Inquiry into the provision and regulation of supported accommodation in Queensland

Submission No: 143

Submitted by: Skymac Pty Limited (trading as Avalon Village)

Publication: Making the submission and your name public

Attachments: See attachment

Submitter Comments:

2nd February 2024

Committee Secretary
CSSC
Parliament House
George Street
Brisbane Qld 4000

CC: cssc@parliament.qld.gov.au

RE: INQUIRY INTO THE PROVISION AND REGULATION OF SUPPORTED ACCOMMODATION IN QUEENSLAND

Dear Committee Secretary

Please find attached our submission to this inquiry.

As the largest Supported Accommodation Facility in Queensland, we believe we are a critical voice in this discussion.

The Supported Accommodation sector already plays a critical role in supporting some of Queensland’s most vulnerable members of society. The sector could play a larger role in addressing the systemic issues in our sector but we need to make it clear that this cannot happen without the requisite systemic funding.

While the regulators have spent the last twenty years largely litigating the fundamental issues, these challenges have already been recognized and largely addressed in related sectors, namely Aged Care Facilities and NDIS.

These sectors have structured funding models that recognize the cost of providing complex care; managing the administrative burden of compliance with appropriate regulations and the 24/7 nature of the care requirements within the context of labour laws.

We would encourage The Committee to use these models as exemplars and address the fundamental questions: why is the Supported Accommodation sector treated like the ‘Ugly Duckling’ of the industry: asked to provide care to some of our most vulnerable citizens with the most complex needs without providing any funding from a State or Federal level.

Our industry is on its knees. There is little industry renewal as there are few incentives to take on the task. This is a ticking time-bomb that, left unaddressed, will continue to put significant pressure on the people who depend on it and the other service providers in this space.

The Supported Accommodation sector has the passion, skill and capacity to solve many of the issues raised by The Public Advocate. Indeed, we believe that this would be the most cost-effective solution available and would pay for itself by taking pressure off related services such as Hospitals, the Ambulance Service, Drug and Alcohol facilities, Homeless Facilities; as well as various government agencies.

We encourage the Committee working with, rather than against, our sector to support the vibrant community of dedicated care providers; to provide critical funding; to foster incentives for people to join our sector and for it to grow and thrive into the future to provide for the needs of our vulnerable citizens.

Yours sincerely

Lee Reynolds
General Manager
Skymac Pty Ltd, Trading as Avalon Village
712 Creek Road
Mount Gravatt East
QLD 4122 (PO Box 1640, Carindale QLD 4152)

Let’s get down to brass tacks: who is paying for all this?

A SUBMISSION TO THE INQUIRY INTO THE PROVISION AND REGULATION OF SUPPORTED ACCOMMODATION IN QUEENSLAND

Report prepared by: Lee Reynolds

Made on behalf of Skymac Pty Ltd, representing Avalon Village, the largest Registered Level 3 Supported Accommodation Facility in Queensland.

Lee Reynolds
General Manager
P: (07) 3343 2277 M: redacted E: redacted www.skymac.com.au
712 Creek Road, Mount Gravatt East QLD 4122 (PO Box 1640, Carindale QLD 4152)

Introduction: The impact of 20 years of Woefully Inadequate Funding for Supported Accommodation Services in Queensland

Skymac wishes to reiterate the formal submission to the Supported Accommodation Providers Association (SAPA) submission but additionally raise grave ongoing concerns about the dire state of funding for Supported Accommodation services in Queensland as a result of the failure of the government to recognise and action the need for providing appropriate funding.

As the largest operator in this sector, we feel compelled to provide a blunt and unvarnished perspective on the challenges we face in delivering accommodation and services to some of the most vulnerable members of our society.

There is currently no Federal or State Government funding support provided to this sector. Most residents of our facilities do not have sufficient income to pay for the true cost of Level 1 and 2 services, let alone for the complex care needs that are common and costly to provide.

Our system is breaking down but the problem is not going away. Ultimately, in a fair society, these services need to be funded, one way or another.

This is not a new request; or a new cry for help; or a greedy industry simply crying poor.

We can provide 20 years of evidence and submissions and countless number of meetings with all Government departments (including the Public Advocate) detailing the pressures of the industry. The latest submission by the Public Advocate simply highlights what we have been preaching for many years.

By properly funding the Supported Accommodation sector we can work together to provide consistent, proactive and preventative support services that will take the burden off other services and ultimately provide a better quality of care more cost-effectively.

Executive Summary

Supported Accommodation providers in Queensland have been the backbone of support for vulnerable individuals for decades. Shockingly, we’ve undertaken this mission without any Government funding, and it’s high time this issue was rectified.

The Skymac Group contributed to and supports the submission made by SAPA (Supported Accommodation Providers Association).
This submission is intended to add to this report by providing an on-the-ground perspective from the largest registered operator in Queensland.
Our submission is independent of the submission by SAPA and other members may have different views and face a different array of challenges.
It is our view that the funding frameworks for the sector are woefully inadequate and are allowing some of the most vulnerable people in our community to fall between the cracks and then bounce between various temporary supports. This is inefficient and provides an inconsistent standard of care.
The pension is currently the primary (often only) source of funding that most residents have for Level 1 and Level 2 services. This is simply inadequate to fund the support of individuals’ basic accommodation and food service needs let alone their complex care needs.
The Supported Accommodation sector currently receives no funding from the Federal or State Governments. Providers are expected to carry all of the risk without the funding to manage the risk.
As a result, many providers struggle to meet the current level of care rightly required by the regulatory frameworks. The industry is therefore struggling to do the impossible - providing high-quality care, at a loss.
The only bright spot in the funding landscape is the NDIS. This funding supports Level 3 activities but can to a certain extent cross-subsidise the Level 1 and Level 2 activities that, in themselves, run at a loss.
For facilities where NDIS funding is not available or adequate, where they focus on Level 1, 2 and 3 services, they are not able to run these activities profitably making these enterprises unsustainable. This leads to a downward spiral in terms of the level of services they can provide.
This leads to the degradation of service quality; cutting corners to make the business sustainable; and to an ageing cohort of operators with little incentive to remain in the industry and little prospect of attracting new operators to the

industry. Adding a greater regulatory burden is a worthy attempt to solve the problems but simply misses the point.

It would be more efficient, provide a better and more consistent standard of care and ultimately be more affordable if the Government provided adequate and structured funding to the sector.
Models already exist in public hospitals; the Aged Care sector; and NDIS. A great deal of care and thought has gone into crafting these frameworks and they share some common elements that are absent in our sector.
- A recognition that individuals with disabilities should not be financially disadvantaged relative to another member of society and should have autonomy over directing their care.
- A recognition that the providers of this care have significant costs that include the cost of compliance and labour costs.
- A recognition that funding needs to be flexible and proportionate to the underlying costs - including the reality of operating in a 24/7 environment with penalty rates for the staff needed to operate them.
These models are a tacit recognition that these issues need to be addressed in a fair and sustainable funding model.
We ask the State Government why similar support is not being provided to support Supported Accommodation, a sector that provides critical support in terms of accommodate and food services as well as the complex needs of some of the most vulnerable individuals in our society in turn saving related services such as hospital and ambulance services a lot of money.
Ultimately the issue - the elephant in the room - is that without adequate funding and recognition of the actual costs and challenges of 24/7 complex care, these issues are likely to persist under any operational model.
There are robust funding models currently in place for the elderly in aged care facilities, and for NDIS recipients. We ask that these be treated as exemplars of how to properly fund the Supported Accommodation sector.

The Reality on the Ground

Our submission is rooted in the firsthand experiences of providers who work tirelessly on the frontlines of Supported Accommodation. We see the harsh realities faced by individuals with lifelong disabilities including complex mental health issues, often compounded by backgrounds of severe drug and alcohol use. These individuals require intensive and specialised support, making their care inherently costlier.

Our residents do not fit neatly into a nine-to-five world. Their physical and mental needs do not operate to a schedule. We operate in a dynamic and challenging 24/7 environment. If a resident has an incident or requires immediate support at eleven pm on a Sunday night, we are there to help them. If a resident has had an unfortunate and embarrassing incident (e.g. an episode of incontinence on a public holiday) we are there to support them, re-dress them and change of linen etc.

Who else is going to come to their rescue?

Do we call an ambulance or the police?

Do we leave them until the next standard business day like most external agencies have the luxury of doing?

This is the lived reality of our dedicated and caring staff.

The reality for operators is that this accommodation, food and personal care support costs money. Like all charities, not-for-profits and business, employment costs the largest expense that needs to be considered.

By contrast, our primary funding model for these services, the pension, does not reflect this reality. Pensioners do not receive additional income to accommodate for the additional costs providers have to absorb to simply have a staff member on the ground and pay them as per the award to which they are entitled.

A Vital Gap Filled

Supported Accommodation plays a critical role in bridging the gap between hospital care and independent community living. Regrettably, the Not-for-Profit sector has largely abandoned this space, leaving many vulnerable Queenslanders without suitable alternatives.

