Friday, June 29 2012
There has always been a question as to what happens to vulnerable people behind closed-doors - whether this be children at kinder, the elderly in nursing homes, or those with limited capacity living in supported accommodation and attending day centres.
Mum worries about her regular three year old at kinder, but he or she can tell mum... Mum, therefore, worries far more about her 33 year old with limited intellectual capacity and little or no meaningful communications, and living in a supported accommodation group home.
The ‘Community Visitor Program’, under the ‘Disability Act’ in Victoria, helps to weed-out some of the questionable activities behind those closed doors, but families were still concerned that many services still lacked the level and quality of service they considered necessary to provide their vulnerable family member with consistent quality of life care. And, the ‘Community Visitor Program’ does not check ‘Day Centres (ATSS)’.
In the early 2000s, it was considered there was a need to evaluate all service provision, day services and group homes, independent of government or pseudo government - through independent accreditation by external accreditation agencies.
This was flagged by DHS Victoria in their publication entitled, ‘The Quality Framework for Disability Services’ as starting in 2009. Those families complaining about services were encouraged to look forward to 2009, when services would be scrutinized by people independent of service providers and government and the outcome results made widely available.
Well, 2009 came, and went and little happened, as the DHS was then under pressure from non government service providers (CSOs), that they would not take part in the independent accreditation program if outcome results were released to families.
So DHS, Victoria, went to water. They made a deal with CSOs that they would not sanction the release of outcome results, if the CSOs would agree to join the program and be independently accredited to help them justify their funding to these CSOs.
This action shows very clearly, that people with a disability and their families are far from the centre of service provision. Rather than at the centre of service provision, as is suggested in most department care policies, standards and values, and is directly proposed by NDS ( National Disability Services) in their ’Disability Services Transition Plan, 2012 – 2016’
This plan says, ‘The central recommendation of this report is for a major capability uplift of the entire Victorian disability system, in order to better position the service system to realise three objectives that are thought to encapsulate NDIS readiness:
- People with disabilities, their caring families and supporters at the centre of service delivery.
- Achieving a sustainable, integrated and equally regulated disability service system.
- High performing organisations achieving real outcomes for people with disability.
And, DHS Victoria says in its publication, Understanding the Quality Framework for Disability Services in Victoria (2007)’:-
3. Elements of the Quality Framework for Disability Services in Victoria (2007), page 7.
3.3 Independent quality monitoring Central to all robust quality frameworks is a mechanism to independently monitor and verify the quality of the product or service.
Independent quality monitoring is a process independent of the organisation that will require service providers to demonstrate how their systems and processes meet each of the standards.
As part of a staged approach to the implementation of the quality framework, independent quality monitoring will commence from July 2009.
An independent mechanism for monitoring the quality of support to people with a disability will:
- focus on outcomes
- involve support users, their families and carers in the process
- be cyclical
- be consistent with or complement existing quality systems
- be applied consistently to department-managed and community service organisations
- be applied across Disability Services Division funding models and activity types
- be aligned with divisional, departmental and government policy objectives
- promote continuous quality improvement.
LISA Inc. was provided with a very good legal team through PILCH, Victoria, to challenge the DHS, Victoria, decision (agreement with CSOs) not to release independent accreditation results for any service, including its own direct care services.
As is the general situation, the all-powerful DHS won the day!
Tuesday, June 26 2012
The relatively few meaningful assets people with limited intellectual ability through intellectual and multiple disability have, need to be treasured and enhanced.
Most in our general society take a pride in their appearance. Although, in today’s trendy and liberal world, there are few boundaries.
Those who have to be well presented all week for business reasons, tend to be very liberal at weekends and holidays. Yet, at such times they are well accepted by society as being way-out dress wise, but having quite acceptable behaviour in comparison.
Whereas, those with unusual behaviours, as a result of their intellectual or multiple disability, tend not to be so well accepted, especially if they are not well dressed and groomed.
It is, therefore, essential a person’s clothing be the very best they can afford, and maintained at the highest standard. It is not good enough to use the old adage – ‘the person has no ability to know how they are dressed, so it doesn’t matter’.
Clothing standards can be a significant problem for those with limited intellectual ability who are living away from their family in a supported accommodation group home, for example.
