Submission to 

Productivity Commission

Disability Care and Support Inquiry

August 2010

Jewish Care Victoria Inc.
619 St Kilda Road Melbourne Victoria Australia 3004

Introduction

Jewish Care (Victoria) Inc. is the major provider of community and aged care services for Victoria’s Jewish community of approximately 60 000 people, with many from culturally and linguistically diverse backgrounds, including Poland,  the former Soviet Union and South Africa. 

Jewish Care provides a range of accommodation, individual support services, respite services, recreational programs and schools integration support specifically for people with a disability. Other services include residential and community aged care, in home support, counselling, financial services, housing and employment services.

Jewish Care’s submission to the Productivity Commission Inquiry in to a long term disability care and support scheme has been informed by our clients and their family members, who contributed in a forum held to gain greater understanding of their experiences and opinions.

Jewish Care supports the need for a new national scheme to ensure people with a disability can access the regular care, support, therapy and equipment they need to achieve optimal levels of participation

1. Eligibility

The focus for a new scheme should be on enabling people with a disability who require specialist support to participate in every day activities, including education, employment, community access, and social activities and increasing their participation in community.

Eligibility for the scheme should be based upon care and support needs, and functional ability, rather than on disability type or diagnosis. One family member described the focus as being based on ‘level of ability to live a normal life’ and that this ‘shouldn’t discriminate one disability from another’ 

The needs and capacity of family/carers should also be considered in the design of the system, but the focus should remain on ensuring that each individual with a moderate to severe disability can access the support they require to participate, regardless of level of family/carer support.

The scheme should address the issue that the definition of disability is different to that of impairment. Under the scheme, the definition of disability should be a long term or permanent restriction that affects engagement in daily activities, rather than short term impairment, with prognosis for full recovery.

Ideally all people who have a disability and require support to engage in daily tasks should have access to that support. To ensure priority of access to services to those with greatest need, the initial focus of the scheme should be on meeting the needs of people with severe disabilities, impacting on everyday activities.

Currently Jewish Care works with clients who have been assessed as eligible for services, including Individual Support Packages, but do not receive services as funding is not available. Under a new scheme, services should be assured for all people assessed as eligible.

Recommended solutions
That a new disability care and support scheme (‘the scheme’) be available to all people with a severe disability impacting upon participation in daily activities, rather than specific diagnosis or disability type.

That the scheme should focus on services for people with long term or permanent disability.

That funding is provided to all people who are assessed as eligible for services. 

2. Assessment

Assessment of applicants for the scheme should be based on level of functional ability, to determine that a person has a severe disability, and the types of services or support required.

A streamlined process with single point of assessment, and identification of service/support needs would reduce the frustration of people with a disability and their families who currently may be required to participate in similar assessments with the multiple agencies involved in their support and care, and the administrative cost and burden for service providers.

The level of support required should be reassessed regularly to ensure that services and supports provided continue to be appropriate for meeting the person’s needs, and also be able to be reassessed, and adjusted as required in response to changing needs or circumstances. 

Recommended solutions:
That the basis of eligibility for a the scheme is a functional assessment conducted at a single entry point.

That reviews are conducted both regularly, and in response to changing needs.

3. Disability and Ageing

The terms of reference for the inquiry exclude disability arising from ‘natural ageing’, with services for this group provided by the aged care service system. The impact of ageing on people with disability increases the need for services and support, and it is difficult for the current aged care system to meet the need of older people with certain disabilities.

Jewish Care currently provides supported accommodation for an ageing group of residents with disabilities. The residents and their families hope that they will be able to ‘age in place’ in their existing homes, with familiar staff experienced in working with people with disability. There is currently limited support available as residents’ health and support needs increase, resulting in older residents with high support needs facing admission to an aged care home. A new scheme should operate in parallel with the existing aged care system, with people assessed as eligible for the disability scheme continuing to remain eligible for the disability support scheme for whole of life.

This would ensure that people with disability continue to have access to specialist disability services across their lifespan, rather than losing access through an arbitrary shift from a disability support scheme into the aged care service system which lacks the specialist expertise in disability.

The current aged care system provides support for people acquiring a disability after age 65. Whilst it is acknowledged that this is an arbitrary age, this creates a distinction between the two schemes, including the types of services that might be provided.

Recommended solutions:
That the disability support scheme provides lifelong support for people assessed as eligible prior to age 65.

That people acquiring a disability after age 65 continue to have services provided under the aged care system.

4. Culturally appropriate services

Currently in Victoria there is inconsistency in availability, level and priority for service access for individuals with similar levels of support need. People with disability and specific cultural needs, including members of the Jewish community, experience a double barrier of limited service availability, and limited access to culturally appropriate services and support. 

