Over 80 per cent of submissions included comments and information about funding for models of supported accommodation. Funding levels varied according to the approach suggested. Costings depended on the type of supported accommodation model; individual needs; funding sources; capital funding for buildings and/or refurbishments; location; equipment; and staffing and human resource arrangements.
Many respondents suggested that some of the initial government programme funding be set aside to evaluate new services set up to support younger people with disability.
‘These proposed changes are considered to be more complex than the current prioritisation system with no clear evidenced based benefit to the person or their family. Process evaluation will need to be implemented at the same time and funding made available for such research’.
‘We recommend that evaluation methods be developed and implemented to assess the outcomes of each of the models of support and supported accommodation.’
Some submissions also recommended that a proportion of the programme funding be set aside for ‘crisis situations’.
‘At present a number of younger people reside in aged care services or are at risk of entering such services because their high level of physical and personal care needs cannot be funded. The program will need to factor the prevention component into the program. A suggested way is to allocate a certain amount of the block funding for crisis management’.
5.1 Funding
Possible funding arrangements were mostly designed to ensure long term viability, and some submissions included support for a specific target group and, more generally, for young people with disability at risk of entering or in residential aged care.
Possible savings were identified for individuals when a number of people share some parts of the support, especially when they live alone or with their family. However some respondents claimed that the savings are not as high for people in congregate care.
Specific areas of savings for people living alone and with family included providing informal, unpaid support and reducing capital funding and/or maintenance costs. As well, some respondents identified savings when people’s skills increase and demands for service support lessen.
Most respondents costed ‘continuum of care’ approaches, mostly because they say these promote greater choice. At the same time, these approaches offer more value for money because the funding is targeted at specific needs.
Some of the proposed models suggested in house clinical support. Others identified savings by using existing networks of clinical support for low levels of care.
Submissions included various ways of co-locating supported accommodation for younger people with disability - for example, with a residential aged care facility and in some cases, sharing resources.
‘This model is based on up to four houses built on one block of land next to an Aged Care Facility. The houses would be staffed to support the residents in their daily living. Significantly, the houses would be staffed to provide age appropriate recreation … the co-located Aged Care Facility would resource the four houses. The direct care resources provided would include laundry, meals and nursing staff. The synergies would include management, fire alarm, sharing staff, training, telephone and insurance’.
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5.2 Partnerships
Savings were suggested by allocating tenancy management to an external party or partner organisation.
Examples of partnerships
‘A housing company and a not for profit organisation have developed a supported accommodation site of 13 independent living units for people with an ABI or other neurological disability. The project is designed for people who are in receipt of … disability support funding … or Transport Accident Commission (TAC) funding, and who require moderate levels of support. The site incorporates 2 respite beds for people with Multiple Sclerosis. Capital funding has been raised through a number of sources including government and charitable grants (50%), resident (mixed equity) contributions, loan funds (housing organisation) and support provider contribution (not for profit organisation) (42%) in return for title. The housing company will provide the tenancy management and the not for profit organisation will provide the support. Refurbishment and modification funding through shared contributions by both organisations (85%), resident contribution (7.5%) and the Slow to Recover Program (7.5%). Operating costs, short and long-term maintenance is funded through accommodation charges (rent) paid by the residents.’
5.3 Individual needs
Individual planning and person centred approaches were central to most submissions, with the majority preferring individual support packages. Some respondents claimed this reduces overall costs because the funding is targeted directly to specific needs.
‘The support model for this service is funded through individual support packages – with funding attached to the individual not the service’.
‘A minimum 34 hours of attendant care funding is required for tenants to be considered for placement, enabling the resident to access 24 shared supervision and support, plus 3 hours per week individual planning assistance. Community access, day placement, rehabilitation and recreational/leisure options are not included in the support model; however, residents are given the opportunity to pool individual support to access recreation and leisure options. Individual funding agreements vary according to individual need. The average support cost per person is $58,615 per annum, including rehabilitation services funded through the Slow to Recover Program in addition to the minimum funding requirement.’
