Submission to the Productivity Commission Inquiry 
Disability Care and Support

July 2010

INTRODUCTION

Baptistcare (WA Baptist Hospitals and Homes Trust Inc) is a community benefit, not-for-profit (NFP) organisation with nearly 40 years experience working in the aged and community care sectors in Western Australia.  The organisation was established in 1972 by local Baptist churches who saw a specific need for residential aged care services in the community. From these beginnings has grown a significant organisation, which presently offers the community residential aged care, Community Aged Care Packages (CACP’s), Veterans’ Home Care (VHC) packages, a range of independent living apartments in communities in Perth and southwest of the State and has a strong profile in the provision of family support services, including residential, home and community based choices for people with mental illnesses and people living with disabilities. 

The disability support programmes in particular have a unique emphasis on individualised service provision. Partners in Purpose is a programme which provides support to about 130 people across metropolitan and regional WA. Supports include accommodation support, intensive family support, alternatives to employment and post school options, provided to people in their own homes and communities. Individualised funding is provided by the Disability Services Commission, and families, in turn, purchase  services from approved service providers, such as Baptistcare. 

In addition to Partners in Purpose, Baptistcare provides group accommodation to 30 people in three separate facilities in one of Perth’s north eastern suburbs. 

Baptistcare is a significant community service provider with extensive experience in a range of services carried out in many communities.  Services stretch from Kalbarri in the north to Albany in the State’s south.  We can speak with solid experience about rural, regional and remote service provision and metro-centricity in service perspectives.

Importantly, Baptistcare’s character, service choices and values’ base are formed and grounded in its Christian origins, which informs its commitment to its Vision, Mission and Values.  These speak clearly on the organisation’s motivations and continuing future engagement in the community in a wide range of services. 

Baptistcare’s disability support programmes are based around a number of central principles: The first is the principle that the person with a disability should be at the centre of their support planning, making choices and decisions for themselves and has the opportunity to develop and maintain their skills and participate in valued roles in the community. Secondly, support options should be flexible. Each person is unique so it is important that supports are provided in a way that is flexible enough to meet their individual needs and goals. 

1.	Who should be eligible?

a.	It is important that any Disability Support Scheme is not limited to people who are disabled as a result of an accident or injury. The needs of people with a developmental disability must be taken into account, recognising that some of these people may not be considered to have a severe or profound disability, but their capacity to speak for themselves is limited or potential for disadvantage is far greater by virtue of their disability.
 
b.	While the terms of reference state the scheme does not cover disability due to the natural process of ageing, consideration must be given to those people with a disability who by virtue of their age are in need of specific aged care services.  Their disability is not diminished by virtue of their age, therefore consideration must be given to how a person who is funded for disability support may continue to receive appropriate disability-focussed services when they move into a residential aged care service or become eligible for community aged care packages.  

c.	Further to the previous point, people with disabilities should not have to move to residential aged care earlier than any other person, simply because they have a disability. Therefore aged care services, either community aged care packages, or some other kind of service, should be made available to people with disabilities to enable them to stay at home as long as possible before having to go to residential aged care. This applies equally to people whose home is in a group setting such as a group home or hostel. 

2.	Who gets the power?

a.	Individualised funding in West Australia makes it possible for services to be provided to individuals in their own homes and for them to have a level of control over the way that money is spent. The West Australian model should be investigated thoroughly in this process.

b.	While individuals appreciate being able to have control over the use of their money, many families are too tired to take on this responsibility completely and are happy for a not for profit service provider to manage the service on their behalf. Baptistcare values the fact that we work in partnership with families, giving them the opportunity to decide how the money should be spent, rather than treating them simply as clients.

c.	The Shared Management Model, embraced by Baptistcare makes it possible for Baptistcare to provide the government with a level of accountability for the funds, but at the same time to give families and individuals the freedom to employ their own staff and manage the way services are provided.  The amount of control they wish to have can be negotiated between the individual, their family and the service provider. 

d.	One of the weaknesses of the West Australian system is that funding is decided by the CAP Panel (Combined Application Process).  This is crisis-driven, which means people can wait, sometimes for years, before funding becomes available. A fairer system needs to be devised so that individuals are not forced into a crisis because of a lack of support.

3.	What services are needed and how should they be delivered. 

a.	People living in their own home. In some cases support is needed 24 hours a day if there are no family members available to help in an informal way. Often this requires innovative ways of providing support such as co-residency with people who are either employed or act as support workers.

b.	People living at home with their families.  In some cases the support that is needed is respite for the family members, in some cases it is about assisting the person to be engaged in meaningful employment, social interaction, education, or recreation.

c.	Respite. Respite is needed for carers and family members either through getting them away from home for a while, or allowing the person with a disability to get away without their informal carers.

d.	Professional services.  A range of services are required including medical, physical and emotional. Sometimes counselling and support is required for family members who are spending significant amounts of time and energy in caring for their loved one.

e.	Travel and equipment. Where travel is not included in funding levels, service providers are left with carrying the cost of  travel for support workers and people with disabilities. These costs need to be taken into account, particularly in regional areas.

f.	The cost of providing services to a person with a disability in regional communities is often carried by service providers who are required to provide staff from a very small pool of people. There is also the cost of training and professional development for staff, travel and additional costs associated with providing services. The costs associated with regional service provision must be taken into account.

4.	Funding.

a.	The Disability Services Commission in WA is well established and has a good record of providing services to people with disabilities in WA. It would be to the detriment of people with disabilities in this state if a Federal system was established that either competed with, or took the place of a structure that is currently in touch with disability in this state. It would make sense that any Federal system made use of the existing state structures, particularly in the case of WA. 

b.	It is inappropriate for people with disabilities to be at the ransom of political funding cycles. The integrity of a national disability scheme will depend on removing the system from political control and establishing a national insurance scheme, that guarantees ongoing funding growth and availability. 

c.	The Modern awards have placed an increased demand on not for profit organisations and family employers in terms of their lack of flexibility for individual family arrangements such as those in a shared management arrangement. There is currently an inequity between funding levels and the expectations of providing appropriate salary levels to support workers. Workforce issues are critical to any future disability funding models. 

5.	Organising and Implementing a new disability policy.

a.	While it is important that individualised funding is provided to ensure that individuals and their families can control the funds and take responsibility for their own lives, not-for-profit service providers have a critical role in the disability sector.  Recognition must be given to the possible viability issues that will be faced by the not-for-profit sector if these organisations are not included in the funding loop.  Not-for-profits play a significant role in community development for the sector as well as in providing services to individuals and groups of individuals.

b.	As indicated previously a considerable amount of work needs to be undertaken in negotiating with state services, in particular in our case, the Disability Services Commission of WA.