This leaves the Supported Accommodation sector as the ‘last line of defence’ for the individuals in the system.

The reality of costs

Nowhere in The Public Advocate’s fifty-three page report does it mention the costs needed to provide the required services everyone is questioning, nor where these funds to meet these expectations are to come from.

In our view, this is entirely missing the point. Indeed, the report seeks to exacerbate the issue by increasing the administrative burden on our industry. Frankly, this adds insult to injury to an industry that is already struggling under the weight of regulations while receiving no Federal or State funding support.

This is not sustainable.

The largest cost to our business is staffing and wages. Our staff operate in a 24/7 environment. This is regulated by Awards that require penalty rates for overtime, weekends, and holidays. This greatly increases the cost of service delivery during these times.

Operators do not have the luxury to restrict their services to 9-5, Monday to Friday. Residents need to be fed; bathroom facilities need to be cleaned etc. This needs to be provided 365 days of the year. There is no mechanism to pass on these additional penalty rates on weekends and public holidays to a person on a pension.

Hard cold fact: staff want to be paid and they are quick to remind us that they are not volunteers.

We anticipate that the people reading this submission are not volunteers so we anticipate your appreciation for this reality.

No Funding = Cutting Corners = Poor Outcomes for Residents

The Supported Accommodation industry receives no Federal or State funding. This compromises some providers’ ability to provide adequate accommodation, food services and personal care to individuals who do not receive NDIS funding for these personal care needs.

The sector receives no direct funding to the facilities, or to the individuals beyond the standard arrangements such as the Pension. This is at odds with funding models within related sectors such as aged care facilities.

In our sector today, there are clear signs of the impact of this financial struggle. By necessity, providers are forced to reduce the level of services in order to survive.

It is not uncommon that facilities have two (or more) adults sharing a room in some facilities. This is not best practice but it is the current economic reality faced by these providers.

The Government continues to spend millions of dollars on the housing sector to meet the housing crisis challenge but has failed to provide any funding to a sector that is ignored.

Why?

We believe that it is due to a widespread and continued lack of understanding. As a general rule, what people do not understand, they brush under the carpet.

This will remain our point of view until proven otherwise.

Many operators are already in acute financial distress. They lack the resources to address the current industry requirements, let alone meet increasing standards.

Heartbreaking decisions

On a regular, if not daily basis, we receive desperate calls from various agencies seeking accommodation; somewhere to live for people to avoid homelessness. More often we are now inclined to regretfully reject an application in order to avoid compounding losses that would be incurred to accommodate and feed these vulnerable people, let alone then take on the extra responsibility to provide complex personal care including assisting with medications.

We could accept many of these referrals if there was adequate and structured funding in place to provide the accommodation and food services required to provide the required level of care.

It is evident to us that the Regulatory Bodies and Agencies have the view that our sector is the last line of defence to look after our most vulnerable citizens and yet they do not think it is necessary to provide adequate funding to achieve the outcomes.

It is also evident to us that our industry is treated as the ‘too-hard basket’ where individuals with complex needs are effectively dumped with little regard for how their well-being is to be funded.

Case Study 1

Referral details:

The applicant is a 59 year old Vietnamese man that has a history of homelessness. We first met the applicant when he was living in someone’s granny flat for $100 a week. This accommodation came to an end and the applicant was left homeless.

We supported the applicant’s move into Public Housing, which he sustained successfully for many years. However, he faced multiple challenges with his neighbours and was offered a transfer to an alternate property due to concerns about harassment and over suspected racism. The applicant did not accept this arrangement and stated he would prefer to be homeless.

We are now facing the issue of this person becoming homeless, and we are concerned that he will not survive on the streets.

He is in receipt of the Newstart Allowance which is $780 per fortnight, and he will be eligible for an additional $140 per fortnight in rent assistance ($990.00 total).

Application was declined.

This is a heartbreaking decision that we are confronted with almost daily. We rejected this application.

Our industry feels that it is looked down upon as being a heartless, for-profit business, but let’s consider the practical reality.

This is an individual with complex needs who would present significant social challenges to the other residents and staff.

If a Government agency was to undertake the level of care required for this individual it would undoubtedly cost substantially more than the total income of this individual.

It is also the reality that charitable organisations in this space are also rejecting applicants like in Case Study 1 on economic and social grounds. We have seen Government-run facilities ultimately close down because they are not financially viable. This is a tacit recognition by Government that these facilities are too costly to keep open. These factors put more pressure on our Sector.

This is the current reality of any business model - Government, Charity, Not-For-Profit or For-Profit. Providing a quality service when there is not sufficient, sustainable funding available is not possible.

The dumping ground of the industry

The Supported Accommodation sector is often the ‘last line of defence’. The individuals that we cannot accommodate typically face homelessness.

We acknowledge that the staff at the agencies who refer applicants to us are caring and well-meaning individuals who are trying their best to support people in need. But they are under their own internal pressures to move a person along; out of their system and off their books.

This reality as we see it: we are expected to be the last line of defence and provide a solution to their problem when there is little recognition and often sceptical contempt for the challenges that we face on a daily basis.

A frank conclusion: that our Sector is being treated by other agencies as something of a ‘dumping ground’: a convenient place to send individuals that do not fit into other services; typically those with the most complex needs; all without apparent understanding that these services cost money.

A banging drum

Month after month, year after year, The Supported Accommodation sector has been raising its concerns and providing countless examples with documentary evidence.

Just as a tiny example, we have attached supporting documentation to this submission.

In 2001, SAPA prepared a submission (attached) that raised many of these same issues.
In 2007, the Residential Services Stakeholder Advisory (attached) discussed and documented these issues again.

We can produce myriad examples of 20 years plus of banging the same drum that no one hears or wishes to fix the real issues in the sector.

We are deeply concerned that any Parliamentary Review will become yet another performative hand-wringing exercise that results in nothing more than an increase in the administrative burden on providers in the sector without addressing the fundamental and underlying issues of funding.

Rewriting the same document over and over again will not solve the very real challenges the industry faces today. Time to support our industry is overdue.

Capping the amount of Pension Income that can be spent on Supported Accommodation

The Public Advocate rightly questions if there should be caps on the amount of this income that can be available for this care. We agree with this in principle - residents rely on a pension as their only source of income. There is no argument that the cost of living is rapidly increasing. However, the stark reality is that there is currently no other source of funding for most of these individuals. This would simply place further financial burden on the sector and the capacity to provide quality care.

This is our dilemma. Even 100% of pension income is woefully insufficient to provide the FULL level of services

Why should a person with a defined disability be penalised by having to afford personal care they need out of their fortnightly pension if they don’t have adequate funding via a NDIS plan.

We feel that the State Government has seen our sector as something of a ‘free lunch’, expecting us to provide exceptional accommodation, food services and care without providing funds or acknowledging the challenges of the providers and their staff.

Falling between the cracks

We believe that the State Government is allowing many of our most vulnerable citizens to ‘fall between the cracks’ through the lack of adequate funding.

If the individual in Case Study 1 was an elderly person then they would be referred to an Aged Care Facility. In this event, there would be funding mechanisms that were provided to both the facility and the individual to provide adequate care. This framework takes into account the relevant labour laws around penalty rates etc so that funding is broadly proportional to the actual cost of providing the required standard of care.

If the individual in Case Study 1 was eligible for NDIS funding then they would have the ability to direct their own care and provide adequate funding. This framework also has been constructed to take into account the relevant labour laws, as well as the regulatory and reporting requirements, so funding is broadly proportionate to the actual cost of the required standard of care.

Our sector, by stark contrast, has no Government funding mechanism, State or Federal, for our sector, let alone a mechanism that acknowledges that we are operating in a dynamic, and often highly challenging 24/7 care environment that

does not fit neatly into a nine-to-five framework. Pension income does not increase on the weekend; the cost of care does.

It is the bedrock of the philosophy of care that the individual should not be disadvantaged because of disabilities or other circumstances beyond their control.

This leads to a casino-like situation for individuals entering our systems of care. If they happen to fall into a classification where funding exists they will have a much different outcome than if they happen to fall between the cracks due to inadequate support frameworks and funding.

As a result, these individuals tend to bounce between different services including hospitals, ambulances, police, and various other Government and private facilities.

If the Government developed a consistent policy approach and provided adequate funding, these individuals could be provided a significantly higher level of care that includes early intervention that would be more cost-effective.

Lack of proactive support by Government agencies

Our sector can and does provide a safe, stable environment for our residents. Our sector is instrumental in reducing homelessness and preventing unnecessary hospital admissions. Our work directly contributes to the well-being of individuals and the overall efficiency of the healthcare system.

As frontline support workers we are very well-placed to help our residents manage their complex mental health issues, particularly when exacerbated by drugs and alcohol. Because we work with these residents on a daily basis, we are well-placed to identify issues and to provide early intervention that can prevent hospital visits and other related costs.

