Anne Ruston (SA, Liberal Party, Assistant Minister for Agriculture and Water Resources) Share this | Link to this | Hansard source

I present four government responses to committee reports as listed at item 17 on today's order of business. In accordance with the usual practice, I seek leave to have the documents incorporated in Hansard.

Leave granted.

The documents read as follows—

Australian Government response to the Senate Community Affairs References Committee report:

Adequacy of existing residential care arrangements available for young people with severe physical, mental or intellectual disabilities in Australia

November 2016

Introduction

On 24 June 2015, the Community Affairs References Committee released a report outlining the findings from the Senate Inquiry into the Adequacy of existing residential care arrangements available for young people with severe physical, mental or intellectual disabilities in Australia. The report makes twelve recommendations for consideration by the Australian Government (one to six), the Joint Standing Committee on the National Disability Insurance Scheme (seven), and the Council of Australian Governments (COAG) (eight to twelve).

The Department of Social Services (DSS), the Department of Health, the Australian Institute of Health and Welfare, the National Disability Insurance Agency (NDIA), and the Australian Bureau of Statistics (ABS) appeared at the Inquiry's hearing in Canberra and outlined Australian Government support available for young people in, or at risk of entering, residential aged care.

According to the Report on Government Services 2016, in June 2015, there were 6,252 young people in nursing homes around Australia. This comprises 555 young people aged 0-49 years and 5,697 aged 50-64 years.

The issues faced by young people with severe disability span the responsibilities of a range of Commonwealth agencies and different levels of government, and involve both specialist and mainstream services. The National Disability Strategy 2010-2020 (the strategy) provides an overarching policy framework for all levels of government to improve the lives of people with disability. Action taken under the strategy to improve the accessibility of mainstream services for people with disability complements specialist disability services and programs currently provided by Commonwealth, state and territory governments, including those provided through the National Disability Insurance Scheme (NDIS). The strategy seeks to ensure that both disability-specific and mainstream support services are available to all Australians with disability. The Australian Government is committed to examining how it can work more collaboratively across sectors to improve service co-ordination and outcomes for young people in, or at risk of entering, residential aged care.

The Australian Government agrees with the need to prevent new admissions by encouraging collaboration between state and territory disability services, the NDIA and the health system to better meet the needs of young people in, or at risk of moving into, nursing homes. As the Committee noted in its reports, we are currently in a time of transition, changing the way that disability services are administered and delivered by the states, territories and the Commonwealth. The Australian Government recognises the importance of supporting participants as the NDIS transitions to a national scheme.

The Australian Government believes that the provision of co-ordinated and integrated services that take into account an individual's needs at different stages of recovery or disability are necessary to assist young people with high care needs. Under the National Disability Agreement (NDA), state and territory governments have all undertaken to deliver on-the-ground services that help younger people with disability in, or at risk of entering, residential aged care.

The NDA is an high-level agreement between the Commonwealth, states and territories. It is the framework for the provision of government support for people with disability, and explicitly confirms jurisdictional responsibilities in relation to the provision of disability services. Prior to the full nationwide rollout of the NDIS, state and territory governments remain responsible for all non-trial site disability services in their respective jurisdictions, including supported accommodation.

From 2006 to 2011, the Commonwealth provided an additional $122 million to the states as part of the Younger People in Residential Aged Care Initiative (YPIRAC). The aim of the initiative was to reduce the number of younger people with disabilities living in nursing homes and over five years an estimated 1,432 people were assisted. Since 2011, the Commonwealth has provided funding to the states and territories to support younger people with disability in, or at risk of entering, residential aged care as part of the Specific Purpose Payment (SPP) for Disability Services related to the NDA. The Australian Government will work with the states and territories to examine how the needs of young people in, or at risk of entering, nursing homes are being addressed in the lead up to full roll out of the NDIS.

Following NDIS roll out, Australians with significant and permanent disabilities will have improved opportunities to determine what is in their own best interests. They will have increased choice and control over the planning and delivery of their supports, including the ability to take reasonable risks and to select supports that best meet their individual needs and preferences.

