A Blueprint to Enhance Life and Claim
the Rights of People with Disability in
South Australia (2012-2020)
© Government of South Australia. Published October 2011.
All rights reserved.
Disclaimer
This document has been prepared by the South Australian
Social Inclusion Board. It is not a statement of South
Australian Government policy. No responsibility is
accepted by the Minister or the Department for any errors
or omissions contained within this publication. No liability
will be accepted for loss or damage arising from reliance
upon any information in this publication.
This publication is available from the Social Inclusion
website at www.socialinclusion.sa.gov.au. If you require
part or all of this publication in a different format, please
contact the Social Inclusion Unit.
Further information
Social Inclusion Board
C/- Department of the Premier and Cabinet
GPO Box 2343 ADELAIDE SA 5001
Telephone: +61 8 8226 0916
www.socialinclusion.sa.gov.au
ISBN: 978-0-9804697-6-9
Foreword by the Commissioner
for Social Inclusion and Chair
of the Social Inclusion Board
Monsignor David Cappo AO
Since the Commonwealth
Government signed the United
Nations Convention on the Rights
of People with Disability in 2008, a
profound shift has occurred in our
community. Now that the rights of
people with disability have been
placed firmly on the agenda, the voices
of people with disability are being
heard louder than ever before.
In South Australia, a state with a
proud history of social innovation and
reform, it has become clear that we are
sorely lagging behind the nation when
it comes to supporting people with
disability, as well as families
and carers.
To address this, in December 2009,
the Premier of South Australia, the
Hon Mike Rann MP, asked the Social
Inclusion Board to tackle what would
be its greatest challenge to date;
a wholesale reform for people with
disability, as well as their families and
carers. This announcement heralded
the beginning of what would be
the largest disability community
engagement ever held in this State,
with more than 2000 people telling
us where systems had not worked for
them and where improvements must
1
be made. The Board not only heard of
a service system that responds mostly
to crisis but also of a system where
the power lays, not with citizens, but
within the bureaucracy.
We uncovered a system that is
unsustainable in its approach, both to
the delivery of services and supports
as well as to funding. The result has
been that for far too long, people
with disability have been shut-out
from participating in the social and
economic life of our society.
In order to get things right, it has
become obvious that bold action is
required and this action must be
delivered with great urgency.
This report, titled Strong Voices,
seeks primarily to address the
power imbalance – to move it away
from systems and bureaucracy and
towards people with disability, their
families and carers. It is a plan, not
just for Government, but for the
whole community, to change the way
disability is considered as an issue. It
is now time that Government and the
community sees people with disability
not for what they cannot do, but
for who they are and what they can
achieve as citizens.
To achieve this paradigm shift,
Strong Voices has focussed on six
important areas of reform. They are:
creating accessible and inclusive
communities; preventing people
falling into crisis by developing a
model of early investment; making
sure that everyday services such
as education, employment, and
health work better for people with
disability; providing more choice
through expanding individualised
funding; providing better support
for carers, broadening the range of
accommodation options available
and closing the Strathmont Centre;
and ensuring there are adequate
safeguards in place to protect
vulnerable people.
Strong Voices proposes a redefining
of the roles of Government in the
provision of disability services and
future roles of the not-for-profit sector.
It also proposes strengthening the
important role that the community
plays in delivering support for people
with disability to participate fully in
the community.
Strong Voices recommends South
Australia adopts a range of new
measures, some based on ideas and
innovations from interstate and
overseas, that can be implemented
quickly and deliver direct benefits for
people with disability. Whilst some
of this work will take some years to
fully implement, the Social Inclusion
Board also recommends a range of
measures, which are particularly timecritical, that the Government of South
Australia should consider as priority
actions. Put simply, people with
disability, families and carers can not
afford to wait several years for real and
profound change.
With important developments, such
as plans for a National Disability
Insurance Scheme, South Australia
has an excellent opportunity to take
the lead on supporting people with
disability to be active citizens in our
society. Strong Voices is a ‘Blueprint’
for South Australia to ensure our
reputation as social innovators and
leaders is also applicable in the area
of disability.
I would like to thank everyone who
has assisted the Social Inclusion
Board and Social Inclusion Unit in
putting together this plan. Especially
the people with disability, their
families and carers who have provided
invaluable insight – we have listened.
The important advice provided by
those in the not-for-profit sector as
well as the vast range of disability
organisations and advocacy groups
has been insightful and greatly
beneficial to this work. The assistance
of those within the Government
of South Australia has also been
appreciated by both the Board and
the Unit.
I wish to thank my fellow members of
the Social Inclusion Board and staff of
the Social Inclusion Unit for their work
on this plan.
I also wish to thank the Premier, the
Hon Mike Rann MP and the Minister
for Disability, the Hon Jennifer Rankine
MP for tasking the Social Inclusion
Board with this important work.
On behalf of the Social Inclusion Board,
I submit the report Strong Voices – a
Blueprint to Enhance Life and Claim
the Rights of People with Disability
in South Australia (2012-2020) to the
Government of South Australia for
its consideration.
2
Table of
Contents
01
Foreword by the
Commissioner
for Social Inclusion
05 07
12
13
19
The Board’s
Vision
What the
community said
Recommendations
16
The disability
context
Introduction
How will
we respond?
48
25
37
56
67 77
Chapter 1 Creating Accessible
and Inclusive Communities
Chapter 4
Investing Early
Chapter 2 Providing
Choice, Taking Control
Chapter 5 Diversifying
Housing Choices
83 120
Appendix A People Living with
Disability in South Australia
Appendix B Social Inclusion
Board Membership
Chapter 3 Strengthening
Safeguards and Protections
Chapter 6 Shaping
Accessible and
Inclusive Services
The Board’s Vision
Strong Voices unites us
all in one vision that
requires strong voices,
bold action and careful
thought and perseverance
to build a truly inclusive,
democratic and
better society.
The Board’s Vision
Imagine that when a South Australian
child with disability is born, their
family is told that they are not alone,
that South Australians will invest
in helping their child develop and
flourish. That the family will get all the
support they need. That one day their
child will be encouraged and assisted
to get an education, gain employment,
and supported to fulfil their potential
and to live their version of a positive
adult life.
Imagine that all South Australians
welcome their fellow citizens with
disability into every part of life.
That the streets, buildings, parks,
shops, cinemas and transport are
all accessible and safe. That people
with disability are free to access any
destination they seek. That their
rights are understood, respected
and enforced, and people with
disability live free from abuse or
neglect.
Imagine that when a South Australian
acquires a disability they receive
support to keep their hopes alive
and to remain connected to their
community and those who love them.
That they have their voice heard and
are given real opportunities to live an
ordinary life.
Imagine that the Government
of South Australia offers a full
partnership to people with disability,
their families, carers and advocates,
with open pathways to services and
support providers, all government
agencies, businesses and community
organisations. That is what this
blueprint, Strong Voices does.
It inspires us, with the support
and assistance of Government, to
realise the expectation of all South
Australians to live in safe, peaceful
communities where everyone is
welcome. It assures us that people
no longer need to be desperate and
in crisis before they receive support.
It commits us to seek quality and
innovation in all that we do. It ensures
that opportunities and resources are
placed in the hands of the individuals
and groups who work together,
while building on our cultural and
community strengths. It helps us
build a workforce of people who are
proud to work alongside people with
disability and their families and carers.
Most of all, Strong Voices unites us
all in one vision that requires strong
voices, bold action and careful
thought and perseverance to build
a truly inclusive, democratic and
better society.
6
Recommendations
These reforms aim to
bring people with disability
and their families and
carers to the forefront
in determining how
they live their lives,
pursue aspirations and
contribute to our society.
Recommendations
01
Priority Action The South
Australian Parliament must
enact a new Disability Act to replace the
existing Disability Services Act 1993 to:
> align with the United Nations
Convention on the Rights of Persons
with Disabilities and specify high
level service standards such as
minimising use of restrictive practices
> direct all State Government agencies
and Local Governments to lodge
Access and Inclusion Plans with
the Social Inclusion Board for
public release
> establish an integrated suite of
appeal processes and safeguards
> establish a Community Visitors
Scheme to monitor standards
of disability housing and
accommodation service settings.
02
Priority Action To meet the
immediate challenge of an
under funded system, Government
funding to address unmet need
must be allocated as a matter of
urgency to remove all ‘critical and
evident risk’ clients from the Unmet
Demand Waiting List within one
budget cycle. Recurrent funding must
be maintained at a level sufficient
to deliver immediate and effective
response to people assessed with
immediate need.
03
Priority Action The new
Disability Act must mandate
a role for the Social Inclusion Board,
or a similar body external to the
disability service system, to monitor
the implementation and quality of
disability services reform and service
standards on an ongoing basis. The
Social Inclusion Board or similar body
will report to Parliament. The new
Act will require Access and Inclusion
Plans to be lodged with the Social
Inclusion Board, or a similar body.
The monitoring body will be advised
by a sub-committee of people with
a lived experience of disability. The
Principal Community Visitor, Health
and Community Services Complaints
Commissioner and Equal Opportunity
Commissioner will provide reports to
the monitoring body.
Chapter 1. Creating Accessible and
Inclusive Communities
04
The South Australian
Government must
establish a $500,000 per annum
Local Disability Innovation fund to
support community innovation and
development. The fund will be
indexed to CPI.
05
To improve accessibility
and participation in
community life, the State Government
and Local Government must prioritise
universal access design principles
in planning, design and contracting
for the renewal of existing built
environments and public space.
To support access to services
for people with disability,
their carers and families and assist
organisations plan and provide
better services, all State Government
agencies, local councils, statutory
authorities and State Government
contractors must develop and
implement an annual Access and
Inclusion Plan. Access and Inclusion
Plans will be public documents and
lodged with the Social Inclusion Board
or a similar monitoring body.
06
07
To improve access to
State services the State
Government must establish a
disability link on the sa.gov.au
website, providing access to
information and resources that is
relevant to people with disability,
their families and carers. 8
08
The South Australian
Government must
ensure that Skills for All (2011-2015)
provides opportunities for people
with disability to increase their
participation in VET. It must do
this by setting a student with
disability participation and course
completion target. The number
of VET to Work programs must be
increased (including regional sites) to
translate training into employment
outcomes. This should be pursued in
collaboration with the Commonwealth
Disability Employment Services
program.
09
To increase flexibility and
successful transition from
school to adult life for students with
disability, the Better Pathways and
the ICAN models must be continued.
The Department of Education and
Children’s Services, in partnership
with independent and Catholic
schools, must expand and enhance
school transition plans between
school sites and post-school pathways.
Department of Education and
Children’s Services funding to schools
for students with disability must be
tied to education needs specifically for
students with
disability and not flow into the
global school budget.
Chapter 2. Providing Choice Taking
Control
10
Priority Action The decisions
of the person with disability
must be the authoritative voice in
finalising an assessment and resource
allocation. The State Government
must ensure that the assessment
addresses all relevant life domains
and includes the person’s life plans
and ambitions. The assessment will
be driven by the person’s needs and
aspirations.
11
Priority Action Individualised
funding must be made
available to all new clients of
government disability services and
those on the Unmet Demand List,
from July 2012. This includes housing
support packages. All people receiving
specialist disability services must
have individualised funding by 2017,
in line with the proposed National
Disability Insurance Scheme rollout.
All agencies administering specialist
disability funds must ensure joinedup arrangements are in place, to
streamline processes for people with
disability, their families and carers.
12
Priority Action The
Department of Treasury
and Finance must work with all
relevant Government departments
and not-for-profit organisations to
plan the transition from current
funding arrangements to universal
individualised funding by 2017, to align
with the proposed National Disability
Insurance Scheme. This includes the
associated business planning in the
not-for-profit sector.
9
13
The disability sector is
rich in its diversity and the
Government must find a way to hear
and respond to all voices in the sector.
Adequate funding of all groups must
be provided in order to ensure all
voices are heard.
14
To better support carers,
the Government must:
> increase recurrent investment in
respite in the next budget (2012/13),
to meet respite demand on the
Unmet Demand Waiting List.
> ensure increased access to respite
in regional and rural areas; including
prioritised roll out of individualised
funding in these areas
> provide greater financial weighting
for carers in regional and rural
areas entitled to respite to recognise
increase costs to access services.
15
In recognition of the special
needs of elderly parents
caring for their adult children
with disability, the Government
must develop a ‘future planning’
mechanism with commitments for
assisting these families in their life
long planning.
16
To assist carers with the
cost of caring, the Government
must undertake an evaluation of
the effectiveness of concessions and
subsidies for carers and implement
further initiatives to reduce the
financial pressures on families and
carers of people with disability.
Chapter 3. Strengthening Rights,
Protection, Advocacy and Safeguards
19
Priority Action The Health
and Community Services
Complaints Act 2004 must be
amended to broaden the mandate of
the Health and Community Services
Complaints Commission (HCSCC)
to include all settings where care of
people with disability is provided.
The HCSCC must be resourced to
perform this role and systemic issues
in line with its current role must
be addressed. In implementing
this reformed function, the HCSCC
must commit to an awareness and
education campaign on rights,
obligations and the HCSCC’s role
as a gateway for complaints about
disability care, support, discrimination
and wellbeing. A specific focus of the
campaign will be to eliminate the use
of restrictive practices.
20
17
18
To ensure the quality of
care for people with
disability, a Community Visitors
Scheme must be established under
a new Disability Act. The Scheme
will be managed by a ‘Principal
Community Visitor’ who will monitor
standards of accommodation and
support for people with disability and
their families and carers in disability
accommodation settings. The Principal
Community Visitor will report to the
Public Advocate.
The safety and protection
of people with disability
must be recognised as a priority
across the criminal justice system.
The Government must develop a
comprehensive Disability Justice Plan
in consultation with people with a
lived experience with disability, the
Public Advocate, and the Health and
Community Services Complaints
Commissioner. The plan must ensure:
> adequate resources are committed
to prioritise investigation and timely
prosecution of crimes against people
with disability
> more effort on prosecution of
matters where a person with
disability is an alleged victim
> increased support for vulnerable
witnesses, particularly children.
In recognition of the
vulnerabilities of women
and children, a gender and child
focus must be applied to individual
assessment and life plans, agencies’
Access and Inclusion Plans, and the
education and awareness campaigns
and materials produced by the Equal
Opportunities Commission and the
Health and Community Services
Complaints Commission.
Chapter 4, Investing Early
21
‘Investing early’ principles
must be explicitly adopted
in all relevant South Australian
Government disability policy and
services, including contracted services.
Early investment strategies should be
reported in the proposed Access and
Inclusion Plans.
22
To support the full
implementation of these
recommendations, the Department of
Treasury and Finance must develop a
detailed across-Government 10-Year
disability business case (2012/132022/23) to support the future funding
of disability services in South Australia.
This disability business case must:
> maintain an ongoing recurrent
funding base to meet the crisis
needs of people with disability
and their families
> quarantine future funding growth
for early investment service models
> include funding related to specialist
and mainstream services
> provide for a review of the outcomes
delivered through the Business Case
in 2015/16 to assess the extent that
an increased proportion of funding
can be directed to early investment
models in the period 2016/17-2022/23
> provide for a mechanism for
cross-agency review as national
negotiations progress on the
implementation of the Productivity
Commission’s recommendations.
> provide for workforce development
in the sector aligned with the
National Disability Agreement and
Productivity Commission findings.
23
Priority Action To support
community engagement
and mobilise local resources around
people with disability, the Government
must implement a place-based
‘Local Development Model’. The Local
Development Model will include
a Family Living Initiative and a
Community Living Initiative. Where
local areas have significant culturally
and linguistically diverse communities
or a significant Aboriginal population,
implementation of the model must be
driven by the demographic profile.
24
A special and particular
emphasis on the needs and
strengths of Aboriginal people will be
a driver for the implementation of, and
recruitment to, the place-based Local
Development Model.
10
25
That the South Australian
Government fund and
establish a Family Living Initiative and a
Community Living Initiative. The Family
Living Initiative will provide flexible
support to people with disability
and their families to foster family
wellbeing and plan for their future.
The Community Living Initiative will
provide support and assistance that
builds independence and resilience to
enable people to live in their own home.
Chapter 5. Diversifying
Housing Choices
Priority Action The Strathmont Centre must be closed with all
people transitioned out of the Centre
and into suitable and appropriate
housing by no later than April 2013.
26
27
The Department for Families
and Communities must
expedite the transition of people
residing within Highgate Park into the
community, through implementing
new assessments and life plans.
28
Disability SA must upgrade
all existing social housing
stock for people with disability, to
South Australian Housing Trust
(SAHT) ‘decent housing’ standards and
ensure that maintenance liability is
addressed. Following the upgrades, all
Disability SA social housing stock must
be assigned to the SAHT for transfer
to the community housing sector as
sustainable community housing for
people with disability.
11
29
Priority Action To support
rights and provide increased
choice for people with disability, the
State Government must ensure new
funding arrangements require that
the not-for-profit and community
sector disability housing providers
ensure a clear separation between
their responsibility as housing
providers and the delivery of care
and services.
30
To support the rights of
people with disability,
Residential Agreements must be
provided for all people in disability
housing, including group-home
settings. Residential Agreements must
be negotiated and agreed with each
person and their family and carer.
The resident’s agreement will specify
the rights and responsibilities of the
resident and the housing provider.
31
Priority Action The placement
of people with disability
under the age of 50 in aged residential
facilities is not appropriate for
meeting the needs of those people and
their families. The State Government
must ensure that there will be no
new admissions of people under the
age of 50 and, as a matter of priority,
will continue working to remove all
younger people from aged residential
facilities.
Chapter 6. Shaping Accessible
and Inclusive Services
32
It is not only specialist
service agencies that need
to be highly responsive to the needs
of people with disability, but universal
agencies (such as the Department
of Health and the Department of
Education and Children’s Services)
must also tailor their services.
Universal agencies must report
annually on how they tailor their
services to be responsive to people
with disability in their Access and
Inclusion Plans (see recommendation 6).
33
To promote a greater
awareness of the rights
and needs of people with disability,
the Equal Opportunity Commission
must be funded to implement an
awareness and information campaign
about people’s rights under the Equal
Opportunity Act 1984. The campaign
must promote the importance of
competency in understanding the
needs, rights and expectations of
people with disability. It must also
address cultural competencies
pertaining to Aboriginal people
and culturally and linguistically
diverse people.
34
Priority Action Access to
public transport must be
increased for people with disability.
This includes:
> free public transport for all
people with disability and their carer
> all taxi travel for employment and
training purposes must be fully
subsidised
> wheelchair accessible buses must be
routinely scheduled and be marked
as an accessible service on all
timetable information
> a transport mobile telephone ‘app’
must be created to support access
to timetables and accessible service
updates
> regional transport networks must
meet and accommodate the needs of
people with disability.
Introduction
A Blueprint to
Enhance Life and
Claim the Rights of
People with Disability
in South Australia
(2012-2020)
Introduction
What the community said
In December 2009, the Premier of
South Australia, the Hon Mike Rann
MP asked the Social Inclusion Board to
develop a long-term reform plan
- a Blueprint - for the way people with
disability, their families and carers are
supported in South Australia.
The Board met with, and heard
from, people with disability, their
families, carers, advocates and service
providers from across South Australia.
In total over 2,000 people were
formally involved in the community
engagement process, making it the
largest consultation ever undertaken
by the Board. Without bias or favour,
the Board has considered the full array
of opinions presented.
This document, Strong Voices: a
Blueprint to Enhance Life and Claim
the Rights of People with Disability in
South Australia (2012-2020),
is the Social Inclusion Board’s
response to this request.
The universal theme heard throughout
the community engagement process
was that people with disability
felt undervalued as citizens and
experienced difficulty finding a place
in the wider community.
People spoke with confidence that
they had greater contributions to
make to their own development, their
families and the community. People
across South Australia made it clear
that they did not want more welfare
but rather basic support proportionate
to their need to live a good life.
People want their contribution to
include input into what affects them.
They expect to be consulted, their voice
heard and respected.
13
People with disability often spoke
about being confronted with
exclusion through stigma and
discrimination. For people from
cultural and linguistically diverse
backgrounds, particularly new and
emerging communities, the cultural
stigma associated with disability often
accentuates this exclusion.
People with disability want to be
welcomed as people and citizens, with
the same rights and expectations
afforded to others. People spoke
about the need for better access to
community life, through better design
of homes, buildings, public facilities
and spaces and transport systems.
People stressed that mainstream
services in the public and private
arenas need to be proactive and
responsive to accommodate people
with disability.
The rights of people were a constant
message and the United Nations
Convention of the Rights of People
with Disability was identified as a
powerful reference on everybody’s
obligation to acknowledge and respect
the rights of people with disability.
Time and again, people with disability
spoke of their desire for a user-friendly
service system with the flexibility to
respond to individual needs. People
spoke strongly about not only
wanting recognition of their right to
choice but also recognition that they
are best placed to make decisions
about their needs.
Additionally, people talked about
abuse and vulnerability, especially for
women and children in institutional
and community settings. Action was
demanded to better prevent abuse
and support people to speak out about
issues. Many people, particularly those
in regional areas, mentioned their fear
or reluctance to speak out against
poor quality of care and inappropriate
practices, for fear of reprisals. The
Board heard the vulnerability of
women and children with disability
was exacerbated through the lack
of protection or access to justice for
crimes and abuse against people with
disability.
Housing was highlighted as a key
concern for people with disability.
People advocated that living in their
own home that meets their needs
would have a positive impact on their
independence, sense of identity and
community belonging.
Parents and their school-age children
with disability emphasised that
educational settings and appropriate
supports are critical building blocks
for a positive life and independent
future. Others spoke of their need to
be listened to and to have input into
solutions that best suit their child.
There was also concern about the
lack of post school options and
pathways into further education,
training and employment.
