SDA market readiness challenges and quality safeguarding | External submission

SUMMER FOUNDATION SUBMISSION TO THE JOINT STANDING COMMITTEE ON THE NATIONAL DISABILITY INSURANCE SCHEME

February 2018

Contact Name: George Taleporos

Contact Title: Policy Manager

Table of Contents

EXECUTIVE SUMMARY ……………………………………………………………………………………………………………….4 How this submission is structured ………………………………………………………………………………………………………………………………………… 4 What the submission recommends ……………………………………………………………………………………………………………………………………….. 4

SECTION 1 – INTRODUCTION ……………………………………………………………………………………………………7 About the Summer Foundation and Summer Housing ……………………………………………………………………………………………………… 7

SECTION 2 – SPECIALIST DISABILITY ACCOMMODATION: A VISION FOR A NEW MARKET …………………………………………………………………………………………………………………………………………….. 9 Eligibility for SDA ………………………………………………………………………………………………………………………………………………………………………. 9 A vision for SDA ………………………………………………………………………………………………………………………………………………………………………….. 9 A consumer driven market …………………………………………………………………………………………………………………………………………….. 9 A diverse range of quality housing in the community ……………………………………………………………………………………………….. 10 An informed, responsive and innovative market ………………………………………………………………………………………………………… 10 Consumers are empowered, informed and supported ………………………………………………………………………………………………. 10 The current market …………………………………………………………………………………………………………………………………………………………… 11

SECTION 3 – SDA MARKET READINESS CHALLENGES: THE ROLE OF THE NDIA AS MARKET STEWARD ………………………………………………………………………………………………………………… 12 SDA Pricing Problems …………………………………………………………………………………………………………………………………………………………….. 13 Location factors …………………………………………………………………………………………………………………………………………………………………… 13 Price uncertainty ………………………………………………………………………………………………………………………………………………………………… 13 Uncertainty about SDA payments in individual plans ……………………………………………………………………………………………………. 14 Lack of accessible data about SDA dwellings ……………………………………………………………………………………………………………………. 15 What is needed to support SDA market development ……………………………………………………………………………………………………. 16

SECTION 4 – QUALITY AND SAFEGUARDING OF THE SDA MARKET: CRITICAL ISSUES, RISKS AND OPPORTUNITIES …………………………………………………………………………………………………. 17 Background …………………………………………………………………………………………………………………………………………………………………………. 17 Separation of Housing and Support\ ………………………………………………………………………………………………………………………………. 17 Risk: Resistance to separating housing and support ………………………………………………………………………………………………….. 18 Opportunity: Develop a model pathway for separation ……………………………………………………………………………………. 18 Risk: Tenants lack capacity to assert their tenancy rights ………………………………………………………………………………………… 18 Opportunity: Build capacity for successful tenancy outcomes ……………………………………………………………………… 18 Risk: Conflicts of interest may dominate the market …………………………………………………………………………………………………. 18 Opportunity: Develop performance standards for the management of Conflicts of Interest …………………………… 19 Safeguards in the built form …………………………………………………………………………………………………………………………………………….. 19 Risk: A lack of knowledge about effective evacuation and safeguarding of SDA tenants in emergencies …….. 19 Opportunity: Develop and disseminate practice knowledge on evacuation of people with disabilities in their accommodation …………………………………………………………………………………………………………………………………………………………………… 19 Risk: Failing to prevent violence and harm through building design …………………………………………………………………….. 20 Opportunity: Prevent violence through innovative design ……………………………………………………………………………………. 20 Risk: The future of Community Visitor scheme ………………………………………………………………………………………………….. 20 Opportunity: Reform the role of the Community Visitor…………………………………………………………………………………… 21

Behaviours of concern and tenancy rights ………………………………………………………………………………………………………………… 21 Risk: New SDA providers may be ill-equipped to respond to behaviours of concern ………………………………………… 21 Opportunity: Educate and build the capacity of SDA providers to respond to behaviours of concern ………….. 21 Risk: A lack of clarity of where responsibility lies for paying for property damage as a result of behaviours of concern………………………………………………………………………………………………………………………………………………………………………… 22 Opportunity: Develop practice standards for the recovery of costs related to property damage …………………… 22 Choice, control and decision-making ………………………………………………………………………………………………………………………………. 22 Risk: That the principle of choice and control is not realised in SDA …………………………………………………………………….. 22 Opportunity: Set performance standards for providers to uphold tenant choice, control and decision-making …………………………………………………………………………………………………………………………………………………………………………………… 23

SECTION 4 – THIN MARKETS AND MARKET FAILURE: THE ROLE OF PROVIDER OF LAST RESORT AND CRISIS ACCOMMODATION ……………………………………………………………………………… 24 Real Life Stories ……………………………………………………………………………………………………………………………………………………………………….. 24 Provider Of Last Resort …………………………………………………………………………………………………………………………………………………………. 26 Market Gaps: Problems & Solutions ………………………………………………………………………………………………………………………………. 26 Urgent need requires a rapid response ………………………………………………………………………………………………………………… 27 Guiding principles for POLR …………………………………………………………………………………………………………………………………………….. 29

SECTION 5 – RECOMMENDATIONS ……………………………………………………………………………………. 30 Market Stewardship …………………………………………………………………………………………………………………………………………………………… 30 Implementation of SDA Policy ……………………………………………………………………………………………………………………………………… 30 SDA pricing …………………………………………………………………………………………………………………………………………………………………………. 30 SDA Registration …………………………………………………………………………………………………………………………………………………………… 31 Practice Standards …………………………………………………………………………………………………………………………………………………………… 31 Capacity Building ………………………………………………………………………………………………………………………………………………………………….. 32 Community Visitor scheme …………………………………………………………………………………………………………………………………………….. 32 Provider of Last Resort and Crisis Accommodation ………………………………………………………………………………………………….. 32

References ……………………………………………………………………………………………………………………………….. 34

EXECUTIVE SUMMARY

The introduction of the National Disability Insurance Scheme (NDIS) is opening up new opportunities for people with disability to live an ordinary life and be included in the community. The NDIS’ approach to housing is a radical change - giving people with disability choice and control about where and with whom they wish to live.

This submission is in response to the Joint Standing Committee for the NDIS inquiry into Market Readiness. We have focused on the SDA market, drawing on our expertise working with new developers and with people with disabilities who have high and complex support needs.

How this submission is structured

The submission begins by explaining eligibility for SDA and how the current SDA market must transform to meet the needs of NDIS participants of today and into the future. We outline a future vision of an SDA market which is consumer driven and provides a diverse range of quality housing in the community where consumers are empowered, informed and supported. We highlight the importance of an informed, responsive and innovative market of SDA providers, very different from the market of “group homes” and “mini institutions” that dominate the existing market.

A range of market challenges are presented, including issues with pricing, uncertainty and inconsistency in the implementation of SDA policy and a lack of demand and supply data to inform market decisions. We highlight the need for the NDIS to fulfil its role as market steward by providing detailed information about demand and supply of SDA, price certainty, and consistency and transparency in the implementation of SDA policy. These provisions will improve confidence among developers and investors and enable the market to grow in a way that it can meet the needs of SDA consumers.

We highlight the importance of separating housing from support provision, managing provider conflicts of interest and ensuring that people can change providers without risking their tenancy. We highlight the importance of establishing consistent and evidence-based building requirements that meet the necessary standards to keep people safe. We explore a range of other risks and opportunities to improve quality and safeguarding and increase choice and control for tenants of SDA.

We also emphasise the need for the NDIS to respond to thin markets and market failure through solutions that can provide crisis accommodation and a rapid response. We emphasise the need for high quality Provider of Last Resort (POLR)solutions as a temporary safety net. We want people with high and complex needs to have the full range of quality housing options and not to be indefinitely relegated to a POLR because the market is not sufficiently supported to respond.

What the submission recommends

With respect to market stewardship, the NDIA must bolster its role as market steward for SDA by:

Providing information to inform the market about the profile of real SDA demand and supply.
Providing data on SDA dwelling enrolments including building type, design category, location, provider type and occupancy status.
Providing case study/examples of both a range of participants approved for SDA (and their pathway into their preferred housing) as well as SDA projects.

With respect to the implementation of SDA policy, the NDIA must:

Address serious problems that are emerging around the implementation of SDA policy.
Improve confidence and understanding of the SDA framework and Rules by acting to immediately address these issues with practice guidance, staff training and information sessions for participants and providers.
Provide clear channels of communication for technical issues about SDA to be promptly addressed.

With respect to SDA pricing, the NDIA must clarify intent, scope, process and timing of SDA pricing reviews by:

Providing early clarity and adequate information about how the pricing reviews will be undertaken, and how they will improve understanding of their likely impact.
Provide a 10 year commitment to current SDA pricing.

With respect to SDA registration, it is recommended that registration should require:

Evidence of separation of housing and support or an action plan to achieve separation within a reasonable timeframe.
The submission of a Conflict of Interest (CoI) policy and procedure and evidence of its efficacy and implementation.
Evidence of personal evacuation plans for all tenants and evidence that they are based on best practice and communicated to tenants and providers on a regular basis and in accessible formats.
Participation in mandatory orientation training for SDA providers covering:
- Human rights and disability awareness;
- ‘Behaviours of concern’ and appropriate policies and procedures for responding to tenants exhibiting aggressive or violent behaviour.
- Quality and safeguarding including SDA practice standards, rules and terms of business, the role of the Quality and Safeguarding Commission, appropriate complaint procedures, and the importance of tenant safety procedures.