However, when we reach out to agencies such as mental health services for support for this early intervention, they are typically unable to assist because the person is not an active client. This often means that the resident’s condition needs to become so acute that they enter the hospital system before they become an active case for mental health services again.

We are exasperated by this and feel like the individual needs to ‘break’ (i.e. return to hospital) before they can be reassessed by mental health services. We see this cycle in action all the time and do our best to prevent it but in this case, we lack not just the financial support but also the pragmatic and proactive assistance from the services that could keep these individuals from leaving our facilities and entering another system.

With appropriate funding and support structures from related agencies, we could greatly reduce this cycle and provide long-term stable care for these residents.

Inadequate Funding Models

While robust funding models exist for aged care facilities and NDIS recipients, the Supported Accommodation sector is left to fend for itself. The current funding frameworks fail to recognize the unique challenges we face in providing care for individuals with complex needs.

When NDIS funding is unavailable for an individual, providers absorb substantial financial losses to maintain their support. This unsustainable practice leads to a decline in the quality of care we can offer, creating a vicious cycle.

A looming Industry Exodus

The population of people currently running services in the Supported Accommodation Sector are either ageing or on the cusp of burnout (physically and financially). These individuals are not being replaced by a younger generation because there are no economic incentives for people to enter the sector. Many facilities are currently for sale and many operations are likely to shut, putting more pressure on the sector.

This exodus threatens to leave vulnerable individuals without essential support.

Zero-Tolerance policies

The Public Advocate has raised a question about the role of zero-tolerance policies and their unintended consequences.

The Supported Accommodation sector staff are responsible for the care of individuals with complex needs and this comes with risks.

All Government Departments have robust policies to protect their staff from harm including verbal and physical abuse. Our industry has a similar duty of care to our staff as well as the other residents in our facilities.

The Skymac Group has a common sense policy around these behaviours but we do maintain a code of conduct that is designed to meet our duty of care to our residents and staff.

The Public Advocate acknowledges that our residents have complex needs. The professionals in our industry have the capability to meet these challenges but the

reality is that funding is required to achieve a good balance between maximising the outcomes of individuals while protecting staff and other residents.

As operators in the sector, we will unapologetically continue to walk this difficult line. Our approach is fundamentally the same as in Government agencies: that our staff have the right to a safe working environment and do not have to face the risk of physical and verbal abuse. We ask that this right be taken into account when reviewing so-called Zero-Tolerance policies.

Food Trucks versus Restaurants

The residents of Supported Accommodation facilities should have access to external providers and have choice and autonomy over their affairs. However, there appears to be a prevailing bias that this is, in fact, best practice.

While freedom of choice is an important standard for the residents and also encourages facilities to maintain and elevate their service offerings, there is an inherent consequence that puts further financial pressure on our industry.

As an analogy, imagine that you were running a restaurant. You provide facilities - tables, chairs; toilets; equipment - cutlery, glassware; services - table clearing, washing up.

However, there is a line of food trucks lined up outside. Customers order and pay the Food Truck operator for their meal and then come into the restaurant to eat.

The Food Safety Regulators then complain when the tables aren’t cleared or the toilets aren’t clean.

This is essentially the model that Supported Accommodation facilities are increasingly being expected to provide.

This is considered to be ‘Best Practice’ by the Regulators of our sector. Without providing an alternative source of funding, this is unsustainable and, frankly, unfair.

A Call for Adequate Funding

We firmly believe that the most efficient, consistent, and affordable solution is for the government to provide adequate and structured funding to the Supported Accommodation sector. Comparable models already exist in aged care facilities, and it’s high time similar support is extended to address the complex needs of our society’s most vulnerable members.

A Proposed Two-Tier Payment Model

In response to this pressing issue, we propose a two-tier payment model. Firstly, a rate per diem per bed to cover basic operational costs. Secondly, an additional rate based on bed occupancy designed to ensure that providers receive funding proportional to the level of care required.

This model needs to be consistent with schemes in related areas that acknowledge and account for the costs associated with compliance and of relevant labour laws.

Conclusion

The Skymac Group operates a high-quality service. Our service standards exceed the Regulatory requirements so that we can be a service of choice for our residents. At present, the only way we can achieve this is by prioritising applicants that have sufficient funding from sources such as NDIS.

We acknowledge that there are a range of operators in the industry and quality standards do vary. The Public Advocate questions whether there needs to be in increase in the standards but this begs two important questions:

Who is going to pay to meet these higher standards?
Is the solution greater regulation or more adequate funding?

The dilemma operators face is stark. To the extent they admit residents who lack viable funding the more they put their business model at risk and the more the quality of their service will spiral downward as a result.

In the main, our Sector comprises many talented and dedicated carers who work tirelessly to provide the highest quality care to our residents as possible. Our Sector is already well-regulated. We have the capacity and skill to help address many of the issues the Sector faces.

What we are asking for is a framework of adequate and consistent funding to provide the expected level of accommodation, food services and care.

We already have exemplars to refer to in related sectors: Aged Care and NDIS. These regimes already address many of the issues that face our Sector which have been highlighted in the Public Advocate’s Report. This includes funding mechanisms that acknowledge the complex needs of the recipients; and cost of compliance to the relevant regulations and the economic reality of complying to all relevant labour laws.

We simply ask that our sector be funded in a manner that is consistent with these principles. In this way, we can work together to stop the cycle that many of our most vulnerable members of society currently face: that they are unfortunate enough to fall between the cracks.

In conclusion, we implore the government to recognise the urgent need for improved funding in the Supported Accommodation sector. Our commitment to caring for some of society’s most vulnerable members remains unwavering, but we cannot continue to do so without the necessary financial support.

Thank you for your attention to this critical matter, and we hope for a swift and meaningful response.

Annexure 1: Benefits of providing robust funding to the Supported Accommodation sector

Cost-Effective Healthcare: Adequate funding for Supported Accommodation is not just a matter of social responsibility but also economic sense. When individuals with complex care needs receive appropriate support in a residential setting, it can prevent costly hospital admissions and emergency interventions. By investing in Supported Accommodation, the Government can ultimately save funds in the healthcare system.

Improved Mental Health Outcomes: Many individuals in Supported Accommodation face mental health challenges. Properly funded and staffed facilities can provide structured mental health support, therapy, and counselling, leading to improved mental health outcomes. This can reduce the burden on mental health hospitals and emergency services.

Social Inclusion and Community Integration: Adequate funding enables Supported Accommodation providers to organise community engagement programs, skill-building activities, and opportunities for residents to integrate into society. This social inclusion can lead to better mental well-being and reduced isolation, positively impacting overall health.

Addressing Substance Abuse: Many individuals in Supported Accommodation struggle with substance abuse issues. This often underlies their long-term mental and physical disabilities. With the right funding, facilities can implement harm reduction strategies.. This approach can mitigate the harm caused by substance abuse and reduce the strain on addiction treatment services.

Quality of Life: Adequate funding directly contributes to a better quality of life for residents. It allows for the provision of nutritious meals, comfortable living conditions, and recreational activities. These elements are essential for physical and mental well-being and can lead to fewer health complications over time.

Reduction in Homelessness: The Supported Accommodation sector plays a crucial role in preventing homelessness among vulnerable individuals. Adequate funding ensures that these individuals have a stable place to live, reducing the number of people living on the streets or in emergency shelters.

Safeguarding Human Rights: Adequate funding aligns with the principles of human rights and dignity. It ensures that individuals with complex care needs have access to the same standards of care and living conditions as others, promoting equality and reducing discrimination.

Workforce Development: Proper funding allows for competitive salaries and training for staff in Supported Accommodation facilities. This, in turn, attracts a skilled workforce and reduces turnover, which is beneficial for residents who require consistent care from trained professionals.

Reduction in Emergency Services Demand: Adequate funding can help prevent crises and emergencies among residents. This means fewer calls to emergency services and a reduced strain on paramedics, police, and emergency rooms.

Public Health and Safety: Well-funded Supported Accommodation services can enforce safety measures effectively, such as zero-tolerance policies for drug and alcohol use on the premises. This contributes to public safety by preventing incidents that might otherwise involve law enforcement.

In summary, advocating for a funding model similar to hospitals and aged care facilities for Supported Accommodation is not only about providing essential care but also about investing in a healthier, more inclusive, and cost-effective society. Adequate funding is an investment in the well-being and dignity of some of the most vulnerable members of the community, leading to better health outcomes and a reduced burden on emergency and healthcare services.

