Submission to the Joint Standing Committee
on the National Disability Insurance Scheme
6 September 2019
Prepared by:
Summer Housing Ltd
ABN 61 617 404 789
Level 18
1 Nicholson Street
East Melbourne VIC 3000
Telephone: +61 3 9916 7939 info@summerhousing.org.au http://www.summerhousing.org.au
Items addressed by this submission
Summer Housing welcomes the examination of Supported Independent Living (SIL) by the Joint Standing Committee on the National Disability Insurance Scheme.
In this submission we will share our experience and submit our views on:
- the process for the funding of SIL;
- barriers to the adoption of innovative and cost efficient SIL models; and
- the conflicts of interest associated in SIL and SDA models adversely affecting participants and scheme more broadly.
Background to this submission
ABOUT SUMMER HOUSING LIMITED
Summer Housing is a not for profit national Specialist Disability Accommodation (SDA) provider committed to increasing the range and scale of housing options for younger people in or at risk of entering residential aged care. SDA is a support funded by the NDIS for the provision of specialist housing solutions NDIS participants with extreme functional impairment or very high support needs who meet specific eligibility criteria.
Presently we have over 180 SDA dwellings under construction in every State and Territory in Australia other than Tasmania and the Northern Territory.
Our predominant focus to date has been on High Physical Support apartments integrated into mainstream developments, providing an end product with a high emphasis on independence, amenity and access to economic participation for our tenants. We are now diversifying this offering with an increasing proportion of Fully Accessible apartments under construction.
Our submission is informed by our practical experience in delivering new high-quality SDA projects
at scale for participants with complex care requirements adopting an innovative Supported
Independent Living (SIL) model.
OUR HOUSING MODEL
Summer Housing’s housing model integrates dwellings for younger people in, or at risk of entry into, residential aged care in well located mainstream residential developments, promoting independence, social inclusion and economic participation.
In particular, our approach to date has been to acquire 11 apartments peppered throughout developments with typically 75 or more dwellings, tailoring the design of 10 apartments to meet the requirements for Specialist Disability Accommodation. The remaining 11th apartment is used to enable the provision of on-call support to tenants by third party SIL providers.
Smart home technology is a key feature of these housing projects. This technology enables residents with severe physical disabilities to use their smart phone or tablet to open doors, open and close blinds, control the air conditioning and turn lights off and on. Communications technology enables residents to contact staff when they need unexpected help, or in the event of an emergency. Tenants are able to maximise their independence and privacy while still having access to 24-hour on-call support.
OUR SIL MODEL
The onsite support provider operates under a concierge model with a SIL provider funded by the NDIS in each of our tenants’ NDIS plans. One staff member is onsite at all times to be shared amongst the 10 SDA tenants. This staff member is located in the additional 11th dwelling described above.
Our tenants are able to call for help and assistance, as required using communication devices, thereby allowing them to maintain independence and privacy.
The SIL provider is selected by our tenants through an Expression of interest and due diligence process. Similarly, tenants have the ability to change the onsite concierge SIL provider.
Importantly, unlike many other SDA providers, Summer Housing does not:
- choose a SIL provider itself which tenants are required to then engage for their supports; or
- provide SIL providers which exclusive rights to select tenants for projects enabling them to restrict housing opportunities to participants which engage them to provide other services.
The onsite concierge agency will be shown in their NDIS Plan as a STATED SUPPORT and will reflect their contribution to the 24-hour onsite support service according to their predicted need over a week. This funding would go directly to the selected SIL provider as per usual for shared SIL funding.
In addition, each tenant will have their individual Core Supports funding for assistance with daily living for their known, 1:1 (or 2:1 etc.) planned support needs. They can then choose which provider(s) they want to use to undertake this type of daily support. This would not appear as a stated support in their plan and should remain flexible to be used as Core Supports. The agencies each participant chooses will draw down from the participant’s Core Supports as per normal.
The benefit of our approach is that it promotes participant choice and quality – the appointment is made by the tenants who are aligned to ensure quality of service. In our experience it has also proved to be more cost efficient as:
- the SIL cost is amortised across 10 tenants; and
- it does not promote over-servicing by an incumbent one-stop provider which is permanently present in a resident’s dwelling.
SIL Funding Process and Implications
Participants who receive SDA will have very high support needs and accordingly will require SIL as a separate support in their NDIS plan.
The process of securing SDA in a participant’s plan is time and resource intensive. In Summer Housing’s case, participants who are eligible for SDA funding, including younger people in residential aged care, will not have SDA in their plan when they become aware of their potential funding entitlement.
The process of compiling the requisite specialist reports and then assessment for SDA funding by the NDIA typically requires at least 5-6 months. However, the journey does not end here.
Participants must then endure a further lengthy and opaque process to assess SIL funding eligibility. Notwithstanding that a comprehensive process is undertaken to assess a participant’s entitlement to receive SDA based on provision on-site SIL funding, a participant may theoretically still be subsequently denied SIL funding.
In particular, there is no presumption of SIL funding for SDA eligible participants or streamlined process for their assessment. Indeed, many participants find themselves back at square one required to re-prosecute their housing goals, requirements and preferences.