With respect to “Practice Standards” for SDA providers, these should:

Support the utilisation of innovative building design and construction based on principles of promotion of safe behaviours in shared accommodation.
Enable providers to recover costs from property damage associated with behaviours of concern.
Provide a model ‘pathway’ that addresses the need to separate housing from support and a timeline for the achievement of full separation.
Outline a rapid response with respect to tenants behaving violently towards other tenants in the property or towards staff and visitors.
Ensure the involvement of tenants in decision-making with respect to house rules and the selection of housemates and service providers.

It is also recommended that government should invest in capacity building opportunities to:

Assist providers to separate housing from support, and develop approaches for collaborative practice between housing and support providers where this is required.
Assist SDA tenants to manage their tenancy rights and responsibilities. This should include skills in understanding and exercising informed choice and control in SDA settings.
Assist mainstream services including tenants unions and administrative tribunals to respond effectively to the needs of people with disabilities accessing their services.

With respect to crisis accommodation and Provider of Last Resort arrangements, it is recommended that the Council of Australian Governments and the NDIS must address the issue of market failure and the need for crisis accommodation by:

Ensuring quality and safeguarding for people needing key safety net provisions such as POLR.
Ensuring that people needing POLR are not left unsupported or allowed to fall between the cracks when rapid responses are hard to secure.
Amending SDA pricing to provide additional loadings to prices for exceptionally complex built form requirements.
Setting up POLR arrangements as temporary, transitional arrangements, to be reviewed rigorously in the light of Australian and international evidence of efficacy.
Preventing POLR situations by stimulating market development of innovative solutions for temporary and crisis housing.
Increasing the availability of rapid responses through increased access to specialist support coordination, capacity for rapid plan reviews, emergency helpline, access to specialist ‘complex participant pathways’ advice and transparent organisational responsibilities.

This submission also recommends the development of a new national safeguarding system to replace the existing state-based Community Visitor schemes.

SECTION 1 – INTRODUCTION

About the Summer Foundation and Summer Housing

The Summer Foundation works to change human service policies and practices related to young people (18-64 years old) living in, or at risk of entering, Residential Aged Care (RAC) facilities.

Our vision is that young people with disability and complex support needs will have access to services and housing that supports their health and wellbeing and a good life in the community.

We are committed to working with key stakeholders towards achieving accessible and affordable housing for young people with disabilities with complex support. We are committed to working to ensure that the NDIS realises its potential to end the forced admission of young people with disabilities into residential aged care.

The lack of accessible and affordable housing is a key factor that results in young people being forced into RAC. For this reason, the Summer Foundation has been heavily involved in working to improve housing for people with disabilities. This work ranges from high-level policy work in relation to the NDIS, sector development in the field of neurological disability, market and technical development in Specialist Disability Accommodation (SDA), as well as in-depth research through our partnerships with leading academic institutions including Monash and Latrobe University. We are also active members of the Australian Housing and Urban Research Institute (AHURI).

In 2012 the Summer Foundation began working on housing demonstration projects to provide concrete examples of alternatives for young people living in nursing homes. We are examining our housing model’s efficacy and sharing the knowledge generated by these projects with other organisations and government to move this work from pilots to policy change.

These demonstration projects are based on apartment living and showcase best practice design to challenge thinking around housing for people with disability. These apartments are peppered throughout larger mainstream residential developments connecting people to their community. Clever communications and smart home technology ensure residents can enjoy their independence and privacy while still having access to 24-hour on-call support. Our latest project is in the Hunter region in New South Wales and a virtual tour of our display apartment can be found here.

The Summer Foundation recently established a separate sister organisation, Summer Housing, to further develop housing for people with a disability. While Summer Foundation no longer has a role in developing housing, we are closely involved in evaluating housing models for people with disabilities and translating our learning into effective social policy.

Our recent policy work has focused on SDA market development and includes a joint report between the Summer Foundation and PwC “NDIS Specialist Disability Accommodation: Pathway to a Mature Market”.

In this report, key features of an effective SDA market are articulated:

A sufficient supply of various forms of dwellings that meet the requirements of a range of accessibility needs in a variety of locations.
A large variety of financing options (both debt and equity).
A transparent portal allowing consumers to locate and adequately assess available SDA dwellings and property managers (or developers) of SDA dwellings to identify potential tenants .
A stable and transparent regulatory regime that encourages investment.
A strong understanding of the SDA regime by all market players.
Quality and safety in providing disability support services in SDA dwellings.

We also undertook a SDA Demand Study, funded by the Sector Development Fund. The results of this study will be released shortly, and Summer Foundation is presenting the results in a series of seminars

in Sydney, Hobart, Melbourne, Brisbane and Adelaide. SDA developers advise that this information is eagerly awaited, to help inform planning of SDA projects.

Summer Foundation’s SDA Demand Study is based on administrative data from the state and territory disability systems, as a basis for assessing future demand. We have undertaken this work in the absence of data from the NDIS about SDA dwelling enrolments and the profile of participants with SDA funding, which will be increasingly critical information for market development.

Summer Foundation has also been involved in the development of policy related to quality and safeguarding for SDA. We recently convened a Think Tank of experts from disability advocacy, provider and government perspectives to understand critical quality and safeguarding issues, risks and opportunities around the provision of SDA into the future. The key findings from the Think Tank are contained in Section 4 of this report and the recommendations are contained in Section 6.

We have also been heavily involved in developing resources and tools to support people with disabilities to pursue their housing goals. This includes The Housing Hub – our information and advertising platform for SDA and other accessible housing options.

There is much work to be done by the NDIA, government agencies, disability organisations and the SDA provider market to progress actions that support market development. The current submission is focused on the emerging new SDA market and how it needs to transform to provide the necessary housing options for people with disabilities who have high and complex needs. We explore the various barriers that are currently impeding the transformation, the role of the NDIA as market steward, relevant quality and safeguarding issues and the role of crisis accommodation and Providers of Last Resort. We have chosen to focus on our area of expertise, SDA, and for this reason have not responded to the issue of disability workforce. We do believe however that a strong, diverse and competent workforce, with the right values and attitudes, is critical to solving the issue of young people in RAC.

SECTION 2 – SPECIALIST DISABILITY ACCOMMODATION: A VISION FOR A NEW MARKET

To understand the issues related to market readiness for SDA, it is important to understand who is eligible for SDA, the NDIS vision for SDA into the future and how this compares to the current SDA market.

Eligibility for SDA

For NDIS participants, eligibility for SDA is defined when they meet the criteria of having either an extreme functional impairment requiring an SDA response, or very high support needs that are most appropriately met by an SDA response (NDIS Specialist Disability Accommodation Rules 2016).

‘Extreme functional impairment’ is defined as a condition that results in an extremely reduced functional capacity of the participant to undertake one or more of the activities of mobility, self-care or self-management; and a very high need for supports in undertaking the activity even with assistive technology, equipment or home modifications. The person requires an SDA response if this form of accommodation would be more likely than other accommodation options, to assist them to reach their goals, be beneficial and effective, represent better value for money and promote stability and continuity of supports.

The eligibility criteria relating to ‘Very high support needs’ is met if the participant has previously lived in SDA for extended periods, and this has impacted on their capacity to transition to alternative living arrangements and supports; or they have a very high level need for person-to-person supports. In addition, there must be either limitations in the availability, capacity or capability of the participant’s informal support network, or they are at risk or could pose a risk to others and this could be mitigated by the provision of SDA.

A vision for SDA

A new and vibrant SDA market has the potential to transform the lives of 28,000 people with disabilities.

The vision for SDA is described by the National Disability Insurance Agency (NDIA) as a vibrant, multifaceted, open and competitive marketplace operating sustainably to meet the housing needs of NDIS participants with very high needs who require a specialist housing solution1. A fully functioning SDA market will have the scale and diversity to match demand and preferences.

Central to the future of SDA is the emergence of a willing and competitive market that will prove to be more cost effective for governments and provide better quality housing for people with disability (NDIA, 2016). An effective SDA market must meet the needs of consumers and be attractive to investors. Furthermore, the role of government and the agency as “active stewards” must be understood with these key players in mind.

A consumer driven market

Through the NDIS, housing and support is moving from a block funded government-controlled model to an open market where SDA payments make it possible for people with disabilities to have choice about their housing by allocating housing payments to the individual with a disability rather than the service provider.

In a consumer driven SDA market, the current limits to choice and control are progressively removed as consumers use their SDA payments to choose housing options that best meet their specific goals. There will also be flexibility within the system to meet the changing needs of people with disability. A dynamic housing market will enable people with disability to access different housing options according to their changing needs throughout their lives.

In this new market system, providers will focus on improving their value proposition and success will be tied to the extent to which they are meeting consumers’ housing needs and preferences. In an effective

1 NDIA. (2016) NDIS Market Approach: Statement of Opportunity and Intent. 9

market, providers will compete to deliver the best outcomes for tenants. Providers of quality and innovative housing will be recognised and rewarded. Providers of poor housing and tenancy management will be remediated, sanctioned or go out of business because of high vacancy rates.

A diverse range of quality housing in the community

In an effective SDA market, accessible and affordable housing will be readily available to meet the diverse needs of people with disability. People with disability will be able to find vacancies and get timely access to housing. There will be real choice and a range of housing options reflecting consumer diversity and specific needs, preferences and priorities.

NDIS participants in an effective SDA market will be able to secure housing near the services they use, close to where they work or study and in the community. Proximity to shops, transport and other services is critical to enabling people with disability to easily get out of their home and have a meaningful life. Being located near family and friends and living in a familiar neighbourhood is also essential for maintaining relationships and community inclusion.

The location of housing will also be dispersed throughout neighbourhoods, not congregated in particular locations. The market and NDIA will need to work together in their stewardship role, to address any market failures to ensure that housing is readily available to NDIS participants living in rural and remote locations.

An informed, responsive and innovative market

For an effective market to emerge and thrive it must be seen as a viable business proposition that is not bogged down by unnecessary regulation or a lack of clarity regarding roles and responsibilities. A flourishing market will require stability and certainty regarding policy, rules and payments.

