|Market Failure of Residents living in pension-level Supported Residential Services (SRSs)|
|Sunday, 24 April 2005 00:00 | Print page:|
Approximately 2,000 Victorians live in pension-level SRSs. Although the original purpose of SRSs was to cater for older people requiring low-level support, an increasing number have high and/or complex needs.
The latest Department of Human Services (DHS) census of pension-level SRS residents reveals that:
Some residents have lived in pension-level SRSs since the closure of large institutions over the past two decades. Others have been placed in pension-level SRSs by guardians, case-workers, hospital social workers or family members who have been unable to find appropriate funded accommodation. Residents pay all, or most, of their Centrelink entitlement to the SRS proprietor in return for basic accommodation and supported care. Their entire entitlement is frequently deposited directly into the proprietor's bank account.
The defining characteristic of most pension-level SRS residents is the overwhelming poverty of their existence. The disability support pension plus rent assistance (approximately 35 dollars a day), does not cover the cost of adequate accommodation, meals and supported care - as well as provide a profit margin for private providers. Thus, conditions that would never be tolerated in funded residential facilities for people with disabilities (such as commonwealth aged care facilities, community residential units or community care units) are prevalent in pension-level SRSs.
Inappropriate mix of Residents
The result is that although SRSs are only meant to provide care for people with low care needs, they actually accommodate many individuals with high and complex needs. This imperative to fill beds also means that there is often an inappropriate mix of residents. It is common for there to be people with a range of disabilities in one facility, great age discrepancies and other anomalies. Residents often share rooms with people to whom they are not related - something that most of us would not tolerate. In some instances, four people share a room. There are other instances where one or two women with disabilities live in SRSs with a predominantly male population and where they do not feel safe - even to the extent of being fearful to use the bathroom and toilet facilities at night.
Cost Cutting vs "Appropriate" Care
The opportunities to cut costs are more plentiful. Firstly, it is in the proprietor's interests to minimise his/her own management time. Here again, full occupancy is a goal and turnover takes time.
For example: If a resident develops significant care needs, there is a natural resistance to having them assessed for high care, thus leaving a bed vacant. When closures occur, it is common to find that a high proportion of residents actually do qualify for commonwealth aged care facility placement. If a resident is troublesome, they can be evicted at very short notice - the Residential Tenancy Act does not apply to SRSs. Furthermore, the planning and documentation (care plans) that supports and directs the care of residents, is often inaccurate or incomplete.
Secondly, there are cost savings to be made in relation to staffing. Staffing level requirements in pension-level SRSs are minimal, both in terms of numbers and training. Many only have one person on duty at any time - cleaning, cooking, washing and providing personal care. At night there is generally one person who sleeps over (not upright) - although this is often the time when residents require most assistance.
Facility Maintenance and Cost Cutting
Thirdly, there are cost savings to be made in not maintaining the fabric of the facilities. Because many of Victoria's pension-level SRSs are located in old and dilapidated buildings, they are particularly hard to maintain. Neither the proprietor nor the freeholder has an interest in paying for expensive maintenance repairs. Thus, disputes between them are common, with the right of residents to live in a well-maintained, functional home coming in a poor second. Old mansions are difficult to keep clean and extremely expensive to heat in winter. It is common for bathrooms and toilets to be in disrepair and they are often shared between large numbers of residents.
Inactivity and Quality of Life
Fourthly, there are cost savings to be made in the provision of meaningful activities. Activities take time to organise and even more time to engage the residents. SRSs now accommodate a predominant number of people who are aged between 20 and 60 whom one might presume to have some expectations for the future. Yet, most have few choices about how even the day is spent. The TV is generally on, cigarettes are handed out and meals are the markers of the day. Early bed time is encouraged (try 6.00 pm) - because of staffing issues (required staff ratios decrease at ‘night'). Certainly, some in-house activities are arranged by proprietors and some case-workers try hard to find outings and excursions suited to their clients' interests. But the reality is that, for many people, days in the SRS are long and hard to fill, each one is very much like the one before and will be like the one tomorrow. Depression is not uncommon and some residents choose to spend most of the day in bed.
Cost Cutting to Basic Health Care
Finally, there are cost savings to be made in both general health care and provision of specialist care. Diet, exercise and hygiene all suffer. There is a great dependence on processed frozen fast foods and seconds.
Although the importance of exercise to maintain our health is well known, most pension-level residents are inactive. The day is often spent sitting around the SRS or lying in bed. Hygiene regimes, such as regular tooth cleaning, are often lacking. The preventative care that most of us apply to our lives such as having regular health check-ups including mammograms, pap smears, dental check-ups, hearing and eye tests, does not generally occur.
Many SRS residents have significant health issues. A considerable percentage has been diagnosed with schizophrenia or bipolar disorder. Some have brain injuries acquired through accidents or the long term use of alcohol or other drugs. Yet the health resources applied to the care of SRS residents is minimal.
Currently, some SRS proprietors are finding it difficult even to obtain basic GP services for their residents. Many residents require specialist assistance and would benefit from a total health and medication review. This all takes time and support from proprietors, staff and caseworkers.
Even Adam Smith, that champion and interpreter of the market system, recognized that ‘a community activated only by self-interest would be a community of ruthless profiteers'. He felt there was an ‘invisible hand' that naturally regulates the market. Supply is balanced by demand. If the service provided by an SRS proprietor is bad, residents will move elsewhere. But this invisible hand has disappeared. Residents themselves are usually not able to relocate without assistance.
When guardians and family members are making decisions on behalf of people with disabilities, they are often forced to use inadequate pension-level services because of acute shortages in funded facilities. Case-workers and paid guardians, overworked, and with too many clients, must find a bed wherever they can. This is their self interest at work. Under the relevant legislation, the Department of Human Services (DHS) is the regulating body.
Generally, SRS proprietors care about their residents. But we should never design any system which requires people to act against their own self interest. We should not create a conflict of interest. The problem here is that there is no ‘invisible hand'. The marketplace is an inept and flawed regulator.
Supported Residential Services Funding Model
The government supports the private-for-profit model for all SRSs, including pension-level SRSs. Thus, they are complicit in providing sub-standard living standards and discriminating against these residents with disabilities.
The pension-level, private-for-profit model of supported care is an unsustainable one.
The inequity which arises when some individuals with high and/or complex support needs are accommodated in minimally-regulated marginal housing, staffed with a largely unskilled workforce, while others with similar needs live in regulated, funded facilities with professional staff is unsupportable.
In 2003-2004, 15 facilities closed resulting in 271 pension-level beds no longer available. The disgraceful shortage of supported accommodation must be addressed as a matter of urgency.
Candy Maughan and Linda Sparrow are associated with several organisations and groups which support, and advocate for, people with disabilities. The opinions expressed in this article are their own. Candy is a member of FCRC.
1 ‘Annual Report 2003/04, Community Visitors, Health Services Act 1988'