When the NDIS commences in their area, young people in nursing homes and their families are able to apply for specialist disability accommodation supports, which will enable them to move to accommodation more appropriate for their needs. Through the NDIS, young people and their families can apply for supports to help them to live independently in the community, including personal and domestic care, home modifications and supports to enable them to access and maintain accommodation. The NDIS will also help people to access other service systems and co-ordinate their supports across systems. The NDIS is currently supporting young people in nursing homes living within areas of NDIS operation. The NDIA is funding the Summer Foundation to work with young people in nursing homes to engage with the NDIS. For those people who have undergone planning, there are a range of capacity building supports and support co-ordination included in plans.

The Australian Government is committed to ensuring people with disability have access to a range of supports that will allow them, their families and carers to participate as valued members of their communities. The Australian Government currently supports younger people in, or at risk of entering, residential aged care through Disability Support and Carer Payments; support for carers; younger onset dementia key worker program; and Commonwealth funding for jurisdictions following the Younger People in Residential Age Care (YPIRAC) initiative.

The Australian Government will continue to work with organisations to provide advice to Government on issues relating to young people in, or at risk of entering, residential aged care, particularly in light of findings from the Inquiry. This will support:

The Young People In Nursing Homes National Alliance has contributed to policy development for the benefit of younger people in, or at risk of entering, residential aged care. Current project work for the Australian Government is focussed on developing practical strategies to address the need for cross-sector and integrated service approaches for this cohort.

Input into the Australian Government's response to the Committee's report was compiled by DSS and includes input from DSS, the Department of Health, and the ABS.

The Australian Government's response addresses the 12 recommendations and explains why each recommendation is accepted, noted, supported in-principle or not supported. The recommendations of the Senate Community Affairs Reference Committee will be taken into consideration as disability service provision is transitioned to the NDIS.

The Australian Government thanks the Senate Committee for its report.

Adequacy of existing residential care arrangements available for young people with severe physical, mental or intellectual disabilities in Australia

Recommendations to the Australian Government

Recommendation 1:

The committee recommends that the Australian Government compile a database of all young people under the age of 65 years living in residential aged care facilities using the data held by the Aged Care Assessment Team (ACAT) program. This list should be provided in a regularly updated form to the National Disability Insurance Agency (NDIA) and to state and territory governments. This data should include the following information:

Response: Noted

The Australian Government is able to respond to such requests, either on an ad-hoc or regular basis, that provide fit-for-purpose data if the request and subsequent use of data meet the requirements of Section 86 of the Aged Care Act 1997.

Components of the data listed in Recommendation 1 are currently made available to the NDIA on a quarterly basis, and to the state and territory governments under the Aged Care Act.

The Aged Care Assessment Program holds assessment and approval related data. As part of their assessment, Aged Care Assessment Teams (ACATs) gather relevant information on a person's medical diagnoses and other background information to support the decision for eligibility for care types under the Aged Care Act. This information is current at the time of the assessment, but may not have ongoing currency, particularly if a period of time has elapsed since the assessment, as the client's care needs may have changed.

While ACAT data does not extend to entry to aged care or length of time in aged care, as part of the Department of Human Services' claims, data is captured on name, age and date of entry to aged care. Length of time spent in the aged care system can also be derived from this information.

The factors that need to be addressed for the person to move out of the aged care facility are complex and would change for individuals over time. As such, it is unlikely that any data system could accurately capture this information. However, should a young person in residential care be eligible for the NDIS, this would be considered as part of the NDIS assessment process. Under the NDIS Specialist Disability Accommodation Pricing and Payments Framework, young people living in residential aged care facilities will be a priority group for access to specialist disability accommodation supports.

Additionally, the Australian Government will work with state and territory governments who are interested in providing pathways for young people in residential aged care who want to transition out of residential care before the NDIS rolls out in their area.

Recommendation 2:

The committee recommends that the Australian Bureau of Statistics (ABS) conduct a Longitudinal Survey of Disability, Ageing and Carers in addition to its triennial survey of Disability, Ageing and Carers.

Response: Supported in-principle

The Australian Government supports in principle the committee's recommendation to conduct a Longitudinal Survey of Disability, Ageing and Carers (SDAC). This recommendation highlights the importance and value of the ongoing ABS Survey of Disability, Ageing and Carers (SDAC) data in informing policy responses and service planning for those with disability and/or those living in aged care facilities.

