Background

NDIS as a “for profit” cost model is disadvantaging those with a lesser degree of disability, where the lower value package does not give the same potential for profit as a high needs package. My experience has been through my brother’s disability journey.

Initially he was 24/7 care with a NDIS package well over $200K. His support requirements were seldom missed and his plan well managed by his plan coordinator. He received supports for accommodation, care, medical appointments and rehabilitation. While my brother had some issues with the quality of some of the supports, the reliability of his supports was good.

His personal journey focussed completely on rehabilitation, declining social activities to focus of making himself the best he could be. The reward was a reclassification to enable my brother to live independently. His next package still exceeded $200K in case he could not maintain this independence. Fortunately he did, and only used 32K of that package.

His recent NDIS review reduced his package to $22K. With the planning session held with the support director it was calculated he could use:

1.  Two hours per week support for physical rehab,
2.  Two hours per week for shopping,
3.  a total 30 hours for guide dogs support, and
4.  Two hours per week for social integration.

Situation

The new package required an implementation plan in October 2018. We expected there would be minor teething problems, particularly since most his needs are at scheduled and routine timings. This is not the case, and measuring performance since October 2018 as a KPI would be: 1. Support for physical rehab = 85% supports supplied. This is 44 out of 52 hours 2. Support for shopping = 35% supports supplied. This is 13 out of 37 hours. 3. Social integration = 0% supports supplied. This is 0 out of 18 hours (estimated)

The support reliability dropped almost immediately from the moment the lower value plan came in. At one time he was informed that two hours is too short for a support worker for the one of his supports. When he agreed to use three hours despite being more than he needs, there was no improvement in supply of services.

The worth of his NDIS package is apparent in the notice given for services not supplied. Mostly it is only a few hours, and at times there is no notice at all and he has been left standing on the street waiting. The emotional stress this puts on him is disturbing.

Consequence

My brother’s needs are expected to continue as his new “normal” for the rest of his life. While he did not choose to be like this, his needs are quite simple:

     1. Shopping helps him eat,
     2. Physical rehab builds and maintains his capability, and
     3. Social interaction is hoped to help build his social confidence to maybe even one day contribute in some form.

If we just look at the current support levels supplied, he can eat a third of his diet requirements, will gain some physical strength back, and never socially integrate.

There is a real concern that the supports not supplied will create a false economy of his needs at the next NDIS review, further impacting his independence and confidence.

The emotional cost is an unmeasured aspect. The current circumstances has at times left my brother traumatised and insecure. It is enough that he realises that life used to be different, but it is difficult for him to come to terms that he now feels like a second class citizen.

Conclusion

While the NDIS scheme was to fix the old system, the level of support described above leaves a vulnerable person at risk and insecure. In this case, not spending the funding is not a savings. It is a failure of the Disability network to supply. I find it hard to fathom that this would be a one off case.

 How many more low value plans are leaving NDIS participants without the support expected?

 How are we measuring value for money for the services supplied?

It seems apparent to me that low value NDIS grants are of lesser interest to profit focussed care providers. The NDIS funding might be there, but from a support business perspective there seems to be “no money in it” when compared to more complex needs.

It’s one thing for service providers to register with the NDIS scheme to supply a service stream - that opens the cheque book to be written in. Even if the value is a commitment for funds availability only, there needs to be a method to measure the value for money promised.

There is a vast contrast between supplying 24/7 live-in care to 6 hours per week. It appears when service provider’s business models are placed to facilitate more intensive support services, there is a struggle for them to have a separate business model for low intensity support requirements. Those with lesser needs, such as facilitating an activity like shopping, or a social outing could be better managed through a support network where their business model is focused on these needs.

An option would be to introduce a new service available to provide these supports, or build on current supports already available. For example, my brother was taught to use the disability bus that operates in the ACT. Unfortunately it does not help him here as at times he still requires assistance and his needs are outside the zone allocated to his area.