Supported Residential Services (Private Proprietors) Bill
Wednesday, June 23, 2010
Second Reading I am very pleased to be here today to speak on the very important Supported Residential Services (Private Proprietors) Bill 2010.
At the outset I have to say that this is an incredible missed opportunity. Accommodation for vulnerable people in our community is a massive issue; there are chronic shortages. Many people are residing in inappropriate accommodation.
In fact accommodation for people with disabilities or mental illness -- and even accommodation for the frail aged -- is in crisis.
It is not just me and the coalition that is saying this; it has been said by many important independent government watchdogs. The public advocate, community visitors, the coroner and the Ombudsman have repeatedly said how accommodation for people who are vulnerable is in very dire circumstances, and a broad and strategic approach is needed. What we needed here was a comprehensive review about accommodation for people who are vulnerable.
When the minister called for this review in response to a series of articles in the Age in 2007 she kept the review very narrow: she did a review of the legislation and the regulations. I have to say that at that point I immediately called for the minister to make it a comprehensive review, understanding the breadth and range of issues that were in place.
Unfortunately it has been a limited review. We have taken three years; there has been broad consultation; there have been many people involved and it has taken an inordinate amount of time, but it has remained a review of the legislation and regulations rather than addressing some of the broader issues. I will come back to that later.
I think it is short-sighted that these bigger issues have not been tackled. The issues include such things as the viability of the SRS (supported residential service) sector, the appropriateness of the resident mix, and also the services that residents are receiving.
That said, what are SRSs? They are private accommodation that provides personal or special care. This assistance can involve showering, personal hygiene, toileting, dressing, meals and medication as well as physical and emotional support.
The sector is divided into two types of SRS -- pension level, which is defined by the government and where 80 per cent or more of the beds are charged at pension-level rates; and above-pension level, where the fees for accommodation can be significantly higher. Currently there are 178 SRSs with approximately 6000 residents right across the state. It is a model that is quite unique to Victoria.
In pension-level services the residents are predominantly male. They are younger than the SRS sector as a whole: 55 per cent of them are under the age of 60; 96 per cent of residents have a disability, with 62 per cent of residents having a psychiatric disability and 98 per cent of residents are considered permanent residents. This is very much a home environment for the residents, particularly in the pension-level services.
This census was held two years ago in 2008. It showed a picture of services that were initially set up for the frail aged becoming a place where predominantly younger men with disabilities, particularly mental health issues, are now residing.
In its review of supported accommodation the Family and Community Development Committee also spent a fair bit of time looking at SRSs because of the interlinking of these types of accommodation -- supported accommodation for people with a mental illness and people with a disability and the SRS sector. There are a number of different issues that were raised through our multi-year review. I would like to touch on some of those points and concerns about the sector as a whole.
Looking at a bigger picture, the Health and Community Services Union said that continuing problems with SRSs over time demonstrate that this is not a service model that warrants endorsement. There were fundamental concerns about the long-term viability of this model. Some of those concerns included: the types of supports that are able to be provided, the fact that the SRS proprietors often do not have the expertise to meet the support needs of residents and the high resident-to-staff ratios. Another issue raised by the Office of the Public Advocate was the importance of the capacity of staff to intervene effectively when residents display behaviours of concern. The Office of the Public Advocate believes that staff in pension-level SRSs are not equipped to manage these behaviours.
The census also showed that nearly half of all residents have behavioural issues of concern, so that is a dominant issue.
As I said, the committee also found that many individuals living in pension-level SRSs have a mental illness but the staff do not have psychiatric training to meet these individual needs, and people are being discharged from acute services straight to these very underresourced and unsophisticated support services.
I would like to quote Colleen Pearce, the public advocate, in relation to this issue. In an article she wrote for the Age of 25 September 2009 she said:
The revolving door syndrome under which people are discharged from mental health units to these homes and then cycle back to hospital is not only cruel but also inefficient. The cost of lives barely lived because people cannot get the help they need is a scourge on us all.
Those are very concerning words from the public advocate.
The evidence given to the committee showed that the needs of people with complex and challenging behaviours are not being met by these pension-level SRSs.
Another major issue was the affordability of accommodation. The cost of SRSs often rules out the ability for social inclusion for people with a disability or mental illness. The census showed that nearly half of all residents do not participate in any social activities outside the SRS and over 50 per cent of the residents either never had a visitor or had a visitor less than once a month. These are very isolated individuals. The cost of accommodation in an SRS often takes the vast majority of people's pensions, leaving them with very little with which to do additional activities.
Another big issue we found through doing the committee report was safety. Carers Victoria highlighted through the review concerns with the mix of residents, the gender of residents and residents with challenging behaviours.
The organisation particularly highlighted some issues in relation to sexual assault and that the result of a diverse population living in SRSs is very concerning on the safety front. The Office of the Public Advocate also reported some situations it had observed where women had exchanged sexual favours for what they perceived as basic necessities, such as cigarettes and money.
Another issue that was raised is the lack of rights, particularly tenancy rights in SRSs, and also the lack of privacy. This ties in very closely to the issue of residents not feeling safe. The Mental Illness Fellowship of Victoria argued that the lack of access to privacy has a considerable psychological impact on individuals who are already psychologically vulnerable.
The compatibility of residents is another area of concern, and frequently the gender of individuals, the ages of the residents and the different types of disabilities that people have affect the dynamic in a residential setting, sometimes with particularly catastrophic results.
The regulation of SRSs is another area that is quite challenging. The evidence suggests that there is a high variability in the operator standards and that inadequate facilities often continue to operate, sometimes without appropriate follow-up from the department.
This brings us to a broader question of the viability of the SRS sector as a whole. There have been some financial supports in relation to keeping the sector afloat, but these are coming to an end. The Supporting Accommodation for Vulnerable Victorians Initiative is completing its funding, and there are some genuine questions on the financial front. SRS proprietors told the Family and Community Development Committee that the regulatory requirements are extremely onerous for proprietors and that the quality standards set by Department of Human Services are too high and unachievable due to the work involved in running the service. Proprietors suggest that many of the residents come to them because there are no other forms of accommodation. Due to this shortage, proprietors believe that the government should be further supporting the facilities to make sure these people have at least somewhere to go.
There are a lot of concerns about the SRS sector, what its future is and what can be done to make sure it is viable in the future. This gives some context to the bill, because the bill does address a number of these issues, although there are a number that are not addressed.
Overall the rights of the individual to a safe and secure place to live and the rights of other residents in terms of their home environment need to be balanced with the ability of the proprietors to be able to run their private business. This is a very hard balance to try to achieve.
It is a very positive position that this is a stand-alone bill which simplifies a lot of the complexities that were there when the provisions were included in the Health Services Act. There are a number of reforms. There is the strengthening of occupancy rights for greater protection of residents; statutory notice periods; circumstances under which a notice or intention to vacate can be issued, and this ranges from immediate, where there is serious risk, through to 60 days; and also statutory requirements for residents in terms of giving notice to the proprietor.
The bill also provides for the right of review of decisions to VCAT (Victorian Civil and Administrative Tribunal). Another key theme of reform is the strengthening of financial protections. The bill provides for the statutory amounts that can be charged for security deposits and up-front payments and the repayment of that money. These financial issues were areas of great concern. The bill provides for the establishment of trust accounts to hold certain fees and safeguards for how those are managed, and once again it allows for any concerns in relation to payments to be taken to VCAT.
The bill enables additional staffing requirements to be met and provides for a mandatory police check for all new staff but not for existing staff.
The bill requires the secretary to assess new day-to-day managers, and there will be a lot of responsibility contained in the regulations in relation to issues such as the requirement to employ people who have first-aid training, minimum requirements for qualified staff, and requirements for such staff to be on site on the weekends for up to 71/2 hours each day and ongoing training for personal care coordinators. There are additional enforcement mechanisms contained in the bill which will improve compliance. Proprietors and the Department of Health can now enter undertakings to fix less serious issues, but compliance notices will be issued where serious breaches occur, and there are appropriate penalties to sit alongside them.
The bill allows for the idea of cumulative non-compliance to be taken into account in the consideration of whether or not an administrator should be appointed. It strengthens incident reporting requirements, requiring the mandatory reporting of serious incidents and the keeping of central records.
The bill amends the Crimes Act to make it an offence also for a person working in an SRS to engage in sexual activities with residents who have cognitive impairment. That will give some of the residents some protections and increase their safety.
The bill requires that a list of compliance notices must be publicly available and be able to be inspected. It also shifts to outcome-based standards, which creates a framework for residents that focuses on the outcomes that need to be achieved so that they can reflect individual needs rather than just having a standard process for everyone. Once again there is a lot of detail to come in the regulations in relation to these outcomes-based standards.
Finally, the bill streamlines administrative processes, reducing some of the red tape while not compromising, or trying not to compromise, residents' safety.
It removes the annual registration renewal and associated fees, which will be an important cost saving for proprietors. The bill also continues the important work of the community visitors.
There is a lot in the bill that will lead to improvements in the way that the SRSs are run and the experience of the residents in that form of accommodation. On that basis the coalition will be supporting the bill, and it is very pleased to be able to do that. But coalition members believe that a number of issues have been left out. Members will not be surprised that I will spend a bit of timetalking about what we think those issues are.
When you look at the history of the SRS bills -- and I have had the pleasure of reading back through the debates on SRS bills over the past 10 years -- you note that the bills continually look to improve the compliance regime, to increase the information available to residents and to increase the staff capacity. A lot of the similar issues we are seeing here are the issues we have seen time and again in similar legislation.
The numbers I have available to me show that in 2003 there were 216 SRSs; now, in 2010, there are 178. There has been a loss of 38 SRSs, which is nearly 20 per cent of them. At the same time we had 7200 residents back in 2003; we have 6000 residents now, so there has been a loss of 1200 residents. There has been a significant reduction in the number of SRSs and therefore in the number of beds that are available to residents. There have clearly been some massive pressures on the industry over time. This is why we believe the sector's sustainability should have been considered more broadly than just in the legislative and regulatory context.
I would like to quote from a Department of Human Services document dated June 2006, which states:
The pension-level SRS sector has been in decline for the last decade, resulting in a significant loss of available beds. Low viability, linked to limited fee revenue and an increasingly complex resident group, has been an important factor in this decline.
There is a very clear understanding of the complexity and the pressure in the sector, but none of these issues was actually incorporated in the review process.
One area that I want to focus on, which I believe needs improving, is the complaints mechanism. Currently there is an avenue to complain to the secretary in relation to the exercise of the power of the authorised officer and a mechanism to complain to the proprietor if there is some issue about the premises. But what we do not have is an independent complaints mechanism.
I have to say the complaints mechanism across the board in terms of accessing the supports and services that DHS provides is quite complex and is an area that residents have quite a bit of difficulty understanding. One of the limitations of this bill is that it does not create an independent complaints mechanism.
When the disability services commissioner made a submission to the SRS review he was very clear, and I quote from his submission:
The creation of an independent complaints arrangement and associated education strategies for both staff and residents of SRS would be an important step forward in protecting the rights of SRS residents. This will enable the residents of SRS to enjoy the same rights as people living in other forms of supported accommodation in both the aged and disability services sectors where access to independent complaint mechanisms is now standard.
We have not seen that in the bill, and I think that leaves a real gap. When you look at section 109 of the Disability Act you see that in fact any matter relating to the provision of services is able to be referred to the disability services commissioner. Here we are going back to the department, which already regulates, which already funds and which also has the complaints mechanism, which is not an approach that provides confidence for the individual consumer.
Another area of concern is the relationship between acute mental health facilities, disability service providers and the way people are discharged from care in those areas into the SRSs. The referrals are often not comprehensive, so residents arrive without the proprietors and their staff knowing about what sort of care and support they need. I think strengthening that process will protect vulnerable residents significantly. What we find also within SRSs is that other community programs are not generally accessible to many of the residents.
Another area of concern is resident safety. I have mentioned the issue of privacy and the mix of residents. Unfortunately some of those issues are not addressed by this bill. There are some mechanisms to improve the situation on the safety front, but certainly in relation to privacy something as simple as putting locks on doors could make a substantial difference.
Staffing is an area that has been addressed partially. It is a very concerning area, and it is a hard area because of the cost associated with it. But I have some concerns, and certainly some concerns have been raised with me by residents in the sector about where staffing has ended up. The SRS census showed that 14 per cent of pension-level SRSs only have between one and five staff, and 18 per cent of personal care workers are without qualifications.
The public advocate has said in her submission to the SRS review:
There is a strong case for raising the level of minimum qualifications of the personal care coordinator to at least a certificate IV.
Currently personal care coordinators only require a certificate III qualification. She also said:
... community visitors have also observed that minimum staffing ratios are inadequate given the complex needs of the residents ... Similarly, the requirement that one staff member be available overnight is not appropriate in the context of residents who often have high and complex health-care needs that require attendance.
I know there are a lot of staffing matters to be resolved in the regulations, but there needs to be more thorough consideration given to having staffing levels that match the needs of the residents who are there and the increasingly complex needs they have, but at the same time making sure that the sector and the proprietors are able to continue to operate. It is certainly not an easy process.
Finally, the Office of the Public Advocate has also raised the issue of the amount of payment, as I mentioned earlier, and has recommended that a maximum of 75 per cent of the pension should be allowed to be paid in relation to SRS fees. Currently we hear stories of up to 90 to 95 per cent of the pension being taken, leaving people with very little disposable income.
There are a lot of concerns. Many of the issues I have raised were outlined in the preliminary themes from the public forums held in July and August 2008.
The department's own document reflecting the early themes highlighted a number of these -- the staffing issues, the safety issues, fabric issues in relation to the facilities and the relationship between the SRSs and the broader sector -- but unfortunately we have not seen them reflected in the bill. Hopefully there will be some opportunities in the regulations to do that more broadly.
This bill started as a response to a series of articles in the Age. When you look back at the media stories over the last three years you see that unfortunately a lot of the complexities of those stories will not be resolved by the bill we are debating today. There are some more fundamental issues about the future and viability of the SRS sector, and we believe those issues need to be assessed, debated and thought about very thoroughly.
As I have said previously, supporting accommodation for vulnerable Victorians initiative funding is now at the end of its cycle, and certainly the proprietors are saying they need additional support to be able to continue to run these absolutely critical services, because for the residents often there are no other places to go.
I believe that a number of the big issues have been avoided in this process. The review has been narrow. It was meant to take 18 months; it took three years. I also have to say, having made a number of FOI requests to try to understand the closures of SRSs across the state and what is really happening to the sector, what I have had substantially from the department in relation to getting SRS data is obfuscation. In one instance I had to revert to writing to the Ombudsman because the situation was so ridiculous in terms of them not providing the information requested.
I think it is a challenge for the Minister for Community Services, who has been a community visitor and who understands these issues, who has seen them, to be able to bring the broader issues in the many aspects of her portfolio, including disability services and mental health, to the forefront through debating them. I was very concerned to read a media article that said that since she has been minister she has not actually visited an SRS. Given they are such an important part of the accommodation system, if that is true, it is certainly very concerning. It is very important that the minister understands the reality of how dramatic these situations can be.
We believe these changes will improve things in SRSs, and we are happy to support this bill and the amendments it will bring about to the operation of SRSs, but there are a number of things that have been missed. Three years of consultation and engagement with the sector broadly has failed to grapple with these bigger issues that should have been considered.
Having observed the cycle of these SRS bills through reading the debates, I note that we tend to see them every three or four years, in between which a significant review is done. I suspect we will be back in the same cycle again shortly, because the pressure on the accommodation system will be so significant that we will have to look at the issues holistically to make sure that the individuals who reside in SRSs are getting the accommodation and support they need.
The Victorian Council of Social Service submission to the SRS review also talked about these broader issues. I quote from the submission:
Several factors have exacerbated the use of pension-level SRS as an accommodation option in Victoria in recent years: the lack of investment in public housing, the decrease in rooming house accommodation, a shift away from residential psychiatric accommodation and insufficient investment in supported accommodation options for people with disability.
This submission encapsulated these broader pressures on the system which all end up focusing on SRSs, which I have described in the past as the melting pots, the end of the line for health services for individuals when there is nowhere else to go. We must have accommodation for people who are vulnerable, and unfortunately we repeatedly see failures on this front. Through the Family and Community Development Committee review and personally I have met many individuals and families for whom accommodation is the no. 1 issue.
They are at their wits' end trying to work out either how they will access appropriate accommodation or how they manage for their child, often their adult child, who is in accommodation where they are not safe, where they are not settled, where the are not helped in terms of their treatment and recovery, and where they are not able to see a positive future.
I believe the government is due to respond in the middle of July to the more than 100 recommendations from the Family and Community Development Committee. There were a number of recommendations on SRSs, including a comprehensive review and some of these broader issues I have discussed today that have not been touched in this bill. I certainly hope the government will support a comprehensive look at the accommodation issues now that this narrow review is out of the way.
We do support these improvements.
We believe they will make a positive difference for residents in SRSs. We hope the system is viable for the future, but we believe there are broader issues that need to be debated, that need to be assessed, that need to be thought about strategically, because I think both sides of the house want the same objective, which is that people who are vulnerable and disadvantaged and who do not have other alternatives, who need care and support and accommodation, can find that care and support and accommodation where they need it. With that, I recommend the bill to the house, and I wish it a speedy passage.
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