In recent times, there has been a growing demand for longitudinal data to allow populations of interest to be tracked—their transitions, pathways and outcomes. Conducting a longitudinal survey has the potential to measure the influence of changes in Government policy, as well as assess the benefits and outcomes of services and programs (for example early intervention programs) on individual population groups, such as young people with severe disabilities. However, the continuation of funding for the SDAC collection remains the priority for the Australian Government before considering funding for any additional surveys.

The ABS has recently released data for the 2015 SDAC, following similar collections in 1981, 1988, 1993, 1998, 2003, 2009 and 2012. In recognition of the importance of this collection in underpinning policy development, planning, reporting and service delivery, the Commonwealth and state and territory Governments have committed to providing additional funding to support an increase in the collection's frequency between 2010 and 2020 (from a six-yearly survey to a triennial survey), as well as an increase in the collection's sample size.

Recommendation 3:

The committee recommends that the Australian Government develop and implement a comprehensive assessment and placement tool or residential assessment instrument to assess the care and accommodation needs for all young people living in or at risk of entering residential care.

Response: Noted

The Australian Government currently engages state and territory governments to provide Aged Care Assessment Team (ACAT) services that include aged care assessments for approval of aged care provided under the Aged Care Act 1997. This includes residential aged care.

ACATs conduct a comprehensive, multidisciplinary assessment of the person's medical, physical, social and psychological needs to determine the person's care needs and the type of services that would be most appropriate to meet those needs. For an ACAT to approve a younger person with a disability entering residential aged care, they must be satisfied that there are no other care facilities or care services more appropriate to meet the person's needs.

States and territories have established collaborative, localised protocols between their relevant disability services and ACATs. These protocols are consistent with the National Guiding Principles for the Referral and Assessment of Younger People with Disability between state and territory disability services and Aged Care Assessment Teams. The principles were developed between the Commonwealth and state and territory governments for the referral of younger people with disability for assessment and co-ordination of their specialist disability accommodation and support services. It is the responsibility of the relevant state or territory disability services agency to initially assess younger people with disability and ensure they are referred to the most appropriate care service available. All options for specialist disability accommodation and support services should be fully explored and utilised before an ACAT accepts a referral for assessment and approval.

As the NDIS rolls out, young people will have the opportunity to be assessed for NDIS services and may become eligible for supports to help them to live independently in alternative accommodation. The NDIA takes a planned approach to look at a range of housing options based on the goals of the participant. In areas where the NDIS has not yet rolled out, the Australian Government is willing to work with state and territory governments who are interested in providing pathways for young people in residential aged care who want to transition out of residential care before the NDIS rolls out in their area.

Recommendation 4:

The committee recommends that supplementary assessment guidelines and tools are developed for the ACAT program to ensure that all young people being considered for an aged care placement are properly assessed. As part of this process, the committee recommends that:

Response: Partially supported

All people entering residential care are already properly assessed regardless of age.

Young people with a disability are eligible for services provided under the Aged Care Act 1997 if they are approved for those services by an Aged Care Assessment Team (ACAT), and only when there are no other more appropriate care facilities or services to meet the person's needs. ACATs comprehensively assess the needs of individuals and determine their eligibility for the types of available services most appropriate to meet their care needs.

Some young people in residential aged care may have specific needs that require additional support from the disability system. In these situations, it is the state and territory governments' responsibility to provide "top-up" services to meet those needs. As the NDIS rolls out, young people in aged care may become eligible for supports to help them to live independently in alternative accommodation.

The Australian Government does not support placing additional requirements on providers to intensively case manage young people in aged care. Providers are already required to meet care needs and comply with quality requirements for all residents. Given that residential aged care is generally a service of last resort for young people with a disability, placing additional requirements on providers for this group may remove a young person's last service option.

The Australian Government notes the proposal for an annual review of ACAT placements for young people. As the NDIS rolls out, young people will have the opportunity to be assessed for NDIS services. The NDIS can support young people living in nursing homes through funding of independent support co-ordination in their plans. Support co-ordinators can assist people to connect with services, find alternative accommodation options and engage them with social and community services for capacity building. In areas where the NDIS has not yet rolled out, the Australian Government will work with state and territory governments who are interested in providing pathways for young people in residential aged care who want to transition out of residential care before the NDIS rolls out in their area.

