The National Disability Insurance Scheme (NDIS), when designed correctly and implemented effectively, will transform the lives of people with disabilities.
However, challenges exist during the current transition phase. Young people in aged care are facing significant barriers accessing the scheme as well as problems developing and implementing their NDIS plans. The bureaucratic processes in the NDIS, as well as a lack of service expertise and appropriate housing, are preventing hospitals from discharging people with disabilities with complex health needs back into the community.
The Summer Foundation is advocating for policy and process improvements that will improve NDIS outcomes for people with complex support needs.
Solution 1: Better coordination between the NDIS, health and aged care sectors
Young people in aged care, and those at risk of entry, require a coordinated effort across sectors to meet their needs. It is not always clear which sector should be delivering a particular service. For people in rehabilitation after trauma or injury, the split of responsibilities between systems can result in delays in service delivery and an inefficient service response.
For younger people in aged care to have good outcomes, a jointly resourced approach across health and disability sectors would be more efficient and effective than the current cross-referral pathways.
For young people in aged care, who have complex support needs, planning is a difficult process. Generally speaking, this is not a group who can navigate the NDIS pathway independently. There are significant inequities emerging because of the varied skill levels of planners, the amount of advocacy or supports an individual has access to and the hasty, haphazard manner in which plans are being developed.
Solution 2: Remove bureaucratic hurdles preventing people from accessing the NDIS
One simple change would be for the Federal Government to stipulate that if you are aged under 65 and living in residential aged care you automatically meet NDIS requirements. The change would require the government to write to the National Disability Insurance Agency (NDIA) and direct it to add aged care to the list of 75 programs across Australia already granted automatic entry to the NDIS. Should any young people not meet the access requirements, the NDIA retains the power to revoke access to the NDIS.
Removing hurdles for entry into the NDIS will result in cost savings by reducing the need for detailed access assessments.
The NDIA should ensure that all young people in aged care coming into the NDIS have the opportunity to leave aged care, by including funding to explore alternative housing in participants’ plans. This is not happening at ground level and ensuring it is requires more training and quality assurance reviews by the NDIA.
Solution 3: Provide more support to bring young people from aged care into the NDIS faster
Bringing young people in aged care into the NDIS faster will have long-term social and economic benefits because leaving aged care – or being diverted away from aged care – is associated with positive health outcomes and reduces the likelihood of institutionalisation.
We are pleased that the NDIA has established dedicated teams who are responsible for making early contact with people aged under 65 in residential aged care to arrange face-to-face access requests, but the NDIA should report publicly on the effectiveness of this response.
Funding to explore alternative housing options should be brought forward for all young people in aged care, including those in the last NDIS rollout sites. This would allow young people in aged care to begin preparations to leave aged care, so their first NDIS plan includes funding to leave aged care, not just to develop a plan to leave. The Summer Foundation estimates it would cost around $8.5m (plus program management costs) to deliver. It would transform the lives of hundreds of young people in aged care across Australia, allowing them to move back to the community faster.
The federal and state governments could also consider amending the Facilitating Participants Plans rule to allow a young person at serious risk of aged care entry to become an NDIS participant immediately, allowing people who do not live in a location where the NDIS has officially begun to submit an out-of-area request.
Solution 4: Develop an effective national approach to quality and safeguarding for Specialist Disability Accommodation (SDA)
An inconsistent and disjointed approach to quality and safeguarding will hamper the SDA market and reduce client choice and control.
Key principles should underline a quality and safeguarding framework for the future SDA market. These principles are:
Mainstream regulation and safeguards are accessible and applicable to people with disabilities.
Capacity building is at the centre of safeguarding – People with disabilities should be supported to build their capacity to make informed decisions and achieve their tenancy rights and responsibilities.
Innovation and investment is promoted while maintaining safety standards.
The diverse needs of tenants are recognised and responded to.
Roles and responsibilities are clearly defined – There will be a range of players responsible for the implementation of SDA including housing providers, support providers, tenancy managers, support coordinators and investors, and obligations and responsibilities need to be clearly and appropriately defined and assigned
Complaints are welcomed and easy to make and disputes are easily resolved.
Solution 5: Commit to a transparent process for Specialist Disability Accommodation (SDA) Price and Framework reviews
Investments in SDA housing are asset-specific and often made over a horizon of 20-40 years. The Disability Reform Council (DRC) agreed that prices would be reviewed every five years. The NDIA has not provided any further information about how the review will occur.
Financial institutions and SDA providers require certainty on the approach to reviewing SDA pricing in order to make these long-term investments.
NDIA and DRC should provide guidance to the sector on the Price and Framework reviews, including the terms of reference, timing and methodology, approach to grandfathering, who will undertake the reviews and what opportunities will be provided for sector engagement.
Solution 6: Invest in building the capacity of people with disabilities to self-manage their supports
Participants need to be supported to build their capacity to self-direct their supports.
The NDIA should increase investment in training staff, outsourced planners and local area coordinators to provide information and support around self-direction. Information and support about self-direction should also be available on the NDIA website in a variety of formats – digital stories around self-direction would assist people to understand what is possible.
The NDIA should also make self-direction more accessible by reinstating the float, which provided upfront funding that self managers could draw on to pay for their supports.
Increasing flexibility around what can be purchased and being able to carry forward savings to spend on achieving NDIS goals is also needed so that participants have incentive to seek value for money.
