NEWSLETTER JUNE 2016

Message from the CEO

Welcome to  Welcome to the June 2016 edition of the MOD.A newsletter. The new financial year kicks off with a bang. The NDIS began its national rollout from Friday 1 July and introduces significant challenges and opportunities for home modification service providers. We provide an overview of the different processes used by the NDIA in various regions to request and approve home modifications as a guide for those services that will be engaging with the NDIS for the first time over coming months. The federal election takes place on 2 July and the government elected on Saturday will oversee the implementation of the remainder of the aged care reform programme. We anticipate that more detail about the second round of reform changes, scheduled to commence 1 July 2018, will be available in a discussion paper toward the end of the year. It will be critical for MOD.A and its members to make strong representation to the Department about how home modifications need to be funded to support strategies to keep more older people at home for longer.

During the latter stages of the election campaign MOD.A released its Election Platform and petitioned a response from each of the major parties. We were pleased to have received replies from all the major parties and are confident that home modifications will become more prominent in ageing and housing policy moving forward. We can assure our members that whoever wins government MOD.A will continue to argue the importance of home modifications and the expertise of our members and providers in general.

Member News

We are very pleased to announce that we now have members in all states and territories of Australia. Our newest organisational member is Systems Homes in Darwin, a family-owned and run company which has added specialised modifications for older people and people with disability to its range of other building products and services for a number of years. It will be interesting to work with the staff there to understand how home modifications, both in the NDIS and CHSP, can be made more available to eligible clients.

Thank you to those services that have already renewed their membership and a reminder to others that Membership Renewal Forms will be issued on the anniversary of joining. MOD.A is committed to progressing home modifications and promoting the interests of home modification service providers and the support of our members is invaluable.

Thanks also to those members that completed our recent Member Feedback Survey. We are still analysing the results but will provide a summary report on the members section of our website in due course. The number of respondents and level of feedback received was encouraging and informative and has provided the MOD.A board and management with useful insights and evidence to progress some key initiatives to deliver better benefits and services to members.

The 2015-2016 financial year has been a very busy one with a number of challenges facing the sector - the next 12 months promises more of the same but MOD.A is committed to the promotion of our members and home modifications as an important way to improve the health and well-being of the elderly and people with a disability.

Michael Bleasdale, CEO

NDIS Rollout: Engaging with Home Modification Providers

At the 2016 MOD.A Conference in Canberra we heard from Dr Lloyd Walker, Director of Assistive Technology at the national Disability Insurance Agency (NDIA), about the way the agency aims to deliver home modifications within the NDIS. Given the significant increase in the rollout of the NDIS from Friday 1 July, MOD.A has been seeking more detail from the NDIA about how it will engage with providers in the regions that come "on line" on that day. We have received a written response from the NDIA which is published in the Members' section of our website. Subsequent communication with Dr Walker has confirmed that the sector can expect a document outlining how major and complex home modifications will be dealt with under the NDIS in the next couple of months, and that MOD.A will be consulted before its final release. From 1 July 2016 the NDIA roll-out schedule is as follows:

NSW

• Northern Sydney (LGAs: Hornsby, Hunters Hill, Ku-ring-gai, Lane Cove, Manly, Mosman, North Sydney, Pittwater, Ryde, Warringah, Willoughby)
• South Western Sydney (LGAs: Bankstown, Camden, Campbelltown, Fairfield, Liverpool, Wingecarribee, Wollondilly)
• Western Sydney (LGAs: Auburn, Blacktown, Holroyd, Parramatta, The Hills Shire)
• Central Coast (LGAs: Gosford, Wyong)
• Southern NSW (LGAs: Bega Valley, Bombala, Cooma-Monaro, Eurobodalla, Goulburn Mulwaree, Palerang, Queanbeyan, Snowy River, Upper Lachlan Shire, Yass Valley)
• Hunter New England (LGAs: Armidale Dumaresq, Cessnock, Dungog, Glen Innes Severn, Gloucester, Great Lakes, Greater Taree, Gunnedah, Guyra, Gwydir, Inverell, Lake Macquarie, Liverpool Plains, Maitland, Moree Plains, Muswellbrook, Narrabri, Newcastle, Port Stephens, Singleton, Tamworth regional, Tenterfield, Upper Hunter Shire, Uralla, Walcha)

ACT

• The remainder of the population from 1 July

Victoria

• North Eastern Melbourne (LGAs: Banyule, Darebin, Nillumbuk, Whittlesea, Yarra)
• (From 1 January 2017) Central Highlands (LGAs: Ararat, Ballarat, Golden Plains, Hepburn, Moorabool, Pyrenees)