Recommendation 5:

The committee recommends that the accreditation standards for residential aged care are amended to include standards relating to the clinical outcomes and lifestyle needs of young people. In order to assist with meeting these new accreditation standards, the committee recommends that the Australian Government:

Response: Not supported

The Australian Government's quality and accreditation framework already provides assurance to care recipients of aged care services, including young people in aged care. Aged care services must meet their 'accreditation requirement' under the Aged Care Act 1997 to be eligible to receive Australian Government care subsidy for their care recipients. Services meet that requirement by being accredited by the Australian Aged Care Quality Agency who assess residential aged care homes against the Accreditation Standards which are detailed in the Quality of Care Principles 2014.

There are four standards that must be met. Within these standards, there are 44 outcomes, or examples of what people should expect when homes meet the standards. This includes clinical care, assisting the aged care resident to achieve active control of their own lives within the residential care service and their community, staffing, health and personal care, resident lifestyle, living environment, catering, cleaning, continuous improvement, and safety and security.

State governments can invest in disability specific training for staff involved in the care of young people living in aged care, consistent with their responsibilities under the 2011 National Health Reform Agreement.

The 2011 National Health Reform Agreement changed the roles and responsibilities of the Commonwealth and states and territories (excluding Victoria and Western Australia). The Commonwealth assumed responsibility for planning, funding, policy, management and delivery of a national aged care system and for funding specialist disability services delivered by the states in accordance with their responsibilities under the National Disability Agreement for people aged 65 years and over (50 years and over for Indigenous Australians).

States assumed responsibility for regulating specialist disability services delivered under the National Disability Agreement; funding responsibility for disability services for people under the age of 65 (under the age of 50 for Indigenous Australians); and funding responsibility for packaged community care and residential care delivered through the Commonwealth aged care program to people under the age of 65 years (under the age of 50 for Indigenous Australians).

Recommendation 6:

The committee recommends that the Department of Social Services' current discussion paper on disability housing consider capital funding options for construction of specialised disability accommodation.

The committee recommends that the discussion paper is released as a matter of urgency.

The committee recommends that the Australian Government establish a supported disability accommodation fund similar to the Supported Accommodation Innovation Fund.

Response: Noted

On 1 July 2016, the NDIA commenced funding specialist disability supports in the individual plans of NDIS participants with very high needs who require a specialist accommodation response. The Specialist Disability Accommodation Decision Paper on Pricing and Payments (the Decision Paper), released on 1 June 2016, outlines the benchmark prices which are paid to providers of specialist disability accommodation that NDIS participants choose to live in. These benchmark prices are formulated based on the policy agreed by the Disability Reform Council of Commonwealth and State and Territory Ministers (DRC) in November 2015 through the Specialist Disability Accommodation Pricing and Payments Framework. The benchmark prices reflect the additional costs incurred in providing specialist disability accommodation and are intended to contribute to the lifecycle costs of the land and the dwelling. The benchmark prices vary depending on factors including the building type; number of residents; design category and whether there is accommodation for on-site overnight assistance.

As established under the Specialist Disability Accommodation Pricing and Payments Framework, people living in residential aged care facilities are a priority group for access to specialist disability accommodation supports.

At the 24 April 2015 meeting of the DRC, Ministers also asked officials to work with the NDIA to support the development and testing of innovative accommodation pilots that will help to expand the supply of appropriate and sustainable integrated housing and support models for people with disability. The NDIA expects that these pilots will be designed to encourage a range of housing options that are consistent with the goals and objectives of the NDIS. This may include existing, contemporary and/or innovative supports. Initially this will focus on trial sites in which there are adequate funds to support meaningful activity in this area.

These pilots are intended to begin providing evidence about how different models contribute to outcomes for participants, and will help define a path forward for specialist housing options to support participants as the NDIS transitions to a national scheme. Learnings from the Supported Accommodation Innovation Fund are also being used to inform decisions on funding arrangements for specialist disability accommodation under the full scheme.

The NDIA ran a Request for Information process, commencing on 30 November 2015, to seek information on a range of innovative models to refine the commissioning approach and requirements for a specialist disability accommodation pilot in the Barwon area. A number of submissions were received and the NDIA is considering these responses. The NDIA intends to approach the market later this year in an open and competitive process.

