered nurse to undertake complex health activities. The program complements mainstream health services by maximizing the opportunity for people with disabilities to manage their conditions without unneccessary hospitalisation or undue health professional intervention in their daily lives.