In regional South Australia, the issues
were even more pronounced. People
with disability, their families and
carers spoke of their isolation, lack
of support networks and need to
travel long distances, sometimes even
interstate, to access specialist services.
They also spoke about limited local
support, a shortage of appropriately
trained workers, poor public
transport and inaccessible social and
recreational facilities.
Many people recognised the
importance of employment for
people with disability for generating
income and nurturing good health,
independence and social engagement.
They consider that their economic
contribution is undervalued. People
spoke of their wish to work in areas
that matched their competencies
rather than being confined to
menial tasks.
Carers spoke of their physical and
mental exhaustion and the need
for greater financial support, as well
as more flexible respite options for
themselves and their families. Others
highlighted the need for supported
housing for their child. For elderly
parents caring for their adult children
with disability, anxiety and uncertainty
about their loved one’s future once
they are gone is a key issue.
Culturally and linguistically diverse
people with disability and Aboriginal
people with disability are frustrated by
the lack of information about services
provided in a culturally appropriate
manner. This makes navigating the
systems and services particularly
difficult.
Women, as the majority of full-time
carers, spoke about their isolation and
the extent to which they, as carers,
lacked the opportunity to pursue
further education, employment or
personal development because of an
expectation that they would not only
undertake their parenting roles, but
also become full-time carers.
14
The Community Engagement Process
The community engagement process
commenced on 29 July 2010, with the
launch of Activating Citizenship, and
ended 27 September 2010.
The Board used several processes
to engage with South Australians
across the State:
1. Sixteen community forums were
held across South Australia. Six were
held in metropolitan areas and 10 in
regional South Australia. They were
facilitated by members of the Social
Inclusion Board. In total 578 people
attended these meetings.
2. An online survey containing a
series of open ended questions was
developed for people to submit
their views on a range of themes
identified in the Activating Citizenship
discussion paper. In total 1267 people
participated. Of these:
> 36.2% (448 respondents) identified
themselves as a person with disability
> 54.1% (669) were family members
of a loved one with disability
> 29.7% (337) provided support to
a person with disability
> 22.6% (279) people worked in the
disability sector
> 7% (86) volunteered in the sector.
15
3. A phone-in was advertised and
held between 29 July 2010 and
27 September 2010. Calls were received
by the Disability Information and
Resource Centre in partnership with
the Social Inclusion Unit. Respondents
were able to speak about any issues
they wanted to raise. A total of 170
phone calls were received.
4. Written submissions were received
from over 120 organisations and
individuals. A full list of organisations
that provided submissions is available
on the Social Inclusion website:
www.socialinclusion.sa.gov.au
5. In addition, the Social Inclusion
Board and the Social Inclusion Unit
facilitated a range of other forums.
These included:
> consultations with Aboriginal
South Australians and culturally and
linguistically diverse communities
were undertaken to understand
the unique issues affecting these
groups
> meetings held at Orana, Minda,
Strathmont Centre, Bedford and
Highgate to hear the views of people
with disability who may not have
been able to participate in the wider
community meetings
> a series of thematic workshops
on issues central to the Activating
Citizenship Discussion Paper was
run by National Disability Services to
enable key and interested personnel
from the sector to identify issues
that were important from their
perspective
> the Social Inclusion Unit was a
stallholder at the 2010 Disability
and Ageing Expo, this was used as an
opportunity to answer questions
from members of the public
and promote participation in the
community engagement process.
The Disability Context
Strong Voices has been developed
at a critical time for disability policy
in the state and national context. In
recent years, there have been several
wide-ranging inquiries and important
state, national and international
developments.
At the international level, Australia
ratified the United Nations
Convention on the Rights of Persons
with Disability (UN CRPD) in July
2008. This enshrines eight guiding
principles based on respect, equality
and non-discrimination. It clarifies
what existing human rights mean for
people with disability. In ratifying the
UN Convention, Australia has moved
towards a rights based approach
providing greater choice, control
and independence for people with
disability.
In August 2009, Australia further
signed the Optional Protocol to the
UN CRPD. In doing so, Australia has
presented itself as ‘an international
leader committed to protecting the
rights of people with disability’.
At the national level, the Board
welcomes the National Disability
Strategy (NDS) and National Disability
Agreement (NDA) and their strong
focus on opening up universal services
to be more responsive to people with
disability and their families and carers.
More significantly, the Board welcomes
the Council of Australian Governments
(COAG) commitment to progress
the exploration of the Productivity
Commission’s report regarding a
National Disability Insurance Scheme
(NDIS) and a National Injury Insurance
Scheme (NIIS) that reaffirms principles
of fairness, equality and access for
people with disability.
Many Australian states have
embarked on systemic and longterm reform. Victoria and Western
Australia are further along the path
of implementing many elements of a
contemporary best practice disability
service system, particularly personcentred planning and individualised
funding. New South Wales has
embedded a strong early intervention
approach. Queensland is developing
a focus on best practice in quality
assurance.
The Board recognises that these
national developments provide
opportunities for South Australia.
Strong Voices aligns with the national
disability agenda to place South
Australia at the forefront of policy
development across the country.
Effective implementation of
Strong Voices will position South
Australia to capitalise on
national reform.
The principles of the present
Convention shall be:
1. Respect for inherent dignity,
individual autonomy including
the freedom to make one’s own
choices, and independence of
persons;
2. Non-discrimination;
3. Full and effective participation
and inclusion in society;
4. Respect for difference and
acceptance of persons with
disabilities as part of human
diversity and humanity;
5. Equality of opportunity;
6. Accessibility;
7. Equality between men
and women;
8. Respect for the evolving
capacities of children with
disabilities and respect for the
right of children with disabilities
to preserve their identities.
United Nations Convention on the
Rights of Persons with Disability.
16
Disability is understood and
experienced differently by Aboriginal
people. That experience and meaning
can also vary between Aboriginal
families and the places they live.
Critical to supporting Aboriginal
people with disability, their families
and carers, is the ability of specialist
services and universal services to hear
what Aboriginal people have to say
and take an empowering partnership
approach.
Historically, Aboriginal people have
been excluded and isolated. As a result,
many Aboriginal people have little
or no trust of government services.
Barriers faced by Aboriginal people
with disability extend to language,
location and racism. A respectful and
culturally sensitive approach is vital.
17
Past experiences for culturally and
linguistically diverse communities,
including refugees, add additional
complexity that is worthy to note. In
community consultations we heard
of the stigma and discrimination in
other countries toward disability, so
people arriving in Australia are both
unaware of supports and services
and could also be fearful of further
discrimination in their new country.
Some disabilities are also undetected
such as trauma, stress and anxiety as a
result of conflicts in home countries.
Language and cultural barriers
prevent culturally and linguistically
diverse communities and Aboriginal
people for whom English is not their
first language, from accessing services.
There are inadequate or limited
responses by services to work with
people with disability in culturally
sensitive and inclusive ways.
What do we mean by ‘disability’?
Historically defining ‘disability’ relies
on medical definitions where the
‘expert voice’ predominates. These
definitions see disability foremost as
a limitation or barrier to activity and
participation.
The United Nations Convention on
the Rights of Persons with a Disability
emphasises that environmental
and attitudinal barriers are just as
important in defining disability as an
individual’s physical or intellectual
impairment.
The Social Inclusion Board adopts this
broader understanding of disability.
It recognises disability is the product
of impairment of functionality and
the environment that a person lives
in. Social, economic and cultural
barriers can limit a person with
disability’s capacity to participate and
be included. These barriers compound
and further define the experience of
disability and associated problems
which need to be overcome.
The Board also recognises that
people with disability differ, not only
in the nature and degree of their
impairment, but more importantly
in relation to their individual
circumstances, capacities and skills.
Impairment can be significant and
it needs to be understood in order
to ensure that individuals get the
necessary social assistance to enable
them to participate. People with
disability are not a homogenous group
and do not have the same needs.
Treating them as such only adds
additional barriers and contributes to
exclusion.
18
How will we respond?
The Social Inclusion Board believes
that South Australia must recognise
people with disability as equal citizens.
Stigma and discrimination have
no place in our communities. Every
South Australian must look beyond
a person’s disability to see them as
a person, vibrant and diverse as any
other. People with disability are young,
old, athletic, ill, fiercely independent
and chronically dependent. They are
our neighbours, children, parents and
co-workers.
Major reforms at both the
community and system levels are
fundamental to achieving a shift in
the way our systems and community
view disability.
The Board believes that there should
be less focus on the specialist disability
system and more focus on people.
Equally universal services should be
designed so that they accommodate
people with disability as clients and
respond to their needs.
The Board recognises that there is
still a strong need for Government to
play a role in funding and delivering
specialist services for those whose
19
disability may require high-level
continuous or ongoing support. Here
the Board strongly and unequivocally
seeks to create mechanisms that
support greater choice and control
for people with disability in achieving
better participation and inclusion
outcomes. It views personalised and
flexible specialist support as the
key area for future investment
and focus for Government and the
disability sector.
Community reform is a key challenge
for South Australia if we are to be a
national leader in social inclusion
for people with disability. Change
within the community will require
strong State Government leadership
and resourcing. Bold action through
partnerships with diverse stakeholders
including business, Local Government
and the not-for-profit sector is
also required.
Importantly, progress of the
implementation of these reforms
must be continuously owned and
driven by the highest levels of
government and informed by people
with disability, their families and
carers as well as other members of the
community.
Visionary, robust and rights-based
legislation is a key foundation
to progressing disability reform.
Legislation needs to be enabling for
individuals and systems, and provide
enduring assurances. A strong
rights-based legislative foundation
drives change in community attitudes
and practice. It acts as a catalyst for
service change and setting standards
of accountability. It can effectively
reduce the barriers facing people with
disability. Importantly, legislation
assists individuals, governments,
employers and private and community
sector organisations to effectively plan
for the future with confidence.
The Board believes new legislation is
required for people with disability and
carers to experience the same rights
afforded to others in the community.
Recommendation
01
Priority Action The South
Australian Parliament must
enact a new Disability Act to replace the
existing Disability Services Act 1993 to:
> align with the United Nations
Convention on the Rights of Persons
with Disabilities and specify high
level service standards such as
minimising use of restrictive practices
> direct all State Government agencies
and Local Governments to lodge
Access and Inclusion Plans with
the Social Inclusion Board for
public release
> establish an integrated suite of
appeal processes and safeguards
> establish a Community Visitors
Scheme to monitor standards
of disability housing and
accommodation service settings.
The immediate challenge
Critical level unmet demand
The Social Inclusion Board feels
strongly that the disability system
in South Australia is underfunded
and crisis driven. A crisis driven and
reactive service system means that
people with disability, their families
and carers, are not able to access
services how and when they need
them. People told the Board that
because they have to present in crisis
in order to receive a service, they delay
requests for support until they are
actually in crisis. Evidence supports
this. This generates unsustainable
stress not only on people with
disability, their carers and families,
but also on the community and the
disability services system.
The South Australian disability system
must focus on increasing access to
universal services and providing early
investment to avert crisis.
The South Australian disability
system focuses on addressing
critical level unmet need. In 2009-10
the South Australian Government
spent $354.4 million on Disability
Services. Disability spending has been
increasing by nearly 7% per annum in
the five years to 2009-101. Despite this
additional funding, reported need for
assistance by people with disability
continues to grow and the number
of people assessed as in crisis with
unmet critical need is also increasing.
Source: unpublished analysis provided to the Social Inclusion Board by the Department of Treasury and Finance June 2011.
The average growth rate is expressed in nominal dollars (i.e. is not adjusted for inflation).
Disability SA records unmet need for
disability services in South Australia
via the Unmet Demand Waiting List.
People with disability on the Unmet
Demand Waiting List are assessed
and placed into one of four categories,
based on the assessed level of need.
Table 1. Definitions of the
Categories of Need
Category 1 Critical
(Homelessness/immediate and
high risk of harm to self or others)
Category 2 Evident (Risk of
harm to self or others/risk of
homelessness)
Category 3 Potential
(Deteriorating health and/or
ability of a client or carer)
Category 4 Desirable
(Enhancement
of quality of life)
1
20
Figure 1. Proportion of clients in each Category of the Unmet Need Waiting List (May 2011)
35%
907 people
40%
1042 people
25%
664 people
13%
333 people
Category 1
Category 2
Category 3
Category 4
Source: Department for Families and Communities Unmet Demand Waiting List May 20112.
Data provided by the Department for
Families and Communities shows that
since December 2008, the number of
Category 1 people on the Waiting List
has increased by 73% from 525 to 907.
At May 2011, 17% of people on the list
were children aged under 15 and 4%
were Aboriginal (96 people of whom 19
were children)3.
21
The Unmet Demand Waiting List is
not reflective of actual levels of unmet
need in the community. The list only
records people who are eligible and
waiting for a specialist Disability SA
service. It does not include people for
whom Disability SA is not the primary
service provider (for example services
for people with sensory disability, or
for children with physical disabilities,
brain injury and some levels of
autism).
Disability SA’s official Unmet Demand
Waiting List recorded 2,596 people
with disability on the List as of May 2011.
Of these, 35% (907) were ‘Category 1’
(in critical or immediate need).
Figure 1 illustrates the proportion of
people on the Unmet Demand Waiting
List in each category of need.
Governance
The specialist disability system is
not keeping pace with demand (and
this deficit often precipitates crisis
situations) according to the consistent
messages the Board heard through the
community engagement process.
Delivering services to people on
the Unmet Demand Waiting List
(and others with need, not on the
list) cannot be solved simply by an
injection of funding. Infrastructure
and services need to be in place to
meet these needs. For example, the
majority of people listed as Category
1 or 2 require housing support, which
is not available. Responding to homes
and housing needs is discussed in
more detail in Chapter 4, Diversifying
Housing Choices.
Recommendation
02
Priority Action To meet the
immediate challenge of an
under funded system, Government
funding to address unmet need
must be allocated as a matter of
urgency to remove all ‘critical and
evident risk’ clients from the Unmet
Demand Waiting List within one
budget cycle. Recurrent funding must
be maintained at a level sufficient
to deliver immediate and effective
responses to people assessed with
immediate need.
The reform needed to the disability
system in South Australia is extensive.
Reform is needed across governments,
not-for-profit sector, private sector and
communities. Urgent and immediate
action is required as are longer term
reforms. Broader changes in the way
people with disability receive support
are anticipated, at the national
level, through the 2011 Productivity
Commission report, ‘Disability Care
and Support’ and the National
Disability Strategy. Strong Voices is
deliberately flexible to respond to
these changes. Additionally, disability
reform needs to ensure there is clear
alignment in objectives and outcomes
with major South Australian policy
initiatives. This reform must extend
across Government and communities
in South Australia.
Governance of Strong Voices must
have the authority, skills and
accountability to enable action and
ownership across Government and
in the community. It is clear that
disability has multiple overlaps and
interfaces with other social issues such
as cultural challenges faced
http://www.sa.gov.au/upload/franchise/Community%20Support/Disability/Disability%20collection
/statistics/The%20provision%20of%20Disability%20Services%20in%20South%20Australia%20June%202011.doc
2
3
Department for Families and Communities Unmet Demand Waiting List May 2011
22
Reporting
by Aboriginal people and culturally
and linguistically diverse people,
mental health, homelessness, and
social exclusion. This was reinforced
throughout the community
engagement and research process.
The Board has determined that it has
an important leadership role to play
in supporting the implementation of
disability reforms and their integration
with a range of other social issues on
which it has expertise.
Mandating the Social Inclusion
Board, or a similar body, external to
the disability service system under
a new Disability Act to monitor
the implementation and quality
of disability services reform as
well as service standards on an
ongoing basis, will support effective
implementation and a joined-up
approach. This includes ensuring
linkages and consistency of Strong
Voices with broader social and
economic reform. In this role the
Board, or a similar body, will provide
advice outside of Government.
This will include identifying and
supporting responsible agencies to
initiate required activity, promote
23
collaborative actions and identify
where efficiencies in process and
outcomes can be achieved.
A disability services user group will be
established by the Board, or a similar
body, to ensure people with disability
are heard and have input into
disability issues.
Additionally the Board, or similar body,
will facilitate annual regional forums
with people with disability, their
families, carers and stakeholders.
These forums will build stronger
partnerships, enable alternative
perspectives and thinking to be
applied to implementation, provide
a more direct voice for people with
disability, and align with the principles
of the National Disability Strategy.
The existing Chief Executive Disability
Reform Committee (CEDRC) will
continue to facilitate joined-up State
Government reform and will serve
as one mechanism for the Board to
consult with State Government agency
representatives.
Through the chairperson, the Board, or
similar, will report as required to the
Social Inclusion Cabinet Committee
and directly to the Minister for
Disability. The Board, or similar body,
will provide an annual report to be
tabled in Parliament.
Recommendation
03
Priority Action The new
Disability Act must mandate
a role for the Social Inclusion Board,
or a similar body external to the
disability service system, to monitor
the implementation and quality of
disability services reform and service
standards on an ongoing basis. The
Social Inclusion Board or similar
body will report to Parliament. The
Act will require Access and Inclusion
Plans to be lodged with the Social
Inclusion Board, or a similar body.
The monitoring body will be advised
by a sub-committee of people with
a lived experience of disability. The
Principal Community Visitor, Health
and Community Services Complaints
Commissioner and Equal Opportunity
Commissioner will provide reports to
the monitoring body.
The next six chapters set out the
reforms the Board has identified to
bring people with disability and their
families and carers to the forefront in
determining how they live their lives,
pursue aspirations and contribute to
our society as active citizens.
1. Creating Accessible and
Inclusive Communities
Shaping Accessible and Inclusive
Communities is about creating
environments that are physically and
culturally accessible and communities
that promote social inclusion for
people with disability and their
families and carers.
2. Providing Choice, Taking Control
Providing Choice, Taking Control is
about ensuring that people with
disability and their families and carers
have the opportunity to control or
influence services that are part of their
lives, this includes building peoples’
independence and capacity and
fostering innovation.
Creating
Accessible
and Inclusive
Communities
Providing
Choice,
Taking Control
Shaping
Accessible
and Inclusive
Services
Diversifying
Housing
Choices
Strengthening
Rights, Protection,
Advocacy and
Safeguards
Investing
Early
3. Strengthening Rights, Protection,
Advocacy and Safeguards
Strengthening Rights, Protection,
Advocacy and Safeguards is about
protecting rights, preventing abuse
and neglect as well as redressing
such incidents.
4. Investing Early
Investing Early is about building
a sustainable system as well as
services that support people to
plan for their future.
5. Diversifying Housing Choices
Diversifying Housing Choices is about
ensuring people’s homes and housing
work best for their needs and support
each person’s life plans.
6. Shaping Accessible and
Inclusive Services
Shaping Accessible and Inclusive
Services is about ensuring that
universal services - including health,
education and transport, are easy to
access and responsive for people with
disability, their families and carers.
24
Chapter 1
Creating Accessible
and Inclusive
Communities
Through the community engagement
process, people with disability, of
all ages, from a range of cultural
backgrounds and occupations told the
Social Inclusion Board that:
> they feel shut out from society
through separate structures such as
sheltered workshops, ‘special schools’
and living in hosptials
> they are marginalised and excluded
from social activities such as sport
and recreation – this is especially the
case for young people
> they want to live a fuller life in
our community but often cannot
participate
> they can experience a sense of
belonging and gain a sense of
control over their lives when they are
genuinely engaged in community life
> community education is required
for employers if we are to stop
discrimination
> they are constantly battling negative
perceptions and barriers prescribed for them by others.
At regional community meetings the
Social Inclusion Board heard that:
> families of a person with disability
felt excluded from social and
community activity
> many people with disability can’t
get around in the community or use
services because of poor
building design
> transport options for people with
disability range from limited to
non-existent, particularly in regional
areas where taxis and public
transport are lacking
> investment in linking key services to
transport networks is required.
The Board strongly supports an
environment where all people
can develop to their full potential,
participate in the community and lead
productive and fulfilling lives. In these
environments people enjoy richer lives
– socially, culturally and economically.
Access and positive participation by
people with disability and their carers
is crucial to achieving this goal.
Chapter 1 of Strong Voices sets out
the Social Inclusion Board’s plan for
shaping more accessible and inclusive
communities. It is essential that
the State Government is proactive
in fostering new partnerships
with people with disability and
the mainstream community
(Commonwealth, local government,
not-for-profit sector, private sector
and community groups) to adopt
leadership roles in working to achieve
better access and inclusion outcomes
for people with disability.
Social isolation, discrimination and
stigma remain an every day reality
for many people with disability. For
Aboriginal people and culturally
and linguistically diverse people
with disability, this community
disconnection is often compounded
by racism. In regional communities,
people with disability also experience
further barriers and community
dislocation as a result of inadequate or
inaccessible services.
The Board is clear that a lack of access
to mainstream services has increased
pressure on specialist services to meet
the needs of people with disability.
26
South Australia’s Strategic Plan
South Australia’s Strategic Plan is a
high level plan that sets out the State’s
priorities across a range of areas and
sets targets against these priorities.
The Plan expresses our aspirations
for resilient vibrant communities,
prosperity, environmental
sustainability, good health and
wellbeing.
South Australia’s Strategic Plan4 has
three new targets about people with
disability. They are:
> Target 11. Housing for people
with a disability: Increase the
number of people with a disability
in stable, supported community
accommodation to 7,000 by 2020
> Target 25. Support for people with
disability: Triple the number of
people with disability able to access
self-managed funding by 2016
> Target 50. People with disability:
Increase by 10% the number of
people with disability employed in
South Australia by 2020.
The specific disability targets in
South Australia’s Strategic Plan
have been informed by people with
disability, their families and carers.
27
Community development and awareness
The Plan is reflective of a community
striving to be open, accessible and
welcoming.
