Housing and living supports that are fair, consistent and promote choice

Housing and living supports for participants who require 24/7 support are a key feature of the NDIS
Housing and living funding decisions are inconsistent, inequitable and opaque
The Panel’s vision: Participants should receive housing and living support funding in a clear, fair and consistent way, in line with their needs and circumstances
Recommendation 8: Fund housing and living supports that are fair and consistent, and support participants to exercise genuine choice and control over their living arrangement

Housing and living supports for participants who require 24/7 support are a key feature of the NDIS

Achieving better housing and living outcomes for participants is critical to the scheme delivering on its promise of greater inclusion for people with disability in the economic and social life of the community. Given a home is foundational to genuine inclusion and participation, participants must have choice and control over where, how and with whom they live. Genuine choice is also fundamental to realising the rights outlined in the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).¹⁵⁹

Participants can access a range of housing and living supports depending on their needs and circumstances - from home-related assistive technology and home modifications to more intensive and ongoing accommodation and independent living support.

These supports are particularly critical for participants who have high support needs and require a significant amount of assistance throughout the day as well as overnight supports. There are close to 41,000 participants receiving 24/7 living supports. This includes around 31,500 participants with Supported Independent Living (SIL) funding and close to 9,500 participants receiving an equivalent high level of Assistance with Daily Life (ADL) supports.¹⁶⁰

We define 24/7 living supports as participants who require at least eight hours of active support and/or supervision with activities of daily living and some level of support for the remaining hours of the day while at home, including overnight assistance (whether active or passive).

Housing and living supports account for a large share of overall scheme costs. In the year to 30 June 2023, SIL payments alone were $8.8 billion, representing a quarter of total scheme payments.¹⁶¹

Housing and living funding decisions are inconsistent, inequitable and opaque

Many participants with housing and living supports in their plans still have limited choice in where, how or with whom they live. Participants with similar levels of need and circumstance do not always receive similar levels of funding.

My friend and I submitted our applications for SDA and SIL supports for our boys in September both have very similar needs. We worked on this together, had the same support coordinator, submitted them on the same day. We included proof that our boys have spent their entire lives together in the form of a pictorial history. My son was approved for both SDA and SIL supports and mention of pieces of information in the reports were included in the reasons why decision was made. A week or so later my friend received a rejection for SIL, SDA and in fact supports were reduced. There were also massive errors in the plan. Remembering this young man is the child of a 73 year old woman who needs to make plans for her son’s future. My friend was totally devastated.

- Carer ¹⁶²

Individualised support for people with very intensive support needs was provided before the NDIS was introduced, and will continue. Single living arrangements with no sharing of living supports (or only sharing overnight supports) for some participants with 24/7 needs are appropriate to be funded in specified circumstances. However, currently there is no clear guidance for participants or providers on when participants should have access to these arrangements. This poses risks to the financial sustainability of the scheme and creates uncertainty for participants.

Too many participants and families are left to seek clarity through the Administrative Appeals Tribunal (AAT). While less than one in twenty participants had Specialist Disability Accommodation (SDA) in their plan, one in ten planning-related AAT applications in 2022-23 had SDA in dispute.¹⁶³

While single living arrangements with no sharing of supports are needed in specified circumstances, they can lead to isolation and poor outcomes for participants.

We have heard participants often do not have access to the information, advice and support they need to make genuine informed choice on where and with whom they live, in line with a human rights framework.¹⁶⁴ Planning conversations are often disjointed and focused on short term issues.¹⁶⁵ Many participants are not supported to prepare for housing and living solutions early. When considering their options, they cannot easily access the information and support that would enable them to explore and compare different housing and living solutions, both within and outside the scheme.

Housing conversations need to happen early on in the planning process to allow people who have a housing need to properly consider their housing and living arrangements. Support coordinators need to be upskilled to have proper housing related housing conversations with people with disability or there needs to be dedicated housing support coordinators.

– Carer ¹⁶⁶

There are also very limited opportunities to trial alternative housing and living solutions. It is very difficult to make informed choices when you have not had the opportunity to experience different options. This particularly affects those with cognitive disability and people with limited informal support networks.

The Panel’s vision: Participants should receive housing and living support funding in a clear, fair and consistent way, in line with their needs and circumstances

There should be a new budget setting pathway for participants with 24/7 housing and living support needs that is focused on exploring options early (Figure 8).

Participants (including those with cognitive disability or limited support from family and friends) should be supported by an independent Housing and Living Navigator at key life stages to articulate their goals, explore their options and secure a housing and living budget. Housing and Living Navigators will require in-depth knowledge of local housing and living options and should build on the expertise of existing organisations in this area including, for example, through partnerships.

Participants with similar levels of need, in similar circumstances, should have access to similar levels of funding. For those requiring 24/7 living supports, funding should be on the basis that supports are shared, except in specified circumstances (this could include, but not necessarily be limited to, where there is a risk to self or others from living in a shared arrangement, participants with dependent children, and those with very complex needs). In general, reasonable and necessary funding should be based on an average shared support ratio of one support worker to three participants (1:3), consistent with an assessment of need that determines the maximum support intensity and level of overnight support that a participant is eligible to receive. It is important to note that the calculation of shared funding does not necessarily equate to living with others. Rather, it is about having access to a more diverse range of innovative and individualised housing solutions that enable some sharing of supports. Participants would be able to choose from a diverse range of innovative housing arrangements (see Recommendation 9).