Providers will have access to high quality and timely market information to inform new supply. This information will enable market shareholders and prospective providers to better understand the areas of expected demand growth and characteristics of particular markets around Australia. SDA market infrastructure will also be readily available to facilitate interactions between participants and providers with minimal search effort and transaction costs.

A fully functioning SDA market will be constantly innovating to create higher quality housing options. Quality will increase in a market where providers can share lessons about their experiences and work collaboratively as a sector to achieve the best outcomes for people with disability. Providers will invest in design and evaluation frameworks that assess the costs and impact of different designs and configurations on the outcomes and quality of life of tenants. This evidence base will assist SDA providers to improve quality and reduce vacancies and costs. There will be sector-wide acknowledgement of what best practice in housing and support looks like and a better understanding of how to deliver quality housing and support options.

A mature SDA market will avoid creating many specialist dwellings with institutional features, and instead use design that is adaptable and accommodates a wide range of individual preferences and abilities. Highly specialised housing that is segregated is often only worth the value of the land that it sits on because it could not readily be sold or rented on the open market. Housing created for people with disability that private buyers and renters also find desirable is more attractive to investors.

Consumers are empowered, informed and supported

In the new SDA market, people with disabilities will be supported where necessary to exercise meaningful choice over their housing options, including where and with whom they live; and to change their support provider without moving house. They will no longer be forced to put up with an ineffective service provider or a poor housing situation.

There will be timely access to support informed choice about housing and support (NDIA, 2016). Appropriate safeguards will be in place and the necessary supports made available to people with disabilities, particularly if they have difficulty advocating for themselves, or difficulty understanding information and taking action related to their tenancy.

The current market

The current population of SDA residents and the types of housing that they live in needs to be radically transformed to achieve the vision we have described. Approximately 90 per cent of existing “SDA” places are in group homes. However, group homes represent an obsolete model of disability housing, where people with disabilities are forced to live together and have had little choice over where they live and who they live with. There is little choice over support provider because the provider of the housing and the support are in most cases the same. The thousands of group homes in Australia today, are largely mini institutions that evolved from the large-scale institutions of the 1960s and 70s. Once upon a time, group homes were seen as innovative, and they were, compared to the large institutions that they were built to replace. The SDA market of today cannot meet the needs of NDIS participants who are likely to receive SDA payments in their plan.

The Summer Foundation has recently undertaken an analysis of potential demand for SDA housing across Australia through a National SDA Demand Strudy, looking closely at the profile of people currently living in SDA and those who have very high support needs and may be eligible for SDA in the future.

Summer Foundation’s analysis has identified 17,482 people currently living in supported accommodation (which will operate as existing SDA for NDIS participants) and 27,613 people who are not living in supported accommodation but have very high support needs. In addition there are currently 6,245 people under 65 years living in residential aged care who are likely to be eligible for SDA.

Our analysis shows that the profile of people not currently living in SDA is very different to those who are current SDA residents.

Those not currently living in SDA:

Have a much younger age profile (median age is 34 years compared with 46 years in SDA).
Have a different disability profile, with a much lower percentage of people with intellectual disability and higher percentages of people with physical disability, acquired brain injury or neurological disability or psychiatric disability..
Have higher support needs.
Mainly live at home with parent/family informal carers.

The SDA market is starting from a base of old models of service provision developed in a highly rationed systems of the past (and ageing property assets). It needs to transform itself to reflect the principles of the NDIS where participants are able to exercise choice about where they live, who they live with and how their supports are provided.

SECTION 3 – SDA MARKET READINESS CHALLENGES: THE ROLE OF THE NDIA AS MARKET STEWARD

The NDIA has articulated its market steward role during transition:

“Facilitate development of the marketplace and as a catalyst for basic market infrastructure (including) information provision, setting prices and pricing policy, demand signaling and supporting the development of a vibrant market of suppliers operating competitively” (NDIS Market Approach: Statement of Opportunity and Intent p 18).

The SDA Decision Paper published in June 2016 clearly anticipated a key role for the NDIA in providing data to support market development:

“As SDA Benchmark Price payments will only be made where there are eligible participants residing in SDA, the supply market will benefit from the Agency regularly providing SDA demand data. These data will inform development decisions by communicating important information such as which SDA types are popular and needed, and in which locations they are most required. This information will become increasingly available to the Agency as participants phase into the Scheme and are assessed as requiring SDA“ p.36

Despite these public statements by the NDIA, we are yet to see significant action from the agency with respect to exercising their market stewardship role, resulting in inadequate information for the market to make decisions to invest in and build SDA.

While adequate policy detail is provided in publicly available documents, what is missing is information about demand and supply to support decisions about investment and development in new SDA properties, as well as confidence in how the SDA processes are operating. The information provision role of the NDIA is falling short of market needs at this time, in the face of the many challenges involved in delivering contemporary SDA housing.

The development of housing supply for the SDA market requires significant upfront capital investment from a range of not for profit and for profit providers in a large amount of housing in the short to medium term (12,000 places needed, as estimated by NDIA).

The SDA housing market is very new and needs significant development to transform. For investors and financiers, there are not comparable properties in the market that can provide a track record of past dwelling types, their locations and occupancy. They also lack a record of sales to judge how these properties perform as assets.

Summer Foundation has worked closely with its sister organisation, Summer Housing (currently working towards creating 300 SDA apartments), and a range of private and community based providers working with the SDA policy, to build an understanding of how the SDA policy is operating, how the market is responding and what factors could be holding this market back. These experiences provide insights into what more the NDIA could be doing to support SDA market development.

The following section explains a range of barriers to developing SDA housing, highlighting the difficulties faced in developing the SDA supply market. We suggest that attention needs to be given to the NDIA’s role in enabling and facilitating the SDA market as market steward.

SDA Pricing Problems

Most SDA properties will have a higher construction cost and consume more space than regular housing. For example, the modifications and assistive technology inclusions in a high physical support apartment may cost over $100,00 additional to the base price of the dwelling.

Once built, there is a likelihood that the “market value” of the property is less than the cost to produce – this matters to financiers who will lend at a ratio of market valuation (limiting the availability of debt finance to fund a project) and to investors who are concerned with capital growth.

While overall, the SDA payment, as it currently stands, provides a strong incentive to develop housing, the SDA payment and the conditions around its operation are presenting challenges to prospective SDA housing providers.

Location factors

Generally, SDA housing developers are advising that the SDA price table is sufficient to meet the costs of SDA delivery around certain building types and locations. However, for well-located areas with higher land costs and building types with higher construction costs, the prices are inadequate. This has particular implications for establishing SDA supply in most of Sydney, which not surprisingly has a significant shortfall to begin with (based on Summer Foundation’s forthcoming SDA Demand Study). But provision of SDA housing in some design and building categories is also challenging in many inner/middle suburbs of Melbourne.

Developers are puzzled by the location factors provided in the Price Guide – the source and rationale for the location factors are not explained, and the factors are clearly insufficient to address SDA provision costs in higher value markets (e.g. the location factor for Sydney Inner West is 1.07, which is same as for NSW Illawarra and WA - Mandurah, but the location factor for Melbourne Inner East is 0.99).

The setting of location factor boundaries at SA4 level (ABS boundaries) also presents difficulties in determining the exact boundaries for where a particular property falls (and therefore which location factor should be applied to the price). One developer advised us:

”I spent several hours on the phone to the ABS until we finally worked out a way to determine SA4 for a street address by using a crude ABS map on their website”

This example provides a small insight into the variety of challenges faced by prospective SDA providers in working with the SDA policy.

Price uncertainty

The most significant issue facing SDA market development is widespread concern about pricing into the future. SDA policy documents indicate there will be a review of prices every five years, and there will also be a review of the pricing framework within three years of policy commencement. In the meantime such uncertainty (combined with other uncertain factors about SDA, discussed below), is a major barrier to financing of and investment in SDA projects.

There are many reports of pricing uncertainty being a major brake on SDA market development. A project on the drawing board today may not complete construction until 2019, providing only two years of price certainty before the SDA prices undergo review.

A typical example from a SDA developer:

“(We) had a potential private investor interested in a multiple dwelling SDA development. They own land which would have been suitable in a good location and would have funded the project. We had many discussions with them and they were very keen. Unfortunately when they investigated the detail of the SDA Payments and the saw the risk associated with not knowing what would happen to SDA Base Rates after the 2021 (5 year) Price Review they lost interest in the project and pulled out.”

Overall there is certainly strong market interest in exploring SDA development based on potential returns. But the questions being asked frequently of Summer Foundation are: where is SDA supply needed, what type and how well is the policy working in practice?

Uncertainty about SDA payments in individual plans

A significant concern of SDA providers at this early stage is around reports of difficulties experienced by participants seeking SDA funding if they are not already residing in an enrolled SDA property “grandfathered” as SDA. SDA developers are reporting difficulties with the current situation where people cannot be matched up with properties with any certainty until SDA is confirmed in the participant’s’ plan, and the property is enrolled on final completion.

The SDA policy is very complicated. It combines an eligibility process for both participants and dwellings and the interaction of the two processes is creating significant confusion for participants, NDIA staff and support coordinators. This is also creating an impossible situation for SDA providers seeking to work with participants to build suitable new SDA housing.

Overall a small proportion of new participants not already living in “existing SDA” are having SDA payments approved in their plan (16% of plans with SDA are for “new SDA” – as reported in response to a recent Estimates Question on Notice NDIA SQ17-000222).

SDA housing developers report that NDIA and LAC planners are providing inconsistent information to participants and families about how the SDA policy operates.

