SaH service list neglects polio survivors
Older Australians living with post-polio syndrome are frustrated at the exclusion of orthotists and prosthetists from the Support at Home program, including Frank Holgye who tells CCR he does not think it was an accidental oversight.
The new Support at Home program services list does not include certified orthotists as allied health to deliver services, potentially preventing older people with post-polio syndrome from accessing orthoses critical to maintaining their independence.
PPS is a diagnosed neurological condition which Polio Australia describes as new muscle weakness that gradually worsens and is often accompanied by decreased muscle endurance during activities, muscle and joint pain, muscle wasting, muscle spasms and twitching, and severe fatigue.
The Australian Orthotic Prosthetic Association said the exclusion of orthotists and prosthetists will see the loss of independence and premature admission to residential aged care, ultimately costing the government more than if they continued to fund access to the crucial allied health service.
Orthotists and prosthetists assess the physical and functional limitations of people resulting from disease, illness, trauma and disability including limb amputation and neuromuscular conditions. It is this expertise, not just the orthoses themselves that Mr Holgye – who is a self-funded retiree – said is necessary for his day-to-day living.
“It’s incredibly crucial. I depend on my orthotics for every second of my waking time during the day. As soon as I finish my shower, I’m using my orthotics until I go to bed,” Mr Holgye told CCR. “If I don’t have them, to put it bluntly, I’m stuffed.”
“The last time I had a caliper made – can be termed in another way, a KFO – that was around the $8,000 mark,” he added. “And I’m sure because of inflation and all that sort of stuff, it’s probably well over $10,000 now – and they don’t last forever. As somebody who’s got the slightest bit of common sense would know, you use something all day, every day, it’s going to wear out.
“It’s not only the actual cost of the actual hardware to make these things, it’s the expertise in looking at my body, looking at how I walk, and looking at what I need, and getting the orthosis, and manufacturing the orthosis, so it will fit me comfortably, so I can wear it all day, every day, without giving me pressure sores, without causing other problems with my muscles… if it’s not fitting properly, it can put incredible strain on other parts of my body.”
For now, older Australians can continue accessing orthoses and associated services via the Home Care Packages Program through a certified orthotist if the trajectory of the person’s disability is impacted by ageing.
However, the new SaH service list and the new Assistive Technology and Home Modifications list are not aligned, with certified orthotists not listed under allied health to deliver services under SaH, even though some limited upper limb orthoses and lower limb orthoses are included on the AT-HM list.
The AOPA also specifically pointed to the commitment to supporting people with post-polio syndrome under the current HCP Program operational manual and questioned why many lower limb orthoses – including a full-leg knee ankle foot orthosis, or KAFO – are exclusions in the AT-HM list.
The AOPA has also rejected the suggestion that access to lower limb orthoses can be obtained through other schemes like state-based equipment initiatives, giving the example of Mr Holgye who would only be able to access $2,000 through the State-Wide Equipment Program despite a new KFO costing around $8,000.
Without access to his orthoses, Mr Holgye would no longer be able to walk and would require a wheelchair alongside substantial modifications to his house to make it wheelchair accessible. With the necessary modifications unaffordable or structurally inappropriate, Mr Holgye would likely have to move to an aged care facility.
The AOPA also published its attempts to engage with government officials regarding the exclusion of orthotists and prosthetists under SaH, which include:
- accompanying peak body Allied Health Professions Australia to a consultation on 12 February 2025 – AOPA’s inclusion was declined
- a letter to the Minister for Aged Care Anika Wells on 20 February 2025 – correspondence acknowledge but no meeting scheduled.
It has recommended the following actions:
- orthotists and prosthetists be added in the SaH service list with allied health and other therapeutic services
- the list of lower limb orthoses in the AT-HM list be more comprehensive to ensure accessibility for older Australians with PPS and other disabilities where the trajectory is impacted by ageing.
Mr Holgye told CCR that given the AOPA had asked numerous times to be included on the panel making the decisions of what would be included on the service list with no success, he finds it hard to believe the exclusion of orthotists and prosthetists was an unintended oversight.
“I’m not convinced that it was an oversight, coupled with the fact that in the blurb that’s going around that introduces the new scheme, it said the new scheme is basically the same as the old scheme, you won’t lose any entitlements. Well, guess what? I’m losing support and entitlements,” he told CCR.
He said he thought it was partly a funding issue but also believed that PPS was seen as “a small group of people [that] can be pushed around, shoved around and forgotten.”
Mr Holgye told CCR he is always hopeful that the exclusion will be reconsidered.
“We’re going through an election campaign at the moment, they’re promising everything under the sun, but they wouldn’t be considering anything to do with people in my position. They’re concentrating on, obviously, the bigger picture.”
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