Conclusion and Recommendations
Throughout the inquiry, the committee has been presented with evidence—including
many personal accounts—that details why residential care is inappropriate for
young people aged under 65 years. The committee notes that this is not a new
issue. In 2005, this committee conducted an inquiry into Quality and equity
in aged care which highlighted the inappropriateness of young people living
in residential aged care facilities (RACF). The Quality and equity in aged
care inquiry recommended that all jurisdictions work together to ensure
that no further admissions occurred and that young people currently in RACF be
The Younger People with Disability in Residential Care (YPIRAC) program
was established as a result of this recommendation, and operated from 2006
until 2011 with the program ceasing due to the discontinuation of the state's
funding contribution. The Commonwealth continues to contribute the funding
allocated for YPIRAC to the states, although this funding is not tied to any
particular program. The YPIRAC initiative was effective as a 'first step' by reducing
the numbers of under 50 year olds living in RACF, whilst the 50–64 year old
cohort—who make up nearly 90 per cent of young people living in RACF—has
increased. Ten years on from the Quality and equity in aged care
inquiry, the total number of young people living in RACF remains largely
The committee notes that this current inquiry has been conducted during
a transition period as the National Disability Insurance Scheme (NDIS) is
phased in. This period of transition is characterised by profound changes to
the way disability services are administered and delivered by the states and the
Commonwealth. The committee recognises the importance of transitioning disability
funding and services towards a person-centred model; however, notes that there
is a lack of clarity around the delivery of certain services using this model.
For example, it is unclear how capital is to be provided to build the 'bricks
and mortar' of specialised disability accommodation. It is the committee's view
that young people living in residential care have waited too long and cannot
continue to wait for policy development to improve their lives during this
This inquiry has established the importance of providing co-ordinated
services to this cohort and highlighted the role of integrated services that
take into account an individual's needs at different stages of their recovery
or disability. It is critical that these support services are provided for
individuals whether they live in hospital, in the community or in aged care.
Transition into appropriate accommodation is predicated on the 'need for people
with disabilities to be provided with specialised assistive therapeutic and
rehabilitation services and technology'.
It is also predicated on the availability of suitable accommodation options. Collaboration
between the state, territories and the Australian Government is critical in
meeting the needs of this group of young Australians. It is the committee view
that there is a need for both a co‑ordinated national approach and
proactive action by the states and territories.
This chapter draws together a number of recommendations that are
directed at three key groups—the Australian Government, the Joint Standing
Committee on the National Disability Insurance Scheme and the Council of
Recommendations to the Australian Government
The lack of up to date and detailed statistical data available on young
people living in RACF has been noted throughout the inquiry. Where this data
does exist, it is not always readily available to those that require access
including many individuals, service providers and government agencies. The
committee has noted the lack of available information on unmet need. This
information is required not only in the short term, but also in the longer term
to allow governments at all levels to plan for the expected increased demand
for disability support services and accommodation in the future.
The committee recommends that the Australian Government compile a
database of all young people under the age of 65 years living in residential
aged care facilities using the data held by the Aged Care Assessment Team
(ACAT) program. This list should be provided in a regularly updated form to the
National Disability Insurance Agency (NDIA) and to state and territory
governments. This data should include the following information:
age and age of entry to aged care;
length of time spent in the aged care system; and
the factors that need to be addressed for the person to move out
of the aged care facility.
The committee recommends that the Australian Bureau of Statistics (ABS)
conduct a Longitudinal Survey of Disability, Ageing and Carers in addition to
its triennial survey of Disability, Ageing and Carers.
The committee makes the following recommendation to establish a standardised
national approach to the assessment and placement of young people. The
establishment of a comprehensive assessment and placement tool utilised within
the health and disability sectors is a first step in ensuring that a young
person's needs are clearly identified and understood by young people, their
families, and state and Commonwealth Governments.
