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Community Affairs References Committee
Adequacy of existing residential care arrangements available for young people with severe physical, mental or intellectual disabilities in Australia

FITZGERALD, Mrs Lucia, Manager, Development Projects, Uniting Church in Australia, Synod of Victoria/Tasmania

KNOX, Mrs Jennifer, State Manager, Tasmania, KinCare

KROMKAMP, Mrs Yvonne Silvia, Chief Executive Officer, Director of Nursing, Mt St Vincent Nursing Home and Therapy Centre Inc.

O'NEILL, Ms Lindy Joy, Chief Executive Officer, UnitingCare Tasmania

PARKER, Reverend David Cameron, Chairperson, UnitingCare Tasmania

TREANOR, Mrs Cindy, Community Leader, L'Arche Beni-Abbes

TREANOR, Dr David, National Leader, L'Arche Australia

Committee met at 11:28

CHAIR ( Senator Siewert ): I declare open this public hearing and welcome everybody here today. Thank you for coming. Senator Seselja is on the phone. We acknowledge the traditional owners of the land on which we are meeting and pay our respects to elders past and present. This is the fourth public hearing of the committee's inquiry into the adequacy of existing residential care arrangements available for young people with severe physical, mental and intellectual disabilities in Australia. That has to be one of the longest titles of an inquiry we have had! We have received 153 submissions to date, although we know there are a couple more coming in from people who have appeared who are going to send us more comments. We had a public hearing in Melbourne yesterday. I would like to thank everyone who has made a submission.

I now welcome representatives from Mt St Vincent home, UnitingCare Tasmania, KinCare and L'Arche. Do you have any comments to make on the capacity in which you appear?

Rev. Parker : I am also chair of the property board of Victoria and Tasmania of the Uniting Church. I am also a member of the group planning the facility that was visited this morning.

CHAIR: Thank you. I understand information on parliamentary privilege and the protection of witnesses and evidence has been provided to everybody. I would like to invite each of the organisations to give an opening statement. If more than one of you from an organisation wants to contribute to the opening statement, that is fine. Then we will ask you some questions. It has tended to work pretty well. We will start on a topic and then each of you will get it chance to talk about it, if you feel like it, and then we will try to move on. We find that is easier in a panel discussion. If somebody says something and you want to contribute, just let me know. Would you like to start, Mrs Kromkamp?

Mrs Kromkamp : I have had 20 years as a director of nursing in the facility that I come from, in Ulverstone. We have predominantly had to have younger people in our facility, because there is really a lack of opportunity for housing for people once their parents or their family are no longer able to look after them. During that time, there is real lived experience from the elderly residents, the younger people and their families and the staff that I have contributed to in my submission.

Rev. Parker : I will just make a quick introduction. We are very grateful to members of the committee, and we are sorry for those who could not get to see the facility that we have just opened in Kingston. However, we have got some material available which staff will share, I am sure. We see the facility as a unique expression of how young people with disabilities might engage in a much wider community whilst still being residents. The Uniting Church has provided the land for the development. It was funded by the SAIF program of the federal government. We are now virtually completed, other than a few difficulties in funding for individual residents, which we referred to earlier on this morning. We are fully occupied as far as our residents are concerned.

It is only stage 1, from the church's point of view, because we saw the extension of the living facility so that we could be a much more inclusive community. So the church is renovating and building meeting rooms and supported kitchen facilities for people with disabilities so that we might be able to engage with training groups and those sorts of things in the south of Hobart, where there are quite some significant gaps in terms of space for this sort of thing. The church is also renovating its own building into a much more user-friendly multifunctional user facility, which will be open to the community.

In addition to that, stage 3 of the project is to create on the site some social community housing so that in fact it is a much broader community, in which the residents, being young people with disabilities, are able to engage in a much wider community. The residents are currently moving in, and we are finding a very significant emphasis on building community. The state Department of Health and Human Services has been extremely supportive of our vision to ensure that we actually have an operating community and not just single individuals who have been selected through the gateway process, which is the selection process. The department has been extremely open to the need for the community to work. Therefore, the residents are in fact consulted with applicants who might be looking to come in. So we are building a significant community in that sense.

We think that this could be a model that might address some of the issues. Quite clearly the cost factor of this facility, which was a $2.8 million grant, plus the land et cetera, is a benchmark, perhaps, but clearly it would depend on the higher care needs in terms of what the cost might be in this sort of model. The facility takes 12 residents. Regionally, the people from the area are essentially from the south of Hobart. So there are a lot of those connections in relation to how you support the community.

We have engaged Optia Inc as a partner in that service delivery. I think they are one of the largest suppliers of supported accommodation in the state. They are managing, if you will, the service delivery, and UnitingCare Tasmania is managing the property. So we have separated out property management. That was part of the requirement of the SAIF funding. And then there is the care of the residents. The facility is four independent single-bedroom units, two double-bedroom units and a group home for four, with care.

With a broader hat on, and part of Mrs Fitzgerald's involvement is that the Uniting Church has a number of sites that might be able to do this. As a church across Victoria and Tasmania, we are looking at how this model might be one where you have a sponsor, in a sense, with the community already there, that can build that next thing up. That is broadening that out.

The other comment I think I ought to make is that in Tasmania and Victoria UnitingCare separates the aged care through Uniting AgeWell. Unfortunately, their director is unable to be with us today. We are extremely supportive of the submission made to the committee by UnitingCare Australia, and we are working within that framework.

Ms O'Neill : I do not have anything to add particularly, but I am sure that in the conversation going forward there will be plenty of things I would like to comment on.

Ms Fitzgerald : To reiterate my position, I work with the property and the project implementation. The vision often comes from the grassroots of the congregations in our broader church. So I can give a focus and give you the experience we had at Kingston, as we pursue this conversation, if it is of interest to the senators.

CHAIR: It will be, because one of the key things we are hearing in the inquiry is the need for more appropriate alternative accommodation.

Ms Knox : Thank you for inviting me to join this panel. I come representing KinCare. We are an organisation that provides innovative, respectful and individually tailored in-home care services. We work with clients across the lifespan. We have a large group of clients who are in the 65-plus age group, but we also have a number of different programs for people who are 64 and under who have a need for home care, or reasons they will find benefit from it, usually due to disability. It supports them to live well and achieve their goals.

My professional background is in mental health nursing, so in past roles I have worked in consulting to residential aged care as well as community care providers. In relation to really tailoring care solutions to people with all sorts of needs, younger and older clients, a lot of times the complexity comes from severe behavioural and psychological symptoms as a result of dementia. This is particularly prevalent in the younger age group, because we know that the younger people with dementia are more likely to have frontotemporal dementias and to display quite severe challenges at times with their communication and behaviours as a result of the damage. I have also worked with carers in terms of providing best care for people with acquired brain injury and people with severe and injuring mental illness.