Queensland

• Townsville, Hinchinbrook, Burdekin, west to Mount Isa and up to the gulf (LGAs: Townsville, Charters Towers, Palm Island, Boulia, Burdekin, Burke, Carpentaria, Cloncurry, Doomadgee, Flinders Hinchinbrook, McKinlay, Mornington, Mount Isa, Richmond)
• (From 1 January 2017) Toowomba and west to the borders (LGAs: Balonne, Bulloo, Goondiwindi, Maranoa, Murweh, Paroo, Quilpie. Southern Downs, Toowoomba, Western Downs)

South Australia

• Continued entrance for children aged 0 14 from February 2016
• (From 1 January 2017) Young people aged between 15-17 will begin to enter the NDIS

Tasmania

• Children aged from 12 to 14
• (From 1 January 2017) adults aged from 25 to 28

Northern Territory

• (From 1 January 2017) East Arnhem Region (LGA: East Arnhem Local Government Authority)

Western Australia

• (From 1 January 2017) trial site extended to LGAs of Bayswater, Bassendean, Chittering, Toodyay, York and Northam)

MOD.A's understanding is that the general rule will be "business as usual", so that home modification providers that already provide services to the NDIS will continue to do so in the same way to additional age groups (eg: Tasmania and South Australia). It is not clear, however, what this means for new locations. Members that already operate in the trial and launch sites have put together a brief list of the different NDIS modes of operation as a guide for those who will be operating in these new areas.

In NSW the mode of operation since 2013 in the Hunter trial site has been:

OT Assessment

• The service had to develop a spacific NDIS referral form that NDIA complete and sent through via email requesting an Occupational Therapy home assessment for the particular participant, stating how many hours have been allocated for OT assessment and any hours that may be allocated for builder consultation, as well as abrief description on the reason for referral.
• Once the OT assessment has been completed and plans/specifications drawn up, these are submitted to the NDIA for approval. On occasions the NDIA has requested an estimate of costs to be submitted with the OT assessment. In these instances the OT liaises with the builder to get an estimate of costs.
• The OT assessment summary and home modification referral (and cost estimate if required) is emailed to the relevant NDIA office (Newcastle or Charlestown) for on-forwarding to a team leader for approval.
• The service then invoices the NDIA for OT hours.

Home Modifications

• NDIA emails a home modifications referral form requesting a written quote on the OT plans and specifications.
• Note: Should a participant be living in rental accommodation, NDIA do not chase up landlord consent
• Should a builder site visit be required prior to quoting, the service emails a request through to NDIA stating required hours
• Quotes are then emailed to relevant NDIA office (Newcastle or Charlestown) for on-forwarding to a team leader for approval. If requested, the service will cc the Planner in on this
• Once the plans and quote have been approved  the NDIA will put details of the quantum of funds on the portal as notification of approval. The service has requested on numerous occasions an email advice of quote acceptance, but this does not always occur.
• Contracts are drawn up and signed as required.
• Admin staff advise builders that quote has been approved and for works to proceed.
• Once mods are completed the service invoices NDIA.

In South Australia service level agreements have been in place for complex modifications since it came on board in 2014 (for children). It is expected that these arrangements will continue. South Australia rolls out by increasing the age group over the next few years, and more simple as well as complex home modifications are anticipated. It is expected that providers will engage with simple modifications through the new "myplace" provider portal, but at this stage the new working arrangements for these are not known.

In Victoria the process appears to have been:

• Eligible NDIS participants work with LAC Planner to identify range of supports including home modifications.
• Home modification requirements are considered by an internal NDIA body to clarify the possible scope of the modifications.
• Referral is sent to occupational therapist for assessment.
• Large and complex modifications can also be sent to a project manager for advice.
• NDIA develops a project plan based on the advice and services are engaged by LAC Planners to complete the project.

In the ACT the free market model is in operation.  The experience there has been:

Set up and admin

• Service agreements need to be in place for OT assessment and builder consultation.
• Regular contracts are suitable for construction engagement.

Process

• Participants work with the NDIA Planner then initiate an OT assessment.
• Only OTs who have attended the (MOD.A) NDIS training for major/complex modifications can assess and prescribe at that level.
• Minor modifications are organised by the participant from the registered provider list.
• Major/complex modifications require an OT assessment, report and recommendations with specs (in line with what the NDIS will fund) and an installation/building quote.
• A NDIA panel approves what will be funded within those recommendations and the participant can then choose the quoting builder or another, but only the amount quoted will be available for claiming on the portal.
• A mix of project managed jobs and straight-to-the-builder jobs exist where the builder has experience in the sector.
• Some major/complex jobs require significant numbers of variations to the contract where the client wishes to pay for items the NDIA does not consider directly related to the client's disability.