The committee recommends that the Australian Government develop and
implement a comprehensive assessment and placement tool or residential
assessment instrument to assess the care and accommodation needs for all young
people living in or at risk of entering residential care.
In addition to the establishment of the comprehensive assessment and
placement tool, the committee recognises the need for effective safeguards to
ensure the effective diversion from, and exit of young people from RACF. The
committee also recognises the need to ensure that those living in RACF are
provided with supports to choose the most appropriate accommodation option.
The committee recommends that supplementary assessment guidelines and
tools are developed for the ACAT program to ensure that all young people being
considered for an aged care placement are properly assessed. As part of this
process, the committee recommends that:
all young people placed in aged care are intensively case
all ACAT placements for those aged under 65 are reviewed on an
The committee recommends that the accreditation standards for
residential aged care are amended to include standards relating to the clinical
outcomes and lifestyle needs of young people. In order to assist with meeting
these new accreditation standards, the committee recommends that the Australian
provide a supplementary payment to residential aged care
facilities to ensure that these accreditation standards can be met; and
invest in disability specific training for all staff involved in
the care of young people living in aged care. This training should focus on
building improved awareness of the needs of young people and those living with
disability in order to provide better support. It should also lead to improved
connectivity between the aged care sector and other service sectors including
allied health and disability services.
This inquiry has received evidence highlighting the undersupply of
specialised disability accommodation (SDA). This undersupply of SDA is noted as
the primary reason that the YPIRAC initiative was not as successful as it could
have been. The committee notes that young people cannot be diverted or exited
from residential facilities if there is nowhere for them to go.
The role of the NDIS, the Commonwealth and the states in the provision
of funding for SDA is unclear with the committee receiving contradictory
evidence from the Commonwealth on this matter. This confusion and uncertainty extends
to individuals, their families and service providers. There have been a range
of innovative housing solutions presented to the committee; however, without
clarity around the funding mechanisms, it is uncertain how or if they will ever
The committee acknowledges that the Commonwealth and the states are currently
seeking to broker a series of bi-lateral agreements and provide certainty
around this issue in the near future. However, it is the committee's view that
a source of capital for SDA should be made available as an interim measure to
ensure that the supply of SDA is increased during this time.
The committee recommends that the Department of Social Services' current
discussion paper on disability housing consider capital funding options for
construction of specialised disability accommodation.
The committee recommends that the discussion paper is released as a
matter of urgency.
The committee recommends that the Australian Government establish a
supported disability accommodation fund similar to the Supported Accommodation
Recommendations to the Joint Standing Committee on the National Disability Insurance
The issue of specialised disability housing is critical to the success
of the NDIS. The committee makes the following recommendation to ensure a focus
remains on this issue.
The committee recommends that the Joint Standing Committee on the
National Disability Insurance Scheme (NDIS) conduct an inquiry into the issue
of disability housing after the release of the discussion paper on disability
Recommendations to the Council of Australian Governments (COAG)
The committee notes the importance of the provision of rehabilitation health
services including speech pathology, physiotherapy and occupational therapy in
promoting recovery and independence in young people with severe disability.
There is a need for a coherent national plan to deliver rehabilitation programs
including slow stream rehabilitation.
The committee recommends that the COAG develop and implement a national
rehabilitation strategy including a framework for the delivery of slow stream
rehabilitation in all jurisdictions.
Young people with complex needs require access to a range of specialist
disability and mainstream services. The committee has received significant
evidence demonstrating that many of these departments and agencies work as
'silos', and fail to provide adequate and appropriate services resulting in
young people falling between the cracks. As a result of this, many of these
young people have and will continue to be moved into residential care. It is
the committee's view that this is unacceptable.
Cross sector co-ordination where 'coordinators actively negotiat[e]
between sectors and services to ensure people obtain the necessary supports' is
the only way in which young people can be assured of being provided with
adequate health, rehabilitation and housing supports.
