Background
The NDIS Quality and Safeguards Commissioner (the NDIS Commissioner) has powers under section 27 of the National Disability Insurance Scheme (Incident Management and Reportable Incidents) Rules 2018 and section 29 of the National Disability Insurance Scheme (Complaints Management and Resolution) Rules 2018 to initiate an inquiry about supports or services delivered by NDIS providers that were the subject of a complaint or a reportable incidents, or a series of complaints or reportable incidents. These are known as ‘own motion’ inquiries.
This first Inquiry using these powers focuses on the experiences of NDIS participants living in supported accommodation. The Inquiry examines reportable incidents and complaints that have been made to the NDIS Commission in connection with the supported accommodation services (specifically group homes) provided by 7 of the largest providers of these services over the period 1 July 2018 to 30 September 2022.
The purpose of this Inquiry is to enable the NDIS Commissioner to identify trends in issues that are occurring in supported accommodation, what is causing those issues, models of best practice to eliminate or address these issues, and how the NDIS Commission can use its powers to support the delivery of higher standards of support in these settings.
About this report
The Inquiry report describes:
- the context for the Inquiry and the approach to undertaking it
- the regulation of these supports and the obligations on NDIS providers and their workers
- the supported accommodation market in Australia: what it is, how it is funded; who lives in group homes, and some broad information about the 7 providers covered by the Inquiry and how they fit in the market
- a summary of the types of reportable incidents and complaints examined in the Inquiry
- the features of a best practice framework for group home living and how these features should be applied in the regulation of these settings going forward
- observations arising from the examination of available material including work that should be progressed to assist in addressing some of the issues that impact on the quality and safety of supports of people living in group homes.
There is also an easy read version of this report.
Approach
This Inquiry has involved:
- Detailed examination of around 7,000 reportable incidents and complaints about supports in group homes notified or made to the NDIS Commission about 7 of the larger Supported Independent Living (SIL) providers in Australia over the period 1 July 2018 to 30 September 2022.
- Major research into models of best practice for the delivery of supported accommodation that might be appropriate for consideration by the NDIS Commission in its capacity building work with providers, and in the context of any future amendments to NDIS Practice Standards and Quality Indicators.
- Detailed analysis of policies, procedures and systems of the 7 providers in managing incidents and complaints, their governance, risk management and assurance, and mechanisms to enable them to identify, analyse and treat the underlying causes of these issues to prevent recurrence.
- Direct engagement with people living in group homes across Australia, and targeted consultation with people with intellectual disability about their experiences and aspirations for their supported accommodation arrangements. There has also been engagement with stakeholders representing the interests of people with disability and the industry.
Providers included in the Inquiry
The providers included in this Inquiry are:
- Aruma Services
- Endeavour Foundation
- Life Without Barriers
- Lifestyle Solutions (Aust) Ltd
- Minda Incorporated (including Minda Housing Ltd)
- Scope (Aust) Ltd (including Home@Scope)
- The Disability Trust.
These 7 providers were chosen because they represent a significant part of the supported accommodation market across Australia, and the NDIS Commission had received complaints and been notified of reportable incidents relating to their supports.
A detailed report has been prepared for each of the 7 providers explaining the reportable incidents and complaints and other things about them that have been examined during the Inquiry. These reports will not be published because they contain protected Commission information under the meaning of the NDIS Act 2013. These reports and the Inquiry examination of their arrangements informs the Inquiry Report.
Although the Inquiry has examined incidents and issues relating to only 7 providers, these providers have a significant market share in respect of supported accommodation, either nationally or in a specific jurisdiction. NDIS participants receiving SIL supports from these 7 providers represent 18% of all NDIS participants receiving SIL across Australia.
For this reason, the observations made in this Report about the underlying factors contributing to incidents and issues relating to these providers may be considered to be indicative of the experiences of people with disability who receive supported accommodation from other large to medium providers in the NDIS. Therefore the findings of the Inquiry are open to broader application by the NDIS Commission in its advice, information, education, training and future regulation of providers of group home settings.
Research into models of best practice for supported accommodation
One of the key aims of this Inquiry was to identify models of best practice for the delivery of supported accommodation that can inform the NDIS Commission’s capacity building work with providers and the development of relevant practice standards and quality indicators. The component of the Inquiry has been delivered through a literature review conducted by a body with expertise in researching models of best practice and supported accommodation for people with disability.
The Living with Disability Research Centre at La Trobe University was commissioned to deliver this element of the Inquiry. The project was led by Professor Christine Bigby and involved the review of relevant literature published (in English) between January 2015 and February 2022. The resulting paper has been included as Appendix D to this report and is available online through the Living with Disability Research Centre at La Trobe University (www.latrobe.edu.au/lids).
