A safe home for people with disability: the contrasting and complementary roles of the NDIS Quality and Safeguards Commission and Community Visitor schemes
In today’s post, moderator Dr Rae West @raelene_west discusses the balance between the roles of the NDIS Quality and Safeguards Commission and Community Visitor schemes in deterring and preventing harm to people with disability utilising funded support services in accommodation settings and homes.
Keeping people with a disability safe in their homes is one of the fundamental responsibilities of the disability services sector. There is a large emphasis in disability policy on building an individual’s capacity, on peer-to-peer support and on people with a disability utilising advocacy organisations to ensure their safety and wellbeing in their living environments and accommodations. Developing circles of support (informal networks of assistance) and local social networks can be key mechanisms in ensuring safety and wellbeing.
In developing the NDIS, Walker et al (2013:4) highlighted that protecting participants that are vulnerable must be a primary consideration in developing service frameworks, and then intuitively questioned ‘and vulnerable to what?’.
In a 2022 research report we noted:
NDIS participants are typically spoken about and cast as a ‘vulnerable’ population in need of protection and lacking agency in decisions about plans. This may be the case in some instances for some NDIS participants, and safeguards should certainly be put in place to avoid the exploitation of this cohort of participants. However, many NDIS participants are empowered, run their own lives, have relationships, work, are university educated and are quite capable of undertaking decision-making around the quality, risk and safety of services they purchase. As such, the design of the entire scheme needs to be flexible enough to incorporate the needs of both of these groups to allow participants to effectively achieve goals and live meaningful lives (Dickinson, Yates, West 2022:8).
This certainly applies to safety frameworks for disability services. Any framework needs to be flexible enough to incorporate the needs of both of these groups. Some, but not all people with disability, are more vulnerable than other people with disability.
For those people with disability who may have increased vulnerabilities, such as people with a disability solely dependent on services for supports, live-in group accommodation settings, people with limited communication capacity and people with behavioural challenges, all where paid support staff are coming into their homes and residencies, safeguards are needed. There are needs for assurances that paid support staff entering their homes are of known good character, and that service providers are providing quality services that meet the human rights of persons with a disability and that these services are delivered within clean, well maintained and appropriate accommodation settings. Cadwallader et al (2018) highlight that violence and abuse against people with disabilities is often reframed as service failure. Balancing the prevention of any mistreatment, violence or abuse of people with disability in utilising support services with preserving their freedom, is paramount.
Within Australia, two formal and separate entities are used to ensure the safety of people with disability utilising funded support services in accommodation settings and homes. They are firstly the recently (2017) established national NDIS Quality and Safeguards Commission (QSC) and secondly, state-based Community Visitor programmes which operate across most states/territories in Australia (excepting WA and Tas) [see for example https://www.publicadvocate.vic.gov.au/your-rights/in-your-home/community-visitors]
The NDIS Quality and Safeguards Commission (QSC) operates as a separate entity from the National Disability Insurance Agency (NDIA) and the National Disability Insurance scheme (NDIS). The key aim of the QSC is to prevent all forms of neglect, abuse, financial or sexual exploitation, harsh or rough treatment, depriving a person of food, sleep or basic needs, bullying, or intimidation and/or vengeful behaviour. It has only been fully operational at a national level since December 2020 (NDIS Quality and Safeguards Commission 2023 a).
The QSC seeks to achieve these aims by in the main, working through registered-only service providers. To ensure these service providers are meeting compliance standards and guidelines related to how they deliver services, the QSC undertakes auditing processes reviewing governance frameworks and policies and procedures of service providers to investigate if service providers are delivering services to the defined standard and quality. This should include investigating if the service users are happy and satisfied with the quality of services that they receive, and that the workforce are satisfied in their work role and with working conditions and that the workforce has undertaken the required amount of professional development and training. The QSC also can also receive a complaint about any NDIS funded service, not just registered service providers, and undertake an investigation with this service provider based on this complaint. The auditing process is preventative in style in seeking to prevent violence and abuse and neglect, whereas the complaints process is more of a responsive model in needing to respond through investigation into allegations of violence and abuse and neglect that have may have already occurred (NDIS Quality and Safeguards Commission 2023 b c d).
Service providers who choose to undertake the registration process with the QSC are designated a ‘registered provider’ in the market with the implied status that the provider is providing services to a higher standard and with better quality due the oversight and compliance processes by the QSC In terms of QSC framework, people with disability are looking for assurances that they will be safe when utilising support services and that they will receive quality services if using a service provider registered with the QSC. However research conducted by Dickinson, Yates and West (2022) has found that a number of current NDIS participants have had negative experiences and have received poor quality of support services from registered service providers despite these providers meeting compliance standards. It should be noted that a number of high profile abuse cases have occurred within registered service providers such as the tragic abuse and death of Ann Marie Smith by a support worker in 2020.
