Submission 30 — Summer Foundation — Supported Independent Living

JOINT STANDING

COMMITTEE ON THE NDIS

INQUIRY INTO SUPPORTED

INDEPENDENT LIVING

1. SUMMARY The Summer Foundation has extensive experience in housing and support provision for people with complex disability needs. Our submission is based on innovative models of Specialist Disability Accommodation (SDA) and Supported Independent Living (SIL) provision for NDIS participants with high support needs.

Our submission provides solutions and makes recommendations to improve SIL provision for younger people seeking housing solutions that enable them to live an ordinary life.

In our experience, the NDIS has supported participants to achieve highly individualised housing and support models that increase their independence and improve social and economic participation outcomes. However, these outcomes are currently the exception rather than the norm.

These case studies in best practice NDIS outcomes highlight what can be possible in the NDIS. This inquiry is an opportunity to deliver consistently high quality SIL outcomes for NDIS participants.

www.summerfoundation.org.au

The table below shows the current SIL environment and the future desired state of SIL.

Current experience Future desired state

Outdated and non-contemporary SIL models

e SlL models are often large, congregate shared living settings with 4 or more residents. 68% of SDA places enrolled with SDA are for 4 or more residents (around 6,800 out of a total of around 10,000 places).

e Evidence shows these models limit participant independence, social and economic participation.

Housing and support models are in line with evidence-based good practice

Key features of the market are:

e Smaller dwelling sizes

e More individualised support provision

e Tenants exercising choice over who they live with

Limited choice when housing and support are combined

e Often the same provider is the tenancy manager and the support provider.

e These models prevent participants from exercising choice over their support provider, requiring participants to move house if they wish to use a different support provider. This removes a critical safeguard to keep people with disability safe and undermines participant choice and control.

Housing and support are provided by separate agencies

Key features of the market are:

e Participants able to remain living in their home and change support providers if they wish to

e Stand-alone disability housing providers grow, offering participants choice about their support provider

Participants have low understanding about housing

options

e Participants are unaware of the housing choices and options available in the NDIS.

e There has been limited capacity building to support

participants to understand and explore best practice housing options.

Participants have access to information about

housing options

Key features of the market are:

e Capacity building initiatives build participant, family and plan nominee understanding of good practice

e High quality information about SIL and SDA is available across all locations and tailored to the needs of particular cohort groups

Housing and SIL providers do not have a

comprehensive mechanism to share SIL vacancy

information with the market

e Existing online platforms are growing, but still in prototype phase (e.g. The Housing Hub).

e Advertising for SIL vacancies is ad hoc and at

the provider level, rather than at a coordinated market level.

Efficient market mechanisms are operating to share

SIL and SDA vacancies and connect participants and

providers

Key features of the market are:

e Mechanisms and processes are well developed to share SIL and SDA vacancy information with

participants and those supporting them to seek housing options

e Online platforms such as The Housing Hub have built a database of all participants seeking housing

NDIA funding for SIL and housing supports are poorly coordinated with long delays for approvals

e SIL decision making can be disconnected from other essential decisions such as SIL and assistive technology.

e Delays in SIL (and SDA and assistive technology) approval are leading young people to enter or remain in aged care, or other inappropriate housing.

Participants can achieve fast, accurate and well coordinated decisions on SIL, SDA and assistive technology

Key features of the market are:

e Participants with urgent circumstances, including those in aged care, can access fast decision making by the NDIA

e Decisions about related supports are made simultaneously by the NDIA

2. RECOMMENDATIONS The Summer Foundation makes 5 recommendations to the committee that would improve the provision of SIL services to people with disability in the NDIS:

RECOMMENDATION 1. The NDIA should set evidence-based good practice principles and guidance for the delivery of SIL services, which signal the future market direction for SIL to be of a higher quality, more individualised and promoting better independence and community participation outcomes for NDIS participants.

RECOMMENDATION 1a. As part of setting evidence-based good practice principles, the NDIA and Quality and Safeguards Commission should require full separation of the provision of housing and support. This would enable participants to remain living in their home and change support providers (whereas currently many participants are forced to leave their home if they wish to change support providers).

RECOMMENDATION 2. The NDIA should increase the flexibility of how SIL and similar services are quoted and funded for participants with high support needs, promoting more individualised support models where participants have increased choice and control of their SIL provider and staffing model.

RECOMMENDATION 3. The NDIA should streamline the processing of SIL applications for participants moving into new housing properties, enabling SDA, SIL and assistive technology decisions to be connected and made at the same time.

RECOMMENDATION 4. Governments should invest in better connecting participants and SIL/SDA providers for available vacancies through:

a. Expanding online platforms (such as The Housing Hub website) to advertise SIL and SDA vacancies and connect participants to SIL providers

b. Supporting a national capacity building initiative to increase knowledge among participants about housing options in the NDIS, and pre-register all participants seeking housing on The Housing Hub to increase the speed of connecting participants seeking housing with SIL and SDA providers with vacancies

RECOMMENDATION 5. The NDIA and state governments should work with the sector and participants to develop SIL models that integrate clinical support needs for NDIS participants with disability and complex clinical care needs. Development of these models is especially critical to reduce the number of NDIS participants entering Residential Aged Care (RAC).

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3. SUMMER FOUNDATION OVERVIEW The Summer Foundation, established in 2006, works to change human service policies and practices related to young people (18-64 years old) living in, or at risk of entering aged care facilities.

Our Vision is that young people with disability and complex support needs live where and with whom they choose, with access to high quality housing and support options that enhance health, wellbeing and participation.

Providing housing and support for people with complex needs, and improving the interface between the disability and health sectors is necessary if we are to stop young people from being forced into RAC.

We are interested in improving access to SIL supports for young people at risk of, or living in RAC. We acknowledge that increasing housing options requires better synchronisation of SDA with SIL provision. It is critical for the SDA market to be expanded so the rights of young people with complex disability support needs are upheld.

4. CONNECTING PARTICIPANTS AND

SIL/SDA PROVIDERS THROUGH

THE HOUSING HUB

The Housing Hub is a website (www.thehousinghub.org.au) dedicated to supporting people with disability to find a home they would like to live in. At the same time, the website is a place for housing providers to list properties and find suitable tenants. It has been established at a time when the disability sector is undergoing major disruption, where we are seeing housing for people with disability transition from a state managed welfare allocation model to a market driven approach with choice and control.