Additionally, the Specialist Disability Accommodation Initiative (SDAI) was established to help address immediate community need for specialist disability housing in areas outside NDIS trial sites by providing 'top up' funding to increase the availability of accommodation for people with a disability and identify project initiatives with self-sustaining specialist disability housing models which could be scaled up in the future. Funding of up to $10 million will be offered through grants of up to $1 million to organisations for projects which meet these needs and which have a particular focus on those housed in inappropriate accommodation settings and those with ageing carers who are in need of a long-term, sustainable arrangement. The Department of Social Services concluded a grant round in February 2016. Twelve organisations presented successful applications to deliver specialist disability accommodation and the Department has entered into negotiations with these organisations.

Recommendations to the Joint Standing Committee on the National Disability Insurance Scheme

Recommendation 7:

The committee recommends that the Joint Standing Committee on the National Disability Insurance Scheme (NDIS) conduct an inquiry into the issue of disability housing after the release of the discussion paper on disability housing.

Response: Noted

The Australian Government acknowledges that there are few issues more important to ensuring the welfare of Australians than housing. Housing provides the stability and certainty needed for individuals and families to deal with the many challenges they face.

As outlined in the response to recommendation 6, the NDIS will provide funding for people with very high needs to access specialist disability accommodation. However, most NDIS participants will have their housing needs addressed through mainstream arrangements, with the NDIS assisting participants to navigate mainstream housing systems where reasonable and necessary. For example an NDIS participant may receive assistance with navigating rental markets, tenancy obligations and short-term transitional accommodation. The NDIS may also ensure the home a participant chooses meets their needs by providing home modifications, assistive products for household tasks, food preparation, linen services, cleaning, and house and yard maintenance.

Recommendations to the Council of Australian Governments (COAG)

Recommendation 8:

The committee recommends that the COAG develop and implement a national rehabilitation strategy including a framework for the delivery of slow stream rehabilitation in all jurisdictions.

Response: Not supported

In a health context, rehabilitation is commonly understood to refer to treatment designed to facilitate the process of an individual's recovery of function following a disabling injury, illness, or disease. This treatment, which typically involves specialised health professionals including doctors, nurses and allied health professionals (such as physiotherapists, speech therapists, occupational therapists) is provided within a planned, supervised and progressive program aimed at enabling an individual to achieve their optimal degree of physical and psychological capability. Rehabilitation's emphasis on therapeutic restoration distinguishes it from maintenance therapy which focuses on maintaining an individual's existing level of functioning.

Planning for the rehabilitation needs of particular geographical catchment populations is a responsibility of Local Hospital Networks, which are established under state and territory legislation. Such planning takes into account not only the current and projected health status of the resident population, but also the existing range of services available across the public, not for profit and private health sectors. Drawing on expert clinical advice and evidence of best practice generated by national and international clinical research, Local Hospital Networks then identify any gaps in service delivery and opportunities for service improvement, and use this information to inform their priority setting and resourcing decisions.

It is considered that the research evidence and clinical guidance available on best practice rehabilitation is now sufficiently mature to provide the necessary framework for rehabilitation specialists, as well as state and territory governments, to deliver necessary and appropriate care.

Recommendation 9:

The committee recommends that the NDIS, in all NDIS trial sites, and the relevant state or territory government in all other areas:

Response: Noted/not supported

Advocacy and other services similar to those recommended by the Committee are already provided through several channels. Young people living in residential care are eligible to access free, independent and individualised advocacy services through two Australian Government programs: the National Aged Care Advocacy Program; and the National Disability Advocacy Program (NDAP). A young person may choose to access either program depending on what their need is for advocacy support. Both advocacy programs can provide support and information to the young person and their families about care options available to them and can advocate on their behalf in raising issues about the care they are receiving. It is important to note that access to advocacy services is voluntary, and the independence of advocacy programs is a key feature.

The National Disability Advocacy Framework, which guides disability advocacy services, is currently under review. This review will, in turn, inform a review of NDAP. The coverage of advocacy services, including to key groups such as young people in residential care, is an important issue in these reviews.

People with disability entering an individually-funded plan through the NDIS may also have access to decision-making supports as part of that plan. If a person with a disability is unhappy with a decision made by the NDIA, they can pursue this through the NDIA's internal review process. If a person is not satisfied with a decision following an internal review, they can apply to have the decision reviewed by the Administrative Appeals Tribunal and may access assistance with this process through the External Merits Review—Support Component.

