THE JOINT STANDING COMMITTEE ON THE NDIS.
NDIS Planning and Supported Independent Living Submission.
ConnectAbility Australia has provided face to face services to people with severe and profound disability for over twenty five years in the Hunter region. ConnectAbility was part of the Hunter trial for 3 years, added to the 3 years of full rollout out in NSW, we have 6 years’ experience of NDIS.
Below are just a small sample of the day to day issues we are facing with the NDIS. By and large I would summarise the issues into;
- Systemic issues on every operational aspect of the NDIS.
- Lack of consistency between planners, regions and states.
- A portal that is still a long way from efficient and fully functional. Contact details:
David Carey - CEO - ConnectAbility Australia
Phone: 02 4962 1000
Address: 26 Warabrook Boulevarde
Warabrook NSW 2304
a) The approval process for access to SIL The NDIS does not have “progress tracker” software related to SIL. The result is the application may sit for months without even being viewed. This places stress on families and participants as violent behaviour keep family stressed and at risk of assault. Providers cannot keep staff on hold to support clients without a speedy and efficient system, staffing is already an issue and will move quickly to another provider if they are placed on hold, then when approval does arrive there can be another delay until staff can be located or the provider employee’s staff then the family may change provider. The NDIS has no solid business rules to guide them, what they do have are often broken. For example we had a quote sit for months, we made continual enquires to NDIS to find out the Planner went on leave for 5 weeks and it sat on their desk. This delay totalled over 3 months. This demonstrates no commercial business practice to acknowledge application and to track application and timely communication to clarify issues. We have had numerous occasions where we were told NDIS have not received the quote. Once it goes to them it can be bounced around from planner to planner, then we get multiple requests from different planners in the process even though the issue was addressed with initial planner. Some planners give contact numbers, some don’t. There is no consistency to this. We do need to contact planners as these quote documents are lengthy and complex. This often gives rise to many clarifications per quote. Sometimes a few words to clarify the question can mean months of hold up. We had a team of people trained by the NDIS on quoting, but once submitted does not mean the NDIS planners follow their own assessment or business rules.
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This year we wanted to roll over 80% of our quotes as nothing had substantially changed for our participants and this process still took 4 months, with layers of questions from the NDIS. All our participants are severe and profound, so if anything they health issue and disability will get steadily worse. This is not an approval system, more interrogation and just takes up valuable time and resources on both the provider and NDIS side.
It takes a provider on average 20 hours to build a quote for a SIL participant. This consists of volumous (up to 50 pages per participant) written material from; the provider, Occupational therapist, physiotherapist, Behaviour Clinician, Speech therapist. To collate this we have allowed 3 months, if it then takes 4 months to approve, that totals 7 months. So you basically have to start the process not long after approval. This is poor practice as you make assumptions on the reasonable needs of the client half way through the plan and may not reflect their essential needs closer to plan end due to the long approval process. Most participant in the system are severe and profound so for all of their life there needs will be 24/7 care. This cohort will never “recover” and return home or find a job and buy a car. The 12 month plan is a draconian system that is built for bureaucracy and serves no meaningful purpose other than to generate jobs for public servants and add overhead cost to providers to pay for someone to pump out quotes. If we went to a 2-5 year funded plan it would save the scheme 100’s millions that go back into service delivery.
For the provider cash flow is critical and 80% of you cost is staff wages. Once a plan runs out there is no money until a new one is approved. This can have a catastrophic impact on the provider as a not for profit and little reserves under NDIS pricing could cause the provider to trade insolvent very quickly. We are required to keep providing support to participants even though NDIS seem to have little regard for the crisis level they make every provider go through at plan renewal time.
RECOMMENDATION: implement a software system to enable tracking from provider/participant side and for NDIS. RECOMMENDATION: Mandatory disclosure of planners contact details. RECOMMENDATION: Rolling a quote over to the next year should be approved within 5 business days. RECOMMENDATION: 3 year minimum SIL plans should be compulsory
b) The vacancy management process of SIL In short there is no vacancy management system. After being in the Hunter trial site and several years post full roll out there are many vacant beds. We currently sit at 13 vacancies and are close to closing homes and merging participant homes. We know there are plenty of vacancies but finding out where they are is one step. The next step is matching (for e.g. all women in one home). Then a staged transition of the participant – which may or may not work out. The current process consists of advertising through the CoS system. What we have discovered is many CoS have their favourites. The current CoS set up is not robust and is open to very poor practice of representing participants. We have gone to the extreme of advertising 3 month free rent and after 2 months have not had one enquiry. There is a high possibility that we will end up overstocking this sector of the market with high levels of vacancies and therefore placing a higher strain on provider’s financial viability.
