QSC's Own Motion part 1: how safe is Supported Independent Living?

The findings of a recent Own Motion Inquiry by the NDIS Quality and Safeguards Commission (QSC) into the state of Supported Independent Living (SIL) have uncovered some worrying trends.

Examining 6,269 reportable incidents across seven major providers and 1075 SIL sites, the study represents a significant portion of the SIL cohort, as the selected providers account for 18% of the total. The report suggests that although it is unlikely to lead to the “abolishment” of group homes, there are serious issues that must be addressed.

This article delves into the troubling elements uncovered by the Own Motion Inquiry, explores the proposed solutions, and assesses the likelihood of real change being implemented.

Why Supported Independent Living is far from safe

The data coming out of the QSC's four-year examination of SIL is certainly alarming. With 112 instances of sexual assault reported over this period, residents in SIL are, on average, five times more likely to be sexually assaulted when compared to the current national rate per 100,000 people.

This is a shocking reality, particularly as the majority of victims are people with intellectual disability who call these group homes their home. Despite the absence of comparable data for serious injuries, it is evident that SIL is failing to fulfill its purpose of providing a safe and secure living environment for many residents, violating their right to live in a safe home.

The QSC conducted a comprehensive analysis of the sources of harm in supported living environments. Although they did not release the raw data, our team compressed their findings to identify which type of reportable incident is “most” likely to come from residents and/or support workers.

Table - Reportable Incidents by type - Inquiry providers

Source: Own Motion Inquiry into Aspects of Supported Accommodation – Inquiry Report

It's not surprising that staff and co-residents represent the most significant vectors of harm to those residing in SIL. Before we move on, it's important to note that harm inflicted by another person with disability in a SIL setting is a direct reflection of the support they are receiving. This analysis is not about placing blame on individuals with disability, but rather evaluating if they're receiving adequate support.

Digging deeper into the roots of harm in supported living

The QSC's analysis identifies the workforce, grouping of participants, and communication as the main drivers of safety concerns in supported living environments. While their assessment is accurate, they also acknowledge why resolving these issues presents a significant challenge.

Violence between residents

Of all people affected by reportable incidents within the seven providers, a small number of individuals were regularly identified as the impacted person across several cases. These incidents were mostly related to repeated abuse by a co-resident or harm caused to themselves due to their own behaviour.

Empathia Group does not actively seek to take extreme positions; however, we can’t help but ask ourselves valid questions about the acceptability of potential harm in SIL for people with disability.

• Why are people with disability subjected to violence in their own homes while the NDIS gathers data on an individual “in vivo” or while a Behaviour Support Plan (BSP) “takes effect”?
• What is the acceptable level of risk of violence for the NDIA when determining a person's support needs?

The fact that there is an implicit or explicit assumption of risk in planning processes dehumanises those individuals and their future co-residents.

The unspoken issue: funding's role in preventing violence

Implied in the funding ratio is an assessment which plays a crucial role in determining the safety of grouping participants in SIL. However, when unexpected behaviours of concern arise in a placement, the agency often struggles to respond promptly. This puts either the organisation in a tough position to provide additional “unfunded” supports, which are unlikely to be recovered, or leaves co-residents vulnerable to an increased risk of violence.

When this phenomenon scales, providers withdraw from the SIL market, and a growing cohort of people who “present” like participants with challenging behaviours won’t find suitable supported accommodation at their level of NDIS funding.

The root cause of violence between participants with disability is funding, which has yet to be addressed. While placement matching, BSPs, and staff training are important factors, the problem of violence will persist until planners bear some responsibility for their funding decisions that result in harm. Only then will this issue truly be resolved.

The complexities of managing violence with behaviour support plans

Despite the potential efficacy and quality of BSPs, the reality is that some instances of violence between people with disability cannot be effectively managed through these plans. It is concerning that this level of abuse unveiled in the QSC’s report is tolerated simply because the individuals involved live with disability. The question remains, are we willing to accept this as a society?

Finally, when a provider recognises that an individual's situation has worsened or their behaviour has become unpredictable, it can be extremely challenging for them to alter the placement arrangement.

Solving the problem at its core: priorities for ensuring resident-to-resident safety

To ensure the safety of individuals living in SIL, it is imperative that the following actions are taken:

• Robust planning processes: The current system needs to be more comprehensive in assessing the risk of violence between residents. This would include considering past incidents and behavioural patterns, as well as the individuals' support needs and capacities.
• Increased regulation and auditing of BSPs: The NDIA needs to take a more hands-on approach in regulating and auditing the standard, quality, and impact of BSPs to ensure their effectiveness in reducing instances of violence.
• Clear escalation pathways: When resident-on-resident violence occurs, there needs to be a clear and efficient escalation process to involve the NDIA. The current "wait and see if it calms down" approach must be eliminated and replaced with a more proactive approach to address these incidents.

At Empathia Group, we strongly believe these three steps are essential in creating safer supported living environments for people with disability and preventing further instances of abuse.

Do you have a perspective on the Own Motion Inquiry you'd like to share? Reach out to our team.

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Coming up in QSC Own Motion Part 2:

• A closer look at the drivers of staff-generated abuse
• The recruitment challenge: selecting with zero error is impossible
• Frontline practice leadership as a potential yet challenging solution
• Three ways providers can respond to the Own Motion Inquiry.

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