South Australia’s Strategic Plan has
as its top priority, the wellbeing of
all South Australians. As citizens,
people with disability must be a
part of every recommendation of
the State’s Strategic Plan. As far as
possible, measurement of progress
against targets of the Plan should be
disaggregated to measure progress
for people with disability. In the first
instance, disaggregated reporting
on Plan targets should include social
participation, access and inclusion
targets.
The Social Inclusion Board believes
there is a need to broaden community
understanding and awareness of the
challenges experienced by people with
disability, their carers and families.
Uninformed community attitudes
regarding disability, a lack of
information, labelling and
stereotyping create barriers in the
community for people with disability.
Community engagement of people
with disability, their families and
carers is a key tool towards building
awareness and shifting attitudes.
Community initiatives from interstate
and overseas such as social, recreation
and arts events that bring everyone
in the community together, have a
powerful effect on promoting the
rights of people with disability, their
families and carers. These initiatives
also increase community acceptance
of people with disability.
Locally generated community
initiatives can also be powerful
incubators for innovation in services
and support. With relatively small
levels of financial assistance,
communities can capitalise on local
Removing barriers
resources and networks to deliver
services better and more efficiently.
The Board believes that a local
community innovation fund should be
established to enable communities to
be proactive in making the community
a better place for people with
disability, their families and carers.
Recommendation
04
The South Australian
Government must
establish a $500,000 per annum
Local Disability Innovation Fund to
support community innovation and
development. The fund will be
indexed to CPI.
The Local Disability Innovation Fund
could be managed in association with
the Premier’s Community Initiatives
grants.
Many people with disability and their
families and carers are restricted, or
altogether omitted, from accessing
local community resources, including
mainstream services, because of poor
service and infrastructure design
and planning.
Nationally, the Social Housing
Initiative5 (2010) states that all
proposals are assessed against
universal design principles that
facilitate better access for persons
with disability and older persons,
where appropriate. Universal
design recognises that design and
built form should serve all people,
without exclusion. Well designed
built environments are a key issue
for people with disability and have
a direct impact on their access and
inclusion, as they do for many other
groups such as families with young
children, culturally and linguistically
diverse people and older people.
“We want to participate in
our local community but
places are not always accessible
and accommodating”
Survey respondent
4
5
http://saplan.org.au/
http://www.fahcsia.gov.au/sa/housing/progserv/social_housing/Pages/energyefficiency.aspx
Better access in communities is
required in the physical spaces shared
by communities and the structural
designs of buildings, canteens, school
grounds, playgrounds, libraries, work
spaces and other public amenities.
This extends to the design of transport
infrastructure, and the use of
technology to connect
people to social and economic
activity; factors which are particularly
significant in reducing isolation for
people with disability in rural and
regional areas.
The Social Inclusion Board strongly
believes that existing built fabric and
public spaces must be adapted and
renewed for universal access. Design
solutions should assert primacy for
dignified access in achieving balance
with other priorities such as heritage
integrity. Barrier free design and
assistive technology may provide
accessibility for people with disability
but they also often result in separate
and discriminating solutions (for
example, a ramp that leads to a
different entry to a building rather
than the principal entry). Innovative
solutions are needed that comply with
the Disability Discrimination Act 1992
and National Australian Building Code
Regulations.
28
Inclusion and Access Plans
Recommendation
“We want accommodation and
appropriate support services near
our homes so that we remain
close to support networks”
Survey respondent
Wayfinding is critical to the renewal of
built environments and public spaces.
Wayfinding is effective environmental
communication that relies on a
succession of communication clues
delivered through sensory stimuli.
For people with vision impairment or
blindness, wayfinding goes beyond
signage points.
The Social Inclusion Board advocates
that the design of spaces and renewal
of existing built environments and
public spaces must assist users with
spatial problem solving by providing
consistent clues. For people with
disability, these clues must be inclusive
of (for example) tactile ground
covering, luminance contrast, Braille
and tactile signage and tactile trails.
The Board challenges those
responsible for the design or renewal
of built fabric and public spaces to
have at the forefront of their thinking
- how can universal access be central
to design?
29
05
To improve accessibility
and participation in
community life, the State Government
and Local Government must prioritise
universal access design principles
in planning, design and contracting
for the renewal of existing built
environments and public space.
There is a natural alliance between
accessible and inclusive communities
for people with disability and the
extensive work occurring in adapting
to an ageing demographic.
With South Australia’s ageing
population and people with
disability living longer, it is critical
that the work for accessible and
inclusive communities builds on,
and complements, strategies and
recommendations within the ageing
policy agenda.
Many (people with disability)
said they face a constant struggle
to obtain what the rest of the
community would consider to be
an ordinary life. They do not want
special treatment—they just want
the barriers removed so they can
get on with living. Shut Out Report
Shut Out Report6
Governments (and private
organisations) must invest in services
and facilities that promote access
and inclusion. The Board repeatedly
heard the daily frustrations people
with disability experience in routine
activities in the public environment.
The Board recommends adopting
Access and Inclusion Plans in South
Australia to provide a planned and
systemic approach to progressively
improve access for people with
disability. It is proposed that these
plans be mandated in the new
Disability Act.
Access and Inclusion Plans will include
multiple groups who are subject to
exclusion by the physical or cultural
environment, such as young families,
the aged, Aboriginal people and
culturally and linguistically diverse
people. People with disability must be
a key focus in the Access and Inclusion
Plans. The Access and Inclusion Plans
will provide a framework and focus
for mainstream service providers to
ensure that people with disability and
others have improved outcomes in
access and participation. There is clear
alignment of Access and Inclusion
Plans with South Australia’s Strategic
Plan targets.
Access and Inclusion Plans must
extend to State Government
agencies, local government, statutory
authorities and government
contracted services. They must be
lodged with the Board or similar body,
which will publicly release the plans, to
promote learning and accountability.
‘….a key imperative is for the
broader community and
mainstream services and
facilities that are part of ordinary
Australian life to be available and
fully accessible for people with
disability. That is, people with
disability need to be able to access
and use local doctors, dentists,
shopping centres, sport clubs,
transport, schools, websites, voting
booths and so on.’
National Disability Strategy , p13
7
The Board’s intention is for Disability
Access and Inclusion Plans to provide a
framework to enable service providers
to:
> plan person focussed services,
environments and infrastructure
that contribute to stronger
communities
> build service design in partnership
with people with disability and
others who use or should use
the service
> utilise existing resources aimed at
increasing awareness about
inclusion and build better
communities, for example the
iSWEAR8 program
> be accountable and continuously
improve.
“Programmes that break down
isolation are the most powerful.
It is the isolation that is the biggest
risk factor of mental health”
Survey respondent
The Access and Inclusion Plans will
enable local communities to have a
voice in decisions that affect them
and contribute to inclusive design
and services. Public access to the
plans provides for accountability and
enables communities to speak up
when commitments are not being met.
Promoting Independence, the South
Australian Government Strategy for
inclusion of people with disability,
should be reoriented from a reporting
framework to a policy framework
that provides direction and support
for inclusive practices and culture
in agencies. It should be a resource
for agencies to develop Access and
Inclusion Plans by showcasing good
practice and tangible outcomes.
Agency reporting should be through
annual reports.
The Department of Planning and Local
Government must also play a strong
leadership role in raising awareness
and promoting Access and Inclusion
Plans with Local Government.
Recommendation
06
To support access to services
for people with disability,
their carers and families and assist
organisations plan and provide
better services, all State Government
agencies, local councils, statutory
authorities and State Government
contractors must develop and
implement an annual Access and
Inclusion Plan. Access and Inclusion
Plans will be public documents and
lodged with the Social Inclusion Board
or a similar monitoring body.
http://www.fahcsia.gov.au/sa/disability/pubs/policy/community_consult/Pages/default.aspx
http://www.fahcsia.gov.au/sa/disability/progserv/govtint/nds_2010_2020/Documents/National_Disability_Strategy_2010_2020.pdf
8
The iSWEAR website is a register established to raise awareness about disability and offer interested organisations
information about accessibility and sustainability and the opportunity to participate in self assessment. This free self
assessment provides the organisation with an opportunity to identify areas of improvement.
6
7
30
Digital inclusion
Telecommunication can help to reduce
disadvantage through connecting
people in cities to regional and
rural communities. It is anticipated
that ongoing improvements in
telecommunication infrastructure
(such as the National Broadband
Network) will transform service
delivery in areas of health, education
and employment. The creative
use of technology, for example, in
banking and social media networks,
contributes to enabling people with
disability to live more independently
and be better connected. This is
particularly important in rural and
regional locations.
For young people with disability – like
all young people - connecting through
social media increases connections
and their sense of community
belonging.
The combination of improvements
in telecommunications technology
and the increased use of social media
provide more opportunities for
communities to share information.
31
“People need to begin to think
outside the square and realise
that just because you have
a disability it doesn’t mean
that you shouldn’t enjoy the
same freedom. This is where
communities can take a key role
in assuming responsibility. It
shouldn’t be the government’s
role to provide these services,
but the community”
Community comment
The Social Inclusion Board believes
there is ongoing opportunity
to nurture online social media
environments so that communities
are better equipped to share
information about disability services
and opportunities for social and
economic participation.
“Life is very tough for those who
live in rural areas. Isolation and
limited services make everyday
matters difficult, especially once
you cannot drive”
Survey respondent
The Board acknowledges the work
of ‘Beyond Disability’ led by Mr
Richard Stubbs OAM, a not-for-profit
organisation where a team of local
volunteers in Mornington Peninsula,
Victoria, assist housebound people
with physical disability to connect
with the world by using online
technologies. Digital technology
presents exciting opportunities for
generating inclusion, connection
and access. This is the kind of
initiative that would be well
supported by the proposed Local
Disability Innovation Fund.
It is imperative that we harness digital
inclusion to ensure no one is left
behind and thereby, further isolated.
This is particularly important for
people with disability who are isolated
and people with disability in regional
and remote areas.
Local government – locally
leading the way
Accessible, navigable and relevant
information online is also important
for socially inclusive communities. The
South Australian Government has
established a website
(www.sa.gov.au) that provides a
central gateway to State Government
services and agencies.
Access to SA Government and
community information relevant to
people with disability, their families
and carers must also be available
through a link on the website’s
front page. This link should provide
information across agencies and
include the option to download
applications to access information in
accessible formats.
Recommendation
07
To improve access to State
services the State
Government must establish a
disability link on the sa.gov.au
website, providing access to
information and resources that is
relevant to people with disability,
their families and carers. Throughout the community
engagement process, Local
Government was identified by people
with disability as having a leading
role in welcoming them into
community and having a strong
influence on improving access and
inclusion outcomes. This was a
particularly strong message from
regional and remote communities
across South Australia.
In South Australia, local councils are
‘closest to the people’ and are a key
provider of services to the community.
They play a fundamental role in
supporting community identity,
cohesion and vibrancy through
services, facilities and social events.
Local councils play a vital role in
shaping accessible and inclusive
communities in South Australia.
Local Government is in a strong
position to listen to and work with
community in developing innovative
ways to ensure that everyone is able
to engage, enjoy and participate in
community life.
The 2010 National Disability Strategy,
developed in partnership with
the Australian Local Government
Association, acknowledges the strong
role of Local Governments in achieving
its objectives.
“There is no long term
planning around service
delivery or local coordination
for Aboriginal people”
Community comment
The proposed Access and Inclusion
Plans will assist in focusing effort to
deliver better services to all South
Australians. Additionally, the Board
encourages Local Government to
work directly with community
groups to generate innovative
projects with funding from the
proposed Local Disability Innovation
Fund.
32
Opening employment opportunities
Employment is an important part
of inclusion in society. Employment
provides people with income,
community connections and increased
opportunity to engage in a wide range
of activities. Paid employment builds
independence and self sufficiency.
Additionally, employment of people
with disability and carers contributes
to South Australia’s collective wealth,
productivity and wellbeing.
The Australian Government provides
employment assistance for people
with disability under open and
supported employment schemes
called Disability Employment Services9
and Australian Disability Enterprises.
33
Disability Employment Services
help employers recruit and
retain employees with disability.
Government support is provided to
both the employee and employers.
Employees receive wage entitlements
and other conditions as per the
minimum standards established
under Commonwealth and State
Awards. As part of these open
employment award conditions, the
Supported Wage Scheme provides
employment opportunities for people
with disability in the open labour
market who do not have the ability to
work at full capacity.
Since Disability Employment Services
was established (in March 2010), it is
reported that it has resulted in a 40%
increase in the number of people with
disability accessing help to secure
employment.10
“We want educational facilities
to take some more steps to
adapt to children with disability
rather than expect children with
disability and their families to
adapt to them”
Community comment
Australian Disability Enterprises
provides supported employment and
targets people with more severe and
profound disability. In South Australia,
there are 46 Australian Disability
Enterprises delivered through 14
organisations and employing over
3,000 people. These organisations
represent a diverse range of industries
including horticulture, furniture,
hospitality, light manufacturing,
laundry, printing, arts, and craft. The
majority of employees within ADEs
have intellectual disability.
The Social Inclusion Board strongly
supports South Australia’s Strategic
Plan Target 50, to increase the number
of people with disability employed in
South Australia by 2020 by 10%.
A specific VET program which
targets people with disability in
South Australia is VET to Work. VET
to Work is currently a pilot program
with a primary focus on supporting
students with intellectual, learning
and sensory disabilities. The pilot
supports employers and TAFE SA to
make the necessary adjustments to
their environments to enable people
with disability to study and access
work placements. A key feature of
the pilot’s success to date has been
the mentoring support provided to
students with disability in their TAFE
and work placements by Disability
Employment Service Providers. This
additional support is critical to
support employers to provide such
opportunities.
South Australia through Skills for All
(2011-2014) has committed $194 million
over 6 years to create an additional
100,000 training places with the
Vocational Educational Training
Sector (VET). The Skills for All approach
enables the VET system to respond
more directly to the individual needs
of students and employers when
matching jobs to people.
9
Job Services Australia also provides employment services for people with disability.
http://www.deewr.gov.au/Department/Budget/Documents/20112012/Future_Arrangements_For_DES_Purchasing.pdf
10
Recommendations
08
The South Australian
Government must
ensure that Skills for All (2011-2015)
provides opportunities for people
with disability to increase their
participation in VET. It must do this
by setting a student with disability
participation and course completion
target. The number of VET to Work
programs must be increased (including
regional sites) to translate training
into employment outcomes. This
should be pursued in collaboration
with the Commonwealth Disability
Employment Services program.
Increasing opportunities for people
with disability to participate in
employment opportunities requires
flexible, creative, and cohesive
approaches by government,
community agencies and the private
sector. People with disability should
not be confined by limited options that
cause social isolation and hinder self
development and aspiration.
34
Making the transition from
learning to earning for young
students with disability
The Social Inclusion Board encourages
government and industry to be
innovative in their approach to
increasing secure and flexible working
conditions for people with disability.
One strategy the Board endorses is for
the State Government, in partnership
with the Commonwealth Government
and industry, to host an annual
Disability Open Employment Round
Table. The Disability Open Employment
Round Table would be an opportunity
to identify strategies, resources
and opportunities that generate
employment outcomes for people
with disability.
The South Australian Government
currently funds two key programs
specifically directed to transition
students with disability into post
school pathways: The State Disability
Transition Program and Better
Pathways (Choices and Connections).
The State Disability Transition
Program in metropolitan Adelaide
is targeted at young people with
disability to effectively support
them into post school pathways and
employment. This program is a joint
response between the Department
of Education and Children’s Services
(DECS), the Department for Further
Education, Employment, Science and
Technology (DFEEST) and Disability
Employment Services.
Better Pathways is a DECS program
that was developed by the Social
Inclusion Board in 2009. Better
Pathways supports young people with
disability in successful transition from
school to employment. It provides
personalised and joined-up support
for students with disability to plan and
successfully transition from schooling
to employment.
35
These transition programs
demonstrate good outcomes for
young people with disability through a
joined-up services model.
The South Australian Government also
supports the Innovative Community
Action Networks (ICAN) model
which provides personalised case
management, and flexible learning
curriculum through community
partnerships to support students
at risk of leaving education. This
includes students with disability.
The goal of ICANs is to strengthen
student and family engagement with
school, through an individual case
management approach that addresses
student and family barriers impacting
on school attendance.
ICAN is also demonstrating strong
outcomes for learning, wellbeing and
school retention. Like Better Pathways,
a key part of the successful formula of
ICAN is personalisation and joined-up
services.
Whilst demonstrating good outcomes,
these programs must be extended
and increase their efforts to transition
young people from learning to the
open employment market.
Recommendation
09
To increase flexibility and
successful transition from
school to adult life for students with
disability, the Better Pathways and
the ICAN models must be continued.
The Department of Education and
Children’s Services, in partnership
with independent and Catholic
schools, must expand and enhance
school transition plans between
school sites and post-school pathways.
Department of Education and
Children’s Services funding to schools
for students with disability must be
tied to education needs specifically for
students with disability and not flow
into the global school budget.
36
Chapter 2
Providing Choice,
Taking Control
Throughout the community
engagement process, people with
disability and their carers, families
and advocates said that people with
disability must be respected as human
beings and valued as citizens.
The Social Inclusion Board heard that
our disability services system:
> should focus on encouraging
people to thrive, strive or accomplish
outside their identities as people
with disability
> needs to recognise people with
disability as highly unique and
diverse individuals
> needs to view people with disability
as experts about their own needs
> focuses on impairment rather than
supporting a person to actualise
their vision of the good life
> would more effectively meet
individual needs and aspirations if
it was more flexible
> should foster creativity and control
so that people can decide what they
need to live the life they want
> emphasises personal care and
domestic support but should also
assist people to achieve and aspire.
The Board believes that South
Australia’s disability services should
focus on people’s growth, autonomy
and capacity to engage in community
activities as citizens while offering
services that build on people’s
strengths and community networks.
Current services would be greatly
enhanced by embracing innovation
and allowing flexibility to meet
individual needs.
The community engagement process
provided strong and clear messages
about what people with disability and
their families and carers need from
South Australia’s disability services.
People told the Board they want:
> to be listened to and consulted with,
in determining the type of services
they require and have greater control
over how they are provided services
that are flexible, personalised and
easy to access
> choices regarding how they
receive supports (they view
individualised funding as a key
mechanism to improving choice
and maximising control)
> dignity through assuming increased
responsibility for choice and control
over their lives.
“Parents are frustrated that if
their child does not fit into a
certain category for a program
or if the program does not meet
their individual needs, they have
no other options.”
Elizabeth Community Meeting
The Board knows that we must change
the way people with disability and
their families and carers receive and
use supports across services and
systems. This change must focus
decision making power with the
individual and away from systems.
Maximising control for people with
disability and responding to their
needs, strengths and life plans is
a prerequisite to transforming
the service into one that is more
personalised.
This chapter discusses how the
Board believes we must transition
to a demand driven, flexible and
responsive system that maximises
autonomy, independence and
efficiency. It is about giving voice,
control and choice to people who are
engaged with disability services.
38
Enshrining personalisation
into our systems
Each person is different, with unique
gifts, strengths, passions, dreams,
limitations and weaknesses. As a
starting point we all want to live an
ordinary, dignified and satisfying life
that allows us to aspire and achieve.
A personalised disability
service system:
> recognises that people with
disability have both the capacity
and the right to control the
supports and services they
need to live full and active lives
> enables people with disability
to explore the possibilities of
what a good life, on their own
terms, can constitute
> builds on people’s strengths,
skills and interests
> fosters a more meaningful
engagement with the broader
community
> facilitates the voice and choice
of people with disability in the
planning, design, delivery
and evaluation of services
they receive
> enables a simpler eligibility and
assessment process to
determine what people need to
live a good life
> recognises diversity, particularly
cultural diversity, and how
that translates to different
services needs.
There is no evidence indicating that
people with disability are not able to
experience lives that are ordinary11,
dignified and satisfying. There is
however, clear evidence about the
barriers and obstacles that currently
impede this from happening.
Systems focused services act as a
barrier to people leading lives that are
purposeful, healthy and empowering.
They also contribute to problems
such as welfarism, dependency, poor
health (including mental health), and
economic exclusion.
“Families and carers of people
with disability are not receiving
flexible services and have limited
control around the types of
services they can access.”
Mount Gambier
Community Meeting
Through embedding personalisation
into our service system, the starting
point is not the service, but the
individual with disability, their family,
carer and community.
“Eligibility criteria to access
funding, services and to enrol
children at school are regarded
as exclusionary measures
by some.”
Mount Barker
Community Meeting
A personalised approach is in line with
national and international directions.
The first principle of the United
Nations Convention on the Rights
of Persons with Disability is “respect
for inherent dignity, individual
autonomy including the freedom
to make one’s own choices, and
independence of persons.”12
Personalisation can be achieved
through a range of mechanisms
but should also be understood as a
philosophy that drives all parts of
systems and services.
The term ordinary is deliberate, the Board heard on multiple occasions that people with disability want to lead normal lives,
not be seen as ‘special’ and ostracised as a result | 12 http://www.un.org/disabilities/convention/conventionfull.shtml
11
39
The Board believes that the services
system must be reformed to foster
the independence, engagement and
aspiration of people with disability.
Personalisation through assessment
The role of eligibility and assessment
processes in a contemporary disability
service system is to identify which
people require support, and what
supports and assistance are needed.
It also influences how a person with
disability, their carers and families will
engage in community activity.
The Board heard through the
community engagement process that
people are frustrated about having
to tell the same story multiple times.
The issue is particularly traumatic for
people with disability from culturally
and linguistically diverse communities,
many of whom expressed concern
about the lack of translation and
interpretive services to assist them
to better understand their disability
and the types of services and supports
that are available. In most cases, their
children act as interpreters, which is
patently inappropriate.
“Current eligibility criteria
and application processes are
presenting barriers to many
people.”
Berri Community Meeting
Multiple assessments in part occurs
because different agencies have
separate assessment processes
with little knowledge of what has
occurred in another agency. Based
on the permission of the individual,
assessment and subsequent relevant
information should be available to
the Department for Families and
Communities, the Department of
Education and Children Services and
the Department of Health.