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There are many reasons for vacancies as historically and with family preference you end with – male only, female only, medical only, frail only and behaviour only homes. There is no vacancy allowance in quotes therefore placing more financial pressure on providers. There are two website in NSW built to register vacancies after several years of running I would say it’s been a complete failure. We have not received one enquiry. RECOMMENDATION: National SIL vacancy register
c) The funding of SIL The funding of SIL is a complex, onerous and bureaucracy driven process. There is nothing commercial about this quoting process. It is easy to rack up some 50 pages plus of information on client support needs along with the 24/7 roster of care which breakdown client supports into 15 minute increment of 1:1 and group support. It takes between 20-30 for one person to perform and assemble one quote. There are multiple people involved as the checking is required to minimise mistakes. The quote then goes to NDIS where they may take 4 plus hours to review the quote. They then may have clarifications, so it’s emailed back and forward a number of times before it is approved. As there is no template each organisation will have its own take on what to submit which cannot help consistency. As there is no hard time line to approve quotes they often run over the end date of the plan. When this occurs the money runs out yet you are expected to keep providing services to participant at an average cost of $2,500 to $3,500 per week per participant. 80% of costs are staff wages so it’s obvious to see why organisation run the risk of trading insolvent. There is weeks and week’s difference between funding approval from an experienced planner versus an inexperienced planner. If you have expertise and experience supporting participants with complex needs your quoting goes to the highest level within NDIS, this adds more time to the process and greater risk of providing support unfunded until the plan is approved. This demonstrate poor business practice by the NDIS and nowhere else in Australia could you be directed to supply services without any payment in place. The planning tool does not allow for the true cost of doing business including CPI. The CPI is capped so regardless of the cost of CPI that we have to forecast a year in advance. The capping of CPI means we cannot quote that amount and have to wait 12 months to re-coup this amount. This cost is very easy to lose track of after a year. No administration is allowed in the quote, yet processing staff pays, workers compensation costs, managing participant’s spending money, liaising with their family and support coordinator is all a cost of doing business as in another Australian business.
RECOMMENDATION: Where plans run over the funding period payment of the last plan amount is paid until the new quote is finalised.
RECOMMENDATION: New SIL plans be approved within 30 days
RECOMMENDATION: Roster of Care should allow full cost of doing business including administration and CPI.
d) Any related issues. SDA payment. The main reason we are struggling to fill vacancies is the SDA payment that our (NSW) State government demands for its housing. The first problem is NDIS have not been able to
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successfully manage and operate the SDA system, even after a major review of SDA the amount of SDA approved participants is still a trickle. There is no sign on the horizon that this will improve. NDIS promised at a breakfast held by National Disability Services that a map showing SDA type and postcode would be published builders and the sector are waiting on this. At its best only 6% of SIL participants will get SDA in their plans, so coming back to our problem at its best only 6 clients out of every 100 will get SDA, I believe it’s currently more like 1%. This has led to long term vacancies in SDA homes across NSW. This puts the homes in a situation where they are not financially viable to operate as if you have 3 vacancies in a 5 bed registered home with NDIS you only get a lower SIL quote per participant.
There is no specific template for SDA application to the NDIS. There is criteria, but Support Coordinators do not know how to apply in a way that clearly addresses all the criteria. Applying for SDA is a highly complex process fraught with failure. If anything is missed the whole application stalls with months going by.
Ageing Parents
A large number of our SIL parents are ageing – 70 –mid 80’s. Their stress is every year they need to go to a planner who could be different and justify why there son or daughter who has been in group home care for 30-40 years still requires SIL. Our experience with families is that they are stressed out each time the planning comes around will the support be taken away altogether or reduced. They say under the old system I could go to my grave knowing there would be care in place for them, but now I worry each year. Along with this is the utter frustration of having to re-state the information every year. In a modern system this should not be the case. The planner should have accurate up to date historical data.
NDIS Planning
a) The experience, expertise and qualifications of planners We believe this has improved. We are not privy to what NDIS set as required qualifications and experience. I would ask the NDIS what is their permanent, casual and contracted staff turnover by region. Anecdotal evidence would suggest this is historically quite high. We have heard that a front desk person was promoted to a planner. On the face of this it seems quite concerning, but there may be valid reasons.
