The pandemic has generated widespread debate about the aged care industry and concern for elderly people and their families.
Supported Residential Services (SRS) are another sector in urgent need of rigorous scrutiny with action by state and federal governments required, according to researchers Liz Dearn and Professor Lisa Brophy.
“SRS residents need to be visible and on our radar if we are committed to protecting the people most at risk of serious illness and death in this pandemic,” they say.
Liz Dearn and Lisa Brophy write:
An outbreak of COVID-19 amongst residents at Hambleton House in Albert Park in Victoria shows the urgent need for government action to ensure the health and safety of vulnerable people living in a ‘Supported Residential Service’.
This is a specific type of facility, legislated under the Supported Residential Services (Private Proprietors) Act 2010. In Victoria alone, SRS house several thousand people with disability and mental illness.
SRS are a privatised model of institutional care, existing in neighbourhoods across Australia, but about which little is publicly known.
In Australia, they were originally conceived of as ‘special accommodation homes’ to support the frail aged. Known as ‘psychiatric hostels’ or ‘registered boarding houses’ in other Australian states, ‘board and care homes’, ‘hostels’ in Canada and ‘registered care homes’ or ‘low care hostels’ in the UK, other states have similarly legislated facilities.
But during deinstitutionalisation in the 1990s, SRS morphed to accommodate the large numbers of people with mental illness leaving institutional care who had nowhere else to go.
Amidst raging debate about the vulnerability of people living in aged care and disability support settings, SRS residents are a discrete cohort at great risk, for whom there appears to continue to be insufficient knowledge, planning or preparation in COVID-19.
While Victoria has taken some pride in the closure of large institutions, SRSs endure as small to medium institutions. They continue to exist because they are the default discharge option for people with mental illness leaving mental health facilities or homelessness services where no alternative exists.
Victoria has 127 SRSs, most of them ‘pension-only’ SRS where, as indicated in Department of Health and Human Services SRS Census, the fee starts at $820 per fortnight out of a baseline disability support pension of $860. They accommodate between 20 and 50 residents on average and, the largest facilities house 80 residents.
As a type of ‘closed environment’, SRS share many of the features of former mental health and disability institutions. Residents experience a high degree of isolation from the rest of the community and, for many, all aspects of life are lived in this one place.
These settings are a kind of ‘end in themselves’ as they have no therapeutic purpose, as revealed in a PhD study being undertaken at RMIT University’s Future Social Services Institute.
The problems of systemic neglect have been raised over many years of inquiries and Community Visitors Annual Reports to Parliament and, outlined in a recent submission to the Victorian Mental Health Royal Commission by the Private Congregate Care Alliance.
Poor physical conditions are hallmarks of many SRS settings, and include substandard living conditions, inadequate care and unhomelike features such as shared rooms, shared bathrooms and unacceptable rates of deprivation, violence, abuse and bullying.
With the mix of residents with disabilities, complex needs and poverty, SRS could be described as a 21st century ‘poorhouse’. They provide few opportunities for residents to work towards a different kind of a life.
Seventy percent of people living in ‘pension-only’ SRS have psychosocial disability. Most people have secondary conditions that produce complex needs. Many residents have a history of homelessness. Critically, residents tend to be isolated with few support systems or family connections.
Poverty is a feature in SRS and most residents receive a Disability Support Pension, leaving them with as little as $7 per day to live on once the SRS fee is paid. Some residents do not have their own phone or television, and most do not have a computer in their room.
There is an assumption embedded in policy that residents live in SRS because they need to live there. In truth, many residents live there because they are poor and are effectively ‘locked-out’ of other forms of housing and support.
Thus, there is a strong argument that many residents live in these settings because of systemic neglect. Many are referred to these places to free up the limited psychiatric beds available in Victoria and in desperation when no other safe and affordable post discharge accommodation is available.
The risks presented by COVID-19 serve to expose the truth about the perilous nature of disability residential settings.
SRS are deeply problematic environments, before one considers the added threat of COVID-19.
The spread of the virus is showing up weaknesses in the system resulting from decades of cuts to services under neoliberal policies, where the cost of care has shifted to the private sector. This sector put profits ahead of staffing levels or, as the Shadow Minister for Government Services Minister, Bill Shorten, recently put it, serves ‘two masters, profit and care’.