In such circumstances, it is essential the service provider establish practical policies to ensure their residents are always well dressed and groomed, from the purchase of appropriate attire, to its maintenance and replacement. Not only to enhance the person’s acceptance in the community, but for their self-esteem and confidence enhancement.
Just two of the areas of frequent neglect are ‘footwear’ and ‘buttons’. Shoes dirty, well worn and with insufficient choice of different types for different occasions. And buttons missing, so the clothing sloppy.
Daily shoe cleaning is not a difficult or time consuming task, but makes so much difference to the person’s appearance in, and acceptance by the public. A clothing review policy helps to ensure all clothing is regularly checked for integrity- damage, missing, cleanliness, size, etc, etc.
A box in the residents’ wardrobes for staff to drop questionable clothing and notes of noticed deficiencies, for the house supervisor to check each week to arrange repair, replacement or new purchase, is not rocket science.
Tuesday, June 19 2012
Those in our society with an intellectual or multiple disability, very vulnerable people, frequently have few meaningful and beneficial assets per se, but especially in comparison with the general society
Although the asset to which we refer is very important to the general society, the end result of this asset is far more important to those who have so little in their lives, as this asset provides them with an area of enjoyment not generally limited by their disability. We refer to teeth, providing the ability to enjoy food as we were all intended.
Despite the need for teeth to be kept in good condition, to allow this one real avenue of enjoyment, this area of personal hygiene has, and frequently does receive poor attention by many direct care staff in accommodation services.
Many of those who came out of institutions had lost most or all of their teeth through neglect, and now have to have their food pureed
In the present group homes, teeth cleaning and regular dental appointments are not a personal hygiene priority for many direct care staff.
Certainly, there are few behaviour management programs focused on moving residents with resistance to teeth cleaning and regular dental care, towards a meaningful process, rather than the person having a general anaesthetic (“GA”) to allow dental care, by a dentist, to occur.
An example of how a ‘behaviour modification program’ can achieve good results, was where an autistic person would not allow any form of dental care by a dentist.
Although it took four years to move from periodic GA’s, to a full and regular clean and check in the dentist’s chair, this was real quality of life/normalisation move for the person.
The move was achieved with the use of a ‘banana lounge’ and a few ‘dental tools’, simulating the dentist’s chair. Steady programming using these tools, followed by gentle trials in the actual dentist’s chair - gradually achieved meaningful results.
Moving those with resistance to standard community practices requires time, effort and dedication. Most of all, an ‘action plan’ focused on the task and desired outcome.
Thursday, June 14 2012
Natasha Robinson of The Australian, on May 22 2012, wrote: “A systemic culture of low expectations means that for disabled children the nation's schools are just babysitting services’, a high-level meeting of figures in education and social service has been told”.
The story is mainly about children with a disability in main stream schools. Whereas, little is mentioned of, ‘Special, or Special Developmental Schools’. We find these schools, and their outreach programs, in Victoria, very good.
The ‘babysitting/minder care’ occurs when the children become adults and, where many move into ‘Day Services’ funded by the Department of Human Services.
Special Developmental Schools provide their students with very good early intervention, behaviour management and skill training, to raise them to a good quality of life. It is disappointing, this drops like a brick for those who, as adults, move into ‘Day Services’, where there is little continuity.
Most of the ‘Day Services’ claim their clients are adults, and should do adult activities. Rather than continue with ‘lifetime learning’ similar to TAFE, as many people with intellectual and multiple disabilities need more time to learn.
In many ‘Day Services’, their clients receive little more than basic minder care with a few simple activities such as going for a walk, going for a coffee and maybe a swimming program. All in the name of not treating them like children, When, in reality, most are functioning at a level far less than a legal adult.
Special and Special Developmental Schools raise the skill level of their students. This skill training should be continued by education department resources, rather than their students be transferred to very second-class minder care services receiving poor funding and resources from the Department of Human Services, Victoria.
Wednesday, June 13 2012
The Parliamentary Secretary for Families and Community Services, Andrea Coote MLC, launched a new resource titled "Peer Support".
This is a guide to how people with a disability and carers can share what they know about self-directing their supports. It acknowledges the value of the collective wisdom that people with a disability and their supporters hold and the benefits of people sharing that wisdom and personal experience with each other.
The guide reflects the experiences and opinions of this diverse group of people.
