Accommodation for People with a Disability
1 EXECUTIVE SUMMARY
1.1 Introduction
Victorians living with a disability face significant barriers to
social and economic participation in the community. These barriers
are exacerbated by the difficulties people with a disability
experience in accessing adequate and appropriate care and
support.
The Disability Act 2006 consolidated the
Intellectually Disabled Persons’ Services Act 1986 and the
Disability Services Act 1991 and provided for a more
whole-of-government approach to service provision. The new Act
recognises (as did the previous Act) that resources are limited and
that people with a disability cannot expect universal and total
access to disability services. Only those who request support and
meet criteria specified under the Act are eligible to receive
support. That support is provided in a manner based on the
Department of Human Services (DHS) assessment of priorities, and
subject to the availability of the required support. The new Act
states that if a person is assessed as disabled, that assessment of
itself does not provide an entitlement to services.
For people at the high end of the scale with the most severe or
profound disabilities, DHS provides shared supported accommodation
(SSA). Currently, around 4 600 people reside in 914 SSA houses.
They live usually in groups of four, five or six, with 24-hour
rostered support. In 2006-07, DHS allocated $395.6 million for SSA.
DHS funds community service organisations (CSOs) to provide around
40 per cent of this support ($156.6 million in 2006-07).
People with disabilities that are less severe than the high end
of the scale, but whose disabilities are still nevertheless severe,
are supported by DHS to live in the community through the provision
of individualised packages such as home help services, equipment
and respite care for carers ($141.1 million was allocated for these
types of support in 2006-07). Around 8 260 individual support
packages were issued in 2006-07. Packages ranged from under $10 000
(77 per cent) to over $55 000 (1 per cent). Eight packages exceeded
$100 000.
The Disability Act 2006 was written within a human
rights framework. It reinforced the transition of the disability
support model from a medical model (health care) to a social model
(one of facilitating more flexible support for persons with a
disability to achieve their individual needs and aspirations).
Under the new Act, the accountability requirements for SSA
service providers have been strengthened. In 2006, DHS’s Quality
Framework for Disability Services established the parameters for
best practice and quality improvement. The framework has minimum
standards for the condition of houses and administrative systems,
and processes for monitoring compliance with the standards. The
framework also incorporates outcome standards, which reflect the
quality-of-life aspirations of people with a disability, and the
measurement of these outcomes.
The objective of this audit was to determine the extent to which
people with a disability receive accommodation and related support
services commensurate with their need. We selected 32 houses to
visit across two rural and two metropolitan DHS regions. Of the 32
houses, 16 were managed by DHS and 16 by 11 CSOs. At each house, we
selected one resident’s file to examine in detail.
1.2 Findings
DHS has taken positive steps to address long-standing system
shortcomings. Establishing the Quality Framework should contribute
to improving the quality of support provided and the quality of
accommodation facilities. Focusing on each person’s support needs
rather than delivering a broad-based service should improve the
level of support. The framework for measuring outcomes will also
help in this regard.
Significant issues remain which, unless addressed, will continue
to impede the transition from a medical to a social model of
support.
Capacity and expertise of service providers
DHS has not yet conclusively assessed whether the disability
sector has the capacity and expertise to adopt the changes (though
DHS has identified the need for such an assessment). Nor has it
established a strategy to address gaps in capacity or expertise.
Service providers are struggling to meet their existing obligations
for supporting residents, particularly in regard to the time
required to provide individualised support. Their capacity to
provide additional individualised support is limited. There is
considerable variation in staff skills and qualifications, which
results in variability in service provision.
Unmet demand for support
DHS is unable to provide support for all those requesting it
(unmet demand is around 1 370 people or 30 per cent), yet demand is
increasing by around 4 to 5 per cent annually and DHS has not
accurately quantified future support needs or the associated need
for resources. The reactive nature of DHS’s response to
accommodation needs, combined with the stringent prioritisation
criteria, is likely to continue, and therefore perpetuate a
crisis-driven system.
