Patients with severe knee osteoarthritis are falling between the cracks of the disability system In its most severe form knee osteoarthritis (OA) can be crippling, leaving patients housebound and unable to self-care. Yet a recent decision by the NSW Administrative Appeals Tribunal has confirmed that patients with disabling knee osteoarthritis are unlikely to be eligible […]
Patients with severe knee osteoarthritis are falling between the cracks of the disability system
In its most severe form knee osteoarthritis (OA) can be crippling, leaving patients housebound and unable to self-care.
Yet a recent decision by the NSW Administrative Appeals Tribunal has confirmed that patients with disabling knee osteoarthritis are unlikely to be eligible for the NDIS.
Vira Pomeroy, a patient with severe bilateral osteoarthritis of the knee, severe low back pain and morbid obesity, was turned away from the NDIS for a second time following the Tribunal’s decision in March.
Ms Pomeroy has been bedbound for the past eight months and remains hospitalised because there are not enough services in the community to support her to live an ordinary life.
She can’t shower, go to the bathroom, or dress without assistance. It now takes two or three people and a sling hoist to get her from a bed into a wheelchair.
Ms Pomeroy’s obesity and multiple hernias prevented her from undergoing gastric surgery. She is not considered suitable for rehabilitation or surgery to treat her osteoarthritis because she is unable to walk and her weight is too high.
The tribunal said there might be treatments to remedy Ms Pomeroy’s osteoarthritis and morbid obesity, and that she was therefore ineligible for the NDIS.
“I am not satisfied either of these impairments are permanent,” a tribunal member said.
To satisfy the NDIS access criteria, a person with knee osteoarthritis would need to be under the age of 65 and have a permanent, life-long impairment that substantially reduces their ability to participate effectively in everyday life.
“The NDIS is based on functional impairment, not diagnosis,” a National Disability Insurance Agency (NDIA) spokesperson told Rheuma Republic.
Impairments are considered permanent when they have no known treatments, or where the treatment options have been exhausted.
To streamline the process, the NDIA has compiled two lists (List A and List B) of medical conditions that may make a person eligible for NDIS.
Rheumatoid arthritis is on List B because it can sometimes be severe enough to cause permanent impairment. Osteoarthritis is not included on either list.
While the vast majority of people with osteoarthritis probably wouldn’t qualify for the NDIS, there were some patients with this condition who might be eligible, Associate Professor Susanna Proudman, the medical director at Arthritis Australia and a rheumatologist in Adelaide, said.
“It’s always going to be assessed on a case-by-case basis determined by the severity and extent of the underlying arthritis and the associations with … other co-morbidities like obesity,” she said.
In cases where obesity is blocking the patient from receiving surgery for osteoarthritis, obesity becomes the main target for treatment, through dieting or bariatric surgery.
“In some of these cases it is hard to know whether obesity is considered an irreversible condition,” Professor Proudman said.
There are few disability services for patients with osteoarthritis who are under 65 and do not qualify for the NDIS. Patients over the age of 65 are able to access services through Home and Community Care.
“Patients that do have genuinely irreversible disability because of arthritis do run the risk of falling between the cracks,” Professor Proudman said.
