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SDA Eligibility Guidance
How to support R&N decision making for SDA Eligibility
Specialist Disability Accommodation (SDA) is designed to support people with extreme functional impairment or very high support needs who meet the SDA Needs Requirement (Section 14 of the SDA Rules) and need to live in a specially designed house. The combination of SDA and other supports must provide greater benefit in achieving a participant’s goals and outcomes than what alternate support options, (without SDA) would provide. A participant is unlikely to meet the SDA Needs Requirement (Section 14 of the SDA Rules), if alternative support options have not been considered. Alternative support options to SDA include (but are not limited to):
• Assistive Technology and Home Modifications • Home ownership • Private rental • Government Housing options • Community Housing options Prior to considering Specialist Disability Accommodation (SDA) eligibility, it is important to consider whether the housing support is most appropriately funded by the NDIS, rather than private ownership or rental, other government or community services. The Applied Principles and Tables of Support (APTOS) and NDIS (Supports for Participants) Rules 2013, provides clear principles surrounding funding roles and responsibilities across the NDIS, other government and community services.
These principles include:
- Social housing providers will be responsible for providing accessible accommodation for people in need of housing assistance in line with existing allocation and prioritisation processes, and consistent with universal design principles and liveable housing design standards as outlined in the National Disability Strategy 2011-2020, including appropriate and accessible housing for people with disability, routine tenancy support, and ensuring that new publicly-funded housing stock, where the site allows, incorporates Liveable Design features.
- Housing and homelessness services will continue to be responsible for homelessness- specific services, including through homelessness prevention, outreach and access to temporary and long-term housing for people who are homeless, or at risk of homelessness.
- Parties responsible for community infrastructure will continue to improve the accessibility of the built and natural environment (including roads and footpaths) through planning and regulatory systems and through building modifications and reasonable adjustment where required.
- The NDIS will be responsible for support to assist individuals with disability to live independently in the community, including by building individual capacity to maintain tenancy and support for appropriate behaviour management where this support need is related to the impact of their impairment/s on their functional capacity.
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- The NDIS will be responsible for home modifications required due to the impact of a participant’s impairment/s on their functional capacity in private dwellings, in social housing dwellings on a case-by-case basis and not to the extent that it would compromise the responsibility of housing authorities to make reasonable adjustments.
- The NDIS is also responsible for user costs of capital in some situations where a person requires an integrated housing and support model, and the cost of the accommodation component exceeds a reasonable contribution from individuals.
- The NDIS and the housing system will work closely together at the local level to plan and coordinate streamlined services for individuals requiring both housing and disability services recognising that both inputs may be required at the same time or through a smooth transition from one to the other.
The NDIS (Specialist Disability Accommodation) Rules 2020 states that a participant is eligible to receive support for SDA under the NDIS if the participant:
- has an extreme functional impairment or
- has very high support needs and
- the participant meets the SDA needs requirement.
When determining if a participant meets the requirement for extreme functional impairment or very high support needs, as outlined in the Supports Funded by NDIA, an assessment is to be based directly on the impacts of the participant’s disability.
It is important to note that if a participant meets an extreme functional impairment and or very high support needs, they may not meet the SDA Needs Requirement. All criteria within the SDA Needs Requirement must be deemed reasonable and necessary, when compared to alternate supports.
NDIA cannot fund supports based on the following:
• the responsibility of another government system or community service. • not related to a person’s disability. • relates to day-to-day living costs that are not related to a participant’s support needs, or • is likely to cause harm to the participant or pose a risk to others.
Extreme Functional Impairment
The SDA Rules 2020 and the SDA Operational Guideline provide clarification on the SDA eligibility of a participant based on whether the participant has an extreme functional impairment. A participant is considered to have an extreme functional impairment if:
- the impairment results in extremely reduced functional capacity to undertake, or psychosocial functioning in undertaking, one or more of the following activities: a. mobility – such as walking, climbing stairs, getting in and out of a bed or chair, carrying or moving items and getting out of the house; b. self-care – such as bathing, toileting, dressing, eating and drinking, talking and taking medication c. self-management – such as housework, following routines, making friends and relationships, maintaining boundaries and managing behaviour and;
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- the participant has a very high need for person-to-person supports in undertaking the activity even with assistive technology, equipment or home modifications.