The Social Inclusion Board recognises
that assessment is critical to ensuring
that people with disability get
the right services when needed.
Assessment should be streamlined
and understandable (such as use of
plain English) with the consumer’s
voice empowered by expert
information.
The Board acknowledges that through
the National Disability Agreement
and the COAG Standing Council
established to review the Productivity
Commission’s recommendations
on Care and Support for People
with Disability, standard and shared
assessment tools are being developed
nationally. It is important that
South Australia supports this work
by advocating person-centred
assessment that includes diagnosis
and expert information, but prioritises
building independence and life
planning.
Separate from this national work,
South Australia’s existing assessment
processes must demonstrate a
commitment to the principles of voice,
choice and control, by minimising the
decision making hierarchy and placing
final decisions with the person with
disability or their guardian, whereever
possible.
The Board supports assessment that
has a stronger emphasis on:
> gathering information about a
person across all life domains - their
strengths, goals, preferences, needs
and circumstances
> meeting an individual’s day-to-day
needs but further recognising that
personalised supports should also
be available to assist an individual’s
aspirations (in some cases
warranting a greater level of support
for a period of time)13
> planning to meet future needs,
goals and aspirations
An example of this could be the provision of more support or services while a person undertook tertiary education with a view
to gaining future employment; such investment would be warranted. Life stage transitions (and major life events) should trigger
consideration of the need for re-assessment. Individuals and their families and carers should also be able to initiate this process.
13
40
> information sharing to reduce
repetition and provide more
joined-up services
> recognising diversity so that the
needs of Aboriginal people and
culturally and linguistically diverse
people are assessed in a manner that
is culturally competent and provides
culturally appropriate services or
supports.
“People with disability and their
families have found agencies
difficult to navigate to access
services. They would like to
see more transparency and
information sharing between
agencies so that they don’t have
to ‘tell their story’ at every
referral meeting.”
Murray Bridge
Community Meeting
41
“We seem to revisit the same
issues over and over and be
assessed and reassessed ad
infinitum where previous
assessments could inform current
issues. Each request results in the
same chain of events, revisiting
issues, and causing unnecessary
delays in provision of services. The
frustrations and delays are a real
source of grief.”
Survey respondent
Carer’s lives are often inextricably
connected to a person with disability,
such as a carer who is a parent,
sibling, partner or child. In gathering
information across all life domains,
assessment should be able to include
the carer, where relevant.
Recommendation
10
Priority Action The decisions
of the person with disability
must be the authoritative voice in
finalising an assessment and resource
allocation. The State Government
must ensure that the assessment
addresses all relevant life domains
and includes the person’s life plans
and ambitions. The assessment will
be driven by the person’s needs and
aspirations.
Personalisation through
Individualised Funding
In South Australia most disability
services are block funded which means
that a Government or contracted
service provider is funded to provide
a defined service to a defined number
of people or as many people as it can14.
This means that services are supply
driven, and the individual consumer
has to fit the service as best they can.
Individualised funding is a system in
which people with disability and their
families and carers make decisions
about the expenditure of funds
assigned to them and, in doing so,
exercise discretion on what services
they buy. This opens the opportunity
to find what will work best for the
individual, in contrast to having to fit
into a pre-determined menu of limited
service types. Through individualised
funding, the consumer drives the
demand for services and in doing so
influences how services are shaped.
Besides delivering better services,
individualised funding can empower
the person with disability to take
greater control of their lives, and plan
for the future.
The national and international
literature about individualised
funding is extensive and the benefits
have been well documented.
“Self-directed funding — the
capacity (but not the obligation)
for people to make choices about
how to spend their individualised
budget — will be key in giving
people with disability greater
autonomy.”
Productivity Commission
Draft Report on Disability Care
and Support15
All Australian jurisdictions have
different forms of individualised
funding in place. These range from
block funding going to service
providers, to negotiating a service
type with the individual, to funding
allocated to the person with disability
to negotiate and purchase services.
These models vary in the level, choice
and authority of the consumer to
decide what services they receive
and how. Funding packages that are
managed by the person with disability,
their family or a facilitator and that
can be spent in the open market, can
generally be tailored more easily
Fisher et. al 2010 http://www.pc.gov.au/__data/assets/word_doc/0016/111346/29-disability-support-appendixe.doc
http://www.pc.gov.au/__1data/assets/pdf_file/0014/111272/disability-support-overview-booklet.pdf
16
Fisher, Gleeson et. al 2010 http://www.pc.gov.au/__data/assets/pdf_file/0010/99712/sub0084.pdf
towards the consumer’s preferences
than more restrictive packages or
those that must be spent through
a single service provider16. Funding
packages that are managed by the
person are referred to as the ‘direct
funding’ model.
Individualised funding, and in
particular direct funding, facilitates
innovation and efficiency in
expenditure. Individualised funding
encourages people to use networks
and informal supports that are
sustainable and innovative.
The Board endorses the individualised
funding model as the preferred
approach to maximise autonomy and
outcomes. For this to be achieved,
individualised funding must be
available in a variety of forms that best
suits the person with disability.
14
15
42
South Australia has introduced a direct
funding model, titled Self Managed
Funding. The Board acknowledges
that this model provides the person
with disability the greatest autonomy,
because it:
> is a pure application of the principles
espoused within the United Nations
Convention on the Rights of Persons
with Disabilities17
> ensures that individuals who are
eligible for specialist disability
services can exercise direct control
over decisions about the funds they
are entitled to
> offers individuals three funding
administration options.
Self Managed Funding is at a very
early stage of implementation, with
limited access to the scheme. The
Board supports the expansion of
Self Managed Funding in South
Australia and believes that it will be
more accessible and efficient due to
reductions in departmental controls
and red tape.
43
The alternative to Self Managed
Funding is ‘Self Directed Service’,
enabled through individuals being
allocated a budget for their service
entitlement. Self Directed Service
means that a service a person is
entitled to is translated into a unit
cost and that funding is allocated to
the person who can then request that
their allocation be spent elsewhere or
redistributed to prioritise a particular
service. Under Self Directed Service
a person does not manage their
own funding, they simply have the
authority to decide how and what
services meet their needs.
A self directed service example
Bob is entitled to six hours per
week in-home support and day
options program two days per
week. The unit value of in-home
support is $50 per hour and for
the day options, the unit value
is $80 per day. Therefore Bob’s
allocated funding is 6 (hours) X
$50 and 2 (days) X $80 totalling
$460 per week.
Knowing his allocation, Bob can
decide his day option funding is
better spent on transport to visit
a brother three times a week.
Alternatively, he could decide
that the money would be more
effectively used if he increased
in-home support and attended
day options once a week.
An important part of an effective
personalised approach is minimising
the hierarchy of approval processes for
the person’s ‘expenditure plan’. This
also assists in ensuring the person
with disability remains connected
with, and in control of, their plan.
Trained staff must have the capacity
and delegation to approve an
expenditure plan in consultation with
the person with disability, without
having to submit it for review and
approval within the system.
In addition to its operational and
outcome advantages, it is anticipated
that individualised funding will
be required for South Australia to
transition to a National Disability
Insurance Scheme in the future.
Implementing and expanding
individualised funding quickly may
enable South Australia to operate as
a pilot region for a National Disability
Insurance Scheme.
The Board recognises that there
are limitations and risks regarding
individualised funding models. A
personalised approach to individualised
funding must be complemented by
supports that enable people to see
what their possibilities or options
are. This is particularly important for
people with disability who have been
entrenched in the specialist disability
system. When people have a vision
of what they can achieve or what life
they may want to live, individualised
funding can become a tool to turn that
possibility into a reality. The assessment
process is important for beginning this
journey. Positive and skilled support in
developing a person’s expenditure and
life plan is critical.
17
Information and training are vital
elements for maximising the benefits
of individualised funding. People
with disability must have access to
information on how individualised
funding is being used and the
opportunity to share stories and
information. This will assist people
with disability and staff in developing
an expenditure plan, as well as
encourage people to think outside
the system for community resources
available to support them to go about
their lives.
Individualised funding should not be
limited to disability specialist settings.
People receiving disability services in
health and education settings should
also have access to individualised
funding that enables them greater
choice and control around what
services they access, and when and
how they are delivered.
Across South Australian Government
agencies, where people with disability
have an entitlement to a service,
individualised funding must be able
to be rolled into a single package with
a single Government approval process.
This approach will give people with
disability better coordinated support
and services and facilitate a cohesive
Government response to their needs.
http://www.un.org/disabilities/convention/conventionfull.shtml
“Individualised funding is a
positive step but it is important
that it is not too bureaucratic.
A current participant of the trial
noted that it provides greater
choice and flexibility in the way
that they are able to receive
services – often enabling them to
have more services.”
Port Lincoln Community Meeting
Recommendation
11
Priority Action Individualised
funding must be made
available to all new clients of
government disability services and
those on the Unmet Demand List,
from July 2012. This includes housing
support packages. All people receiving
specialist disability services must
have individualised funding by 2017,
in line with the proposed National
Disability Insurance Scheme rollout.
All agencies administering specialist
disability funds must ensure joinedup arrangements are in place, to
streamline processes for people with
disability, their families and carers.
44
Individualised funding will transform
the management of public funding
for disability services and the notfor-profit sector will be profoundly
affected. Individualised funding
will end large block funding
going to organisations to deliver a
predetermined service. Funding will
be more fluid across organisations as
people with disability will individually
choose where their funding is
best spent.
This dynamic market will have
implications for organisations in
terms of business planning, including
services design, workforce recruitment,
tenure and development.
The disability sector, in partnership
with the State Government, must
begin planning for the transition to
this new environment.
Workforce planning and development
will be central to the success of this
transition.
The Social Inclusion Board recognises
that the quality of service and care
to support people with disability is
45
dependent on the capacity of the
workforce. The transformation to
a citizens’ focus with more power
and choice available to people with
disability will require a workforce
that is skilled, adaptable and
innovative. This will be relevant to both
mainstream and specialist service
providers. A workforce that is better
supported through training and
development, as well as understands
how personalisation translates to
service and business planning, will
help reduce high turnover and the
dissatisfaction of both workers
and clients.
The promotion of individualised
funding models should enable more
flexible employment beyond standard
service providers and provide wider
workforce opportunities. This is
particularly important in regional
and remote locations where services
may be limited due to population
density. Individualised funding has
the potential to benefit culturally and
linguistically diverse and Aboriginal
communities by providing greater
choice in selection of service providers.
The Board heard through the
community engagement process that
there need to be greater awareness
of disability issues impacting on
culturally and linguistically diverse
communities.
Recommendation
12
Priority Action The
Department of Treasury
and Finance must work with all
relevant Government departments
and not-for-profit organisations to
plan the transition from current
funding arrangements to universal
individualised funding by 2017, to align
with the proposed National Disability
Insurance Scheme. This includes the
associated business planning in the
not-for-profit sector.
The Social Inclusion Board or a similar
body will monitor and support the
progress of this recommendation.
The Board recognises the broad
nature of disability and the breadth
of organisations, large and small,
working in the disability field. It is
important that all organisations
have the capacity and resources to
represent themselves, their members
or client group.
Recommendation
13
The disability sector is
rich in its diversity and the
Government must find a way to hear
and respond to all voices in the sector.
Adequate funding of all groups must
be provided in order to ensure all
voices are heard.
Ensuring personalisation for
Families and Carers
Service systems can and should
provide services and supports in a way
that fosters greater independence and
autonomy among service users. This
includes the families and carers of
people living with disability.
Through the community engagement
process, families and carers told us
that they wanted more respite and
flexibility in terms of when, where
and how respite can be used. These
issues are exacerbated for carers
across rural and regional South
Australia due to factors including
the shortage of care workers and the
difficulty in maintaining a professional
care workforce. This has limited the
availability of formal respite services in
regional areas.
In addition, as noted by Carers SA,
carers’ access to respite is negatively
affected by challenges including
accessing transport, constrained to
respite when it is offered rather than
when it may be needed, and the issues
associated with a workforce that is
declining in numbers.
‘Respite’ is a term that describes what
we commonly know as a break from
the routine or stress of day-to-day
life, an opportunity for carers to do
other things. The Board heard that
overwhelmingly families and loved
ones are committed to their caring
“There is no respite support
for young carers of parents
with disabilities.”
Coober Pedy
Community Meeting
role and deeply love those for whom
they care. But in order to sustain
this role, they need a break, some
meaningful time out and opportunity
to participate in other aspects of
their life such as education, work, and
leisure and community engagement.
Carers told the Board that they need
more respite and more choice about
how they can use respite.
Carers stressed that respite can be
provided in a range of settings. This
can include care in the home of
the person with disability, with an
alternative family carer, formal respite
service/carer and community settings;
through camps, holidays and social or
recreational activities.
People with disability should also
experience respite in a positive way,
that also enables them to enjoy a
break from their daily routines and
feel safe.
Respite funding must be provided
within an individualised funding
model to give carers and people
with disability, greater autonomy in
determining what will work best for
them. Critical to respite programs
is the active voice of carers, people
with disability and their families in
the way that this support is offered.
There should be no restriction on
how respite can be utilised other
than evidence that it gives the carer
a genuine break, and, in the long
term, sustains them to continue their
caring role. In addition, the person
with disability experiencing respite
should be ensured quality care and
support, safety and an opportunity
to enjoy the break. An individualised
approach to respite entitlements
should be of particular benefit to
regional carers by giving greater
flexibility in how this funding is used.
Respite funding should be able to be
rolled into any Family Living Initiative
support available, so that people with
disability, their family and their carers,
can exercise increased flexibility and
choice in what works best for them.
Carers’ lives are often inextricably
connected to a person with disability,
such as a carer who is a parent,
sibling, partner or child. The needs,
interests and wishes of both the carer
and person with disability must be
considered in the provision of respite.
A positive experience for one will
translate to the other.
46
Support for carers in performing
their crucial role is fundamental
to a sustainable and high quality
disability system. The Board recognises
the importance and value (social,
emotional and economic) of the role
carers provide to individuals and the
community. Whilst some unmet
respite needs are categorised as critical
and evident (category 1 and 2 Unmet
Demand Waiting List), there is also
unmet need for respite categorised at
lower levels.
The Board believes that the
investment in caring for people with
disability should be increased to meet
the demand registered by Disability SA.
Recommendation
14
To better support carers,
the Government must:
> increase recurrent investment in
respite in the next budget (2012/13),
to meet respite demand on the
Unmet Demand Waiting List.
> ensure increased access to respite
in regional and rural areas; including
prioritised roll out of individualised
funding in these areas
> provide greater financial weighting
for carers in regional and rural
areas entitled to respite to recognise
increase costs to access services.
47
Carers SA has advocated it is essential:
“… to adopt a family centred
approach to the access, provision and
maintenance of support for people
with disability. This involves looking
at family as a whole and assessing
and providing for family need and
under this assessing and providing for
individuals within the family…”.
The Board has heard older carers
express their anxiety for the future of
a person with disability that they care
for. Data shows that South Australian
carers are ageing. Carers aged 45 to
65 years make up 45% of carers and
a significant proportion of carers are
over 65 years. Since 2009, this 65 years
and over cohort has increased
by 10 per cent18.
Recommendation
15
In recognition of the
special needs of elderly
parents caring for their adult
children with disability, the
Government must develop a
‘future planning’ mechanism with
commitments for assisting these
families in their life long planning.
The Family Living Initiative and
Community Living Initiative should
be used as a resource to assist future
planning for people with disability
and their ageing carers prepare for
the future.
Carers have reported the financial
stress they experience and that they
feel trapped in financial hardship due
to reduced access to employment and
higher than average dependency on
a pension for their income. In 2009,
carers had a lower than median gross
income of $393 per week compared
with $500 for non-carers19.
There are several reforms in Strong
Voices that alleviate the financial stress
on people with disability, their families
and carers, such as increased transport
concessions, and the Family and
Community Living Initiatives. However,
the Board believes that further
assessment and exploration on how
the community can better support
carers and families is required.
Recommendation
16
To assist carers with the
cost of caring, the Government
must undertake an evaluation of
the effectiveness of concessions and
subsidies for carers and implement
further initiatives to reduce the
financial pressures on families and
carers of people with disability.
18
19
SDAC, ABS unpublished data
SDAC, ABS 2009
Chapter 3
Strengthening Rights,
Protection, Advocacy
and Safeguards
Enshrining personalisation
into our systems
Through the community engagement
process, the Social Inclusion Board
heard that safety, rights, enforcement
and vulnerability to exploitation or
abuse were key concerns for people
with disability, their families and
carers. People across South Australia
spoke of the need for systems that
prevent abuse and provide a strong
voice for, and on behalf of, people with
disability, their families and carers. The
community engagement process also
emphasised:
> people with disability do not
always feel safe in service settings
> women and children with disability
are particularly vulnerable to abuse
and sexual exploitation in service
settings and in the community
> people with disability experience
stigma and discrimination and
this increases vulnerability
> people with intellectual disability
and those who exhibit behaviours
perceived to be challenging, are
among the most discriminated,
excluded and vulnerable in
our community
> people with disability do not feel
empowered to make complaints
> people do not understand their
rights, how they can enforce them
49
or advocate for themselves
> robust advocacy is considered a
standard requirement to get service
responses. As there are limited
advocacy options, many parents and
carers are forced to take on the role
of advocates for the person(s) they
are caring for. Parents of adult
children with disability are concerned
about the lack of advocacy available
for their disabled loved ones once
they are no longer around
> people with disability require
stronger, clearer complaints and
advocacy mechanisms to contest
breaches of care, trust and law
> stronger enforcement of
anti-discrimination laws should
be applied to ensure people with
disability are treated fairly,
particularly in the workplace.
The Board believes that recognising
a person’s rights as a citizen, and
having full access to those rights,
is fundamental to an individual’s
wellbeing, participation and
achievement of their life ambition. This
represents a ‘rights based approach’
and underpins the reform needed
across a range of areas. Rights need to
be understood, applied and protected,
by everybody in our community.
Nationally, there has been a strong
shift towards a rights based approach
for people with disability. This is
evident though Australia’s adoption
of the United Nations Convention on
the Rights of Persons with Disabilities.
The 2010 National Disability Strategy20
also commits to implementing a rights
based approach.
This section of Strong Voices sets out
how the Board intends to reform and
strengthen rights and protection
mechanisms to improve the wellbeing,
participation and contribution of
people with disability, their carers
and families.
Strengthening a system of protections
and safeguards is about giving people
with disability and their carers and
families access to equal rights afforded
to other citizens in our community.
People with disability have different
needs and require different
protections to achieve equal
participation. Some people with
disability are particularly vulnerable
to having their rights abused. This
means that the rights of people
with disability must be recognised,
Complaints and advocacy
that abuse, exploitation and neglect
is prevented from taking place
and that such incidents, if they do
happen, will be redressed. Children,
women and Aboriginal people are all
particularly vulnerable. There must
be an additional focus on ensuring
that their rights are upheld and that
they are protected from abuse and
exploitation.
There is clear research that shows
people with disability are more
vulnerable to abuse and violence,
particularly in institutional settings21.
The research evidence is strongly
backed by the submissions and
consultations through Strong Voices.
Strong purposeful legislation provides
the bedrock for rights and protection
but it is not effective without systemic
implementation. A systemic approach
to safeguarding people with disability
in South Australia should include a
coherent mix of mechanisms ranging
from developmental (training and
awareness) to the preventative
(good policy and practice) to the
corrective (investigation, advocacy
and enforcement).
Social Inclusion Survey
Respondent
Through the Community Engagement
process the Board heard that people
did not feel they could make a
complaint or they did not know where
to take a complaint. An accessible and
responsive complaints mechanism is
essential to maintaining standards,
protecting rights and ensuring
accountability.
Currently there are several avenues
to make a complaint such as the
Ombudsman, the Public Advocate,
Equal Opportunity Commission,
Health and Community Services
Complaints Commission or service
based systems such as the Police
Complaints Authority and internal
agency procedures.
The Board believes one specific
authority should have a higher
profile in the disability community
as the principal complaints authority.
The profile will be built by leading
community awareness education on
rights and obligations and providing a
broad based complaints service to deal
with disability related complaints.
http://www.fahcsia.gov.au/sa/disability/progserv/govtint/nds_2010_2020/Documents/National_Disability_Strategy_2010_2020.pdf
http://www.fahcsia.gov.au/sa/disability/progserv/govtint/nds_2010_2020/Documents/National_Disability_Strategy_2010_2020.pdf page 38
20
21
Often, people with a disability
don’t know that they have rights,
or even that a situation they
might be in is not acceptable to
the general public. While there
is much red tape with which
organisations need to comply,
there is little accountability to
the individual person - in other
words, do they ever ask the
question: Will this action make
someone’s life better or worse?
50
“People with a disability feel
powerless to contest breaches
of legislation and regulations
because they have no support
or advocates to assist them.”
“An effective complaints process
is a critical component of
disability services legislation.
It is necessary to ensure rapid,
just and sensitive resolution
of complaints and for the
upholding and enforcement of
client rights and entitlements. It
should also be a valuable source
of information and data to
improve the service system.”
Mount Barker
Community Meeting
In addition to addressing individual
grievances, the authority will also
pursue and advocate on systemic
issues. A principal complaints
authority will remove the complexity
of having to find the correct authority,
before coming forward with a
complaint.
Peak Body Submission
To fulfil its proposed role, the HCSCC
must have its mandate broadened to
cover environments where care and
guardianship for people with disability
occurs (such as schools, detention
facilities and private homes). It must
also actively promote itself in the
community to build awareness and
ensure accessibility.
An existing central complaints based
service is the Health and Community
Services Complaints Commission22
(HCSCC). The Board believes the HCSCC
is best positioned to take up the role
as the principal complaints authority.