Practices by NDIA and LAC planners reported to Summer Foundation include:

general uncertainty about how the funding for SDA can be included in a NDIS plan in the absence of a dwelling type specified (when that might still need to be determined).
policy and rules being interpreted to mean that SDA eligibility cannot be tested unless there is a completed SDA property.
a planner expressed concern that if SDA was included before the dwelling was built that the Registered Provider might claim the SDA Payments.
a planner who explained that everyone is eligible for SDA.
a planner reported that the SDA rule 2016 is out-dated and does not reflect the current state of affairs.

SDA developers are also reporting that the SDA dwelling enrolment process is taking much longer than expected, with no decisions several weeks after enrolment documents are submitted, leading to extended vacancy periods with no occupants and no revenue.

The uncertainty of SDA funding remaining in a person’s NDIS plan creates further uncertainty – the funding is reviewed annually, and for some participants a successful SDA housing outcome could see a future assessment where the SDA payment is considered no longer reasonable and necessary due to reduced support needs.

For those considering investment in and development of new SDA supply, the combination of uncertainty over individuals being approved for SDA, the chance of SDA payments being removed from that plan at a later date and the poor track record of properties being enrolled as SDA, provides very negative signals.

Finally, for developers working with participants early in the development process on a dwelling to suit their needs, the uncertainty in the NDIS about provisional SDA funding in plans where the dwelling does not yet exist, is a major barrier to development. A SDA provider needs certainty that SDA payments will be available on completion of the property to raise the necessary finance and proceed with the project.

Confusion around building standards

SDA dwellings which are highly accessible are designed across several sets of standards – AS4299, Livable Housing Australia standards and the design categories in the SDA policy. There are areas of variation between these standards, and SDA housing designers need to have adequate knowledge and skills to navigate these requirements, or end up with dwellings that do not comply with NDIS design requirements.

All new and refurbished dwellings are subject to minimum standards under the National Construction Code. However, determination of the class of dwellings (and therefore minimum standards) are subject to interpretation depending on the occupancy arrangement (e.g. where a house may move from being a Class 1 dwelling to a Class 3 dwelling by virtue of who is living there). This can create confusion about the building standard and require higher cost inclusions. In addition, there are requirements specific to state jurisdictions (particularly in Victoria where disability policies and legislation currently impact on SDA provision).

Appropriate knowledge and expertise is required to ensure the various standards and policies are complied with. However, there is a limited market of access architects, Livable Housing Australia assessors, building certifiers etc. who have the expertise to work effectively in this specialised area.

Lack of accessible data about SDA dwellings

Early SDA developers report a need for more information about the location of enrolled SDA properties – this helps with decisions about where to develop new projects. Currently there is no visibility of what properties have been enrolled, to enable identification of clear market gaps.

With unclear and inconsistent decisions about who is eligible for SDA payments, as reported above, the market is not getting early signals about who to build for and where. This means that market players are left to work with the existing high level estimate (28,000 participants) and the details of how the policy works, including the pricing table.

The NDIA already holds data about the type and location of currently enrolled SDA dwellings and must make this information publicly available.

In addition, a capacity to notify the NDIA about SDA properties under construction, and make available this information, would be of great assistance to the market in planning further SDA development. A “pre-enrolment” process would be very beneficial to people with approved SDA funding in their plan, enhancing their property search to forthcoming new developments. Early data on the SDA development pipeline will also help the market operate more efficiently, avoiding situations where multiple SDA projects may be planned for the same area by different providers.

What is needed to support SDA market development

SDA market players – including builders and developers, financiers and investors – are largely unfamiliar with the people who will live in SDA housing, and the way they wish to live – what locations and features will attract residents who have the SDA payment, who will they live with, how often will they move? With the SDA payment attached to the participant, the SDA provider must make the right decisions about the housing investment, as the market for alternative users is limited. A project financed on the basis of SDA payments has no alternative users able to generate similar revenue.

Early market players are calling out for SDA demand data and are reporting significant difficulties with the NDIA’s processes for including SDA in participants’ plans. With an expensive upfront investment to bring new SDA supply to the market, negative early experiences will discourage other potential market players. Better information about how the policy is to be applied and practice support for planners and assessors will help to improve SDA processes and address early problems being experienced by participants and SDA providers.

In its role as market steward, there are a range of actions that the NDIA needs to take to address the key market challenges that are emerging:

Provide price certainty
- Clarify the process for price reviews, as well as the review of the pricing and payments framework, including clear timing.
- Provide price certainty for SDA dwellings delivered in the early phase – e.g. all prices set for 10 years for new SDA enrolled up to the first price review.
- Acknowledge the complexities of the policy and pricing framework by improving information to market and in response to practical issues being raised.
Provide consistency and transparency in the implementation of SDA policy
- Address the lack of clarity around the operation of the policy among planners and associated providers, including provision of practice guidance around decision making for SDA in plans.
Provide accessible data about existing and upcoming SDA
- Make comprehensive SDA data easily available to the market on dwelling enrolments and SDA funding approvals for individuals – numbers, categories, levels.
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SECTION 4 – QUALITY AND SAFEGUARDING OF THE SDA MARKET: CRITICAL ISSUES, RISKS AND OPPORTUNITIES

Quality and safeguarding considerations are essential to any discussion of market readiness and market development.

This section will explore the impact of the Quality and Safeguarding framework on the SDA market. We will explore the emerging critical SDA quality and safeguarding issues, risks and opportunities that have been identified by a panel of experts convened by the Summer Foundation.

Background

In an SDA setting there are two primary providers both of whom are subject to different regulatory requirements. Supported Independent Living (SIL) providers are regulated through the NDIS provider registration rules. Along with terms of business and operational guidelines, the rules set in place safeguards that apply to SDA tenants when they receive SIL services in their SDA.

Currently SDA regulation is contained in the SDA rules of the NDIS Act 2013. The rules cover the determination of design categories and building types, conditions for SDA payments to be made, and the requirement for all SDAs to be registered providers. When it comes to safeguarding, the regulations stipulate that SDA providers must enter into a Service Agreement with each participant, and that these must cover a number of aspects of the obligations and responsibilities of the provider and of the tenant. SDA tenants are also protected by general NDIS requirements for providers to have an organisational policy for managing conflicts of interest. We also understand that the Department of Social Services is in the process of developing Practice Standards that will also regulate the provision of SDA and to which SDA providers will be audited against.

It is important to recognise that the scope of the SDA regulatory framework must address the built form and the tenancy relationship, from when the tenant enters into a tenancy relationship with a provider and until they exit their tenancy. It does not need to regulate the personal care delivered in the home as this responsibility sits with the SIL provider.

It is also important to note that a period of transition is underway. As the NDIS has been progressively rolled out across Australia, the existing state quality and safeguards have continued to apply. This will change when the NDIS is fully rolled out across Australia, from July 2018 through to July 2020 depending on the jurisdiction. Quality and safeguards will move from state governments to the National Quality and Safeguarding Commission.

The commission will implement the NDIS Quality and Safeguarding Framework which was released by the Council of Australian Governments Disability Reform Council in February 2017. The Framework will come into effect as each state and territory reaches full scheme NDIS. The Framework sets out a national system to support NDIS participants, carers and providers – upholding the standards that participants deserve, and ensuring clarity on the rights and responsibilities of participants, providers and their staff.

The development of a new housing market for people with disabilities together with the establishment of a new way of funding their housing raises a range of critical issues with respect to quality and safeguards. In 2017, the Summer Foundation brought together a Think Tank of experts from disability advocacy, provider and government perspectives to consider the critical issues, risks and opportunities that need to be addressed in the emerging SDA market. These are outlined below.

Separation of Housing and Support\

“We are supporting the separation in Victoria because of choice and control. But there is not a pathway at present for this. We clearly need separation agreements, but if you separate too early this is not good, but it does need to be in the future. We need to set a future date”. (Arthur Rogers, Victorian

government).

“You can have good policy, have an independent mediator, (but) it is very difficult for participants, especially if young, to say they want a different SIL than the SDA–provided one. There is an issue of conflict of interest: when service is not separate a request for a new SIL can be awkward. There may be a role for Community Visitors here. Maybe there is a role for organisations with conflict-of- interest issues to report back as part of the registration process”. (Leah van Poppel, Youth Disability Advocacy Service).

Risk: Resistance to separating housing and support

Commitment is needed to working towards achieving full separation of housing and support as outlined in the market vision for SDA. However, some providers are seeking ways to maintain the status quo and to do the bare minimum to achieve compliance. Their resistance to the policy of separation of housing and support is likely to make change difficult and slow.

At the same time, there is a risk that with the greater commercial response to SDA funding, many of these providers do not see their role as maintaining ongoing relationships with tenants. Separation of SDA and support providers may result in heavy reliance on the support provider to assist tenants with their tenancy obligations. There is also a risk of the SDA provider setting up an agreement with the support provider to devolve responsibility to the support provider for ensuring the property is appropriately maintained and kept in reasonable condition, and for reporting any issues relating to the property. Furthermore, if the SDA provider does not understand each tenant’s support requirements, it will be very difficult for modifications to be made, or have the needs of the support providers addressed and maintain continuity of supports.

Opportunity: Develop a model pathway for separation

There are opportunities to guide and enforce a relationship between the SDA provider and the tenant beyond that entailed in the residential tenancy agreement/service agreement. There is an opportunity to assist SDA providers to maintain constructive relationships with tenants through the development of practice guidelines. A “model” pathway, consistent with policy and backed up by regulation, can be developed to assist SDA providers and tenants to achieve separation of housing from support within a specified timeframe. The Summer Foundation Toolkit for the separation of housing and support could form the foundation of a national training opportunity for SDA providers.