Marketing

• Workflow hinges (at least initially) on a supplier's ability to market themselves well, but ongoing work tends to rely on positive word-of-mouth among the participants themselves and their participant-driven networks.

MOD.A understands that this more free market based approach will apply in the Southern NSW region.

In Tasmania the process for home modification delivery has tended to be:

• NDIA planner refers to the service with an OT report requesting quotes (NDIA request 3 quotes for all jobs, whereas service practice has been just two quotes for non-NDIA jobs under $25k and 3 quotes for over).
• Service contacts family about process and arranges quotes.
• Quotes received and sent to NDIA for approval/action. Most of the time NDIA request alterations to quotes asking for some items to be removed so that the client/family pay for some of the modification.
• Service then asks builders to re-quote and sends new quotes to NDIA.
• Once approved the service contacts the builder to arrange start date.
• Service pays full invoice on completion if the client/family are satisfied with the works.
• Service claims funds (including coordination fee) from NDIS portal.

There is a risk that some builders will stop quoting if they are constantly asked to change their quotes or if they don't 'win' jobs.

In Queensland, which only commenced in April 2016, there is no clear indication of how the NDIS will engage with the sector now that the scheme is rolling out more fully.

NSW ADHC Funding Variations

Services operating within areas that come under the NDIS will be subject to progressive reduced funding variations as they make the transition from block-funding to individual funding. The NSW Department of Families and Communities, Ageing Disability and Home Care (ADHC) has made available to MOD.A information sheets that were sent to affected providers in May 2016 that outline the schedule and magnitude of funding variations. These are available here.

At this stage MOD.A has no information about similar arrangements in the other states or territories.
If MOD.A members have questions about funding and other transition arrangements, or any other concerns about the rollout of the NDIS, they should contact us at info@moda.org.au

Aged Care Update

MOD.A Engagement with the Department of Health

Our CEO, Michael Bleasdale, met with Karen Pickering, Assistant Secretary Home Support Branch at the Department of Health, and her staff on Thursday 23 June to discuss ongoing concerns and issues with MAC and the CHSP. The following issues were raised on behalf of the sector:

• Problems with incorrect referrals from the MAC call centre, and other issues relating to oversights and wrong information provided by RAS staff.
• Confusion on the part of health professionals attempting to refer people into the aged care sector, in particular for home modifications.
• Delays and other problems relating to OT assessments getting done prior to home modifications being referred.
• A range of problems around the referral of OT assessments to home modification providers: ignoring client preferences and having jobs done by providers other than those referred to, resulting in both client and provider dissatisfaction.
• Incorrect information about home maintenance services on the My Aged Care website that raises client expectations of home maintenance services that our outside of the guidelines.
• The need to clarify that home modifications can often be urgent enough to trigger a direct service referral.
• A range of building and other regulatory issues that can impact on home modifications and maintenance service delivery that the Commonwealth needs to be aware of in each jurisdiction.

Some of these issues have been evident since the MAC was introduced a year ago. The Department has undertaken to look into specific cases in detail to determine whether the root cause of a problem is systemic or behavioural. We are currently in the process of putting services that have contacted us with detailed case studies in touch with the Department so that their root cause can be investigated.
Another issue discussed was how to handle cases of financial hardship given the $10,000 limit on the Commonwealth subsidy for home modifications. MOD.A is aware of at least one instance where a client cannot afford their contribution for a bathroom modification that is clinically required and may have to access residential aged care instead. We have been told by the Department that in this and any other instance on no account can additional Commonwealth funds be used to pay for the outstanding amount.

Online Content Relocates

Providers should have received information from the Department of Health that from 1 July 2016 Ageing and Aged Care content will be moved from the Department of Social Services website to the Department of Health's platform at agedcare.health.gov.au

Recent Changes to MAC

Changes to the My Aged Care system were put into effect over the weekend of 25 and 26 June. MOD.A is interested in any member feedback on whether these changes have improved the client and/or provider MAC experience. In particular we wish to know:

• Can services now view OT assessments attached to referrals?
• Does the Review Support Plan function, able to be accessed by assessors, allow the addition of small maintenance job adjustments without the need for another home visit?
• Will the ability to view a PDF of the client record now give more detail about clients who may have already accessed home modifications from other providers?
• How long is it taking services to process referrals? Is it about the same time as it used to take in the old system, pre-MAC, or longer? If longer what it is about MAC referrals that takes longer than it used to?

MOD.A Election Platform

The Federal Election was held on Saturday 2 July and it is fair to say that issues concerning aged care and housing did not received much media attention during the campaign. MOD.A's own election platform was released on Tuesday 21 June and sent to the major parties and cross benchers. This article outlines the 2 major asks MOD.A has put to those charged with governing Australia, and explains why.