The HCSCC is an independent
statutory office that receives and
investigates complaints about health
and community services (including
specialist disability services) across
Government, not-for-profit and
private sectors.
Improving access will be enhanced by
the HCSCC operating on a ‘no wrong
door’ policy for any disability related
complaints received. If a complaint is
received that is not within the HCSCC
jurisdiction, appropriate information
will be gathered and passed to the
responsible authority for action (with
the permission of the complainant).
Incorporating ‘Disability’ into the title
of the Health and Community Services
Complaints Commission will improve
the profile and recognition of the HCSCC
as the principal complaints authority.
Recommendation
17
Priority Action The Health
and Community Services
Complaints Act 2004 must be
amended to broaden the mandate of
the Health and Community Services
Complaints Commission (HCSCC)
to include all settings where care of
people with disability is provided. The
HCSCC must be resourced to perform
this role and systemic issues in line
with its current role. In implementing
this reformed function, the HCSCC
must commit to an awareness and
education campaign on rights,
obligations and the HCSCC’s role
as a gateway for complaints about
disability care, support, discrimination
and wellbeing. A specific focus of the
campaign will be to eliminate the use
of restrictive practices.
http://www.hcscc.sa.gov.au/cgi-bin/wf.pl?pid=I28aZ&mode=cd&file=../html/documents//05_making%20a%20complaint
Bigby, Office of the Senior Practitioner including people with Behaviours of Concern in the Social Inclusion Agenda, Office of
the Senior Practitioner, Melbourne, 2010
22
23
51
The complainant may return to the
HCSCC for follow up on progress or the
outcome of a complaint.
Use of restrictive practices
A key concern raised through the
community engagement process
was the inappropriate use of
‘restrictive practices’.
“without data, it is difficult to make a
formal quantitative conclusion about
the extent of restrictive practices in
this State” 24.
Restrictive practices include the
isolation, detention, seclusion or
restraint (physical, chemical or
mechanical) of a person for reasons
other than medical necessity or
criminal law. Such practices are often
used as a response to challenging
behaviours such as physical
aggression, destruction of property,
self injury or inappropriate sexual
behaviour 23.
The Office of the Public Advocate has
also noted that South Australia needs
legislative reform to better protect
people who have disability from the
unnecessary use of restraint, detention
and seclusion.
In addition to the community
engagement process, the usage
of restrictive practices has been
highlighted through both media and
government reporting, however the
extent to which it has been employed
is unknown. The South Australian
Office of the Public Advocate has
provided an in-depth analysis of the
application of restrictive practices
in disability settings, noting
however that:
While there are rare exceptions where
restrictive practices might have useful
or therapeutic application, its overall
use has largely had negative and
adverse consequences for people living
with disability25.
“The use of restrictive practices
must be minimised. The Office of
the Senior Practitioner, created
within Victorian legislation, has
been instrumental in assisting
services to improve the support
they provide to people who may
be thought to be at risk of causing
harm to themselves or others.
The approach taken has been one
of collaboration—information,
training and support have been
a feature (with action taken on
ongoing misuse).”
Peak Body Submission
Safely reducing the use of restrictive
practices requires strategies around
workforce development and training,
strong interagency partnerships and
engendering personalised service
models across all service settings.
In performing its expanded role
to eliminate the use of restrictive
practices, the HCSCC must work in
partnership with the Public Advocate
and Disability SA.
South Australian Office of the Public Advocate, Annual Report 2010, p. 70.
Australasian Society for the Study of Intellectual Disability (ASSID), Official Position Statement:“Against the Use of
Restrictive Practices in the Support of People who Have an Intellectual Disability”, 2010 http://asid.asn.au/LinkClick.
aspx?fileticket=1-5Xv1RYHuU%3d&tabid=116 and Office of the Senior Practitioner, Annual Report 2008-2009, Victoria
24
25
52
Community Visitors Scheme
Across Australia, Community
Visitors bring community values
and standards into care settings
across a range of areas including
aged care, mental health, health
and disability. The 2009-10 Victorian
Community Visitors Scheme Annual
Report, describes Community Visitors
as “the eyes of the community on
the standard of care for those with
disability, who are vulnerable or who
have a mental illness.”26
Community Visitors regularly visit a
range of settings where people live or
are cared for, including small group
homes in the community, institutional
settings, supported residential
facilities and mental health facilities.
They meet people, inspect facilities,
ensure that individuals’ needs are met,
and check that problems raised on the
last visit have been corrected. In service
settings with longer-term clients or
residents, Community Visitors can be
a source of trust and confidence for
consumers to raise issues.
53
A Community Visitors scheme has
recently been established in the South
Australian Mental Health system.
Key stakeholders in South Australia,
in addition to comments received
through the community engagement
process have emphasised the need
for a community visitor scheme in
disability settings.
Using the lessons imparted by the
Victorian experience, the Social
Inclusion Board further notes the need
for a Memorandum of Understanding
to be established so that information
collected by the Principal Community
Visitor, is relayed in a regular manner
to Disability SA as the funder and
provider of specialist disability services.
The Social Inclusion Board is
supportive of amalgamating the
mental health Community Visitors
Scheme with a disibility Community
Visability Scheme. Such an
arrangement could:
Recommendation
> provide stronger development and
support for staff and volunteers
> better identify systemic issues across
mental health and disability services
> achieve more efficient allocation
of resources.
18
To ensure the quality of
care for people with
disability, a Community Visitors
Scheme must be established under
a new Disability Act. The Scheme
will be managed by a ‘Principal
Community Visitor’ who will monitor
standards of accommodation and
support for people with disability and
their families and carers in disability
accommodation settings. The Principal
Community Visitor will report to the
Public Advocate.
The Board proposes that the new
Disability Act provides for the role and
powers of the Principal Community
Visitor and Community Visitors similar
to the provisions within the Mental
Health Act 2009.
26
27
Victorian Community Visitors Annual Report 2009-10.
http://www.courts.sa.gov.au/community/going_to_court/guide_self_rep/Evidence%20Act.UN.pdf
Accessing Justice
The Social Inclusion Board recognises
that people with disability must have
their rights protected and upheld.
People with disability should be
supported to participate in the justice
system on an equal basis with other
members of the community. People
with increased vulnerabilities should
be provided with supports to manage
their interactions with legal processes.
Reform is needed to better identify
and respond to the needs of people
with disability in the criminal justice
system, whether they are a victim,
witness, or the person charged.
The Board acknowledges the
ground-breaking work done in South
Australia through the Magistrates
Court Diversion Program (Mental
Impairment Court) that provides
diversion and access to services
through the courts. However, there
has been little reform beyond the
introduction of this initiative in 1999.
Failure to identify and respond to
vulnerable people with disability
charged with an offence can result in
unnecessary incarceration of people
who need support services rather
than imprisonment. The regular
incarceration of Aboriginal people
who have experienced brain injury is
an example that was brought to the
Board’s attention.
People with disability, in particular
intellectual disability, are vulnerable
to victimisation and abuse. The
vulnerability of women and children
to abuse and assault has been
highlighted through the community
engagement process.
People with disability must be
supported to use the justice system
and enable more effective prosecution.
The justice system can be intimidating
for anybody; this is exacerbated for
people with disability who lack the
appropriate support to reduce barriers
to participation in the legal system.
Supporting people with disability who
are victims of crime and protecting
others in the community, requires
a significant reform of the way the
justice system responds to people
with disability.
Police play a vital role in the process
of building a case for the prosecution
authority. It is essential that police
have the skills and expertise in
working with people with disability.
Failure to adequately investigate or
understand crime against people with
disability, contributes to the lack of
prosecutions and deterrence of crimes
against people with disability.
Barriers for children as victims (and
witnesses) in the criminal justice
system is well established. While
recent amendments to the Evidence
Act 1929 have improved access to
special provisions for vulnerable
witnesses, more reform is needed.
Advocates have called for further
reform of the Evidence Act 192927 so
that a person with disability is able
to give evidence with the use of an
interpreter. The Board understoods
that the South Australian AttorneyGeneral is currently reviewing this
recommendation as part of a review
of the Act.
Too much abuse, neglect and
indifference occurs in the
shadows. If people really knew
the reality of life for people with
disabilities and their families they
would be horrified. Put a spotlight
into the dark corners.
Survey respondent
Recommendation
19
The safety and protection
of people with disability
must be recognised as a priority
across the criminal justice system.
The Government must develop a
comprehensive Disability Justice Plan
in consultation with people with a
lived experience with disability, the
Public Advocate, and the Health and
Community Services Complaints
Commissioner. The plan must ensure:
> adequate resources are committed
to prioritise investigation and timely
prosecution of crimes against people
with disability
> more effort on prosecution of
matters where a person with
disability is an alleged victim
> increased support for vulnerable
witnesses, particularly children.
54
Women and Girls with Disability
Gender is a major factor in all domains
of life. Gender is particularly an issue
for women and girls with disability
in child-bearing and parenting,
domestic violence, sexual abuse
and exploitation, employment
opportunities and preferences,
housing, leisure choices, health
services, and safety in public places.
The importance of considering gender
when thinking about disability
is clearly articulated in the UN
Convention on the Rights of Persons
with Disability, Article 6 (Women with
Disabilities)28.
This states that:
“1. Parties recognise that women and
girls with disabilities are subject to
multiple discrimination, and in this
regard shall take measures to ensure
the full and equal enjoyment by them
of all human rights and fundamental
freedoms.
Under the Convention, Australia is
urged to undertake a comprehensive
assessment of the situation of women
with disabilities and, as a matter of
priority, to address the abuse and
violence experienced by women with
disabilities living in institutions or
supported housing.
The vulnerability of women with
disabilities is recognised in the
National Plan to Reduce Violence
against Women and their Children
and recommends that there should be
promotion of improved ways to access
services and respond to women
with disabilities.
Recommendation
20
In recognition of the
vulnerabilities of women
and children, a gender and child
focus must be applied to individual
assessment and life plans, agencies’
Access and Inclusion Plans, and the
education and awareness campaigns
and materials produced by the Equal
Opportunities Commission and the
Health and Community Services
Complaints Commission.
The implementation of Strong
Voices, gives the South Australian
Government and community the
opportunity to address the particular
vulnerabilities and issues of women
and girls with disability.
2. Parties shall take all appropriate
measures to ensure the full
development, advancement and
empowerment of women, for the
purpose of guaranteeing them the
exercise and enjoyment of the human
rights and fundamental freedoms set
out in the present Convention”.
55
28
http://www2.ohchr.org/english/law/disabilities-convention.htm#6
Chapter 4
Investing
Early.
Through the community engagement
process, the Social Inclusion Board
heard strong and consistent
messages that:
> people with disability, their families
and carers need access to resources
and support when they need them,
not when their needs become critical
> people want confidence that there
will be support and continuity to
plan their life
> carers and families want support
that is flexible and family-centred to
keep families strong and resilient
> parents of children with disability,
particularly in regional areas, often
wait months to access or be assessed
as eligible for services and are
provided with minimal support
or training to address their
children’s needs.
Regional communities have told us
that traditional specialist services
are limited, poorly coordinated,
inconsistent and unreliable.
Additionally, in many regional
communities, people with disability do
not have access to:
> local allied health services
(and therefore rely solely on
infrequent visiting services)
> support services to provide families
with respite and personal care even
when brokerage funds are allocated.
Across the State, the Board spoke with
many people who had requested
services from Government but were
unable to access them because they
were not available. The Board also
heard from people who required
services but did not request them
because they believed the system
could not provide them.
The Social Inclusion Board believes a
stronger and more dominant early
investment approach is needed
to empower individuals, improve
services, avert crisis and achieve better
outcomes for all South Australians.
57
The term ‘early investment’ in
the context of this report is used
to describe access to a wide
range of formal and informal
supports at an early stage and
at key transition points in life.
These supports facilitate a
personalised approach to service,
build independence, capacity
and plan for risks before people
reach crisis.
The Board believes that early
investment facilitates the
broader reform directions
proposed in Stronger Voices
including personalised
approaches, capacity and
independence building, social
participation and shared
responsibility across the
community.
This section of Stronger Voices sets out
how the Board will reorientate South
Australia’s specialist disability system
to incorporate a planned transition to
early investment.
A system geared towards crisis
Unmet need
While the Board acknowledges that
any service system must contain
mechanisms to help people in crisis,
there is an urgent need to develop
ways to assist people within their
communities to avert crisis and plan
for their futures.
Of the 196,700 South Australians with disability under 65 living in households30 in
2009, 84% (166,000) reported needing some form of assistance31 including:
Strong Voices proposes that
South Australia focuses on delivering
assistance for people with disability
before they reach crisis point,
in line with best practice in other
Australian states.
> household chores and property maintenance
> transport
> self care and health care
> cognitive or emotional tasks
> reading and writing.
Of those who reported needing assistance in 2009, 14% (22,800)
did not receive it. This was a significant increase from 4% in 2003 (refer Figure 2).
The Board has found that if these services are not provided in a timely way, the needs
of people can increase rapidly, resulting in the need for intensive, professionally
driven crisis services. This is the situation South Australia is currently experiencing.
Figure 2. Proportion of people with disability who reported needing assistance who did
not receive it (2003 and 2009)
14.0%
4.0%
2003
2009
Source: SDAC 2009 and 2003 (ABS unpublished data Cat. No. 4430.0)
Further, for the 143,400 people who reported they were receiving assistance in 2009:
> 17,600 (12%) reported needing more formal assistance
> 12,500 (9%) reported needing more informal assistance.
as opposed to ‘Cared Accommodation’.
http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/978A7C78CC11B702CA256F0F007B1311/$File/44300_2003.pdf
30
31
58
Delivering services earlier
It is widely recognised that funding
systems dominated by crisis
management, or responding to
immediate high-risk need, are
inefficient in terms of cost and
outcomes achieved.
Delivering services earlier reduces
the crisis level pressure on a system,
better meets the needs of citizens and
promotes greater social and economic
participation32.
Early investment principles must
underpin disability services, across
service design, delivery and funding,
to improve the way people with
disability, their families and carers
access services.
Early investment service design
will address the support and care
that people want. Early investment
requires a joined-up Government and
community approach that is personcentred, to deliver support that fits
individual needs.
59
Australia’s disability service systems
currently face a number of significant
challenges, many of which are not
specific to the disability services sector.
However, limited resources coupled
with the perception that the disability
service system should be the sole or
main source of support for people with
disability, their families and carers, has
put stress on the service system33.
In this context, the Social Inclusion
Board supports the following
principles to inform an early
investment framework:
> supports and services recognise
and build on the strengths of
the individual with disability, their
families, friends and carers
> supports be provided as people
need them
> supports be provided at all stages
across a person’s life – with particular
focus during life transition periods
> supports enable a person with
disability to plan proactively for the
future minimising risks for the need
of crisis responses
> supports enable people to connect
to and access the natural resources
in their local communities that are
available to everyone.
“Early investment in high-quality
intervention services will
generally reduce the need for
long-term support services and
will increase the ability of people
to work. The need for assistance
from families and carers will also
be reduced.”
Peak Body Submission
Recommendation
21
‘Investing early’ principles
must be explicitly adopted
in all relevant South Australian
Government disability policy and
services, including contracted services.
Early investment strategies should be
reported in the proposed Access and
Inclusion Plans.
Adequate funding and
outcomes focused
The process of delivering meaningful
reform to the specialist disability
system (in addition to increasing
support for people beyond the
specialist system) requires that
the best possible funding model
is in place.
Current service models are expensive
(in particular, crisis management
focused and reactive service responses)
and do not deliver the outcomes
that people with disability, their
families and carers and the broader
community require and to which
they are entitled.
The Productivity Commission’s Report,
Disability Care and Support, indicated
that the system in Australia is
underfunded, inefficient, unfair,
and gives people with disability
little choice.
The high cost of addressing people
with crisis needs impedes funding for
other support services. This displaces
funds for early investment and respite
programs, increasing further the
number of families falling into crisis,
and leading to an ongoing causal
relationship between shortages and
crises34.
“Early intervention is key to
everything, get it right in the
beginning and it helps all the
way through.”
Survey Respondent
This is consistent with what South
Australians told the Board during the
community engagement process.
In an environment constrained by
limited resources, a critical challenge
for the State Government is deciding
how to allocate funds for people who
have high and immediate needs, as
well as people who are not in crisis,
and may require low levels of support.
Without quarantining, the
Government is trapped by constant
and self-perpetuating pressure
to react to crisis and high priority
immediate need. This ultimately
consumes funding and human
resources that are likely to be more
productively invested in an early
investment approach.
A strategic and disciplined business
case is required to provide growth
funding for expected demand, and to
deliver early investment services as an
increasing component of a joined-up
service delivery framework.
In addition to a significant injection
of new funding for immediate and
urgent needs, the State Government
must invest in services that better
prepare people for the challenges
of the future. New funds to secure
early investment supports must
be quarantined in the future and
not be allocated to crisis. This is
consistent with jurisdictions across
Australia where disability services
have a dominant crisis driven service
component but also support a funding
approach to quarantine the delivery of
early investment.
Victorian Department of Human Services, The Contemporary Disability Service System, final Report by KPMG, pg 14
http://www.dprwg.gov.au/sites/default/files/attachments/Contemporary%20Disability%20Service%20System%20Full%20Report.pdf
33
Ibid | 34 Productivity Commission 2011, Disability Care and Support, Final Report July 2011, p. 5.
32
60
A community-based approach
to services
Recommendation
22
To support the full
implementation of these
recommendations, the Department of
Treasury and Finance must develop a
detailed across-Government 10-Year
disability business case (2012/132022/23) to support the future funding
of disability services in South Australia.
This disability business case must:
> maintain an ongoing recurrent
funding base to meet the crisis
needs of people with disability
and their families
> quarantine future funding growth
for early investment service models
> include funding related to specialist
and mainstream services
> provide for a review of the outcomes
delivered through the Business Case
in 2015/16 to assess the extent that
an increased proportion of funding
can be directed to early investment
models in the period 2016/17-2022/23
> provide for a mechanism for
cross-agency review as national
negotiations progress on the
implementation of the Productivity
Commission’s recommendations.
> provide for workforce development
in the sector aligned with the
National Disability Agreement and
Productivity Commission findings.
61
35
The Social Inclusion Board recognises
that, while embedding early
investment principles into the State’s
funding strategy is essential, so too is
broad reform of the service system at
the ‘front end’.
Through the community engagement
process, the Board heard that
individuals and families want better
access to information about a whole
range of issues, so they can feel more
supported in the choices they made.
They also want a support system that
empowers them to plan for their longterm needs.
In regional areas, people with
disability, their families, and carers
told the Board stories about travelling
long distances to get specialist services
and waiting months, even years,
for assessments and thereafter to
receive specialist services. The Board
acknowledges regional differences and
maintains that the current disparity
in service provision cannot continue;
it must be addressed in reforming
the system to include a focus on early
investment.
As opposed to ‘cared accommodation’. |
36
The tyranny of distance,
especially getting to the
services in the city centres
from regional areas.
Survey Respondent
Today in South Australia, people
with disability, their families and
carers engage with multiple services,
delivered through a range of
government, private and community
settings, which are broader than
the specialist disability sector. Data
from the 2009 Survey of Disability
and Carers clearly illustrates that
government is by no means the
only source of assistance for people
with disability living in households35.
Government is classified as a ‘formal’
provider along with not-for-profit and
commercial organisations. In 2009,
60% of people with disability received
assistance from formal providers,
while 87% received assistance from
‘informal’ providers – partners,
parents, children, relatives or friends36.
Government’s role as a formal provider
has declined since 2003 when it
provided 59% of formal assistance by 2009 this had reduced to 46%. In
relation to informal assistance, there
has been a moderate increase in
reliance on assistance from partners
since 2003 (refer Figure 3).
Note this data refers to people with a disability of all ages – including those aged 65 and over.
Figure 3. Sources of assistance for people with disability 2003 and 2009(%)
50%
46%
35%
20%
33%
19%
17%
15%
Partner
Parent
Child
13%
11%
Other relative
Friend
Sources of Informal Assistance
2003
64%
59%
54%
46%
20%
Government
Sources of Formal Assistance
2009
17%
Private non-for-profit organisation
Private commercial organisation
2003
2009
62
A Local Development Model of
support for South Australia
In a third of cases, it was a child who
provided informal assistance, and
in a quarter of cases it was another
relative, such as a sibling, or friend.
Ninety six % of people with severe and
profound disability, who were living in
households, received assistance from
informal providers.
The Board recognises that timely,
community-oriented support is
fundamental to moving away from
the current focus on specialist services
and crisis driven support, and to
promoting social inclusion.
A key way for South Australia to build
an early investment foundation into
its disability services is through the
establishment of a Local Development
Model that provides a timely placebased approach to service, support,
community engagement and future
planning. The Local Development
Model supports people with disability,
their families and carers with practical
assistance, and enables people with
disability (and, where appropriate,
their families and carers) to draw from
local services and supports in order to
live ordinary and dignified lives.
63
The Local Development Model,
is informed by the Local Area
Coordination models implemented in
Western Australia and Queensland.
These models provide a best practice
example of how to build the principles
of timely investment and locally based
support into our disability system.
Local Area Coordinators work with
family members and others involved
in supporting people with disabilities
so that they are strengthened and
supported in their caring role.
Local Area Coordinators also work
with people with disabilities and
their families/carers to make local
communities more inclusive and
welcoming through education,
advocacy and development of
partnerships with local community
members and organisations,
government agencies and businesses.
(Disability Services CommissionWestern Australia).
The Social Inclusion Board believes
that a Local Development Model
should provide:
> flexible assistance to enable people
to identify their individual needs and
vision of a ‘good life’
> practical support to participate in
community life
> information and advocacy to access
local services and facilities
> planning support to clarify
long-term goals and, where
appropriate, pathways to living
independently within the
community
> opportunities to engage with the
broader community
> liaison with the wider community
to develop new opportunities and
supports to meet the needs of people
with disabilities within the local
community
> be culturally appropriate to the
community.