There have been many less-than-optimal solutions. I have seen situations where people have needed to stay in acute hospitals, sometimes for one to two years, awaiting some sort of community solution or placement, and a lot of times where people have ended up in residential aged care where other solutions may have provided a better outcome. I note from HammondCare's submission that they are quite strong in saying that premature placement in residential aged care is a horrible outcome for the younger person, whose needs and life stages are vastly different from those in residential aged care. They say it is critical that support is provided to help the individual continue to live at home for as long as possible. I would really support that from my professional background and experience.

Just to tell you a little bit about KinCare, we employ our field staff with a range of skills, experience and background. We have people with qualifications in aged care and home care. Quite a significant proportion of our workforce also have qualifications in disability care and community services. We really seek to employ a diverse team of home care workers, because we always strive to match home care workers to clients according to skills, experience and client need and what is going to provide the best solution for that individual. So really my perspective is that many young people with disabilities, and their families and carers, if given the choice would prefer to stay in their own home until such a time as that is not sustainable any longer. If we can provide adequate supports in the home environment then we can extend the amount of time people are able to stay at home.

Dr Treanor : It is a great privilege to be here today. I thought I might give an overview about L'Arche—what our principles are—and then Cindy is going to talk a bit about one site in Tasmania and what our service looks like. Fifty years ago Jean Vanier invited two men with an intellectual disability to come and live in a house with him. It was the 1960s, and people thought he was a bit mad. He had been visiting people in an institution and was quite taken, I suppose, by the adverse living circumstances he encountered. He really felt that they could live in a house together, so that is what happened. This then moved from France to Canada and then out to India and then in to England and other parts of Europe. It came to Australia in 1978, to Canberra, and it has been in Australia since then.

I would see the difference in our model being on the basis of three philosophical principles. The first is around human dignity, the second is around mutual relationship and the third is around community life. L'Arche believes that each person, regardless of their abilities, has a need to love and to be loved and that this need is above and beyond a need for an intimate relationship. Indeed, having a relationship that nurtures our heart is at the core of our being, and these relationships always meet our needs more than any social or emotional need. We feel connected with people as human beings in these relationships. We also feel connected to our local community and to the society we live in. In terms of human dignity, L'Arche believes that each person is of unique value and that we are bonded together sharing a common humanity. Accordingly, each person, regardless of age, creed, disability, gender or race, is equal to other people, and each person is entitled to the best of care, and this includes the opportunity to create and sustain relationships.

This leads to two important implications. If we want people to develop their ability and talents to the full and realise their potential, then people need to live in an environment that fosters personal growth. Each person, regardless of personal limitation, has something to offer other people. When L'Arche develops person-centred plans, we specifically design programs that offer people with disabilities opportunities to engage with each other, with the members of the community and, of course, with people in the wider community. Our belief is that, as people, we are essentially social and that we live in relationship with other people.

In terms of community life, we are an intentionally based community where people with and without disability share their homes and their lives together. As individuals in a share home, we develop and acquire social and emotional intimacy with each other. This depth of relationship cannot be replicated in a roster care only model.

L'Arche also works in ways where people with disabilities develop positive and meaningful relationships with people without disabilities, who then choose to become part of the community although they live in their own households. This living and sharing together that occurs between people with and without intellectual disabilities gives prominence to a people who can accomplish, offer and learn. In a shared living environment, all members of the community are responsible for the group's wellbeing through cooking, washing up and spending time together or through whatever activity.

Forming mutual relationships at the centre of the L'Arche community is about relationships between people with and without disabilities. This is the respectful relationship between people who treat each other as equals and as having value and providing security. L'Arche allows personal growth, development and freedom to become more fully the people we want to be. Importantly, mutual relationships promote the acceptance of each person as a unique and valuable individual, whatever his or her abilities of disabilities.

L'Arche has always been aware of the needs of people with complex and severe physical and mental and intellectual disability. Through the 1980s in Europe, we welcomed people to community who needed a place to call home. We are fortunate to have a gentleman in our community in Brisbane who may well be living in an aged care residential centre. His mum said, 'When he turned 30 we celebrated his birthday with his family at a community gathering, where over 50 people gathered on this day. I was hoping for 30 and was again reminded that his life has exponentially affected so many other people through the L'Arche community.'

Finally, L'Arche acknowledges that there will always be difficulties such as personal complex needs, gaps in support, personnel skills and knowledge, physical accommodation options, financial costs of care and dignity of issues. Nonetheless, there will always be reasons not to act. The decision in 2006 to reduce the number of people with disabilities in residential aged care was momentous and radically changed the life of many people. My understanding is that there are still nine people remaining in aged care in Tasmania. The YPINH initiative needs its own priority to continue to successfully implement multiple program responses from health, housing, disability and mainstream programs so that people's lives are worth living.

Mrs Treanor : The L'Arche Beni-Abbes Community has been operating as a community for nearly 29 years in Hobart. We currently assist 11 core members—people with a disability—to live in a shared housing setting, with other people without a disability. There are another 11 tenancy members who live in their own house or unit and receive some ISP support.

The membership of our community is probably 60 people, because, as David said, our communities are based on people with and without disability creating a life together. This is the fundamental basis of our community. In that sense, we have a person-centred model. We would say that each person with a disability is the core of what we do, and then we would surround them with community. The intention is to build mutually and transforming relationships so that the relationship that I have with someone makes a difference to them and the relationship that they have with me makes a difference to me. We have the person in the centre and, if you imagine, there is a next circle, which is our intentional community, and the outer circle is the aspect of service provision, but that comes through the filter of community to the person. We say that community is primarily what we are aiming to do and what we create together.

Our model in the houses is that people with and without disabilities live together and create homes together. They are part of our community but not the sum total of our community. People's needs are changing. People came as quite young people to our community nearly 30 year ago, and they have aged. In that time one of the younger members developed Alzheimer's. We support her. She had been living in our community for 19 years when she was diagnosed with Alzheimer's. We say when we welcome people that we welcome people for life. If they choose to stay in community, we would support them to do so.

I might just read a bit of her story. She lived in our community for 19 years prior to her diagnosis. She was 48 when she was diagnosed with Alzheimer's, and she wanted to stay in her own home. What made that possible was a combination of the community. The community surrounded her. Many unpaid members in our community spent time with her every day. We were also supported by GPs, community nursing and palliative care, but it was the surrounding of her with community that meant she could stay in her own home, and that is where she died.

We received advice at that time. I remember speaking to someone on the phone from health services and them saying, 'Ring us back when you can't cope anymore, and we'll have a bed for her in a nursing home, because you won't be able to do it.' But we did do it. It was not easy. It was not without issues, but what made it work for her was community. If it had been purely a group-home model we would not have been able to do it. But she died with dignity at home, surrounded by people who loved her.