The NDIA provides support to people through Information, Linkages and Capacity Building (ILC). ILC is a key component of the NDIS insurance model and will contribute to the sustainability of the NDIS by building the capacity of the community, people with disability, their families and carers which in turn will reduce the need for funding of supports for people with disability through Individual Funded Packages.

The NDIA has supported peer advocacy in some trial sites using Community Inclusion and Capacity Development (CICD) funds. The NDIA is working in collabor

Glenn Sterle (WA, Australian Labor Party) Share this | Link to this | Hansard source

In respect of the government response to the Regional and Rural Affairs and Transport Legislation Committee's report on the Shipping Legislation Amendment (Provisions) Bill 2015, I move:

That the Senate take note of the document.

As most would know, I have chaired the committee in one shape, way or form for the last nine or 10 years, but I was on the committee inquiry into this legislation. This is an absolutely disastrous piece of legislation. The opposition has put in a dissenting report; the Greens have put in a dissenting report. I notice that the committee, of which I am a member, without the support of the Labor senators, has endorsed the report and the recommendations and the government has picked it up.

What we have here, Madam Deputy President, is an absolute attack on Australian shipping jobs. There is no argument that the shipping industry is trying everything that it can to be competitive around the world, but we are fooling ourselves if we think that we can drop ourselves to the lowest common denominator and compete with foreign seafarers on flags-of-convenience vessels. What we have here is the federal government's attack on our industry. We are an island and, make no mistake, shipping is absolutely our main thrust of moving freight on and off this great country, this island, to all parts of the world and in between and coming back.

We do not have the ability to train captains and masters in three- or four-day session in TAFE. These jobs, these skills, these professions are grown over years and years of seafaring expertise from our sailors and seafarers. Unfortunately, I cannot for the life of me believe that the Australian government goes to an election and all the government can talk about is 'jobs and growth, jobs and growth'. The sad part about this—and every Australian needs to understand this—is: if you are an Australian seafarer plying your trade between Australian ports, the 'jobs and growth' is fine so long as it is not Australians doing it. I am not making this up. This is a pure attack on Australian seafarers.

I have heard all the bulldust and all the arguments of why we cannot have Australian seafarers, but there comes a time when we have to draw the line and we have to say to someone at the top end of town, 'You may want to deliver more for your shareholders'—I understand how it all works—but when we talk about the environmental consequences that can come. We have seen collisions on the Great Barrier Reef, oil spills and ships falling apart. They are not Australian-crewed vessels that do this.

We also have to sit through—I will tell you what—the beefed up stuff on 'Don't be alarmed but be alert' and all this sort of stuff. You want to talk about security; we all want to talk about national security; we want to protect our borders and we want to know who is coming into this country. We can't guarantee that if we are doing away with Australian seafarers and we are letting flag-of-convenience vessels ply their trade in and out of our ports, carting our freight on previously Australian-flagged vessels with Australian crew. What the hell is this nation coming to?

I am going to look across the chamber to the little corner over there of One Nation and others—you cannot just keep your head down. One Nation senators have to understand that you are very good at stirring up the possum about protectionism and nationalism—Senator Xenophon and the NXT Senators as well—but if you do not stand up and you do not support Labor's position on this terrible bill, I will call you out because you will be selling out Australian seafaring jobs.

You can challenge me in every corner of this building because I have done the inquiry. We have heard from numerous people and from the Australian shipping industry as well, who have come to tell us how bad this could be. We had figures put to us. We asked the MUA. You can challenge it. You can go and ask the owners of the ships: how many Australian jobs could we lose? They have told us uncategorically 1,200 Australian jobs will go if this terrible legislation gets up. I am glad Senator Xenophon is walking in because Senator Xenophon has been a very strong, solid supporter, and I would hope and pray that nothing has changed his position on Australian seafaring jobs.

My colleague the good Senator Gallacher from South Australia wishes to make a contribution, and I do not want to thwart his contribution on another bill. I seek leave to continue my remarks later and I will have another crack again on Thursday. I am not going to give up. I have been going on about this for about the last two years and, unfortunately, there does not seem to be any support from the other side. They are glad to see jobs and growth as long as they are not Australian jobs.

Leave granted; debate adjourned.