A South Australian Local Development
Model must focus on early investment
in people who may not have reached
a stage of immediate, high need
or crisis, but who will benefit from
local support, or long term planning
that builds capacity, independence,
community connection and long-term
well-being.
A key focus of a Local Development
Model should be to help people
identify local sources that are
alternative to, or can enhance the
specialist services, and to work with
community resources and networks
to create inclusive support networks
and opportunities from existing
community resources.
Adopting a more decentralised
approach and better engagement
of people at the local level is part of
a place-based strategy that provides
meaningful local community
involvement in determining issues
and finding solutions. Place-based
initiatives provide for capacity
development within a local
community and enhances Local
Government’s ability to respond.
In working locally, there is a greater
understanding of economic and
social conditions of the community,
including the alignment of
community needs and programs
offered by governments and notfor-profit organisations. Place-based
models work best when there is a
commitment to flexible funding
arrangements and building local
leadership and governance capacity,
including the ability for local
coordinators to broker local solutions.
Under the model, Local Development
Coordinators are person and family
centred and a support plan is driven
by the identified needs and life plans
of the person with disability. Supports
will cross over all life domains such as
education, employment, health, social
and cultural connections and personal
living needs. The Local Development
Coordinator would be expected
to work across State Government
services, Local Government, the notfor-profit sector, private sector, family
and local community members and
resources.
The Board emphasises that a Local
Area Coordination model differs from
the current Department for Families
and Communities (DFC) Disability
Service Coordination approach. With
the current high level of unmet need,
DFC Disability Service Coordination is
necessarily focused primarily on those
with moderate to severe disability and
their families in crisis or severe distress
or with high and complex needs.
As the State Government invests,
urgently, to remove all Category 1 and
2 clients from the Unmet Demand
Waiting List, Disability SA staff working
at regional and district levels will
have the opportunity to refocus their
roles to a Local Area Development
Model of early investment. Training
and support for staff to perform this
community role outside of traditional
system responses, will be important.
64
This model to support people with
disabilty, their families and carers, will
link into supports available within
their local communities in a timely
and practical manner. This is critical
for South Australia to build an early
investment approach. The approach
must be particularly responsive to the
cultural backgrounds of those who
make up a community, and the Local
Development Model must be tailored
to meet particular needs of Aboriginal
people and culturally or linguistically
diverse people within the local area.
The Social Inclusion Board supports
a Local Development Model that
is unique to South Australia and is
strongly embedded in principles of
early investment, personalisation and
flexibility.
A local development model
of support for South Australia
(Case Study)
Mary had an active social life
with many friends at her local
social club and church for several
years until a stroke left her with
a disability. A single mother of
two teenage daughters, Mary
was forced to give up full-time
employment and rely on a
Disability Support Pension for
income. Over time, she worried
that the combination of school
and caring responsibilities
was affecting the health and
wellbeing of her daughters who
rarely went on social outings
or had friends come over. Mary
and a Local Coordinator worked
together to resume her social life
and take some pressure off
her daughter.
The plan centered on:
> more community involvement
> getting tutoring for her
daughters and linking them
with regular activities
> empowering Mary to better
understand her disability,
enabling her to develop positive
strategies for problem solving
and relationship building.
65
Recommendation
23
Priority Action To support
community engagement
and mobilise local resources around
people with disability, the Government
must implement a place-based
‘Local Development Model’. The Local
Development Model will include
a Family Living Initiative and a
Community Living Initiative. Where
local areas have significant culturally
and linguistically diverse communities
or a significant Aboriginal population,
implementation of the model must be
driven by the demographic profile.
Recommendation
24
A special and particular
emphasis on the needs and
strengths of Aboriginal people will be
a driver for the implementation of, and
recruitment to, the place-based Local
Development Model.
Providing earlier support for people
with disability and their families
For many children and adults living
with disability, their family is critical
to providing day-to-day care as
well as opportunities that promote
participation in community life
at the local level.
Often family members serve as
primary carers to individuals with
disability and provide support that is
complementary to disability services.
Family members such as siblings will
often provide important support roles
to people with disability and carers.
The Board repeatedly heard stories
from families carrying high levels of
responsibility in delivering support
and care.
Many carers, often women, reduce
their work or stop work altogether
because of their caring responsibilities,
and there is a greater likelihood that
family members juggle multiple roles
in paid and unpaid work. Compared to
families from the general population,
a higher proportion of families of
carers suffer from increased financial
hardship37.
Timely and flexible supports for a
family can be beneficial for the health
and wellbeing of individual family
members, as well as the family unit
as a whole. It can also enable families
to sustain their caring role as well
as create opportunities for their
participation in the workforce and
local community.
In Western Australia (WA), the
Disability Services Commission has
established a Family Living Initiative
to support people with disability
to live at home with their families.
The Family Living Initiative provides
practical assistance, through flexible
funding to purchase items or services
that support a rich family life. The
Family Living Initiative recognises the
importance of the family unit and the
wellbeing of all family members. In
WA, people gaining support from the
Family Living Initiative can apply for
funding (up to $20 000 per annum), to
support specific aspects of their “Family
Living Plan.”
Local Area Coordinators or Family
Living Facilitators can support families
to develop a family plan, submit the
plan for funding where appropriate,
and provide ongoing support.
Disability sector organisations may
also assist with developing a Family
Living Plan.
A South Australian Family Support
Initiative can provide support that is
flexible, personalised and useful for
families living with a loved one with
disability so that they can experience
a healthier and vibrant lifestyle that
builds resilience, thereby keeping
families together.
In addition and complementary to
the Family Living Initiative, Western
Australia has established the
Community Living Initiative38. The
Community Living Initiative supports
people living in their own homes and
reduces the demand for supported
disability housing. The Community
Living Initiative aims to provide a
range of flexible and tailored lifestyle
options for people with disability to
make the transition into, or to support
existing, home arrangements in the
community.
The nature and impact of caring for family members with a disability in Australia, Martin and Cole,
1993 Chapter 4, Section C. http://www.aifs.gov.au/institute/pubs/resreport16/chapter5.html
38
http://www.disability.wa.gov.au/forindividuals/clivinginitiative.html
The initiative is inclusive of people’s
family and support networks and the
approach is focused on strengthening
people’s own capacity as well as
that of their family to not only make
lifestyle decisions but also provide
direction in terms of ongoing support.
Importantly, the Community Living
Initiative recognises that the needs
and aspirations of people with
disability and their families and carers
vary considerably, therefore flexible
and personalised approaches are
critical. Support arrangements are
intended to complement existing
local and informal supports provided
by family, friends (and carers). This is
based on the premise that informal
supports will continue to be the
primary support base for a person
with disability.
Recommendation
25
That the South Australian
Government fund and
establish a Family Living Initiative
and a Community Living Initiative.
The Family Living Initiative will
provide flexible support to people
with disability and their families to
foster family wellbeing and plan for
their future. The Community Living
Initiative will provide support and
assistance that builds independence
and resilience to enable people to live
in their own home.
37
66
Chapter 5
Diversifying
Housing Choices
Home is more than shelter; it is a
place of identity and expression,
sanctuary and safety, a place that
fosters strength, wellbeing and revival.
Home is intimately and inextricably
connected to the person. People
with disability need to have choice
in the place and with whom they
live rather than simply accepting an
accommodation offer or not. Current
accommodation offers rarely relate
to social networks, location of family,
recognition of culture, personal desires
or ambition.
Through the community engagement
process, people with disability, their
carers and families told the Social
Inclusion Board that:
> people want to live in their
own home
> current social housing is not
disability friendly. People want
choice about who they live with and
where they live
> organisations which facilitate
congregate living or special
education should have greater
opportunities to ensure that people
with disability have the chance to
mix with others and participate in
mainstream activities
> since deinstitutionalisation, many
people with disability are often cared
for in the community by their
parents, causing great strain
on families.
Regional respondents said that:
> more housing (including supported
housing) is needed in regional
locations.
The vast majority of people with
disability live in their own home
as owners or rent in the private
market. However, people with
disability are more dependent on
Government housing (8% rent
from the Government) than people
with no disability (2% rent from the
Government).
68
Figure 4. Proportion of people with a disability living in households aged 15 to 64 years, by type of private dwelling occupied, 2003 and 2009.
41%
35%
25%
23%
21%
11%
Owner with a
mortgage
Private Dwelling Type
Owner without
a mortgage
17%
8%
8%
State housing
authority
Other landlord
11%
Other private
dwellings*
2003
2009
*Includes boarder, rent free, life tenure schemes, participants in rent/buy or shared equity schemes and other housing arrangements
not elsewhere classified.
69
Individualised funding arrangements
In advocating for the right of people
with disability to exercise greater
choice and control in where, how
and with whom they live, this section
of Strong Voices sets out the Social
Inclusion Board’s plan for reshaping
the way community, not-for-profit
organisations and the Government
plan for, design and implement social
housing options. As such, the focus
is on housing and accommodation
provided by Government and
specialist service providers.
The complexity in providing adequate
housing for people with disability
is not unique to South Australia.
Affordable housing that meets the
needs of a range of groups of people
in our community is a national and
international challenge. The test for
any government is the ability to deliver
a suite of sustainable housing options
that gives people choice.
39
http://www.un.org/disabilities/default.asp?id=279
Under the UN Convention of the
Rights of Persons with Disability,
Article 19 recognises that “persons
with disabilities must be able to
live independently, to be included
in the community, to choose
where and with whom to live
and to have access to in-home,
residential and community
support services”39.
As a community we have embraced
deinstitutionalisation. However we
have been limited in our solutions,
moving people into smaller, yet more
preferable, institutional environments,
in the form of group or cluster homes.
The Board has found that too often
people are given little choice or
consultation before being placed into
accommodation.
The Board advocates that control over
housing and living arrangements can
be fostered by individualised funding,
giving the person with disability
purchasing power and choice as to
how and with whom they live.
In practice, an individualised funding
model in the area of housing
would translate into a more active
relationship between the person with
disability and housing providers.
Other benefits include:
> a genuine shift from a welfare
model and dependency for people
with disability from ‘service user’
to ‘service purchaser’ promoting
independence and self sufficiency
> decisions made based on the support
needs and wishes of the person with
disability
> diversity in housing options
> the housing sector (Government,
non-government and community)
being responsive to the needs and
choices of people with disability in an
innovative and flexible way.
70
Unmet housing need
As of May 2011, the Department for Families and Communities’ Unmet Demand
Waiting List recorded 2,596 people with disability awaiting services. Of these 35% (907)
were ‘Category 1.’ A staggering 72% of the people on the Waiting List are waiting for
accommodation support services (refer Table 2).
Table 2. Services Needed by People on the Waiting List
All Categories
Category 1
Accommodation Support
72%
74%
Community Support
23%
11%
Community Access
12%
9%
Respite
16%
18%
Note: the same client may require more than one service, hence the percentages
do not add to 100%
Source: DFC June 2011 Report - The Provision of Disability Services in South Australia.
The currently available communitybased accommodation arrangements,
such as group homes and cluster
housing, do not offer sufficient choice
for people with disability. They also
rely on paid care, without sufficiently
incorporating family or community
resources where available.
The Board strongly supports social
housing options that build upon the
person with disability’s engagement
with their informal networks and
sense of neighbourhood and
community. This is not always the
case in group homes. Often people
with disability do not have a choice
about where they will live, in which
community or with whom; they are
grouped based on similar care needs
not common interests, friendships or
other more personal choices.
The Social Inclusion Board notes that
in order to sustainably meet the
current and future housing needs
of people with disability, the South
Australian Government must take
a proactive lead in offering a range
of housing options and involve
strong private sector and community
partnerships.
71
The South Australian Government
must shift investment away from
group homes as a primary form of
supported housing. To meet the
unmet demand in the Waiting List, in
the timeframe advocated by the Board,
the Government needs to work in
partnership with the people in urgent
need of housing and with private
and community housing sectors
to generate a range of alternative
supported living and housing options.
Small group homes, where provided,
must move away from clinical
environments that house people
based on their disability need.
A group home environment should
reflect a natural living environment
where residents live with equal power
and autonomy.
The person with disability must be
able to explore housing options that
work for them. This can include
approaching community housing
providers and seeking private rental,
including share housing.
In the Providing Choice, Taking Control
chapter, workforce development
is discussed. It is important that
staff are supported and have
regular professional development
in contemporary care practice that
encompasses a ‘whole of life’ approach.
Carers and support staff must be
supported to maximise outcomes for
people with disability. We have many
excellent service providers in South
Australia that can lead the way in this
regard. There are many community
support groups that can also assist
in the development of staff skills and
knowledge.
Rosa is a 44 year old woman
with multiple disabilities and is
on a Disability Support Pension.
She says that she has been
treated as a ‘third class’ citizen
for the whole time she has had
a disability. Rosa has been on a
waiting list for Domiciliary Care
for the past three years and does
not like the idea that she may be
placed in an aged care facility
with people twice her age. She
wants supported accommodation
that is age appropriate. She also
wants someone to ‘listen’ to her
and understand her issues and
wishes for the way she wants
to live and for the appropriate
support she needs to recognise
her cultural background, beliefs
and values. Rosa currently lives in
a Housing SA home next door to
troublesome neighbours, who she
alleges have threatened her with
physical violence. Rosa wants
Housing SA to listen to and act on
her concerns and fears.
Case study - consultation 2010
72
Large care facilities - Strathmont
Centre and Highgate Park
Since the 1980s, there has been a
strong emphasis in moving people
with disability out of institutional
care and into community based
accommodation, mainly toward
smaller congregate care or group
homes in the community.
“A community that only sees deficits
when it sees a person with disability
is a community that creates barriers
to participation and entrenches
dependencies on formal support
systems.”
National Disability Strategy40
The Board advocates the need for
planning and assessment of people
with disability in large care facilities
whereby they make decisions about
where they want to live. The Board
believes we need to abandon familiar
formulas to provide alternative,
innovative accommodation. We
need to focus on the person, explore
options, encourage aspiration and give
assurance that each person will be
supported along the way.
Modbury Community Meeting
In early 2011, the community was
appalled to hear media reports
highlighting the living conditions
for residents within the Strathmont
Centre41 . The community heard of
people being locked in their rooms
without access to bathroom facilities
and the inability of residents to switch
on (or off) lights in their rooms. We
learnt of the low staff to client ratio.
We learnt of the degrading services
that people are subject to and that
the staff are powerless to address. In
line with community concerns about
the Strathmont Centre, the Board has
found the facility to be inhumane,
degrading and an abrogation of the
Government’s duty of care. The time
for talk is over; Strathmont Centre
must be urgently closed.
In 2005, there were 249 people with
disabilities residing in Strathmont
Centre. The Department for Families
and Communities has been working
to support the transition of people
with disability out of Strathmont
Centre into community based living
options. At September 2011, 63 people
with disabilities remain living at
Strathmont Centre. By late January
2012, a further 32 people with disability
will move to small group homes.
The Board calls on the Government
to work directly with the remaining
residents, their nominated advocate,
and their families to identify new
housing options. Where people do not
have up to date assessment and life
plans, these must be conducted as a
matter of priority, with the resident
and the person’s nominated advocate.
Where an advocate is not identifiable,
then a representative of the Office of
the Public Advocate should fulfill this
role. The new assessment and life
plans must contain a clear support
and housing needs profile for each
and every person within Strathmont
Centre.
National Disability Strategy , page 17 http://www.fahcsia.gov.au/sa/disability/progserv/govtint/nds_2010_2020/Documents/National_
Disability_Strategy_2010_2020.pdf | 41 Centre for Disability Health, Strathmont Centre Health Clinic http://www.sa.gov.au/upload/franchise/
Community%20Support/Disability/Information%20sheets%20-%20Disability%20SA/100531-Centre%20for%20Disability%20Health.pdf
40
73
“Many people feel segregated
from the community because
there is not enough funding for
in home support or for people to
get their house modified.”
Separation of landlord
and service provider
The transition to new homes must
be initiated quickly and their family
supported throughout the process, to
minimise instability and anxiety for all.
Recommendation
26
Priority Action The Strathmont Centre must be
closed with all people transitioned out
of the Centre and into suitable and
appropriate housing by no later than
April 2013.
Highgate Park42 is a large care
facility that provides housing and
service support for 104 people.
The support and health needs of
people within Highgate Park varies
considerably. Similar to all members
of the community, their plans, wishes
and future aspirations also vary
significantly.
Services and facilities at Highgate
Park include a Huntington’s Specialist
Service, aged care services and high
need support facilities such as
ventilators. These are delivered in an
environment that is not dissimilar
to contemporary hospital settings.
Services and support provided is often
without the active participation of the
person with disability; there is little or
no opportunity for people to exercise
personal authority.
As a community advocating
deinstitutionalisation, we must
ascertain for each person residing
at Highgate Park their wishes, hopes
and plans for the future. The Social
Inclusion Board advocates that new
assessment and life plans must occur
with each person residing at Highgate
Park, where up to date life plans do
not exist. While many people residing
at Highgate Park will plan to leave
the facility, others will nominate to
stay. What is critical is that the choice
remains with the person.
Recommendation
27
The Department for Families
and Communities must
expedite the transition of people
residing within Highgate Park into the
community, through implementing
new assessments and life plans.
People with disability must feel safe
and confident within their homes. In
listening to community concerns and
consulting disability service providers,
the Board considers that service
providers who act in the dual role of
landlord and care provider within the
home are compromised in their ability
to deliver a genuinely personalised
approach. By the very nature of the
locked connection between housing
supply and care and support service
the person with disability is restricted
in exercising choice and disempowered
in a welfare service model.
A consistent message heard by the
Board was that people with disability,
felt a very real fear of punishment and
sense of powerlessness with regards
to making a complaint about services
or support.
The Board believes that it is critical
that housing services and care services
be separately delivered so that the
person raising the complaint doesn’t
feel the threat (real or not) of losing
their housing.
Centre for Disability Health, Highgate Park Clinic http://www.sa.gov.au/upload/franchise/Community%20Support/Disability/
Information%20sheets%20-%20Disability%20SA/100531-Centre%20for%20Disability%20Health.pdf
42
74
Furthermore separation is important
to implement individualised funding.
A person living in a service provider’s
housing must be able to exercise the
option of choosing a different provider.
The Social Inclusion Board believes
that State Government must lead the
not-for-profit and community sector
by example in this regard. The transfer
of disability housing away from
Disability SA will assist the agency to
focus on working with people with
disability, their families and carers on
flexible and innovative specialist and
mainstream support services.
Recommendation
28
Disability SA must upgrade
all existing social housing
stock for people with disability, to
South Australian Housing Trust
(SAHT) ‘decent housing’ standards and
ensure that maintenance liability is
addressed. Following the upgrades, all
Disability SA social housing stock must
be assigned to the SAHT for transfer
to the community housing sector as
sustainable community housing for
people with disability.
75
Recommendation
29
Priority Action To support
rights and provide increased
choice for people with disability, the
State Government must ensure new
funding arrangements require that
the not-for-profit and community
sector disability housing providers
ensure a clear separation between
their responsibility as housing
providers and the delivery of care
and services.
All people in rental housing have
access to a tenancy agreement.
People with disability in supported
housing, typically do not have tenancy
agreements but have a range of
administrative arrangements in place
that, to varying degrees, set out their
payment schedule, tenure, service
entitlements, and obligations. The
Board has found the arrangements
in place for group homes and cluster
housing are often inadequate in
providing the person some control
over where they live, and who they
live with.
A Residential Agreement is a tool
that can be used to clearly set out,
in plain language, the rights and
responsibilities of the housing
provider and the tenant. Based on
the Victorian model, a Residential
Agreement is a statement between
the person with disability and the
residential organisation, which
explicitly describes rights and duties,
for example safety, maintenance and
accessibility arrangements. It must
include information such as the right
to see a community visitor; the right to
make a complaint and how to make a
complaint. The Residential Agreement
must also clearly say what the person’s
rights are in relation to tenure in the
housing, including their right to leave
in preference of alternative housing.
The Residential Agreement is a key
reference for Community Visitors to
assess the housing standards.
Recommendation
30
To support the rights of
people with disability,
Residential Agreements must be
provided for all people in disability
housing, including group-home
settings. Residential Agreements must
be negotiated and agreed with each
person and their family and carer.
The resident’s agreement will specify
the rights and responsibilities of the
resident and the housing provider.
Younger people in nursing homes
As a community we are clear that
nursing homes are not set up, nor
resourced, to support younger people
with disability.
Younger people with disability in
nursing homes go out less often
than their peers, have less access to
community activities and family life
and see friends less frequently. Many
have been left, languishing in nursing
homes, due to a lack of appropriate
alternatives. The Board heard people
with disability in the community
who talked about their fears of being
moved into a nursing home due to
a lack of supported care options. For
Aboriginal people and culturally and
linguistically diverse communities,
the loss of autonomy and identity is
compounded by a lack of, or limited
connection to, culture, language and
community in nursing homes.
43
In 2006, the Federal and State
Government agreed to move 689
people under the age of 50 out of
nursing homes. The Younger Persons
with Disabilities in Residential Aged
Care Program43 was established to
reduce the numbers of young people
with disability living in, or at risk of
admission to, residential aged care
throughout Australia. It also provides
enhanced disability support services
for those who choose to remain in
residential aged care, or for whom
residential aged care is the only
suitable accommodation option.
As a priority, Government must
continue towards the removal of all
young people in nursing home care.
Personalised assessment and life
plans should be developed with the
person and family members to ensure
that appropriate care options are
developed and implemented.