So that is the model for us in our community and for our tenancy members, who often live fairly traditionally isolated lives, alone in a unit, often with very little contact with their families, with no circle of friends, in a neighbourhood where they are often persecuted. People often have very small IS packages, like maybe three hours a week, and the rest of the time they are left to their own devices. But we invite them into community, so, even though they might get three hours a week of funding, they join the community; they come to community gatherings; they are welcomed into the household for meals; they come on community holidays; and they come on community weekends. That is not about funding; that is about how they can join in the life of the community. And that is cost neutral. It does not cost anything to welcome another person to a community weekend or for the households to say, 'Come and join us for dinner.' For us, we are committed to that model of it being about the person but in the context of community. I guess that is what we do in L'Arche. It happens around the world and for people with very severe levels of physical and intellectual disabilities and for many people with a dual diagnosis relating to their mental health. We welcome them into community, and people spend their lives there.

CHAIR: Thank you very much.

Senator BILYK: One of the things we have discussed in similar round tables throughout the inquiry has been the issue—and I mentioned this earlier, when I was at Rowallan Park—around whether disability and housing should be separated with regard to funding. There is a difficulty sometimes for caseworkers, case managers, having to deal with both issues at once. I am just opening it up to anybody who might want to make a comment about that to us. David, I know you had a thought earlier this morning, so you might like to start the ball rolling.

Rev. Parker : Our experience, I think, is caution about separating them because of the sorts of issues we have been talking about in terms of inclusion and community. One of the difficulties we are having at the moment is with some of the new NDIS trials in terms of long, long delays in getting the packages approved so that the housing can be allocated. The other is that the state government, through the Gateway Services program in this state, makes the decision about a person's availability for accommodation, and to separate the two I think would potentially make significantly more problems. It seems that, if we are talking about the person as the whole, we need to be as holistic as possible in that relationship. Could I invite Lindy to comment?

Ms O'Neill : I probably have a different point of view.

Rev. Parker : I know, and that is why—

Senator BILYK: We have heard lots of different points of view, so that is fine.

CHAIR: I have been asking others about this too.

Rev. Parker : I wanted Lindy to share hers.

Ms O'Neill : I think that the accommodation part of it can get severely tied up in knots and prevent people from being able to use the rest of the package that they might have with them. In terms of being able to create any kind of a model of care for young people in residential care, the amount of bureaucratic red tape that is involved in being able to secure that funding, get a loan or sign contracts to be able to build something means that it might be two years from when you thought about doing it to when it happens. Life does not work like that, and there are so many entry points for disaster to come in and derail it. I think we need to do that bit—the building of the brick and mortar—in a different way. People need to have their funding packages for their support, but the bricks and mortar and all of that capital stuff has to be done in a different way.

It could be some sort of bucket—for want of a more appropriate professional term—there at the start so that people can build. Then, if clients do come with money, their money goes back in the bucket and then, when they move on, it comes back out. But someone has to fund the bit at the start, because it is fraught with danger. What happens if a person wants to move out and take their money with them? What happens to the rest of the people who are still there? If you end up with a situation like we have at Rowallan Park, where we have vacancies, and no-one can go in, how does that work?

CHAIR: How do you do the bit at the start?

Ms O'Neill : I think there needs to be a bucket, and that is like seed funding to start off.

CHAIR: Yes, sort of like transition funding.

Ms O'Neill : It is similar to what happens in aged care where you pay to go in and then you can take your money out when you go, but someone has to underwrite it at the beginning because it cannot start from fresh air. These buildings cost a lot of money. If you are talking about universal principles—aged care have got it down to a fine art where you can have a vacancy in the morning and it is filled by the afternoon. Disability does not quite work like that, and it should not. What I know from my experience down here, my experience is that there is often such a waiting list that that has happened. Someone might have passed away in the morning, and there will be a brief conversation, the phone calls get made and the people are ready to move in. But in disability group homes, where you have personalities that you need to match up in group homes, care needs and all of those kinds of things, you could end up with a vacancy that sits there for a period of time.

CHAIR: I do not know that the aged care process would work. You are talking about RADs or DACs or—

Ms O'Neill : I am just talking about the money going in and out, here a person has to pay money to go in and then when they leave or progress through that system it comes back out.

CHAIR: I understand that. I am trying to mentally determine how a young person or parents of a young person going in do it? Let us not have the argument about how we are going for some of the things around aged care, but the point is they are working out a system there. You do not have the same asset base for—

Ms O'Neill : No, but I am thinking about the government having to give that person the money to be able to move in and out as their needs change, because some of the people's needs are not staying static either. It may be that what suited them now is not going to suit them further down the track. So, if the money goes with the person, there does need to be something to start the process off.

Mrs Fitzgerald : I can articulate it very clearly with two examples. One is the successful project we have had at Rowallan Park. The way that we were able to build the accommodation there was with a capital grant.

Senator BILYK: With government funding.

Mrs Fitzgerald : It was federal government money, from SAIF and that gave certainty around the whole project because the money was there for the accommodation. It therefore allowed the state government to be aware of it, and they certainly came through with the individual support packages as required. The issue now with my portfolio is that we have available land to replicate the pilot project, but we do not have the capital for the accommodation, because that structure has now moved on; it is gone. We are now talking about what structure is going to assist us to replicate this model. At the moment, if we attach the capital with any type of individual person, there are problems. That is because all of a sudden you have to herd people together and for a reasonable amount of time, because a project, as Lindy said, takes a fair bit of time in planning and to coordinate before you actually get the accommodation on the ground. There, you see, is the problem.

Senator BILYK: Rowallan Park has taken about five years or so, hasn't it?

Rev. Parker : It has been at least four years.

Senator BILYK: I think that they first came to talk to me probably five years ago. I just wanted to ask Yvonne about Mt St Vincent. I know that you have built a separate facility up there for young people.

Mrs Kromkamp : We attached a wing onto our facility.

Senator BILYK: Was that funding out of Mt St Vincent or was that government funding?

Mrs Kromkamp : That is just a mortgage. Because we have not been fortunate enough to get any government capital funding at all through the 40-plus years that it has been in existence, so because Mt St Vincent is run by St Vincent de Paul, the board made the decision to take out a loan. Those rooms are really amazing. They are much larger than a normal aged care room, and they have ensuites with their separate hoists. Some of the clients are very disabled, and they have their own hoists to go from the bed directly to the toilet and the shower. It has saved a lot of double handling and that sort of thing. They have computer access and they have big desks in their rooms. Some of them have a little courtyard just outside. It is much better than a normal accommodation room for an elderly person.