Risk: Tenants lack capacity to assert their tenancy rights

Some tenants may not have capacity to take on the increased responsibility that comes with the separation of tenancy and support. For example, upholding their mainstream tenancy rights, managing their tenancy and managing multiple providers may be difficult without assistance. Furthermore, risks of loss of tenant protection may arise in situations where neither the SDA provider nor the support provider takes responsibility for safeguarding, and the onus is shifted to the tenant without safeguards or consideration of their situation.

Opportunity: Build capacity for successful tenancy outcomes

There is an opportunity to develop and implement capacity building supports for SDA tenants to assist them to manage mainstream tenancy responsibilities and to uphold their tenancy rights. This could involve providing capacity building grants to tenants unions and to disability organisations to develop resources and services to support people with disabilities in managing their tenancies.

There is also an opportunity to develop performance targets for SDA providers to deliver high-quality SDA in a way that is accessible and customer focused, particularly for people who may find it more difficult to understand complex tenancy matters or who may have complex tenancy needs.

Risk: Conflicts of interest may dominate the market

“You need to lead people to water, and show what does ‘good’ look like. Re conflict of interest – we need to unpack what is conflict. What does conflict-of-

interest mean? There are better ways to describe it. We can show examples and frame the ‘good’”. (James Bannister, National Disability Services)

While the separation of housing and support is not mandated, provider conflicts of interest have the potential to maintain the status quo and act against the interests of tenants. Where the provider is reinforcing their interests at the expense of tenant rights, there may be a role for regulation and rule setting. The current requirement for all registered providers to have a conflict of interest policy does not ensure that the policy itself is effective or enacted appropriately.

There are significant difficulties already for tenants to call out a conflict of interest, particularly tenants who do not have the capacity to understand this concept and/or to speak up for themselves. These difficulties are compounded by diversity in the tenant group – cultural background, learning disability, communication impairment etc. There is a risk to SDA tenants if the registration process relies on SDA providers complying with a requirement to have a COI policy without specifying standard requirements for documented (and auditable) procedures.

Opportunity: Develop performance standards for the management of Conflicts of Interest

There is an opportunity to assist providers to manage conflict of interest by specifying strategies to understand COI, addressing questions such as: what are the situations that generate a potential conflict and what are the measures that would minimise or eliminate such a conflict? Providers benefit from examples of “what good practice looks like”. There is also an opportunity to implement regulation and performance standards that require providers to effectively manage conflicts of interest and prioritise the interests of tenants above their own.

Safeguards in the built form

“I am scared of fire and water. I have seen evacuation wheelchairs, but how to get in and out of them if there is a ‘no lift’ policy operating? Builders need to be aware of evacuation risks and consider different ramifications. Insurance companies also play a role as they may try to influence construction to minimise costs”. (Liz Ellis, NDIS participant)

Risk: A lack of knowledge about effective evacuation and safeguarding of SDA tenants in emergencies

As the market develops, the range of housing options will increase with more opportunities for people with disabilities to live on our own and to live in apartment style accommodation. Current approaches to safeguards in the built form are more closely aligned with the traditional ground-level group home. There are risks in the mismatch between current safeguarding approaches and the diversity and range of new housing in the SDA market.

New housing options create new risks for SDA tenants such as evacuation from a multi-story and/or multi-residential building where there are no National Construction Code (NCC) requirements relating to people using a wheelchair; adverse reactions to fire and water; reliance on use of lifts, and non-requirements for sprinkler systems. There are added concerns relating to appropriate manual handling procedures to assist persons in wheelchairs into evacuation chairs, or wheelchairs if they have gone to bed. This risk would be intensified if there were no staff located overnight in the SDA.

In addition, tenants lack information on evacuation procedures and what the building is designed to do. There is a risk that neither the support provider or the SDA providers will take responsibility for the upkeep of Personal Emergency Evacuation Procedures and ensuring that these are understood by staff and tenants.

Opportunity: Develop and disseminate practice knowledge on evacuation of people with disabilities in their accommodation

Opportunities exist for the achievement of the most effective preventative safeguarding approaches to be implemented in all new SDA developments. It is also timely to conduct investigative research to understand best practice with respect to managing risk for people with disabilities living in apartment

complexes and other multi-storey developments. This would inform practice standards that could be implemented more effectively and at a lower cost before many of these developments are built.

Risk: Failing to prevent violence and harm through building design

“Unfortunately, we have plenty of experience of participants being violent… As part of our agreement, the SIL provider is responsible for having well–trained staff to protect themselves and others. To some extent the SDA developer can help by having specifications to have robust construction: walls, windows, remove doors. This needs cooperation between families and the SIL and SDA to work out what is the best design and the extent to which you can prevent problems through good design features”. (Steve Anthony)

“I don’t want to down play the amount of violence out there that is real. I will go back to what Steve is saying – there is a really interesting design element we need to look at. We need to look at innovation in reducing harm. In shared accommodation there are different ways you can set this up to reduce interpersonal agitation. There is a whole world of innovation ready to go. I would hope the NDIS would act as a catalyst”. (James Bannister, National Disability Services)

Building and environmental design in SDA affects behaviour and relationships. There is a risk that such behaviours may be exacerbated by poor building design. Without appropriate and readily available building and practice standards based on knowledge of the capacity of interior and exterior spaces to mitigate harmful behaviour, there is a risk that SDA building design may increase the difficulties for tenants and staff to manage conflicts.

Opportunity: Prevent violence through innovative design

Opportunities exist for the use of the growing body of knowledge and practice wisdom about innovation in building design aimed at reducing the occurrence of harm in disability accommodation. Purposeful building design and construction can result in significant positive outcomes for safety and reduction in harm to tenants and staff. Given that building design is site-specific, specialist architects and expert designers need to inform best practice.

Risk: The future of Community Visitor scheme

The Community Visitor (CV) role was set up initially to introduce an external monitoring role especially relevant to “closed congregate care” in order to reduce the power imbalance between residents and staff. As the change to mainstream tenant regulation occurs, there is a risk that this role will not be as readily available as a safeguarding mechanism for tenants. Risk is multiplied for SDA tenants who do not have circles of support, and/or experience social isolation or the impacts of age or impairment.

“CV is not an issue for family governed models. Because we have a very unique level of family involvement, we don’t think it (Community Visitor Scheme) is necessary. We use Google Drive and Viber communication –parents can read and contribute to progress notes. They can see what’s going on. Good circles of support are natural safeguards. With technology available you get easily available communication, and we also have (a system) where each of our participants spends time at the family home every week - our homes encourage visitors - family, friends and other visitors – so it’s a comfortable place to live. So the closed community homes that Community Visitors were established for, we address problems through family involvement.” (Steve Anthony)

“From the Carers Vic perspective, we would err on the side of having a CV, perhaps with the framework of proportionality. The residents identified as vulnerable and/or isolated can receive more support. An independent body that provides real people, not just written safeguards can provide peace of mind.”

(Margaret Boulos, carers Victoria)

Opportunity: Reform the role of the Community Visitor

Opportunities exist in the consideration of the benefits and costs of existing alternatives to the current CV scheme. An SDA provider has utilised design for a setting that encourages a high level of family involvement as circles of support. The high level of family visitation acts as a natural safeguard of tenant rights and well-being and may, in some circumstances, reduce the need for an external CV role. There are also innovative alternative and person-centred overseas schemes such as one UK example, where people with disabilities have paid roles to visit people and ask what is important in their lives. If a re-modelled CV scheme were to be adopted as part of quality and safeguarding, an in-built opt-out function, and the principle of proportionality should apply.

Behaviours of concern and tenancy rights

Risk: New SDA providers may be ill-equipped to respond to behaviours of concern

In protecting the rights of tenants in situations where they are expressing violent behaviour, there is a risk in labelling this as “challenging behavior” and categorising people on this basis. Labelling may de-contextualise the behaviour and obscure the need to address behaviour as a situational response, and a form of communication of something the tenant does not like. New SDA providers are likely to have limited knowledge about “behaviours of concern” and how to respond effectively. This may have implications on the tenancy relationship and on the ability of providers to appropriately respond to “behaviours of concern”.

“We do need to acknowledge that at present a key driver of demand for SDA is the presence of violence in family homes. Families don’t get access to sufficient (or sometimes any) positive behaviour modification support, and seek SDA accommodation because they experience harm from the behavior of their son or daughter. This just transfers the problem behaviour to another setting. The whole issue of family violence was addressed in the review of the Residential Tenancies Act. There were proposals to have requirements on landlords to cover property damage and have surveillance measures.” (Anne Muldowney, Carers Victoria).

“We’ve had a lot of experience of rooming house sector where low-income people share facilities and have their own room. Under the RTA, when there are problems, they can get an immediate hearing in the VCAT, within 24 hours. VCAT can end a tenancy, which could mean immediate eviction. We need something similar for SDA tenancies. We also need respite so people are not put on the streets, and there is actually a back up, at least temporary. We need support networks.” (John McInerney, Common Equity Housing)

In shared accommodation it may be necessary for one tenant to move from the SDA quickly. In the context of the separation of housing and support providers, there is a risk that the SDA will not respond quickly enough and leave people in harmful situations. Risk is increased if there is a lack of clarification of where the responsibility sits to facilitate this.

Opportunity: Educate and build the capacity of SDA providers to respond to behaviours of concern

There is an opportunity to educate and inform SDA providers about disability rights and the origins and reasons behind behaviours of concern. There is an opportunity to make training a requirement for SDA providers. There are opportunities for a range of organisations to support the development of knowledge and expertise among SDA providers including, the Australian Human Rights Commission, the Office of Professional Practice and the Office of the Senior Practitioner.

In the context of the mandated separation of SDA and SIL providers there is an opportunity for protocols to be put in place and adopted by SDA providers as evidence that they are competent to respond to situations of actual or potential violence and conflict. There are opportunities for the

utilisation of current best practice rapid response regimes such as that implemented by the Victorian Government, as a basis for protocol development. In the transition period, there are opportunities for capacity-building of SDA providers to assist them to understand the consequences of harmful behaviour and how to respond effectively.

