PRIVATE SUBMISSION TO SENATE INQUIRY INTO THE PROPOSED
NATIONAL DISABILITY INSURANCE SCHEME AMENDMENT (GETTING THE NDIS
BACK ON TRACK NO. 1) BILL 2024
CONTENTS
INTRODUCTION
SUMMARY
DISCUSSION
What is SIL?
What is a SDA?
SIL Service Provider
How are support workers provided?
What is a RoC?
What is a SoS
How are participants funded by NDIS?
Why are sharing ratios variable?
What can affect the share ratio?
Rights of service providers and existing participants to filter
proposed new participant tenants
How participants are billed by the SIL Service Provider?
What are the components of billing?
Consequences for participants?
CONCLUSION
What can be done?
_________________________________________________________
Abbreviations list
CS Submission to Senate Inquiry NDIS Bill – May 2024 Page 1 of 10
INTRODUCTION
The NDIS Review report was released in December 2023 and contained numerous recommendations. Included in these was a section relating to housing and the Review stated:-
Fairer housing and living support: The Review recommended consistency should be introduced to housing and living support budgets to make it fairer for NDIS participants. The Review recommended a more flexible and innovative approach to housing supports to help people access solutions that suit them better
The report included Recommendations 8 and 9 with associated 15 action points to address participants’ access to and their choice and control in, suitable housing.
Supported Independent Living (SIL) is a program in the NDIS system to help participants to access suitable housing. It is not the only assistance available to participants but is very significant.
The numerous Review submissions referring to SIL indicated a general lack of understanding by consumers of this system
The proposed NATIONAL DISABILITY INSURANCE SCHEME AMENDMENT (GETTING THE NDIS BACK ON TRACK NO. 1) BILL 2024 refers to a number of initiatives which are general in nature, to alter the NDIS legislation and rules to provide, amongst other things: - clarity for participants regarding access to the scheme, - a new funding structure, and - various actions designed to protect participants These changes to be developed in accordance with the legislation and in consultation with people with a disability.
The Senate now has referred the provisions of the Bill to the Community Affairs Legislation Committee for inquiry and report by 20 June 2024. The Committee invites submissions until 17 May 2024.
SUMMARY
The Bill does not directly refer to housing, but changes to the NDIS legislation overall should be informed of consumers views on the effectiveness of the current system when making fundamental changes.
SIL is the NDIS system to fund participants to live in registered Specialist Disability Accommodations by providing them individually with funding to pay for personal support provided by disability workers. Generally this is based on sharing supports in a congregate setting with varying arrangements for the building – multiple bedrooms, single occupant villas, etc. The disability workers are managed by a SIL service provider.
Participants are funded in their plan on the basis of the complement of participants that they will share supports with at the site and their individual daily support needs. This forms the basis of an annual funding dollar amount included in their plan.
CS Submission to Senate Inquiry NDIS Bill – May 2024 Page 2 of 10
Participants know the funding amount in their plan and expect it to pay for the supports that have been identified by them and their therapy team.
Unfortunately this is a deception as the supports they may ultimately receive can be severely eroded by having the site complement reduced by such events as participant vacancies. This reduces the aggregate revenue able to be claimed from the now reduced number of plans which can force the provider to cancel or reduce individual supports. The participants have no control over this and can be faced with their plan being billed for the total funding (or sometimes more) but receiving less supports than was agreed and funded originally.
This can have duty of care versus financial lack of viability implications for the service provider and destroys the participants’ rights to choice and control and individualised support. Thus they have been deceived by the NDIS.
DISCUSSION
What is SIL?
Supported Independent Living is a NDIS program to facilitate participants to access suitable housing together with disability worker support. There are a number of models for housing in NDIS but the SIL program is meant for those with a serious disability requiring significant, perhaps 24 hour, support.
NDIS may accept and fund a participant for residence in a Specialist Disability housing (SDA) with associated personal SIL.
What is a SDA?
Specialist Disability Housing (SDA) is a NDIS scheme to encourage the private housing market to build housing suitable for people with a disability. SDAs must be registered with the NDIS and conform to varying standards.
