The Younger People with Disability in Residential Aged Care (YPIRAC) Program is a joint initiative of the Commonwealth, State and Territory Governments to provide accommodation and support to younger people with disability living in, or at risk of admission to, residential aged care (RAC). The Program was announced in February 2006 by the Council of Australian Governments (COAG), and represented a joint commitment by the Australian, State and Territory Governments to decrease the number of younger people with disability living in RAC.
The Program was informed by an Inquiry into accommodation for people with disabilities, held by the Senate Community Affairs Committee in 2005.
Concerns were expressed at the time about the current system’s capacity to meet the needs of younger people with a disability. The report detailed the diverse and complex care needs of this client group:
The younger cohort is likely to have a significant representation of high level needs. This group includes young people physically incapacitated through road and other trauma. There are a proportion of people with an Acquired Brain Injury (ABI) as a consequence of alcohol misuse and trauma. There are also people experiencing the degenerative effects of specific medical conditions such as Multiple Sclerosis and Huntington’s disease. The group is therefore more likely to represent a broader and at times more complex range of carer issues than other people who are more likely to have similar disabilities such as dementia and age related frailty.
The Inquiry heard a range of issues and concerns from witnesses which are detailed below:
- Younger people with a disability face the prospect of becoming residents in aged care facilities because no other suitable accommodation is available. Many are at risk of admission to aged care facilities because they are cared for by ageing parents and/or they have medical based needs that cannot be supported by community services.
- Staff in aged care facilities may not have received appropriate training or be skilled/experienced in caring for younger people with a disability.
- Social isolation is a grave concern for young people residing in aged care services. The Committee heard that many young people suffer from depression – this may be exacerbated by ‘living with the very elderly or demented and witnessing the death of other people in their homes.’
- In facilities designed for frail aged people or people at the end of their life, there is generally a lack of rehabilitation services, specialist equipment and palliative care for those with degenerative disease and other disabilities.
- The burden on carers can be extremely high and carers may have the additional responsibility of raising a family and earning an income. It was reported that some children take on the role of caring for their affected single parent, or when the healthy parent is working.
- The impact of chronic illness and the stresses of caring on families are considerable. Support groups have found that this can lead to marriage breakdowns which can further exacerbate the care and accommodation needs of disabled people.
A series of recommendations were made from the inquiry and some of these have been addressed by the YPIRAC Program.
The Australian Institute of Health and Welfare (AIHW) notes that, as at June 2007, nationally, there were 6,613 residents under the age of 65 years in RAC, comprising 4% of all residents.1
1.1 Program Objectives
The YPIRAC Program aims to reduce the net number of younger people in RAC by between 425-689 people, through the implementation of three strategic objectives. These are to:
- Move younger people with disability currently accommodated in RAC into appropriately supported disability accommodation where it can be made available and if this is what clients choose.
- Divert further admissions of younger people with disability who are at risk of admission to RAC into more appropriate forms of accommodation.
- Enhance the delivery of specialist disability services to those younger people with disability who choose to remain in RAC or for whom RAC remains the only available suitable supported accommodation option.
The primary focus of the initiative is on people with a disability aged less that 50 years living in RAC, however the overall target group is people aged less than 65 years either living in RAC or at risk of admission to such care.
The focus of this Mid-Term Review is to assess whether the Program is on track to achieving its intended outcomes.
[ top ]
1.2 Key Evaluation Questions
The key evaluation questions for the review are as follows:
- Were the Bilateral Agreements underpinning the Program designed to allow the objectives for the Program set out by COAG to be met?
The evaluation shall examine:
- (a) whether the Bilateral Agreements between the Commonwealth and each of the State and Territory Governments are structured to achieve the objectives of the initiative;
- (b) whether the implementation processes of States and Territories are capable of delivering the objectives;
- (c) whether it can identify the extent to which States and Territories are meeting their agreed target; and
- (d) whether the data provided by the States and Territories inform COAG that jurisdictions are meeting the objectives consistently, and conclusions about the Program can be made.
- How is the Program being implemented in each State and Territory as set out in the Bilateral Agreements and what are the challenges and issues impacting on the Program?
In considering this, the evaluation shall:
- (a) examine the challenges, issues and best practices, identified through implementation of the Program;
- (b) identify how States and Territories are addressing the challenges;
- (c) examine how successful measures to address challenges will be in meeting the Program’s objectives; and
- (d) examine implementation activities of each State and Territory Government’s disability services agencies to determine outcomes in terms of:
- a. supports provided;
- b. community access;
- c. aids and equipment;
- d. transport assistance.
- To what extent will the funding available to States and Territories meet the demand for support required by the YPIRAC initiative?
In considering this, the evaluation shall have regard to:
- (a) availability of suitable housing;
- (b) planning and development;
- (c) developing system capacity;
- (d) capital works;
- (e) staff maintenance; and
- (f) recruitment of skilled staff.
[ top ]
1.3 Methodology
The methodology for this review included the following:
1.3.1 Review of data and documentation
A review of available program and reporting data to provide a baseline profile of activity and implementation across the jurisdictions. This Review drew on Program plans and administrative reporting for each of the jurisdictions, including their aims, objectives, performance targets and progress, implementation issues and functional needs assessment and other program delivery guidelines. It also drew on routine monitoring and performance reporting data already collected by respective jurisdictions and the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA).
1.3.2 Literature review
In parallel with the data review above, Urbis conducted a limited literature review of relevant research and evaluation regarding comparable approaches to accommodation and support programs for young people with disability. The review aimed to identify key issues and criteria to refine the review approach.
1.3.3 Stakeholder interviews
The key stakeholders in this process were the relevant Program managers from respective Commonwealth, State and Territory Governments supporting this COAG initiative. In-depth telephone interviews with State/Territory officers to discuss responses to questions in the discussion guide was undertaken. It should be noted that any broader stakeholder consultation was not part of the scope of this evaluation.
1.3.4 Reports
This final report addresses the key evaluation questions, includes an assessment of findings, and reflects feedback provided by FaHCSIA and State and Territory Governments on draft reports.
[ top ]
1.4 Structure of this report
The structure of this report is as follows:
- Chapter two briefly outlines the nature of the Bilateral Agreements negotiated with each of the State and Territories to support the implementation of the Program.
- Chapter three details the performance of individual jurisdictions in relation to the targets established against the Program Objectives (POs). This includes analysis of reports provided by AIHW, the jurisdictional bi-monthly data reports and Implementation Progress Reports for the 2006/07 and 2007/08 periods.
- Chapter four provides analysis and discussion of the Program strengths and challenges based on the data provided by each jurisdiction and the targeted literature review which was undertaken for the project.
- Chapter five presents the findings and conclusions of the Mid-term Review and provides the rationale for a series of recommendations.