This section summarises the qualitative findings relating to the funding and provision of disability supports to older people with disability.
The Older People with Disability study finds that:
the NDIS has a clear positive impact on older participants;
both the aged care reforms and the NDIS roll out are pushing in the same direction of person-centred and consumer-directed care, making comparisons unavoidable and offering opportunities for synergies;
the NDIS funding levels are higher than for the aged care and state disability systems, as is satisfaction with supports quality, and access, giving rise to concerns about overall fairness;
instances of unmet demand were reported following difficulties with plan implementations, poorer access for specific minorities and the need for additional specific services;
both disability and aged care support sectors are undergoing intense change and development, with some uncertainty as to how they will co-exist in the future;
the extent to which the aged care sector has the capacity, skills and funding to care for people with disability is an important question. Training for specific skills to care for people who are both older and with a disability is needed;
the NDIS is increasing the choice and control of its older participants, but the main evaluation has shown that this impact is (among all participants) at its lowest for age 50+;
there are broad concerns about supports being reasonable and necessary and the reported need to top up from other sources;
uncertainty about NDIS eligibility, difficult bureaucracy and navigation through the system, lack of information give rise to feelings of unfairness and lack of equity for older people with disability;
many aspects of the review process need attention and fixing. Reviews must not only be disability-appropriate, but also age-appropriate;
broader concern arises among those older people who will not qualify for supports under the revised systems, with much fear about those who may fall between the cracks of the new system;
the positive role of charitable organisations in looking after vulnerable older Australians with a disability is mentioned frequently, in the context of both the past and future of such provisions;
the interface between the NDIS and several mainstream sectors that are important for older people is also a source of uncertainty and anxiety about the future; and
overall, older people with disability are going through a period of change and uncertainty. The NDIS is presenting modest improvements and some optimism, but the big picture remains uncertain and precarious for some of the most vulnerable older Australians.
Supply and demand of support services
The NDIS was found to have a positive impact on the supports of older people with disability, including a greater focus on person-centred supports and the development of new services. Similarly, the move to greater consumer-directed care within the aged care sector was leading to changes in the types of supports provided to older people with disability. Concerns were raised, however, about the future provision of services for older people with disability who were outside both the NDIS and the aged care funding streams.
Higher levels of funding were available to participants in the NDIS compared to the aged care and state disability systems. Under the NDIS, both the level and types of supports available to many older people with disability had increased. In contrast, the aged care system offered home care packages for a prescribed amount which were often considered insufficient to meet the care needs of many older people with disability. Meanwhile, in the state-funded disability systems, access to funding and supports was perceived to be highly variable.
Most older NDIS participants were satisfied with the quality of their supports. However, some issues had been experienced around accessing services and the skills of disability workers. Older people with disability outside of the NDIS, and particularly those receiving services directly from charitable or healthcare organisations, also expressed satisfaction with the quality of their supports. Within the aged care and state disability systems, however, issues were noted with waiting lists, fees and charges, and the skills of workers.
Some instances of unmet demand were reported under the NDIS as a consequence of difficulties with the implementation of planned supports. These difficulties centred on delays in service provision, a lack of registered providers or skilled workers, and issues over service agreements.
Challenges were reported in accessing appropriate services and supports within the aged care and state disability system. Across all the different funding schemes, poorer access to supports was reported for those living in rural and remote areas, Indigenous and CALD people with disability, and for those needing short-term or episodic services.
Improvements in the provision of supports to older people with disability in rural and remote areas, and those from Indigenous and CALD backgrounds was seen as being required. Issues around access to specific services (such as assistive technology, home modifications, short-term and episodic supports, specialist disability services and carer supports) for older people with disability in general was also found to need addressing.
Additional funding to address the current and future support needs of older people with disability within the state disability and aged care systems was seen as being necessary. Moreover, assessment processes and the types of supports funded by the aged care system were perceived to require change to allow these to be more appropriate and responsive to the needs of older people with disability.
