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Minutes of Home and Living Reference Group Meeting 4 — 26 June 2023

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DOCUMENT 8 Independent Advisory Council

Minutes of Home and Living Reference Group

Meeting 4 — 26 June 2023 12.30pm — 4.45pm, MS Teams videoconferencing

Reference Group Members:

Ms Leah Van Poppel, Principal Member & Co-Chair Dr Leighton Jay, Co-Chair Dr Sharon Boyce Adjunct Associate Professor Jennifer Cullen Mr Mark Tonga Mr Peter Gregory Ms Grace Mills Associate Professor Mary-Ann O’Donovan Ms Pat Sutton Dr George Taleporos Mr Peter Tully Mr Robbi Williams Ms Leanne Pearman Ms Rebecca Evans

NDIA Representatives:

Mr Tim Stork, Branch Manager, Performance Management and Quality (Session 2) Mr Ed Duncan, Branch Manager, Operations and Housing Support (Session 2) Dr Sam Bennett, General Manager, Policy, Advice and Research (Session 4) Mr Ross redacted: s47F - personal privacy, Director, Agency Policy (Session 4) Ms Penelope McKay, DCEO Market Stewardship and Home and Living (Session 3 and 4) Ms Kathy redacted: s47F - personal privacy, Director, Strategic Advice, Policy, Advice and Research Ms Gemma redacted: s47F - personal privacy, Assistant Director, Independent Advisory Council (IAC) Secretariat Ms redacted: s47F - personal privacy, Assistant Director, IAC Secretariat

Attending:

Ms Anna Burke, acting as IAC’s Independent Consultant

Apologies:

Ms Liz Dutton Mr Alan Blackwood

Delivered by the National Disability Insurance Agency

FOI 23/24-1307 Independent

Advisory Council

1. Co-Chair’s welcome and open

1.1. Principal Member’s welcome and update

Dr Leighton Jay opened the meeting at 12.30pm as Chair of today’s meeting, noting redacted: s47F - personal privacy

Ms Jennifer Cullen provided Acknowledgement of Country.

Dr Jay noted apologies from Liz Dutton, Leah van Poppel and Alan Blackwood.

Dr Jay noted that the update to the Reference Group membership will be confirmed soon and thanked members for their patience.

Dr Jay noted Penelope McKay, Deputy CEO Market Stewardship, and Home and Living, will attend the meeting from 2.30pm. The agenda has been adjusted so Ms McKay can be in attendance for member reports.

1.2. No co-chair welcome.

1.3. Minutes confirmation and Declarations of interest

Members confirmed the minutes from the previous meeting – Meeting 3 – 17 May 2023.

Matters arising from the previous meeting were noted, and there were no new Declarations of interest.

2. Intraplan inflation in relation to Supported Independent Living (SIL)

2.1. Intraplan inflation in relation to SIL

Dr Jay welcomed Ed Duncan, Branch Manager Operations and Housing Support and Tim Stork, Branch Manager Performance Management and Quality to the meeting.

Mr Stork provided an explanation of the inflation that can occur in existing plan (intraplan) or between plans (interplan). A written brief was provided with data from the Scheme Actuary.

Mr Stork noted:

  • The Agency has been looking these issues over last two years.
  • Intraplan inflation often occurs with spending on core supports, or on quotable items. It is more commonly seen when a plan is reduced.
  • With core supports intraplan inflation often happens when provider changes the number of hours of support or ratio of support.
  • Interplan inflation is more common with section 100 requests and Administrative Appeals Tribunal.
  • Intraplan inflation is less predictable so potentially harder to understand or control. It may not always be a bad thing, but the Agency needs to understand the cause.
  • Participants who have a complete change of circumstance will likely fall into this data.

Members noted:

  • Questions about where most inflation is occurring. For example, if it is for legitimate reasons such us degenerative condition or change in informal supports, or other issues, eg. provider activity.
  • There is a need for the Agency to address the indexation element in a better way.
  • Concerns that the Agency often provides additional funds in the next plan when inflation occurs.