Participants should have greater flexibility and more choice in their housing and living arrangements within the budget that has been allocated to them. But because of the centrality of living arrangements to a person's social and economic participation, health and wellbeing, housing and living budgets will be stated in a participant's overall budget. Participants will be able to add funds from their flexible budget to increase the amount spent on housing and living supports, but not vice versa.

At the heart of a new housing and living approach should be a more urgent shift away from group home settings with little choice and control to one where participants can choose their living arrangements and the supports they receive. No one should be forced to enter a living arrangement that is not of their choosing. Capacity building supports should start from an early age and continue throughout their life, with a focus on independent living skills. This would reduce the need for future high intensity living supports for some participants.

Participants requiring 24/7 living supports should receive funding to trial new living arrangements before they commit to them and vacancy management arrangements should allow more time for residents to choose who they live with.

The co-tenant matching process is vital for a harmonious living situation. This needs to be a process not just one-night sleep over and then the decision to push that person into the SIL vacancy. It is vital to consider behaviours of the prospective co-tenant and whether these are compatible with the other person e.g. noise level, annoying behaviours, bullying behaviours, aggressive behaviours, tactile issues.

- Carer ¹⁶⁷

Finally, participants sharing supports should be assisted by a Shared Support Facilitator to have a say in the governance of their shared living arrangements, irrespective of their level of access to informal supports, and in who fills a vacancy in a shared living arrangement.

Transition to these new arrangements should be graduated. Participants should be supported to explore shared support arrangements but should not need to move from their current home unless they choose to do so. New participants, and those who choose to move, will access the new budget setting process and be allocated a Housing and Living Navigator to support them through the process.

Figure 8: Budget setting pathway for participants with 24/7 living support needs

Pre-budget setting	New participants with 24/7 living support needs will, initially, follow the same pathway as all other people with disability (Recommendation 3). Existing participants would, at key life stages, be supported by navigators to explore alternative living arrangements and go through a change of circumstance process.
Needs assessment and budget setting	Holistic assessment to understand needs A comprehensive assessment of need is undertaken by a skilled Assessor. Participants will have as long as they need to ensure they are understood and will be able to view the assessment before the budget is set. Depending on the participant’s needs, circumstance and life stage the housing and living budget may include: SDA, home modifications, medium term accommodation, housing related assistive technology and/or 24/7 living supports. These supports will all be stated. Provisional housing and living budget set Where the holistic assessment reveals a need for 24/7 living supports, the participant receives a provisional budget based on their maximum support intensity and individual overnight support needs. Assessors and participants have clear guidance on exceptions where 1:1 living supports, with no or limited sharing, is reasonable and necessary.
Exploring and securing supports	Navigation to support participant to explore and evaluate different living arrangements Options explored must not exceed the participant’s provisional budget amount. Participants with different overnight support needs can share with each other, opening a wider range of options. Participant chooses preferred living arrangement and provider advises actual cost Living support provider working with navigator or shared support facilitator advises actual cost of providing services based on individual participant support needs, model chosen and, in shared arrangements, how supports will be pooled and shared across participants. The actual cost for a participant cannot exceed their provisional budget. Housing and living budget adjusted to reflect the actual cost of the preferred arrangement The NDIA adjusts the value of the participant’s living support budget to reflect the actual costs of the arrangement.
Maintaining supports	Participant accesses supports with ongoing check-in on progress from navigator and support from shared support facilitator.

Recommendation 8: Fund housing and living supports that are fair and consistent, and support participants to exercise genuine choice and control over their living arrangement

* Legislative change required

Action 8.1*: The National Disability Insurance Agency should change the budget setting process to ensure that housing and living budgets are consistent and sustainable. The budget setting process for housing and living supports should ensure housing and living budgets are consistently based on an assessment of need and are considered at a whole of-person level (see Action 3.3).
Action 8.2: As part of the local navigation function (Action 4.1) the National Disability Insurance Agency should commission Housing and Living Navigators to provide advice on participants’ housing and living options. Participants and Navigators (see Action 4.1) should have access to advice from an independent Housing and Living Navigator with specialist expertise in the range of local housing and living supports. The Housing and Living Navigator should work with the General Navigator (or this could be the same person) to support a participant to explore the range of housing and living options available and understand what options align with their preferences and provisional NDIS budget. They should also help participants connect with suitable providers to identify new living opportunities or those with vacancies. This approach should ensure any change in housing and living arrangements at key life stages is explored, designed and planned well in advance of a change.
Action 8.3: The National Disability Insurance Agency should design, fund and implement a process for participants to try new living arrangements at key life stages, before they commit to them. A process for participants to try new living arrangements should be designed to help participants feel more comfortable with any move into a new arrangement. This should encourage participants to try diverse, innovative options that are more inclusive and contemporary and reduce the cost of poor matching and housing outcomes. The process should be designed and trialled with people with disability and the sector before being rolled out. Priority for taking up this opportunity to trial new arrangements should be given to those living with ageing carers and in ageing Specialist Disability Accommodation (Legacy and Basic) dwellings.
Action 8.4: The National Disability Insurance Agency should commission a shared support facilitation function to empower participants sharing supports to exercise joint decision-making. A shared support facilitation function should be introduced for participant groups sharing supports, as well as their families and/or other representatives, to embed participant-led household governance in shared arrangements. This should involve designing, negotiating, monitoring and implementing an agreed model for shared support delivery for the group. This function should be independent of the support provider and property manager.

Housing and living supports that are fair, consistent and promote choice

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Housing and living supports for participants who require 24/7 support are a key feature of the NDIS

Housing and living funding decisions are inconsistent, inequitable and opaque