Wednesday, August 7, 2013

Disability Care Expert Panel June 2013 – Discussion Summary



 
The Health Care Consumers' Association recently  convened a forum on the National Disability Insurance Scheme, now known as Disability Care Australia. We were very pleased to have two members of the ACT NDIS Expert Panel and the Director of the Taskforce present and then take questions.

  • Sue Salthouse – Community Co-chair on the ACT National Disability Insurance Scheme Expert Panel
  • Simon Rosenberg – CEO Northside Community Council and Member of the Expert Panel
  • Kate Starick – Director of the ACT NDIS Taskforce

What follows is a summary of our notes from the forum. We have done our best to accurately capture what the speakers covered in their presentation but suggest you go to the ACT Community Services Directorate if you have specific questions.

Sue Salthouse
According to OECD Gender Gap Indicators, Australia is ranked first in terms of its education of women, but only 22nd in terms of the economic participation of women, and is 25th overall. Women with disabilities have far worse outcomes in every Gender Gap Indicator.
Disability Care (DC) planning will need to take into account the inequities faced by women with disabilities. There is currently a 17.4% gender gap in earnings for PWD. Women are also more likely to be single, working part time and in a caring role, which places them at a further financial disadvantage. Women who have experienced violence are also less likely to access support.
Women with disabilities have indicated that they would like assistance with transport, including taking children to and from school, rather than just personal care in the assistance packages they receive.
In the ACT, 17% of women have disabilities, whereas only 11% of the male population have disabilities. Despite the higher numbers of women with disabilities, 60% of people accessing disability services are men. It will be important to ensure that the greater proportion of women with disabilities in the ACT is recognised in DC services.
In the first stage of DC roll-out, the focus will be on individuals with relatively high support needs, or of a chronic episodic nature. The employment services not covered by DC will be separately funded by other federal government schemes. 
 The Australian Government has opted to use targets rather than quotas for employment rates for PWD. However, the Committee on the Elimination of Discrimination against Women (CEDAW) has recommended that Australia adopt quotas for women with disabilities. Targets are aspirational in nature and have historically been shown to be ineffective.
My Access Checker’ is an online tool that has been developed for PWD to check whether they will be eligible for the DC packages. At the moment, it is only available in states where DC has already been launched and requires a postcode for access.

The Disability Care Australia website will be another useful online tool that is easy to understand and has a number of accessibility options. 


Simon Rosenberg
The launch of DC in the ACT has been delayed until 2014. In the 12 months leading up to the launch, there will be an enhanced service offer.
Aged care packages are also being reformed at the moment, although this has largely gone under the radar. Both aged care and disability packages will have a similar philosophy of client centred care.
The message has been taken on board that DC packages need to be inclusive of mental health consumers living with long term, severe mental health issues. The term psychiatric disability is being used, but only in Victoria.
The take up of DC packages by people with mental illnesses is likely to be much less than by people with physical disabilities.
There is still a tendency of mental illness and physical disability to be perceived as separate issues. We need to address the stigma associated with mental illness and the perception that people with physical disabilities have more of a right to treatment.

Kate Starick
DC is focusing on redirecting funding from providers to the clients themselves.
At present, providers have to consider their capacity to meet the needs of each client and may need to refuse more complex patients if they do not have capacity. Under the new system, the preferred assistance and services will be assessed so that funding can be provided to purchase those services.
It is hoped that DC will facilitate cultural change, rather than just a change to the funding model.
Resources will now come with the clients, so they won’t need to just take what they can get. This will also mean that decision making and care coordination responsibilities are transferred to the consumer. Some PWD will need support during the transition to these new models, which may also be able to be purchased in some instances. $16 million has been allocated to assist in making this transition over the next generation.
The implementation of DC will require a significant culture shift to choice, control and resources being placed in the hands of the consumers. For some PWD, this will not be an easy transition and they will need support to manage the range of choices becoming available to them.
Timetable for the ACT:
·         2013 – training to assist with transitioning to the new scheme and looking at lessons learned from implementation in other jurisdictions
·         July 2014 – 2500 PWD with the highest and most complex needs move into the scheme
·         July 2015 – another 2500 PWD in tier 2 move into the scheme
·         2020 – full scheme implementation
The key challenges we face will be to decide what is reasonable to fund under DC and to learn what works and what doesn’t as quickly as possible.