Developers and owners are compensated under the SDA scheme for offering this type of housing by being able to claim an SDA fee from a participant’s plan for each participant acting as a tenant. The funding of this SDA fee is dependent on the type of housing (house, apartment, villa, etc), the degree to which it has disability facilities, location, etc. The SDA fee can be tens of thousands of dollars for each resident, but relies on a tenancy agreement between the SDA owner (landlord) and the tenant/participant to trigger claims.
There can be a lag between construction of this housing and being tenanted before an SDA fee can be claimed.
The SDA fee is separate to the rent that a tenant/participant pays to the SDA owner (landlord) and is itself subject to a NDIS cap associated with a set percentage of the disability support pension.
SIL Service Provider
An SDA owner or landlord will generally require a service provider to manage aspects of the SDA site including employing, training and rostering disability workers and their supervision.
NDIS requires separation of these functions of owner and service provider and a SIL provider will be chosen by consultation with participants and the SDA provider. A collaboration agreement between the SDA provider and the chosen SIL provider will set out the general principles of how participants are to be supported
The SIL provider manages the site with a focus on the well being of the resident participants.
The SIL provider bills the participants according to their Plan funding and this in aggregate constitutes their revenue stream. Depending upon the site circumstances and agreement they may also collect money from participants for food, energy, etc used by the participants.
This revenue stream has basically two components - that required to pay for the direct costs associated with employing disability workers, and a margin to pay for overheads such as management, accounting, insurance, etc.
Employing and rostering disability workers is a complex task and they are in turn allocated to perform specific and generalised tasks s for participants as described further below.
The nature of SIL Disability supports required by participants are generally of two types :-
- Specific personal supports delivered as:-
- Particular workers allocated to perform a task and dedicated solely to a participant (a 1:1 or 2:1 ratio of workers to participant for example) and lasting for a discrete elapsed time (e.g. one hour for morning dressing and grooming), and
- Particular workers allocated to perform a task and dedicated solely to a participant (a 1:1 ratio of worker to participant for example) and lasting for a significant proportion of a day – such as 12 hours,
- Passive support services delivered as:-
- A shared pool of workers not allocated to either 1a or 1b at the time and available as stand-by support in the event of an unplanned support need of a participant, and
- Particular workers assigned to a specific task for all participants (e.g. a night shift to cope with emergencies should they arise )
How are support workers provided?
The SIL Service Provider will roster workers to be on hand to be allocated to a particular participant for Type 1 supports, or to a group of participants for Type 2 supports.
This is a complex calculation requiring matching of worker training, participant choice, varying times of personal needs, participant absences, worker leave, and employment regulations.
What is a RoC?
A Roster of Care (RoC) is a table of a participant’s support needs by the time of day and day of the week. It attempts to identify the support ratios required for each support category (specific or passive) by identifying the number of workers required at a particular time and interval and the number of participants this will be shared with at the SDA. For example a participant requiring 2 workers for an hour working exclusively for him/her would have a share ratio of 2:1 for an hour (2 workers not otherwise shared). At other times where only passive (stand-by) support may be
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needed the ratio can differ; for instance when 2 workers are available and there are 4 participants at home the ratio would be 2:4.
NDIS have tools to enable this RoC to be costed to provide a dollar amount to be funded in a participant’s plan. This relies upon two main factors:-
- The NDIS Price Guide for costing $/hour relative to shift times, shift type, weekends and public holidays, and
- The number of participants sharing the support at a particular time.
This SIL funding is very sensitive to the number of participants that support is shared with as passive support elapsed times are effectively divided between the number of participants.
The RoC is supposed to be developed by therapists and support coordinators and perhaps a SIL Provider if one has been identified; in conjunction with a participant and their informal supports if any, but this process is far from being defined and controlled.
What is a SoS?
A schedule of Supports (SoS) is a plan of the support a participant needs over a typical day and/or week. It includes details of direct and passive supports and integrates with the RoC to identify what workers are needed at the required times to fulfil the support tasks. It will refer to details of specific worker training needed, what supervision may be required, participant preferences, etc.
This nomenclature is being replaced by the term Program of Support but is essentially the same thing.
How are Participants funded by NDIS?
To summarize the NDIS system a participant is funded through his/her Plan by reference to a RoC. The RoC is explained above; it has a major flaw in that the number of participants sharing a support is not fixed.
Thus a participant is deceived by having a RoC and a funding dollar amount in his/her Plan but not advised that the sharing ratio can vary wildly resulting in the cost of a support dramatically increasing if the number of participants sharing decreases – the cost being divided between less participants..
