Older NDIS participants had very mixed experiences of the NDIS’s planning processes. Some (particularly those who had joined the NDIS in the early trial stage) felt that adequate time had been available during planning to fully discuss their goals and support needs. In addition, the planner was reported to have listened to participant needs and had actively tried to understand how their disability affected their lives.
Most NDIS participants, however, expressed criticisms of the initial planning of their supports. Many had entered the planning meeting with a lack of understanding about the process ahead or the supports they needed; this was particularly the case for people who had more recently acquired a disability.
You don’t know anything because you have never been in this situation before. How do you know what [my husband] needs after you have a stroke? You’ve never lived with someone having a stroke. He’s never been in that situation before...It was a very basic plan and it wasn’t a plan that included much thinking beyond the box. And I had yet to learn that we can use these plans to actually make changes and things within the life. (OPS04PWD)
Other participants felt that they had not been encouraged to actively participate in the planning of their supports or that their views had been disregarded. Hence the subsequent NDIS plan was not seen to meet their actual support needs.
The role of the planner was perceived to have changed over time as the roll-out of the NDIS had progressed. Several respondents described NDIA planners as moving from an advocacy role in which they encouraged participants to consider their life goals to becoming more of a custodian of funds.
I really would like to see a major overhaul, a major rethink of the role of the planner. I think when they first started out it seemed to me that the planner was very much just somebody who facilitated and advocated for the participant. I think that’s moving away from that now and having the planner being a gatekeeper for making sure that the rules of the organisation are followed…[The planner should] be somebody who came out and encouraged people to do things that overcame their disabilities and to facilitate their aspirations. (OPS20PWD)
Further difficulties regarding NDIS planning processes were highlighted by respondents from all interview groups. Planners were reported to not fully understand the needs of, and supports required by, people with particular types of disability including degenerative neurological illnesses, psychosocial disability, autism and sensory impairment. This lack of knowledge was felt to be leading to inconsistencies in the types and levels of supports provided to older people with disability through their NDIS plans.
I just wish NDIS actually had people working in there that had disabilities. Like that they understood the type of disabilities that were there. You know like people that have got hearing problems to deal with people who have got hearing problems. (OPS02PWD)
The importance of adequate preparation and time for planning meetings was highlighted by respondents across all groups. The provision of accessible information to enable all participants (including those with visual impairment and communication difficulties) to understand and prepare for their planning meeting was therefore seen as being important.
The benefits of having an advocate to assist older people with disability during plan development was discussed by many respondents. Provider organisations reported that they were frequently taking on this role and were conducting considerable unfunded work with existing and prospective clients around NDIS planning, reviews and plan implementation. Potential conflicts around provider organisations acting as advocates for older people with disability, however, were also raised.
With pretty much everyone we’ve worked out that we probably provide between 15 to 20 hours for each client of preplanning support, and a lot of that’s around the fact that the majority of our clients have never used this service sector before, they’ve never had to use a service sector, they’ve just been diagnosed with a terminal illness, so they don’t really know where to start. (OPS04P)
Planning processes were seen by some respondents as becoming less person-centred and more prescriptive as the NDIS roll-out progressed. The use of automated plan development systems were felt to be leading to greater dissatisfaction over funded supports.
Support to assist older people with disability to be able to implement their NDIS plans successfully was also seen as being vital by respondents. Plan implementation support was felt to be particularly important for older people with intellectual disability, psychosocial disability, dementia and brain injury. In order to fully implement the support plans of these individuals, the provision of NDIA funding for support co-ordination was important.
[The NDIS] doesn’t recognise the difficulties that customers experience in understanding how to go through a review, in understanding how to implement their plan, in, in just understanding what their plan means, what the dollars means, what kind of services they can access. How to manage their funds, all of those things. So I do think that’s a gap….I suspect a lot of those customers may never actually find someone to provide that co-ordination and so they never really get their plan implemented properly. (OPS03P)
Aged care system
In comparison to the NDIS, the standardised assessment processes used by My Aged Care to determine funding of supports were seen as having more of a clinical and functional emphasis. Moreover, these assessment tools were targeted towards the concerns and needs of frail older adults and were considered inappropriate for many people with disability.
Frontline staff within the My Aged Care contact centre and assessment teams were not felt to possess adequate knowledge of disability. Inconsistency in outcomes were reportedly occurring for older people with disability when determining eligibility and funding.
As a consequence of these issues relating to assessment processes and knowledge of disability, the types of supports which were funded under aged care for some older people with disability were felt to be inappropriate to address their support needs.
If you [a person with visual impairment] ring up and say, ‘I’ve got trouble with cooking,’ their first response will be, ‘Would you like to talk to Meals on Wheels?’ But we could modify their home, we could also give them some cups and spoons training for recipes and show them safely how to fill a cup of tea, and all those sorts of things, as a rehab independence model rather than a dependence model where you say, ‘Okay, well if you can’t see any more we’ll go and get people to do something, everything for you. You won’t have to do another thing yourself.’ (OPS06S)
Charitable disability organisations and health care services
Respondents who were receiving funded disability supports from charitable organisations or health care services typically reported that, at least initially, decision-making about the supports they would receive had been largely led by their service provider. However, some non-NDIS participants described becoming more proactive about their supports needs over time. In contrast, respondents with degenerative neurological conditions preferred their service provider to take the lead and give advice about their likely future support needs and make arrangements for appropriate supports.