“Because Coober Pedy has no
long term supported disability
accommodation, young
Aboriginal people with disability
who need support can find
themselves living in the Umoona
aged care facility”
Coober Pedy
Community Meeting
Recommendation
31
Priority Action The placement
of people with disability
under the age of 50 in aged residential
facilities is not appropriate for
meeting the needs of those people and
their families. The State Government
must ensure that there will be no
new admissions of people under the
age of 50 and, as a matter of priority,
will continue working to remove all
younger people from aged residential
facilities.
Younger Persons with Disability in Residential Aged Care Program http://www.fahcsia.gov.au/sa/disability/progserv/people/ypdracp/Pages/default.aspx
76
Chapter 6
Shaping Accessible
and Inclusive Services
Through the Community Engagement
process, the Social Inclusion Board
heard that people with disability want
to access universal services as ordinary
citizens. They do not want services to
be delivered solely on the basis of their
disability. People with disability want:
> to access universal services where
people understand disability issues
> integration not segregation in
service delivery
> service practices that respond to
their needs, not just a focus on their
disability
> flexible service practices that are
committed to working across
agencies to deliver an outcome
> better access to services in regional
areas
> better awareness of cultural issues
associated with disability for
culturally and linguistically diverse
and Aboriginal people.
In line with rights based principles
underpinned by the United Nations
Convention of the Rights of Persons
with Disabilities, people with
disability should be able to access
universal services that enable
them to participate in all aspects
of community life. This includes
participation within an education
system that is inclusive and fosters
achievement and aspiration; access to
services that provide opportunities to
develop life-skills that promote health
and well-being and achieve improved
health outcomes, and transport that is
easy to use and fosters independence
and mobility for all people with
disability, no matter where they live.
Services need to look beyond a person’s
disability and see the person. Services
work in a diverse community - of
which people with disability are a part.
Service providers need to be enabling
and outcome focused.
This section of the report recognises
the importance of universal services
and sets out how they can improve
to cater to people with disability.
While this chapter focuses on State
Government services, the themes and
principles can equally be applied to
the private sector and other spheres of
government.
Universal services are rightly assuming
increasing responsibility for services to
people with disability, once considered
the domain of specialist services.
The Board understands that full
participation in community activity
and access to universal services is
important for social inclusion and
ensuring engagement with other
people as citizens. Social inclusion
is also important, and often critical,
to achieving positive life outcomes,
including in the areas of health,
learning, mobility, and productivity.
The Board heard clearly that people
with disability are often:
> treated as ‘special’ in a way that is
patronising
> provided with services that focus on
the disability not the person
> ostracised
> not able to access certain service due
to design issues.
This chapter builds on reforms
that apply to universal services in
the Investing Early chapter and
individualised funding models set out
in the Promoting Voice, Taking Control
chapter. This includes a preparedness
to share information, to exercise
flexibility to better achieve outcomes,
and where possible, shifting the
decision making to the individual.
78
All agencies must adopt universal
design principles in their services.
Importantly, the proposed Access
and Inclusion Plans will be a tool for
universal services to identify and
report on their strengths, weaknesses
and areas in need of reform to deliver
better services to all people, without
exclusion. Universal services must
be flexible to adjust to different and
evolving environments. Increasingly,
people are expecting their rights to
be acknowledged and honoured and
are prepared to vocalise this as they
lift themselves out of the welfare
paradigm to a rights based platform.
The Board commends work being
undertaken by a number of agencies
to better respond to people with
disability, their carers and families.
But there is more effort required of all
agencies.
The Board heard from people with
disability, their families and carers
about not being welcomed by
universal agencies and being told or
feeling that they should go elsewhere
for services. An example raised
multiple times in the community
79
engagement process was from parents
who were made to feel unwelcome
when enrolling their children
with disability at school. This was
particularly distressing for parents in
smaller communities where education
options are limited.
The Board is aware of instances where
cost shifting occurs between agencies
arguing that a person with disability is
not their responsibility or client.
Effective and quality service requires
understanding of the client’s needs
and for people with disability this has
proven to be a constant challenge. The
failure of the health system to respond
to underlying or separate health needs
to the person’s disability, resulting in
compounding health problems, was
an often quoted example.
People with disability experience
poorer health outcomes than
others and more effort is needed in
preventative health.
Figure 5. Health outcomes for people with a profound/severe disability compared with those without disability.
69%
57.9%
57.6%
43.4%
39.3%
30.9%
30.9%
21.9%
17.8%
age 18-64
overweight
or obese
age 15-64
reporting low level
or no exercise
Source: AIHW Bulletin 83 2010 - Health of Australians with
disability: health status and risk factors Tables A12, 16, 17 and 18.
37.7%
age 15-64
daily
smokers
age 15-64
commence smoking
before age 40
with profound/severe disability
age 15-64
commence smoking
before age 18
with no disability
80
The State Government’s Health in
all Policies applies to people with
disability across their life domains. To
support improved health outcomes for
people with disability, the full range of
universal health services, from general
practitioners to health promotion
programs, must understand and
incorporate their needs. People with
disability must feel confident that
their interactions with health service
providers will consider their overall
health, not simply their disability.
32
Recommendation
It is not only specialist
service agencies that need
to be highly responsive to the needs
of people with disability, but universal
agencies (such as the Department
of Health and the Department of
Education and Children’s Services)
must also tailor their services.
Universal agencies must report
annually on how they tailor their
services to be responsive to people
with disability in their Access and
Inclusion Plans (see recommendation 6).
More broadly, the Board is aware that
similar issues arise for people with
disability in accessing services outside
of Government.
81
Recommendation
33
To promote a greater
awareness of the rights
and needs of people with disability,
the Equal Opportunity Commission
must be funded to implement an
awareness and information campaign
about people’s rights under the Equal
Opportunity Act 1984. The campaign
must promote the importance of
competency in understanding the
needs, rights and expectations of
people with disability. It must also
address cultural competencies
pertaining to Aboriginal people
and culturally and linguistically
diverse people.
Transport was identified as a major
issue for people with disability, their
families and carers. The importance
of mobility and access is discussed in
the Creating Accessible and Inclusive
Communities chapter. Participation
of people with disability in the
community is dependent on their
capacity to access the same facilities
as all citizens. Restricted provision of
accessible transport creates one of the
major barriers to the full participation
and contribution of people with
disability in community activities.
“There should be more variety
and accessibility around all
forms of transport. There are
current issues around waiting
for bus services as well as
taxi services”.
Key Theme, Noarlunga
Community Meeting
It has been reported that 92% of
people with disability who use
public transport in South Australia
experience difficulty using the
service44. Significantly, this is not
just about “transportation” but is
about all aspects of access including
negotiating steps out of vehicles,
getting to stops or stations and issues
with seating/standing arrangements.
The Social Inclusion Board knows that
access to public transport is critical for
achieving socially inclusive community
and has found that people with
disability do not have full and proper
access to services.
The Board commends the substantial
investment in reviving our flagging
public transport system and that
disability access has been a priority
consideration. However, there is much
more to be done. Relatively
simple strategies to improve the
practicality of using public transport
includes improving information and
coordination of services.
Overview, People with Disability in South Australia Report by Australian Bureau of Statistics on the 2009
Survey of Disability, Ageing and Carers (SDAC) commissioned by the Social Inclusion Board, pg.12
44
The Board believes that public
transport systems facilitate social
equity and economic participation.
The public transport system must
promote and encourage people with
disability to use the transport system
more frequently and for its use to be
practical and enjoyable.
The Board, through its community
engagement process, has become
aware of restrictions around
entitlement to taxi vouchers under the
South Australian Transport Subsidy
Scheme. The limitation around the
entitlement has made it impractical
for people to access their employment,
training and other community activity.
“A lack of public transport
services makes it difficult for
young people with disability
to stay engaged with school
or employment to be active
participants in their community.”
Key Theme, Mount Gambier
Community Meeting
Case study
Alison is a young woman with
disability who relies on subsidised
taxi vouchers to travel to her
supported employment, which
she has enjoyed for several years.
Living at home is difficult for
Alison as her elderly parents
also have caring responsibilities
for another child with multiple
disabilities and younger family
members. Her bi-annual
allocation of subsidised taxi
vouchers was not sufficient to
enable Alison to travel to work
and her only option was to pay
full taxi fare for her travel to work.
Alison’s disability and previous
negative experiences on public
transport mean this was not an
option. Without the taxi voucher,
Alison’s travel cost for the week
was more than her wage, making
her job financially unviable.
Alison was forced to wait nearly
three months before she could
obtain her next allocation of
travel vouchers and recommence
employment. Whilst the agency
responsible for the scheme was
sympathetic to Alison’s personal
and familial circumstances, the
scheme’s eligibility criteria do not
allow any discretion or flexibility.
The Board heard many examples
where lack of transport options
meant that people experience
barriers to participation and access
to work, health services and training.
The South Australian Transport
Subsidy Scheme needs to be more
flexible in its administration to better
achieve the scheme’s objectives.
Access to programs and activity that
build independence and capacity
must be recognised as a priority
objective for the transport subsidy.
34
Priority Action Access to
public transport must be
increased for people with disability.
This includes:
> free public transport for all
people with disability and their carer
> all taxi travel for employment and
training purposes must be fully
subsidised
> wheelchair accessible buses must be
routinely scheduled and be marked
as an accessible service on all
timetable information
> a transport mobile telephone ‘app’
must be created to support access
to timetables and accessible service
updates
> regional transport networks must
meet and accommodate the needs of
people with disability.
82
Appendix A
People Living with
Disability in
South Australia
People Living with Disability
in South Australia
The South Australian population
living with disability, especially those
with a profound or severe disability,
differs significantly from the rest of
the population and these differences
are important to recognise in
designing and carrying out policies
and programs. Some of the key
characteristics are as follows:
> In 2009 there were 336,000 South
Australians living with disability
of which around a quarter had a
profound or severe disability.
> They are older on average than the
rest of the population but there are
200,000 aged less than 65 of whom
51,000 had a profound or severe
disability – 4 per cent of the total
population of that age.
> Among the population living with a
disability 53 per cent are female.
> The incidence of disability is
significantly higher among the
Aboriginal population, with 51 per
cent of those aged 15-54 having a
disability and 8 per cent a severe or
profound disability.
> The incidence of disability is higher in
non-metropolitan than metropolitan
parts of the state and there are
higher rates of incidence in northern
and western suburbs of Adelaide
than other parts of the city.
> There is a higher prevalence of
disability among people from
culturally and linguistically diverse
(CALD) backgrounds.
> People living with disability are
more likely to live in non-private
dwellings, live by themselves or live
in government rented housing
than others.
> People living with disability
have lower levels of participation
in the workforce and women with
disability were more likely than
their male counterparts to not be
in the workforce.
> Some 8.4 per cent of people
with disability were unemployed
compared with 5.2 per cent of the
total population.
> People living with disability have
lower incomes on average than the
rest of the population. They are more
dependent on government pensions
or allowances than others who
do have disability. Some 45 per
cent of people with disability are
in the bottom two income quintiles
compared with 28 per cent of the rest
of the population.
> A lower per cent of people with a
disability had post-school education
and completed Year 12 than the rest
of the population.
> Of the 84 per cent of people with
disability who indicate they need
assistance with daily activity,
14 per cent did not receive the aid
they needed compared with
4 per cent in 2003.
> Informal carers provide the largest
part of assistance and support to
people with disability. In 2009 in
South Australia, 60 per cent of people
with disability received assistance
from formal providers, while
87 per cent received assistance from
‘informal’ providers – partners,
parents, children, relatives or friends.
> There were 213,000 South Australians
providing care to persons with a
disability, some 9,300 fewer than
in 2003. Some 55 per cent of the
carers were female.
> Carers had poorer workforce
outcomes than non-carers, lower
incomes and higher reliance on
government pensions or allowances.
84
Figure 1. Prevalence of Disability, by State or Territory of Usual Residence
Source: ABS 2009
%
25
20
15
10
5
0
nsw
vic
qld
sa
wa
tas
nt
act
State of Territory of Usual Residence
It is important to recognise that there are significant spatial variations in the occurrence of disability. This has important
implications for provision of support services. As mentioned earlier, South Australia has a higher incidence of disability than other
mainland states and territories, as indicated in Figure 1. In addition, despite the migration of people with disability to capital cities in
order to gain access to services, the prevalence of disability remains higher outside capitals as is evident in Figure 2. This shows that
the prevalence is 17 per cent in capital cities compared with 22 per cent in inner regional areas and 20 per cent in remote areas.
85
Figure 2. Prevalence of Disability, by Remoteness, Australia, 2003 to 2009
Source: ABS 2009
%
25
20
15
10
5
0
Major Cities
State of Territory of Usual Residence
Inner Regional Remoteness
Outer Regional and Remote
2003
2009
In developing a blueprint for supporting the population living with disability in South Australia, it is important to have an
understanding of the characteristics of this population. Accordingly, this chapter seeks to provide a profile of South Australians
living with disability. It relies predominantly on data from the Australian Bureau of Statistics Survey of Disability, Ageing
and Carers, 2009.
86
Demographic Characteristics
Box 1. Profile of South Australians Living With Disability, 2009
The Population With Disability
Number
Percent of State Population
Total
335,900
20.9
Profound
54,900
3.4
Severe
48,100
3.0
8 per cent of Aboriginal population aged 15-54 had a profound or severe disability in
2008 - twice the rarte of the general population in 2008.
Unmet Needs
> May 2011 – 2,596 people with disability on Disability SA’s Unmet Demand Waiting List
> 35 per cent (907 persons) have Category 1 (critical) level of need
> 72 per cent need accommodation services
> 84 per cent of all people living with disability in households need assistance with
daily activity (166,000 persons). Of these, 14 per cent did not receive assistance.
Key Characteristics
People With Disability
People Without Disability
Per cent Aged 65+
41.2
8.7
Sex Ratio (males per 100 females)
88.5
100.0
Labour Force Participation
55.0
84.0
Unemployment Rate
8.4
5.2
Completed Year 12
29
50
Bachelor Degree and Above
14
22
Annual Median Personal Income $313
$575
87
In 2009 there were 335,900 people
living with disability in South Australia
which represented a decrease of 7
per cent since 2003. Of these, 54,900
were considered to have a profound
disability and 48,100 a severe disability,
making up 30.7 per cent of those with
disability. Table 1 shows that South
Australia, like other states, experienced
a small decrease in the rate of
disability between 2003 and 2009.
Nevertheless, South Australia had a
higher rate of disability than any of the
mainland states. This partly reflects
the fact that South Australia has an
older population than those states
and territories. It is important to
note in Box 1 that women outnumber
men among the population of people
with disability. This is especially the
case among people with a profound
disability. This is especially the case
among the profoundly disabled (sex
ratio 51.6).
Table 1. Persons Living With Disability by State and Territory, 2003 and 2009
Source. ABS
State or Territory of Usual Residence
Number Rate
Number
Rate
New South Wales
1,190.5
17.9
1,329.0
18.6
Victoria
992.3
20.0
1,000.0
18.4
Queensland
834
22.1
781.5
17.9
South Australia
362.1
23.8
335.9
20.9
Western Australia
405.5
20.6
382.3
17.4
Tasmania
111.7
23.5
113.9
22.7
Northern Territory
np
np
26.7
15.2
Australian Capital Territory
Australia
45.2
14.2
56.7
16.1
3,958.3
20.0
4,026.2
18.5
Figure 3. South Australia: Percentage Distribution of Persons With and Without Disability, 2009
Source. ABS 2009
65+
45-64
25-44
15-24
5-14 With Disability (Shaded)
and Without Disability
0-4
Females
Males
25
20
15
10
5
0
5
10
15
20
25
%
88
There is a clear concentration of the
disabled population with disability in
the older age groups as is shown in
Figure 3. In fact, as Table 2 indicates,
over half (55.6 per cent) of the 65+
population of the State are disabled
in some way while 14.5 per cent of the
population aged less than 65 have
disability. If we concentrate, however,
on those with a profound or severe
disability there are almost equal
numbers between the 65+ (52,300)
and those aged less than 65 (50,700)
but they make up 20.4 and
3.7 per cent respectively. There are
also some important gender
differences with age. Among those
living with disability who are aged
65 or more, there are only 51.6 males
for every 100 females while for those
aged under 65 it is 94.2. Nevertheless,
it is important to note that the
gender dimension is significant and
more female South Australians have
disability than do males.
Table 2. South Australia: Estimated Number of Persons With Disability as Percentage of
Total Population, 2003 and 2009 Source. ABS, 2009
All People
With Disability
(‘000 persons)
Total SA
Population
(‘000 persons)
% of
Total Population
2003
2009
2003
2009
2003
2009
Total <65
232.3
197.5
1,293.6
1,360.7
18.0%
14.5%
65 and over
129.8
138.4
224.6
249.1
57.8%
55.6%
Total
362.1
335.9
1,518.2
1,609.8
23.9%
20.9%
Table 3. Australia: Estimated Number of People With Disability
Source. SDAC 2009 and 2003
All People
With Disability
(‘000 persons)
Total Australian
Population
(‘000 persons)
% of
Total Population
2003
2009
2003
2009
2003
2009
Total <65
2,556.8
2,474.4
17,312.4
18,888.0
14.8%
13.1%
65 and over
1,391.5
1,551.8
2,498.7
2,903.1
55.7%
53.5%
Total
3,958.3
4,026.2
19,811.1
21,783.1
20.0%
18.5%
The Australian Bureau of Statistics (ABS) has suggested that the decline in the
proportion of Australians with disability since 2003 is due to a decline in the number
of people having disability because of physical health conditions such as asthma
and back problems. The four states with significant declines in disability rates were
Victoria, Queensland, Western Australia and South Australia1.
http://www.abs.gov.au/AUSSTATS/[email protected]/Latestproducts/4430.0Media%20Release32009?opendoc ument&tabnam
e=Summary&prodno=4430.0&issue=2009&num=&view=
1
89
Figure 4 shows the change in number of South Australians with disability between 2003 and 2009, by age group. Over these six
years, the total number of people with disability under 65 has fallen by 15 per cent. The only age group to show an increase are those
aged 45-64 years (7.1 per cent).
Nationally in 2009, there was an estimated 2.5 million people with disability aged under 65 – a fall of 3.6 per cent from 2003. People
with disability comprised 13 per cent of the total national population aged under 65, a decline from 15 per cent in 2003 (refer Table 3).
In relation to the total population (including those aged over 65) there was a small increase in the number of people with disability
from 3.96 million to 4.02 million (2 per cent).
Figure 4. South Australia: Estimated Number of People With Disability, 2003 to 2009
Source: ABS 2009 and 2003
140,000
120,000
100,000
80,000
60,000
40,000
20,000
0
0-4
5-14
15-24
25-44
45-64
65 and over
2003
2009
90
Figure 5. Proportion of National Population With Disability, 2003 and 2009
Source: ABS 2009and 2003
60%
50%
40%
30%
20%
10%
0%
All under 65
65 and over
Total population
2003
91
2009
Profound and Severe Disability
When we look at the entire South
Australian population, people aged
65 and over made up 51 per cent of
the total number of people with a
profound or severe disability in 2009.
If we focus on those aged under 65 in
2009, there were an estimated 50,700
people with a profound or severe
disability. They represented 26 per
cent of all people with disability under
65 and 4 per cent of the total South
Australian population under 65. The
majority (54 per cent) of people with
profound and severe disability were
aged (45-64), followed by 20 per cent
aged (25-44) (refer Figure 6).
Figure 6. South Australia: Number of People with Profound or Severe Disability by Age Group
Source: SDAC 2009
1,700
0-4
8,000
5-14
3,600
15-24
10,300
25-44
52,300
65 and over
27,100
45-64
92
Gender
In South Australia, the number of
people with disability aged under
65 (197,500) was split quite evenly
between males and females (48 per
cent and 52 per cent respectively).
However, males dominate the younger
age groups, comprising 81 per cent
of pre-schoolers (0-4) and 61 per cent
of those aged 5-14. The balance then
changes in the (45-64) age group, with
56 per cent being female (refer Table 4).
Table 4. Estimated Number and Proportion of South Australian Persons With Disability,
By Age and Gender, 2009 Source: SDAC 2009
Male
Number
%
Female
Number
%
..
0-4
1,700
81%
np
5-14
9,100
61%
5,800
39%
15-24
9,600
55%
8,000
45%
25-44
24,000
51%
23,000
49%
45-64
51,000
44%
64,800
56%
Total <65
95,400
48%
102,000
52%
65 and over
62,200
45%
76,300
55%
Total
157,700
47%
178,200
53%
Note: Rounding errors may occur. The term ‘np’ refers to ‘not available for
publication’ due to insufficient sample size.
93
Aboriginal People
The SDAC 2009 does not cover the
Aboriginal population, so here we
draw on data from the National
Aboriginal and Torres Strait Islander
Social Survey (NATSISS 2008)2.
Figure 7. Aboriginal People Aged 15-54 – Disability Status, 2008
Source: ABS 2008
profound/severe
disability (1,200)
8%
In 2008, an estimated 17,900
Aboriginal people aged 15 years and
over were living in South Australia,
with 15,700 being under the age of 553.
Of those under 55 years, 51 per cent
reported having disability (7,900)
compared with a national average
of 46 per cent.
> 1,200 (8 per cent) of Aboriginal
people aged (15-54) reported having
a profound or severe disability,
compared with the national average
of 6 per cent.
> The rate of 8 per cent in the (15-54)
Aboriginal population in South
Australia is twice the rate of
4 percent of people in South
Australia with profound or severe
disability in the general population
aged (15-64) in 2009.
no disability
(7,800)
49%
unspecified
disability (6,700)
43%
Young Aboriginal People (Aged 0-14 years)
As the NATSISS survey does not include data on children, we referred to 2006 Census data
to provide some indication of the situation for young Aboriginal people with disability4.
The Census recorded 825 Aboriginal people under the age of 55 as having a profound or
severe disability in South Australia. Of these, 214 or 26 per cent were under the age of 15.