The disability sector and its workforce
The NDIS was seen as encouraging new providers to enter the disability sector. However, issues were raised as to the capacity of these organisations to provide quality supports to older people with disability. The aged care reforms were also leading to changes in that sector including organisational closures and mergers and also the entry of some disability providers into that sector. The impact these changes would have on service provision for older people with disability was as yet uncertain.
The skills and ability of aged care workers to provide quality supports to older people with disability was questioned. Similarly, disability workers faced challenges in meeting the increasing healthcare needs of people with disability as they aged. Therefore, training which provided workers with more specific skills to meet both the disability and age-related needs of older people with disability was recommended.
Choice and control
We must recall that the main evaluation found that many of the positive outcomes of the NDIS were less prominent among those NDIS participants aged 50 and over. The comparisons in this Chapter are more specific and they concern only older people who are all either approaching the age of 65 or are already older.
In general, older people with disability participating in the NDIS had greater choice and control over the content and provision of their supports compared to those within other funding streams. However, not all older NDIS participants had experienced increased choice and control; capacity building and assistance with planning processes was therefore recommended. In response to client demand, some provider organisations were offering more flexible and individualised supports to older people with disability.
A lack of understanding of disability and the use of standardised assessments in the aged care sector was found to be leading to inconsistency of outcomes and the funding of inappropriate supports for older people with disability.
Most of the older NDIS participants interviewed had not chosen to self-manage their funding and instead preferred to receive assistance with the management of their support arrangements. Those older NDIS participants who were self-managing either all or some of their funding felt that this had led to greater choice and control over the provision of their supports.
Reasonable and necessary supports
A majority of the older NDIS participants expressed concerns about the level and types of supports which were funded under the NDIS. Particular supports which were considered to lack funding included transportation, therapeutic supports, equipment and home modifications. Likewise, many older non-NDIS participants reported that the funding and supports they received were inadequate to meet their needs. These respondents were either foregoing needed supports, or were obtaining additional supports through charitable organisations or self-funding.
Wellbeing, social, educational and economic participation
The NDIS was seen to be improving access to supports which assisted the social and community participation of older people with disability. Access to these supports was perceived to be particularly lacking for older people with disability in the aged care sector.
Fairness, equity and access
Uncertainty around the NDIS eligibility of older people with particular types of disability including stroke, low vision and mental health issues was reported.
Moreover the NDIS was seen as being bureaucratic and difficult for older people with disability to navigate. The My Aged Care system was likewise perceived to be difficult for older people with disability to understand and there was a lack of accessible information (particularly about disability support needs). In contrast, pathways to access disability supports directly from charitable organisations were perceived to be straightforward.
While the ability to have regular reviews of planned supports was a positive aspect of the NDIS, issues were raised about review processes and outcomes. Concerns were highlighted that support needs were not reviewed adequately and having review meetings conducted by telephone was considered to be inappropriate for many older people with disability. Formal review processes for older people with disability outside the NDIS were lacking and adversely impacted upon the ability to have services reviewed as support needs changed.
Greater clarity around eligibility processes along with adequate time, preparation and support with planning and review processes was recommended.
Considerable variation in the funding and provision of supports to older people with disability was evident across the different funding schemes. Inequity was observed in levels of overall funding, the types of supports funded, expectations of co-payments, and the extent of choice and control. Older people with disability who were part of the aged care system were felt to be considerably disadvantaged compared to their counterparts in the NDIS.
Additional funding to address the current and future support needs of older people with disability who were ineligible for the NDIS was reported to be needed. This included the continuation of block funding arrangements to charitable organisations providing supports to older people with disability. Ideally, a single funding system which provided funding and supports to all people with disability regardless of their age was recommended in order to address inequities across the different schemes.
Mainstream interface
The interface between the NDIS and the health sector was perceived to be unclear and adversely impacting upon the supports accessed by older people with disability. For some older NDIS participants, this had led to the refusal of funding for specific supports under the NDIS. Other older people with disability were reported to have been found ineligible to join the NDIS as their needs were considered to be primarily health rather than disability-related.
