Risks of missing out in user choice reforms

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User Choice Reforms | 1

Who’s at risk of missing out in the user choice reforms?

2 | User Choices Reforms User Choices Reforms | 3

Introduction Overview

Australian Red Cross is committed to improving the wellbeing of those                                       Major social reform in the aged care and         The review showed that there are two main areas of

concern about who might be at risk of missing out inexperiencing extreme vulnerability in our community. We recognise that many disability sectors is being implemented in user choice reforms and why: people are excluded from the opportunities that others enjoy. Australia through the implementation of the

i. that the system and structures themselves can create                                                                                                            National Disability Insurance Scheme (NDIS)                                                                                                                                                                                                               barriers to entry

and the ‘Living Longer, Living Better’ aged ii. that demographic and social factors mean some

Major social reforms are being           We share the stories of three resilient Red                                     care reforms.                                                                                                                                                                                people are less likely to have the capabilities neededimplemented across Australia’s aged           Cross clients who may face barriers to                                                                                                                                                                                                to use the system.care and disability sectors, which aim to        accessing the supports they need to live

increase people’s access to support, and       happy and healthy lives under the reforms.                                                                                                                     These reforms aim to increase people’s access to          The case studies of Red Cross clients Demi, Samprovide greater choice and control.             Their stories emphasise the responsibility                                                                                                                                  support, and provide them with greater choice and        and Keith in this report demonstrate the real-life                                 we have to ensure that the user choice                                                                                                                                       control over services. Enabling people to have choice        decisions and challenges faced by people lookingHowever, the success of the reforms is         reforms work for everyone, particularly                                                                                                                     about their supports and services is a progressive            for support through the user choice reforms.based on an assumption that all consumers     those who are already vulnerable.                                                                                                                     approach and is broadly welcomed by both sectors.          This includes challenges faced by people at thehave equal capacity to exercise choice and                                                                                                                      However, the success of the reforms is based on an          intersection of aged care and disability reforms,control - a key challenge is how to ensure     We believe the challenges to implementing                                                                                                                       assumption that most consumers have equal capacity to    people with psychosocial disability, people who havethat the reforms work for everyone.           a user choice service system that works for                                                                                                      make and manage their choices.                           multiple and complex support needs and those living                                          everyone are surmountable.                                                                                                                                                                                                                   in regional and remote areas.To understand who is most at risk of                                                                                                 A key challenge is how to ensure that all people do, in

missing out as these reforms roll out,

Australian Red Cross commissioned                I am inspired by the many                                                             fact, have meaningful choice and control.                The full review demonstrates who is at risk of                                                                                                                                                                                     missing out in user choice reforms and why. While

researchers from the University of           stories that show what happens                                                 In order to understand these challenges, particularly for     there are a range of challenges to address, none ofAdelaide’s Centre for Housing Urban and                          when people are able to                                                 people who are experiencing extreme vulnerability, Red     these are insurmountable. Knowing this, we areRegional Planning to review how the                                                                                                                                Cross commissioned researchers from the University       compelled to do everything we can to help make surereforms might impact people experiencing     exercise choice and control over                                                                                                                                        of Adelaide’s Centre for Housing Urban and Regional         that these once in a lifetime reforms can be made

extreme vulnerability.                  the supports they receive.                                                   Planning to look at how the reforms may impact those       to work for all Australians, especially those who are

who are vulnerable. most vulnerable.The review drew heavily on unpublished works, including opinion pieces, to identify Red Cross has invested in this research to what is going on at the coalface of these understand more about who is most at major system reforms and determine who risk. We want to work with governments, will or is likely to miss out. businesses, philanthropists and people who are affected on solutions, so that we have The review found that, without safeguards, aged care and disability service systems people who are already the most that work for everyone. vulnerable are at the greatest risk of being left out. They are the least likely to have the skills and knowledge to advocate for what they need or to be able to navigate new processes and systems. Many of these people live outside major cities, are from already marginalised groups, and many Judy Slatyer – CEO

have complex medical and social problems.      Australian Red Cross                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Desmond

Cross/Lesley

Red

This document contains the names and images of Australian Aboriginal and Torres Strait Islander peoples who may now be deceased. Image:

Cover: Australian Red Cross/Rodney Dekker

4 | User Choice Reforms User Choice Reforms | 5

Systemic barriers TO

The review found that there are a range of issues within the systems that may create barriers                                                                                                                                                                                                                                                                                                                                       HEALTH                           SYSTEM                                     ADVOCACYSUPPORTto entry and use. The way that both the aged care reforms and the NDIS work can make it hard               &                                                                                                                                ACCESS

for some people to get the help they need. The main systemic concerns that were noted in the                                                                                                                                   PEERreview are outlined below.                                                                                                                                                                           CARER                 POORDISADVANTAGED                       MENTALCONCERNS                           LIMITEDLITERACY                           LIMITEDOR               POORINFORMATION

Accessing information about the reforms Thin markets Putting major reforms in place within already complex Thin markets occur in situations where there are systems has required large scale, rapid change. The limited agencies offering services in a location or the ability to easily access and understand the reforms is range of services to choose from is limited. In Australia, critical for people to be able to get the help they need. the major concern is how the market approach for

user choice reforms will work in rural and remoteThis is particularly important given many of the people      communities, where the cost of running services,                                                                                                                                         BARRIER

who need services are also most likely to find it population size/density, environmental conditions and challenging to understand new and complex processes. cultural needs impact on service viability. In remote locations, it seems likely there will not be an increase in choice and control for some people. The issue of The place of advocacy thin markets also occurs for specialised services, for

people with rare conditions, Aboriginal and TorresAdvocacy is important in making sure the voices of                                                                                                                                                                                 BARRIER                                                                     Strait Islander people and people from culturally andpeople who are ageing or living with disability are

linguistically diverse communities who have specificbeing heard as new systems roll out. For marginalised cultural support needs.groups in user choice markets, individual advocacy is valuable in supporting people to understand their rights and entitlements and to navigate systems, Interface with mainstream servicesespecially with people who find it hard to manage BARRIER complex issues and systems. Within the NDIS, there is a need to clarify how the scheme intersects effectively with other mainstream Support is also needed to ensure consumers achieve services such as health, housing and education. There the goals they are working towards, and raise issues and are also concerns about where the NDIS and aged care concerns about whether the system and its processes reforms intersect and how people with disability and

are suitable, effective and efficient. The availability of                                                   complex medical needs or who are ageing and haveappropriate, personalised and timely advocacy in both                                                                                                                                                                              BARRIER                                                       non-ageing related disabilities will have their needs met.

reforms remains uncertain.

Data and outcomes An important finding of the review of Australian and international literature is that there is little evidence about the effect of user choice systems in achieving measureable, positive outcomes. This gap in outcome measurement is apparent across both systems. Without a clear evidence base to measure the effectiveness of

the                                                          reforms                                                                             generally,                                                                            the                                                                                                    ability                                                                                          to understand                                                                                                   the

limitations                                                                       of                                                                    the                                                                   system                                                                     and                                                                                                                  its impact                                                                              on vulnerable

people                                                                                 will                                                          be                                                                compromised.                                                                                                                                                                                                                                                                                                                                                          CULTURALNEEDS                               IMPAIREDABILITY                   RURALREMOTE                               CRIMINALSYSTEM               FROMSERVICES                THINMARKETS

OR                                                                                                                                                                                                                                                                                                                                       LIVING              THE                                                                                                                                                                                                                                                                                                                                                                                                                                          JUSTICE                       OTHER                                                                                                                        IN                                                                                                                                                                                                                                                                                                                                                                                                                                                               COGNITIVE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      DISCONNECTION

CASE STUDY Submission 67 - Attachment 1

User Choice Reforms | 7

Isolated with psychosocial disability Groups at risk of missing out

Demi* is a 60-year-old woman living with            Currently her PHaMS support worker visits Demi in                  The second area of concern is the demographic

her home and this is her only access to mental health and social factors that mean that people fromformally diagnosed depression and anxiety.

services locally. This helps Demi to cope in between her                                                                                                                     highly marginalised groups are less likely to                                                     appointments with the mental health nurse.

have the capabilities needed to ensure the

As a young girl, Demi was taken from her parents’ home                                               Demi is often overwhelmed by her depression, anxiety,                 user choice reforms work for them.