ABS Cat. No. 4714.0 3 Ideally, we would be focussing on Aboriginal people under the age of 50. However, data available in the NATSISS and Census can only
be meaningfully estimated for Aboriginal people under the age of 55. Hence we use the group aged under 55 as a proxy for Aboriginal people under the age
of 50. 4 2006 Census questions relate only to profound or severe disability, not disability as a whole:“The Census variable ‘need for assistance’ was designed to
be conceptually comparable to the SDAC measure of profound or severe core activity limitation” (People with a Need for Assistance – A Snapshot, 2006).
2
94
Spatial Dimensions Of Disability
95
Figure 8. South Australia: Percentage of Total Population With Profound or Severe Disability
Aged 0-64 by Selected Statistical Subdivisions, 2006 Source: ABS 2006 Census
>
Where people with disability live can
impinge significantly on their ability
to access services. It is important
then to examine the distribution
of people living with a profound or
severe disability in the State. Figure
8 and Table 5 show the numbers of
persons aged 0-64 who were living
with disability according to the
statistical subdivision in which they
live. It is noticeable that in most
non-metropolitan areas the rate of
profound and severe disability is
greater than in Adelaide. The rates
are especially high in the northern
statistical subdivisions and the Murray
Mallee where accessibility issues are
important. It is also important to note
that there is considerable variation
within the metropolitan area with the
rate in northern Adelaide being almost
twice that in the eastern suburbs.
There is clearly a strong negative
association with socioeconomic status
and poverty; ie. The highest rates of
people living with disability are found
in areas characterised by low
socio-economic status and higher
rates of poverty.
North
% Profound or severe disability
No value
1.00 to 1.99
2.00 - 2.99
3.00 and above
Table 5. Number and Proportion of People Aged 0-64 With Profound or Severe Disability by
Selected Statistical Subdivision, 2006 Source. ABS 2006
Persons With Profound or
Severe Disability (number)
% of Total Population With
Profound or Severe Disability
Outside Adelaide
Yorke
771
4.0%
Pirie
733
3.6%
Whyalla
656
3.5%
Murray Mallee
689
3.1%
Fleurieu
842
3.0%
Lower North
451
2.9%
Riverland
885
2.6%
Lower South East
879
2.4%
Northern Adelaide
9,153
3.0%
Southern Adelaide
6,900
2.5%
Western Adelaide
4,546
2.7%
3,248
1.7%
Within Adelaide
Eastern Adelaide
96
Figure 9 presents the geographical
distribution of the number of people
with profound or severe disability
and it is clear that there are significant
numbers in more remote areas of
the State. This points to the need
to have disability services which are
sensitive to the isolation of people
with disability living in rural
South Australia.
Figure 9. South Australia: Total Population With Profound or Severe Disability Aged 0-64 by
Selected Statistical Subdivisions, 2006 Source: ABS 2006 Census
Number of persons
10,000
5,000
1,000
500
0 kms
97
200
Statistical Subdivision
Turning to the Aboriginal population,
regional subdivisions with the highest
proportion of Aboriginal people
with profound or severe disability
are shown in Table 6 and Figure 10.
Eastern Adelaide has the highest
proportion within the metro area
(6.6%), while Kangaroo Island,
Whyalla and Lincoln have the highest
rates outside of Adelaide5. Again,
there are some significant regional
variations in the rate of disability. It
is notable, however, that the rates are
greatest within Adelaide, reflecting
the migration of many Aboriginal
people with disability from remote
areas to Adelaide.
Table 6. Number and Proportion of Aboriginal People with Profound or Severe Disability
Aged 15-54 by Statistical Subdivision, 2006 Source: ABS 2006 Census
Aboriginal Persons
With a Profound or Severe
Disability (number)
% of Aboriginal Population
With a Profound or
Severe Disability
Northern Adelaide
62
5.4%
Western Adelaide
179
4.2%
Eastern Adelaide
125
6.6%
Southern Adelaide
118
5.9%
Kangaroo Island
7
7.6%
Whyalla
19
5.6%
Lincoln
46
5.5%
Fleurieu
61
4.8%
Riverland
83
4.7%
Mt Lofty Ranges
67
4.6%
Upper South East
26
4.5%
Far North
62
4.4%
Murray Mallee
64
4.4%
Lower South East
110
4.4%
Within Adelaide
Outside Adelaide
Kangaroo Island had a small total aboriginal population of 92 persons in 2006. With seven
of these recording disability, the rate of disability in the population is very high.
5
98
>
Figure 10.South Australia: Percentage of Aboriginal Population with Profound or Severe
Disability Aged 15-54 by Selected Statistical Subdivisions, 2006 Source: ABS 2006 Census
North
% Aboriginal with profound
or severe disability
No value
0.1 to 4.9
5.0 to 5.9
6.0 and above
99
Figure 11. South Australia: Aboriginal Population with Profound or Severe Disability Aged
15-54 by Selected Statistical Subdivisions, 2006 Source: ABS 2006 Census
>
Figure 11 shows the numbers of
Aboriginal people with profound or
severe disability in different areas.
Again, there is a real danger that
the small numbers in isolated areas
experience particular difficulty in
accessing services.
North
Number of Aboriginal people
200
100
50
20
10
0 kms
200
Statistical Subdivision
100
Country of Birth
There are also some differences in the prevalence of disability among culturally and linguistically diverse populations. Disability
rates are significantly higher among the Southern European-born. Moreover, the rates increased between 2003 and 2009 while
the lower rates among the Australia-born got even lower. This clearly raises issues of the need for cultural sensitivity and linguistic
appropriateness in provision of disability services.
Figure 12.Prevalence of Disability, Country of Birth, Australia, 2003 to 2009
Source: ABS 2009
50%
40%
30%
20%
10%
0%
Australia
Country of Birth
New Zealand
Italy
Greece
United Kingdom
2003
2009
In South Australia of the 197,500 people living with disability under the age of 65, 17,600 (9 per cent) were born in countries where
the main spoken language is other than English. Of these, 81 per cent were aged 45-64 and 14 per cent aged 25-44. Clearly these
prevalence rates are partly associated with age but nevertheless the importance of the cultural dimension needs to be stressed.
Moreover, language barriers can be an important factor in impeding access to services.
101
Living Arrangements
Among people living with disability who were aged 0-64, 99 per cent (196,000 people) live in a private dwelling while 1 per cent
(1,500 people) live in non-private dwellings. One fifth of those living in a private dwelling lived alone.
Housing is a critical element in the wellbeing of people living with disability and Figure 13 shows that they differ significantly from
the rest of the population in the tenure of their housing. They are more likely to own their dwelling outright (23 per cent) compared
with the rest of the population (18 per cent) but a smaller percentage own their house with a mortgage than is the case for the rest
of the population. Persons with disability have a higher propensity (8 per cent) compared with the rest of the population (2 per cent).
Nevertheless, a higher per cent age of people with disability (17 per cent) are private renters. The relatively high proportion owning
their dwelling outright points to the older age structure of the population living with disability. Figure 14 shows that almost a third
live in rental accommodation and 8 per cent in other non-ownership tenures.
Figure 13.Disability Status, by Housing Tenure, Australia
Source. ABS 2009
50%
40%
30%
20%
10%
0%
Owner
without
mortgage
Owner
with
mortgage
Renter Public
Renter Other
Boarder
Rent Free
Has disability
Other
Nonprivate
dwelling
Does not have disability
102
Figure 14. Proportion of People with Disability Living in Households Aged 15 to 64 Years, by Type of Private Dwelling Occupied,
2003 and 2009 Source: ABS 2009 and 2003
%
45
40
35
30
41
35
25
25
20
23
21
15
10
11
5
17
8
8
11
0
Owner with a
mortgage
Owner without
a mortgage
State housing
authority
Private dwelling type
*Includes boarder, rent free, life tenure schemes, participants in rent/buy or shared
equity schemes and other housing arrangements not elsewhere classified.
103
Other
landlord
Other private
dwellings*
2003
2009
Figure 15. Proportion of People with Disability Living in Households Aged 15 to 64 Years, by Type of Private Dwelling Occupied,
2003 and 2009 Source: ABS 2009 and 2003
%
100
80
60
40
20
0
Profound
Severe
Moderate
Mild
Lives alone
Specific lim.
All disability
Lives with others
No disability
Non-private dwelling
The stark difference between the living arrangements of the populations living with and without disability is evident in Figure 15.
Compared with the population with no disability, those with disability are much more likely to not only live in non-private dwellings
but also are more likely to live alone.
104
Labour Force
The ability of people to engage in
the labour market is basic to their
independence, economic security
and social inclusion. As the ABS
(2011, 33) points out:
‘A person’s disability status factored
heavily into whether or not they were
likely to be participating in the labour
force. Those with a profound level of
core activity limitation had a labour
force participation of 17 per cent, much
lower than the participation rate of
the non-disabled population.’
Australia-wide, Figure 16 shows that 54
per cent of the population aged 15-64
living with disability participated in
the workforce compared with 83 per
cent of those without disability. In
South Australia, there were 179,600
people with disability in this age
range, 17 per cent of the total South
Australian population in this group:
105
> 97,800 (54.5 per cent) reported being
in the labour force, compared with
83.5 per cent of people without
disability.
> 81,700 (45.5 per cent) reported they
were not in the labour force,
compared with 17 per cent of people
without disability. This includes
49 500 people who identify as
permanently unable to work.
> Women with disability were more
likely than men to not be in the
labour force (49 per cent compared
with 42 per cent), similar to the
national trend.
Figure 16. All Persons Living in Households Aged 15-64 Years: Labour Force Participation by Disability Status, Australia, 2009
Source: ABS 2009
%
100
80
60
40
20
0
Profound
Severe
Of the 97 800 people with disability
in the labour force, 92 per cent were
employed (58 per cent employed
full-time and 42 per cent part-time).
> For people with no disability,
95 per cent of the labour force was
employed, (67 per cent full time and
33 per cent part-time).
> The South Australian employment
rate for people with disability was
similar to the national rate.
Moderate
Mild
School/Employ
restrictions
Specif.
limitation
All
disability
No
disability
In 2009, the unemployment rate was:
> 8.4 per cent for people with disability
and 5.2 per cent for people without
disability in South Australia,
compared with
> 7.8 per cent nationally for people
with disability, and 5.1 per cent for
people without disability
(see Figure17).
106
Figure 17. Australia and South Australia: Unemployment Rates by Disability Status in 2009 Source: SDAC 2009
%
9
8
7
6
5
4
3
2
1
0
People with
disability
People without
disability
Total
population
SA
107
Aus
Socioeconomic Dimensions
Of those people with disabilities in the
South Australian labour force, 92 per
cent of men and 91 per cent of women
were employed. However, the ratios
of full to part-time employment were
different by gender:
> 71 per cent of men were employed
full-time, 29 per cent part-time;
> 45.5 per cent of women were
employed full-time, 54.5 per cent
part-time.
Part-time employment was more
common for South Australians with
disability compared to those without
disability across all the age groups:
> 15 to 24 years: 67 per cent compared
with 54 per cent
> 25 to 44 years: 37 per cent compared
with 28 per cent
> 45 to 64 years: 40 per cent compared
with 29 per cent
It is somewhat disturbing that the
number of people with disability aged
15-64 who were employed fell from
94,400 in 2003 to 89,700 in 2009.
Among those employed, 53,500 (54.7
per cent) reported that they have some
restrictions which had some effects
on the way they did their job and
required some adjustment (e.g. special
equipment or supervision).
The ability of people living with
disability to lead fulfilling lives is
often compromised by restrictions
of poverty or having inadequate
economic resources. One of the
starkest differences with the
remainder of the population was
with respect to education. As the ABS
(2011, 36) has pointed out:
Learning skills is one of the six
policy areas highlighted in the
National Disability Strategy, in
acknowledgement of:
‘A significant gap between students
with disability and those without,
notably in the attainment of Year 12
or equivalent, vocational education
and training qualifications, and
participation in university studies.
Targeted support is needed to assist
people who are disadvantaged in
education and in the workforce, but
mainstream education programs
need to be designed for people of
all abilities.’
The United Nations Convention on
the Rights of Persons with Disabilities
also addresses the rights of people
with disabilities to access education.
Article 24 notes signatories should
ensure that:
‘Persons with disabilities can access
an inclusive, quality and free primary
education and secondary education
on an equal basis with others in the
communities in which they live’.
Figure 18 shows that people with
disability are considerably less likely to
have a post-school qualification than
the rest of the population. For South
Australia, of people aged 15-64:
> 29 per cent of those with disability
completed year 12 compared with 50
per cent of those with disability.
> 14 per cent of those with disability
hold a bachelor degree or above
compared with 22 per cent of the rest
of the population.
The most disadvantaged with
respect to education were those with
profound or severe disabilities.
108
Figure 18:Highest Non-School Qualification Obtained, by Disability Status, Australia
Source: ABS 2009
%
80
60
40
20
0
Profound
Severe
Moderate
No non-school qualification
Mild
Certificate
Other disability
No disability
Diploma or higher qualification
Persons living with disability have significantly lower incomes than the rest of the population. Figure 19 shows that they are much
more likely to rely on government pensions and allowances and less likely to rely on wages than the rest of the population.
109
Figure 19:Principal Source of Personal Income: South Australia, 2009
Source: SDAC 2009
%
80
70
60
50
40
30
20
10
0
Wages or
salary
Uninc. business
income
Govt. pension/
allowance
Other
All with reported disability
Not stated
No disability
People with disability have a significantly different income status to those without disability.
> 42 per cent sourced their principal income from a government pension or allowance, compared with 12 per cent of people
without disability.
> 37 per cent sourced their principal income from salary or wages, compared with 68 per cent for those without disability.
> the median gross personal income of people without disability was $262 per week higher than for those with disability
($575 compared with $313).
> 45 per cent of people with disability were situated in the bottom two quintiles of household income, compared with 28 per cent
of those without disability6.
This relates to the ABS measure of ‘equivalised gross household income’ quintiles.
6
110
Unmet Need for Assistance People With Disability
Of the 196,700 South Australians
with disability under 65 living in
households7 in 2009, 166,000 (84 per
cent) reported needing some form of
assistance. They required assistance
for activities which included:
> household chores and property
maintenance;
> transport;
> self care and health care;
> cognitive or emotional tasks; and
> reading and writing tasks.
Of those who reported needing
assistance in 2009, 14 per cent
(22,800) did not receive it. This was a
significant increase from 4 per cent in
2003, as is shown in Figure 20 and is
an area of concern.
Figure 20. Proportion of People Who Reported Needing Assistance Who Did
Not Receive It, 2003 and 2009 Source: SDAC 2009 and 2003
%
16
14
12
10
8
6
4
2
0
2003
2009
Further, for the 143,400 people who reported they were receiving assistance in 2009:
> 17,600 (12%) reported needing more formal assistance; and
> 12,500 (9%) reported needing more informal assistance.
The Department for Families and Communities official Unmet Demand Waiting List
recorded 2,596 people with disability on the List as of May 2011. Of these 35% (907)
were ‘Category 1’ (in critical or immediate need). Figure 21 illustrates the proportion of
people on the Waiting List in each category of need.
As opposed to ‘Cared Accommodation’.
http://www.sa.gov.au/upload/franchise/Community%20Support/Disability/Disability%20collection
/statistics/The%20provision%20of%20Disability%20Services%20in%20South%20Australia%20June%202011.doc
7
8
111
Box 2. Definitions of the
Categories of Need
Source. DFC June 2011 Report The Provision of Disability
Services in South Australia8
Category 1—Critical
(Homelessness/immediate
and high risk of harm to self
or others)
Category 2—Evident (Risk of
harm to self or others/risk of
homelessness)
Category 3—Potential
(Deteriorating health and/or
ability of a client or carer)
Category 4—Desirable
(Enhancement of quality of life)
Figure 21. Proportion of Clients in Each Category on the Waiting List, May 2011
Source: DFC Unmet Demand Waiting List May 2011
%
45
40
1042 people
35
30
907 people
25
664 people
20
15
333 people
10
5
0
Category 1
Category 2
Category 3
Category 4
Data provided by DFC shows that since December 2008 the number of Category 1
people on the Waiting List has increased by 73% from 525 to 907. Further, in May 2011:
> 17% of people on the list were children aged under 15, and
> 4% were Aboriginal (96 people of whom 19 were children).
The majority of people on the list (72%) are waiting for accommodation support
services as Table 7 indicates.
112
Table 7. Services Needed by People on the Waiting List
Source: DFC June 2011 Report – The Provision of Disability Services in South Australia
All Categories
Category 1
Accommodation Support
72%
74%
Community support
23%
11%
Community Access
12%
9%
Respite
16%
18%
Note: the same client may require more than one service, hence the percentages
do not add to 100%
113
In South Australia in 2009 there were
320,700 people with disability aged
5 years and older (including those
aged over 64). Of these, 115,000 (36%)
reported using public transport. The
national average was 39%.
> Of the 115,000 people with disability
using public transport in South
Australia (an alarming) 92% (105,400)
reported experiencing difficulty
using the service.
> Nationally, 83% of people with
disability using public transport
reported experiencing difficulty
using the service (Figure 22).
Figure 22. Proportion of People with Disability Aged Over 5 Who Use Public
Transport and Who Experience Difficulty, 2009 Source: ABS SDAC 2009
%
100
80
The key obstacles reported were:
> trouble negotiating steps into or out
of vehicles or carriages
> getting to stops or stations,
> difficulties with seating and/or
standing arrangements, and
> fear and anxiety associated with
travelling on public transport.
60
40
20
0
SA
Aus
114
South Australian Carers of People
with Disability
Informal carers provide the largest
part of assistance and support to
people with disability. In 2009, in
South Australia, 60 per cent of people
with disability received assistance
from formal providers, while 87
per cent received assistance from
‘informal’ providers – partners,
children, relatives or friends.
In 2009 there were an estimated
213,400 South Australians aged 5 years
and over providing a caring role for
a person with disability. As Table
8 shows:
> 9,300 fewer carers than reported in
2003 (4 per cent reduction)
> lower carer numbers among
children, young people and those in
early adulthood
> higher numbers of older carers,
particularly among those aged 45 to
64 years, making up the majority
(45 per cent) of carers.
Figure 23 shows that South Australian
women were more likely to be carers
than men (55 per cent versus 45
per cent). Female carers were more
common in the ages (25 to 64 years),
although male carers were more
common in the 65 years and over
category (accounting for 55 per cent).
The extra load on women, particularly
in the years of labour force age, is of
significance.
115
Table 8. Number of South Australian Carers Aged 5 Years and Over, 2003 to 2009
Source: SDAC 2009 (ABS unpublished data)
SA 2003
SA 2009
% Change
5–14 years
9,300
6,600
-29
15–24 years
20,600
17,900
-13
25–44 years
72,400
46,100
-36
45–64 years
77,300
95,400
23
65 years and over
43,000
47,500
10
Total
222,700
213,400
-4
Figure 23. Proportion of Carers by Gender and Age Group
Source: SDAC 2009
43%
46%
27%
24%
19%
8%
8%
15-24 years
Age of carer
18%
25-44 years
45-64 years
65 years and over
Males
Females
South Australian carers aged 15 years and over had poorer workforce outcomes than their non-carer counterparts:
> a much higher rate of carers reported not being in the labour force than non-carers (45 per cent and 32 per cent respectively)
> carers who were employed were less likely to work full-time (60 per cent) compared with non-carers (66 per cent).
There were also key differences between carers and non-carers in principal source of personal income.
> 41 per cent of carers received their income from wages or salary, and 40 per cent from a government pension or allowance.
> Non-carers received 54 per cent of their principal income from wages or salary, with only 25 per cent from a pension or allowance.
Carers also had a lower median gross income of $393 per week in 2009 compared with $500 for non-carers. Notably, around one third
of carers (37 per cent) reported having disability themselves.
116
Overview of Services for People
with Disability
The Government of South Australia
provided services for 20,145 people
with disability under National
Disability Agreement (NDA)
arrangements for people with
profound and severe disability in
2008-099. However, due to historical
service arrangements within Disability
SA, 20 per cent of the people receiving
services were defined to have a
‘moderate or mild’ disability
(refer Figure 24).
Figure 24. Disability Status of Service Users Funded Under the NDA, 2008 to 2009 (%)
Source: South Australia National Minimum Data Set 2008-09
moderate
/mild
20%
not stated
8%
In 2009-10 South Australia expended
$354.4m on Disability Services. Sixtytwo per cent of this was allocated to
Accommodation Support, 15 per cent
to Community Support and less than
10 per cent to the other services10
(Figure 25). This pattern has been
similar for the past six years.
profound and
severe disability
72%
Productivity Commission (2011), Report on Government Services 2011, Chapter 14.
Definitions of the different NDA service types are provided in Appendix 2.
9
117
10
Figure 25. Government Expenditure by Service Type (%), 2009 to 2010
Source: ROGS 2011
respite
5%
other
8%
However, while the majority
of funding goes to providing
accommodation support, the greatest
proportion (74%) of service users
access community support.
community
access
9%
community
support
15%
accommodation
support
62%
118
Appendix B
Social Inclusion Board
Membership
Social Inclusion Board Members
2009-2011
Social Inclusion Disability Blueprint
Sub-Committee
Monsignor David Cappo AO (Chair)
Dr Lorna Hallahan (Chair)
Mr Bill Cossey AM
Mr Bill Cossey AM
Professor Bettina Cass AO
Professor Bettina Cass AO
Professor Graeme Hugo
Professor Graeme Hugo
Dr Lorna Hallahan
Ms Mary Patetsos
Ms Mary Patetsos
Ms Margaret Wagstaff
Ms Margaret Wagstaff
Mr John Brayley (Ex Officio member)
Ms Kerry Colbung
Mr Alwyn McKenzie
Associate Professor Mark Halsey
Ms Pauline Peel
120