Risk: A lack of clarity of where responsibility lies for paying for property damage as a result of behaviours of concern

Without clear practice standards, there is a risk that disability-related behaviours will result in property damage without a fair and reasonable approach in place to recover the costs of repair. Under the NDIS, the landlord or SDA provider will receive the SDA payment to fund routine maintenance and property replacement. This should also include property damage in instances where this is the result of wear and tear, and this is protected by the Residential Tenancies Act. In situations where the damage is deliberate, it would be important for the landlord to have the ability to take reasonable action to stop the damage from re-occurring and to recover their costs. In circumstances where the damage is the result of behaviours that stem from the tenant’s disability it would be appropriate for the NDIS to cover the cost and put measures in place to minimise future damage.

There is an opportunity to develop practice standards with respect to handling property damage that results from a person’s disability and to embed this in mainstream tenancy regulation. Clarifying responsibility will reduce the likelihood that people with disabilities who have behaviours of concern are not disadvantage in their tenancy and access to housing. It will also increase confidence amongst SDA providers.

Choice, control and decision-making

“I was placed in somewhere that was really inappropriate. And I was placed with people many years my senior. When I was offered the place I didn’t think much of it because I thought I could make anything work. The matching process is not good enough in that you only get a brief look at a house, a surface look. We asked for a sleep over to give us an idea of what a house really looks like but they wouldn’t do that. That would of told me exactly what it was like. I am now in my second house and live with four men. The environment isn’t about choice and control it isn’t person centred to a certain extent. It is very insular in a way that is not good for your health. The ultimate decision with the structure we currently have is always going to lay with the provider. I wish someone said to me that I have the right to say no. Instead I always felt like if I said no, I would never be offered anything.” (Liz Ellis, NDIS participant)

“It is important that we think about this with the vision of what of the SDA provides. Because unless we put some controls around what the SDA provider does they could make the decision for the person with disability and then we have a system where people have no choice as to who they live with. Let’s think about the future and how we want it to work and now is the opportunity to say, SDAs need to meaningfully involve PWD in who they live with, and choosing their housemates.” (George Taleporos, Summer Foundation)

Risk: That the principle of choice and control is not realised in SDA

It is important that SDA residents are involved in all decisions about how the household operates, including where they live and who they live with. There are risks to the achievement of this objective if the current systemic barriers to tenant decision-making in SDA are not recognised. At the moment, service providers are responsible for setting house rules.

People with disabilities have always been given a bar that is very low, and they have been forced to accept this. Tenants can feel that it is not safe to say “no”, for example in choosing a new SDA, as they fear that could result in alternative options being withdrawn. There are also risks to the achievement

of increased tenant choice and control if there are no processes in place to back-up the change from the default position of substitute decision-making to one of assumed capacity. The risks lie in failure to achieve culture change towards a rights-based organisation.

There are risks in assuming that modelling a new SDA system on mainstream tenancy scenarios such as shared housing, will be sufficient to achieve “an ordinary life”. While tenant rights and obligations must be better protected in mainstream tenancy laws, there are risks to the quality and safeguarding of SDA tenants if critical factors in their accommodation needs are not recognised. These include the possible difficulties in reversing a decision, the need for protected continuity of accommodation, and the need for a lengthier decision-making process.

There are opportunities in moving towards an ordinary life for SDA tenants by maximising their rights and protections under mainstream legislation. Alongside this important step of mainstream tenancy law reform, there are opportunities for safeguarding SDA tenants by developing best practice guidelines for SDA and SIL providers to work together on promoting tenant participation in decision making with due consideration of the critical factors.

Opportunity: Set performance standards for providers to uphold tenant choice, control and decision-making

There are opportunities to set in place policy and practice standards to ensure that SDA tenants can participate in all decision-making. Cohabiting tenants should be supported to establish house rules. This process should be facilitated through appropriately trained staff from a tenancy support service or the community visitor program. Capacity building and support will be essential for some people to meaningfully participate in this process. Establishing the processes to enable people with disabilities to have a say with respect to who they live with will improve the quality of SDA. We recommend that people who are house sharing are involved in tenant selection and are supported to take part on interview panels. We recognise that this will require additional support and this should be adequately resourced.

SECTION 4 – THIN MARKETS AND MARKET FAILURE: THE ROLE OF PROVIDER OF LAST RESORT AND CRISIS ACCOMMODATION

Market growth in the NDIS is still in its development stage and this is especially true for SDA. It is not surprising that there are market gaps, ‘thin markets’ and potential market failures. We know that market failure is increased when the complexity of the ‘product’ is added to the complexity of demand. For participants with high and complex needs, the risk of market failure is high and the impact of market shortcomings can have serious consequences.

Market failure can be understood as a situation where the quantity and quality of a product demanded by consumers does not equate to that supplied by market providers. Sources of potential market failure relevant to SDA include:

A lack of access to information by potential providers about market need and demand.
Externalities such as remote location and sparse existing infrastructure.
Monopolies or duopolies where there is exclusive control of a service, or the market is dominated by a few suppliers.
Overregulation and unnecessary red-tape that reduces new entrants to the market.

Closely related to the issue of market failure is the existence of ‘thin markets’, defined as market gaps ‘where a limited or only one provider exists’ (Carey et al, 2017, p390). For people with high and complex needs the consequences of market failure or thin markets, can be dire and result in outcomes such as homelessness; nursing home admission; loss of liberty and human rights violations through unnecessary incarceration; psychological harm, and loss of community and family bonds.

It is important to look at strategies to strengthen market development to reduce these seriously adverse outcomes, and to put in place a safety net to mitigate the harm caused by market failure.

When the market has failed to supply critical services such as SDA, government and the NDIS are required to find ways to fill the gap. We propose that Provider of Last Resort (POLR) solutions are needed as a ‘safety net’ to ensure that extreme vulnerability does not expose people with high and complex needs to greater risk. We argue that POLR functions are not an end in themselves. Extreme housing needs can be anticipated and met in a stronger housing market and with key system improvements. Over time the need for POLR can be reduced by early intervention and greater diversity of long term and temporary housing options in the NDIS market.

Real life stories set the scene to understanding POLR situations associated with an unsuccessful search for suitable accommodation. They illustrate that market failures can result in homelessness, nursing home admission for young people, loss of liberty, psychological harm and loss of family and community ties. They provide the backdrop to the following analysis of market gaps as problems and solutions. In order to achieve the aim of market strengthening, we present a set of principles to guide SDA market regulation and market stewardship. Our recommendations cover strategies to reduce thin markets in disability housing, access to better rapid response resources and capacity building. They emphasise that while a robust safety net must be in place, improved market provision will foster early intervention and reduce the need for POLR functions.

Real Life Stories

Stories from young people in Residential Aged Care demonstrate the day-to-day impact of POLR experiences. For many, the harmful effects of market and system shortcomings for those being forced into residential aged care has reached every corner of their lives.

Michelle: with the right support, 19 year old Michelle would have avoided moving into a nursing home. Instead, she found herself living with people at the end of their lives. Michelle’s story reveals that the result for her was loneliness and misery, cessation of rehabilitation, loss of friends and social life, and loss of home life.

Dennis believes his family would not have suffered a breakdown if he had not been admitted to a nursing home. When he returned home, Dennis’ wife and young children were faced with the overwhelming task of being hands-on carers, and became ‘collateral damage’ of his serious health breakdown (aneurism and stroke). The impact on Dennis of un-availability of SDA and lack of support carers was loss of family, loss of independence, severe stress and risk of re-admission to nursing home.

Bree: After a prolonged stay in hospital (complication of Osteogenesis Imperfecta) at the age of 19, Bree’s parents made the difficult decision to move interstate without her. Bree essentially became homeless. She split her time between two respite beds, one she would occupy during weekdays and the other on weekends. Each Friday she was forced to pack up her room and lock away her belongings. Bree describes this time in her life as a dark place. The instability meant that Bree had little opportunity to develop her independence, maintain relationships and take responsibility for her own future.

Kevin believes he was discharged home to his family too early. This had a significant impact on their relationship due to the pressures of dealing with his newly acquired disability and the lack of support provided to manage his aggressive behaviours. Kevin was soon re-admitted to hospital and unable to return home due to the family conflict. Kevin has been living in a transitional care unit for 12 months now, which has inhibited his ability to build his capacity for independence. “I’ve been going backwards. Now I need help showering and with meals. I can’t even feed myself. I feel low every day. I’m bored and angry. If I had somewhere to move to it would make a massive difference.”

Mark has a spinal cord injury (since age 16) and after a hospital admission that resulted in a tracheostomy could not go back to living in his independent unit with support. He required full nursing care for suctioning and had only two nursing homes in the area who could provide this. Mark was forced to move into a nursing home temporarily while an alternative was found, but he soon became a permanent resident. Mark has been living in the nursing home for four months with no community engagement, which has left him feeling frustrated, isolated and uncertain about his future.

Jill: “I live in a hostel with 19 other people. It’s noisy and I get anxious and angry. There’s lots of drugs and alcohol and people sexually harass me. It kind of scares me. The hostel is being sold… so I’ll be homeless if I don’t find somewhere else to live soon.” Despite Jill’s complaints of sexual harassment from other residents, Jill was forced to stay there because of lack of housing alternatives and funding. Her mobility was limited given she spent most of her time in her room for fear of her safety and relied on support workers to take her out into the community. This resulted in increased anxiety, anger and isolation from her support network.

It is our view that the NDIS must do everything it can to avoid future systemic failures such as those outlined. We need the NDIS SDA market to develop in such a way as to avoid forcing young people to live in Residential Aged Care.

