National Office
PO Box 397
Matraville NSW 2036
Submission to the Joint Standing Committee on the NDIS: Transitional Arrangements for the NDIS 8/11/2017
Spinal Cord Injuries Australia (SCIA) has a number of concerns with the transitional arrangements as the scheme progresses to full implementation. There are service gaps, particularly across the disability/health interface, Continuity of Support Program and inconsistencies for new NDIS participants in the area of transport funding, with little information currently available on how these issues will be resolved.
- Disability/Health Interface Every major metropolitan centre across the country has at least one specialist spinal injuries unit and rehabilitation facilities for those catastrophically injured. Until the full implementation of the National Injury Insurance Scheme (NIIS) gets underway, those newly injured will be accessing the NDIS – if they are noncompensable – for all of their care and equipment needs once they return to the community.
Prior to the commencement of the NDIS, those newly injured and over the age of 65 were well supported through state and territory funded disability services. With the implementation of the NDIS and the age eligibility requiring new participants to be under the age of 65, those unfortunately catastrophically injured above this age are now directed to aged care services – My Aged Care. There is a huge gulf between what My Aged Care offers its service users against the supports available for NDIS participants.
As is to be expected, My Aged Care programs are designed for the frail of age; those services have no expertise in disability and spinal cord injury, especially severe and profound levels that requires significant ongoing support. Aged care programs are completely unsuitable and inappropriate for anyone with a significant disability. Unlike an NDIS plan which considers the level of disability and provides services based on need, My Aged Care programs are capped. The most support anyone can expect through the My Aged Care Gateway is a level four Home Care package which is currently valued at less than $50,000. There are some small supplementary programs as add-ons to this but eligibility is for such things as dementia care as an example. This level of funding is woefully inadequate for anyone with a significant disability.
It leaves anyone in this predicament – including family members – in an invidious situation. The burden either falls back on a family member such as a spouse to fill the gap in care support or they have to pay for additional services themselves. It leaves people very vulnerable as they are missing out on suitable care. It is also inequitable by comparison to what someone with a similar disability would receive as an NDIS participant.
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Applicants for My Aged Care are required to undergo an ACAT (Aged Care Assessment Team) assessment with long delays before receiving any level of support. In many cases, this results in someone languishing in a spinal unit hospital bed for extended periods even though they have been ready for discharge for some time – adding a huge unnecessary cost to the Health system. Clinicians and social workers from spinal units and rehabilitation centres have come to SCIA with deep concerns due to an inability to find appropriate services to support people on discharge. This has led in some instances to people being discharged to aged care facilities simply because of the level of care required to support someone.
Once a person receives a My Aged Care package they are asked to make co-payments towards the cost of services. NDIS participants are not expected to make any financial contribution towards the supports they receive.
The provision of equipment supply (assistive technology) to this cohort is also highly variable and inconsistent. Again, prior to the implementation of the NDIS there was no age barrier to state and territory funded aids and equipment schemes. This has now changed with the rollout of the NDIS. In many cases, those in receipt of a My Aged Care program (Home Care Program and Commonwealth Home Support Program) are being denied access to state and territory equipment services. When this happens they are expected to cover all of their care requirements and equipment needs within their allocated funding. Considering the cost of such equipment for people with significant disabilities, this can run into many thousands of dollars for high-cost items such as power wheelchairs, ceiling hoists, specialist commode chairs, electric beds, pressure mattresses and cushions. SCIA has approached the federal government and agencies on this issue however to date there has been little progress made on resolving this. The Commonwealth Department of Health has stated that My Aged Care service users are free to use state and territory funded equipment schemes however the eligibility information for these programs is contradictory and states in many cases this cohort is not eligible. Appropriate Assistive Technology supply to those newly injured and over the age of 65 needs to be resolved. The most appropriate forum for consistency across the country for this area would be to address it at the Disability Reform Council within the Council of Australian Governments (COAG).
- Continuity of Support gaps The Continuity of Support program (CoS) was set up to support the many people in receipt of State and Territory disability services who would not be eligible for the NDIS due to age (i.e. over the age of 65). Continuity of Support is rolling out across the country at the same time and in geographical areas consistent with the rollout of the NDIS. There are still questions that need answering for those currently receiving state and territory specialist disability services who will likely not meet the disability eligibility of the NDIS due to what may be deemed complex “health” issues. The bilateral agreements with State and Territory governments states that Information, Linkages and Capacity Building (ILC) will be available to support these people who will not be eligible for the NDIS and that “ILC supports will enable the person to transition to alternative arrangements over time.” However there are no alternative arrangements or services currently available to support anyone in this circumstance. This is a potential service gap that will need to be addressed. The numbers that may fall through the gaps are not clearly defined but it may be a substantial number.