PROPOSED MODEL

for

GOVERNMENT SUPPORT

for

RESIDENTS of

PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

prepared by: Supported Accommodation Providers Association Inc

contact: Kay Johnston RN, BN, Dip Applied Science Nursing Mgt 3899 2060 (w) or redacted (h)

date: 29 January 2001

PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

Table of Contents

summary ………………………………………………………………………………………. i

1 INTRODUCTION 2 SUPPORTED ACCOMMODATION RESPONSIBILITIES CAN BE
DIVIDED INTO THREE DISTINCT CATEGORIES. 3 ASSISTANCE FOR BUILDING AND OTHER PHYSICAL
STANDARDS
3.1 Rationale 3.2 Funded Maintenance Model (Property Owners & Business Operators). 5
3.3 Government Funded Maintenance Rebates
3.4 Dollar for Dollar Capital Subsidies (Property Owner) 3.5 Access to Government Works / Training Programs (Property Owners
& Business Operators)
4 Reduced Utility Costs (Business Operators)
5 RESIDENT SUPPORT SERVICES
5.1 Previous Funded Service Delivery Models
5.2 Existing Service Delivery Models
5.3 Proposed SAPA Model for Resident Support
6 ROLES AND RESPONSIBILITIES
6.1 Funding
6.2 The Role of Auspicing Agencies
6.3 Access to Support Workers by Industry
6.4 The Role of Supported Accommodation Provider
6.5 Duties of Support Workers

prepared by: Supported Accommodation Providers Association Inc

contact: Kay Johnston 3899 2060 (w) or redacted

date: 29 January 2001

PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

7 COSTINGS ………………………………………………………………………………. 13 7.1 Cost of SAPA Proposals ………………………………………………………….. 13 7.2 Cost Comparisons with Current Funded Models …………………………… 13 7.2.1 Project 300 …………………………………………………………………………. 13 7.2.1 Not For Profit Supported Accommodation …………………………………. 15 7.3 Cost Comparison …………………………………………………………………… 15 7.4 Estimated Subsidy for Buildings ……………………………………………….. 16 7.5 Total Cost of SAPA’s Proposal …………………………………………………. 16 8 CONCLUSION …………………………………………………………………………. 18 APPENDIX 1 COST COMPARISON ………………………………………………. 19

prepared by: Supported Accommodation Providers Association Inc

contact: Kay Johnston 3899 2060 (w) or redacted

date: 29 January 2001

PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

SUMMARY

The supported accommodation industry provides essential accommodation and services to approximately 2000 disadvantaged people across the state, many of whom have disabilities and most of whom have social security payments as their only source of income.

This industry receives no funding from any level of government to assist them in meeting the support needs of residents. In fact over the years, additional burdens have been placed on the industry by government and by funded services redefining and narrowing their roles and range of services offered.

Supported accommodation facilities provide residents with accommodation, three meals a day, cleaning and laundry, plus personal supports such as assistance with medication, personal hygiene services, assistance with budgeting, making appointments, managing correspondence and forms etc., for approximately $25 per day. This is not a lucrative industry and additional demands are being made for improved standards and services as accreditation is introduced.

For this industry to be able to continue to provide services for this group of people and to be able to meet industry standards and accreditation requirements, we need assistance from government.

The attached submission proposes support at three levels:

improvement of services and supports for residents through carers auspiced and funded through appropriate non-government organizations;

assistance to maintain and improve the physical standards of premises, many of which are in prime locations close to residents services and networks, but many are also old stock which low margins make impossible to maintain and improve; and

reduction of utility costs, given that we house primarily pensioners, access to discounts and concessional rates would free up resources for other resident services.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

Our proposals will:

ensure the viability of this sector and reduce the likelihood that responsibility and costs for these 2000 people will be shifted to State Government (applying current Government service delivery models for these residents would cost in excess of $50 Million plus the capital costs of building suitable public housing in the vicinity of $100,000 per bed in Brisbane)

provide an outcomes’ focussed program which will be both cost efficient and effective in delivering improved standards and services for residents

ensure the success of the government’s proposed accreditation scheme to improve the standards, professionalism and accountability of our sector.

The total cost of our proposals is in the vicinity of $9.5 Million. We are prepared to discuss how these ideas could be piloted and evaluated before full implementation.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

Introduction

Private sector Supported Accommodation Facilities in Queensland provide housing for approximately 2000 people requiring support in various aspects of their lives. Many have disabilities related to mental illness and / or intellectual disability and some have age related needs. The residents are, almost without exception, dependent on social security pensions for their incomes. They represent, as has been well documented, a very vulnerable sector of the community and their needs have remained, to date, largely unmet by anybody except the providers of their housing. Often they are people with very challenging behaviours who have not fitted into the conservative environments of funded support facilities especially those managed by church based organisations. Many residents have very high support needs.

As government departments have restructured, what little help that was given to these residents through case management is now restricted to clinical response only. More than ever, operators of supported accommodation businesses are being expected to provide a level of care they are neither paid for nor have expertise to deliver. This situation is no longer acceptable to the supported accommodation industry, to advocacy organisations, or to the community at large.

As current models of funding for supporting people with disabilities continue to overlook this group or prove to be unworkable, we in the Supported Accommodation Providers’ Association (SAPA) have developed a support model the “Auspiced Carer Model” which we present for consideration by government for funding.

This model delivers support services, based on needs, directly to residents in a flexible, efficient, cost effective manner.

It significantly improves the quality of life of its target group by direct practical response to their long unmet needs.

It requires no further infrastructure.

It separates support from accommodation.

It does not improve profit margins for business operators at government expense.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

This model provides an ideal, affordable way for government to respond to the demands of advocacy groups recently lobbying very publicly on behalf of this group.

Estimated costs for this proposed model and costing comparisons with current models of support are included in this presentation.

In addition to meeting residents’ support needs, this proposal also addresses the community need to maintain this type of affordable housing stock in a safe and habitable state. Return on investment in this industry is significantly less than the norm for viability in the private sector, and is constrained by the social security dependence of its residents, therefore upkeep of buildings is a major financial concern. As accreditation demands better standards there will be the temptation for owners to succumb to the lucrative re-development offers which are available for these types of properties, rather than spend large amounts on investments showing poor returns.

We believe that for accreditation to be successful and the industry “cleaned up” there needs to be avenues for industry to access assistance from government to meet the associated increase in costs. Financial assistance could be used as incentive for improvements linked to specific accreditation goals. It should be directed at facilities which demonstrate commitment to the accreditation process.

We have presented a range of options for industry assistance in this area as well as an assistance model for resident services.

Supported Accommodation responsibilities can be divided into three distinct categories.

Property Owners Responsibilities

Business Operators Responsibilities

Resident Support Services

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Each of these has urgent and specific support needs if this model of accommodation is to meet standards required in today’s society and continue to provide essential housing. It has been estimated that to replace this model of housing and support would cost in the vicinity of $150 Million in today’s economy.

2.1 Property Owners are responsible for:

capital works; and

physical condition of buildings.

Holding these buildings against the tide of redevelopment requires financial injection (not achieved through current level of return) if indeed they are to survive in reasonable condition and meet standards for accommodation provision. The rate of return in this industry is not sufficient to encourage new development in present locations. It follows that if this model of accommodation is to continue in close urban areas, some form of assistance is required to maintain current stock in an acceptable state of repair and meet accreditation standards.

Current cost of replacement for an approved Department of Housing development in New Farm scheduled for construction this year is in the vicinity of $130,000 per bed.

2.2 Business Operators are responsible for:

hotel style services;

day-to-day operation of facilities;

delivery of agreed services; and

general standards of operation including repairs and maintenance.

For these businesses to remain viable and to keep up with required standards they also need incentives which will help to encourage long term investment in this industry. Business operators may or may not be the owners of the property.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

2.3 Resident Support Services in Supported Accommodation comprise:

personal care;

emotional support;

medication assistance;

access to primary health care;

secretarial support;

assistance with budgeting;

community access;

assistance with daily living activities; and

24 hour crisis response.

Many of these supports fall outside the agreed services provided by business operators and residents’ needs are often left unmet despite best attempts by operators to access funded supports for these residents. This leads invariably to business operators taking on responsibilities they are neither paid for nor have expertise in delivering. It has led to a situation in which this industry has been much maligned as it has struggled unassisted and in the absence of any alternatives, to provide an unrealistic level of support for residents with very complex needs.

Because these residents have been living in private sector accommodation it has been easier for funded support organisations to blame the industry for failing to meet their needs than to find the resources to support them.

Assistance for Building and other Physical Standards

3.1 Rationale

Most facilities are large buildings in desirable development areas. Over time much housing stock of this nature has been lost to new higher return developments. To retain these buildings which house people who need the infrastructure of urban living, it will be necessary to make it financially more attractive to maintain them than to sell them to developers.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

The cost of replacement with new buildings for this purpose is prohibitive to the private sector, given current rates of return on investment. The alternative of rebuilding in cheaper, outer areas leads to alienation of residents from their networks and further potential for disconnection to the community.

As a solution, we submit the following proposal which will help to maintain current buildings at a realistic and affordable cost.

3.2 Funded Maintenance Model (Property Owners & Business Operators)

Maintenance in these predominantly ageing buildings is a significant cost. Safety of residents is a priority. Operators, with resources limited by the social security constraints of residents’ incomes, balance costs and often find themselves able to meet only high priority issues, leaving many areas unattended and the industry the target of much criticism.

