Effectiveness of Individual Funding Approaches for Disability Support

Use of Individual Funding: Individual funding is defined in this report as a portable package of funds allocated for a particular person that facilitates control over how they purchase their disability support needs. The way individual funding is organised varies in relation to who holds the funds, which parts of it are portable and what disability support types it can be spent on from which parts of the market. The profiles from the Commonwealth State and Territory Disability Agreements (CSTDA) National Minimum Data Set and surveys show that individual funding is more likely to be used by people of working age with low support needs, by male and non-Indigenous service users, by people with one disability and by people without informal care networks. This applies across disability types and disability support services. Individual Funding in the States and Territories: Australian government disability agencies demonstrate a growing policy interest in individual funding and self-directed approaches. They are developing policies and guidelines, extending pilots, introducing and refining models and conducting evaluations to better understand consumer outcomes. The dominant approach to individual funding in Australia is a portable individual funding package held by a service provider, except in Western Australia (WA), which has a longer history of individual funding and use of direct funding. Managing effective approaches to individual funding: Issues to be Considered Include: • person-centred disability support • support according to capacity and vulnerability • administrative systems to support management responsibilities • viability of support type and amount of funding • workforce and quality of care • service integration • contextual impact. Costs of Individual Funding: The average individual package funding size in this study was $28,500 and ranged from $700 to $250,000. The variation relates to disability support type and support need. The average management cost was 14 per cent of the individual funding package and ranged from 5 to 22 per cent. This is similar to the management cost of other disability and community services. Individual funding has not increased the total specialist disability support cost to government. Officials said some individual funding is more cost-effective than other models of organising support, particularly where it supplements social housing and informal care. Some government officials and service providers said that costs were higher during the transition to a mixed system of funding and organising disability support, because during the transition, new systems need to be established to support informed decision making and accountability for people using individual packages. Individual funding packages pay for disability support and management support. The cost of disability support and management support is not usually less expensive than other forms of organising disability support. Rather it enables choice in the types of disability support the funding is spent on, who provides it, and when and where it is provided. Some packages are not sufficient to pay for all the disability support a person needs, either because of restrictions on the amount available or what it can be spent on, or because the funding allocated for the assessed need is insufficient to meet the actual cost. In these cases the person receiving the support, informal carers or service providers incur the additional costs of the disability support or the costs of managing the support, either in time or expenses, or the person does not receive the support they need. Outcomes of Individual Funding: The outcomes data compared people’s experiences before and while using individual funding; outcomes for people with disabilities who have individual funding (as reported by people using individual funding or their carers) with the outcomes for people whose disability support is organised in other ways (as reported by service providers); and an Australian population norm for personal wellbeing. Most people using individual funding experienced personal wellbeing, and physical and mental health at levels similar to both the Australian population norm and the Victorian norm of people with intellectual disabilities (the study was conducted in Victoria - therefore the norms are for Victorian people with intellectual disabilities). In the interviews, they attributed these positive results to the better control they have over the way they organise their disability support. Using a standard measure of personal wellbeing, scores on all domains (standard of living, achievement in life, personal relationships, personal safety, community connectedness) were similar or higher than the scores for the broader Australian population, except for personal health and future security. The scores of people using individual funding were also higher than normative data for Victorians with intellectual disabilities in the domains of personal health, achievement in life and personal safety, but lower in personal relationships, community connectedness and future security. People with disabilities and their families also commented on how changing to individual funding had improved the wellbeing of family members because they could share the responsibilities. They were worried about what would happen in the future when the family members could not help manage the individual funding. Most people were happy with their social relationships and community participation. Service providers attributed this to the whole-of-life approach they can take providing support for people with disabilities who have individual funding compared to disability support clients who have other arrangements. The type and amount of individual funding used by people with disabilities sometimes limited the contribution individual funding could make to their social participation. For example, if it was support restricted to economic activity, the person could not use support workers to attend social events. All respondents said that individual funding had improved their control, choice, independence and self-determination in their lives. Possible Limitations of the Primary Data: Possible limitations to the primary data collection were addressed using mixed methods, including validated scales in the instruments, and incorporating advice from people with disabilities, families and providers through piloting and draft versions. • The survey response rates from people with disabilities and service providers were approximately 50 per cent. While the response rate and sample sizes are acceptable for this analysis, the sample sizes may decrease the generalisability of the conclusions. • Using proxy interviews and questionnaire completion with family members instead of people with disabilities where cognitive impairment presented a problem to communication enabled contribution of information about these people’s experiences. The proxy views might compromise the validity of the data collected. • Using simplified scales in the easy English survey for people with disabilities enabled participation by people for whom the full scale might have been too complex. A possible limitation is that scales with fewer points can have lower sensitivity compared with full point scales. • Comparison data about the experiences of outcomes and risks of people with disabilities who do not use individual funding was available from two sources: asking service providers to compare support they provide to people organised through individual funding with support organised in other ways; and asking the people with disabilities to compare their current individual funding support service experience to their support service experience prior to individual funding. A control group was not included. Conclusions drawn from comparing people receiving support organised through individual funding to people receiving support organised in other ways should be read with this analysis framework in mind.