The Housing Hub website is being used by housing providers in Victoria, New South Wales, Queensland and South Australia to list properties that are available to be tenanted, for both SDA and non-SDA properties. People with disability are using the site to search for housing.

During 2019, we have plans to expand The Housing Hub geographically (to other states: WA, NT, TAS, ACT) and technologically (through a new platform to deliver better functionality for people with disability).

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In 2017 the Summer Foundation established the Tenancy Matching Services (TMS) to assist SDA providers locate tenants for their SDA properties across Australia. The TMS uses a tailored community engagement approach to locate potential tenants for SDA vacancies and identifies applicants’ potential for SDA funding. Younger people at risk of RAC admission or already living in RAC are a significant group of TMS users.

The TMS has worked with 7 different SDA providers across Australia and has supported 103 people to receive an offer for tenancy. At this time, 67 people have been approved for their SDA funding and the remaining people are awaiting outcomes.

Further information on The Housing Hub is at Attachment A.

5. CONTEMPORARY PRACTICE IN SIL Evidence on housing outcomes for people with disability consistently shows better outcomes at lower cost when people with disability live in smaller housing settings where they have more contact with people in the community, friends and family.

Independent living housing models achieve better outcomes at the same or lower cost than group home settings International evaluations have compared people with similar functional support needs living in either group homes or independent living models. These evaluations show that people in group homes had higher support costs and, compared with those living independently, did not score higher on any of 24 life Quality of Life outcomes. 1

Similar evaluations of around 400 people with disability in Australian group homes compared with independent living in the community showed that group homes required much higher funding.2 A similar study of people with intellectual disability leaving large institutions found better outcomes for those who left institutional living for more personalised arrangements rather than group homes.3

Providing housing and support in a group setting results in social exclusion and creates a long term dependency on paid staff at a fixed cost. 4 Other Australian and international studies have made similar findings of higher support costs and poorer outcomes for those in group homes.5 6

1 Roger J Stancliffe & Sian Keane (2009) Outcomes and costs of community living: A matched comparison of group homes and semi-independent living, Journal of Intellectual & Developmental Disability, 25:4, 281-305 2 Bigby, Christine, Emma Bould, and Julie Beadle-Brown. “Comparing costs and outcomes of supported living with group homes in Australia.” Journal of Intellectual & Developmental Disability (2017): 1-13. 3 McConkey, et al (2015) Relocating people with intellectual disability to new accommodation and support settings: contrasts between personalised arrangements and group home placements, Journal of Intellectual Disabilities v20 (2) 116 4 Mansell J, Knapp M, Beadle-Brown J and Beecham, J (2007) Deinstitutionalisation and community living – outcomes and costs: report of a European Study. Volume 2: Main Report. Canterbury: Tizard Centre, University of Kent. 5 Miano, M. M., & Brail, R. K. (1997). Transitions and backfilling: The movement of group home residents to more independent settings. New Brunswick, New Jersey: Rutgers, The State University of New Jersey, Centre for Urban Policy Research. 6 Felce, D., Perry, J., Romeo, R., Robertson, J., Meek, A., Emerson, E., & Knapp, M. (2008). Outcomes and Costs of

Community Living: Semi-Independent Living and Fully Staffed Group Homes. American Journal on Mental

Retardation, 113(2), 87.

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Social isolation and the risk of abuse is exacerbated in congregate and institutional settings People with disability living in group home and institutional settings are more likely to be socially isolated than those in independent and community settings.

The Victorian Public Advocate has highlighted three factors putting those in congregate living arrangements at higher risk: Inappropriate placements (particularly, a lack of alternative accommodation); workforce issues (such as lack of training, insufficient staff, high numbers of casualised staff and a lack of leadership); and, cultural issues (particularly tacit acceptance and normalisation of violence and bullying)”.7

A literature review by the Living with Disability Centre at La Trobe University has found that “most cases of abuse occur in institutional or service settings” and that United Kingdom research shows that “54% of the perpetrators were peers with intellectual disabilities and 43% were people involved in the care of the person”.8

Independence is promoted through personalised support models and the use of technology Research finds that when staff are not present in the dwelling, the participant has greater independent choice making, as well as less reliance on staff for domestic tasks such as washing up and meal preparation.9

Independent living is the most cost-effective way to support people with disability because assistance is precisely matched to individual needs and can be reduced over time as independence increases.10

People with disability living in group homes in Australia are a heterogeneous group. Recent analysis of the Australian Government data indicates that many people currently living in group homes have the potential for more independent living at a lower cost. 11

This is reinforced by the Victorian Transport Accident Commission (TAC)’s evaluation of its apartment support model. This research found that home automation technology, and apartment locations being close to transport and amenities, improves a participant’s independence to do tasks without a support worker.12

The Summer Foundation and InHousing have worked together to document the evidence base for contemporary housing, and principles for the future. This Briefing Paper is at Attachment B.

7 Parliament of Australia’s Senate Standing Committee on Community Affairs (2015) Report on the Inquiry into abuse and neglect against people with disability in institutional and residential settings, Colleen Pearce, Public Advocate, Office of the

Public Advocate, Victoria 
Page 215

8 Aratem-Bergan, Tal, Christine Bigby, and Gail Ritchie. “Literature Review of Best Practice Supports in Disability Services for the Prevention of Abuse of People with Disability. Report for the Office of the Disability Services Commissioner.” (2017). 9 Roger J Stancliffe & Sian Keane (2009) Outcomes and costs of community living: A matched comparison of group homes and semi-independent living, Journal of Intellectual & Developmental Disability, 25:4, 281-305 10 European Network on Independent Living. (2014). Comparing the Cost of Independent Living and Residential Care A Survey by the European Network on Independent Living. Retrieved from http://www.enil.eu/wp content/uploads/2012/06/Cost-survey_FINAL.pdf 11 Australian Institute of Health and Welfare 2016. Disability Services National Minimum Data Set: data guide, July 2016. Cat. no. DAT 4. Canberra: AIHW. 12 Callaway, Libby, et al. “Evaluating access and mobility within a new model of supported housing for people with neurotrauma: a pilot study.” Brain Impairment 17.1 (2016): 64-76.

