Social Development Committee: Supported Accommodation

31 Mar 2004 archivespeech
This speech is to express support for the social development committee: supported accommodation motion. Also, this speech is to commend our chair, Gail Gago, my colleague from the Legislative Council, the Hon. Terry Cameron, and our three House of Assembly colleagues, the lion of Hartley, Joe Scalzi, the member for Playford, Jack Snelling, and Frances Bedford. I also thank our researcher, Susie Dunlop, for her very comprehensive work and our secretaries Robyn Schutte and Kristina Willis-Arnold.

The Hon. J.M.A. LENSINK: I rise to support this motion. The supported accommodation inquiry commenced before I became a member of that committee. I did join after much of the evidence had been heard, but I was assisted in some of my understanding through past work. I draw to the attention of the chamber the reference on page 1 of the report, which acknowledges that there has been new funding for disability services but that supported accommodation has not been the highest priority in that funding. The report states:

Funding for accommodation support under the Commonwealth State and Territories Disability Agreement (CSTDA) increased by 23.3 per cent from 1998 to 2002. However, supported accommodation funding increases have not matched rising demand in this state. Furthermore, mental health expenditure in South Australia is heavily concentrated in inpatient services and per capita spending on community residential services is very low, equating to 0.3 per cent of total mental health services expenditure compared to a national average of 6.7 per cent.

That sets the tone for much the report. I think it is probably a situation that, when funds are tight, there is a tendency for the agency to implement what can be kindly called `rationing mechanisms', which take the effect of shrinking their client base so they feel they are adequately able to service it and not be overwhelmed by additional clients. That leads to some of the more complex and needy clients being difficult to place as they fall through the cracks and become orphans of all agencies. Some of the people that this report was looking at have very complex needs and can be very vulnerable. A combination of services cross over from mental health, corrections, disabilities, and drug and alcohol services. There can also be significant family issues, although I acknowledge the fact that in many cases families provide significant support. Homelessness is also an issue.

Providing additional supported accommodation has often been a problem in securing the necessary recurrent funding to provide the support staff. However, I think into the future, and perhaps in the current situation, low levels of home ownership affordability, generally, will affect the capital costs of finding suitable housing in the first place. I acknowledge that this government has provided additional recurrent funding in 2003-04 for particular programs, which will assist supported accommodation, including $11 million for supported residential facilities, funding which is aimed to slow down or avoid closures and provide alternatives for those people who are displaced by closures; $20 million per annum through CSDA; and $7.4 million in HACC funds. The latter two involve significant commonwealth investment.

The previous government also obtained significant funds in difficult circumstances for what has generally been called the `unmet needs' program. The `unmet needs' funding went towards respite, accommodation and day programs. The then minister (Hon. Robert Lawson) was the first to accept the commonwealth's offer, which led to additional recurrent funding of $8.09 million. In his term as minister for the ageing, he always ensured that South Australia accepted the commonwealth HACC offer to maximise funds for these important programs in this state.

The Hon. R.D. Lawson interjecting:

The Hon. J.M.A. LENSINK: Indeed. The Hon. Robert Lawson says, `More than this mob'. Country clients have particular difficulties because of the tyranny of distance. In order to find suitable accommodation, country people with disabilities are often away from their family familiarity and their community. It is a similar situation for supported accommodation, as we witnessed some years ago with the commonwealth aged-care hostels and nursing homes, where some people were placed at some distance from home, which was quite distressing.

This report also highlights that in the country there are no rural institutional places for people with psychiatric disabili-ties, which is perhaps a reflection of under funding in mental health. Page 79 of the report shows two pie charts, which starkly and graphically represent that, while 26.9 per cent of South Australia's population lives outside the metropolitan area, only 8.7 per cent of all DHS-funded supported accommodation and supported residential facility beds are outside the metropolitan area.

Of all the people on the urgent needs list for supported accommodation, about 20 per cent live in rural areas. The lack of places leads to more people with disabilities living in aged-care accommodation, which is not considered a particularly appropriate place for them, because commonwealth funding often does not provide for their additional needs; and staff can be inexperienced in dealing with some of their particular difficulties. This is a problem, in particular, for younger Aboriginal people with disabilities for whom proximity to home is very important. Therefore, they are overrepresented in those numbers.

In relation to the issue of family carers, I did not hear much of the evidence on this topic, but I am aware of some of the desperate needs of families of people with disabilities. While day options may assist in the provision of some form of respite, in the long term many families need the peace of mind that there will be a long-term solution; the role of continuous care and support will be shared by the rest of the community when family members eventually run out of energy and can no longer provide that support. Cynthia Betterman, the Executive Officer of Parent Advocacy, said:

We normally do not think of people in their 50s as being aged — Heaven forbid! Many members in this chamber are in that bracket — but when you have been caring for a son or daughter with high support needs for 20 or 30 years, by the time you are in your 50s you are totally exhausted.
The Carers Association of Australia, which conducts a health and wellbeing survey, mentions a number of the issues that particularly affect carers, including that 58 per cent of carers have worse physical health than people who are not carers; a third of all carers have been physically injured; and over 70 per cent felt they had less energy.

