Service providers front Royal Commission over violence and abuse

This week’s public hearing, Service Providers Revisited, was the 32nd hearing held by the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, covering an extensive list of topics.

Witnesses who spoke at the hearing discussed issues such as the amount of control and choice people with disability have about the services they receive, whether service providers utilise inclusive design principles and the best practice management of complaints and incidents.

The Royal Commission also heard that portable leave entitlements for registered National Disability Insurance Scheme (NDIS) workers would strengthen staff recruitment and retention. 

Recruitment and retention struggles impact care

Sam Petersen, a visual artist, writer, performer and advocate, is a wheelchair user who utilises Augmentative and Alternative Communication (AAC) when interacting with others. Due to their disability, Sam lives in Supported Independent Living (SIL) which is mostly funded by the NDIS.

In a pre-recorded witness statement, Sam outlined experiences with ‘slow violence’ and the ongoing challenges of receiving quality care from a disability support provider.

“In this case [slow violence] is done through a lack of knowledge and funding, and these can feed off one another,” says Sam.

“The support worker isn’t given enough training and time to do their job so then they are short with the client, then the client is upset, and this can be seen as bad behaviour to the support worker, so the support worker spends less time engaging with the client.”

Sam says their support provider often reacted to participant complaints with psychological abuse and regularly ignored complaints about worker conditions.

“I was expressing concerns to the manager at one point, saying a support worker was working too much and showing signs of burnout,” explains Sam.

“The manager accused me of being critical of the workers and said I was in danger of all the support workers not liking me because of this.

“And they kept the support worker on who I found to be dangerous and complained about. This put me in a position where I didn’t feel safe using the shared support service.”

Sam has since turned to independent support workers rather than a provider, but workforce shortages mean it’s difficult to consistently find workers.

Senior Counsel Assisting, Kathy Eastman, highlighted a need for additional support in recruitment and retention.

“National Disability Service (NDS) members have identified a range of concerns arising with the workforce: providers reported moderate or extreme difficulty recruiting allied health practitioners; difficulty identifying and recruiting suitably qualified disability support workers and noting that the current award rates of pay do not reflect the complexity of the roles,” says Ms Eastman.

She adds that limited applications for positions have also made it difficult to recruit highly qualified staff, while there are bureaucratic barriers stopping many providers from employing international candidates.

Providers working hard to create change

Disability support providers held the floor on several occasions, with representatives from organisations such as the Endeavour Foundation, Livebetter and Cara all fielding questions from Commissioners.

Endeavour Foundation Chief Executive Officer (CEO), David Swain, says his organisation has continually developed its feedback policy to better identify and address instances of violence.

“The nature of the violence is – or abuse is – often around the disempowerment of individuals,” says Mr Swain.

“So around the neglect, not hearing the voice of individuals and allowing them to exercise choice and control. And that’s not just in relation to our own staff, but that may also be in relation to families as well. 

“In our organisation, there is a number of falls that occur and that may be related to neglect. There is client-on-client abuse that may be related to the environment and the management of triggers. 

“We identify the nature of incidents, the contributing factors for those and also the actions that we are taking to respond to those.”

Meanwhile, Cara Interim CEO, Sonya Furey, says there has been an increased focus on identifying the trends and patterns among reports of neglect or abuse.

“In the month of October, we had 28 incidents. The majority of those related to medication errors, to sunburn – neglect in the sun – and not following care plans properly,” says Ms Furey.

“We do go through a thorough investigative process, which includes meeting with our staff, with our customers, their families, and depending on the severity of the matter, [provide] further training. 

“Depending on the severity, we will do a root-cause analysis to really understand how this has arisen.”

Ms Furey says Cara’s management team meets monthly to analyse trends in abuse or neglect, if present, and to determine the appropriate responsive actions to minimise harm to their clients.

National Disability Service promotes industry reform

Australia’s peak body for non-Government disability services, the National Disability Service (NDS), made several recommendations to improve the sector’s delivery of services.

NDS CEO, Laurie Leigh, says a balanced approach to supporting service providers is necessary as a sledgehammer approach could harm those doing the right thing.

“Whilst we know there are thousands of committed and dedicated people in this industry providing excellent service and support, the Royal Commission has shown examples of poor practice which must be addressed,” Ms Leigh says.

“Reforms and initiatives in these areas, appropriately funded and successfully implemented, can give people with disability greater choice and control in how they live and work with providers.

“However, we also need to make sure that reforms aren’t just a sledgehammer to many providers, especially smaller organisations. 

“It is critical that the industry is provided with the appropriate time and support for changes to be delivered correctly.”

The initiatives proposed by the NDS focus on widespread improvements, such as:

• Embedding Supported Decision Making in practice across the entire sector
• Additional Government funding to improve the availability and accessibility of advocacy and self-advocacy development
• Increased funding for Positive Behaviour Support and practice leadership
• Mandatory NDIS Worker Screening for workers in risk-assessed positions

Ms Leigh also spoke in depth about the need for mandatory national registration for disability support providers and the benefits of training and development for disability support workers.

She says there are Zero Tolerance resources available for providers to improve their practices and safeguards for the benefit of people with disability.

“A skilled, capable, diverse and sustainable provider landscape is a desirable outcome for people with disability,” Ms Leigh says.

“Our vision is for an inclusive Australia where all people with disability live safely and equitably and we stand ready to work with the Royal Commission to see this vision realised.”

The Royal Commission is yet to announce its next public hearing date.

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