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6. NEW HOUSING MODELS FOR

PEOPLE WITH COMPLEX

DISABILITY SUPPORT NEEDS

As the SDA market expands, different housing options for people with complex disability support needs are emerging. This housing is built to levels of Livable Housing Australia accessible standards (silver and platinum level as a minimum) and can be further adapted to meet the specific needs of NDIS participants enabling them to live independently in the community, and avoid admission to RAC.

The Summer Foundation has prototyped the ‘10+1’ option which consists of 10 individual SDA high physical support apartments (peppered throughout a new multi-apartment development), plus another apartment that is made available for the shared on-site, 24-hour SIL provider whose services are shared by the tenants of each SDA-funded apartment. This is listed as ‘Stated Support’ in individual tenants’ NDIS plans.

Separate to this on-site SIL support, in the 10+1 model, each tenant has choice and control over who they choose as the provider of their core supports or ‘planned supports’. This is listed in their plan as Core Supports: Assistance with Daily Life. Tenants share the 24-hour SIL provider and have collective input into the choice of this provider with the SDA provider acting as facilitator.

Potential SIL providers are required to supply a shared-SIL quote based on information on anticipated individual support needs, made available either by the tenants themselves, or through their support coordinators or family members. The Summer Foundation’s 10+1 model illustrates the close connection of the SDA provider with the shared SIL provider required by this innovative housing for people with very high support needs.

A full case study on the 10 + 1 apartment model is at Attachment C.

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ATTACHMENT A

The Housing Hub: Summer Foundation’s

housing matching social enterprise

21 August 2019

The Housing Hub is an initiative of the Summer Foundation Ltd

ABN 90 117 719 516

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Overview

The Housing Hub website

The Housing Hub is a website (www.thehousinghub.org.au) dedicated to supporting people with disability to find a home they would like to live in. At the same time, the website is a place for housing providers to list properties and find suitable tenants. It has been established at a time when the disability sector is undergoing major disruption, where we are seeing housing for people with disability transition from a state managed welfare allocation model to a market driven approach with choice and control.

The Housing Hub website is being used by housing providers in Victoria, New South Wales, Queensland and South Australia to list properties that are available to be tenanted, for both Specialtist Disability Accommodation (SDA) and non-SDA properties. People with disability are using the site to search for housing.

During 2019 we have plans to expand The Housing Hub geographically (to other states: WA, NT, TAS, ACT) and technologically (through a new platform to deliver better functionality for people with disability).

Tenancy Matching Service

In 2017 the Summer Foundation started its Tenancy Matching Services (TMS). The TMS uses extensive experience and networks to assist SDA providers to locate tenants for their SDA properties across Australia. To do this, the TMS uses a tailored community engagement approach to locate potential tenants for SDA vacancies and as subject matter experts, identifies the applicant’s likeliness for SDA funding.

So far, the TMS has worked with seven different SDA providers across Australia and has supported 103 people to receive an offer for tenancy (at this time, 67 people have been approved for their SDA funding and the remaining people are awaiting outcomes).

About the social enterprise

Why we need it

With the implementation of the National Disability Insurance Scheme (NDIS), the disability sector is in the midst of major disruption. Providers of housing to people with disability have to shift their approach and mindsets as housing moves from an allocation system to a market-based system with choice in the hands of people with disability.

Housing providers have not had to market their properties in the past and must now find a way to do so and to find tenants for their properties or face costly vacancies. People with disability now need a place to go to find housing that meets their needs, with the mainstream housing search platforms providing little information on accessibility features.

Providers of Specialist Disability Accommodation are finding that identifying tenants who are suitable for their properties is extremely hard due to the underdeveloped market. There are very few NDIS participants with SDA funding in their plans ready to move into new SDA properties.

To tackle this, the overarching problem we wish to address is that there is nowhere to go to search for a home (for rent or purchase), that allows you to filter for accessibility features. This results in people with disability needing to make calls to agents to ask about features or visit numerous locations to look for themselves. This is time consuming, exhausting and costly for people who have restricted mobility and is an additional burden in time, cost and supports which can easily be addressed through a platform which has this functionality.

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The website

The Housing Hub is a website where housing providers can list accessible properties that are available to people with disability. People with disability and their supporters can search on The Housing Hub for a property that is in a given location with certain features to meet their needs. Inquiries can be made to connect with the housing provider and properties are then tenanted.

Our vision for The Housing Hub over the coming 18 months is to grow it so:

The Housing Hub is the place to find a home that is just right for you. We are the largest online community of people with disability and housing providers working together to increase the housing options available to people with disability.

The Housing Hub serves both people with disability and housing providers:

e People with disability can search and find accessible housing and choose to live where they want and with who they want

e Housing providers can list properties and receive inquiries from potential tenants for vacant properties (currently free)

The homepage:

Find a Home Housing Providers Help

The Housing Hub

/Our disability housing

Looking for a hom Looking for tenants

Find diea ede Advertige your pr erest

Find tan

GET National Conference

BUILDING 22 March 2018 BOOK NOW

Marvel Stadium, Docklands, Melbourne

The Housing Hub is a new way for people with disability to find suitable housing. The Housing Hub advertises vacancies for apartments and houses that are owned by housing providers. It also has a library of useful information about housing options and

planning your move.

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Search results by region:

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Brisbane

SHOWING RESULTS WITH :

Any Support Type Any Housing Type CHANGE FILTERS

23 properties found

a

Sorted by Last Updated ( Newest First ) ~ } view on MAP

Modern & Accessible Apartment Living — Available

Now

BHC Creating Liveable Communities

ENOGGERA QLD 4051 - Brisbane

Specialist Disability Accommodation (SDA) - Improved Liveability

Bedrooms: 1 - Bathrooms: 1

Posted: 2 months ago - Edited: 6 days ago

Sleek and Stylish Living at The Mews

Summer Housing

WOOLLOONGABBA QLD 4102 - Brisbane

Specialist Disability Accommodation (SDA) - High Physical Support

Bedrooms: 1 Bedroom - Bathrooms: 1 Bathroom

Posted: 10 months ago - Edited: 1 week ago

Circa Three — Essence of Modern Living

Summer Housing Ltd

NUNDAH QLD 4012 - Brisbane

Specialist Disability Accommodation (SDA) - High Physical Support

Bedrooms: 1 Bedroom per apartment - Bathrooms: 1 Bathroom per apartment

Posted: 7 months ago - Edited: 1 week ago

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Circa Three - Essence of Modern Living