and placed in a state run children’s home. Later in life and loneliness. She is not well equipped to take a Demi experienced domestic violence where threats of proactive consumer role to understand what she is

burning down or blowing up the house were frequent                                                                     eligible for and how to access it under the user choice                              It is clear that for people who experience overlappingand Demi’s actions and whereabouts were closely                                                          reforms, let alone being able to strongly self-advocate.                      layers of disadvantage, the chances of exclusion frommonitored by her ex-partner.                                                                                                                    The evidence shows that system and                                                                                                                         the reforms are highest. For example, for someone

demographic factors combine to create                                               Demi is unlikely to be eligible for an NDIS individualised               who is not living in a major city, has low literacy, isAs a result of her experiences in the state run                                                        funding package on the basis that her psychosocial                        experiencing family violence and managing on a low        challenges for some people to have their needsresidential facility and with her ex-partner, Demi                                                                     disability is episodic in nature. Funding for the service                    income, the chances of getting the right support         met through user choice reforms.struggles to engage with and trust new people. She                                                            that Demi currently receives will be withdrawn as the                     through the reforms are reduced.also finds it difficult to communicate and assert                                                   NDIS is implemented and Demi can not afford to pay for

herself, and at times finds it hard to leave her house. a similar service even if it were available. Demi has a limited social support network and is socially isolated and lonely. Demi is also approaching the cut-off age for NDIS and she may have to access assistance through the aged Demi lives alone in a small town that does not have a care system. Given her limited social supports, she is

mental health service and she does not drive. She relies                                                                        likely to have difficulty understanding how to navigate                                                      LOWon a public bus and car service to take her to a town                                                                    this system and to negotiate effective supports for her                                                                                 CULTURE

43 km away so she can access her GP and mental health                                                    mental wellbeing.                                                                                                  INCOME

nurse as part of her current Mental Health Plan. The

mental health nurse is often so busy that Demi cannot          * Protecting the privacy of people in our programs is of utmost importance to Red                                                                                                                                                                                      NEEDS                                                                                                                                                                                 GEOGRAPHYsee her for up to six weeks.                                                    Cross. For this reason, stock images have been used and names have been changed.                                                                                                                                                                    COMPLEX                                   ?                                              ?

Demi struggles to engage with and trust new people. She also finds it difficult to communicate and assert herself, and at times finds it hard to leave her house. ? ?

Jansen

istock.com/Silvia Credit:

Submission 67 - Attachment 1 CASE STUDY

8 | User Choice Reforms                                                                                                                                                                                                                                                                User Choice Reforms | 9

Groups at risk of missing out Multiple challenges

In the Australian community, many people face exclusion and disadvantage. It is not surprising that             Sam* is an Aboriginal man in his late twenties       His current service has been instrumental in helping

many of them are at risk of missing out in the user choice reforms, thus creating further divisions             who lives in regional Queensland.                 him to secure housing and manage his gambling and

substance use problems, as well as supporting hiswithin our communities between those who have support and those who do not. recovery from mental health issues. Without ongoing Sam had a difficult upbringing, with his mother leaving supports in place, Sam has self-identified that he will the family when he was five. In childhood Sam was often be highly vulnerable to returning to his past ‘at risk’

They include:                                                                                                                                                    left home alone for long periods or was exposed to            lifestyle, recidivism and re-imprisonment.

gambling, spending days in gaming rooms as his father (who was a problem gambler) played the pokies. Sam Sam has generally had negative experiences across attended school sporadically, leaving school altogether multiple service systems and as a consequence expects

People who are financially and                   People living in rural or                                                                                                    when he was 12.                                           that his requests for assistance or support will be

socially disadvantaged                         remote areas                                                                                                         rejected. His view is that there is little point in asking

Sam has struggled with drug and alcohol issues for most because he will get knocked back, regardless of his of his life and developed a chronic gambling habit during needs. Sam has limited support networks around him

People who are homeless,                                his teenage years, leading to a conviction and custodial      to advocate on his behalf. As such, he will struggle to

sentence for robbery with violence (undertaken to         engage with or trust local NDIS planners, and to appeal            People with specific                      who have lived experience                                                                                                                     pay for his gambling habit). While in prison he was          or review any decisions.

cultural needs                                     of homelessness, or who are                                                                                                                          diagnosed with bipolar disorder, anxiety and depression.

at risk of homelessness                                 After his release from prison Sam was homeless, couch     Sam faces considerable barriers to engaging with

surfing and living on the streets. He continues to services in a user choice system, including ongoing experience housing insecurity. experiences of stigma and discrimination from service People with limited or providers. His experience is influenced by being a young

People leaving care                          Sam is unlikely to be eligible for an NDIS individualised       Aboriginal man who has spent time in prison, having            poor system literacy                                                                                                                               funding package because his psychosocial disability is       mental health conditions and experiencing ongoing

episodic and fluctuating in nature. Sam is focused on challenges with multiple addictions, being at risk of recovery and moving forward positively with his life. homelessness and having limited financial means.