In regard to SIL Mr Duncan noted:

  • When a person requires additional supports in their home, or they need to move to short-term SIL due to change in circumstances, plan funds are used up much quicker than expected.
  • There is intraplan inflation occurring in 38% of plan reviews.
  • Impacts of previous plan decreases is a significant cause of inflation.
  • The Agency has seen a 41% increase in home living, and many requests are due to change of circumstances.
  • The current housing crisis is potentially driving some of this as SIL is an opportunity to have a home.
  • Ratios in SIL supports can cause inflation, eg, when funded for 2:1 but receiving 1:1 support.
  • The better planning initiative (Reform for Outcomes) should aim at identifying issues early and addressing issues early.

Members noted:

  • The need to make plan managers more accountable for managing plan funds over the plan period.
  • NDIS Quality and Safeguards Commission is a significant stakeholder in this work. However, there is a lack of follow up when complaints are made.
  • The need to link this work with other areas of the Agency, such as those leading the hospital interface and Justice work.
  • Also need to consider homeless, those as risk of homelessness and those requiring palliative care.
  • Questions about the methodology of how the Agency decides reasonable and necessary supports.
  • Concerns that it is not fully understood what it takes to support people with complex needs.
  • Providers are charging for a large range of non-face to face activities. For example, not providing ‘back of house’ supports that should be expected (eg. team meetings) without the participant incurring additional costs.
  • There is a need to provide information in accessible formats and easy read. It is vital the participant fully understands their plan.

3. What you’ve heard

3.1. Issues Members have heard in their communities

Members noted:

NDIS access and planning

  • The need for future care planning, particularly among people with disability who have ageing parents. There is a need to consider supported decision making, reliable supports and information about supports for these people.
  • Reports that planning does not encourage independent living, especially for those with psychosocial disability.
  • There is inconsistent information about how people can and cannot use their NDIS plan funding. The disability community require clear information, in accessible formats, for equal information access.
  • There needs to be consistent decision making about SIL and SDA.

NDIS service and supports

  • The significant impact that circles of support around a person can provide to a person, particularly for people with complex needs and ageing parents.
  • Concerns around safety and quality of supports with reports that some people with disability are sleeping in their mobility chairs even though they have multiple service providers.
  • In relation to hospital discharge, there is a need for the various support roles to work in a more coordinated way. For example, hospital liaison officers, aged care, planners, navigators etc., should work together to provide streamlined supports.
  • There is a lack of appropriate accommodation, particularly core and cluster, for people with psychosocial disabilities.
  • There is a need for NDIA to acknowledge the risk of homelessness for people with disability and work closely with states and territories and mainstream services to address the issue.
  • Concerns around the power imbalance and sense of intimidation a person with disability feels when they go to the Administrative Appeals Tribunal.
  • Calls for NDIS and NDIS Quality and Safeguards Commission to do more to stop service providers who overcharge participants for services, above the NDIS Pricing Arrangements and Price Limits. For example, misconduct in charging for crossover shifts, SIL supports, assistance with daily living.
  • Calls for the more clarity around the recently released [NDIS SDA Pricing Review 2022-23 Final Report (2.3MB DOCX)](NDIS SDA Pricing Review 2022-23 Final Report (2.3MB DOCX)). Particularly for people with disability who have SDA and want to update existing housing or want to live in a one-bedroom house.
  • The information in the appendix to the SDA Pricing Review report needs to be accessible.
  • Current individualised living options (ILO) are not being applied the Consumer Price Index. The ILO price brackets have not changed as far as members are aware. There has been no increase in the guidelines.
  • There seems to be a disconnect between different parts of Agency about how home and living is operationalised.
  • There is a need for a navigator position for people with psychosocial disability or cognitive impairment. This person can provide accountability to ensure the support allocated is properly provided to the participant.
  • There is a lack of flexibility in NDIS plans, in shifting core and capacity building funding in particular.
  • In regard to the pathway out of SIL, people find themselves trapped into what we would have referred to previously as forced co-tenancies.