The clients have their own dining area, and they have their own huge lounge. So they can have Saturday night football. The lounge is right at the end of the building, so it does not impact on any of the elderly residents. The clients have access with an electronic key, so when their family bring them back home from a social event, there is a phone in that room and they can just let the sister know that they have brought somebody back. So the person does not actually have to come into the main entrance of an aged care facility, as such.

Dr Treanor : There are only two things that I would say. One is that in the typical housing market, if you and I go buy a house, that is what we do. We go and we look, and we are usually looking for a two, three or four bedroom house, and there are lots out there to choose from. There is not anything out there. Like what Lindy is saying: there needs to be some investment somehow—some encouragement for private industry to invest in the future. I would have thought, with the degree of information that we have through the Australian Bureau of Statistics, that we could estimate what the future demand is in terms of my needs as I age and what I would need in my house to seek support from investors to build housing which is going to be more accessible for everybody into the future, and particularly for some groups of people with some physical needs. I agree that we need some kind of community investment. Whether or not we call it a social capital or a community capital investment, we need something. Maybe that is a joint partnership between private and public expenditure.

The second thing is that, as a citizen, I have security of tenure once I pay my landlord or I pay my mortgage. I think that the people who are moving into these accommodation services need some security of tenure. So there needs to be some form of agreement. If people are moving into a house and it meets their needs, the threat of losing that would be great unless there is a written agreement. Whether or not there needs to be a third party to have a tenant manager to run and separate the support level, that will all come out. For some cases, that will be good; for other cases, probably not. I think it is really important, if we are branching out, that we give citizens the right to security of tenure. It seems to me a fairly basic right in this country.

Mrs Fitzgerald : We actually have that at the Rowallan Park experience. We have Optia, who is our service provider. They have entered into a lease with the property trust who owns the land. Then each individual has engaged in an agreement with Optia and have also undertaken a lease with the landlord. So they have tenure, absolutely. That system has been operating since October. It has worked and gives people that security.

Rev Parker : We cannot reinvent the wheel. The funding for this development in Kingston came from the Supported Accommodation Innovation Fund, or SAIF, which I think was a $60 million national fund. Many of the things that we have been articulating around the table today were among its objectives. I think, for government, it might provide a model to rethink—it could evaluate how people supported through the program are living now. There are obviously another $57 million worth of projects that were part of it. The program had quite strict criteria about some of those fundamental issues we have been talking about. That is part of this bucket that I think Lindy is referring to. It could well provide the community, once we know the size of the problem, with some really innovative approaches to it. We have included our comments on the SAIF funding in the document we provided today—to encourage it, although we identified a few shortcomings as well.

Ms O'Neill : I think Tasmania has some issues—similar to other places in Australia, obviously—relating to its rural and remote nature, the size of the population and the dispersion of the population. It is hard to get your head around issues relating to economies of scale with funding and how to maintain excellent support for people living in those places. I think that buildings, or accommodation, with different types of people on the same site—or near the same site—could be the way to go. That could help to maximise the efficiency of the support system. But you need to be really careful. I have more than 35 years of experience in disability care and I have worked in nearly all of the institutions in Victoria during the time they were getting bigger and bigger. It got to the point that, every time I turned up at a new place, it got closed down. In fact once when I turned up they all went on strike—because they said, 'Lindy O'Neill is here; we are obviously closing down.' And it was true. I have lived through all of that.

What I have seen over the years is that a single house can be as institutional as a massive institution. It is about the culture, the staff training, an outward-looking attitude, social inclusion—all of those kinds of things. It does not matter whether a small facility is built or a court situation is built. It is about more than the bricks and mortar. I hesitate to say this, but I have seen young people in nursing homes who are better off and better cared for—and their needs are better met—than they would have been had they been in something purpose-built where they were lonely, isolated and chronically depressed. So just coming up with buildings that meet universal principles, look nice and apparently meet people's needs is not all of the answer. There is more to it.

Mrs Treanor : I will give you an example of one of the things we have explored in our community. One of the households of people living with disabilities was a housing department house. One of the men, who has an acquired brain injury and an intellectual disability, had changing needs. So we got some community funding and we converted part of the garage and house into a self-contained unit that is attached to the household. It is like a bed-sitter that has an accessible bathroom and some tracking for when, at some stage in the future, he will need to use a hoist. At the moment he walks with a walking frame. He has remained connected in a household of people who are also reasonably independent. Part of our concern would be the idea that one model fits all, but another part of our concern would be about the inclination we sometimes have to put people with complex physical and intellectual disabilities all together in the same unit. This is in a usual street in Newtown; part of the house has been converted that way. It was originally his house anyway—he used to live in a unit in the backyard with another man, and that became not good for him. So we adjusted the existing house so he could stay in his own home with the people he was used to living with in his local neighbourhood where he had already lived for 15 years. It is a housing department house, and there was an agreement about that.

CHAIR: That was agreed?

Mrs Treanor : There was some community funding.

CHAIR: It might be a good opportunity, Senator Bilyk, for the senators who do have these proposals to go to attachment 2, which provides a layout of the site. It articulates very clearly some of the things Mrs Treanor, and certainly Lindy, were talking about. It talks about an intentional community. The idea of this community is not the fact that the community comes with the building, the community has been there. This idea has been generated by the congregation and the community. In effect, as David said this morning, it has three stages. The first stage is the residential accommodation—that has been operational since October. We are now looking at redevelopment of the church and community centre. The community centre is a fundamental core because it brings people into the space, whether through day programs or for people within the Kingsborough community who want to utilise the space. We have got the opportunity for the minister to have his residents there, but then we have surplus land. The surplus land at the rear is the stage 3 element, and that is going to be there for community housing, again to incorporate and reinforce this sense of community. The fact is that the accommodation is there, and it is one component. But it is the interaction with the community which is the important base of what we are producing there as an intentional community. That is fundamentally what we are talking about with our Polar Project. We want to seek to replicate that because we have seen the benefits of community. Quite clearly, it is the community that looks after these people, as Mrs Treanor has expressed from the work that they do.

Mrs Treanor : For all of us, we are not individual islands who are not connected to others. It is our familial-type community, and this is another version of that.

Senator POLLEY: It is great to be here and to have all your input. I think it is really challenging for governments to think about the funding models—and there are some unique models. My questions are around the aged care facilities and combining young people into those facilities. I think that, as we have experienced from St Vincent's, it is unique that there would be a separate entrance for younger people going into an aged care facility. In terms of putting it on the record, when it comes to aged care—yes, there was a time when somebody would pass away in the morning and by the afternoon you would find that that bed would be taken up. Unfortunately in Tasmania now there are a lot of vacancies in aged care because, like with us as a society, things move along. One of the difficulties we have here is the age of our infrastructure and that there is not the funding. Heaven help the facility that has to deal with me or Senator Bilyk into the future, because I will expect to have a gymnasium, I would expect to have access to a swimming pool, I would want to have my own ensuite and I want to make sure that the doona and the drapes all match and all those sorts of things. That is great—we should be aspiring to do that. But there is basically a problem about funding, and that is replacing the infrastructure we have here. So building is one issue. With the complexity of bringing younger people under the age of 60 into a residential aged care facility, I would like your input into the impact and your knowledge of that area, because even though our numbers in Tasmania, thankfully, are not as great as elsewhere, it still has an enormous impact.