b) The ability of planners to understand and address complex issues Each planner has their interpretation of complex needs. For e.g. a participant may be funded at high complex needs in a group home but when they go to day programs they are not funded at the same level. For e.g. A participant at risk of sexual abuse from family members had besides ourselves involved – Department of Education, FaCS, Psychologist, Psychiatrist. This case was still not deemed complex by NDIS. If this case does not qualify what does. We get a sense of reluctance from planners to forward these cases on. There is a disconnect between planners and the helicopter view of that persons needs across a 24/7 cycle of their life. As an example; A participant is funded at standard SIL rate. Their health needs are complex – they were born without an anus and had to have this surgically created. As a result the client does not have a sense/feeling that they need to have a bowel motion. The intervention
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required is 3 x weekly enemas that were always by a registered nurse. Under NDIS they refused to fund this and said house staff can perform this intervention, we argued unsuccessfully that staff are not qualified in this specialist case to administer the enema. If the bowel was punctured by administering an enema it could put the participant’s life at risk. NDIS failed to understand this complex health problem or its risk mitigation. Our next step was to go to the AAT, in conjunction with Disability Advocacy NSW a submission was put forward. Before it went to court the NDIS special resolution team intervened and the matter was settled (appropriate level of funding supplied for a registered nurse to administer enemas). What was the financial cost to the participant? Our Support Coordinator spent 99% of the participants support coordination funding on this single issue. The funding ran out 2 months prior to end plan and no further support could be given until the plan and funding renewed. The entire case took 10 months to be resolved. It was a disgraceful waste of time and money to fight for what was reasonable and necessary.
c) The ongoing training and professional development of planners Yes there should be both initial and ongoing regular training. The fact that lack of consistency in applying their knowledge and skills is due to vastly different career backgrounds and experience. We note NDIS training far exceeds what the NDIS allow providers to train their staff (via the hourly rate) which is 2 days per staff per annum which barely covers orientation in year 1. And for an industry to remain professional to the needs of its participants then this should be increased to 5 days per staff per annum in line with the NDIS. As an e.g. we have had planners ask “how long does severe autism last” and someone with quadriplegia – “how long before you can walk again.” These are real examples reported back to us by our staff attending planning sessions.
d) The overall number of planners relative to the demand for plans I understand the KPI for a planner is 1.5 plans per day. If this is the case its way to low considering there will be 460,000 + plans that need reviewing and approving every year. By way of an e.g. At 235 days worked per year per planner (excludes AL and 5 days SL per year) at a productivity of 1.5 plans per day would equal 352.5 plans reviewed per planner per year. The NDIS would need to hirer 1,304 planners to keep pace. The 1.5 plans checked/approved per day is an unrealistic number given most people’s disability does not improve and mostly remains stable until ageing becomes an issue, A more realistic number for planners would be 6 plans per day. This would only see the need for 326 planner to be employed and if a 3 year plan was implemented this number could be lower and could save the NDIA over $70 million per annum which could go back into front end use for participants.
e) Participant involvement of planning processes and the efficacy of introducing draft plans Low functioning participants have little involvement in the planning process. In a lot of cases families decline to have their disabled adult son or daughter involved which goes directly against NDIS and the person centred practice it is designed to uphold. Planners ask few question to the participants and mostly having then present is more to “sight” them and tokenistic. If families are not present or not in the participants life to support them at the planning session then the Trustee and Guardian may be involved, but under their guidelines do not make decisions on those NDIS area other than their legislated remit. As a result it falls to the Support Coordinator to provide the case for support
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levels and what is reasonable and necessary for the participant. As parents age and pass away or are too frail to attend and more TAG is involved this will become a growing problem to the scheme – it is not best practice more stop gap. Draft plans eliminate mistakes and a “no surprise” result from the process leading to less contested plans, less animosity and build better relationships. Our experience says around 50% of plans have incorrect basic data – such as name, address etc. The process to correct this is onerous, cannot be billed and is a cost to both provider and NDIS. Given the high level of basic errors a focus on mitigating this should take place as it would save the scheme tens of thousands of hours to re-convene and correct.
f) The incidence, severity and impact of plan gaps The major concern is that without cash flow business cease, jobs are lost and participants needs to look elsewhere, which disrupts everything that has been set in place. In our region two long term not for profits in the NDIS space went into administration and closed. There really should not be any reason for plan gaps but they occur regularly. If a majority of your plans occur close together the risk is extreme with a high likelihood of plan gaps occurring. This has occurred with us and plans gaps ran to 3 month for 50 - 60 plans. I believe it was because of; understaffing, poor processes and communication, as we were rolling over 85% of the SIL plans due at the same time. Around 85% of our cost is staff wages, so on time approval and payment is mission critical to surviving in NDIS. As an example any plan gap requires a new plan we have had to meet with the NDIS to create a 5 day plan in order to fill the gap. This means a new 5 day service agreement to families, split claims. It’s an administrative nightmare and again drains the support coordination funding into correcting NDIS plan errors. This money is wasted on this and not spent correctly on Participants. This is a portal issue that after 6 years is still not corrected.
