Submission to the Joint Standing Committee on the NDIS: Transitional Arrangements for the NDIS

8/11/2017

National Office PO Box 397 Matraville NSW 2036

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.

Applicants’ Concerns Regarding My Aged Care Assessments

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 depth 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

Funding Support and Transport Interface

Section Heading: 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.

Two Tier System:

There are two tiers within the current funding structure:

1. Those well supported through the NDIS scheme based on need;
2. those aged over 65 and supported through CoS or My Aged Care with a cap placed on funded services. The only difference between these groups being an arbitrary number (65).

NDIS Interface with Transport

Scheme experience has shown that transport funding has been inconsistent and often does not align with participant’s individual 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 available to participants whose disability prevents them using public transportation without difficulty; Levels two and three correspond directly with Mobility Allowance payment levels. However consistency issues persist once individuals enter into schemes - numerous cases show lower amounts received post-entry compared pre-enrollment periods. Adjustments prove extremely challenging in such scenarios.

Almost no data exists regarding what constitutes ‘exceptional circumstance’ justifying higher payments beyond participation in employment activities alone. Current eligibility criteria require recipients either working/studying/volunteering before receiving mobility allowance benefits which transitioned towards becoming part-of-the-NDIS framework as additional transport support measures but lack broader application categories needed today.

Many disabled persons including both eligible-and-noneligible candidates depend heavily upon wheelchair accessible taxis(WATs) due their physical limitations preventing usage alternative modes like buses/trains depending location availability factors making defining demand patterns difficult fitting neatly within existing work-study-volunteer parameters used currently by mobility allowances transitioning toward being incorporated under new ndis guidelines related specifically transporting needs among its members now.

These users also rely significantly on state/territory funded taxi subsidy programs covering approximately half costs up $60 maximum limit per ride however several jurisdictions began excluding newly enrolled nDis applicants from these subsidies after trial phase ended leading significant financial burden increase for affected parties particularly SA, TAS & QLD who fully removed access while VIC negotiated potential removal expectations during 2017–18 and subsequent years until full implementation completed across all regions involved.

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