Ms O'Neill : We tried to do exactly the same model as the one Yvonne talked about. One part of the facility is on two storeys, and one part is single storey. It would have been perfect to carve off and replicate. It was exactly what they are talking about—completely separate entrance; five bedrooms, all with ensuites; and larger sized rooms meeting all the universal principles for people who have special beds, special hoists or those very big wheelchairs. There were a couple of different living spaces, because some of these people do not like being with other people—they want to be near but not with.

We wanted to do that but could not get any capital from the state government. They were happy for us to do it if we could, but we could not do it. It would have been ideal, because the medical assistance for some of those people who need that medical assistance was right there. It would have been a great compromise. It would have given them everything they needed in terms of independence and space. It was new and contemporary—all of those things—but that help would have been right there.

Senator BILYK: We heard evidence—just going back to what Senator Polley was talking about—yesterday from a fairly youngish man with cerebral palsy who had to sign a waiver about taking his own bed. He is in an aged-care facility. He had to sign a waiver about taking his own paintings and pictures to put on the wall and taking his own bed. Yet you go to these facilities like Rowallan Park where people have their own furniture, their own bedspreads and so on—the place is home. When you see the difference, it is quite a worry. I assume that risk mitigation is behind a lot of that in the aged-care facilities. That is a bit of a concern to me. They cannot be home if you cannot take your own things. I know there are a lot of aged-care facilities where you can take your own furniture, but for those places where you cannot—and I assume there was no other choice for him when he had to go there—it is very disheartening to think that people spend the rest of their lives there but that it will not feel like home to them.

Dr Treanor : A home is not a building.

Senator BILYK: That is exactly right. That is a bit of a lead-in to the next thing I wanted to mention—areas where families can live together. Yesterday, once again, in Melbourne we took evidence about plans from—I cannot remember the name.

CHAIR: I am bad with names, but I think it was Mr Iliopoulos from Freedom Housing.

Senator BILYK: He had a different concept again, but it was based around the issue of families being disjointed. Throughout the inquiry, we have heard from all sorts of families who had literally been split up. One of the most heart-wrenching stories was one we heard yesterday. There was a 30-year-old woman with two young children whose husband has an acquired brain injury. She spends six or seven hours a day with the two young kids in his room—looking after him. This is in an aged-care facility. Her hope is to be able to bring him home eventually and have the family back together. We do these things like putting in ramps and making doorways wider and so on in individual housing, but to have people together with a support base there—not isolated from the rest of the community, their friends and so on—is really important. I just wanted to open that up for conversation.

Ms O'Neill : Before coming to Tasmania, I worked for Karingal in Geelong. We had more than 200 clients we were providing services to—in-home care—and we were organising more than a thousand episodes of care each week. You can imagine how many staff were required to do that and the infrastructure around organising it. But that was all in people's homes and that was with people whose disabilities were as severe as quadriplegia. I was mentioning to Senator Bilyk this morning that I think there is a woman there who was the manager of that program. Her name is Robyn Bradshaw. I think she is worth you talking to because the woman has forgotten more than I am ever going to know about this stuff. She is brilliant.

There are ways to provide that care, and some of that was with the support packages that those people had, but it was about the most efficient ways of using the hours and being quite clever about how to combine the support hours with the changes that had to be done in the family home. There needed to be a lot of discussion and negotiation with family members because you have people coming into a family home and having respect for that and where the family members sat in all of that—whether they were actually a carer or not a carer. The staff needed to work in a sensitive way so that they were not in the family's way, and they could still respect the privacy and the family times outside of the care times. It certainly can be done with profound disabilities. It can be done. I have seen it done very well.

CHAIR: Maybe we can flick over to you, Mrs Knox, because of your organisation's experience with home care.

Mrs Knox : Very similarly to Lindy, we have found that there are opportunities to provide those very tailored solutions. It is really interesting to hear the discussion on the funding for housing and the funding for care and support. I can see that it would be very helpful to have that. We are looking in aged care at home care moving to a model of consumer directed care, so the clients are contributing to their own care in addition to the government funding for their level of care and their package. They have choice within that, and our role is to enable, empower, support and help people to understand the choices and options, help them to determine what is most important to them in life—what are their goals and dreams, and what would they like to achieve?

I can see that this model would apply. It is about being a human being. It is not necessarily about an age that a person is at. Everyone has things that they aspire to that they really care about that are important. Younger people with disabilities all have their own thoughts about that and also have families and friends and people who are important to them who might assist in the decision. So having a flexible funding structure that allows people to make decisions about what is most important to them will enable a lot more choice and control for people to achieve their goals. It may be that, down the track, the funding is used for something like joining an intentional community, but it might be that, before things get to that stage, there might be another five years where spending some money on a few modifications in the home or to assist the family in selling the family home and moving to a more suitable type of accommodation is actually going to give that family a number more years to live together in the same place before it becomes necessary to look at any sort of separation.

Again, with the funding for care, it is about working with that client and their family to direct the priorities—so that high level of respect to the family time and supporting and assisting. We have a younger man, in his early 20s, who we support with home care. His mother is his primary carer. We work very, very closely with her. We have a small team of home care workers who go into that home, so we are not having lots of different change. It is very important to him to have that stability and consistency. These are home care workers who have had additional training and qualifications in disability care—and just with practical things like our workplace health and safety obligations. For our home care workers, when they are going into a client's home, that is their workplace, so we need to ensure the additional training so that not only do they know how to use a hoist but they know how to use the hoist in that client's home safely for the client and safely for themselves.

We look at developing very closely with the family: 'What is going to be most important to support you to attain your goals?' For this young man, it is for him to be at home with his family and maintain the optimal level of health and wellbeing that is possible within the context of his disability, and the family are very satisfied with that arrangement at this point in time. We will keep reviewing the care plan with them and work with them if in future they need to make a transition to an alternative form of care and accommodation.

CHAIR: Senator Seselja, I am aware that you are on the line. Do you have any questions?

Senator BILYK: He has gone.

CHAIR: Okay.

Senator POLLEY: In relation to the care that is given to younger people in aged-care facilities, is there adequate training of the staff to be able to deal with people that are younger, with various disabilities, as opposed to the residents of older age that have obviously different requirements? What sort of training is available there for staff?