NUNDAH QLD 4012 - Brisbane

Specialist Disability Accommodation (SDA)

SDA Registered: PENDING COMPLETION

Building Class: New Building

Building Type: Apartment

Design Category: High Physical Support

Details

Available Bedrooms: 10 x 1-bedroom, 1 resident High Physical Support Apartments

Total Number of Bedrooms: Number of Bathrooms: 1 Bedroom per apartment 1 Bathroom per apartment

Features

Air Conditioner Split System

Wide Doorways Automatic Doors

Accessible Kitchen Dishwasher

Under Cover Parking Close to train

Housing Provider

Summer Housing Ltd

Contact: Mark Edmonds

Phone: 0455 110 679

VIEW LISTINGS

VISIT WEBSITE

BROCHURE

Contact the Provider

Your name *

Your email *

Your phone number

Your message

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Work to date

The Housing Hub was developed in late 2017. Since that time over 61,000 people have used the website showing there is demand for this service. There are currently more than 500 property listings live on the website. The website has been launched in Victoria, New South Wales, Queensland and South Australia with state government support in each state.

Work is now underway on version three of the website to enhance the features and ensure the site is easy to use for both people with disability and housing providers. We held co-design workshops in early 2019 with people with disability, support coordinators, support workers, family members and housing providers and feedback is summarised as follows:

People with disability want to be asked what they want in housing and who they live with People with disability want a site that works well and looks cool like other mainstream platforms Housing providers wish to increase the volume of inquiries and need support with converting inquiries from people with disability to people living in their properties

e Housing providers would value support to write listings and take photographs

The next website is due to be developed during the first half of 2019 (subject to raising adequate funds) and will include:

Ability for seekers to set up a profile that includes their housing preferences

Housing listings pushed to housing seekers once listings are published

An events page listing events by region

Monthly SDA vacancy updates by region to proactively promote housing opportunities

Ability to measure housing matches generated from THH, to demonstrate the value and impact of

THH

The benefits

The Housing Hub plays an important role in connecting housing providers with accessible properties with housing seekers. The change in the market with the introduction of the NDIS means that an intermediary is required to undertake this connecting work. The Housing Hub aims to provide a service to make the market more efficient to reduce the certain negative impacts and increase positive impacts as shown below:

wrk wn

Current negative costs to society are New value is unlocked for society reduced Hospital overstay @ $4.8b in development of new housing Family burnout e $700m in recurrent spending on new e Negative outcomes from RAC housing

admissions e 12,000 people will be able to live in Abuse in group homes new SDA properties Market inefficiency leading to wasted @ $1.8b will be spent on Supported

resources Independent Living supports for

The Housing Hub people with disability, creating 24,000 new jobs

e Positive outcomes for people with disability to live a more independent

life

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BRIEFING PAPER:

WHAT HAVE PEOPLE LIVING WITH DISABILITY

TOLD US ABOUT THEIR CONTEMPORARY

HOUSING EXPECTATIONS?

THE CONTEXT FOR HOUSING OPTIONS AVAILABLE TO PEOPLE

WITH DISABILITY

In Australia today, people with disability do not enjoy the same housing choices as other Australians. Housing options for people with disability have traditionally congregated people with disability together with others who have a disability, and separated people with disability from the community.

Australia has been on a journey of reform towards more mainstream housing options for people with disability. Large institutional settings housing up to 300 people with disability have gradually been replaced by smaller group home settings within the community, often housing 4-6 residents. However group homes continue

to fall far short of the goals and objectives of the NDIS to provide choice and control for people with disability. The NDIS has emerged at a time when the endemic violence and abuse that prevails in the group homes

has been revealed in a range of state and federal parliamentary inquiries and is well-known to people with disability and disability advocates. Choosing where you live and who you live with is a human right and critical to addressing the high levels of violence and abuse that people with disability are subjected to.

Contemporary approaches to housing for people with disability start with the belief that people with disability can live like everyone else in the community.

Living like everyone else means living arrangements that resemble those of other community members. That is, people with disability are not required to live in circumstances that would not be typical in the wider community.

The NDIS emerged out of Australia’s obligations to realise the rights of people with disability as defined by the

UN Convention on the Rights of Persons with Disabilities (UNCRPD). It is a response to changes in Australia’s objectives and vision for the lives of people with disability. Australia has embraced public policy goals that put primacy on an ordinary life, independence, choice and control, and community inclusion. This is a radical shift away from previous objectives, which often disempowered people with disability and put exclusive primacy on the need to protect and safeguard people with disability against a seemingly dangerous, risky and non-inclusive community. This transformation in objectives has profound implications for the housing options that people with disability should be able to access in the community.

e e@ SUMMER inhousing. FOUNDATION inclusive and accessible

Most of the current housing options available to people with disability do not match Australia’s public policy objectives. The dominance of the group home housing model responded to pre-NDIS priorities and objectives which were founded on principles of exclusion and segregation. While some individuals will choose to share

a dwelling many will not, and those that do, want greater control and choice about who they live with.

In the era of the NDIS, more housing options are needed to give people with disability the opportunity to lead a life where they can maximise their independence, be fully included in the community and have choice over where they live, who they live with and how they are supported.

WHAT DOES THE EVIDENCE TELL US?

Creating an environment where people with disability have housing options that enable a life like everyone else is informed by the UN Convention on the Rights of Persons with Disabilities (UNCRPD) and the research and evaluation of housing models. Article 19 of the UNCRPD sets out a foundational statement that should underpin all people with disability’s access to housing:

“Persons with disabilities have the opportunity to choose their place of residence and where and with whom they live on an equal basis with others and are not obliged to live in a particular living arrangement“

Despite the UN Convention promoting for people with disability, the dominant model of supported accommodation for people with disability is currently group home settings. Around 17,000 people with disability currently live in group homes where they share their housing with un-related adults who also have a disability!

THE CURRENT HOUSING LANDSCAPE

HOUSING IS A MORE SIGNIFICANT ENABLER OR BARRIER TO GOOD LIFE OUTCOMES

FOR PEOPLE WITH DISABILITY THAN OTHER AUSTRALIANS

People with disability face systemic barriers to participating in society. Housing plays an important role in either overcoming or reinforcing these barriers.