This inquiry has also highlighted the need for advocates to assist young
people with information and decision-making throughout their journey. The
committee has heard evidence noting the lack of information available when a
diagnosis is made with young people often being forced to make uninformed
decisions that often lead to them living in a RACF. Advocates can help guide
and inform a young person—and agencies—on the range of support and
accommodation options to enable a young person to make the best decision for
their transition and placement. Advocates can also assist with complaints
resolution and 'speaking out' and act on behalf of a young person.
The committee notes that the YPIRAC initiative sought to achieve three
objectives—to exit those living in RACF, to divert those young people at risk
of entering RACF, and to enhance the delivery of specialist services for those
choosing to remain in RACF. The committee also notes that the states no longer
have dedicated funding for this initiative, whilst the Commonwealth has
continued to contribute its share. It is the committee's view that this
funding—approximately $25 million per year—should be used to partially fund the
three recommendations below which seek to achieve the same objectives as the
YPIRAC initiative. The committee recognises that jurisdictional responsibility
is split based around locations of the NDIS trial sites. The Commonwealth has
jurisdiction in the NDIS trial sites whereas state and territory governments
retain jurisdiction for the rest of their respective states and territories
until the NDIS is fully phased in.
The committee recommends that the NDIS, in all NDIS trial sites, and the
relevant state or territory government in all other areas:
assign an advocate to all young people living in residential care
to provide information to a young person and their families about their
options. If appropriate, the advocate can act on behalf of the young person;
assign an advocate to all young people at risk of entering
residential care to provide information to a young person and their families
about their options. If appropriate, the advocate can act on behalf of the
young person. The advocate should be made available as early as possible after
diagnosis of an illness or disability and be assigned before any placement
extend the National Younger Onset Dementia Key Worker Program
(YODKWP) to all young people identified as being at risk of placement in residential
care to provide collaborative case management.
The key worker should be assigned before any placement commences; and
these programs should be proactively extended to young people
living in residential care facilities under the age of 65 years by June 2017.
Consideration of the mental health status of young people should be prioritised
with appropriate support provided where necessary.
The committee recommends the following for those with Foetal Alcohol
Spectrum Disorder (FASD).
The committee recommends that the NDIS, in all NDIS trial sites, should
consider how it supports those with Foetal Alcohol Spectrum Disorder (FASD).
The committee also recommends that the NDIS, in all NDIS trial sites,
and the relevant state or territory government in all other areas work closely
with community health services to provide the following for those with FASD
agreement on a standardised diagnostic tool; and
provision of early intervention services and other health
services such as speech pathology, physiotherapy and occupational therapy.
The committee recommends that the COAG establish a joint taskforce for
young people living in residential care. This taskforce will:
facilitate the development and implementation of integrated
service pathways involving a range of portfolios at a state and federal level
including housing, health, aged care, disability, and transport; and
facilitate the collation and development of information packs outlining
support, transition and placement options for young people. These packs should
be made available to young people, their families, health practitioners and
other relevant professionals in hospitals and aged care facilities. This
process should collate all information and tools developed by the states during
the Younger People with Disability in Residential Aged Care (YPIRAC) program and
lead to the development of a standardised national information pack and make
available to all state and territory governments for deployment.
The joint taskforce will also be responsible for oversight of the
following for young people living in a Residential Aged Care Facility (RACF):
access to appropriate prescribed specialist services including
speech pathology, physiotherapy, occupational therapy and other allied health
the national rehabilitation strategy;
the provision of advocates;
the expanded key worker program;
access to fully funded equipment as part of all state and
territory Aids and Equipment schemes;
a cross sector approach is adopted to explore options for the
provision of short term respite services; and
that all young people who indicate that they do not wish to live
in residential care are transitioned into appropriate alternate accommodation
by June 2018.
The committee recommends that the joint taskforce issues a half yearly
report on the progress of Recommendation 11 to the COAG.
Senator Rachel Siewert
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