In contrast to the QSC, the Community Visitor schemes operating across States and Territories in Australia (excluding WA and Tas) are very much focused on a preventative safeguarding model. Community Visitors undertake outreach advocacy to people the disability, in that they physically visit the site of a person with disability’s accommodation and/or living environments. The onsite visits (usually 3 to 4 visits per year on average) seek to review if residents are safe, if the accommodation is clean and kept to a good standard, assess if the food is fresh and if the setting is well-maintained. Community Visitors, who may be unpaid volunteers or paid public servants, speak with individuals about their felt safety or if there are any issues they wish to raise (such as with how services are being delivered or say with another resident). They may review client files and paperwork to ensure funding is being correctly spent on the clients such as with community outings and/or in supporting NDIS participants in their achievement of defined goals.
Community visitors often refer to themselves as ‘the eyes and the ears’ of the public advocate in seeking to ensure the human rights of people to disability are upheld. The community visitors resolve most issues at a localised level with discussion and negotiation with the service providers themselves. They helps service providers to become aware of standards that they need to adhere to, what good practice is and reflect on any gaps in the service delivery where improvement is needed. In most cases, the service providers listen to the advice and responds well improving their service delivery and the issue is resolved. However, Community Visitors also have the statutory power to refer serious incidences to QSC for further investigation or to their principal Public Advocate/Guardian of their state in relation to state-based issues such as housing and justice services related to service provision.
Historically, Community Visitors were advocates, independent of government, who could observe the quality of care and safeguard the rights of people with disability who resided in state-based residential facilities such as institutions or group homes only. Privatisation of disability accommodation and services alongside of development of the NDIS, however, has created major structural changes in how Community Visitor schemes can operate. The capacity of the Community Visitor schemes to undertake enough visits has also been affected. Representatives from some of the schemes say they are underfunded and only able to achieve approximately 60% of the visits they are legislated to attend because of the increasing scale and size of the NDIS participant numbers (personal correspondence with author). There is also a particular issue in negotiating with private service providers and seeking to ensure human rights in a privatised, corporate environment rather than state based residential facilities who are obligated to respond to issues. This has extended to service providers gatekeeping out community visitors or not responding at all when issues are raised about service provision, and issues with what constitutes legislated visitable sites for Community Visitors with the large variety and number of independent living types of accommodation now available under the privatised service landscape of the NDIS.
The Disability Royal Commission has highlighted countless numbers of abuse neglect violence and exploitation in accommodation and home settings. All consequences of harm for people with disability are severe. Abuse of people with disability is often cumulative, occurring in many different forms over many years. In seeking to move forward and ensure the safety of our most vulnerable people with a disability receiving services, it is crucial that safety frameworks can be counted on. People with disability want a balance between their own ‘choice and control’ and compliance and oversight that genuinely provides solid and robust safeguards and protections from abuse, and that effectively demonstrates strategies and mechanisms to deter and prevent harm.
No service framework can be risk free. There is risk that people with disability could receive poor quality supports that do not help them achieve their goals, and risk that people with disability could be harmed in some way. Our safety frameworks, and the service providers and workforce working within them, must target not just those areas where the dangers are greatest and where abuse has ‘traditionally’ occurred such as in group homes, but must work hard and remain open to discussion, oversight and transparency about the ways people with disability receive services. Further, it is vital that schemes such as the Community Visitor schemes, which play such a vital on-the-ground safeguarding role, are adequately funded so that they can undertake their role within the increasingly complex landscape of the NDIS. Both top-down and bottom-up approaches are required in keeping people with disability safe and for people with a disability themselves to have confidence in our disability service safety frameworks.
References:
Cadwallader, Jessica Robyn; Spivakovsky, Claire; Steele, Linda; Wadiwel, Dinesh --- "Institutional Violence against People with Disability: Recent Legal and Political Developments" [2018] CICrimJust 5; (2018) 29(3) Current Issues in Criminal Justice 259
Dickinson, H., Yates, S., & West, R. (2022) Exercising meaningful choice and control in the NDIS: Why participants use unregistered providers. Canberra: University of New South Wales, Canberra
NDIS Quality and Safeguards Commission (2023a) Understanding the different types of providers retrieved from https://www.ndiscommission.gov.au/providers/registered-ndis-providers Mar 2023
NDIS Quality and Safeguards Commission (2023b) The NDIS Code of Conduct Retrieved from https://www.ndiscommission.gov.au/about/ndis-code-conduct Mar 2023
NDIS Quality and Safeguards Commission (2023c)The NDIS Worker Screening Check, Retrieved from https://www.ndiscommission.gov.au/workers/worker-screening/ndis-worker-screening-check Mar 2023
NDIS Quality and Safeguards Commission (2023d) How to make a complaint Retrieved from https://www.ndiscommission.gov.au/contact-us/makeacomplaint Mar 2023
Walker M; Fulton K; Bonyhady B (2013) A Personalised Approach to Safeguards in the NDIS, Safeguards and Quality Assurance Expert Group, NDIS implementation groups, March 2013: