Government perspectives on housing,technology and support design within Australia's National Disability Strategy

Australia's National Disability Insurance Scheme (NDIS) is a significant disability reform and part of a 10‐year National Disability Strategy that aims to build well‐being and inclusion of Australians with disability. Housing is recognised as a key determinant of health. Transition of state‐funded supported accommodation to an NDIS, within the new Specialist Disability Accommodation framework, aims to deliver housing responses that positively influence NDIS participant outcomes. This study aimed to gather perspectives of government disability and housing representatives on current opportunities and issues for Australians with disability. The study investigated four key research questions, relating to built design; integrated technologies; the relationship between housing and support provision; and community precinct design. Nineteen government representatives from seven of the eight Australian states and territories participated in a roundtable focus group in Melbourne, Australia (March 2017). Focus group data were audiotaped, transcribed verbatim and thematically analysed. Twelve themes were identified in response to the research questions identified. Key policy and practice implications were highlighted. This research offers insights from government that can contribute to strategic housing, technology, support and community design decisions and Australia's National Disability Strategy, to deliver improved outcomes for people with disability.     

Australia's Individualised Disability Funding Packages: When Do They Provide Greater Choice and Opportunity?

Australia's new National Disability Insurance Scheme (NDIS) uses individualised funding packages instead of traditional block‐funded disability services to support people with disability. The NDIS works with the person and their family to assess the person's needs and develop a plan that determines their funding allocation. Funding can be used to purchase support from a disability service or from the open market. People can purchase support that suits their cultural and personal preferences. This paper examined whether individual funding packages met their aims in Western Australia, where they had been the primary mechanism of disability support for over 25 years. An exploratory case study was conducted consisting of face‐to‐face, in‐depth interviews with 11 key participants: people with disability, senior government administrators, service provider managers, and a support worker. Complex systems theory was used to review the data and findings showed that individualised funding packages did not automatically result in more choice and greater opportunities. People needed information to make informed decisions; supportive and creative support from social workers and other professionals; and welcoming communities. The findings can inform policies and assist social workers facilitate maximum choice and opportunities for people with disability and their families.     

NDIS Self‐Management Approaches: Opportunities for choice and control or an Uber‐style wild west?

This article examines the emerging challenges and opportunities presented by self‐management options in Australia's National Disability Insurance Scheme (NDIS). We examine the three different ways in which NDIS participants can opt to self‐manage their funding and services, including direct employment and emerging Uber‐style online platforms, and explore the potential implications of these options for NDIS participants, service providers and the disability support workforce. In particular, we focus on these options in relation to the transition to a marketised services landscape being developed alongside the NDIS, and examine both the risks and opportunities for each stakeholder group. Through this analysis, we identify implications for policy and practice, in particular around regulatory mechanisms and the role of government within this emerging market economy and transforming service landscape.     

Audit of advertised housing and support vacancies for people with disabilities in Australia

The introduction of Australia’s National Disability Insurance Scheme (NDIS) has changed the way housing and support are delivered to Scheme participants. NDIS policy reform focuses on coordinated housing and support responses. These responses are guided by the Specialist Disability Accommodation (SDA) Rule, Framework and pricing and Supported Independent Living payments. To date, the National Disability Insurance Agency (NDIA) has only released limited data to understand SDA demand or inform market development. To understand changing housing and support approaches and the impact of NDIS housing policy on market responses, this research had three aims: (1) to examine the locations and characteristics of housing and support vacancies advertised for people with disability; (2) to investigate funding sources for, and providers of, these supported housing options; and (3) to examine the proportion and source of government, nonprofit and private sector funding for housing and support developments advertised. An audit was undertaken of all advertisements on the two main non‐government organisation Websites that list Australian supported housing vacancies. A total of 562 property adverts were reviewed in March 2019. Audit findings are considered in relation to the current NDIS policy context. Possible housing futures and market gaps for people with significant and permanent disability in Australia are discussed.     

Rural Victorian service provider responses to the National Disability Insurance Scheme

The National Disability Insurance Scheme (NDIS) has transformed the nature of funding available to health and human service organisations to provide services to people with disability in Australia. However, there is relatively scant literature on the rural implementation of the NDIS, particularly how rural NDIS service providers are affected by the NDIS. Researchers conducted semi-structured interviews with 20 health professionals employed by rural providers, and analysed data using rural and remote health and organisational change frameworks to understand how rural providers were impacted by and responded to the NDIS. The findings suggest rural providers were impacted to differing extents and responded to the NDIS in different ways. Participants reported that disability and community health services were affected more than hospitals and private allied health practices. Impacted rural providers responded by changing the nature and types of services, service processes and their workforce, and redefining organisational characteristics. Impacted rural providers may require additional support to continue providing services, and those less impacted may require other incentives to better engage with the NDIS. Rural proofing of NDIS policy could reveal suitable supports and incentives to ensure rural people with disability can access required services.     