‘Individualised funding is the preferred option however in the light of limited resources strategies to make the best use of resources may involve some sharing or pooling of resources. Some examples of or suggestions for sharing of resources include:
- People living in close proximity pooling support services to enable flexible use of resources.
- Town houses/units (no more than four) on one site with staff unit to enable 24 hour access to support’.
‘Individuals need to have the opportunity to administer their own package of funds or to choose the organisation they would like to administer the funds.’
Several responses pointed out that costs could change as an individual’s needs change.
‘For people with Huntington’s Disease … recognise and validate the need for variation in the maintenance costs for each resident where this arises from the inherent nature of the disease – this would apply, for example, to the extra catering costs for residents … who require a high food intake and food supplements.’
Other organisations favour block funding.
‘That funding for this cohort be by way of block funding to relevant organisations during the transition and establishment of innovative models of support until program stabilisation is evident and sustaining patterns of service delivery emerge. In addition this organisation noted … that the yearly block funding reflects the actual CPI increases in real terms.’
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5.4 Funding sources
Other options for funding arrangements included funding for capital or refurbishment costs for supported accommodation facilities. Generally, the respondents wanted recurrent funding from government for support and clinical care.
‘Capital funding for each development is separate from recurrent support and is to be sourced through partnerships with not for profit community housing providers.’
Some respondents suggested a mix of funding from various levels of government and government agencies.
‘Our organisation (Residential Aged Care provider) believes (as with other current models to date), that the most cost effective means of running such a program would mean that Aged Care provides top-ups to places and Disability Services also contribute additional funding to support the disability needs. Overall the Commonwealth funding covers the accommodation and care component but, in terms of providing that additional support, the … disability … state programs would be required to do that’.
The Transport Accident Commission (TAC) ‘will be a primary fund provider for many of our proposed permanent clients. Other compensable clients such as work cover, and private insurance recipients may also be expected as permanent residents.’
‘There is a clear need to develop workable and viable options for people who have received, and continue to receive, compensation funds for their catastrophic injuries. Considering alternative ways to supplement the actual compensation fund itself … is one recommendation. This option requires the injection of funds from government, with the emphasis on extending the overall lifespan of the individual’s compensation funds.’ The respondent suggests early injections of government funding, together with compensation funds, could pay for the appropriate level of care, reduce the need for high level care, and at a minimum lessen the chance of premature admission to residential aged care).
Several submissions included the option of client contributions towards operational and maintenance costs, although the amounts were minimal.
5.5 Equipment
Some responses included equipment as an extra cost to the individual and/or their family. Others suggested coordinating equipment which would be offered at ‘no cost’ or ‘minimal cost’ to people with disability.
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5.6 Staffing/human resources
All of the responses that proposed supported accommodation models included information about the staff required to maintain the support. Options included:
- staff to coordinate services, often from external agencies - for example, therapy, specialist clinical support, equipment, transport, hairdressing, and recreation)
- nursing and other support staff, including in-home support workers and for recreation or leisure activities
- staff to support individuals, families and carers
- ancillary staff – for example, for grounds maintenance and the kitchen
- ongoing training for staff
- human resource management staff
While most respondents provided costings, there were many variations in the support model because of individuals’ needs and different types of accommodation options. Some respondents also mentioned that the mix of external and internal support could vary in rural and remote areas where some external services may not be available. Staff training was also a key consideration in the budgets.
To support people with a progressive disability and people with high clinical care needs, it was suggested that nursing staff and clinical support coordinators (registered nurses) should be a key part of service responses, and that skilled staff should be available to support people in and out of their accommodation.
‘After consulting with service providers currently providing similar service it would appear that if the service supported eight residents, there would be a requirement for two registered nurses each working an 8 hour shift per day and two assistant nurses per shift.’
‘Complex medical clients would need a model with … nursing staff … managing the clinical care. The registered nurse could work across several homes or be employed jointly by a number of service providers with homes in the same geographical area as a care co-coordinator. Registered nurses wages are $28 per hour. Enrolled nursing (EN) wages are $19 per hour. Certificate 4 EN’s can administer medication. Assistant in Nursing (AIN) wages is $16 per hour. (All these are flat rates with no penalties or shift loading)’. (This option relates to a specific model and State).