Design of the NDIS – what it will mean for health and aged care services

Catholic Health Australia National Conference 2013 John Walsh Albert Park, Melbourne Tuesday 27th August 2013

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1. Programs or people ?

2. The NDIS / NIIS

a) The problem b) The PC proposal c) Implementation timeframe

3. Impact on the health and aged care systems

Contents

Page 3

The life span approach - Its all about the person

Early Intervention & Information

0-4 years Early

Childhood

5-17 years School

18-24 years

Transition to Employment

25-64 years

Employment

65+ years

Retirement

Child Protection

Disability Services

Informal support

Aged Care

Disability

Domestic Violence

Mental Health Issues

Loss of Job

Disability (acquired)

Housing Services

Page 4

The Continuum of Care

Early Intervention & Information

Mild Moderate Severe

Appropriate, Seamless & Timely

Profound Limitation

Care Type

Considerations

Residential

Care

Community Care

Core Activities

Service Types

Self Care

Mobility

Communication

Food Services

Personal Care Nursing

Respite Services

Allied Health Services

Food Services Domestic Assistance

Domestic Assistance

Transport Services Property Maintenance

Respite Services Planned Activity Groups

Planned Activity Groups Respite Services

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Real life disability isn’t measured by a functional capacity assessment, but rather by the impediments faced by people in achieving

“ordinary valued lives”

• Access to employment

• Access to education

• A place to live

• Friendship groups

• Financial independence

What is “disability” ??

• Relationships

• Aspirations

• Choice and control

• Alternatives

• Resilience

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Up until this year the disability system was governed by the National Disability Agreement (previously CSTDA). This provides Commonwealth and State funding in the following areas: • Supported accommodation ( large residences, group homes and some in-

home support eg attendant care program)

• Community support – largely day programs

• Community access – therapy

• Respite care

• Supported employment

In addition, people with spinal cord injury are supported by the home and community care program, residential aged care, and in some states specific programs.

What is “the disability system” ??

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The NDIS / NIIS

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• “... underfunded, unfair, fragmented and inefficient... “

• How do we address current arrangements? – double funding from $7.2b to $13.6b ($15b), funded by the Commonwealth

– introduce a national assessment process for eligibility and entitlement, based on support need

– create a NDIA, with localised coordination and innovation

– replace block-funding with individual packages, introducing supported choice and control.

National Disability Insurance Scheme (NDIS)

The National Disability Insurance Scheme (NDIS)

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People with an disability and age less than 65:

• Intellectual disability

• Autism

• Congenital or acquired severe physical disability, eg cerebral palsy, muscular dystrophy, musculoskeletal

• Neurological disability, e.g. spina bifida, multiple sclerosis, motor neurone disease

• Profound sensory disability – sight, hearing and deaf-blind

• Significant and enduring psychiatric disability – community support needs

Types of people covered by NDIS

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In the NDIS:

• attendant care; community access; aids and appliances; home and vehicle modifications; supported accommodation; respite; taxi vouchers, supported employment; community support for psychiatric disability

• early intervention

• carer support

• community development and capacity building

• innovation welcome

Outside but parallel to the NDIS:

• mainstream funding of public housing, education, health (except some early intervention therapies), income support, open employment

NIIS also includes hospital and medical

Expected types of support services

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Federation of state-based lifetime care and support schemes – covers all major injury regardless of cause (special consideration of cerebral palsy)

Prospective and fully-funded by a range of mechanisms to be determined by states:

• existing levies and premiums

• savings and offsets

• “user pays” on a range of activities – eg local rates and taxes

Small national coordinating unit linking with NDIS

Estimated 1,000 new entrants per year (SCI and brain injury) at a total gross incurred cost of $1.8b per annum, or $830m extra to be funded by states

National Injury Insurance Scheme (NIIS)

The National Injury Insurance Scheme (NIIS)

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Universal insurance cover Insurance-based governance framework Surety of funding base Support based on reasonable and necessary need Support focused on the individual and their carers Choice and Control

Key features of both schemes

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NDIS Tiers

3a

Tier 1 Tier 2

Tier 3People receiving funding support from the NDIS Target = people aged 0 to the pension age with sufficient needs for disability support and early intervention

(3a) People with intellectual, physical, sensory, or psychiatric disabilities who have significantly reduced functioning (330 000) (3b) Early intervention group (80 000)

Total = around 410 000

(3c) Others optimally supported (unknown, but modest)

3b 3c

Information, referral, web services, and community engagement. Target = all people with disabilities (4 million) and their primary carers (800 000)

Social participation, minimising the impact of disability, insurance (target = Australian population) 22.5 million

3d

(3d) Funded support for some carers

A consumer perspective

People with disabilities their needs and approved spending plan

determine the types and nature of services from the groups below

private, for- profit firms

non-government

organisations in the

disability area

paid individuals

eg neighbours

other government

services

state and local

government providers

Disability Support Organisations (DSOs)if people with a disability wish, they could choose an intermediary to be a service broker, provide management services, personal planning etc

NDIA local area coordinators would

provide case management services, connect people to the community, liaise with

the NDIS and other government services

Service providers (SPs)$ funding

National Disability Insurance Agency

Assessment, plans& budgets

specialist disability service

providers

Local community

groups

Com

mun

ity

inte

ract

ion

Resources to activate the community

Gra

nts/

leve

rage

to b

uild

com

mun

ity c

apac

ity

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• NDIS LTA – DisabilityCare Australia - established in July 2012

• Has responsibility for building readiness for an NDIS launch in agreed locations from 1st July 2013

• Attracting expertise from government, disability sector and insurance experience

• Working on system development and capability

• Launch sites in NSW, Victoria, South Australia, Tasmania – next year in NT, ACT and WA

• Full scheme rollout has bi-partisan support from 1st July 2016

NDIS Launch and roll out

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Impacts on the health and aged care system

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The main impact will be blurring of the boundaries:

• Eligibility: NDIS does not seek to replicate community care for people with a chronic disease

• Services provided: NDIS does not seek to provide “health services”

However there will be boundary issues on both of these points, and the need for collaboration and goodwill

Mental illness / psychiatric disability, and some chronic diseases are special cases

For these types of conditions, team-based support seems to provide the best evidence of good outcomes. We could have a situation of people working in the same team but funded from different systems.

Impact on the health system

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The main issues are blurring of boundaries, and the age 65 cut off of the NDIS – onset of disability at older ages ceases to be an “insurable risk”

• Eligibility: NDIS does not cover people whose disability emerges after age 65

• However, there is still some discussion around potential for lifetime coverage for people who enter NDIS before 65 – for these people the issue will be which bucket the funding comes from.

• Services provided: NDIS will not fund residential aged care

The recommendation of the Productivity Commission was that people who were in the NDIS before age 65 could continue to receive their funding packages, but that funding responsibility would shift to the Commonwealth-funded aged care system, at age 65 in keeping with the agreements under the National Health Reform.

Impact on the aged care system

DRAFT for discussion purposes

The NDIS is the most important enabler to a better life.