‘Any one of us could be among that number’: Comparing the Policy Narratives for Individualized Disability Funding in Australia and England

In this article we compare the introduction of individualized budget policies for people with disabilities in Australia and England. Data is drawn from semi‐structured interviews undertaken in Australia with politicians, policymakers, providers, disability rights groups and care planners, along with analysis of policy documents. This data is compared to the authors’ earlier research from England on the personalization narrative. We argue that the National Disability Insurance Scheme (NDIS) currently being introduced in Australia deploys an insurance storyline, emphasizing risk‐pooling and the minimizing of future liabilities. This contrasts with the dominant storyline in England in which attention has focused on the right to choice and control for a minority of the population. This difference can be explained by the different financial context: the NDIS needed to build public and political support for a large increase in funding for disability services, whereas in England the reforms have been designed as cost‐neutral. Tensions in the English narrative have been about the extent to which personalization reforms empower the individual as a consumer, with purchasing power, or as a citizen with democratic rights. Australia's approach can be characterized as a form of social investment, evoking tensions between the citizenship of people with disabilities now and the future worker‐citizen.     

Experiences of National Disability Insurance Scheme planning from the perspective of adults with intellectual disability

The Australian National Disability Insurance Scheme (NDIS) is attempting to address long‐term inequalities experienced by people with disability. Planning is central to the NDIS. People with intellectual disability will be the largest group of NDIS participants, and their perspectives are underrepresented in the literature. It is important to understand how they experience and perceive NDIS planning. Ten adults with intellectual disability participated in semi‐structured interviews to explore their experiences of NDIS planning. Data were analysed using Braun and Clarke's (2006, Qualitative Research in Psychology, 3, 77) six stages of thematic analysis. Six themes were identified: planning preparation not fit for purpose, creating goals, goals not met, planning not meeting real needs, lack of choice and control and importance of relationship with planner. In principle, the NDIS presents a real opportunity to increase the choice and control, social and economic participation, and independence of people with disability; however, this does not always translate into practice for people with intellectual disability.     

Tensions and contradictions in Australian social policy reform: compulsory Income Management and the National Disability Insurance Scheme

This paper explores contemporary contradictions and tensions in Australian social policy principles and governmental practices that are being used to drive behavioural change, such as compulsory income management. By means of compulsory income management the Australian Government determines how certain categories of income support recipients can spend their payments through the practice of quarantining a proportion of that payment. In this process some groups in the community, particularly young unemployed people and Indigenous Australians, are being portrayed as requiring a paternalistic push in order to make responsible choices. The poverty experienced by some groups of income support recipients appears to be seen as a consequence of poor spending patterns rather than economic and social inequalities. By contrast, Australia's National Disability Insurance Scheme (NDIS) has been constructed as a person centred system of support that recognises the importance of both human agency and structural investment to expand personal choices and control. Here we look at the rationale guiding these developments to explore the tensions and contradictions in social policy more broadly, identifying what would be required if governments sought to promote greater autonomy, dignity and respect for people receiving income support payments in Australia.     

The disability self‐direction movement: Considering the benefits and challenges for an Australian response

The following article provides a snapshot of the current self‐direction movement within the disability sector across the industrialised world, with particular emphasis on the Australian context. As a global movement, self‐direction has been in progress for several decades through a variety of implemented responses. Despite implementation variation, all self‐direction models aim to facilitate individual control and decision making in care and support services. We describe self‐direction, its various models and programs, and explore its benefits and challenges. We conclude by making broad recommendations for decision makers involved in self‐direction. In particular, we offer a hierarchical decision tree that can be used to inform policy decisions at a systems – government policy – and organisational level.     

Australia's disabling income support system: tracing the history of the disability pension from 1908 to today

This article is based on a historical‐comparative policy and discourse analysis of the principles underpinning the Australian disability income support system. It determines that these principles rely on a conception of disability that sustains a system of coercion and paternalism that perpetuates disability; this is referred to as disablism. The article examines the construction of disability in Australian income support across four major historical epochs spanning the period 1908–2007. Contextualisation of the policy trajectory and discourses of the contemporary disability pension regime for the time period 2008–now is also provided. The system was found to have perpetuated disablism through the generation of disability categories on the basis of normalcy and ableness as a condition of citizenship. Two major themes were found to have interacted with the ideology of disablism. The first theme – Commonwealth authority – set the tone for legitimising the regulation of disabled citizens. The second theme – conservative sanctioned paternalism and coercion – reflected the tensions between the paternalistic concern for income support provision while attempting to prevent idleness and welfare dependency. This article argues that a non‐disabling provision based on social citizenship, rather than responsible or productive citizenship, counters the tendency for authoritarian and paternal approaches.     