The process for preparing SIL quotes is also very complex and time consuming which is compounded by a further lengthy period for the assessment of such quotes. In our experience to date, we have had dwellings standing vacant for 2-3 months with SDA funded participants unable to move in as they awaited the determination of their SIL applications. We expect this trend will continue with our pipeline as it is rolled out over the coming months.
This is a fundamentally unsupportable outcome - high-quality purpose-built housing unable to be occupied by younger people in, or at risk of entering, residential aged care even though they have already been determined as being eligible to receive SDA funding for such housing.
We are particularly concerned with the extent to which this issue will only grow over the coming years as the supply of new SDA grows with consequential growth in SDA and SIL applications.
Recommendation: If a participant is funded for SDA with OOA, a presumption of SIL funding should automatically apply. Further a streamlined approach should apply for SIL quote preparation and assessment for such participants.
Innovative SIL Funding Models
Typically, SIL funding is provided based on a group home model where a single provider will provide all of the supports for the residents. The support ratio is typically low with one or two workers supporting 4-5 residents with support constantly available and present within the dwelling.
Our model is inherently more efficient and promotes greater independence.
SIL is provided for 10 residents via an on-call concierge model for unplanned or emergency assistance on a backup 24/7 basis with flexibility for participants to engage a separate provider to deliver other core supports.
However, our experience to date is that there is not widespread awareness or willingness from NDIA planners to engage with alternative and innovative models of delivering SIL. This not only adds to the delays and inefficiencies in the SIL funding approval process but is concerning as combining traditional SIL models with SDA has the potential to significant increase the combined cost to the scheme of SDA and SIL.
Recommendation: Alternative and innovative models for the delivery of SIL should be actively encouraged within the NDIS to encourage quality, participant choice, participant independence and value for money.
Additional investment should be made in the education of planners in SIL funding models and consideration should also be given to adapting software and systems to better accommodate non traditional SIL models.
Conflicts of Interest and Anti-Competitive Practices
As stated earlier, participants who receive SDA will have very high support needs and accordingly will require SIL as a separate support in their NDIS plan.
Based on our experience to date, there are extensive anti-competitive practices in connection with the provision of SIL in SDA dwellings with adverse implications for participant choice and control, competition, quality and value for money.
For instance, in contrast to Summer Housing’s model whereby a third party SIL provider is selected by participants with ability to retain separate core supports, the following practices are presently commonplace:
- One Stop Shops: SIL providers who also act as support coordinators and SDA providers delivering a “one stop shop” outcome for participants.
This is worrying practice as there is an inherent conflict of interest for the SIL provider. We are aware that many of these arrangements reflect historical practice and arrangements which pre-date the NDIS. Further, many service providers in this space are not profit groups which are not being driven by any nefarious motives.
However, it is a practice which we do not feel should be supported to persist as we have experienced first-hand, SIL providers leveraging this position to conduct a “closed shop” denying opportunity for their clients to become aware of, or otherwise explore, alternative arrangements.
- Third Line Forcing: An emerging trend is sees SDA providers pre-select SIL providers for their projects. Projects are then marketed to prospective SDA tenants on the basis that they engage the pre-selected SIL provider for all of their supports. Effectively, you can only lease an SDA dwelling in the project if you accept service from the SIL provider.
This practice is also inherently anti-competitive, raising issues of cost efficiency, quality and participant choice and control.
As we outlined earlier, Summer Housing’s model enables its tenants to both jointly a SIL provider from those expressing interest in the role. Importantly, SDA tenants can maintain separate core support providers driving quality, efficiency and support.
- SIL Provider Vacancy Guarantees: Another emerging trend is for SDA providers to not only pre-select SIL providers for their projects but to also charge the SIL provider with the responsibility of selecting its tenants. We understand these arrangements can include vacancy guarantees and exclusivity payments being made by SIL providers to SDA providers.
In this scenario, SIL providers are incentivised to only offer SDA housing opportunities to those participants who engage them to provide supports.
This model replicates the concerns which apply in the historical one-stop shop model outlined above. Separately, there are concerns as to the economic viability of SIL providers
who are required to guarantee SDA income streams or otherwise provide supplemental payments not contemplated in SIL or SDA funding models.
- Use of SIL as a quasi-accommodation payment: Whilst SIL is intended to comprise a support for participants to live independently, we are aware that many SIL providers are providing non-SDA accommodation to participants, cross subsidised by SIL payments.
This has encouraged SIL providers to provide group homes that accommodate multiple tenants that have minimal choice in support providers or co-residents.
There is no separation between supports and housing which compromises security of tenure where tenants are perceived to have complex behaviours or significant needs, as well as limiting choice and control in support options. Nor do any of the design or other requirements which apply to SDA apply to these dwellings.
Recommendation: SDA providers should be separate from SIL Providers and coordinators of support. To this end, the above anti-competitive practices and conflicts should be expressly prohibited in any new SDA developments to stop the continuation of this cycle.
Further, a timetable and transition plan should be formulated to unwind existing arrangements recognising that very large number of SDA dwellings subject to these arrangements.