[At the outpatient clinic] they make recommendations about things that you need…They’re really good, they know the disease and they know what’s going to happen next…So they’re always predicting what you’ll need and not consulting you about whether you need it or not. You just get. The wheelchair just arrived and by the time the wheelchair arrived we needed it. So those services are just fantastic. (OPS13C)
10.4.2 Choice and control over supports
NDIS
Older people with disability participating in the NDIS were considered to have more choice and control over their supports compared to their counterparts within the aged care and state-disability sectors.
NDIS participants and their carers commonly felt that their choice and control increased with time in the NDIS. Many of these respondents considered that they now had a greater say over their disability support providers and workers; this had led in some instances to changes being made as to who delivered their supports. An ability to have flexibility over the timing of services and to make specific requests for workers who met their preferences was also reported.
The thing I like most about NDIS is that you’re in the driver’s seat. The disabled person is in the driver’s seat. They can hire and fire, they can speak up when they say they’re not happy with you, they want to replace you…Too often choices are taken away from the disabled and the mentally ill and someone else says what happens to them and why and when and how and they don’t have a voice…And I have a voice, and I’m being listened to and that’s the best thing about it. (OPS14PWD)
Provider organisations were responding to the emphasis on choice and control under the NDIS by offering more flexible and individualised supports to older people with disability. For some of these organisations, this change in service provision entailed the reconfiguring of staffing roles and working patterns.
Limitation in choice and control were also acknowledged. Choice and control was not seen as being totally flexible under the NDIS; in particular participants were reported to not have full control over the types of supports included in their plans nor how their funding was spent.
Not having that choice, you know, that’s possibly the biggest thing, being told, ‘You have this bucket of fund’, but not having a choice as to how to use it. I don’t want to be stupid, I don’t want to go and buy lollipops with it or a fur coat, but at least we had a choice [before] of being able to say, ‘This is what you need at the moment.’ (OPS13PWD)
Some older NDIS participants (including people with intellectual disability, complex needs or who had been in the disability support system for a long period of time) were reported to find it difficult to exercise effective choice and control over their supports. Moreover, older people with disability were less likely to have family members or carers who could actively assist with decision-making. For these individuals, adequate support to arrange and monitor their disability supports or capacity building to enable them to better express their wishes was recommended.
We found that for a lot of them just having that independence, that choice and control, is quite challenging in itself because they’ve been so used to being told what they can have. So it’s a real re-education process for a lot of participants. (OPS03P)
Aged care system
A lack of choice and control was perceived to exist within the aged care system by many respondents in the provider and key agency interviews. While the introduction of consumer directed care (CDC) was bringing in elements of choice and control to the sector, this was limited due to a lack of flexibility around the level of funding and types of supports received. In addition, there was a lack of provision within the sector for older people with disability to fully manage their own packages of care.
Even if you can choose your provider you pretty much have one provider for your whole package. The price is not set so different providers can charge different amounts and there are a lot of hidden costs around case management, administration and exit fees…So in a sense the aged care system favours the market providers more than it favours the consumers. And so choice and control in the aged care space is much harder to actually exercise which is a disadvantage. (OPS11P)
The non-NDIS participants receiving supports under the aged care system, expressed mixed views about the level of choice and control they had over their supports. Some respondents felt that they had a say over the supports they needed and the workers who delivered them. Others, however, reported a lack of control over the content of their support package and their care arrangements.
State disability schemes
Opinions as to the level of choice and control held over their disability supports were also diverse amongst the non-NDIS participants receiving funding through state disability schemes. As with aged care, some respondents felt that they had considerable control over their support arrangements, particularly over the choice of staff and the tasks undertaken by these workers. However, others reported a lack of choice and that their disability support provider had been automatically allocated to them by the state-funding body.
If there’s a new person going to be coming they send them for a meet and greet beforehand, so you can sit and chat and see how you feel in the company of that person. And then after the first time that they come you’re asked to ring in and let them know how things went, if you were happy or if you weren’t. So that works out really well as far as I’m concerned. (OPS07C)
10.4.3 Self-management
A fifth of the older NDIS participants interviewed had chosen to fully or partly self-manage their own supports. Through self-management, these respondents felt they had more of a say over their workers and supports. While a further three participants wished to self-manage their funding in the future, others preferred to retain assistance with their support arrangements.
We have ended up self-managing everything because that seems to be working well for us at the moment….I already had found someone to clean my house and we already had someone doing our grass…and I thought, well, if I want to keep using those they said that was okay as long as they had an ABN. But [our case co-ordinator] thought that it was better if we had more flexibility, if we self-managed, so we could make the choices. (OPS09PWD)
The option to fully self-manage supports was not available to older people with disability who were receiving funding through the aged care and state-disability systems. Several respondents, however, expressed a preference to be able to have more control over their disability funding including being able to independently employ their own workers.