Models of disability support governance: a framework for assessing and reforming social policy

In many developed countries, the provision of disability services has undergone significant transformations, from institutional to community based care, and from oganisational to personalised funding. Yet delivering disability support remains an ongoing challenge for governments. Specifically, the relative success of different types of disability support governance is convoluted and problematic given the diversity and complexity of disability support systems and the people they serve. To enhance the systematic analysis and evaluation of disability support governance, this paper conceptually advances four distinct models based on the locus of control and coordination of such support: uncoordinated; casework governance; dwelling‐based governance; and user‐coordinated. Using illustrations from case studies of individuals receiving care, the identification of these ideal types enables their relative strengths, weaknesses, and the occasions of governance failure to be articulated. No one model is universally applicable to people, nor immune to failure. Furthermore, the paper presents a novel approach to visualising actual disability support arrangements as social networks. The utility of such visualisations for analysing individual and system‐ wide arrangements is outlined. In the context of Australia's developing National Disability Insurance Scheme, these conceptual and analytical developments are argued to be important tools for policy and service analysis and reform.     

Disability poverty and ageing in regional Australia: The impact of disability income reforms for indigenous Australians

Australian disability policy has undergone considerable reform since the early 2000s. While recent research and scholarship has largely focused on the new National Disability Insurance Scheme, there is a dearth of research that examines the impact of reform to the Disability Support Pension, and even less so the effects on Indigenous Australians living with disability. This is surprising as a higher proportion of Indigenous Australians live with disability than the non‐Indigenous population. This article pays particular attention to the experiences of Aboriginal Australians who have acquired a disability after extensive years of working (25–40 years), yet are still of workforce age (less than 65 years of age). Because of tightened eligibility criteria for the Disability Support Pension, people in this group are placed onto the lower paid Newstart Allowance (general unemployment benefit). The article illustrates the high levels of poverty that Aboriginal Australians with disabilities experience daily, and the ongoing costs they incur in managing Newstart conditionality to maintain continued access to the general unemployment benefit.     

Introducing social insurance for long‐term care in Taiwan: Key issues

Nadash P, Shih Y.‐C. Introducing social insurance for long‐term care in Taiwan: Key issues Taiwan will shortly complete its comprehensive social safety net, which includes national health insurance, retirement security, and unemployment insurance, by introducing long‐term care (LTC) insurance – putting it ahead of the many countries that rely on a patchwork of policies to address the need for LTC. The program, to be implemented in 3 to 5 years, will cover all citizens on a primarily social insurance basis. The range of LTC policy options considered is discussed, particularly how to structure the program, how to finance and regulate it, and how to develop its inadequate LTC infrastructure and workforce. Particularly thorny issues include the choice of social insurance, the feasibility of cash benefits, and how to address Taiwan's heavy reliance on foreign workers. Taiwan's increasingly democratic character, along with high levels of public support for the program, creates significant pressure on politicians to deliver on their promises to implement LTC reform. Key Practitioner Message: ?Emphasizes the importance of policy learning from other environments; ?Highlights the need for a strong regulatory and provider infrastructure for delivering long‐term care services; ?Emphasizes the need for training, support, and appropriate regulation of the long‐term care workforce.     

A Long‐Term Disability Care and Support Scheme for Australia: Opportunities for Disability Sector Reform

Social insurance schemes in Australasia have a long‐standing involvement in leading systemic change as well as funding services for eligible scheme participants. Establishing a long‐term disability care and support scheme for Australia provides opportunities to remove barriers to community access and improve the employment participation of all Australians with a disability, and to increase the use of evidence in policy development and in the delivery of disability supports. Using the examples of successful models in Australia and New Zealand, the authors will propose a model for the development and management of a long‐term disability care and support scheme that enables sector reform in employment participation, barriers to access and participation in all aspects of community life, and funding of disability research to benefit all Australians with a disability.     

Changing the culture of social care in Scotland: Has a shift to personalization brought about transformative change?