This can result in funding instantly being insufficient and a Service Provider being faced with a choice between duty of Care to provide services not billable, or reducing services (i.e. rostered workers) to stay financially viable.
Why are sharing ratios variable?
Sharing ratios are fundamentally derived from the particulars of the SDA (see above) which is designed and NDIS registered to accommodate a set number of participants (for example 4 participants). The RoC basically assumes that this will form the basis of support sharing.
What can affect the share ratio?
- Vacancies,
- Participant significant use of other than SIL funding (example Community Access funding),
- Participants utilising significant 1:1 SIL support, and
- Participants requiring and funded for less than 24 hour support
Vacancies
Perhaps the greatest affect on share ratios is caused by vacancies – where the SDA assumed complement of participants is not met.
Participants have the right to move out and this reduces the share ratio. The effect on finances may be partially offset by reducing the workers rostered to provide specific supports to the participant vacating but all remaining participants will now be sharing passive supports, and the associated costs which are mostly fixed, with less people thus dramatically increasing the allocated costs.
Significant use of other funding
Participants may have significant Community Access (CA) funding e.g. 12 hours per day, which entitles them to be away from the SDA for a significant time. SIL Service Providers may consider this in the same manner as a vacancy, and reduce the share ratio for billing purposes during these times.
Note that if the CA provider chosen by the participant is the SIL provider, then they will receive the CA revenue, but this may not be the case.
It is arguable that this change to the share ratio is not equitable as passive SIL supports are still available should an unforseen event occur while away, such as transport failure, illness, etc necessitating early return home.
Additionally in the case of a no-show by a CA worker, SIL worker will be required to provide support. SIL Contingency funding may be available for this but recalculating others share ratios for such short periods is impractical
Significant SIL 1:1 funding
Participants may have significant (e.g. 12 hours per day) SIL 1:1 funding (for example behavioural supports) which has the same practical effect as a vacancy as the participant is
Less than 24 hour support
Participants who have this arrangement for their support have the same effect as vacancies as explained above.
Rights of service providers and existing participants to filter proposed new participant tenants
Existing participants are supposed to have the right to accept a new participant resident but this generally relates to suitability of personal attributes and, due to privacy considerations, does not extend to an understanding of funding the new person might bring to ultimately share with others. Indeed participants and their external supports may not understand the possible consequences of the new funding nix.
SIL providers should have the right to not accept new participants if their funding will jeopardise the financial operation of the site. However this is a grey area with competing priorities. The SDA owner wishes to fill any vacancy as soon as possible to maximise their SDA fee receipts; similarly the SIL provider may make short term decisions to restore their SIL billings revenue as much as possible as soon as possible notwithstanding it may adversely affect all participants in the long term if the new SIL funding is disproportionate to the group.
Additionally the emotional aspects of seeing a person with a disability securing a home may be considerable.
How participants are billed by the SIL Service Provider?
NDIS allows two methods for providers to bill participant’s plans for SIL support:-
- Daily billing, and
- Weekly billing
Daily billing
This involves the provider to submit a bill for the detailed supports provided to a participant on every day. For participants requiring 24 hour support this is not practical.
Weekly billing
This focuses on the total annual funding in a participant’s plan (not including any contingency amount) and billing weekly by an amount calculated by dividing the annual funding amount by 52.
If the original funding was based on an agreed RoC and associated SoS and the share ratios on the RoC are maintained, this would be a fair and practical method.
But these assumptions may be grossly invalid.
As previously explained if the RoC share ratio is distorted and/or the SoS is not provided then this method is fundamentally flawed.
There is anecdotal evidence that unfair practices by service providers can occur by billing for services not provided and there is no NDIS mechanism to independently assess this. Additionally the system is so complex that participants and their external supports will be hard pressed to relate services provided to provider billing given the opportunity to obfuscate the issue with changing share ratios which are opaque to participants.
Reputable providers have attempted to introduce simplistic systems to paint a fair billing process related to an equitable sharing of total costs to SIL funding revenue for participants. Various methods have been tried including calculating the proportion of each participant’s total support hours relative to the whole number of support hours over the complement of participants.
Because of the varying share ratios, the mix of needs between the more expensive weekends and evening rates, these approximations cannot really be fair and avoid cross-subsidisation of support funding between participants in the same SDA.