SDA AND SIL practices and quality

  • Concerns about quality of supports in SIL and SDA.
  • Reports the NDIA tells some people with assistance dogs that they need to live in SDA, despite wanting to rent appropriate properties through ILO supports.
  • Reports there is a lack of choice and control and supply in supported independent living (SIL) dwellings.
  • The short-term nature of property leases in the open rental market means it is very difficult to obtain long term rental accommodation for participants who qualify for SIL funding. Every time a participant moves and is removed from a familiar environment it often significantly impacts their quality of life.
  • Providers are using inappropriate practices and advertising techniques to fill vacancies in SIL.
  • Concerns that SDA providers are only focussed on money. Some companies build SDA apartments as a means only to get people into that space, however there is no community resources around them.
  • Lack of flexibility around the use of core supports, particularly where a person is in a 1 to 3 SIL arrangement and funding for behaviour support plans.
  • Some participants are having a positive experience, for example a family member has interstate and is receiving SDA funding to live independently in and SDA apartment for the first time.

Action 1: Identify any work or communication the NDIA is doing with others in the sector to address the issue of lack of long-term rental options for participants who quality for SIL funding.

4. Home and Living Framework

4.1. Update on the Home and Living Framework and Implementation

Ms McKay was welcomed back, along with Ross redacted: s47F - personal privacy Director Agency Policy, to present on the Home and Living Framework (the Framework). Ms McKay first responded to questions raised in the previous session in relation to the SDA Pricing Review:

  • As ILO is not priced as a package the cost is made up of the priced items that are included for the participant.
  • An SDA owner can have a property reclassified as a new build if over 45% of the new build price is spent on renovations.
  • The SDA price guide does not include one-bedroom homes as they are not readily available, they are villas and apartments. There is a gap where the dwelling has one participant living with others who are not participants, this still needs to be reviewed.

Ms McKay provided an update on the Framework, noting:

  • The Framework document is comprehensive, and the co-design work that has gone into creating it is commended.
  • The Framework has been to the Senior Leadership Team (SLT) who made the decision it should go to Board.
  • The NDIS Review team Agency had been in discussion as the release of the Review outcomes gets closer, and there is no indication that Framework is out of alignment with the Review.
  • Regarding timing of release of the Framework, considering the Review and the Royal Commission, it is not about priority but the sequencing that is significant.

Mr redacted: s47F - personal privacy noted that:

  • The new framework includes some minor changes regarding housing supply, language and formatting.
  • Following the SLT outcome, the business ownership of the Framework will move into Ms McKay’s group, Market Stewardship, and Home and Living.
  • When the Agency talks about legacy stock, this is the 6+ bedroom housing that is being transferred from States. The next element is how do we work to ensure participants have access to inclusive housing.

Members praised the co-design approach of the NDIA to finalise the Home and Living Framework and Implementation Plan.

Members noted concern that if the NDIA waits on outcomes from the NDIS Review and Disability Royal Commission this work may be lost. There is a need to ensure the group can continue to co-design and walk alongside the Agency in implementation.

In regard to the SDA Price Review report members noted:

  • Concerns you cannot live alone in a one bedroom home according to the SDA price guide. The house option is only there if you are sharing with other people. You need to live with another person to qualify for SDA.
  • Concerns this is a supply and demand issue, if it was priced these dwellings may be available.
  • This is an issue for people in criminal justice system who are required to live alone.
  • When putting in evidence for reasonable and necessary support, is it clear that there are certain dwelling types and living arrangements that suit different people. For example, a single person dwelling with overnight assistance.
  • Robust housing should not be a housing option, only a short to medium term support.

5. Meeting close

5.1. Other Business

N/A

5.2. Next Meeting

The Chair thanked Reference Group members for their participation today, acknowledging that this will be the last meeting for some members.

The next meeting is scheduled for 14 September and is online.**

The meeting closed at 4.45pm.

** Meeting date later changed to 18 September 2023