Specific cultural requirements of the Jewish community, that need to be considered by not only Jewish service providers, but other service providers seeking to meet the needs of Jewish clients include:
•	Services that respect and meet cultural and spiritual needs
•	Access to Kosher food
•	Closeness to the Jewish community, including being able to access synagogues without use of vehicles
•	Provision of language and translation services
•	Attracting and retaining staff who understand, and are sensitive to the needs of Jewish people

The shift to individualised funding is based on the assumption that it gives individuals greater control over funds and choices about access to services. This should include the ability to select a culturally appropriate service. 

There is a need to ensure that there is a viable disability services sector, with sufficient levels of funding, including funding that ensures ethno-specific agencies are able to thrive.

Provision of materials including Easy Read versions of documents in relevant community languages, and access to specialised interpreter services with experience in working with people with disabilities is currently limited. The combined impact of disability and English as a second language results in increased disadvantage, and a new scheme should provide additional resources to meet the needs of specific cultural groups.

Recommended solutions
That a new scheme includes an additional loading for cultural and spiritual needs.

That funding is provided for appropriate language services and materials.

5. Services required under a new scheme

It is currently difficult for people with disabilities and their carers to find out about the availability of services, and obtaining case management. This is particularly important at key transition points such as starting school, leaving school and entering workforce or identifying vocational options and leaving home. A new scheme should provide for service coordination and/or case management services to support people to access the services they seek.

People with high support needs, including medical support currently have significant difficulties accessing and coordinating services. One parent described how her school aged child currently receives a range of services from ten different disability service providers, and still has unmet needs. Individualised funding for the child would enable the family to seek a single service provider to meet these needs, and reduce duplication.

The scheme should provide for a universal assessment with each person having the ability to select their preferred method of obtaining support, including choice of disability service provider.

Jewish Care experiences a high level of demand for all services currently provided, including supported housing, employment, flexible home-based support, respite and provision of equipment. 

There is a strong demand from the Jewish community for facility based respite, rather than in-home or recreational respite. Families of children and adults with high support needs state that the extended break provides opportunities for siblings to experience increased parental attention, and that they value the sense of security they experience knowing that their family member is in a safe environment with culturally appropriate care. 

Many Jewish people with a disability and their families would prefer to receive services from Jewish Care, due to the focus on culturally appropriate services and support, however the ability to provide services and therefore the choice for service users, is currently limited by the availability of funding.

Jewish Care’s service users and carers have identified a range of services that are limited, and that should be increased in a new scheme, including:
•	Support to attend and participate in education at any school
•	Access to vocational education / placements / employment
•	Behavioural therapies including early intervention and allied health
•	Home based care and support
•	Facility based respite
•	One stop shop for information
•	Advocacy that is easily accessible
•	Life skills and transition programs
•	Support and counselling for families
•	Accessible transport
•	Provision of assistive technology

Services and supports provided by the scheme should be identified, so that each eligible person is able to access clear information about availability. 

The scheme should also include a provision for ongoing research and evaluation of the effectiveness of services provided. The results should be used to regularly review the types of services provided, focusing on services which result in positive outcomes for people with a disability such as increased independence or reduction of paid support, or increased work capacity should continue to be provided.

Recommended solutions
That services available under the scheme include planning and service coordination and/or case management.

That the supply of services currently provided to a limited group of service users be available to all people assessed as eligible and in need.

That resources be made available for research and evaluation of service outcomes, and the results used to inform future service delivery.

6. Funding for a new scheme

Funding a new scheme through social insurance, with the cost spread across the community would ensure that services were available to all in need. This is preferable to a private insurance model, which would have limited coverage.

The scheme must be financially sustainable over the long term, and able to respond to the needs of people with a disability at a time when the involvement of unpaid carers is decreasing. 

Establishing a Medicare-style levy, with an identifiable funding stream, separate from general revenue would provide ongoing revenue for the scheme. The size of the levy would need to be developed considering
projections of demand for, and cost of services provided, the economic and social benefits of increased participation of people with disabilities, but also the costs to the wider community.

Recommended solutions
That the scheme be funded using a social insurance model, via a Medicare-like levy.

That the costs and economic and social benefits be measured to determine an appropriate level of the levy.

7. Workforce 

The ability to attract, develop and retain a skilled workforce is a critical issue in the disability services field. A new scheme should also address the need for an appropriately skilled work force. A mandatory minimum standard of a relevant Certificate III qualification for direct care workers should be a requirement, to ensure a base level of knowledge for all workers. 

Individualised funding improves opportunities for people with disabilities to exercise choice and control over funding, but the range of services, and the requirements that a service provider must meet to be able to receive funding should be clearly articulated, to ensure that there is not a decline in workforce capacity and skill level.

In Victoria, community workers, including disability support workers are lowly paid, and have limited career paths. There is a need to increase the wages to ensure consistency with jobs of similar skill profile and increase the attraction of a career in disability services. 

Recommended solutions
That there be a requirement under the new scheme that services be provided by appropriately skilled staff, with a minimum qualification of Certificate III in relevant field.

That the wages of community workers be increased where there is a lack of parity with other similarly skilled workforces.