If these buildings are to survive and as a consequence affordable inner city housing is to be retained, it will be helpful if some form of assistance is given to the owners and or operators of these facilities to help meet maintenance costs. This could be by way of government maintenance rebates, dollar-for-dollar subsidies and direct access to government works/training programs.

All of these models could be linked to the industry accreditation improvement model and also carry contract provisions for the ongoing use of the building for housing.

3.3 Government Funded Maintenance Rebates

Operators would need to apply to the relevant government department submitting details of work carried out and receipts from bona fide tradesman for work completed on accredited facilities. Rebates could be reimbursement of the amount spent up to a ceiling limit. Auditing of this system is then simple; inspection of completed works could be undertaken before payments are processed. This could also become part of the following round of accreditation assessments. Much needed maintenance could be attended in this manner and standards of accommodation and safety would be raised significantly by using this model.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

Owners would need to sign agreement to continue current useage of property for a prescribed period to access maintenance rebate. Payback clauses need to be included with terms and conditions clearly stated and understood.

3.4 Dollar for Dollar Capital Subsidies (Property Owner)

This would operate in a similar fashion to the above described rebate system but would require the owners to fund 50% of the total expenditure. Capital expenditure such as the upgrading of ageing services related often to safety issues e.g. electrical wiring, plumbing and drainage upgrades could be carried out using this model.

Other large maintenance projects such as repainting a facility or replacing floor coverings could also be attended in this manner. Priority for these projects would be established on a needs basis putting safety issues foremost.

For larger amounts of subsidy, application could be made for approval of funding prior to work being undertaken.

Auditing of this work could be done by inspection of completed works prior to payment. Similar contractual arrangements and conditions to maintenance rebates could accompany this subsidy.

Some suggestions for funding priorities could include:

fire safety items;

new laundries;

commercial standard kitchens;

vented skylights;

electrical safety equipment;

secure storage facilities for residents;

installation of equipment for residents’ privacy; and

replacement of unsafe floor coverings.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

3.5 Access to Government Works / Training Programs (Property Owners & Business Operators)

We present the following modes of indirect funded support as options for maintenance/capital works to improve physical standards in Supported Accommodation Facilities.

Access to:

“work for the dole”;

training schemes (e.g. apprenticeships);

long term unemployed work projects;

Corrective Service Community Projects;

HACC funded Home Secure Services; and

subsidy per bed for maintenance/capital works.

4 Reduced Utility Costs (Business Operators)

In line with the Not For Profit Sector supported accommodation programs, concessional rates could also apply to the following costs for the private sector:

local authority rates;

low interest finance;

reduced charges for electricity, gas and water;

telephone account reductions; and

tax discounts (e.g. land tax, GST, income tax).

All our residents are pensioners and would be entitled to reductions in many of these costs if they were in single unit accommodation and many other concessions if they were housed in public rental housing.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

To reduce these costs for private sector supported accommodation providers would help to lower overheads and improve industry viability. This in turn would encourage business operators to look to a long term future in the industry and greater security of tenure for residents.

5 Resident Support Services

5.1 Previous Funded Service Delivery Models

In the past, the role of case managers provided by Queensland Mental Health and Disability Services Queensland to some residents of private sector supported accommodation was one of support worker as well as clinical manager. This role, with the restructuring of health and disability services has, over time, been reduced to clinical management only, with no funded uptake of their previous support role. This has created enormous pressure on facility operators to fill this gap using already over extended resources.

Case managers took responsibility for such services as shopping, help with secretarial tasks such as liasing with Centrelink and Public Trust Office, maintaining family networks by visits and letter writing, social outings, community access, and appointments for health related matters. These needs now go unmet unless attended by facility operators.

5.2 Existing Service Delivery Models

Case management by government employees has now been reduced to clinical management only. No provision for any other support is now included in this model.

Any other support for residents depends on the ability of facility operators to seek out and access services. This often proves to be a fruitless exercise and depends entirely on the goodwill and expertise of the operator.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

Individualised funding packages (Disability Services Queensland funding) for residents of supported accommodation are rare and appear to be neither cost efficient nor of significant benefit to residents. One example quoted by a facility operator describes the following scenario; “A support worker arrives to visit a resident and the particular resident chooses not to participate in activities planned by worker; the worker then spends the ($25.00 /hour) funded hours sitting, reading and drinking coffee (provided by facility). Because of the nature of funding i.e. “Individualised” the support worker has no obligation to offer services to other residents and facility manager has no right to request this. Not only does this create a situation of wasted funded hours which are so desperately required for other residents it also creates resentment and conflict between facility operator, resident and support worker and no perceived benefit to the resident.

Visiting Support Services are usually HACC funded. They provide personal care services to some residents of private sector supported accommodation. Many facility operators have found great difficulty in accessing these services for residents. Budget constraints of the funded agencies are given as the reason for refusal of requests for personal care.

When services are delivered to residents, lack of flexibility often causes breakdown. Often the resident is unmotivated, disorganised or mentally unwell or the bathroom is occupied by others who refuse to vacate when required. As time is a serious constraint for agency workers with scheduled clients waiting at other locations, these problems often lead to services for these residents being left unattended.

This model clearly does not offer the flexibility required in this environment nor does it allow sufficient time for adequate support for this group.

Visiting Support Services model of personal care delivery also lacks capacity for the establishment of lasting relationships of trust between client and carer because of staff changes and rostering. Residents in supported accommodation have profound needs for such relationships given the long term isolation many have suffered as a result of their illnesses. Many are suspicious and unsettled about being undressed by a succession of different attendants. This is another significant cause of breakdown of services.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

Community Linking Project is a newly funded initiative by Disability Services Queensland, specifically for residents of private sector boarding houses and supported accommodation. While this is a clear indication that government is recognising the needs of this sector, its chance of success will be limited if a flexible, workable model of in home personal care and support is not provided in tandem with this project. There is a need for residents to be ready both physically (showered and dressed appropriately) and mentally (motivated & willing to participate) for community access. The flexible SAPA model (following) can deliver this support and help to ensure the success of this project.

5.3 Proposed SAPA Model for Resident Support

The Auspiced Carer Model is proposed by SAPA (Supported Accommodation Providers’ Association) for funded service delivery to residents of private sector supported accommodation facilities. It is an outcome focused model which will provide optimum services for residents in a cost effective manner.

Benefits of SAPA model:

delivers direct on-the-spot needs-based services;

allows flexibility to accommodate labile nature of residents’ needs;

capacity to build relationships of trust between carers and residents;

ability to respond quickly to changing needs and emergencies;

maximises outcome potential with minimum cost;

ability to deliver a wide variety of services;

potential for facilitating personal development of residents;

enlarges the community contact of residents;

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

maximises success potential of other funded projects; and

eliminates waste of resources by flexibility to assist any resident in need .

Flexibility of delivery is its main focus with funds being used to provide direct on-the-spot support at an appropriate level and according to needs of individuals.

6 Roles and Responsibilities

6.1 Funding

Funding for resident support could be made available jointly by Disability Services, Queensland and Queensland Health. (Residents in supported accommodation are invariably clients of one or both of these government departments although many are not currently case managed under the current system.) Joint funding would eliminate the perennial problem of both of these government departments’ lack of ownership of the support issues for these residents. Equal contributions could come from each department and managed by an independent agency (e.g. Public Trust Office). These funds would then be available to approved Not For Profit organisations (Auspicing Agencies).

6.2 The Role of Auspicing Agencies

The role of Auspicing Agencies would be to access funding and employ support workers to meet the needs of residents in private sector supported accommodation. Support workers would work specifically in their allocated supported accommodation facility providing direct flexible service delivery on a needs basis to residents. Because workers would become a stable part of the residents’ environment, opportunity exists for establishment of trust between residents and carer, leading to greater cooperation and better outcomes. The time constraints of other models would also be overcome because of the ability of carer to be available for the length of a shift at the one place.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

Administrative responsibility and accountability for funding would be the responsibility of the auspicing agency. Auspicing agencies would need to be suitable Not For Profit Incorporated organisations. Project Micah and Boarding House Project Association Inc. have both indicated interest in this proposal.

6.3 Access to Support Workers by Industry

Access to Support Workers by Industry would be through the auspicing agency. Accredited supported accommodation facility operators would liase with the auspicing agency and ratio of workers required in that facility would be established collaboratively. (SAPA suggests a ratio in most facilities for adequate support would be in the order of one full time worker per ten residents).

Auspicing agency would then make application for funding to employ required number of support workers plus on costs. Suggested level within Disability Support Workers Award and SACS Award Level 2.1 (Personal Care Attendant)

6.4 The Role of Supported Accommodation Provider

The role of Supported Accommodation Provider would be one of Care Co-ordinator. This would entail liasing with residents or their agents to identify and document resident’s needs, then to access support workers to meet those needs through the auspicing agency responsible for that facility. Level of need varies in different facilities and between residents of the same facility. Referring agencies could also have input into assessment of residents’ needs.