To assist with assessing whether a participant has an extreme functional impairment, it is important to review the evidence provided by the participant. This may include:
• any assessment or examination conducted in relation to the participant such as a relevant functional capacity assessment and/or behaviour support plan. • the daily support requirements of the participant; and • any assessment tools undertaken in relation to the participant. • any other evidence deemed appropriate.
Very High Support Needs
The SDA Rules 2020 and the SDA Operational Guideline provide clarification on the SDA eligibility of a participant based on whether the participant has very high support needs. The SDA Rules 2020 state that a participant has very high support needs if:
-
the participant has lived in SDA for extended periods and living in that accommodation has impacted on the capacity of the participant to transition to alternative living arrangements and support; or
-
the participant has a very high need for person-to-person supports, either immediately available or constant, for a significant part of the day and either: a) there are limitations in the availability, capacity or capability of the participant’s informal support network or risks to its sustainability; or b) the participant is at risk or poses a risk to others, and that risk could be mitigated by the provision of specialist disability accommodation, having regard to the participant’s response to risk and the interaction of the participant with the environment.
To assist with assessing whether a participant has very high support needs, it is important to review the evidence provided by the participant. This may include:
• any assessment or examination conducted in relation to the participant such as a relevant functional capacity assessment or behaviour support plan. • the daily support requirements of the participant; and • any assessment tools undertaken in relation to the participant. • any other evidence deemed appropriate.
SDA Needs Requirement
The SDA Rules 2020 and the SDA Operational Guideline provide clarification on the SDA eligibility of a participant based on whether the participant has met the SDA Needs Requirement. The SDA Rules 2020 state that a participant meets the SDA needs requirement if, when compared to other supports alone, combined SDA and other supports would:
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a) better assist the participant to pursue the goals, objectives and aspirations set out in the participant’s statement of goals and aspirations; and b) be more effective and beneficial, where possible, in: i. mitigating or alleviating the impact of the participant’s impairment upon the participant’s functional capacity; and ii. preventing the deterioration of the participant’s functional capacity; and iii. improving the participant’s functional capacity; and iv. maintaining or promoting the participant’s ability to build capacity, including in the medium or long term; and v. maintaining or promoting the participant’s opportunities to develop skills; and c) if the participant has very high supports needs—be more effective and beneficial, where possible, in: i. reducing the participant’s future needs for supports which might be required due to inappropriate accommodation; and ii. assisting the participant to pursue goals related to life opportunities and life transitions; and d) if the participant has an extreme functional impairment—be more effective in providing the participant with stability and continuity of support; and e) represent better value for money. When considering the SDA Needs Requirements for e) ‘represent better value for money,’ regard must be had to the following matters if the participant has an extreme functional impairment or very high support needs:
- whether combined SDA support and other supports would be likely to substantially improve the life stage outcomes for, and be of long-term benefit to, the participant;
- the cost of providing the participant with supports needed to live in accommodation other than specialist disability accommodation, considering: i. whether those supports may be shared with other participants; and ii. limitations of the participant’s informal support network.
Does SDA help the participant better pursue their goals, objectives and aspirations?
It is important to review the SDA Operational Guideline to determine whether funding SDA will support the participant to pursue their goals, objectives and aspirations. The following considerations should be applied when determining whether the support is Reasonable and Necessary (R&N), under s34 of the NDIS Act 2013:
• What is stopping the participant from living in a standard home that is not specially designed? • Are there other supports that are more aligned to the participant’s goal, objective or aspiration such as home modifications or assistive technology? • Will a specially designed house reduce the need for other supports compared to where the participant currently resides? • Does SDA help to pursue other goals within the plan?
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Is SDA more effective and beneficial?
It is important to review the SDA Operational Guideline to determine whether funding SDA is effective and beneficial for the participant. The following considerations should be applied when determining whether the support is R&N:
Is it likely to reduce the impact of the participant’s disability on their daily life?
Will SDA improve the participant’s functional capacity i.e. the things the participant can or cannot do because of their disability, or stop the participant’s functional capacity from deteriorating?
Will it support the participant to learn new skills and abilities over the medium to long-term? Will SDA maintain the level of informal supports?
Will SDA reduce the amount of funded support required i.e. less levels of person-to-person care may be required if the correct SDA is provided.
Will SDA pursue major life events for the participant i.e. moving out of home with a partner?
Is SDA value for money?