What are the components of billing?
The NDIS Price Guide publishes prices that a provider may not exceed when providing disability services to NDIS participants.
For SIL (and many other support types) these prices for personal support differ for week days, weekends, evenings, nights, public holidays and sleepovers.
The basic dollar rate published is meant to cover the providers costs associated with: -
- Employment costs associated with direct support workers,
- Training of workers
- Worker shadow shifts, and
- Provider administrative costs (including supervision, management, general and administration costs)
Employment costs
These are the pay rates provided to workers including any on-costs
Training of workers
These are any costs associated with worker training both generalist and participant specific.
Worker shadow shifts
Generally not associated with SIL support.
Provider administrative costs.
In accounting parlance this is the Gross Margin calculated by deducting from revenue (participants’ billings) the direct costs of employing disability workers and their next level supervision.
This is not generally advised to participants and is not independently monitored. NDIS did have a voluntary benchmarking (now discontinued) Survey but this did not include GM - only overheads as % of costs and EBITDA
A private organisation, Ability Roundtable, hosts benchmarking services including one for SIL for the information of Service Providers.
It is important to note that when a vacancy occurs; when a funding package has less than 24 hour support; or where significant CA is utilised using another (not the SIL provider); then the SIL provider will incur reduced revenue and reduced quantum of GM (although the percentage may not necessarily change significantly). The provider may try to compensate by charging more than the plan funding (reflecting the increased theoretical billing due to share ratio increasing), but this cannot occur except if contingency funding is accessed; or by reducing employment costs. However the latter is restricted as reducing passive support workers may not be possible to less than a safe number (usually 2 for transfers, etc), and specific task shifts such as night shift cannot be less than one worker. The provider may then face a dilemma between a duty of care to provide the SoS support or become financially unviable.
Consequences for participants
Thus through no fault of their own, participants may face a serious reduction in necessary supports that they are entitled to be provided with according to their RoC and SoS that their SIL funding was originally based upon. This is a deception around the original funding - that even though they still have the same $ funding there safety and well being could be seriously compromised.
**CONCLUSION**
What can be done?
NDIS state that they will not fund vacancies, but this does not accord with the plight of participants who may face their right to choice, control and individualised support obliterated by circumstances over which they have no control. Indeed their safety may be compromised.
It is questionable whether this situation will be supported by NDIS in relation to a change of circumstances claim. But even if possible, the time delay in having such a claim assessed is disproportionate to the dangers which may present themselves.
SIL funding already has a contingency available for situations where SIL support is unexpectedly needed should a participant be unwell and unable to attend a CA funded activity. This is meant for relatively short-term conditions.
The following suggestions are offered for the stated reasons that a participant’s share ratio changes over a significant period.
One vacancy passive support contingency
A practical solution to avoid a dangerous temporary situation of a provider finding it financially necessary to reduce supports due to share ratio change could be to add a further contingency to cover funding of passive support.
Where a vacancy is involved it would be a relatively simple calculation to evaluate the difference between calculated billing for the SDA complement of participants and the now reduced number of sharing participants for passive supports. This assumes that the direct support worker costs for the departing participant are removed by not rostering the involved workers.
The SIL provider can do this calculation and advise each participant the effect on each of their plans to present at their next plan review to request funding of a SIL Passive Support Contingency. This would apply to only one vacancy and would assume the vacancy does not extend beyond 12 months. The participants would agree to the provider to access this funding weekly in the event of a vacancy triggering the need.
Vacancy exceeding 12 months and other reasons for support ratio change
Where a participant is threatened to have supports adversely affected by any of:-
- A vacancy extending beyond 12 months or more than one concurrent vacancy
- Participant significant use of other than SIL funding (example Community Access funding), and
- Participants utilising significant 1:1 SIL support
- Participants requiring and funded for less than 24 hour support
Then it is assumed that the participant will need to present this evidence at their next plan review – either planned or specifically requested – to ask for a permanent change to their SIL funding.
Anonymous
16 May 2024
Abbreviations used in this submission
NDIS - means the National Disability Insurance Scheme PoS – means Program of Supports RoC – means Roster of Care SDA – means Specialist Disability Accommodation SIL – means Supported Independent Living SoS – means Schedule of Supports