A wide range of housing options are especially important for people with disability:

@ Housing can promote higher levels of employment - Australians with disability experience some of the lowest workforce participation rates in the OECD2 Just one in five NDIS participants (22%) are employed.? A limited range of housing options that are disconnected from employment opportunities is acontributor to this problem, especially in areas where accessible public transport is limited.

@® Proximity to community amenities and health services is vital - a lack of accessible transport in many regions of Australia means that people with disability need housing options that are closer to the community and health services they use.

© Transaction costs of moving are very high - moving is more difficult for people with disability than others. Home modifications and customisations make moving costly, and for people with disability seeking a highly modified dwelling there are high search costs due to the very limited supply of accessible housing.

© Relationships with other disability supports are critical - for people with disability who require assistance with daily activities of personal care and meal preparation, housing is a driver of these costs. A well designed home, with technology and proximity to amenities can reduce the need for funded support.

1. SGS Economics (2018) Specialist Disability Accommodation Market Insights

2. OECD (2017) Connecting People with Jobs: Key Issues for Raising Labour Market Participation in Australia, OECD Publishing https://www.oecd org/australia/connecting-people-with-jobs-key-issues-for-raising-labour-market-participation-in-australia-9789264269637-en.htm

3. NDIS Quarterly Report https://www.ndis.gov.au/medias/documents/ql-201819-report-summary/Report-COAG-for-Ql-of-Y¥6-Summary-Part-A.pdf (p12)

THE HOUSING NEEDS AND PREFERENCES OF PEOPLE WITH DISABILITY ARE DIVERSE

Just as the Australian population has a wide range of needs and preferences, so do people with disability. Housing solutions need to enable people with disability to live together with their partners and children

and maintain family relationships. There are 6,200 people with disability under the age of 65 currently living in Residential Aged Care (RAC). Of these, 20% are married and a further 20% are divorced or separated.*

A quarter have school aged children.°

Finally, access to home ownership remains out of reach for the vast majority of Australians with disability. Just 13% of Australians with disability are home owners, compared with around 70% of the Australian population.®

THE CURRENT RANGE OF SUPPORTERD ACCOMMODATION IS DOMINATED BY

GROUP HOME SETTINGS

The dominant model of supported accommodation for people with disability is currently group home settings.

Around 17,000 people with disability currently live in group homes.’

Individualised living options (i.e. not sharing housing with other people with disability) are more prevalent

in some jurisdictions than others. Western Australia in particular has a strong individualised living sector.

For example, My Place WA supports around 400 people with disability to live in their own homes, or remain in their family home, and become valued and contributing members of their community.®

SMALLER DWELLING TYPES, INCLUDING APARTMENTS WITH ON-SITE SUPPORT,

ARE GROWING IN THE NDIS

The NDIS’ Specialist Disability Accommodation (SDA) initiative is leading to a greater diversity of options.

A significant number of new SDA properties are apartments for single residents, spread throughout a mainstream private apartment complex. Providers such as Guardian Living and Summer Housing are providing between 6 and 10 apartments for people with disability, in a mixed tenancy apartment building, which are fitted with accessibility and assistive technology. These apartments are arranged in a way so support can be accessed when needed, from an on-site overnight support unit, located in the apartment building. The Victorian Transport Accident Commission (TAC) has a similar model through its Residential Independent Projects.? Providers such as inhousing in South Australia, have moved from group home models 10 years ago, to develop independent living dwellings dispersed in community in micro-clusters or a “salt and pepper” approach. These types of housing options give people who have significant support needs the opportunity to live alone, while having immediate access to on-site high quality support when needed. Reform and innovation in models of personal support provision are occurring in response to contemporary housing settings.

4. Australian Institute of Health and Welfare (2018) AIHW National Aged Care Data Clearinghouse “Table 5: Selected characteristics of people aged under 65 years in permanent residential aged care (a), by state/territory, at 30 June 2018”

5. Winkler D, Sloan S, Callaway L. Younger people in residential aged care: Support needs, preferences and future directions. Melbourne, VIC: Summer Foundation Ltd; 2007

6. Crabb, A, (2017) Unlocking home ownership for people receiving Specialist Disability Accommodation payments: What role financial institutions play. Melbourne: Summer Foundation Ltd.

7. SGS Economics (2018) Specialist Disability Accommodation Market Insights

8. My Place (2019) About Us. https://www.myplace.org.au/

9. Transport Accident Commission (TAC) Residential Independence project http://www.tac.vic.gov.au/clients/what-we-can-pay-for/services/assisted-living-accommodation/ about-the-ripl-project

EVIDENCE ON HOUSING TYPES AND MODELS

Evidence consistently shows that when people with disability live independently, outcomes are better and costs are lower, people with disability have more contact with friends, family and people in the community.

INDEPENDENT LIVING HOUSING MODELS ACHIEVE BETTER OUTCOMES AT THE SAME OR LOWER

COST THAN GROUP HOME SETTINGS

International evaluations have compared people with similar functional support needs living in either group homes or independently. These evaluations report that people in group homes had higher support costs and, compared with those living independently, did not score higher on any of the 24 Quality of Life outcomes. 10

A similar Australian evaluation compared around 400 people with disability living in Australian group homes with people living independently in the community. This study showed that group homes require much higher funding.11 Research also shows that people leaving large institutions for more personalised arrangements, had better outcomes than people in group homes.12

Providing housing and support in a group setting results in social exclusion and creates a long-term dependency on paid staff at a fixed cost. 13 Other Australian and international studies have made similar findings of higher support costs and poorer outcomes for those in group homes.14 15

SOCIAL ISOLATION AND THE RISK OF ABUSE IS EXACERBATED IN CONGREGATE

AND INSTITUTIONAL SETTINGS

People with disability living in group homes and institutional settings are more likely to be socially isolated than those living independently and in community settings.

