NDIA Accountability Project

Recommendations for Independent Assessments

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Dear Sir/ Madam

Attached, for the Committee’s consideration, is our Association’s submission on Independent Assessments. Our submission was also made to the NDIA consultation on Independent Assessments.

Supportive Families and Friends Association Inc (SFF) is a volunteer-run not-for-profit support association. It is for families of adults with a disability who live in Specialist Disability Accommodation (SDA) in Victoria. We have been in operation for more than 10 years.

SFF was formed by a group of families in the Eastern Metropolitan Region in Melbourne, who had a family member living in disability accommodation managed by the Victorian Government. Our original name was the Supportive Families and Friends Association Eastern Metropolitan Region Inc. The focus of our advocacy was the Eastern Region office of the then Department of Health and Human Services (DHHS).

Following the decision by the Victorian Government to transfer the management of group homes to non-government providers, and the introduction of the NDIS, the focus of our attention shifted to the central offices of the Victorian Government. In 2019, members resolved to change the name of the Association to its current name. Our focus is now Victoria-wide.

Through its advocacy for families and residents, SFF has gained widespread respect in the Victorian disability community. We have developed strong relationships with the Victorian Minister for Disability, Luke Donnellan, the Minister for Health and former Minister for Disability, Martin Foley, Members of Parliament, senior officers in the Victorian Departments of Premier and Cabinet, and Families, Fairness and Housing (formerly DHHS), the Office of the Public Advocate (Victoria), the Office of the Disability Services Commissioner (Victoria), NDIA, NDIS Quality and Safeguards Commission, National Disability Services (NDS), Health and Community Services Union (HACSU), VALID, service providers and other disability agencies.

SFF was invited by the Victorian Minister for Disability to be a member of the NDIS ITF Participants with Complex Needs sub-working group, which was later reconstituted as the NDIS ITF Participant Needs and Mainstream Interface Working Group,. The Minister also invited SFF to be a member of the Government’s Stakeholder Advisory Committee, which oversaw the transfer of the management of group homes to non-government providers.

in 2020 SFF made a submission to the Joint Standing Committee concerning Supported Independent Living (SIL). In its General Issues Report of December 2020, the Committee referred to several of the key issues raised in the Submission (Chapter 1 para. 20).

Regards, Phil Lipshut President Supportive Families and Friends Association Inc.

www.supportivefamilies.org.au

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22 February 2021

To the Manager Community Consultations National Disability Insurance Agency Geelong, Victoria, 3220 Via online

Dear Manager,

Re: Consultation on Access and Eligibility Policy with Independent Assessments

We welcome this opportunity to comment on this important initiative, which has been posted on the NDIS website. Supportive Families and Friends Association Inc accepts the need for changes in the assessment process to improve fairness but does not support the approach outlined.

About us

Supportive Families and Friends Association Inc (SFF) is a volunteer-run not-for-profit support association. It is for families and extended families of adults with disabilities who live in Specialist Disability Accommodation (SDA) in Victoria. We have been in operation for more than 10 years.

The scope of our support and advocacy includes, but is not limited to:

  • SIL staffing ratios and skill levels in SDA.
  • Supported Independent Living (SIL) quoting process.
  • Lack of transparency about contract performance by service providers.
  • Safeguards in SDA homes and with SIL staff.
  • SDA Residency Agreements.
  • Residential Tenancies Act 1997 and tenants with a disability.
  • Vacancy Management.
  • Dedicated transport resources for residents in group homes (in place in Victoria for many years)
  • Crisis issues, such as Covid-19 risk management

Supportive Families and Friends Association Inc

ABN 20 573 694 289

  • Inadequate service provision, particularly for residents without independent advocates.
  • The unmet need for Independent Advocacy, which is essential for many residents to benefit fully from the NDIS.

We have an ongoing relationship with the NDIA, senior officers in the Victorian Departments of Health and Human Services (DHHS) (recently renamed as Families, Fairness and Housing (DFFH)) and Justice, the Victorian Public Advocate, the Victorian Disability Services Commissioner, National Disability Services (NDS), Health and Community Services Union (HACSU}, many SIL & SDA providers, and other disability service and advocacy agencies.

We have ongoing communication with the Victorian Minister for Disability, Luke Donnellan, who raises our concerns and others, when meeting with the Council of Australian Governments (COAG) Disability Reform Council.

SFF is a member of the Victorian Government NDIS ITF Participant Needs and Mainstream Interface Working Group and the Victorian Government Stakeholder Advisory Committee.

Feedback

The SFF has decided not to respond directly to the questions in the Consultation Paper, as they presuppose that the Independent Assessments are a good thing for people with intellectual disabilities living in group homes (SDA). The SFF does not hold that view. Additionally, this consultation is seen as superficial, as it is only about how to deliver the assessments (fait accompli) rather than whether the assessments, as proposed, will meet the needs of people with a disability.

The SFF cohort is adults living in Supported Disability Accommodation (SDA) in Victoria., The nature of their permanent disability is typically well documented. Another assessment by the NDIA would be a duplication of effort,

Our members are extremely worried about the potential adverse consequences of the Independent Assessments, as they have been described in the Framework1 and Consultation Paper.!