Observations and actions
The Inquiry has been able to deduce broader issues in the NDIS around people’s experience in supported accommodation other than those that are related to the NDIS Commission’s functions from the breadth of matters that were able to be examined through the Inquiry. This is because issues such as how these supports are funded, how NDIS participants access support and guidance independent of their provider to plan for any changes to their living arrangements, and how they interact with mainstream services (particularly health) contribute to the incidents and issues that affect them in their homes.
The Inquiry was not able to identify solutions to all these issues, however it identified a range of areas of work for NDIS providers and the NDIS Commission to pursue to improve the quality and safety of supports to NDIS participants living in group homes.
Particularly, there is a compelling case for mandating elements of the Best Practice framework, particularly Active Support and Frontline Practice Leadership. This framework would go a significant way to addressing the quality of life of people with disability living in supported accommodation, and the benefit of applying these practice elements to reduce the incidents and issues experienced by people with disability is borne out through the detailed examination of matters undertaken by the Inquiry.
There are a number of aspects of regulatory and scheme design that warrant much further exploration than the broad observations made through in this Inquiry.
It is also apparent through this Inquiry that additional oversight and regulation of these types of supports is warranted.
The main areas of observation and action arising from the Inquiry include the following:
- The need for specific regulation of group home settings to enhance the quality and safety of these settings for people with disability, most of whom have the most significant support needs in the NDIS, and as a result for whom poor quality outcomes would have a catastrophic impact on their quality of life. This can be achieved through a range of measures, starting with the development of new Practice Standards specific to these settings.
- The attitude and aptitude of the workforce drives a considerable number of the issues evident in group home settings. The majority of workers in this sector are committed, capable and well versed in and observant of the rights of people with disability. There are some workers however whose attitude and aptitude will not be addressed by training or routine supervision. Providers should work to develop organisational cultures that eliminate abusive and neglectful conduct of their workers, and take action to address such conduct, including through referral to the NDIS Commission when appropriate.
- The way that Supported Independent Living (SIL) and Specialist Disability Accommodation (SDA), interact appears to drive some issues for how people with disability are able to work with their providers to make changes to their living arrangements when they wish to make them. There are limited levers for providers to assist people to make changes where they wish, or to fill vacancies efficiently, or to easily adjust support arrangements as a person’s needs change. There is a broader design issue about whether people living in group homes have the same extent of choice and control over their NDIS supports as other NDIS participants.
- There has been limited engagement with those people who have transitioned to the NDIS from state and territory funding arrangements about options for more contemporary living arrangements within the NDIS, should people wish to explore these. This is mainly left to their current providers to facilitate on an individual or house by house basis, and almost always limited to the options that the current providers might have available.
- This is particularly apparent in remaining large institutional settings where it is up to providers to plan for and facilitate redevelopment, where they own the existing property. A number of larger facilities are owned by state and territory governments with no plans for redevelopment however. In all cases close consultation with people with disability living in larger settings and their families should be undertaken to make sure that their views and preferences are taken into account as the home and living landscape in the NDIS evolves.
- The interface with health and the supported accommodation services is not effective for many people and is reflected in high levels of incidents and complaints. Incidents arise in relation to the transition of participants from the health system to the disability support system, inadequate access to health care resulting in accelerated deterioration where a person has a chronic condition, and poor quality end of life support. Providers are trying new approaches to address these interface issues, however it is apparent that a system level approach would be beneficial.
- Understanding the supported accommodation market and how people interact with it. There are limitations in the data of both the NDIS Commission and the NDIA which constrain analysis of the market and how people who live in these settings engage with other supports, or have assistance with exercising their choice and control to the extent of others in the NDIS. It is critically important that these settings are more closely monitored and that both agencies are aware of where they are and who lives in them to enable more active engagement across each agency’s respective functions. This is particularly important given the characteristics and circumstances of this population.
The body of the report provides deeper consideration of these and a range of associated issues, including matters relating to engagement with participants, provider behaviour, provider governance, markets and the regulatory environment.
Next steps
The NDIS Commission has commenced planning for the implementation of actions to address issues arising from this Inquiry.
Further detailed consultation with people with disability is planned to inform how best to implement changes arising from this Inquiry.
The NDIS Commission encourages people with experience living in or related to supported accommodation to share feedback about this report, or insights about supported accommodation, with the Commission. The views of people with disability and those who support them help the Commission to find ways of improving the experience of people living in supported accommodation.
If you would like to share your experiences or feedback on this report, please email contactcentre@ndiscommission.gov.au.