1. A stand-alone program which funds home modifications and is available across the country. MOD.A sees the benefit of a dedicated, housing-focused home modifications programme, similar to the Disabled Facilities Grant in the UK, which is available to all people who require it. Means-tested and attracting contributions from recipients it would sit outside of aged care, disability and other funding programmes, but would respond to the housing needs of those within them. A programme like this would have its focus on quality and meeting additional needs that arise as more and more people age in their homes or access regular housing with complex disabilities. MOD.A, as the industry peak, would be well placed address and improve quality across the industry, and also to raise awareness and provide information to consumers who wish to renovate and modify their homes for lifelong living.
2. Tax and other incentives for home owners and property owners (ie landlords) to encourage them to think ahead and renovate their homes to a standard which will make life easier for them as they age. Evidence from the UK, and also in Australia where it has been investigated (principally Victoria) indicates that the housing stock in general is either poorly designed for older people and people with disability, or not maintained to a level which will make homes safe and useable for people with mobility and other impairments. With the anticipated increase in the numbers of people ageing and living longer in their homes, as much as possible needs to be done to encourage property owners to improve their properties and install features, such as level access bathrooms, as part of their regular renovation cycle. Incentives and inducements, and possibly subsidies, should be provided to further encourage this, so that in later life specific modifications are easier to install and people are less likely to be faced with the dilemma of going into residential care primarily because their place of residence is not suitable.

MOD.A has received acknowledgements from the major parties and a substantive response from Senator Rachel Siewert of the Greens, summarised here:
"The 11 measures you have identified are crucial and the Greens are strong supporters of universal design and accessible housing stock and will commit to working with you and other advocates in this area in the coming years to achieve a funding package to retrofit Australian housing and to review and upgrade the National Construction Code to include stronger universal housing design standards in new housing."

In addition the response points to the Greens' policy on national housing affordability, which includes:

1. a package to introduce a national minimum standard for Australia's private and public rental homes (about one third of all Australian housing stock), worth $118 million per year.
2. a plan to retrofit and refurbish all of Australia's existing public and community housing stock.

The Greens also affirmed their support for a proactive ageing policy, which addressed age discrimination as well as reforms and adequate funding for aged care, and for the rollout of the NDIS.

MOD.A will continue to pursue our goals not just with politicians but with other stakeholders and supporters, and aim to raise the profile of the housing stock as the foundation for all the positive policies currently being enacted to enable older people and people with disability to live at home.

Members may also be interested in the positions adopted by the NSW Ageing Alliance, which include a statement about the need for affordable and accessible housing.

Update on Slip-resistance of Ramps

Recently MOD.A alerted its members to the new provisions in the National Construction Code (NCC) which have changed the allowable gradient of external ramps to 1:8 and increased the slip resistance requirement of all ramps fixed to Class 1 buildings. For those that missed our email notification early in June the Home Modification Information Clearing House (HMinfo) have published an Industry Fact Sheet about the new requirements, and what surfaces are likely to comply with the required slip resistance of P5 or R12. The Fact Sheet should be updated with examples of slip resistance in the next few days.

Testing has indicated that most wooden ramps will no longer meet the requirements, which has cost implications for both providers and consumers. The additional slip resistance will also not work well for many consumers who need an easier path of travel than it will allow. MOD.A and HMinfo will be raising these issues with funding bodies and directly with the Australian Building Codes Board, which reviews and amends the NCC each year.

MOD.A in the Media

MOD.A CEO Michael Bleasdale appeared on the Sky News Real Estate programme on Saturday 18 June to promote the benefits of home modifications and timely accessible renovations for seniors who wish to remain at home rather than move into residential aged care. If you missed that interview you can watch it on our YouTube channel.

Events/training

Australia

Australian Assistive Technology Conference: Collaborate, Empower, Transform - Realising opportunities with assistive technology solutions, Jupiters Hotel & Casino, Gold Coast, Queensland, 27-29 July 2016.

Active Ageing Conference 2016: Wellness, reablement and restorative care in aged care. Swissotel, Sydney, 4 August 2016.

Griffith University NDIS Symposia Series. Housing for people with disability: What does an inclusive housing system look like? Brisbane Convention and Exhibition Centre, South Brisbane, 8 August 2016.

OTNSW Workshop: Environmental Home Modifications - The Basics, Taree, 12-13 August 2016.

Universal Design Conference, Sydney Town Hall, 30 -31 August 2016.

ACSA 2016 National Summit. Hotel Grand Chancellor, Hobart, 6-9 September 2016.

Free online courses on disability and a good life