The Victorian Public Advocate has highlighted three factors putting those in congregate living arrangements at higher risk:

“inappropriate placements (particularly, a lack of alternative accommodation); workforce issues (such as lack of training, insufficient staff, high numbers of casualised staff and a lack of leadership); and, cultural issues (particularly tacit acceptance and normalisation of violence and bullying)”.16

A literature review by the Living with Disability Centre at La Trobe University has found that “most cases of abuse occur in institutional or service settings” and that research from the UK shows that “54% of the perpetrators were peers with intellectual disabilities and 43% were people involved in the care of the person”.17

10. Roger J Stancliffe & Sian Keane (2009) Outcomes and costs of community living: A matched comparison of group homes and semi-independent living, Journal of Intellectual & Developmental Disability, 25:4, 281-305

11. Bigby, Christine, Emma Bould, and Julie Beadle-Brown. “Comparing costs and outcomes of supported living with group homes in Australia.” Journal of Intellectual & Developmental Disability (2017): 1-13.

12. McConkey, et al (2015) Relocating people with intellectual disability to new accommodation and support settings: contrasts between personalised arrangements and group home placements, Journal of Intellectual Disabilities v20 (2) 116

13. Mansell J, Knapp M, Beadle-Brown J and Beecham, J (2007) Deinstitutionalisation and community living – outcomes and costs: report of a European Study. Volume 2: Main Report. Canterbury: Tizard Centre, University of Kent.

14. Miano, M. M., & Brail, R. K. (1997). Transitions and backfilling: The movement of group home residents to more independent settings. New Brunswick, New Jersey: Rutgers, The State University of New Jersey, Centre for Urban Policy Research.

15. Felce, D., Perry, J., Romeo, R., Robertson, J., Meek, A., Emerson, E., & Knapp, M. (2008). Outcomes and Costs of Community Living: Semi-Independent Living and Fully Staffed Group Homes. American Journal on Mental Retardation, 113(2), 87.

16. Parliament of Australia’s Senate Standing Committee on Community Affairs (2015) Report on the Inquiry into abuse and neglect against people with disability in institutional and residential settings, Colleen Pearce, Public Advocate, Office of the Public Advocate, Victoria Page 215

17. Aratem-Bergan, Tal, Christine Bigby, and Gail Ritchie. “Literature Review of Best Practice Supports in Disability Services for the Prevention of Abuse of People with Disability. Report for the Office of the Disability Services Commissioner.” (2017).

4

INDEPENDENCE IS PROMOTED THROUGH PERSONALISED SUPPORT MODELS

AND THE USE OF TECHNOLOGY

Research has found that when staff are not present in the dwelling, the participant has greater independent choice making, as well as less reliance on staff for domestic tasks such as washing up and meal preparation.18

Independent living is the most cost-effective way to support people with disability because assistance is precisely matched to individual needs and can be reduced over time as independence increases.19

People with disability living in group homes in Australia are a heterogeneous group. Recent analysis of the Australian Government data indicates that many people currently living in group homes have the potential for more independent living at a lower cost.20

This is reinforced by the TAC’s evaluation of their apartment support model. This research found that home automation technology, and apartment locations being close to transport and amenities, improves participant’s independence and ability to undertake tasks without a support worker.21

FUTURE DIRECTIONS IN THE LITERATURE

MODELS THAT ALIGN MORE CLOSELY WITH THE VISION AND PRINCIPLES

There is no fixed list of preferred housing models for people with disability. The range of housing needs and preferences amongst people with disability requires a diversity of options to meet these needs.

The evidence promotes an outcomes-based approach to housing, rather than a prescriptive list of preferred models. The outcomes listed below were identified by Griffith University in its work supporting the NDIA to promote housing innovation.22 These are a base to begin from in creating a framework for reviewing and assessing which housing options to promote.

Best practice         1.   Vision: The participant has a positive vision and a plan for their life.

outcomes for                           2.  Choice: The participant has a place that he/she calls home.

participants

3. Inclusion: The participant is able to participate both socially and economically in mainstream society.

4. Rights: The participant has the same rights and responsibilities regarding his/her home as other people. Best practice 5. Efficacy: The housing solution meets the individual needs of the participant.

   outcomes 6. Inclusive design: The housing solution enhances the participant’s inclusion and social and economic

for housing participation. providers

7. Sustainability: The housing solution is simple to provide, manage and maintain.

8. Enabling Support: The housing solution separates housing and support and enhances participant’s choice and control over their support.

   Best practice 9. Flexibility: The support solution maximises participant choice and control

outcomes and meets the individual and changing needs of the participant. for support 10. Respect: The support solution works towards a respectful and rights-based relationship with the providers participant, his/her informal networks and chosen allies.

11. Empowerment: The support assists the participant to envision and plan and to reach his/her full potential over time.

12. Roger J Stancliffe & Sian Keane (2009) Outcomes and costs of community living: A matched comparison of group homes and semi-independent living, Journal of Intellectual & Developmental Disability, 25:4, 281-305

13. European Network on Independent Living. (2014). Comparing the Cost of Independent Living and Residential Care A Survey by the European Network on Independent Living. Retrieved from http://www.enil.eu/wp-content/uploads/2012/06/Cost-survey_FINAL.pdf

14. Australian Institute of Health and Welfare 2016. Disability Services National Minimum Data Set: data guide, July 2016. Cat. no. DAT 4. Canberra: AIHW.

15. Callaway, Libby, et al. “Evaluating access and mobility within a new model of supported housing for people with neurotrauma: a pilot study.” Brain Impairment 17.1 (2016): 64-76.

16. Margaret Ward, Housing Innovation Bank: Best innovative practice in housing and support, including Specialist Disability Accommodation Final Report. 36-37 5

SUCCESSFUL INTERNATIONAL MODELS HAVE POTENTIAL FOR ADOPTION IN AUSTRALIA

The UK has home sharing models that are used by large numbers of people with disability for permanent housing, as well as short-term accommodation. These models bring together a person with disability who is the householder and requires some companionship and assistance; and the home sharer, a person or persons who needs somewhere affordable to live. Generally, the householder provides free or reduced rent in exchange for companionship and negotiated assistance by the home sharer.

The home share model, delivered through Shared Lives in the UK, had 11,600 users in 2016-17, which has seen a 30% growth over 5 years.23 The majority of Shared Lives users are living in permanent arrangements (55%), while a quarter use Shared Lives for short breaks and a smaller portion for day support (20%).24

Cost benefit analysis of initiatives such as Shared Lives has shown these alternatives can reduce the cost of support by 43% for people with intellectual disability and 28% for people with mental illness.25 These reductions in cost are achieved while increasing the personalisation and individualisation of housing options for people with disability. WHAT NEEDS TO BE DONE? Moving towards an Australia where people with disability can live like everyone else is a significant transition – for people with disability, for providers, for governments and for the community.