Supported residential facilities probably have had a lot of publicity in the past few months and since this report was tabled. It is an industry that itself acknowledges it often does not provide appropriate support. A number of people are inappropriately placed because they have nowhere else to go. At the time of the report, some 14 sites had closed and six were under threat which, I understand, works out to some-thing like 450 people. A number of these facilities are in older properties, old mansions perhaps, and in areas where the capital value has increased. The value of the property certainly outweighs the income that can be derived, so the commercial decision that lots of proprietors would obviously make is whether it is worth it.

I also note that a number of providers do their utmost, but they are being squeezed so tight that they consider that it is no longer viable. Of the $11 million the government has allocated for supported residential facilities, $5 million is for the board and care subsidy. Problems with the previous administration of this particular subsidy were highlighted in the 2002-03 report of the South Australian Ombudsman, as follows:

 ...the board and care subsidy, as it was currently paid, discriminated against the vast majority of SRFs which housed people with a mental illness. More importantly, it discriminated against the vast majority of people with a mental illness who had extra needs because they could only access the subsidy if they lived in one of the SRFs around metropolitan and country South Australia.

So, additional funds have been provided. Some $2062 will be provided for every resident in every facility in addition to some additional supports for residents with the most complex needs, and that is to be commended. However, in comparison with the model that was presented in the Financial Analysis of Supported Residential Facilities Report 2003, the figure for that model was in the order of $7500 per resident. I question whether that will be enough to keep the facilities running.

Regarding the extension of the subsidy to all residents in facilities, I understand that there have been some complica-tions in its administration. Funds cannot be provided directly to clients to purchase services as there is no guarantee that the subsidy would be spent on care. There is also some difficulty with funding facilities directly because, under the rules, the board and care subsidy will mean that facilities have to cap client fees and, additionally, some facilities do not provide care. There is also another $6 million that is for contingencies in case facilities close.

I have been informed that no existing provider will be entitled to accept clients from facilities that have closed, the rationale for which I do not understand. Perhaps this is the extension of a philosophy that I have previously come across in government: that the private sector is an inappropriate provider of care services and perhaps should not be in partnership with government. Again, that is something I do not understand, particularly in the aged care sector, where we have recently seen that the non-profit provider the Salvation Army has had to admit that it is no longer able to be in the business of running nursing homes, while a number of private sector operators continue to thrive.

In the previous minister's grieve on 12 November 2003, the day after the announcement of the subsidy, some com-ments were made in relation to the viability of the industry, which I would like to quote. With respect to the model that was seeking $7500 per resident, the then minister stated:
What the model did not do was ensure that the subsidy contributed to the quality of care for residents.

So, that would have been an additional cost on top of that. She went on to say:

In effect, the model was proposing the subsidy to guarantee the profitability of proprietors. This government has provided a suitable response — and I emphasise these words — but it is not in the business of guaranteeing profits regardless of care standards or business efficiency or making sure that the residents are looked after.

In light of the $64 million that recently has been announced in relation to gas, I find that statement astounding. Perhaps cabinet would like to have some sort of consistency with respect to where it stands with these sorts of issues. I also wonder what the government's attitude would be in light of those comments by the previous minister if supported residential facilities continue to close. Where would those residents go? There are some 1400 residents in supported residential facilities. That would be quite a specific problem for them to deal with. I also understand that, in relation to the $6 million contingency, DHS has been inviting expressions of interest from interstate not for profit providers, and I urge the government to ensure that these funds will be genuinely expended on client support and not chewed up in some allocation process.

I think the committee recognises that there is some considerable anxiety in the community in relation to the issue of deinstitutionalisation, which is probably based on past bad experiences of people moving out of institutions without having appropriate supports in place. I commend two of our large residential institutions for people with disabilities—the Intellectual Disability Services Council and the Julia Farr Centre—for developing a range of community services for their current residents. To be successful, deinstitutionalisation requires proper planning and coordination. As was stated in the House of Assembly in support of the tabling of this report, deinstitutionalisation is not a cheap option to save money, and transitional funds are required.

One of the key recommendations of our committee's report was to continue a process of deinstitutionalisation which would be in line with national standards, but to ensure that we would have a proper plan which would ensure that the process occurred as it ought to rather than perhaps as has been the experience in the past, where people are left to their own devices without any help. I would also like to state for the record that this is a government that, while in opposition, promised to do everything to provide services for people with health care or support needs. I point out that the bill for mental health has been estimated at some $6 million per annum, and there is a desperate need for community-based services.

Whilst the state government has accepted the CSDA offer from the commonwealth, which will provide a total of $129 million in this financial year, it was dragged kicking and screaming to match the commonwealth growth offer on HACC and it grandstanded on the Australian Health Care Agreement. I remind it that joint commonwealth-state funding offers are a bit of a no-brainer, because you get so much more bang for your buck. I would have thought that, given its base philosophy, it also would not hesitate in taking those funds and applying them appropriately.

I would like to commend our chair, Gail Gago, my colleague from the Legislative Council, the Hon. Terry Cameron, and our three House of Assembly colleagues, the lion of Hartley, Joe Scalzi, the member for Playford, Jack Snelling, and Frances Bedford. I also thank our researcher, Susie Dunlop, for her very comprehensive work and our secretaries Robyn Schutte and Kristina Willis-Arnold. I believe that this report provides a sound foundation for the future direction of supported accommodation and a call to provide services for the many people who are missing out and who are among the most vulnerable in this state. I support the tabling of this report.