Mrs Kromkamp : There is not really. And because, as everybody said, everyone is so individual and comes with their own individual needs, you cannot actually perceive what someone's behaviour or outcomes will be, because sometimes it is to do with how they interact with their new environment and that whole settling-in. There is not the training.

I guess what is really difficult is that it is a real adjustment for staff who are trained to look after the elderly to be asked to adapt to the needs of the younger people. Some of them are the age of their own children. It is very confronting. Some of them do not understand how to cope with the questions the elderly residents are asking about the younger people. I think there should be. Because it is a new thing, you find that the staff all of a sudden become very averse to some of the things that are happening that they have to handle—even someone menstruating, for instance. That is very common for the people who are carers to deal with in their own life, but in their caring world they have not had to deal with that. That is not part of looking after the elderly.

So there are a lot of different things that are thrown in, but you do not anticipate them, because there has not been a need. So I think that, if we are going to look at the model, we really do have to multiskill them. They are very multiskilled, but it is just very—

Ms O'Neill : It is different.

Mrs Kromkamp : Yes, their needs are very different.

Ms O'Neill : Even different social—

Mrs Kromkamp : Yes, exactly.

CHAIR: Different social activities.

Mrs Kromkamp : Night-time activities.

Senator POLLEY: But it is really about community though.

Mrs Kromkamp : It is.

Ms O'Neill : It is.

Senator POLLEY: I visited a fantastic facility in Sydney, just one group home that accommodates people with dementia but also people who have severe behaviour problems with dementia. There was one woman that we met who was—for want of a better word—not welcomed in a number of facilities because of her behaviour issues. But when she went into this house—when we pulled up outside, we thought it was a really nice neighbourhood, a great house. You would not even know that it was a group home of any distinction, but when you went inside it was a home. This particular lady used to get so frustrated in the facilities where she had been living before because she would want a cup of tea, but of course we know that in the institutions it is not always convenient. It was a very simple thing of getting to know her, so she, in a very supervised and careful way—it is a normal kitchen like we all have at home—would go and make herself 50 cups of tea a day. It did not matter. She was happy. She no longer had those aggressive outbursts. She lives in a home environment where they have their lounge. They negotiate about what movies they are going to watch for the day. They go out on outings.

If you can do that with people with severe behaviour issues around dementia or people living with dementia, it is the same principle. Really I think everyone said it today. It has to be an individual, holistic approach of how we care for people, whether you are 30 or you are 80 or in between; it does not matter. But you have to come up with a way of how governments can actually fund this and sustain it. And—I think it was mentioned before—you really do need to have projects that are supported by the business community. We need that involvement so it becomes more of a community expectation rather than just putting everything onto a government or just onto St Vincent's or UnitingCare. We have to take it as a holistic approach.

CHAIR: Mrs Knox, you look like you want to respond to that.

Mrs Knox : It just reminded me of a story from my experience in Western Australia. I think it is very interesting that you have said that at Mount St Vincent that has been at your own expense, putting on an extra mortgage. I am not sure whether there are any top-up funding arrangements there, but it is very difficult if you are trying to do more with the same funding that is designed for a completely different model of care.

I had an experience with one of the residential care organisations I worked with in WA. We had a younger woman with severe dementia and behavioural and psychological symptoms associated with that. She was in her early 50s. Her husband had been caring for her at home since she became unwell in her mid-40s, and for him it was extremely wrenching for her to be admitted to residential care. He still spent many hours per day there participating in her care, and she was much calmer when he was there and could have as much time as possible with her.

I was called in because the care staff had absolutely reached the end of their tether; they could not cope anymore. There had been escalating aggressive behaviour, especially around shower time. This poor lady was so severely distressed by showering and was physically aggressive, causing injury to the care staff, so they had gone from having her showering with one person to two people to three people. Because of her incontinence and hygiene requirements, we really needed to make sure her skin was not breaking down and that she stayed physically well, but this was just a daily battle.

We were very fortunate in that organisation that we had two separate homes that had high-dependency units which received top-up funding from the state government. These were designed for people who had severe and enduring mental health problems and had been unable to be discharged from the hospital system. We had all of those funded beds, and then we had one additional bed which was ours to use as we wished, and this lady was able to go into that smaller unit. The advantage was that, because of that top-up funding for the high-dependency clients, we were able to very carefully select our staff—people who had the compassion, the aptitude, the interest and the ability to work with people with complex needs. We could then invest in those staff members by giving them additional training and support, and we could have those close links with community services like the mental health teams and geriatric medicine teams and look at building a holistic approach.

So this lady moved into the smaller unit with the highly skilled staff—a much quieter, calmer unit. They were able to go back to showering her just with one person, keeping things very simple and very calm. It was no longer distressing for her and, although she had such a severe illness, her husband was able to have some reassurance and take some comfort in the last two years of her illness. She was less distressed and less tormented because we had been able to make that adjustment. So I think it is just having those sorts of structures where there is top-up funding to enable smaller environments with people with a higher level of skill, and we value those people.

Another thing that I just wanted to quickly mention is that I see that the government is looking at a new model of funding for consultation for people with dementia and severe and challenging behaviours. The caution that I have, having worked in a lot of those environments, is that sometimes these services can be almost like fly-in fly-out; they just sort of drop in to—

Unidentified speaker: They are known as the flying squad.

Mrs Knox : Yes. They go in, assess the client, talk to the registered nurse, liaise with the GP and are gone. I never found that that model worked when I worked in community mental health services or anything else. It takes more time and it is more resource intensive, but the only thing that I found that came up with a better solution was, yes, to assess the client and speak with the registered nurse but then to meet and have a care conference with the carers that are doing the direct work with that client, as well as involving the family. That is where you get the understanding: these are the things that are not working, these are the things that are distressing, these are the things that are causing problems, these are the things that sometimes work and these are the things that really work well. You need to have that opportunity to unite everyone in a discussion, keeping the client themselves and their family at the centre so that their voices are heard and you are able to come up with solutions. So I would suggest that the model for that new service needs to take that in.

Unidentified speaker: It is only a pilot.

Mrs Knox : Yes.

Dr Treanor : I think that in answer to your question, 'Is there sufficient training out there,' what Mrs Knox has said is right. The AQF is a very good qualification framework. Like any framework, it trains us in universals. It does not train us in particulars, and there needs to be particular training in some things. I know how to take blood because somebody has taught me, 'Here's the process.' But then applying that to a person is very, very different. So we need to have that contact. All training needs to be individualised, so to speak. Someone with maybe some years experience can pre-empt some things, but we have to journey with that person as an employee and as somebody that we want to stay in our service or in our industry for a long period of time, because we also know that not providing good, robust training to people means we will lose many good support workers.