Provider Of Last Resort

‘Provider of Last Resort’ (POLR) is one approach to address market failure. It is defined by the NDIA as a function or arrangement ‘where the Agency directly commissions the provision of goods and services in order to ensure supply’.2

It is our view that POLR must be considered in its historical context. For too long, Residential Aged Care (RAC) has functioned as a POLR for people with high and complex support and housing needs. It is the mission of the Summer Foundation to stop young people under 65 from being forced into RAC and we advocate for the NDIS to be designed and delivered to prevent any future admissions, and support younger people to exit RAC.

From our perspective the existence of POLR should not simply be attributed to the failure in the market, but also a failure of the NDIS itself to address the needs of a complex group. Individual funding packages, pricing reviews and planners need to account for this complexity. The development of a workforce of expert planners and support coordinators is also vital for complex needs to be accounted for in the market. Furthermore, unnecessary regulation or barriers to market entry that do not function to improve the quality of supports need to be removed.

Block funded and NDIS commissioned services cannot deliver on the NDIS promise of choice and control for people with disabilities. Therefore, we must aim to reduce the need for this response over time as the market develops. If this commitment is not built into system reform there are risks of creating a ‘two tiered system’ of an individualised consumer controlled service response where only the proverbial low hanging fruit can exercise choice and control.

To prevent and reduce admissions of young people into RAC we need the market to provide rapid responses to critical and unexpected needs. It is unlikely that the SDA market, which will be focused on serving the needs of long-term tenants, will always have the capability of offering appropriate housing at short notice. Instead, some NDIS participants with SDA payments will need to wait for a suitable vacancy to arise, and even then, the urgency of the need will not impact on their ability to secure housing. Furthermore, they may be significantly disadvantaged if the housing need was the result of complex behavioural issues. As with the general rental market, there will be some people with disabilities who could be locked out of the market as a result of a poor rental history.

Pre NDIS, state jurisdictions carried a ‘safety-net’ responsibility for people where urgently-needed resources have not been available or have been exhausted. If there is involvement of other sectors such as health, justice and homelessness sectors, skilled system interface negotiations may be critical. System interface support must be based on transparent accountability to minimise boundary disputes between sectors and institutions.

Safety-net provisions are a critical back-up for vulnerable people. They represent the social contract that government has for ensuring citizens’ basic needs are met. With many state governments withdrawing their responsibility as the NDIS rolls out, it is essential that alternative safety nets are put in place.

Assurances with respect to quality and safeguards here is important. We argue that urgent and rapid response POLR solutions must not be provided at the expense of quality as a result of the power imbalance between NDIS participant and market providers.

Market Gaps: Problems & Solutions

2 NDIS Market Approach: Statement of Opportunity and Intent, 2016, p27. 26

We have identified a number of situations where a POLR arrangement may be required. These relate to a SDA response, specialist temporary accommodation (STA) and/or an emergency response. Solutions discussed here emphasise prevention, although the need for quality crisis or rapid responses is also recognised and addressed.

Urgent need requires a rapid response

An urgent need for SDA or STA can arise from unpredictable or predictable factors. In the first case, unsustainable family care arrangements causing family breakdown and possibly relinquishment, is an example of an unforeseeable, urgent need for SDA. A POLR is required where respite arrangements are exhausted, STA is unavailable, and an SDA response is unknown or takes time.

In other cases, immediate SDA is needed, but timely access is delayed and not available within a reasonable period of time. The need is therefore (to a degree) predictable, although market gaps result in an urgent situation arising. Typical situations include when people with complex needs are:

unable to be discharged from hospital when ready typically following a lengthy period in acute care and/or rehabilitation resulting in a decision for discharge into SDA.
held in restrictive settings such as prisons or remand without legal reason.
held in hospital or mental health facilities without need for hospitalisation.
accommodated in nursing homes because of high and complex needs and lack of suitable accommodation.
unable to leave respite care because alternative accommodation is not available.

Urgent need for SDA can be associated with behaviours of concern (or behaviours of protest) and/or the experience of violence. Behaviours of concern/protest may be caused by frustration arising from contextual factors, and misinterpreted as unprovoked aggression. POLR are called on when SDA tenants are unable to live with others because of actual or potential risk to themselves or others, resulting in a need for urgent re-housing. People in this situation can cycle between providers and not be offered vacancies in SDA. Lack of continuity in housing can have harmful effects.

Currently there are no incentives for SDA providers to build crisis accommodation. SDA providers can choose tenants to minimise their business risk based on a belief that crisis accommodation is an area of increased risk.

Solutions

Stimulate the market for specialist crisis accommodation including skilled SDA and SIL providers. Direct commissioning of existing preferred providers with ‘track record’ for quality in complex needs, will increase short term solutions during the NDIS transition period. Longer -term SDA resources will result from market incentivisation, accompanied by information for market providers on consumer demand for rapid response providers.
Expand access to temporary accommodation by increased individual funding; use short term accommodation flexibly to access bespoke temporary accommodation such as hotel rooms; and utilise market incentivisation to stimulate an increase in SDA market providers for innovative temporary housing.

People with complex disabilities require highly skilled support coordination to deliver effective housing outcomes.

There is a lack of access by participants to specialist support coordination resources. This is a critical resource where multiple sectors (acute and sub-acute health, mental health, criminal justice, child protection, etc.) are involved with a POLR situation, requiring skilled sector coordination and interface negotiation. The LACs cannot provide this resource.

Activating a speedy plan review can be difficult. Urgent plan review may be needed to secure funding for specialist support coordination and temporary or crisis accommodation.

Solutions

Ensure speedy access to specialist support coordination for people at risk of POLR arrangements, both for early intervention, and for crisis situations. Build capacity for the Specialist Support Coordination (SSC) skills to manage complex housing and support needs, particularly during transition.
Incorporate capacity for a streamlined/rapid plan review (including within 24 hours), when criteria for POLR crisis triggers are evident.
Ensure access by the family and/or SIL provider to an emergency call service to trigger triage functions and locate crisis accommodation. Block funding via direct procurement may be the required funding model as individual funding may not be accessible in a short response time.
Guarantee that tenants and providers of last resort have access to rapid response behavioural support teams funded through commissioning of specialist SIL providers where the market is underdeveloped.
Provide contingency funds to STA providers to repair property damage.
Establish protocols to ensure the transparency of agreed processes and identify the accountability of NDIA and jurisdictions to safeguard people with complex needs in high-risk crisis situations. Such protocols complement market provision and act as necessary safeguards for participants at risk of falling through the system cracks.

Lack of access to high quality complex behaviour support

An SDA resident is challenging to the continuation of their tenancy, resulting in the SDA provider terminating the tenancy. Tenant-caused property damage may be an instigating factor and/or an unacceptable level of risk to employees and tenants.

Experienced SDA providers have observed a reluctance of new some SIL market providers to engage in information exchange. This can be a critical factor in preventing escalation of Behaviours of Protest that may lead to risk of eviction.

Solutions

Longer-term capacity building approaches can assist tenants to build skills in managing their tenancy obligations to minimise behaviours that jeopardises their tenancies.
Build capacity of market providers through the establishment of best practice processes and protocols to assist them to support tenants at risk of eviction.

A lack of culturally safe providers for Indigenous people in remote areas

Demographic analysis of numbers of young people with disability in nursing homes reveals that 396 Indigenous young people are in residential aged care (RAC) across Australia representing 6.4% of the total cohort of young people in RAC3. This indicates a substantial over-representation when compared to the 2.8% of Australia’s population that are Indigenous. In the NT, 75% of young people in RAC are Indigenous (45 young people), possibly indicating a severely thin market of alternative accommodation in the Territory (there are approximately 50 accommodation/tenancy, and 19 SDA registered providers in the NT).4 There is also evidence of ‘thin markets’ of Aboriginal and Torres

3 Summer Foundation analysis of Australian Institute of Health and Welfare (2017) customised data - Younger People in Residential Aged Care, Table 2. 4 NDS registered providers database. 28

Strait Islander NDIS workforce development and lack of availability of registered Aboriginal Community Controlled (ACCOs) including the provision of Aboriginal Support Coordinator positions especially those offering Specialist Support Coordination).

Solutions

Short term solutions for remote Indigenous people can be difficult to implement as the ‘fit’ between Indigenous culture and disability is problematic.5 Marketisation of Aboriginal Community Controlled Organisations (ACCOs) as NDIS providers is also slow and difficult6. Short and long-term solutions need to further Aboriginal self-determination7 which entails capacity building strategies for service provider readiness, and skills development for the Aboriginal disability services workforce.

Guiding principles for POLR

As mentioned above the Summer Foundation has carried out extensive policy analysis of market development specifically in regard to Specialist Disability Accommodation in the NDIS.8 In this context, we have defined a set of six principles that underpin an effective regulatory framework. Five of these relate to POLR and can guide market stewardship strategies as well as market regulation activities.

These principles must be at the centre of all actions taken to address market failure and to support the transition from the current block funded congregate care model of today to an effective SDA market of tomorrow. We call on the NDIA and governments to play their role of active stewardship by developing appropriate safeguards and clearly articulating the rights and responsibilities of all players.

put capacity building at the centre of safeguarding. People with disabilities should be supported to build capacity to make informed decisions, know their rights and meet their responsibilities. People requiring a POLR (sometimes in crisis situations) must receive a solution that strengthens their choice and control, and builds their capacity to make and exert informed choices.
promote innovation and investment while maintaining safety standards. Innovative forms of accommodation can extend the volume of temporary accommodation available to prevent POLR, or provide unique and flexible options for crisis situations. Relocatable housing options with flexible and adaptable spaces may assist in addressing the gap between demand and supply particularly in emergency situations.
recognise and respond to the diverse needs of tenants while ensuring the necessary support. Similarly, SDA that is designed to address the considerable range of diverse needs in regard not just to types of impairment, but cultural difference (CALD), Indigeneity, LGBTI, age, gender etc), can prevent or reduce stress and behaviours of protest that may jeopardise a resident’s tenancy and lead to POLR situations.
be based on clearly defined roles and responsibilities. POLR occasions frequently have the involvement of a range of sectors (health, housing, criminal justice, child protection etc.) multiple providers, and others. Agreed roles and responsibilities are as critical to effective crisis responses as they are to preventative measures.
establish complaints systems that welcome complaints and resolve disputes easily. Clear, accessible and non-litigious complaints systems further the rights of SDA residents. They can be linked to capacity building strategies that give residents greater security in their tenancy role and again will over time, reinforce safeguards for prevention of POLR occasions.