6.5 Duties of Support Workers

Duties of Support Workers would be decided collaboratively by care co-ordinator and auspicing agency. Job descriptions would include personal care and grooming, organisation of personal effects, help with making and attending appointments, personal shopping etc. Hotel type services would continue to be the responsibility of the accommodation provider. Selection panel for employment of workers would include care co-ordinator and auspice representative. Job descriptions would be written and performance appraisals done regularly and jointly. An audit process would be established and could be linked to the accreditation process.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

SAPA suggests that this model be conducted as a pilot in a number of facilities to iron out problems and test ratios of carers per resident before commitment to full implementation.

7 Costings

7.1 Cost of SAPA Proposals

Using the “Auspiced Carer” model and SAPA’s estimated ration of carers to residents, each resident would receive an average of 3.8 hours of support per week or just over half an hour per day. Included in this would be personal care, lifestyle support and flexible response to individual needs. There is built in ability to divert resources to changing needs of individual residents.

Cost of Resident Support Services using SAPA’s Auspiced Carer Model we estimate would be a maximum of $7.5 Million per annum for delivery of optimum support services to 2000 adults throughout Queensland or $3,750 per resident per year.

7.2 Cost Comparisons with Current Funded Models

Project 300

Project 300 is a funded project to support 300 clients discharged from long term psychiatric hospitals. It has achieved only 66% of its target but uses 100% of its budget!

Figures as at January 16, 2001 show 199 clients receiving:

$10.5 Million for support packages;

$1Million to fund host agencies;

$500,000 for training and advocacy; and

$15,000 per person for public housing (averaged over 10 years, total cost $150,000 per person).

This is an average cost of $75,000 per person per year. Total amount of recurrent funding is $12 Million (excluding cost of public housing).

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

Project 300 provides the following support services to its clients:

accommodation support, including 24 hour response;

assistance with cleaning, washing and cooking where necessary;

help with shopping and access to other commercial facilities;

assistance with banking, budgeting, bill paying and financial management;

access to recreation and social activities and linking to the wider community;

help with using public transport to community services and recreation activities;

access to training and further education facilities and services; and

facilitating access to employment programs.

(source: Project 300 Handbook 1996, “Moving from Hospital to Community”)

Project 300 clients have very similar support needs to those in private sector supported accommodation facilities. Many long term patients of Wolston Park, while awaiting Project 300 placement have spent considerable periods in private sector facilities to assist with transition from hospital to community.

There are many examples of project 300 clients being housed in private supported accommodation facilities because of their difficult behaviours or to provide respite for their carers. It needs to be recorded that, invariably, their funds for support have not flowed on to the providers of their care when they move to this model of accommodation. A ludicrous situation exists where funds of $60,000 per year fail to provide required support, usually because of very challenging behaviours, the client is then moved to a facility which has no access to funding.

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7.2.1 Not For Profit Supported Accommodation

Not For Profit Supported Accommodation also houses residents with similar needs to those in private sector facilities. Cost to government for this model per resident over 10 years is $883,535 or $88,353 per resident per year.

Endeavour Foundation describes its accommodation support services thus: “This support is flexible, tailored to the needs of the person at the particular time. It includes domestic support as well as personal support. This ranges from assistance with basic self care and household tasks to recreation and community access”.

(source: Endeavour Service Support Information, January 2001)

There are also many examples of residents moving from this model of accommodation to private sector facilities often citing “dissatisfaction with services” as the reason for moving.

7.3 Cost Comparison

Current cost to government in Private Sector Supported Accommodation per resident over 10 years is $7,280 or $728 per resident per year.

Thus the cost to government of the Not For Profit form of supported accommodation is 121 times higher than the cost of the private sector alternative. This does not reflect less obvious other benefits such as tax discounts which are also available to the Not for Profit sector.

This enormous difference in cost to government does not equate to lower costs for residents. In the Not For Profit supported accommodation sector despite the $85,000 per year per resident received from government actual charges to residents are only $1.26 less per week than in the private unfunded sector.

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PROPOSED MODEL FOR GOVERNMENT SUPPORT FOR RESIDENTS OF PRIVATE SECTOR SUPPORTED ACCOMMODATION FACILITIES

7.4 Estimated Subsidy for Buildings

SAPA has estimated the amount of subsidy required for upgrading and maintenance of current buildings used for supported accommodation to acceptable standard for accreditation. We suggest an annual amount of subsidy of $1,000 per resident be made available for maintenance and or capital works up to a limit of $30,000 per facility. The estimated number of private sector supported accommodation beds in Queensland is approximately 2000 (HIDU data base) which equates to a cost to government of a maximum of $2 Million to keep existing housing stock and upgrade standards significantly.

7.5 Total Cost of SAPA’s Proposal

Total cost of SAPA’s proposals to government = $7.6 Million for resident support services +

$2.0 Million for building works

Maximum Total = $9.6 Million

This money would improve housing and deliver high levels of personalised support to 2000 very vulnerable people at the annual maximum cost to government of just $4,800 per person per year.

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Cost Comparisons to Current Funding Models

Existing Funding *

Not for profit Supported Accommodation $88,353 per person per year

Project 300 $75,000 per person per year

Private Supported Accommodation $728 per person per year

source: David Renfrey and Associates, Cost of Accommodation and Care Alternatives for People with Intellectual and Psychiatric Disabilities 1998

SAPA’s Proposed Funding

Private Supported Accommodation $4,800 per person per year

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Conclusion

The on-going absence of government support for this sector will inevitably lead to industry collapse and these 2000 residents requiring the high cost models which currently fund similar citizens. This proposal entails co-operation between the private sector and government to deliver an acceptable level of accommodation and services and has benefits for all.

It benefits residents by upgrading their homes, improving their quality of life, and addressing their currently unmet needs.

It benefits supported accommodation providers by providing resources to improve buildings and increase support services to residents.

It benefits government by providing a model to support and house people with a disability at an extremely reduced cost compared with currently operating models.

It offers the capacity to help retain inner city low cost housing options.

Figures quoted in this proposal are available from the Hostel Industry Development Unit’s independent analyses conducted by Price Waterhouse Coopers and David Renfrey & Associates Pty Ltd. in October 1998 and updated in October 2000.

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Appendix 1 Cost Comparison

Costs Comparison of Providing Accommodation

Costs per Resident over 10 years	Private Supported Accom	Not For Profit Supported Accom
Capital cost (cost of providing the building expressed per bed)	$ 12 155	$ 55 556
Total provider cost (total cost to the service provider)	$ 60 520	$ 700 280
Total Government cost	$ 7 280	$ 883 535
Total individual cost (in rents charged)	$ 85 420	$ 84 760
Net cost of service over 10 years	$ 79 995	$ 745 121
Net present value (at 8% over 10 years)	$ 56 749	$ 514 140

(Note: This table has been condensed.)

The 1998 David Renfrey and Associates Report, Cost of Accommodation and Care Alternatives for People with Intellectual and Psychiatric Disabilities identified the costs associated with providing accommodation across the Government. The study made cost comparisons for a range of accommodation alternatives and compared the cost to the resident and the cost to Government and the community to provide the service on the basis of a discounted cash flow over a period of 10 years. The cash-flow costs are brought back to net present value (NPV). This provides a measure of the cost over 10 years expressed in current day dollars by applying a discount rate which reflects the cost of finance and the likely acceptable rate of return that Government or a private operator may accept when the risk of the investment is accounted for.

source: David Renfrey and Associates, Cost of Accommodation and Care Alternatives for People with Intellectual and Psychiatric Disabilities 1998

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prepared by: Supported Accommodation Providers Association Inc

contact: Kay Johnston 3899 2060 (w) or redacted date: 29 January 2001

Department of Communities

RESIDENTIAL SERVICES STAKEHOLDER ADVISORY COMMITTEE

Minutes of Meeting

9 March 2007

Attendees
Kerry Batchler	Department of Communities(DoC)
Helen Warneke	Department of Communities(DoC)
Tina Oppes	Department of Communities(DoC)
Lorraine Gorman	Supported Accommodation Providers Association
Damien Negus	Supported Accommodation Providers Association
Karen Webber	Disability Services Queensland (DSQ)
Deborah Barrett	Public Advocate (JAG)
David Breen	Residential Tenancies Authority
Kirrily Booker	Department of Premier and Cabinet
Janelle Klein	Community Visitor Program (JAG)
Melissa Yim	Office of the Adult Guardian
Penny Carr	Tenants Union Queensland
Carolyn Perry	Tenants Union Queensland
Frances Ingram	Department of Housing
Nicole Randall	Department of Housing
Jenny Mulkearns	Queensland Health
Laura Stevens	Queensland Health
Amanda Croker	Queensland Health
Theo Haralampou	Office of Fair Trading
Mariella McTavish	Department of Local Government, Planning, Sport and Recreation
Michelle Kennedy	Department of Emergency Services