The impact of the COVID-19 pandemic in aged care facilities has demonstrated the highest rates of infection are in private aged care facilities. This has been attributed to a broken system, with inadequate levels of qualified staff and the casualisation of the workforce and cohorting of patients. It has been demonstrated in Victoria and overseas that anticipating the management of complex infection control procedures from relatively poorly trained workers is too high an expectation.
There is a similar conflict between profit and care in the SRS sector. Given that only one staff member in an SRS is required to have a minimum Certificate III qualification in disability or aged care and the required staff-resident ratios are 30:1, there is cause to be concerned about the effective management of COVID-19 in these settings.
Within the legislation that regulates SRS, proprietors are charged with some responsibilities relating to the health, safety and welfare of residents. There seems to be an expectation implied in present departmental communication that it is proprietors who might be seen to be responsible for the welfare of residents in a COVID-19 context, like ordering Personal Protective Equipment (PPE) on behalf of residents.
This assumption is problematic and requires urgent scrutiny. We need to ask whether proprietors in a for-profit private accommodation facility are sufficiently skilled or qualified to balance the complex safety and human rights issues of residents in this situation.
There is also concern about residents being required to remain in their rooms for any length of time, given the small size and sometimes shared nature of their rooms and the lack of phones, TVs, computers and other essential items most of us take for granted to make ‘lock-down’ bearable. Are residents being quarantined in their rooms? How is this being monitored and enforced?
A recent DHHS circular shows that masks are available on request. What support is being provided to prevent transmission and to help residents understand the risks? Are staff and residents wearing masks at all times or only when an infection appears? How are facilities like shared bedrooms, bathrooms and other living spaces being managed?
For residents with no family, formal advocacy or support systems and no choice to go elsewhere, there are grave risks.
Before COVID-19, some external workers came into SRS to support residents, but since the lock-downs started in March, for most residents the only contact with external support workers is by phone, sometimes a communal one. There is only the barest monitoring and surveillance and since the lock-downs started in Victoria, Community Visitors no longer have a physical presence in the settings.
We should be concerned about whether the public health risks inherent in SRS may be used to justify insensitive, disrespectful and heavy-handed approaches to enforcing lock-down, that could undermine the rights of residents and jeopardise their health in other ways.
Governments must act
Centrally, the private nature of these SRS settings and the conflict inherent in the role of proprietor necessitates assertive effort on the part of government to ensure the rights of the residents are foremost in the planning and preparedness efforts.
Government cannot shift the responsibility for the safety of SRS residents to private proprietors. They are conflicted and not qualified to manage a pandemic. Government needs to step up. Otherwise, we will fail to contain the virus in SRSs at terrible cost to residents and the communities within which they live.
Given that SRS are regulated by the Victorian Government under the Special Residential Services (Private Proprietors) Act 2010, and subsidised by the State Government, SRS are clearly a state responsibility. However, we must act now at both State and Commonwealth levels.
The Victorian Government should provide advocacy services for all SRS residents during lock-down as well as publicly reporting data on SRS COVID-19 rates.
The Commonwealth Government should fast track NDIS funding for SRS residents, particularly for Supported Independent Living and Specialist Disability Accommodation funding. Many residents could live on their own if provided with support and accommodation to live independently.
Premier Andrews was right in looking at moving residents to alternative housing to prevent the spread of COVID-19 through an SRS like Hambleton House. Similar to the State response to homelessness during the pandemic, COVID-19 reflects a key opportunity to respond to the needs of SRS residents and address longstanding vulnerabilities and neglect.
SRS residents need to be visible and on our radar if we are committed to protecting the people most at risk of serious illness and death in this pandemic.
Liz Dearn (below L) is a PhD candidate with the Future Social Services Institute, a partnership between RMIT University and Victorian Council of Social Services. Their PhD explores the experience of choice and control people with psychosocial disability of people living in SRS during the first 18 months of the National Disability Insurance Scheme.
Lisa Brophy (below R) is Professor and Discipline Lead in Social Work and Social Policy at La Trobe University. She is also an honorary principal research fellow in the Centre for Mental Health in the Melbourne School of Population and Global Health at the University of Melbourne.