The introduction of the NDIS and the aged care reforms had prompted some disability organisations to become registered aged care providers for the first time in order to continue to receive funding and offer supports to their clients with disability aged 65 years and older. This was seen by some respondents as providing positive opportunities for organisational expansion.
We are a registered aged care provider because we knew that there would be a proportion, albeit small, of the people that we currently support who would be over the age of 65 when the NDIS rolled into their LGA. And we wanted to be in a position where those people if they so choose could continue to receive our services under the continuity of care provisions. We also saw it as strategically a means of diversification of our revenue base with a similar capability applied to a new cohort….We felt that a cross-over between our disability and aged care cohorts would give us both scale and volume. (OPS07P)
Other aged care organisations were either exploring processes for becoming an NDIS registered provider or were waiting for the impacts of the NDIS to become more known before deciding whether to move into the disability sector.
We’ve had confirmation now that we do have that State HACC money for another 12 months which is great, so that we’ll be able to continue the services for people we have now, and some people will be eligible for NDIS and some won’t…We’re working on how do we then become an NDIS provider so that we can continue to provide for people under 65 and what that looks like, so that’s that piece of work that we’re doing now. (OPS19P)
Provider organisations reported that the level of funding available to them under the NDIS for supports such as in-home services, group support, supported-decision making and services for people with complex disability was less than that received through state-disability funding.
As a consequence of the new NDIS funding arrangements providers reported that they were evaluating which supports they should provide and the types of client groups they should work with in the future. Financial analysis of the viability of services for older people with disability was therefore occurring and the actual or threatened closure of some programs were noted.
Services are struggling to make ends meet on the unit rates that the NDIS is paying. For example, if the NDIS is paying $42 an hour for an hour of direct support and everything has to come out of that $42 an hour, any management structure, supervision, professional development, coaching, non-contact time, administration staff, everything has to come out of that $42 an hour including staff member’s wage, most places are struggling to make that work…We are considering a number of things and one of them does have to be whether we continue to provide those services or not. (OPS06P)
Uncertainty was also expressed about the future provision of services for older people with disability who were not eligible for NDIS funding. If funding issues were not resolved satisfactorily, respondents queried their future ability to be able to provide services to this client group.
We’re trying to get commitments from the state government and the NDIS [about] the money that they currently paid…for that we cover 12,000 clients of which 75 per cent are over the age of 65…We will lose all that funding from the state under the NDIS system as it’s been set up, and …that’s only going to provide money for 3,000 people or something. So it’s not a big income, if you know what I mean. The biggest problem we’ve got, of course, is [people with disability] over 65. (OPS06S)
Several respondents from charitable organisations reported that they had previously relied on a mix of government funding and public donations to provide services to their members. With the advent of the NDIS, concerns were expressed regarding whether the public would continue to be willing to financially support disability organisations. If not, the reduction in their income could have a detrimental impact on their ability to provide services.
The NDIS was perceived by some respondents to be opening up the disability support sector and leading to new providers entering the market. Respondents queried, however, the ability of generalist disability and aged care services to provide quality specialist disability supports suitable for the needs of older people with disability.
The aged care reforms (and in particular the further implementation of consumer directed care) was also felt to be leading to changes within the aged care sector. As a consequence of this and the changes brought about with the NDIS, closures of some providers and mergers of other organisations were anticipated in the future. This could lead to further changes in service provision for older people with disability.
I think we have to find a way to make it work, to remain active in the market. But it also means that there’ll be providers who don’t thrive in that space and there will be some consolidation as well. Well we’re okay but we’re also looking at a merger with [a provider organisation]…They’re also a large aged care provider but they’re also a hospital provider as well…so it also broadens out the reach to different customer bases. (OPS09S)
For people with disability receiving aged care funding and services, the ability of aged care workers to provide quality supports to these clients was questioned by respondents. Particular concerns related to the knowledge and skillset required when working with people with disability; these skills were felt to be lacking within the aged care sector.
The need for a work ethos which promoted person-centred care and capacity building when supporting people with disability was also seen as challenging for aged care workers more familiar working with frail older adults.
Changing the culture of your workforce is quite a big step. Going from doing things for people to this whole new active support and identifying exactly ‘What is the priority for this individual and let’s forget about the untidy house or whatever else’, is quite a big change for aged care workforce. (OPS01S)
Workers within the disability sector were also seen as facing skill deficits in meeting the increasing healthcare needs of people with disability as they aged. Therefore the need for training which provided workers with sufficient skills to meet both the disability and age-related needs of older people disability (regardless of which funding system the individual was situated in) was recommended. This training was also felt to be necessary for frontline staff working for the NDIA and My Aged Care.
The NDIS model of individualised funding was seen as necessitating workers having broader skillsets (both formal and soft skills) when working with older people with disability. In order to improve service provision, some provider organisations reported that they were looking to recruit workers with particular skills including understanding of mental health issues and fluency in languages other than English.
There has to be more flexibility within the company, because if they [NDIS participants] don’t want personal care on one day, they can cancel it and maybe have shopping. Whereas before, when it was all structured through whatever agency they had, it was set in cement, a little bit of flexibility, but now, you know, there has to be total flexibility because you’re meeting the needs of that individual. It’s going to take a lot of working around. You need to know your workers and their availability, and you need to have a worker that is multi-skilled as well. (OPS18P)
However, the retention of skilled staff within the disability sector was highlighted as a potential area of concern for the future. The anticipated poaching of skilled staff across care sectors (in disability, aged care and health) also had the potential to affect service provision to older people with disability.
The introduction of an individualised funding model under the NDIS was also reported to be negatively impacting upon the working conditions and shift arrangements of disability support workers. Moreover, some provider organisations were responding to the introduction of the NDIS and the aged care reforms by restructuring their workforces. For example, the streamlining of management structures was occurring and positions were being created to aid the transition of existing clients into the NDIS or My Aged Care and to better engage with potential new clients.
So what we’ve developed is service engagement consultants to assist with the transition of clients to become participants. So that’s been a bit of providing them with information in their preferred formats about what the NDIS is and what the process is and also sort of make them aware of what that process is and to help them to understand how the NDIA goes about making decisions about what supports and services are reasonable and necessary across the domains. (OPS02P)