Apologies:
Karin Swift	QDHC
Tim Feely	Public Trustee
Leesa Mills	Queensland Police
Yvonne Zardani	Australian Pensioners and Superannuants League
Terry Ryan	JAG
Janet Frost	Local Government Association of Queensland
Roslyn Wallace	Property Owners Association
Anna Dean	Boarding House Owners and Managers Association
Greg Wagner	QDN

Summary actions arising from RSSAC Meeting March 2007

No.	ACTION	WHO	DUE DATE	STATUS
1	DOC to amend minutes from 26 September RSSAC meeting to reflect SAPA’s comments.	DOC	16 March 07	Actioned
2	Members to email Theo Haralampou (`redacted` ; OFT) regarding suggested amendments to the OFT spreadsheet and statistical needs.	ALL	31 March 07	Actioned
3	DOC will distribute membership contact details to members out of session.	DOC	31 March 07	Actioned
4	DOC will invite QH (Jenny Mulkearns) to Residential Services Evaluation Working Group meetings.	DOC	16 March 07	Actioned
5	Public Advocate (Deborah Barrett) to contact DSQ (Sue Brady; `redacted`) to discuss concerns relating to researcher’s contacting residents.	Public Advocate	23 March 07	Actioned
6	DOC will seek feedback from members regarding the consultation methodology for the final evaluation out of session.	DOC	15 June 07	Actioned – to be included under Agenda Paper 4B
	DOC and DSQ will request that the researchers present their initial research findings and report progress regarding the unmet needs project and final evaluation at the next RSSAC meeting.			To be discussed at September RSSAC meeting
7	DOH to advise SAPA regarding the outcomes of discussions with the Minister for Public Works, Housing and Information and Communication Technology regarding any change to the conditions of the fire safety sprinkler grants.	DOH	31 March 07	Actioned
8	DOH to provide SAPA with advice regarding the take up of the DOH financial assistance packages.	DOH	31 March 07	Actioned
9	DOH to provide SAPA with advice regarding release of the third viability of the residential services sector report.	DOH	31 March 07	Actioned – report released.
10	RTA to provide members with information regarding the two prosecutions currently underway in the sector.	RTA	31 March 07	Actioned – to be included as Agenda Paper 5D.
11	DSQ request that CentaCare contact SAPA.	DSQ	23 March 07	Actioned
12	DOC will lead development of a good practice guide to assist level 3 operators with their responsibilities regarding medication.	DOC	15 June 07	Actioned
	DOC will provide a draft version for discussion at the next RSSAC meeting.
13	CVP to provide advice to DOC regarding provision of medicines, access to medical	CVP	31 March 07	Actioned

treatment and allied health services and ensure these issues are relayed to the consultant undertaking the DSQ research into unmet needs.

1 Introduction and Apologies

Kerry Batchler fulfilled the role as Chair in Anna Moynihan’s absence. Kerry welcomed all members to the 17th meeting of the Residential Services Stakeholder Advisory Committee (RSSAC) and acknowledged apologies.

2 Minutes of previous meeting

SAPA (Lorraine Gorman) requested a minor amendment to the minutes from 26 September 2006. Amendment to page 6, third last paragraph to read “mortgage their properties”, not “mortgate their business”.
Minutes otherwise supported by members.

Action 1. DOC to amend minutes from 26 September 2006 RSSAC meeting to reflect SAPA’s comments.

3 Business arising from previous meeting

Action item 1. QH, TUQ, SAPA and CVP submitted a response to Synergies Economics (consultant) for the DSQ Public Benefit Test.
Action Item 2. The Department of Communities informed members that it was unable to distribute its submission to the DSQ Public Benefit Test.
Action Item 3. To be discussed as part of agenda item 6b.
Action Item 4. DLGPSR (Natalie Wilde) advised SAPA out-of-session of the frequency with which fire safety sprinklers need to be inspected (once a month).
Action Item 5. SAPA (Damien Negus) wrote to the Premier requesting that his residential service which was previously a nursing home be removed from the QFRS inspection registry. Damien advised that three properties are linked to this registry – one at Highgate Hill, Ipswich and his property. Premier declined request.
Agenda Item 6. DSQ advised SAPA out of session of the staged implementation of the RSP.
Agenda Item 7. Medication guidelines to be discussed under agenda item 6F.
Agenda Item 8. Members to email OFT (Theo Haralampou redacted) regarding the statistics which are required and suggested improvements to the OFT spreadsheet.
Members requested that membership/contact details be distributed.
Action Item 9. DES (Michelle Kennedy) advised that residential services are inspected until buildings meet compliance levels. Residential services then enter into an inspection program, with properties inspected every three years. A notice of inspection is sent to the owner three weeks prior to inspection. The only other time a property is inspected is to investigate a complaint or to conduct a familiarisation inspection. Inspections will examine fire safety management plans and maintenance inspection reports. AS1851 – lists how often maintenance checks of fire sprinklers need to be checked. This Australian Standard can be obtained from the QFRS website.

Action Item 10. Members were advised that a workshop will be held on 27 March 2007 at MICAH (South Brisbane) with SAPA, QPS (Sargeant Dull), and the Coroner’s office to discuss strategies for minimising resident distress following a death in a residential service.

Action 2. Members to email OFT (Theo Haralampou redacted) regarding the statistics which are required and suggested improvements to the OFT spreadsheet.

Action 3. DOC to distribute membership contact details to members out of session.

4 Research and evaluation activities in the residential services sector

DOC (Helen Warneke) advised that there are three major pieces of research being undertaken with the sector in the first six months of 2007.

DOC final evaluation

DOC advised members that it is in the process of engaging a consultant to undertake the final evaluation of government reforms in the residential services sector. The Final Evaluation will assess impact on reforms on operators and residents. Researchers will be engaged to undertake the research that will include consultation with the sector. The project is expected to be completed by August 2007.

DSQ research into unmet need

The University of New South Wales has been engaged by DSQ to conduct research into the unmet service needs and profile of residents in residential services. Susan Brady (redacted DSQ) is engaging with the consultant to develop the methodology for the research project. The consultants will also be undertaking consultation and fieldwork in the sector, with research to be completed in August 2007.

DOH Responding to Homelessness

Members were advised that the DOH research would have limited impact on the sector in 2007. Christopher Banks (redacted DOH) is the contact officer for the project.
DOC has established a Residential Services Evaluation Working Group to ensure that consultation within the sector is coordinated. The Senior Executive, Residential Services Reform committee will oversee the research into unmet need and the final evaluation.
QH (Jenny Mulkearns) requested that she be invited to attend the Residential Services Evaluation Working Group meetings.
Public Advocate (Deborah Barrett) raised concerns about previous researchers making inappropriate contact with residents. DSQ (Karen Webber) advised Public Advocate’s office to contact Sue Brady with their concerns. DOC (Helen Warneke) reassured members that ethical clearance was to be obtained prior to research commencing in the sector.
SAPA (Damien Negus) requested that the sector be advised in advance if researchers were going to be conducting research on their premises. DSQ (Karen Webber) advised that industry had been informed of the research through RSSAC.
Members agreed to:

Provide feedback to DOC on the consultation methodology for the final evaluation out of session; and

Provide feedback regarding the initial findings of final evaluation and research into unmet need.

The DOC will request that the researchers attend the next RSSAC meeting to report on progress and present their initial research findings.

Action 4. DOC to ensure QH (Jenny Mulkearns) is invited to Residential Services Evaluation Working Group meetings.

Action 5. Public Advocate (Deborah Barrett) to contact DSQ (Sue Brady; redacted) to discuss concerns relating to researchers’ contacting residents.

Action 6A. DOC and DSQ will seek feedback from members regarding the consultation methodology for the final evaluation out of session.

Action 6B. DOC and DSQ will request that researchers report on progress and present their initial research findings at the next RSSAC meeting (June 15).

5 Updates on the industry – A provider’s view

SAPA (Damien Negus) raised concerns about the viability of the residential services sector, in particular level 3 services. SAPA discussed the South Australian government subsidy offered to service providers (approx $10 per person per day, up to $100K per service provider).
SAPA referred to various government reports (e.g., DOH viability report) and in particular the Hostel Industry Development Unit’s report which identified a range of different initiatives. In the main, SAPA contends that government has established systems and structures to monitor an industry (e.g., accreditation and registration) which is in rapid decline, yet provides little financial assistance to the sector.
SAPA stated that there is no DG or Minister interested in supporting the sector. SAPA therefore questioned the usefulness of additional research/evaluation activities, particularly where there is no champion to implement the recommendations. SAPA maintain that government is contributing to homelessness by not assisting residential service providers.
SAPA requested that various industry incentives be considered. For example, permanent land tax rebates for level 1 and 3 services; bed per day subsidies (e.g. as provided by the South Australian Government); or grants for capital improvements (e.g., 100% rebate for fire safety sprinklers).
Public Advocate acknowledged the issues raised by SAPA.
The Chair (Kerry Batchler) advised that government is focussing on homelessness and mental illness and developing initiatives to respond to these community issues. The Chair advised members that RSSAC, as an advisory body is not able to action SAPA’s requests.
The Chair agreed to note the recommendations contained in the agenda paper and the concerns raised by SAPA. The DOC and DSQ suggested that these issues be raised with the consultants’ undertaking the evaluation and research projects.

