New disability housing must avoid mistakes of past

The future of disability housing in Australia is in focus as the Federal Government considers how to respond to the findings of the Disability Royal Commission and the NDIS Review. The government has a unique opportunity to reset decades of flawed policies and practices, which at their worst saw thousands of incidents of serious injury, abuse and neglect of people living in group homes.?

The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability heard that up to 17,000 people with disability living in group homes are at significant risk of harm. While their recommendations differed, all the commissioners agreed that major improvements are needed when it comes to group homes.?

There is little evidence available to indicate group homes are cost effective, provide quality support or deliver good outcomes for people living there. Many group homes in Australia fail to keep people safe and deny them their basic rights. The commission restated the importance of enshrining the Convention on the Rights of Persons with Disabilities in Australian law.

Similarly, the NDIS Review affirmed the need for participants to have ‘choice and control over where, how and with whom they live’ (p.138). It also noted:?

There has been little innovation in housing and living supports, and increases in supply of Specialist Disability Accommodation (SDA) have been slow and have not always met the needs of participants. Outdated group homes still dominate the system and, despite pockets of innovation, service models appear relatively unchanged — leaving participants with little choice. (p.146)

To avoid repeating the mistakes of the past, new disability housing must be built with tenant outcomes in mind. This will help ensure safe transitions to more contemporary, individualised housing, and avoid new models of housing that only replicate the institutional homes that are common in the market.

Building an evidence base: The Home and Living Outcome Framework

To understand what ‘works’ in the disability housing space, La Trobe University, the Summer Foundation and a range of partners have developed the Home and Living Outcome Framework. The framework is being used as part of an ongoing, longitudinal study funded through an Australian Research Council linkage grant.?

The project is actively recruiting new participants and partners. Preliminary findings reveal insights into the transition experience of moving into, and living in, newly built SDA funded through the NDIS. To date, these findings have been published in 2 peer-reviewed journals and presented at academic conferences.?

Analysis of quantitative data found that well located and appropriately designed SDA was associated with significantly improved outcomes for tenants. Researchers interviewed 15 NDIS participants living in single-occupant SDA apartments and collected data before and after tenants moved into their new homes. After moving into SDA:?

• Overall health improved for 60% of tenants?
• Wellbeing ratings improved for 66% of tenants?
• Community integration scores improved for 73% of tenants?
• Average daily support hours fell by 2.4 hours?
• Only 66% of tenants required overnight support, dropping from 87% pre-move?

The qualitative analysis aimed to understand the experience of moving into SDA for people with acquired complex disability. Study participants described their pre-move housing as largely unsuitable, and not reflective of their unique needs and preferences. For many participants, their pre-move housing experience was accompanied by feelings of hopelessness and a lack of control over their future. Participants felt they lacked autonomy, missed meaningful relationships, and had limited housing choices before moving into SDA.?

After moving into individualised housing, many participants experienced a period of adjustment navigating new funding, housing, and support arrangements. The move into SDA was a positive experience overall, but many felt unprepared and insufficiently supported for the transition. Despite the challenges, participants described an overall sense of ‘moving in the right direction’.?

Participants noted that living alone meant adjusting to new responsibilities, like paying bills and other daily tasks unfamiliar to those who had come from group-living situations. However, that change also brought with it greater freedom:?

“It allowed me to grow … I feel like I can do a lot more for myself.”? - SDA Tenant

Despite a small sample size, the early results collected using? the Home and Living Outcome Framework demonstrate the positive personal outcomes that can be experienced by people with disability when they move into individualised housing. The findings also strengthen the contemporary evidence underpinning the social importance of residential environments as significant determinants of health, wellbeing and community integration.

The findings of these 2 studies relate to single-occupant SDA apartments; however, the next phase of the study will evaluate individual experiences and outcomes of moving into and living in a range of different SDA across Australia.

Implications for government

Consistent with the findings of the Royal Commission, the NDIS Review final report sets out a clear vision for greater diversity and innovation in the delivery of housing and living supports. Achieving better housing and living outcomes for people with disability ensures greater inclusion for people with disability in the economic and social life of the community. This aligns with good outcomes for people with disability, an evidence-based NDIS and a sustainable ecosystem of supports.

Building disability housing that is based on rigorous evidence is essential for enabling people to exercise their right to live a good life. There is an urgent need for the co-design of new models of housing and support that deliver high quality, cost-effective support. These models should build on local and international evidence and best practice. Better outcomes will not only benefit people with disability, providers and investors, but also state and federal governments as they address the rising costs of the NDIS.