It is important to review the SDA Operational Guideline to determine whether funding SDA is value for money for the participant, when compared to the cost of other supports. The following considerations should be applied when determining whether the support is R&N:
Will other parts of the plan result in less funded supports?
Will the cost of other funded supports reduce?
Will funding the SDA assist the participant to be more independent for longer?
Will funding the SDA support the participant to maintain informal supports and relationships?
Will funding the SDA affect the total cost of all supports in the plan?
SDA Design Categories
There are 4 Specialist Disability Accommodation design categories. These are:
PWNS
Improved Liveability Fully Accessible Robust
High Physical Support
The NDIS Pricing Arrangements for SDA 2023-2024, provides further information about the minimum design requirements for each of these SDA Design Categories:
Definition Minimum Requirements
Improved Housing that has | e Liveable Housing Australia ‘Silver’ level. Liveability | been designed to|, the designed environment responds to the needs of
improve ‘liveability’ | participants through improved physical access and by incorporating €! enhanced provision for participants with sensory,
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Minimum Requirements
reasonable level of physical access and enhanced _ provision for people’ with sensory, intellectual or cognitive impairment.
intellectual or cognitive
impairment. For example, Improved Liveability dwellings should include one or more additional design features such as luminance contrasts; improved wayfinding; and/or lines of sight depending on the needs of the participants:
Fully Accessible
Housing that has been designed to incorporate a_ high level of physical access provision for
people with significant physical impairment.
Liveable Housing Australia ‘Platinum’ level.
External doors and external outdoor private areas to be accessible by wheelchair.
Bathroom vanity/hand basin to be accessible in seated or standing position.
Power supply to doors and windows (blinds), for retrofit of automation as necessary.
Consideration must be given to whether it is appropriate for the kitchen sink, cooktop, meal preparation bench area and key appliances (dishwasher, oven, microwave oven and laundry appliances) to be accessible in seated or standing position.
Robust
Housing that has been designed to incorporate a_ high level of physical access provision and be very resilient, while reducing the likelihood of reactive maintenance and reducing the risk to the participant and the community.
Liveable Housing Australia ‘Silver level.
Resilient but inconspicuous materials that can withstand heavy use and minimises the risk of injury and neighbourhood disturbance including:
— high impact wall lining, fittings and fixtures (e.g. blinds, door handles);
— secure windows, doors and external areas;
— appropriate sound proofing if residents are likely to cause significant noise disturbances (if required must retro-fit in new builds if not previously installed at building stage); and
— laminated glass.
Layout with areas of leaving or retreat for staff and other residents to avoid harm if required.
Consideration must be given to providing adequate space and safeguards throughout the property to accommodate the needs of residents with complex behaviours.
High Physical Support
Housing that has been designed to incorporate a_ high level of physical access provision for
people with significant physical impairment and
Liveable Housing Australia ‘Platinum’ level.
External doors and external outdoor private areas to be accessible by wheelchair.
Bathroom vanity/hand basin to be accessible in seated or standing position.
Power supply to doors and windows (blinds), for retrofit of automation as necessary.
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Design Definition Minimum Requirements
Category
requiring very high |e Consideration must be given to whether it is appropriate levels of support. for the kitchen sink, cooktop, meal preparation bench area and key appliances (dishwasher, oven, microwave oven and laundry appliances) to be accessible in seated or standing position.
e Structural provision for ceiling hoists. e Assistive technology ready.
e Heating/cooling and household communication technology (e.g. video or intercom systems) appropriate for the needs of residents.
e Emergency power solutions to cater for a minimum two hour outage where the welfare of participant(s) is at risk.
e Doors with 950mm minimum clear opening width to all habitable rooms.
Version control Version Amended by Brief Description of Change Status
JIF358 ISDA Eligibility Guidance document developed toDraft for06/02/2024 Support delegates make R&N decisions based onjconsultation ISDA Rules and Operational Guidelines.
0.2 |ELO148 Edits to examples Draft 08/02/2024
0.3 WIF358 Included feedback on document from HaLjDraft 22/02/2024 Practice Improvement Working Group
0.4 WIF358 Included feedback on document from HaLDraft 13/3/2024 Practice Improvement Working Group
0.5 |ELO148 Edits to examples Draft 08/04/2024
1.0 |ELO148, JIF358 [Final Final 22/04/2024
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