Block to Insurance Model – the NDIS
Little more than, “Carry on as Usual” for those in group homes
With block funded disability support not being made consistent or accountable, the productivity commission’s evaluation was, “Current disability support is inequitable, underfunded, fragmented, inefficient and with no choice”.
Governments were therefore reluctant to provide a level of funding necessary to ensure all people with disabilities had reasonable and necessary support services – hence the unmet needs waiting list
A national funding source was needed to remove the state made support service circus, but the Federal Government needed some assurance they would not be funding a bottomless pit.
Assurance came in the form of an insurance model of funding support service costs. The insurance model theory is. “funding-up-front, means less-down-the-track” - through expectation the level of support will reduce over time.
The most practical example of this theory is early intervention for children. There is general acceptance that early and consistent behaviour management and skill training / ABA (applied behaviour analysis) is really effective in reducing the level of support needed later in life.
Despite similar theory for adults, as explained by Dr Norman Doidge in his book, “The brain that changes itself”, it is much more limited as behaviours have become entrenched and support staff have less motivation and resources to implement effective PBS (Positive Behaviour Support).
There are many electronic aids to help reduce the staff support time, but many families would not be comfortable their vulnerable family member was reliant on other than human support for their safety and wellbeing, with regular NDIS support service assessments repeatedly seeking to reduce support services in accordance with the philosophy of the insurance model.
Non-government, CSO (community service organisation), service providers are being very actively encouraged by their peak body, NDS (National Disability Services), to move from their traditional block funded support service provision, to being an assertive marketplace support service provider, by ensuring they are cost effective and sustainable when receiving just ISP (individual support package) funding from consumers.
They are being told this means not taking-on work having the potential to be loss-making, unless this can be offset by a surplus from other work. In reality, this means those with high support needs and behaviours of concern could find themselves on the service provider’s black-list, as are families who frequently raise support service concerns on behalf of their family member.
Black listing has been rife for years, for those who attend day services. They have the finances to move, but are limited by their behaviours of concern, their stakeholders questioning service level and quality, or both.
The current NDIS primary focus is people living with their families or who have sufficient ability to live individually, providing them with support packages to do things in the community, go on holiday, etc, etc. Therefore, one of the most key factors in considering or completing a NDIS support service level assessment is, “Individualisation, Individualisation and Individualisation”.
Conversely, the following are some of the areas the NDIS are not to keen to talk about. These being, shared supported accommodation group homes and full time day services. Especially a combination of both. At several large NDIS seminars in Victoria, group home residents under NDIS funded service provision were never mentioned.
We see the only benefit for most living or continuing to live in existing shared supported accommodation (SSA) group homes where the residents attend a day service five days per week, as being just their financial ability, under NDIS ISP funding, to move (relocate). Certainly, residents can chose their day activities. But, is this all?
Or will the NDIS provide individual (1:1) support service funding for in-home and community activities in the evenings, weekends and holiday times, as these are the mindercare times for the residents of many SSA group homes.
The consideration of each resident of a group home having individual support, as would a person living alone, appears to be classified as unreasonable. As is moving six high support needs residents of an SSA group home into individually supported accommodation, where the cost would move from around $600,000 pa to $2million pa for the six residents.
With no federal service quality and safeguarding framework estimated to be available for at least two years, consumer protection is to be covered by existing state material and bodies.
This will give the states ample time to become key players in what was intended to be a federal service because the state bureaucrats turned their services into inequitable, underfunded, fragmented, inefficient, with no-choice, charity-hand-outs. This being one of the main reasons for the NDIS There is, therefore, a real danger we will eventually see the same old bureaucratic services but funded by federal coffers.
As the productivity commission could see no way the bureaucratic mess by the states could ever be resolved, they decided to place the onus for service level and quality on the consumer – they put the money in the consumer pocket, rather than that of the service provider.
With most SSA group home residents and their stakeholders having little idea of the complexity of group home support services, most will just hand over the NDIS fee-for-service money to their existing service provider and say, carry on as usual, The support staff will just note a transparent change of support service funding source, and carry on as usual.
Non-government service providers (CSOs) are effectively being moved into the marketplace. Their peak body, the NDS, is very actively encouraging them to be vigilant with their costing and pricing of services in order to stay in business, as they will no longer be getting block funding, and will have to attract and retain customers.
Whereas we see very much, business as usual. With most consumers handing over their NDIS ISP and saying, carry on as usual. In many cases, the intention that the NDIS will improve service provision will be negated
As a fraction of any service provider’s business will be in each NDIS area, and of that just a few consumers will change service provider, business will be very much carry on as usual. Including there being little difference in the level and quality of support services, especially as there will be little competition with insufficient service providers to meet the demand.
Initially, choice of service provider will be even more limited as the Federal Government has finally decided to remove the Victorian State Government – the Department of Health and Human Services (DHHS) from direct service provision. The Feds saying they want people to have genuine choice and control over the supports they receive, and they say this cannot happen if the Victorian Government, DHHS, continue to dominate disability services.
The movement of government direct services into the non-government sector is usually a quite standard but elongated process where there is an agreement that government staff, group home direct care staff, have basically four choices – continue to work in the same house under a non-government employer, be offered another government position, take a redundancy package (if offered) or resign.
The potential negative factor for consumers, residents of DHHS managed group homes and their stakeholders is the potential rise in residential charges from the current DHHS charge of around 45%of DSP + 100% of CRA, to 75%of DSP +100% of CRA. This is not only a significant increase, but a percentage-charge rather than an actual-charge masks the rent component, thus the resident has no residential rights, effectively living in a hostel – no choice and control
This is in contrast to that being envisaged under the NDIS, factors such as: Entitlement, Choice & Control, Individualisation, Reasonable & Necessary and Not worse-off under NDIS, than existing support service provision.
When your NDIS entitlement comes-up. A letter will be received from the LAC (Local Area Coordinator) requesting a date for a service needs assessment meeting to formulate and cost a support service plan
Those on state government packages (ISPs), the ISP will, in most cases, be automatically rolled-over to a similar NDIS, ISP. Unless the consumer is not happy with the state government support service package.
Consumers receiving NDIS ISPs have three basic choices of how to manage this. Pay for the support services themselves out of their ISP, have an agent manage the ISP, for which the NDIS will pay or have the NDIS do it for free. The last is the most popular.
In conclusion, we suggest people try to get a NDIS service needs assessment well before being eligible, as this will test your considered needs. And, join the Carers Australia Peer Conversation Project. This project supports carers of people eligible for, but not yet enrolled in, the National Disability Insurance Scheme (NDIS) by putting them in touch with carers who care for someone receiving supports from the NDIS. Email: Carers.NDIS@carersaustralia.com.au
Extra 1: Disability Service Providers must plan Strategically under NDIS
Extra 2: NDIS Consumers encouraged to manage their ISPs like a business
Extra 3: Lots of NDIS jobs envisaged for South Australia
Extra 4: The NDIS by Carers Australia
Extra 5: Affordable and Appropriate Accommodation - NDIS
Extra 6: NDIS Questions & Answers - Victoria
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