Mrs Treanor : For me, too, it is that sense of people with disability not being the sum total of their disability. All of us have things we can and cannot do that impact on who we are, but we are more than that. So it is also that question of: what does that person themselves have to offer? The sum total of a person is not being the recipient of a service. So what do they have to offer, what do they have to teach staff? They are bigger than their disability. People with disability can be contributors to our society, to our communities, and that gathers people around them as well—that they want to be with people. We have paid assistants to assist people, but the vast majority of them also spend unpaid time with people because they develop long-term relationships with people and they are mutual. Speaking for myself, I have been a member of our community for 28 years and employed there for 11. People have long-term relationships with others that are mutual, and that does not cost anything.

CHAIR: But it is so beneficial. In the department's submission, they are saying that in Tasmania there are 150 younger people with disability in residential care. Now, that is those aged under 65, and the bulk of them are between 50 and 65. But, when we talk about younger people, we are obviously talking about anybody under the age of 65 because that is where the cut-off is. Can I ask about that cohort of people between 50 and 65? We have been talking a lot about really young people in aged care, and they are a separate cohort from the 50- to 65-year-olds—but they are still a younger cohort and have very different needs from the average 80- to 85-year-old in aged care. I am 53 and I have very different needs from my mother, who at the moment is living very independently. But we have different needs. What is your experience of working with that particular group of people with disability? Because they seem to be a disproportionately large group in Tasmania compared to some of the other states. For your percentage of the population, it seems to be larger than some of the other states.

Ms O'Neill : The Tasmanian government has been focusing on getting the under 50s out of the nursing homes.

CHAIR: Which is what they are doing in WA, too.

Ms O'Neill : Yes. So that is where they have focused their attention. That older group is not forgotten, but it is certainly down the list of priorities. But the older people who are there, because they have lived long enough to be that age and to be in receipt of those services, are not particularly enamoured with having younger people there either, because it disrupts their lives to have noisier people and rock 'n' roll music and footy and whatever else. But at this stage, to my knowledge, there is nothing specific, a new initiative or something, being done. But I know that you are talking to DHHS after lunch.

Senator MOORE: It is on my list of questions for them.

Mrs Kromkamp : Food is one of the real issues. Food is issue for anyone in a facility; but having those people—people our age—in a facility with older people—

Ms O'Neill : Young people. We are still young.

Mrs Kromkamp : That is right. What they want on the menu is completely different. The times that the meals are structured do not suit them, nor does bedtime. In aged care your staffing numbers get lower at the end of the day. That is when those younger people say, 'Excuse me, I want to go to bed at 11.' Our staff finish at 11 and we bring in night staff. We do not have three people to put someone with severe disabilities to bed at 11 o'clock. Those things really do affect people. They have to make a lot of sacrifices, those younger people, because they are compromising.

CHAIR: I suspect with that group that some of them will have been in aged care for a significant period of time.

Ms O'Neill : They are actually becoming institutionalised themselves and so we force them to become old before their time.


Senator BILYK: And more dependent than they may need to be in a lot of cases, we have heard, too.

CHAIR: It is sounds like that group is missing out a bit. Would that be a fair analysis to make?

Unidentified speaker : I think so.

CHAIR: I am not criticising. I really want to get younger people out, but I am also very concerned about that.

Dr Treanor : There are some missed opportunities for those people. How you might recreate those opportunities would be different because of what their lived experience has been.

Mrs Fitzgerald : In fact, we have a project that has been earmarked for Victoria—not Tasmania—for exactly that demographic in a place called Rosebud. We basically have earmarked land for a similar type of intentional community where we will have a community centre and a group home facility. This is community-based, again; some parents have come together who are elderly and who are looking after a lot of these children in their homes.

CHAIR: That is what worries me. That is what we were finding in Western Australia: when the children are 45 to 50, their parents are 70 to 80 and they are no longer able to lift. People are going straight from their home into aged-care facilities.

Ms O'Neill : At Karingal in Victoria we are playing around with the notion of getting some land and creating an environment where the parents of adult children with disabilities who have lived at home with their parents all of those years and then got to the stage where the parents were unable to care for their child any longer and were needing some sort of residential facility themselves could go—even if it was independent, but moving towards total nursing care. They were trying to develop a project where they would have that for the parents—going from independent units right through—and on that same site having a group home where these adult children with disabilities could live. So they would be on the same site; they would be receiving care from the same set of staff and support people and they would still have close access. There is grief and loss suffered by those parents who have cared for their child for 50 years—of course they are not going to think their child is going to receive the same kind of love and care and support they have provided themselves. For that adult child, that grief and trauma is huge. They were looking at that to see whether they could get something like that.

Unidentified speaker : Separation is an issue.

Rev. Parker : That is one of the drivers of the Rosebud project. It is interesting to see that some of the parents who have been looking after these young people are inquiring about whether they might be able to retire into the social housing.

CHAIR: Out to the social housing.

Rev. Parker : It is anecdotal but I think it is a fairly powerful issue for us.

CHAIR: The issue that has come up during the inquiry with the model you have just talked about, with using the same care staff, is that some of the feedback has been—and they are not being disrespectful to the staff working in the aged-care facility—that they bring the same mindset from aged care to caring for the younger people, even though it is in a different unit or wing. Some residential facilities have been talking about having a separate wing or already have them. That is where the training comes in—you are actually supporting a different group of people. That has been one of the criticisms levelled at the wing on the side of an aged-care facility.

Mrs Treanor : There were similar issues there with the de-institutionalisation process when people left Willow Courtand staff moved with people into smaller household settings in the wider community and came with a mindset of still being in the big hospital. There are lots of similar issues.

Senator POLLEY: Can I ask a question of another cohort? I visited facilities in Victoria. And it is something I am becoming acutely aware of and, I think, it is something that Tasmania is going to have to deal with in the future. For the people who end up on the street and are homeless, there is nowhere for those people to go. The only alternative they have is to go into a charitable aged-care facility, where those challenges are really quite great. Not only are there psychological problems, and problems with drugs and alcohol abuse and those sorts of things, but, physically, the body has aged so much more. I would not have thought that in Tasmania in the previous 50 years there would have been a very large amount of young people that would have fit into that criteria. But I think that is something that, unfortunately, Tasmania is going to have to deal with, particularly in light of the fact we are now on a level footing with every other state in terms of the drug abuse in this country. I was just wondering if you had come across that and if you had given any thought, from your experience in the sector, to that cohort of younger people—and they can range from their 30s, to their 40s or to their 50s.

Rev. Parker : Again, this is anecdotal. But at the Wesley church in Hobart we have a drop-in centre called Nobucks, as opposed to the other known coffee place. The incremental use of that now, from originally being just a hospitality type experience to being provision of meals, has grown dramatically. That is mainly in the cohort that you have referred to. Some are not homeless but some certainly are, and they are now getting up to 50 for a barbecue lunch on a Friday. I think that is indicative of what you are indicating.