Block funding for SSA
Funding for SSA is delivered to each service provider (per
house) in a block, based on the level of support a particular house
provides. As funding is tied to the service provider rather than
the individual, it reinforces a ‘group approach’ to service
provision rather than a system that services the needs of the
individual.
Availability of SSA houses
In 2003-04, DHS identified the need to replace or upgrade
approximately 443 of its SSA houses, at an estimated cost of $225
million. DHS subsequently identified that approximately 200 of its
houses did not meet current building access requirements for people
with a disability and occupational health and safety standards, and
therefore needed to be replaced or substantially upgraded. To date,
DHS has requested $123.2 million over time to meet the liabilities
identified. Since 2004-05, DHS has received $44.5 million which has
provided for 51 new (replacement) houses and nine major
refurbishments. A further $10 million was funded for minor upgrades
to facilities that did not meet occupational health and safety or
building regulations. In 2006-07, $15 million was provided to
replace facilities and provide equipment to the CSO sector.
Some houses operate from an ‘institution’ mindset, catering for
residents’ physical needs rather than operating like a home where
residents are encouraged to develop an independence limited only by
their own capacity. DHS has not assessed the suitability of its
houses in regard to the goals of the State Disability Plan and the
Disability Act 2006. Likewise, operators of CSO houses have not
assessed the suitability of their houses.
Due primarily to the high cost of SSA, DHS has in the last
decade been moving away from these services to the provision of
less costly services and more flexible accommodation options. More
support is being provided for people to live in the community
through, for example, community access programs or home-based
support. Nevertheless, DHS has estimated demand for SSA will grow
by around 4 to 5 per cent annually from the current level of 4 600
people. Some steps have been taken to address this growth but not
in the structured and cohesive manner necessary to reliably address
this growing demand.
Over the past four years, DHS has created 77 new facilities to
replace unsuitable facilities but has not increased SSA bed
capacity.
Individual support plans
DHS has not clearly specified the detailed contents of
residents’ support plans, and the form they will take, beyond the
key elements. As such, there is a risk these support plans will not
be prepared on a consistent basis or to a quality consistent with
providing individualised service responses. Existing plans,
prepared under the previous legislation, often lack relevant
detail. In consequence, approaches to planning by DHS and CSOs lack
consistency and coordination.
1.3 Conclusion
Due to the significant issues identified in this audit, there
remains a disconnect between the new support model and the actual
delivery of the model by service providers. It will be critical for
DHS to address these issues. In particular, DHS needs to establish
mechanisms to monitor how well the new service model is being
implemented and applied.
Of particular concern to audit is that the three issues of
capacity and expertise of service providers, block funding for SSA,
and individual support plans were raised by us in 2000. In the
course of the present audit, DHS advised us that it had initiated
actions to address these issues. It remains to be seen whether
these actions will have the desired effect.
The future service requirements of the people currently
receiving support need to be better understood. In addition, there
is a need to identify those people who may seek, and be eligible
for, support in the future. Some initial work has been undertaken
but it needs to be far more extensive and systematic. Without this
information, DHS is poorly placed to plan for and manage the full
extent of its future resourcing requirements. This may perpetuate a
service system that is reactive and crisis driven.
1.4 Recommendations
DHS should:
- provide focused support, guidance and
resources to facilitate the development of individualised plans by
service providers. This should involve:
- adopting a team-based approach to
preparing plans, comprising relevant support and professional
staff
- on-the-job training
(Recommendation 3.1)
- allocate specific resources for
undertaking individual planning for residents within SSA
(Recommendation 3.2)
- develop its information systems to provide
relevant historical information relating to SSA residents for
support staff to assist in meeting residents’ day-to-day and
long-term needs (Recommendation 3.3)
- review the SSA funding model to
better align it with the new service model of individualised
support (Recommendation 3.4)
- systematically assess the capacity and
expertise of SSA staff to deliver support services in accordance
with the new service (social) model and to address gaps
subsequently identified (Recommendation
3.5)
- guide and support service providers on the
conduct and documentation of the review of individual support plans
(Recommendation 3.6)
- assess residents’ satisfaction, directly
or through their family and friends, with their accommodation on an
on-going basis, and incorporate the results into a system of
continuous improvement (Recommendation
4.1)
- expand its demand management strategies
and explore options for accelerating the implementation of existing
demand management strategies (Recommendation
5.1)
- systematically measure projected need and
develop strategies, such as alternative delivery mechanisms and a
workforce management strategy, to meet future resourcing
requirements (Recommendation 5.2).