For those that will transition into CoS, there is also a concern that should anyone’s needs change over time, as they age, the current program guidelines and explanation for gaining additional
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funding support are not adequately defined. The only clear explanation is if the additional support required was less than $8000, in which case you would gain further assistance through the Commonwealth Home Support Program under aged care. There are many people transitioning to CoS who have significant and profound disabilities. It is likely that their needs will grow as they age. Clearer information needs to be provided on how they will be well supported if circumstances change. The aged care system – and entering as a resident – is not well suited or equipped for the needs of this cohort.
Essentially we have a two tier system: 1. Those well supported through the NDIS scheme based on need; and 2. those aged over 65 and supported through CoS or My Aged Care with a cap placed on funded services. The only difference between the two being an arbitrary number (65).
- NDIS Interface with Transport Scheme experience to date has shown that funding for transport has been inconsistent and often does not align with need as set out in participants’ plans. Firstly, how is the Agency devising funding for transport? We know from the NDIS participant transport fact sheet, there are generally three levels of transport funding provided to participants, who, due to their disability are unable to use public transport without difficulty with levels two and three aligning with the two Mobility Allowance payment levels. However there is not always consistency in providing these amounts once a participant enters the scheme. There are many instances of a participant receiving a lesser amount once they are in the scheme as compared to what they received before entering. It has also proved very difficult to get this adjusted.
There is almost no information available about what is deemed to be “exceptional circumstances” that would warrant a higher payment beyond “their participation in employment.” The current eligibility criteria for the Mobility Allowance requires recipients to be either working, studying or volunteering. What sets the criteria for transport funding once they enter the NDIS? Surely the categories need to be more broadly applied.
Many people with disability – NDIS participants and those falling outside of eligibility – rely on wheelchair accessible taxis (WATs) as their only form of transport. Because of the severity of their disability, they cannot use other modes of transport and depending on where they live, other forms of accessible public transport – such as buses and trains – may not exist. Their demands on WAT usage will be varied and not necessarily easily definable into work, study or volunteering which is the current eligibility for the Mobility Allowance supplementary payment that is transitioning into the NDIS as transport funding for participants.
Those same users rely heavily on state and territory funded taxi subsidy programs that in most cases cover around 50% of the cost of a taxi fare (with a maximum limit of $60). Unfortunately as the NDIS moved out of trial status, some state jurisdictions began removing eligibility to those taxi subsidy programs for new NDIS participants; South Australia, Tasmania and Queensland completely removed eligibility with Victoria in negotiation with an expectation that it would remove eligibility. This has had a major effect on the cost of taxis for those participants. Because of this, South Australia, Tasmania and Queensland have since temporarily reinstated taxi subsidy eligibility for NDIS participants although only up to the rest of the NDIS transition period over 2017-18 and 2018-19.
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With this lack of consistency in how participants are treated around the country in their use of taxi subsidy schemes, it makes a mockery of the NDIS as a universal program. This inequity will need to be addressed in how transport funding is applied to participants who are disadvantaged by this change. In all cases, the reasons given by state governments for removal of access to taxi subsidy schemes for NDIS participants is that they will receive transport funding in their plan. It makes no accounting for the needs of those participants who travel out socially or for other reasons not covered in the participant plan that will attract no transport funding. They are most certainly disadvantaged because of this.
It is also worth noting that these taxi schemes offer bonuses to taxi drivers to improve response times for picking up subsidy scheme participants, called lifting fees or driver incentive bonuses, which give drivers around $15 additional per fare. Obviously if you are no longer eligible the driver does not get this bonus – government departments have not thought through this aspect of service that was designed to improve services to people with disabilities. We know from experience that this will also have a negative effect on those being denied access to a taxi subsidy scheme with drivers less likely to accept jobs without the bonus.
There appears not to be any communication between the various state government agencies, the NDIA and the coordinating bodies (Department of Social Services in partnership with state level steering committees) responsible for the full role out. This is clearly an issue that will need to be taken up at a national governance level with the Disability Reform Council. As it currently stands, there is no equity for participants that lose eligibility to taxi subsidies without a corresponding increase in their transport funding through the scheme. Transport agencies have a responsibility to provide adequate accessible services as part of their universal service obligation – irrespective of scheme eligibility – and not shift costs onto the NDIS.
Beyond the transition period of the NDIS, a clear policy needs to be put in place across the entire country on how taxi subsidies are to be applied to participants to ensure continued equity and access for all people with disability.
Yours sincerely,
Tony Jones
Policy and Advocacy Officer
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