6 Updates of key reports

Item 6A, 6B and 6H (DOH).

DOH reported no closures in progress.
DOH is seeking the Minister’s approval to change the conditions of the grant and DOH is to soon consult with SAPA regarding the outcomes of these discussions.
DOH advised RSSAC members that the financial assistance packages will soon cease (this does not include the sprinkler grants). SAPA requested that the DOH provide advice regarding the numbers of providers who took up the financial assistance packages.
SAPA noted that when developing grants or assistance packages, the conditions of the grants must be reasonable to ensure the industry takes up the offers. Where there is a poor uptake of grants, the government needs to examine why this is the case.
DOH is seeking advice from their Minister regarding the release of the Viability of the residential services sector reports. The final viability report is to be completed in June 2007.

Action 7. DOH to advise SAPA regarding the outcomes of discussions with the Minister for Public Works, Housing and Information and Communication Technology regarding any change to the conditions of the fire safety sprinkler grants.

Action 8. DOH to provide SAPA with advice regarding the take up of the DOH financial assistance packages.

Action 9. DOH will provide SAPA with advice regarding release of the third viability of the residential services sector report.

Item 6C (TAASQ)

TAASQ reported that as at 31 January 2007, 1130 households were assisted in the 2006-07 financial year, with the majority of clients accessing services residing in boarding houses.
CVP (Janelle Klein) and TUQ (Penny Carr) advised RSSAC that residents fear reporting complaints due to potential retribution.
SAPA offered TUQ to advertise their services through their industry body.

Item 6D (RTA)

RTA (David Breen) advised RSSAC that the Policy Review Paper for the Residential Services (Accommodation) Act 2002 was released in October 2006. The consultation period was extended to allow for late submissions.
RTA is currently preparing a report for their Minister outlining the outcomes of the consultation process. RTA could not advise, at this stage, when this report would be made public. A submission is due to Cabinet later in the year which will include a Bill to amend the Act.
It was noted that the RTA was conducting two residential service prosecutions. RSSAC members requested further advice regarding the details of these prosecutions.

Action 10. RTA to provide members with information regarding the two prosecutions currently underway in the sector.

Item 6E – DSQ/QH

DSQ (Karen Webber) stated that redacted extra funding had been provided to three service providers in the central, redacted north and south Brisbane regions. SAPA advised that CentaCare had still not been in contact.
Public Advocate (Deborah Barret) and CVP (Janelle Klein) identified levels of unmet need with respect to personal services delivered in residential services (e.g., podiatry services).

Action 11. DSQ request that CentaCare contact SAPA.

Item 6F (QH)

QH (Jenny Mulkearns) advised that it is conducting information sessions with district mental health workers to inform workers of the guidelines for managing mental health clients in the residential services sector.
QH (Amanda Croker) also advised of the potential changes that the Health and Community Care program may undergo as a result of Machinery of Government changes.
DOC advised RSSAC members that QH has advised that the draft Medication Guidelines for the residential care sector remain subject to Director-General approval.
In acknowledgement that this issue has not significantly advanced, the RSSAC Chair proposed to take leadership of this issue by developing a good practice medication guide which will satisfy registration and accreditation requirements and QH standards.
DOC will progress by organising a workshop with stakeholders (e.g., QH, OFT, SAPA, CVP and Adult Guardian) to develop the guidance material. Environmental Health Unit (QH), OFT and SAPA indicated support for this approach.
SAPA reiterated that they wish to be involved in the development of the guidelines and that it would not be feasible for registered nurses to be required to deliver medication.
DOC will seek advice from legal services to ensure no inadvertent legal implications for providers and DOC in developing these guidelines (e.g., transfer of liability).
DOC to provide draft material for discussion at the next RSSAC meeting (June 15).

Action 12: DOC will lead development of a good practice guide to assist level 3 operators with their responsibilities regarding medication. DOC will provide a draft version for discussion at the next RSSAC meeting.

Item 6G - CVP

CVP (Janelle Klein) discussed their agenda paper including training programs recently conducted by the CVP and continued development of the Program’s database.
CVP also raised concerns regarding provision of medicines, access to medical treatment, allied health services and alternative housing options for residents.

Action 13. CVP to provide advice to DOC regarding provision of medicines, access to medical treatment and allied health services and ensure these issues are relayed to the consultant undertaking the DSQ research into unmet service needs of residents.

Item 6I – OFT

OFT (Theo Haralampou) advised members that site visits are on schedule with a majority of service providers (e.g., 98%) responding to registration or accreditation issues within a day of undergoing inspection.
SAPA raised concerns regarding the discrepancy in figures produced by OFT, particularly in relation to the numbers of service providers in level 1, 2 and 3 services. OFT agreed to provide clarification to members regarding the current status of registrations/accreditations.

Action 14. OFT to clarify for members the number of registrations/accreditations in level 1, 2 and 3 residential services.

Item 6J – DES

DES (Michelle Kennedy) advised members that the Budget Accommodation Building (BAB) project finished on 31 December 2006.
Given that the project has finished, it was decided that a final joint DES/DLGPSR BAB paper be prepared for the next RSSAC meeting.

Action 15. DLGPSR and DES to prepare a final joint DES/DLGPSR paper on the BAB project for the next RSSAC meeting.

Item 6K – DLGPSR

DLGPSR (Mariella McTavish) thanked members, particularly SAPA for their assistance throughout the BAB project.

6 Other Business

Penny Carr (TUQ) advised members that the Residential Tenancies Act is under Review and distributed pamphlets for members’ information.
Members also requested advice regarding whether the Residential Services Accreditation Act was to be reviewed.
SAPA requested that the Brisbane City Council attend meetings. RSSAC Chair (Kerry Batchler) advised members that it would examine whether membership on RSSAC was specified in previous cabinet submissions.
DOC will distribute RSSAC contact list to members and will request that each agency to identify one member.

Action 16. OFT to advise members whether the Residential Services Accreditation Act is to be reviewed.

Action 17. DOC to examine whether RSSAC membership is identified in previous cabinet submissions.

Action 18. DOC to distribute RSSAC contact list to members and request that each agency identify one member.

Meeting closed 4.10pm

7 Next Meeting

15 June 2007.

Skymac Pty Limited submission on structured funding models and operational sustainability in supported accommodation

Let’s get down to brass tacks: who is paying for all this?

Executive Summary

The Reality on the Ground

A Vital Gap Filled

The reality of costs

No Funding = Cutting Corners = Poor Outcomes for Residents

Heartbreaking decisions

Case Study 1

The dumping ground of the industry

A banging drum

Capping the amount of Pension Income that can be spent on Supported Accommodation

Falling between the cracks

Lack of proactive support by Government agencies

Inadequate Funding Models

A looming Industry Exodus

Zero-Tolerance policies

Food Trucks versus Restaurants

A Call for Adequate Funding

A Proposed Two-Tier Payment Model

Conclusion

Annexure 1: Benefits of providing robust funding to the Supported Accommodation sector

SUMMARY

Introduction

Supported Accommodation responsibilities can be divided into three distinct categories.

2.1 Property Owners are responsible for:

2.2 Business Operators are responsible for:

2.3 Resident Support Services in Supported Accommodation comprise:

Assistance for Building and other Physical Standards

3.1 Rationale

3.2 Funded Maintenance Model (Property Owners & Business Operators)

3.3 Government Funded Maintenance Rebates

3.4 Dollar for Dollar Capital Subsidies (Property Owner)

3.5 Access to Government Works / Training Programs (Property Owners & Business Operators)

4 Reduced Utility Costs (Business Operators)

5 Resident Support Services

5.1 Previous Funded Service Delivery Models

5.2 Existing Service Delivery Models

5.3 Proposed SAPA Model for Resident Support

6 Roles and Responsibilities

6.1 Funding

6.2 The Role of Auspicing Agencies

6.3 Access to Support Workers by Industry

6.4 The Role of Supported Accommodation Provider

6.5 Duties of Support Workers

7 Costings

7.1 Cost of SAPA Proposals

7.2 Cost Comparisons with Current Funded Models

Project 300

7.2.1 Not For Profit Supported Accommodation

7.3 Cost Comparison

7.4 Estimated Subsidy for Buildings

7.5 Total Cost of SAPA’s Proposal

Cost Comparisons to Current Funding Models

Conclusion

Appendix 1 Cost Comparison

Summary actions arising from RSSAC Meeting March 2007

1 Introduction and Apologies

2 Minutes of previous meeting

3 Business arising from previous meeting

4 Research and evaluation activities in the residential services sector

DOC final evaluation

DSQ research into unmet need

DOH Responding to Homelessness

5 Updates on the industry – A provider’s view

6 Updates of key reports

6 Other Business

7 Next Meeting