Mrs Knox : In a consultation liaison role in Royal Perth Hospital, one of the things that we used to come across fairly regularly was trying to find suitable accommodation for similar people. For the younger people with Alzheimer's or frontotemporal dementia, it was particularly hard to find accommodation and placement for. In addition to that were the younger people with brain damage as a result of sustained alcohol use or drug use. When we are talking about the importance of community, often these were the people that had the most disconnection from community. Their family had long given up on them. They had been homeless for many years or had been out on the streets for many years. So when they finally got to the stage of being in hospital and we were able to do comprehensive assessments of their executive function, their brain function and their ability to make decisions and care for themselves, we would find that they did not have that capacity but there was simply no-one else to take that on or to advocate for them. So that cohort is particularly challenging. Even if places were available in residential aged care, most homes would say they could not possibly have them because their manner of interaction was something that just would not fit in the environment of residential aged care.

Again, I found the HammondCare submission quite interesting because it is saying that under the age of 65 in Australia there are 23,900 people with a diagnosis of dementia—so almost 24,000. Not all of them are going to qualify for the terms of reference of this inquiry because they may be much earlier in their illness, but we know that it is a progressive illness and we know that, if there are good interventions early on, we are going to reduce the need for that admission to residential care or to shorten the amount of time that people have to be in residential aged care. Those are really positive outcomes, but we also know that when younger people need that full-time care it is much more appropriate for younger people to be with other younger people. I found that one very interesting.

Ms O'Neill : We deal with some of this particular cohort that you have raised in emergency relief because that is another program that we run. Our experience would be that they would resist, tell lies and just not turn up. They just would not engage with a service or be in one place long enough to be admitted to a facility, even if one would take them. It seems to be that somehow they find each other and they support each other as best as they can. They would end up going in and out of mostly homeless men's shelters, and they fade away. I think that they are some of the people who die under bridges. They resist. Even if you could them into a facility, it would not be a good fit for any of the people living there or them.

Mrs Knox : We would also find it difficult even if it was a security facility because their dementia had progressed to such a point that they were at risk if they went out and wandered and got lost. They would be admitted to a secure facility. But secure facilities for older people with dementia are designed for older people with dementia. These younger men are in their early 50s and they would climb the fence and get out, and then you would have the police looking for them. There would be massive resources put into place.

Senator POLLEY: It has to be a unique facility. We visited one that was making it work by using the severe behaviour supplement that the government just cut. The new flying squad will not assist them in this long-term care. I saw photos of them—predominantly men; the facility took photos of them when they came in—and just you could see the physical change in them after being there for three months. I think those people have every right to the same sort of care as what I get or anyone else, but it is a unique setting without a doubt.

CHAIR: I want to ask about your interactions with the NDIS and how is it going?

Rev. Parker : We made a statement that we are having real difficulties. The cohort of the current pilot in Tasmania is aged 25. Leaving that aside, Optia, who are the people dealing with it face to face for us, are going to work with your support staff at the senator's request. We have gaps that I think I referred to in the opening. The person has been selected and we are now three months down the track, and we still do not have the approval from the NDIS process. There seems to be significant confusion and a lack of clarity around the objectives and how you might run a business model that can provide service to customers as opposed to being bureaucratic. I do not have the detail, but in principle it is quite a significant issue right at the moment.

Senator BILYK: It is causing some delays.

CHAIR: I understand we are going to get some freedom of information. Is that time delay the main issue? We have heard issues around not providing rehab, lack of coordinated care and coordinating with the health department and those sorts of things. Have you come across those as well?

Rev. Parker : I think Optia would say that there is very little understanding of the holistic nature that is required in that packaging on the sorts of issues you have just identified, and they are struggling very much in the accommodation component.

CHAIR: Part of the role of this committee is to gather information on that and provide it to the joint committee on the NDIS.

Rev. Parker : I spoke to the chief executive of Optia and the team have their details. They are very willing to provide information that would be helpful.

Mrs Fitzgerald : Just an example, we have vacancies in our accommodation and we finished in October. That is a problem. Great accommodation is not being taken up because of the delays.

Senator BILYK: People are ready.

Rev. Parker : The names have been allocated. That is the process.

Senator BILYK: That is right.

Mrs Treanor : For us it has been positive in terms of someone being able to access funding for equipment. That seems to be quite quick, but that is all they are able to access. Does that make sense? They got a new bed and things—and that was really good—but there seems to be lots of confusion around anything else.

Mr Treanor : We are all, I think, fairly committed to the idea of a community based model. In the funding structure it is about what, as a provider, you can apply for to support people to access community. I am still wondering where the categories are for that. There seems to be some assumption in the rhetoric that the community have got to embrace people. When has that happened? That may be what Optia are talking about, as well. Those categories are not clear. As it has been rolled out in other territories we are finding that that is a question. People may get funding but they may end up being in a walled house because they have no-one to take them anywhere.

Ms O'Neill : I just think it will be interesting to see NDIS in 12 months or two years. I think, very clearly, it is a trial site down here. Very clearly we are seeing teething problems. We have had a brand new bureaucracy created—which will take time to make itself work anyway—much less a completely new philosophy of care, with the training of all the people who are doing the planning with the individuals. They are sussing some of it out. I have a friend who is a planner. She comes home and says, 'Goodness me, you wouldn't know what has happened today!' And she will tell me the story. They are thinking up responses. If a new issue comes before them that they have not faced before they are thinking up the response on their feet and trying to figure it out.

So, we are all very frustrated up this end because we think, 'Good, here it is; let's go.' But it is not like that on the inside. Those people are working their way through it all. So I think we need to watch this space.

CHAIR: We are trying to watch this space so that we can be feeding that through to a joint parliamentary committee and to the NDIA.

We are just coming up to time. I think we have exhausted our questions.

Senator POLLEY: I think there are a lot more questions!

CHAIR: We have exhausted our questions for today.

Senator BILYK: I was going to ask Ms O'Neill to quickly mention some international stuff she knew about if there is just a few minutes for that.

Ms O'Neill : Robyn Bradshaw at Karingal, I mentioned before. Karingal did a lot of work because they were trying to figure out all of these different models, 10 years ago when I was there. Robyn did a lot of investigation into what was happening internationally with lots of different kinds of things. So in terms of international stuff about what is going on, what is contemporary and what works, you would be well advised to talk to her.

I had better contact her and tell her that I have put her right in it!

CHAIR: Yes. It is on the record now, so she will know exactly who has done it!

Ms O'Neill : She will be helpful to you.

CHAIR: Thank you very much for your time and for your evidence; it is extremely helpful for us.'

Proceedings suspended from 12:58 to 13:38