Achieving this transition requires leadership from across the community. Without a clear, coherent and consistently applied vision and set of principles, people with disability will remain constrained to housing options that are not supported by evidence or contemporary practice.

Promoting a more diverse range of housing options for people with disability needs to be supported by all levels of government.

The Roadmap Towards Contemporary Housing for People with Disability includes an implementation plan that would enable the government to put these recommendations into practice.

Making these changes will ensure the NDIS vision can be realised by people with disability. Without an investment in a contemporary home and support service, we cannot expect the NDIS to deliver on its vision for people with disability to live a full and independent life in the community.

23. Plus, Shared Lives. “The state of shared lives in England.” Liverpool: Shared Lives Plus (2017).
24. Plus, Shared Lives. “The state of shared lives in England.” Liverpool: Shared Lives Plus (2017).
25. Finance, Social. “Investing in shared lives.” London: Social Finance (2013) 6

RE

FERENCES

SGS Economics (2018) Specialist Disability Accommodation Market Insights

OECD (2017) Connecting People with Jobs: Key Issues for Raising Labour Market Participation in Australia, OECD

Publishing https://www.oecd.org/australia/connecting-people-with-jobs-key-issues-for-raising-labour market-participation-in-australia-9789264269637-en.htm

3. NDIS Quarterly Report https://www.ndis.gov.au/medias/documents/q1 -201819-report-summary/Report- COAG -for-Q1 -of-Y6-Summary-Part-A. pdf (p12)

4. Australian Institute of Health and Welfare (2018) AIHW National Aged Care Data Clearinghouse “Table 5: Selected characteristics of people aged under 65 years in permanent residential aged care (a), by state/territory, at 30 June 2018”

5. Winkler D, Sloan S, Callaway L. Younger people in residential aged care: Support needs, preferences and future directions. Melbourne, VIC: Summer Foundation Ltd; 2007

6. Crabb, A, (2017) Unlocking home ownership for people receiving Specialist Disability Accommodation payments: What role financial institutions play. Melbourne: Summer Foundation Ltd.

7. SGS Economics (2018) Specialist Disability Accommodation Market Insights

8. My Place (2019) About Us. https://www.myplace.org.au/

9. Transport Accident Commission (TAC) Residential Independence project http://www.tac.vic.gov.au/clients/what- we-Can-pay-for/services/assisted-living-accommodation/about-the-ripl-project

10. Roger J Stancliffe & Sian Keane (2009) Outcomes and costs of community living: A matched comparison of group homes and semi-independent living, Journal of Intellectual & Developmental Disability, 25:4, 281-305

11. Bigby, Christine, Emma Bould, and Julie Beadle-Brown. “Comparing costs and outcomes of supported living with group homes in Australia.” Journal of Intellectual & Developmental Disability (2017): 1-13.

12. McConkey, et al (2015) Relocating people with intellectual disability to new accommodation and support settings: contrasts between personalised arrangements and group home placements, Journal of Intellectual Disabilities v20 (2) 116

13. Mansell J, Knapp M, Beadle-Brown J and Beecham, J (2007) Deinstitutionalisation and community living — outcomes and costs: report of a European Study. Volume 2: Main Report. Canterbury: Tizard Centre, University of Kent.

14. Miano, M. M., & Brail, R. K. (1997). Transitions and backfilling: The movement of group home residents to more

independent settings. New Brunswick, New Jersey: Rutgers, The State University of New Jersey, Centre for Urban

Policy Research.

15. Felce, D., Perry, J., Romeo, R., Robertson, J., Meek, A., Emerson, E., & Knapp, M. (2008). Outcomes and Costs

of Community Living: Semi-Independent Living and Fully Staffed Group Homes. American Journal on Mental

Retardation, 113(2), 87.

16. My Place (2019) About Us. https://www.myplace.org.au/

17. Aratem-Bergan, Tal, Christine Bigby, and Gail Ritchie. “Literature Review of Best Practice Supports in Disability Services for the Prevention of Abuse of People with Disability. Report for the Office of the Disability Services Commissioner.” (2017).

18. Roger J Stancliffe & Sian Keane (2009) Outcomes and costs of community living: A matched comparison of group homes and semi-independent living, Journal of Intellectual & Developmental Disability, 25:4, 281-305

19. European Network on Independent Living. (2014). Comparing the Cost of Independent Living and Residential Care A Survey by the European Network on Independent Living. Retrieved from http://www.enil.eu/wp-content/ uploads/2012/06/Cost-survey_FINAL.pdf

20. Australian Institute of Health and Welfare 2016. Disability Services National Minimum Data Set: data guide, July

21. Cat. no. DAT 4. Canberra: AIHW.

22. Callaway, Libby, et al. “Evaluating access and mobility within a new model of supported housing for people with neurotrauma: a pilot study.” Brain Impairment 17.1 (2016): 64-76.

23. Margaret Ward, Housing Innovation Bank: Best innovative practice in housing and support, including Specialist

Disability Accommodation Final Report. 36-37

23. Plus, Shared Lives. “The state of shared lives in England.” Liverpool: Shared Lives Plus (2017).
24. Plus, Shared Lives. “The state of shared lives in England.” Liverpool: Shared Lives Plus (2017).
25. Finance, Social. “Investing in shared lives.” London: Social Finance (2013) Summer Foundation Ltd. ABN: 90 117 719 516 Connect with us:

PO Box 208, Blackburn VIC 3130 £ SummerFoundationLtd in) summer-foundation-ltd

P: 1300 626 560 _ E: info@summerfoundation.org.au rw) @SummerFoundtn © SummerFoundation

www.summerfoundation.org.au summerfoundation

ATTACHMENT C

Case Study of SDA

Individual Living

An innovative example: Summer Housing’s Greenwich,

Fairfield: Support Model (January 2019)

The Summer Foundation is working to solve the issue of young people under 65 having to live in aged care. Like everyone else, young people with disability should have the right to choose where they live and who they live with. They also deserve to have high quality, relevant and suitably skilled supports.