g) The reassessment process, including the incidence and impact of funding changes The reassessment process and change of circumstance process take as long as normal 12 monthly planning in our experience. When there is a change of circumstance for a participant it triggers a “pro-rating” of the funding for some unexplained reason. The result is a loss of funding for the participant. This is an area that needs immediate attention. It achieves the reverse of what is supposed to happen in a change of circumstance. At the other end of the spectrum we have had a client that has had 3 plans per year for 3 years. So 9 plans in a 3 year period. No one from NDIS can explain why this is occurring, and there is no will on the NDIS part to fix it. If we don’t follow the bouncing ball the participant loses out. So that 3 times a years all your story has to be re-told, 3 times a year your identity has to be verified a 10 page multiple document along with a 100 point check. The time and money we have to charge the participant sees there money spent on bureaucracy and not where it should be on the participant.
h) The review process and means to streamline it. The review asks for the same information as the first plan. All documentation must be re-submitted. Numerous consent forms must be re-submitted, 100 point ID must be
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resubmitted. Participant diagnosis must be resubmitted. A detailed review and recommendation form the Support Coordinator has to be submitted and in our experience are not read or discussed. Sometimes families are contacted for the review and not their Support Coordinators as a result the meetings go ahead and with no support coordinator present who has the evidence plan funding is reduced.
i) The incidence of appeals to the AAT and possible measure to reduce the number. Our understanding is that the NDIA are not legally bound to adopt recommendations arising from AAT decisions. If this is true then the flood of cases going to the AAT will not cease as the NDIS just deals with them on a case by case basis. There is no legal obligation to adopt system wide application of AAT recommendations or to adopt precedence within a systemic application to participant plans. It is our understanding that the “negotiated” funding resulting from the AAT submission only lasts the length of the plan. Once the plan has run its course the money is then removed and the whole issue goes round the same circle again.
j) The circumstances in which plans could be automatically rolled over. Where the adult participant has a permanent ongoing disability that requires activities of daily living to be performed, has no job prospect, no family or friends as supports. Health requirements are stable. There is still an NDIS requirement every year to reconfirm the medical diagnosis. This is a ridiculous requirement and does not serve any purpose other than bureaucracy. We have a large number of ageing parent and the stress they go through every year to prove their son/daughter. Since full rollout we have seen plans go from being prescriptive of every hour of the day to become vague statements. Sometimes a paragraph if you are lucky. This has been the case for at least three years. The result is there is no way at all to identify which part of the participants funding is yours. So if the plan has; SIL, Community Participation, Allied Health there is no clear delineation of what dollar amount each has. It left up to those nominated in the plan. There is a solution and its that each planner can generate a breakdown which could save hours of argument and solve the matter in minutes. This breakdown should be made mandatory to save time and unbillable money.
k) The circumstances in which longer plans could be introduced. Where the adult participant has a permanent ongoing disability that requires activities of daily living to be performed, has no job prospect, no family or friends as supports. What needs to occur is not just the SIL plan going to say three years. Participants have community participation, Allied health in their plans and these also need to be three years, otherwise there is no efficiency gained at all.
l) Any other related matters.
Ageing Parents
I believe the NDIS need to seriously consider participants who are still living at home with their ageing parents. By way of example – we had a 94 year old man who has both sons living at home both have disabilities, one more pronounced requiring day programs and visual aids. The participants plan was around $40,000 per annum. On review the planner reduce the plan to around $7,000 per annum. Can you imagine the stress this must have placed on a 94 year single parent? Would is the thought process of the
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planner to think they had done well for the day in removing the supports for this family? Where were the checks and balances to stop this being approved? It took 11 months for the review to occur in order to re-establish a decent plan that should not have gone through a large cut. My point being there should be an age factor/loading applied. If for example you are 70 and your disabled son/daughter is still living with their parent(s) then say a $5,000 loading would apply, 75 year old - $10,000, 80 year old - $15,000. This is cheap money in order to keep family together and save the cost of going into full time care cost some $220,000 per annum. I know the legislation is about the individual with a disability, but a loading for ageing parents ticks so many boxes for what the NDIS is all about.
Local Area Coordinators
The portfolio size of a LAC is between 90-110 cases per LAC. It is our experience that LAC’s have never even sighted their participant and the result of this is with no lower level support or intervention the participant floats in the system. This sees there support requirements increase and they end up back with NDIS planners and providers mostly with increased supports. This is a direct result of caseloads being too high.
Portal Improvements
We would recommend further portal improvements that has a column dedicated to what the service booking is dedicated to for e.g. SIL, CP, Support Coordination. Countless hours of non-billable time is lost trying to track the split in funds down. Admin burden for families NDIS have instigated a new ID process. This requires the family member of the participant to gain a 100 point check. They also have to answer question at the front desk to identify themselves. There has to be 2 consent forms filled in as well. The provider is considered best placed to provide a letter stating that the participant cannot represent themselves and that we (provider) endorse the nominee. We understand this is an annual process and we are highly concerned about the amount of admin “creep” that is occurring within the NDIS that impact on providers and families. For providers any extra admin process is unbillable yet is mandatory to complete. We know of no other business type where only direct facing of a client can be billed.
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