In April 2014, the Social Care (Self‐directed Support) (Scotland) Act 2013 (SDS Act) was implemented in Scotland. This marked a major shift in how social care is delivered and organized for both users and professionals across the country. Whilst it emerged through the personalization agenda—which has dominated international social care systems over recent years—self‐directed support (SDS) represented a significant shift in thinking for service provision in Scotland. In this article, we review the initial stages of policy implementation. Drawing on two Freedom of Information requests from 2015 and 2016 and a series of interviews with local authority practitioners, we argue that, to date, SDS has yet to produce radical transformative change. We explore the reasons behind this through four key themes. First, we highlight the challenges of promoting the principles of co‐production in policy and suggest that, in reality, this has been compromised through SDS implementation. Second, we suggest that SDS has been caught up in a policy overload and ultimately overshadowed by new legislation for health and social care integration. In looking at the impact of this relationship, our third theme questions the role of new partnership working. Lastly, we argue that the timing of SDS in a period of acute austerity in social care has resulted in disabled people being offered limited choice rather than increased opportunities for independent living.     

Swedish Family Policy – Continuity and Change in the Nordic Welfare State Model

The main question addressed in this regional issue is whether or not the Nordic welfare states can still be considered a distinct welfare regime cluster given recent changes, such as the introduction of more private elements into the welfare state. The Nordic welfare states are often described as emphasizing full employment, economic and gender equality, and universal access to cradle‐to‐grave welfare state benefits and services. In the case of Sweden, often pointed to as the model of a social democratic welfare state, such elements remain intact in most aspects of the welfare state, even given the challenges presented by the global neo‐liberal economic paradigm since the 1970s. One way to determine whether or not the Nordic welfare states remain a distinct cluster is to provide an in‐depth examination of various welfare state policies in each Nordic country. To contribute to this analysis, an investigation of family policy in the Swedish context will be provided. Even given recent challenges, such as the introduction of private for‐profit childcare providers and a home care allowance, I argue that Swedish family policy has remained largely social democratic in its underlying goals, and thus acts to support the case for a distinct Nordic welfare regime cluster.     

Cash‐for‐care payments in Europe: Changes in resource allocation

Resource allocation has been a main policy issue in cash‐for‐care schemes (CfCs) for older people in Europe since their inception. It regards how publicly funded care benefits and services are distributed among older people. The raising pressures of an ageing population and the tensions on the financial sustainability of welfare regimes in place have further exacerbated the relevance of this topic over the recent years. Nevertheless, comparative research so far has overlooked changes in resource allocation in CfCs over time. This article contributes to fill this gap, exploring changes in resource allocation of CfCs for older people in a sample of European countries—Austria, England, France, Germany, Italy, and The Netherlands—since the early '90s (or since the introduction of the scheme). It examines three analytical dimensions: (a) The mix of public services and benefits provided to older people (CfCs, community services in kind, residential care); (b) the level of CfCs coverage; and (c) its generosity. A combined view of these dimensions leads to the discussion of two dilemmas: How to allocate the resources devoted to CfCs in the light of the trade‐off between its coverage and intensity? And, within the whole long‐term care system, how to allocate resources between CfCs and services in kind?     

Issues and Challenges in Performing Family Impact Analysis – Implications for Hong Kong

Family impact analysis (FIA) is informed by a growing vision of incorporating a family perspective into policy making. It is a skillful and technical exercise in examining past, present, or probable future consequences – both intended and unintended – of a policy on family well‐being. Originating in the USA in the 1970s, it has become state/provincial or federal policy in the USA, Canada (Alberta), Australia, and Hong Kong. The policy has had different degrees of success in these countries. This article reviewed the critical issues and challenges for implementing the policy and the countries’ different responses to the challenges. It also discussed the implications of these international experiences on Hong Kong's policy of FIA as the newest member of the ranks. Attention to the diversity of families in defining family, adequate training and support to policy staff, building of quality control mechanisms, and the development of grassroots and political support of FIA were recommended. The review also found that there was a dearth of evaluation research on the policy. Further studies are necessary to examine whether FIA is an effective means of affecting policy‐planning decisions. It is a shared obligation of all countries that voted for a policy on FIA.     

Gatekeeping disability income support: A conceptual model

In most developed countries, disability income support caseloads are on the rise. Little empirical knowledge exists, however, about how policy-makers design these programmes, contributing to caseload growth. This article specifically explores how the boundary between who is eligible and who is not for disability income support is drawn in Australia and Canada. Forty-five interviews were conducted between March 2012 and September 2013 with informants who were or are currently involved in designing disability income support in these jurisdictions. Analysis followed the fundamental steps of grounded theory. Findings revealed that the informants describe this process as “gatekeeping,” which can be subdivided into two stages: (a) establishing the gate (definition of disability) and (b) operating the gate (who interprets the definition and how). I present the results using a conceptual model I developed, deconstructing each stage of the process of gatekeeping into discrete units of analysis. The model is useful for future comparative studies, providing a historical perspective and allows policy researchers to concentrate on specific aspects of the process in detail, which could lead to finding solutions to the challenges related to disability income support.