When is high intensity no longer high intensity??
Karenza Louis-Smith
Chief Executive, social entrepreneur and innovator in the not for profit sector, currently CEO at ermha Ltd
Opinion
Its Friday 3rd July, and I am reading the new NDIS price guide in shock. Is this right? I ask myself. In a deeply concerning move, it appears the new NDIS price guide has redefined High Intensity Supports, effectively removing the ability to claim for all supports for people with high intensity behavioural supports. Surely this must be a mistake. An oversight?
This change, if I am correct meant that as of the 1st of July 2024 all high intensity supports for people with complex and challenging behaviours had been downgraded to standard supports. I spoke to colleagues in the sector. No one had any idea this was coming. We were all stunned.
Why would the agency reduce the level of support for some of the most vulnerable people in the scheme overnight? Participants with intellectual disabilities? Autism? Dual disabilities? Psychosocial disabilities? It didn't make sense to me. It still doesn't.
As the CEO at ermha365 a provider of high intensity supports (amongst our many other services) I am deeply concerned that The NDIA’s approach to pricing falls far short of what the sector needs to provide the support that people with disability have relied on from us. We know how essential these supports are.
Thank God for ermha is something we hear often from referrers, care teams and families. We don't say no. Instead, we have always tried to find a way to say yes. We are known by many as being a provider of last resort.
From our experience in providing complex supports and services, I know how crucial it is that participants with challenging behavioural needs receive support from trained and experienced professionals, and that the skills and training of those workers are adequately recognised through the pricing limits.
Skilled staff are essential in helping to keep participants, themselves and the community safe. They are also an essential part of an insurance scheme. With appropriately skilled staff we are able to see the impacts of challenging behaviours reduce over time. And with that, the amount of money in a participant's plan reduce over time too.
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Richard* is one of the people who gets high intensity support from us at ermha365. Richard is an autistic man in his 30s with an intellectual disability and additional diagnoses of oppositional defiant and antisocial personality disorders. Richard has some challenging behaviours that can pose risks to himself and others. Our skilled and experienced high intensity support team works 2:1 with Richard for all his daily living tasks. Over time, and supported by ermha365 and his wider care team, Richard is working on his life skills, emotional regulation and has more positive social connections in his community. Over time Richards supports are reducing from 2:1 to being single staffed.
The future of this work and the essential supports for thousands of people in the NDIS like Richard is under threat.
These current changes announced only a couple of weeks ago were implemented without any consultation with providers or participants leading to widespread uncertainty and potentially significant service gaps.
Already, I have seen an alarming number of articles about providers who are considering withdrawing from complex service provision. I am worried there will be many, many more.
Just last week our peak body the NDS surveyed over 1,200 small to large organisations from every state and territory. Their findings are alarming with 84% saying that they are “actively reconsidering their future” due to the new price limits and 75% considering stopping some or all of their disability services.
This would be catastrophic for people with disabilities, their families and the communities in which they live. What kind of NDIS do we want? A safe, quality-driven NDIS is important for EVERYONE. It is essential that both the agency and the commission urgently reinstate high intensity payments for participants with challenging behaviour.
(*Not his real name)
Founder & Lead Consultant | Strategic Growth, Management Development & Consulting
5moThank you for sharing. I enjoyed the read. It's clear that policymakers are often more focused on talking than listening, a trend that can be quite detrimental. We all aim for a safe and sustainable NDIS, which includes redefined services and practices. However, I believe the NDIA is currently prioritizing the wrong support areas. There are indeed some providers misusing the system by billing for 2:1 High Intensity and applying these supports as restrictive practices. Simply removing behavior from the descriptor doesn't stop this—it merely explains the actions of unscrupulous providers. This removal restricts access to essential supports for participants and increases risks for workers and the community. As providers, we have a duty of care to both participants and workers. These changes only magnify existing risks and could lead to increased burdens on other systems, including Healthcare, Workcover, the Justice Department, and Mental Health Clinics. This is not the solution. Urgent consultation with those at the forefront—providers, participants, families, community stakeholders, and mainstream supports—is essential.
Convenor, Democracy First; Director, Civil Society Australia.
5moNDIS has been plagued by poor design and inadequate scrutiny of its model from the outset. Too many people in the disability sector told us to not scrutinise the design 13 years ago so they could rush it through and set it up quickly. That was a disaster. They are still doing that, urging us to pass Shorten's Revision Bill that doesn't fix any of the deep flaws. Too many people in the sector jumped into bed with politicians and have built careers out of NDIS instead of focussing on getting good systems that work. More than ever, it's clear that to reform the NDIS culture and operations, we need to replace the people running it with a whole new set of people who understand disability and who are not careerists. That is now our challenge, www.democracyfirst.org.au/ndis/
Social worker
5moIt's so sad that trained, experienced, skilful, empathetic support workers give up working in the high intensity space due to a lack of support from middle management.
Certified Forest Therapy Guide
5moIt doesn’t make sense but I feel NDIS isn’t financially sustainable for Australia.
NDIS service provider - Providing trained mental health support workers
5moSarah Green