Question and answer session



Q. Will PWD who now don’t qualify for support now because of family income means test be eligible for assistance under the new scheme?

A - Clients will need to be aged under 65 and an ACT resident at the launch date to be eligible, and will just need to meet the requirements of the NDIS legislation for being a disability. Medical and pharmaceutical services would probably not be funded for people on higher incomes but transport to access medical services and household modifications might.

Q. What happens to people who don’t qualify for DC (eg. Are aged over 65 years) but still need to purchase services. Will the services be more expensive?

A - The pricing of supports and services will need to be fixed so that the people under the scheme and those who don’t qualify pay the same for similar services. We need to avoid price gouging.

Q. How will DC be funded?

A - The funding system will evolve over time, with funding currently going to federal programs being redirected to DC. This will be managed by a Board. Once the funding has been allocated to DC, it will then be directed to the individual clients, trusted third persons or a nominated agency to purchase the necessary services.

Q. How will funding be allocated for early intervention programs for children with disabilities?

A DC is a social insurance scheme to reduce the long term financial impacts of having a disability. Early intervention has been recognised under the scheme. In order to receive funding, there needs to be a strong evidence base that the treatment/intervention is effective.

A - A fixed portion of funding will be allocated to early intervention, wheelchair modifications etc. along with a flexible amount that can be spent to meet an identified outcome.

Q. What about clients who cannot negotiate for themselves?

A - It may be necessary to organise a broker in a similar fashion as for the Advanced
Care Directives.

Q. What level of disability is required to be eligible for DC?

A - Enduring disability is the term referred to in the scheme, not temporary. DC packages will be based on a tiered scheme outlined below:

·         Tier 3 – severe, ongoing support needed

·         Tier 2 – moderate, some support needed

·         Tier 1 - everyone else meeting the eligibility criteria

Q. Will wheelchairs and other home modifications be covered?

A - ‘Regular support’ under the DC scheme is not restricted to clients needing regular care. The support could also be used for home modifications, wheelchairs, etc.

Q. How will the assessment process operate?

A - Assessors will be set with local area coordinators. Clients are also able to self-refer online or go in person the agency to see if they are eligible. Clients will not need a referral from their GP.

Q. How will people with recurrent and fluctuating disabilities be treated under the scheme?

A - there will be a review process built in to the process, but we don’t want to make people feel as though they have to ‘spend it or lose it’.

Q. Will Aboriginal and Torres Strait Islander assessments be culturally appropriate? I.e., will funding be allocated for traditional medicines or going back to country to fulfil spiritual needs?

A. There are a number of Aboriginal and Torres Strait Islander people on an advisory group, so it is hoped that these considerations will form part of the scheme. There is recognition of the need to consider the diverse needs of CALD, Aboriginal and Torres Strait Islander PWDs. The package provided to each client should be formulated based on mutually agreed outcomes.

Q. How will the age cut off work?

A - Clients will need to have acquired their disability before the age of 65, otherwise they will need to be covered by age care funding.

Q. Does the scheme recognise the crucial role of carers; will there be funding for carers?

A. We recognise the significant role of carers and the importance of keeping them well, but there is unlikely to be funding for carers. Ideally, if the right supports are put in place for the person with a disability, the carer would be well supported by default.

Q. Will people be able to purchase equipment through the ACTESS scheme?

A. Eligibility criteria sits with the client and not with the individual equipment. Clients will be free to purchase the equipment they believe will best suit their needs. Providers will need to position themselves so they can meet client needs appropriately or risk losing business.

For more information on Disability Care, go to www.disabilitycareaustralia.gov.au

Nicole Moyle
Policy Officer

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