People with limited decision making                People with complex medical                                                                                                                *Cross.ProtectingFor thisthereason,privacystockof peopleimagesinhaveour programsbeen usedisandof utmostnames importancehave been changed.to Red

and problem solving capacity and/or behavioural needs

Sam faces considerable barriers to engaging with services in a user choice

People in contact with the                       People resistant to receiving                                                                       system, including ongoing experiences

criminal justice system                                social support                                                                                          of stigma and discrimination.

People with mental People at the age intersection health concerns of NDIS and aged care

These groups are vulnerable for a range of reasons            People who are carers                                                                    fully explored in the review.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Photography

Radler

Gary

Credit:

CASE STUDY Submission 67 - Attachment 1

10 | User Choice Reforms                                                                                                                                                                                                                                                              User Choice Reforms | 11

Intersection of aged care and NDIS Where to from here?

Keith* is a 67-year-old man who lives with           Keith has had regular periods of living on the streets                    Since the initial review of the literature, a number of reports and reviews have been released,

bipolar disorder and severe depression. Keith      and is at high risk of homelessness. He has a low level of             many of which aim to address concerns identified in the review.

literacy and is easily overwhelmed by appointments andalso has physical health problems including paperwork. He is very worried about any transition from arthritis, continence issues and is overweight. his current community-based support. He has been told

These include multiple reviews undertaken by the          These developments demonstrate the progression of                                                            that he will not be eligible for mental health support

Joint Standing Committee on the National Disability         the reforms and growing knowledge and understanding                                                      through the NDIS because of his age and that he will

Insurance Scheme; strategies released by the National      about how to ensure implementation is successful.He struggles to look after his health, often forgetting      need to access aged care services to meet his ongoing

Disability Insurance Agency including the Aboriginal andto take his medication which results in Keith making support needs. However he doesn’t think he needs to

Torres Strait Islander Engagement Strategy, the Rural       The pace of change is rapid and, at times, confusing.impulsive and irrational decisions with negative            access aged care services at his age and he says that if

and Remote Strategy, the Information, Linkages and             It is critical that we ensure these reforms include allconsequences, as well as leading to risky situations        he needs to he will live on the streets.

Capacity Building Commissioning Framework and the people and that everyone has the same choices andsuch as leaving his front door unlocked or placing

NDIS Quality and Safety Framework; the Productivity        opportunities. Red Cross is committed to workingtowels on the stove.                                  As a consumer, Keith’s need for support is significant

Commission’s report of Government Services and            collaboratively with government, sector partners and                                                      but his capacity to make and manage choices about

NDIS Costs position paper; and the Draft Fifth National       others to tackle this challenge so that the reforms canKeith has a history of trauma dating back to his early      the supports he receives is extremely limited. In a user

Mental Health Plan.                                 work for all Australians.childhood and is mistrustful of others. As a result         choice service system, Keith is unlikely to be able to

of his mental health concerns and deep mistrust of exercise choice and control over the services he receives

A number of research reports have also been released        If you want to know more about this work, pleaseothers, Keith is currently refused access to various        without considerable support and assistance from a

including ‘How to get the NDIS on track from National      contact servicedevelopment@redcross.org.au.local services, and his lack of insight means that he is      trusted advocate.

Disability Services’1 and ‘Choice, control and thelikely to repeat his past actions of refusing referral,

NDIS – Service users’ perspectives on having choiceor to agree initially and then subsequently turn away      Further, his support needs are diverse and go beyond                                                                                                                                                                                        1 National Disability Services, (2017). How to get the NDIS on track. Report National                                                                                                             and control in the new National Disability Insuranceservice providers.                                       the aged care service system (including housing, health                                                                                                                                             Disability Services, May 2017

Scheme’ from the Melbourne Social Equity Institute,                 2 Warr, D., Dickinson, H., Olney, S., et. al., (2017). Choice, Control and the NDIS.                                                 and mental health). Without appropriate support

University of Melbourne.2                                               Melbourne: University of Melbourne.Keith often feels lonely and unsafe at home and requires     Keith is likely to become homeless and his physical and

regular support to retain his accommodation; on one mental health are likely to deteriorate. occasion when he forgot to take his medication he cancelled his recent housing lease and gave away all of * Protecting the privacy of people in our programs is of utmost importance to Red his household goods. Cross. For this reason, stock images have been used and names have been changed.

Without appropriate support Keith is likely to become homeless and his physical and mental health is also likely to deteriorate greatly.

Droop

Cross/Renea Monino

Red

Australian istock.com/Juan Image: Image:

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