5 Productivity Commission Report 2011 Volume 2. 6 NDIS Market Position Statement: Northern Territory 2017. 7 See the Victorian Aboriginal Governance Strategy 2018 8 PWC and Summer Foundation (2017) NDIS Specialist Disability Accommodation: Pathway to a mature market. 29

SECTION 5 – RECOMMENDATIONS

Market Stewardship

1.0 The NDIA must bolster its role as market steward for SDA by:

   1.1    Providing information to inform the market about the profile of actual SDA demand
        and supply. The NDIA has accumulated data over the first 18 months of operation of
          the SDA payment to be in a position to start providing aggregated data on participants
          being approved for SDA – this is most important in relation to people approved for new
       SDA payments, rather than transitioned into in-kind SDA. Valuable information for
         market development would include the design category the person has been approved
            for (if notional or if associated with an existing property) and broad location.

   1.2    Providing data on SDA dwelling enrolments including building type, design category,
            location, provider type and occupancy status.

   1.3    Providing case study/examples of both a range of participants approved for SDA (and
            their pathway into their preferred housing) as well as SDA projects.

Implementation of SDA Policy

2.0 The NDIA must address serious problems that are emerging around the implementation of SDA policy. There are widespread difficulties with the way the SDA framework is currently being implemented. NDIS participants and SDA providers are dealing with confusing and inconsistent processes and decisions about how SDA is being included in plans.

   2.1   NDIA can improve confidence and understanding in the SDA framework by acting to
         immediately address these issues with practice guidance, staff training and participant
        and provider information sessions.

   2.2    Clear channels of communication should be available for technical issues about SDA to
         be promptly addressed – through FAQ documents and efficient enquiry channels (e.g.
            reliable contact forms). NDIA should look to establishing internal technical capability to
          address technical issues about the dwelling design and enrolment aspects of the SDA
            policy, as well as maintain an industry advisory panel to assist with resolving technical
           issues in the establishment phase of the policy.

SDA pricing

3.0 The NDIA must clarify intent, scope, process and timing of SDA pricing reviews. Uncertainty about SDA pricing in the medium term is having a serious impact on market confidence and the willingness of banks and investors to back SDA projects. NDIA must:

   3.1    Provide clarity and adequate information about how the pricing reviews will be
         undertaken to improve understanding about their likely impact.

   3.2    Provide a minimum 10 year commitment to current SDA pricing (with CPI indexation)
            for all new SDA dwellings.

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SDA Registration

4.0 SDA registration should have clearly specified requirements of SDA providers including:

   4.1    Evidence of separation of housing and support or an action plan to achieve separation
          within a reasonable timeframe. Ultimately, all SDA tenants should have the right upheld
           to change providers without changing their housing.

   4.2    Submission of a conflict of interest policy and procedure and evidence of its
          implementation. This requirement should be assessed against performance standards
           to address, potential conflicts of interest for SDA providers. For example, a
         demonstration of mechanisms available where the tenant wishes to change service
           providers.

   4.3    Evidence of personal evacuation plans for all tenants and procedures for information
        on emergency processes (such as evacuation)are made available to tenants on a regular
           basis and in accessible format. This information must be included in the tenant/SDA
          provider service agreement. An additional requirement should be to provide evidence
           that these plans are backed up by evidence of their efficacy as the most appropriate
         approach with respect to the needs of the individual.

   4.4     Participation in mandatory orientation training for SDA providers that will cover the
           following issues:

            4.4.1  Human rights and disability awareness, including the principles of the NDIS
                with a focus on choice and control and how to support tenant decision-making
                with respect to house rules and choosing housemates.

            4.4.2   “Behaviours of concern” and appropriate policies and procedures for
                responding to tenants exhibiting aggressive or violent behaviour. The training
                should orientate providers to the relationship between communication and
                  behaviour, how to manage tenancy fairly and with consideration of other
                  tenants in the house, how to access support and resources available to reduce
                  harmful behaviour in SDA settings, and the roles of The Office of Professional
                   Practice and the senior practitioner.

            4.4.3   Quality and safeguarding including SDA practice standards, rules and terms of
                   business, the role of the Quality and Safeguarding Commission, appropriate
                 complaint procedures, and the importance of tenant safety procedures.

It may be appropriate for some SDA providers to be exempted from some of these requirements such as in circumstances where a person with a disability uses their own SDA provider or when complete separation of housing and support has been achieved.

Practice Standards

5.0 The quality and safeguarding commission should develop robust practice standards that:

   5.1    Support the utilisation of innovative building design and construction based on
           principles of promotion of safe behaviours in shared accommodation.

   5.2    Enable providers to recover costs from property damage associated with behaviours of
          concern.

   5.3    Provide a “model pathway” that addresses the need to separate housing from support
        and a timeline for the achievement of full separation. The model pathway should

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include the Summer Foundation Toolkit for the separation of housing and support.

   5.4    Outline a rapid response with respect to tenants behaving violently towards other
          tenants in the property or towards staff and visitors.

   5.5    The involvement of tenants in decision-making with respect to house rules and the
           selection of housemates and service providers. This should include their participation
            in interview panels for tenant and service provider selection.

Capacity Building

6.0 The government should invest in capacity building opportunities to:

   6.1     Assist providers to separate housing from support, and develop approaches for
           collaborative practice between housing and support providers where this is required.
          Capacity building should introduce options for support for collaborative practice
        between housing and support providers (e.g. emergency procedure development).

   6.2     Assist SDA tenants to manage their tenancy rights and responsibilities. This should
           include skills in understanding and exercising informed choice and control in SDA
             settings. The design of capacity-building programs must address diversity within the
       SDA population, and tenant characteristics such as age, type of impairment, cultural
          background, indigeneity and level of vulnerability.

   6.3     Assist mainstream services including tenants unions and administrative tribunals to
         respond effectively to the needs of people with disabilities accessing their services.
          Capacity building support for tenants could also be provided by increasing funding to
            disability organisations and advocacy services who could be supported to develop their
           expertise service offerings in the area of tenancy support.

Community Visitor scheme

7.0 The government should explore options for a new national safeguarding system to replace the existing, state-based Community Visitor schemes. The design should be based on best international practice and consider the issue of proportionality. The safeguarding system will need to be flexible to sustain quality in safeguarding while aiming for a reduction in demand as tenants become better informed over time. The new scheme will ensure that all SDA tenants can access independent safeguarding protections by default, but also have the choice to opt out of the scheme.

Provider of Last Resort and Crisis Accommodation

8.0 The Council of Australian Governments and the NDIS must address the issue of market failure and the need for crisis accommodation by:

   8.1    Ensuring quality and safeguarding for people needing key safety net provisions such as
         POLR. The urgency of some situations that trigger POLR responses may lead to short
           cuts that sacrifice quality. Standards of quality and safeguarding must be implemented
            in addressing a crisis. People with high and complex needs requiring urgent housing
        and support and occasionally exhibiting ‘behaviours of protest’, have rights for quality
           solutions that meet their levels of need, and further their choice and control.
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8.2 Ensuring that people needing POLR are not left unsupported or allowed to fall between the cracks when rapid responses are hard to secure. The NDIA must accept this responsibility for all of its participants.

8.3 Amending SDA pricing to provide additional loadings to prices for NDIS participants requiring SDA exceeding platinum level design specifications. For example, participants who are bariatric, require shower trolleys or have behaviours that require a more specialised built form beyond the robust category. However It will be important to develop an evidence base for the application of these loadings and make them available to people with disabilities and the market. SDA pricing for the small group at the highest and most complex end of the continuum needs to be based on a comprehensive analysis of these costs.

8.4 Setting up POLR arrangements as temporary, transition arrangements, to be reviewed rigorously in the light of Australian and international evidence of efficacy. This recommendation relates to the principle of non-distortionary market intervention strategies that are targeted or temporary with identified exit timeframes and strategy.

8.5 Preventing POLR situations by stimulating market development of innovative solutions for temporary and crisis housing. Greater access by people with high and complex needs to a larger range of temporary or transitional housing will give more choice for a housing solution to meet diverse needs. Innovative housing options such as re-locatable units can increase flexible housing stock.

8.6 Increasing the availability of rapid responses through increased access to specialist support coordination, capacity for rapid plan reviews, emergency help line, access to specialist ‘complex participant pathways’ advice and transparent organisational responsibilities. A suite of rapid response mechanisms will respond to the complexity of need for responses and a more holistic and coordinated approach. Timely assistance in conjunction with more market providers of temporary and long term accommodation will reduce the need for separate crisis services.

References

Carey, G. Dickinson, H. Malbon,E. Reeders, D. (2018) The Vexed Question of Market Stewardship in the Public Sector: Examining Equity and the Social contract through the Australian National Disability Insurance Scheme. Social Policy & Administration. Vol 52,(1)

NDIS Market Approach: Statement of Opportunity and Intent (November, 2016)

PWC and Summer Foundation (2017) NDIS Specialist Disability Accommodation: Pathway to a mature market.