RESPONSE provided by Secretary, Department of Human
Services
The Department of Human Services (the department) welcomes
external examination of the operation of accommodation services for
people with a disability through the Auditor-General’s report. This
report rightfully acknowledges that progress has been made to
enhance the operation of disability accommodation services and that
reforms will continue into the future. The Victorian State
Disability Plan 2002-2012 and the Disability Act 2006 have placed
stronger emphasis on the rights and needs of the individual.
Positive changes are occurring but the department acknowledges that
there is more to be done.
Over the past five years the department has implemented
significant policy and practice changes to enhance choice and
opportunities for people with a disability. It is important to
recognise that the Auditor-General’s review occurred during the
latter part of 2007 and examined the performance of a relatively
small number of disability accommodation services during a period
of substantial transition. This period included:
- implementation of the Disability Act
2006 on 1 July 2007
- implementation of individualised
planning approaches and support and choice initiatives. These
approaches are putting in place new processes to tailor planning to
the individual’s needs and aspirations and reinforces plans are to
be directed, to the greatest extent possible, by the person and
their network to promote participation in community
life
- revision of the Quality Framework for
Disability Services resulting in a stronger emphasis on service
quality being aligned with personal outcomes for people with a
disability. This resulted in outcome standards being added to the
existing industry standards and planned major changes to monitoring
and reporting arrangements
- introduction of the Industry Plan to
enhance the capacity and networking of Disability Services within
Victoria. The Plan focuses on five key result areas: creating
individualised support responses; workforce planning and
development; increasing community awareness and valuing of
diversity; community strengthening through partnerships and
industry governance, management, planning and
investment
- initiation of the department’s
Community Sector Investment Fund in 2003. This resulted in the
allocation of $7 million for initiatives to support efficiency and
sustainability for community service organisations
- workforce development and planning
initiatives, including a five-year workforce planning strategy to
increase workforce attraction, retention and culture
change
- funding for residential accommodation
support in Victoria has increased by 65 per cent from 1999-2000 to
2007-08.
These changes mean that the environment today is
substantially different from that of five to six years ago. The
previous Auditor-General’s report on Disability Services was
released prior to the proclamation of the Disability Act 2006 and
since that time there have been many changes, and there will
continue to be, to systems and processes in accordance with the
principles of the Act.
The department welcomes the Auditor-General’s office’s
constructive comments regarding how improvements may be made to
achieve a more individualised support approach for people with a
disability living in disability accommodation services.
It is worth noting however that whilst this model of
accommodation support offers many benefits for people with a
disability who are amongst the most vulnerable in our society, it
does present limitations to individual choice inherent in living in
a group home.
The department has commenced a number of initiatives to
reduce barriers to individual choice for people with a disability
in accommodation services including:
- person centred active
support
- personal outcome measures as part of
the revised Quality Framework for Disability
Services
- a sustained program of culture and
practice changes to help staff work differently to support people
with a disability.
The department is mindful that it needs to maintain a
constructive and collaborative partnership with the Disability
Services sector to continue the positive change agenda for people
with a disability. In this way, it will be possible to build
further capacity of the sector to embrace and respond to the
changes. The planned move to independent certification of
Disability Services from 2009, along with the monitoring framework
for the health, housing and community services sectors, will help
build a sustainable funded sector by strengthening and monitoring
accountability arrangements.
The department supports eight of the nine recommendations
(3.1, 3.2, 3.3, 3.5, 3.6, 4.1, 5.1 and 5.2) and partly supports one
recommendation (3.4). Further comments made by the department are
contained in parts 3, 4 and 5 of this report.