1 IA Framework https://www.ndis.gov.au/participants/independent-assessments/independent-assessment-framework

The following are our concerns, with a focus on the implications for SDA and SIL budgets:

  • We question the value in reassessing this cohort in terms of the SDA and SIL components of their NDIS budget. How would a new layer of assessment help the residents at this stage of their lives? These residents/participants are now residing in accommodation that suits their established level of functioning. Most would have plenty of capacity related assessments on their files already. Some of them have already moved out of congregate care into these group homes. A new type of assessment is a stressor for all concerned and a costly activity, of questionable value to residents.
  • There is no evidence that that the new process will deliver better outcomes for people living in SDA homes for either the SIL, community access or other NDIS supports. There is a risk that their supports could reduce if the assessment was done poorly and did not identify their needs.
  • Many of the residents are non-verbal and have limited ability to communicate. If they do not have an impartial advocate to support them in the assessment, it is unclear how they will be assessed. This is a risk for them. There is nothing to prevent them from being worse off, despite having already supplied adequate reports in the past,
  • Even the residents who can communicate, may not be able to fully comprehend the purpose of the assessment. They may not be able to give informed responses if they could not understand the abstract consequences of their responses. Some responses may be inappropriate due to a misunderstanding of the question in the first place. If the full picture of their functional impairment is not detected by the assessor, the consequences on their support arrangements could be detrimental to them. The case studies included in the Consultation Paper (a woman in W.A requiring a wheelchair, and a young man in Queensland with autism spectrum disorder are not representative of our family members living in SDA.
  • The Assessor’s suitability for the task of interacting with a cognitively impaired person is entirely unclear. No criteria or standards have been made public; An unsuitable assessor may not be able to draw out the true circumstances for each individual. Particularly as the time proposed for each assessment is noticeably short for these clients who have significant impairments. The Consultation Paper (par 2.1) acknowledges that people with a disability may have information provided by a variety of health professionals including doctors and specialists. It is a simplistic approach to believe that an Assessor drawn from one discipline can be substituted for experts from a range of disciplines.

The NDIS Paper2 has indicated that, in accordance with an insurance model:

  • Requiring people to use only one Government commissioned supplier of assessment takes away a Participants choice and control, which is a central principle of the NDIS.
  • It seems that only the Independent Assessment will be used to determine a Participant’s budget. This is not enough information on which to fully understand a person’s needs.
  • The approach is unfair in that the results of the assessment would not be fully shared with the Participant and there would be no right of review with the AAT.
  • It is of concern that the assessment seems to be being used for two purposes, access and budget level. The SFF has not seen any evidence that the tools in use can be used to define a budget.
  • There has been a general lack of transparency by the NDIA on this topic. We were not consulted, despite being one of the more expensive cohorts in the NDIS. We understand that even though there was a pilot done, the full results have been withheld from the public. This does not inspire confidence in the integrity of the NDIA on this topic.
  • Many people who live in group homes have autism. We note that the autism advocacy bodies have serious reservations about the suitability of the approach. They have not endorsed the approach. Nor has advocacy agency, VALID, or the Victorian Public Advocate.
  • Eligibility reassessments will be conducted using this new Independent Assessment process. The Paper states “A participant will be supported to transition out of the NDIS if they no longer meet the residence, disability or early intervention requirements of the NDIS.” This suggestion is alarming to SFF members as a false result in an assessment could have serious ramifications for residents. The SFF is not confident about the actual independence of assessors paid for by the NDIA/ government. There is a potential conflict of interest where the provider could have a bias towards the results preferred by their employer, i.e. a reduction in NDIS costs which the Minister has alleged are too high, instead of really seeking to understand the disabled individual and their life circumstances.
  • My experience working in Occupational Rehabilitation, where WorkCover recipients were required by their WorkCover Insurer to attend an “independent assessment” conducted by a specialist nominated by the Insurer has made me extremely sceptical of “Independent Assessments”. In that sector, the reports were consistently biased in favour of the Insurer paying for the assessment.

2 Consultation Papers located on https://www.ndis.gov.au/community/have-your-say/access-and-eligibility-policy-independent-assessments

Recommendations

As already stated, the SFF is not in agreement with the proposed approach as it currently stands. But the SFF has some recommendations, below:

  • The SFF appreciates that some people who need SDA, or other supports may not have been granted an adequate NDIS budget in the past due to an inability to obtain an assessment(s). The SFF supports optional assessments with the government provider.
  • The NDIA should ensure that a resident living in SDA who needs to supply a new assessment, has an independent advocate present to support them during the process. Currently, there is an acute shortage of funding of independent advocacy.
  • Residents in SDA should be given a choice about which provider they want to conduct an assessment, using the tools preferred by the NDIA.
  • The resident should be allowed to supply supplementary assessments, which must be considered by the NDIA as part of budget determination.
  • Residents with a limited capacity to communicate should be exempt from Independent Assessments. They may wish to supply other reports as evidence for the supports needed to meet goals apart from maintaining safe and stable accommodation.
  • The NDIA should recognise that there is a baseline of SDA and SIL funding needed for any resident. It would save time, effort, and money to have a predictable baseline budget (i.e., SDA and SIL funding baseline). Any additional SIL requirements could be dependent on the supply of supplementary information. This would give a resident choice and control because, upon knowing their accommodation budget, they could seek quotes from other providers if they wish to choose another.
  • The NDIA should stop all changes to the NDIS Act until it has engaged in genuine consultation with the disability community and has independent evidence that the new approach will deliver better outcomes for vulnerable, intellectually disabled people.

If you have any questions or require clarification about the above, I am happy to be contacted.

Yours sincerely,

Phil Lipshut

President