7/3/2018
SUBMISSION IMPLEMENTATION OF NDIS SERVICES
Respite (Short term out of home accommodation)
This submission is on behalf of the Nardy House Board. I am the CEO of this charity. The NGO provides respite and accommodation services to people aged 0-65 with profound physical disabilities. This group of people requires assistance with every aspect of daily living; they are wheelchair confined or move only with assistance. Their physical disabilities are often in combination with intellectual disabilities and their needs are complex. They have high health needs and because of these needs require daily RN assistance.
NHI started transitioning our permanent accommodation clients to NDIS in October 2016. We were told that transitioning of our respite service would not occur until July 2017. This has not been the case and some of our respite clients transitioned early. We started to prepare for NDIS well before transitioning. We developed protocols of care related to our permanent residents. When the LAC team visited Nardy House they informed us that our clients were too complex for LAC; the Assistant Director of Planning Southern Region then visited us and Plans related to our (then) clients were developed.
We transitioned to NDIS only after the Assistant Regional Director in Planning (at that time, Ian Gumm) and a number of his colleagues visited the house and took away related evidence, It was acknowledged that NHI needed to quote for both our accommodation and our respite service. The benchmark figure, as was also acknowledged by Ian Gumm, did not cover our costs in the supply of service. It was also acknowledged that the service was unique, was required and kept people within their families for much longer periods of time than would otherwise be possible (without the break that short term supported out of home accommodation – i.e. respite-provides).
NHi provides respite 24/7 every day of the year. In order to establish respite costs an average was used to be fair to all our clients. Our respite clients require 2:1 DSW workers for personal care; they require constant supervision outside care requirements and have high medical support needs (RN support). Our respite provision costs $57.08 per hour. Our accommodation costs are quoted on an individual client basis.
NHI needs to know what the intent of NDIS, in regards to our service provision funding, is. We have tried to place existing respite (out of home supported accommodation) clients, who have already transitioned and already received a service, on the NDIS portal to request a payment. We cannot get an acceptance of a payment- the portal response is it is above the benchmark. This is the case except for one client: James Blinman. Mr. Blinman started to receive a service from Nardy House because we accepted him in our respite service. He was an NDIS Client transitioning from hospital to home and we could assist that transitioning. We quoted for the provision of that service- this was because it was acknowledged that his costs could not be covered by the benchmark figure. NHI was funded to assist NDIS new clients (because it suited an NDIS need) and we require also to be able to support our existing clients in the manner that they have been supported in the past.
There is a further problem with our respite clients. Many of our clients are receiving much less respite than they have had in the past because of the costs of our service. These clients have been seriously disadvantaged, as have their carers. The end result of this disadvantage will be earlier requirement for permanent placement. Our clients, at that stage, will require nursing home or hospital care. A group home of the benchmark type cannot cater for their needs. The cost makes our respite costs of $57.07 per hour and our accommodation costs a very inexpensive alternative.
The new benchmarking costs for respite that cover our costs- released 28th October 2017 were released AFTER the annual review of plans of many of our current clients. Our clients’ carers believed they could not afford our service so did not apply for funds for short-term out of home accommodation. Review of plans takes months; therefore NHI is able to offer a service only to those aware of the current level of funding and those who have included it in their plans. This number represents about one seventh of our client base
Permanent Accommodation SIL
NHI has never received any quote acknowledgement for our clients. Between October 2016 and July 2017 we received no SIL or SDA component of our clients plans- this was despite the submission and resubmission of quotes for care. Finally we received a manual payment for our clients for SIL and SDA. The SDA component received was below our quoted figure. The SDA component was quoted after Kothes (Auditing Accountants) determined a figure using the NDIS SDA Guidelines NHI is unable to fill vacant beds in our accommodation facility. If a client does not have an accommodation package that is sufficient to cover the costs of care they cannot get it. They may not have an accommodation need when
their plan is drawn up. When the need occurs they cannot access accommodation because it is not in their plan. Plan review takes months. We have a young woman who could have taken our bed. She is a short term out of home (respite) NHI client. NDIS was contacted but did not undertake action. It is our understanding she was placed in an Aged Care setting- exactly the situation the NHI beds are meant to address. This is the Catch 22 created at present. We cannot fill bed vacancies and there remain thousands of young people in Nursing Homes in this State. They are never going to get out. If there was a plan to take these young ones out of Nursing Homes a bed vacancy flagging at Nardy House would have been filled immediately as would the accommodation vacancies flagged by other services through out this State. There is no plan and at present no hope of one.
The closing off of the VOOHC (Voluntary Out of Home Care) register for children is a further problem for our organization as is the NSW FACS funding of the SIL component of children’s ‘plans. Firstly the FACS component has not been paid to us at this stage and further NHI cannot take a child not on the VOOHC register. Children are either on the register or will not be funded by FACS. The alternative, Statutory Care of the Minister (with its fostering, adopting and rigorous oversight), is the domain of Community Care. The mid field is a funding black hole. Children with profound physical disabilities are unlikely to be fostered or adopted and they will be unfunded because they are not relinquished.
The time and energy required to meet constant lack of response by NDIS is unsustainable. NHI no longer has secure financial footing. The organization has been forced to discontinue some aspects of our service provision. Given the already limited availability of accommodation and respite for people with complex physical support needs this seems ridiculous-especially given the NDIS emphasis on choice by the individual. The actions, or lack of actions by NDIS are ensuring the opposite of the contention that more choices will be available under the new scheme
Our organization is being bled of funds and NHI cannot keep going in this manner. We need answers related to our quotes. The individual plans call for quotes and they have been supplied. What has not been supplied is a response regarding these quotes and a funding equivalent .We need our respite clients receiving adequate respite time allocated in their plans. Time that allows them either to receive respite with us or receive a comparable service elsewhere- that is if it exists! NHI needs to be able to draw down
money that reflects the true cost of service provision for the absolute, upper support- needs clients.
Denise Redmond
CEO Nardy House