There are limited number of printed copies to distribute, if there are particular organisations or people who you think could benefit from this guide, please contact Eilis Hughes on firstname.lastname@example.org and she will organise for copies to be sent.
Monday, June 11 2012
A regular three year old child is seen by common law as vulnerable, and in need of parents to legally protect the child’s best interests. Parents, therefore, have the necessary legal power to make decisions on behalf of the child – the vulnerable person.
When the child reaches the age of 18 years, he or she is considered by common law to have the necessary ability to protect themselves and manage their own affairs – They are now known as an adult.
Although, so far, we have common sense, common law, it is no longer so for those who do not fit the regular mould for which common law was written – adults with limited intellectual capacity due to intellectual or multiple disability.
In total contrast to the regular 3 year old, a 33 year old with the intellectual ability of a regular 3 year old, is given legal adult status under common law. This status is the basis on which applications for guardianship in Victoria are based.
A guardianship application is considered by VCAT (Victorian Civil and Administrative Tribunal) under the Guardianship and Administration Act (“the Act”). VCAT considers the application mainly under three key factors, and within the common law adult status.
These key points are in Section 22 of the Act, being: (a) the person has a disability, (b) the person is unable by reason of their disability to make reasonable judgements in respect to all or any of the matters relating to her or his person or circumstances and, (c) is there a need for a guardian.
Most applying for guardianship can meet 22 (a) and (b) quite easily. Section 22(c) is that which provides the overwhelming ability of VCAT to protect the vulnerable to be vulnerable.
If the parents of a regular three year old were subjected to 22(c) in the way VCAT apply it, the regular three year old would, as a result, have no parents.
VCAT uses Section 22(c) as a tool in an attempt to allow a legal adult some freedom from parental control. This is fine, where realistically possible. And it is not realistically desirable when a person has such limited ability to make them extremely vulnerable
Rather than use Section 22(c) as the sole filter, VCAT needs to place the guardianship applicants under far more regular scrutiny to ensure they consistently have the right attitude, approach and actions towards the person for whom they are seeking whole of life guardianship or being whole of life guardians – plenary guardians.
The Guardianship & Administration Act
Monday, June 11 2012
Supported residential services (SRS) are currently regulated under the Health Services Act 1988, and the Health Services (Supported Residential Services) Regulations 2001. The current model of regulation is based on a broad definition of SRS and a set of principles guiding how those services are provided, coupled with more detailed minimum requirements for those services.
In 2008 the Department of Health commenced a review of the current Act and Regulations. Consultation was a critical element of the review process. A discussion paper was used to highlight key issues with the current SRS regulatory scheme and to seek input from stakeholders. Residents of SRS, their families, SRS staff and proprietors provided feedback to the department. The department also ran a number of public consultation forums across Victoria.
The information gathered through the review process led to the new regulatory regime set out in the Supported Residential Services (Private Proprietors) Act 2010. The SRS Act streamlines the administration and regulation of SRS, strengthens occupancy rights, strengthens financial protections, promotes staff capability, introduces outcome-based standards, strengthens reporting of serious incidents and introduces new enforcement mechanisms.
The purpose of the proposed Regulations is to provide for effective administration of the new Act, which is planned to commence from 1 July 2012.
Regulatory Impact Statement
Statement of Reasons
Sunday, June 10 2012
Adults in Victoria who are unable to manage their financial affairs, through having limited intellectual capacity due to intellectual or multiple disability, may have an administrator appointed by VCAT (Victorian Civil and Administrive Tribunal), under the ‘Guardianship and Administration Act, 1986 (“the Act”).
The tribunal encourages parents/families, but not service providers to take on this role due to their potential conflict of interest. Where there is no suitable person/s, ‘State Trustees’ take on the role of the person’s administrator, at a cost.
Although an administrator has extensive powers under the ‘Guardianship and Administration Act, they have no legal right to check the integrity of their person’s property!
Administrators are empowered to purchase, and/or provide the finance for the purchase of goods and services for the person for whom they are administrator, Yet, they are not empowered, under the Act, to check the integrity of the goods and services provided for, and to their person.
The most common example of the need for an administrator to check the integrity of their person’s property, is where their person is living in a supported accommodation group home (shared supported accommodation).