The Summer Foundation has a history of prototyping innovative housing and support model designs, with the view to sharing what has been learnt with the sector. These would include examples of excellent innovation that exist, and leading a discussion to encourage a variety of housing with related support options for people with disability to choose from.

www.summerfoundation.org.au

One example of individual living that honours choice and control for the delivery of supports is

Summer Housing’s Greenwich, Fairfield Apartments in Victoria. The Summer Housing

development in Fairfield aims to show how the combination of well-located housing and good quality support - using advances in communications and environmental control design and technology - can enable young people with high and complex needs to live a ‘good life’, or as the NDIA describes it, ‘an ordinary life’, in the community with as much autonomy and independence as possible, while at the same time being healthy and safe.

This housing and support innovation will be judged as successful if the following goals are met:

Participants/tenants living in the apartments:

• Live their life with as much autonomy, privacy and independence as possible, with the supports they need to achieve this

• Have as much control over their home environment as possible

• Have a home environment that can support the maintenance of family roles and contact with friends and family

• Are connected with others and participate in the community as full citizens National and systemic impact:

• Demonstrate how investing in well-located high-quality housing and innovative support can assist people with disability to better achieve their goals

• Demonstrate how people with disability can maximise choice and control over how their supports are delivered in a National Disability Insurance Scheme (NDIS) context

The tenants for Summer Housing’s Greenwich, Fairfield SDA

Apartments

10 tenants will live in the 10 Summer Housing apartments in Fairfield. Each tenant will move into their own SDA apartment in order to live a life with more independence and to increase their participation in their community. Each of the 10 tenants was determined as being eligible for SDA high physical support apartment, single occupancy, and has the related funding in their NDIS plan.

The apartments for Summer Housing’s Greenwich, Fairfield

There are 10 SDA high physical support apartments (1 bedroom, 1 resident) peppered throughout the Fairfield building of 77 medium density mainstream housing apartments. These 10 are leased by NDIS participants and there is an 11th apartment for the on-site 24-hour shared support provider to use. Summer Housing is the property owner and the landlord. It has legal responsibility for the property and the tenancy, which includes entering into a Residential Tenancy Agreement (lease) and a separate SDA Agreement with each tenant. Summer Housing retains this legal responsibility but delegates these particular duties to an appointed property and tenancy organisation to undertake.

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The support model for Fairfield Before the advent of the NDIS, people with disability who had lived in ‘disability housing’ had little or no choice over who their support provider(s) would be. The housing and support were one in the same, provided by the same service. The NDIS Act 2013 outlines that the way of the future is for housing and support to be separated.

Offering the chance for people with complex support needs to live alone, and maximising choice, means that a range of different organisations will be involved in providing support at Fairfield. Tenants will need enough daily individual, planned support and access to the 24-hour on-site shared support for when they are alone, to live in their apartment safely. This means that one agency, Northern Support Services (June 2019 - amalgamation with genU), has been appointed as the 24-hour on-site shared support (concierge support) and consists of 1 staff member on-site at all times shared among the 10 tenants. This will be shown in their NDIS plan as a Stated Support and will reflect their contribution to the 24-hour on-site support service according to their predicted need over a week. This funding goes directly to Northern Support Services as per usual for ‘shared SIL’ and is requested as a ‘SIL quote’ for the NDIA.

In addition to this, each tenant will have their individual Core Supports Assistance with daily living funding 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 selects will ‘draw down’ from the participant’s Core Supports as normal. This will be shown in their NDIS plan as ‘self managed’ or ‘plan managed’ or ‘NDIA managed’ as per discussion between the NDIA planner and individual.

An example to explain this innovative model: David has 1:1 known support needs 8am–1pm, 4–6pm, 7-10pm daily for Assistance with daily living. The NDIA has funded him 10 hours daily to meet this need and this funding of 70 hours per week appears in his plan under Core Supports. David has a service agreement with the support agency, Independent Living, for these 70 hours per week. They provide this to David in his apartment and also to go to the supermarket. David also has community, social and recreational support 10 hours per week. He has a service agreement with the support agency, Outdoors, for these 10 hours per week.

So, in total, David has funding in his Core Supports budget for 80 hours of 1:1 support per week and he can choose the provider(s) for this funding.

David also needs on-site, immediately available but not in his apartment, support during the times he is alone in his apartment, including overnight. Based on his current functional capacity, and known possible emergencies that may arise, (such as seizures and issues related to learning the technology), it is estimated that David will need to access the 24-hour on-site support 7 hours per week on average during the period of transition (that is, the first 12 months post move). David has been part of the selection process for the 24-hour on-site provider, and agreed to Northern Support Services for this support (as have the other 9 tenants).

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Northern Support Services will put in a shared SIL quote which will include David’s 7 hours of need per week, which will contribute to the 24-hour on-site staff member’s funding. This will appear in David’s Plan as a Stated Support for Northern Support Services.

Outline of the 24-hour on-site shared support (concierge support):

• Provides shared supports to all the tenants with unplanned assistance, such as planned and/or emergency 2 person transfers, or short periods of assistance, which could not efficiently be delivered by other providers.

• This is expected to be a 24-hour roster, staffed by 1 support worker each shift within the 24-hour period for the first 12 months after tenants move in.

• Shared supports will occur during the day and overnight; the overnight will be an active shift; it is for any time the tenant is alone in their apartment.

• Provides unplanned support to all tenants during transition for any problems or situations related to the following, given it is the first time most people have ever lived alone:

• Emergencies (medical, physical, emotional, fire, disaster, etc)

• Learning and using the assistive technology

• Problem solving ‘in the moment’ for novel situations related to moving into SDA apartment independent living for all tenants

• Recruits and trains a carefully selected team of support workers to provide this 24-hour on-site shared support service

• Completes the SIL quoting tool, including the roster, profiles and quotes in collaboration with each participant’s Coordinator of Supports, their individual support providers and Summer Housing’s Transition Coordinator.

• Works with the Coordinators of Support and Transition Coordinator to ensure that each tenant’s individual transition goals for living in SDA apartment are integrated into the work of the 24-hour shared on-site support team.

• Collects clear and meaningful data regarding each tenant’s use of the unplanned support to:

• Continue to provide the NDIA with up-to-date reasonable and necessary support needs related to each participant

• Assist the Coordinators of Support and Transition Coordinator to monitor each tenant’s use of unplanned support so that any regular issues may be moved into the ‘planned support’ role as required

• To monitor each individual’s need for 24-hour on-site shared support and continually review what they use it for and why it is require

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