Most residents of supported accommodation group homes have little or no ability to adequately monitor the integrity of their property. Personal effects are, by the very nature of the living situation and the owner’s limited ability, very vulnerable to loss and damage – especially clothing. In most circumstances where parents are administrators, service providers permit them to regularly check on the integrity of their family member’s personal effects – especially clothing.
But they don’t have to, unless the parent is a guardian – especially a plenary guardian.
The service provider can support their resident’s human rights, as a legal adult, to exclude or restrict parents and others from interfering in the life of an adult person - claiming, ‘client’s choice’. It is their client’s choice not to have parents checking on their resident’s clothing and personal effects, they might say.
In most group homes, the integrity of residents’ clothing is a major problem for direct care staff, especially those who see their residents being well dressed, as a major factor in quality of life care. Clothing going missing, needing repair and needing replacement are all major concerns for direct care staff. So most welcome good parent/family involvement.
The Guardianship & Administration Act
Thursday, June 07 2012
Care for those with limited intellectual capacity (intellectual or multiple disability) has moved from ‘traditional institutions’ to ‘self directed approaches’(living in the community with circles of support).
Many traditional institutions were little more than confinements. They were built on very large blocks of land to help allay public fears, whilst the bureaucrats claimed the residents needed ample room for activities. In practice, the land was mainly isolation/privacy, as few outside activities occurred in comparison with the large land allocation of most institutions
This traditional isolation/privacy has been retained in many government mini-institutions – government group homes in the community. Community access for the residents of many government group homes, is often just a drive-around with staff in the front, and the residents in the back of the house mini-bus.
Life within many government group homes is ‘paranoid-silo-privacy’, where families are discouraged from knowing each other, or from knowing anything about the other residents. They are told, for example, their son or daughter enjoyed a co-resident’s birthday party. They are told their son or daughter went here or there with a co-resident. Names are never mentioned!
Those with almost any level of reduced intellectual capacity have a lifestyle many, many times less than the general population. They are effectively in confinement and isolation, given their limited lifestyle, through their limited ability and comprehension
They certainly don’t need more isolation in the form of the service provider inflicting ‘paranoid-silo-privacy’ on them. They need a lifestyle which is as open as possible, to compensate for the natural isolation created by their limited ability. They need an, ‘all-family-friendly-home’ and ‘Circles of Support’ to help break the isolation of their limited capacity. ‘Circles of Support’ are totally opposite to Paranoid-Silo-Privacy.
Parents are often the only people who take a great interest in protecting the interests of their sons and daughters. Yet we know that in order for people to have good lives into the future, it is desirable that they have friendships and relationships with other people who take a real interest in their lives.
People who have disabilities are more vulnerable and will be for the whole of their lives. They will need people in their lives, who like and know them well and even love them, who will stay close to them, advocate for them and ensure that their dreams for 'a good life' are fulfilled.
Service providers, especially government direct care services need to understand how and why their traditional ‘Silo-Privacy’ add to the natural isolation of those with limited intellectual capacity, and learn how to provide support to people, their family, friends and their support staff to aim for family friendly togetherness.
Parents have often held life long, protective, practical roles of all kinds. They often need to be shown that others can provide their family member with real quality of life care in an open and friendly environment, rather than silo style living practiced in many group homes – especially government direct care group homes.
Circles of Support increases the social networks for people who have been institutionalised, or are at risk of being institutionalised by ‘Paranoid-Silo-Privacy’ in group homes.
Circles of Support & Self Directed Approaches
Tuesday, June 05 2012
Sixty-four organisations will receive grants of up to $30,000 from the Australian Government to help them get ready for a National Disability Insurance Scheme (NDIS).
Parliamentary Secretary for Disabilities and Carers, Senator Jan McLucas said the NDIS Readiness Fund is part of the Australian Government’s $3.1 million investment to help Australian Disability Enterprises prepare for reform.
“A National Disability Insurance Scheme will significantly change how we deliver disability care and support across the country,” Senator McLucas said.
“We want all areas of the disability sector to be ready to make the change, including our Australian Disability Enterprises, which employ more than 20,000 Australians with disability."
See full Press Release
LISA Comment: We ask, "What expectations, if any, were set on the funding?" Especially to ensure NDIS funded services are not just more of what we have now - especially not more of those by government direct services!