SECTION TWO: ASSOCIATE PROFESSOR GREEN'S ADVICE
2.1 Key Issues Considered
Associate Professor Green identified and then analysed the following
key issues in providing his advice to the Department:
Scale and Client Profile
The pension-only sector are
commonly small businesses with poor economy of scale (less than
25 beds) providing residential care for younger high need residents
(73 per cent under 70 years of age) with a diverse range of care
needs at a maximum income of $245 per week per resident ($35 per
day)  . They tend to operate in largely leaseholder
premises, with rent accounting for an estimated 35 per cent of expenditure.
In comparison, pension plus
facilities tend to be larger scale (greater than 40 beds) and operate
from purpose built facilities, catering for a predominately aged
client group (83 per cent over 60 years of age, 49 per cent aged
80 plus) with a fee structure ranging from $300 to in excess of
$400 per week  .
The pension plus sector can be differentiated from the pension-only
sector on a number of indices including:
- More sophisticated infrastructure and care models and complex
corporate structure, increasingly incorporating the horizontal
integration of a number of facilities in differing locations and
in some instances the vertical integration of other forms of aged
care  .
- Well developed administrative, financial and professional supports.
In comparison the pension-only sector is characterised by isolated
services without the opportunity to access a company or network
support, low levels of infrastructure and lower levels of generic
and specialist business skills.
Nature of Service Model
Overall the pension plus sector is providing a model of aged care
consistent with and close to a mainstream model of residential aged
care. At the other end of the spectrum the pension-only sector,
with its increasingly dependent resident profile and without additional
external support services, may be unable to adequately provide for
the care and rehabilitation needs of some residents, some of which
are considered problematic in other professional, subsidised service
Compliance with Community Standards and Regulations
The combined pressure of operating from older and less appropriate
buildings, with the minimum staff requirement and under considerable
cost pressures has compromised the quality of care provided to residents
in some pension-only SRSs, evidenced by the level of sanctions applied
in relation to breaches of Departmental regulations
 . Clearly, many pension-only SRSs meet community
standards and legislative requirements, however, there is ongoing
concern about those that continue to experience difficulty maintaining
Demand for pension-only SRS is high and likely to remain so as
a result of closures in this sector and the ongoing referral of
people with disabilities into this form of supported accommodation.
The increasing number of older people with independent income will
continue to drive demand in the pension-plus sector which provides
an alternative to Commonwealth subsidised residential care.
In summary, assessed against the 'survival' indicators of financial
viability, business capacity, model of care against resident profile,
compliance with standards and demand for services it becomes apparent
that the two sectors have very different future prospects. Associate
Professor Green concluded that across virtually every indicator
the pension-only sector can be assessed as being less viable than
the pension plus sector, creating the business case for a differential
2.2 Framing the Solutions
In formulating his advice Associate Professor Green postulated
and considered three interrelated threshold questions as follows:
Can Victoria continue to lose the low-cost, supported
accommodation provided by pension only SRSs?
Associate Professor Green argues that Victorian will continue to need both supported
housing services and residential care services for a predominately
younger and middle aged adult population with high level dependency
needs. Associate Professor Green contends that pension-only SRSs
should be viewed primarily as being in the business of providing
low cost accommodation and Government should consider strategies
to maintain this housing supply.
Associate Professor Green postulates that the issue of support to pension-level
SRS residents should be dealt with separately from the issue of
accommodation. He contends that pension-only SRSs can only provide,
within the constraints of its existing business model, basic support
and supervision for residents and that this support must be significantly
enhanced through access to funded support services available to
people with similar care needs.
He also found that the 'best practice' models of pension-only SRSs should be
supported to continue to provide accommodation and support for low
income residents with complex needs.
If there is a continuing demand for pension-only
SRSs, but some SRSs are increasingly inappropriate for particular
groups of users, are the solutions found in different forms of in-home
residential care or in supported housing services or in providing
more support packages to residents in SRSs with complex care needs?
Associate Professor Green contends that pension-only SRSs, particularly those
operating in high cost, leasehold facilities, cannot provide the
required level of care and support services for residents with complex
needs at the estimated maximum income of $35 per day.
Across the continuum of care needs, Associate Professor Green acknowledges that
some pension-only SRS residents with relatively low dependency could
live in more developmental and less restrictive accommodation options,
such as supported rooming houses and group living arrangements,
and that Government should give consideration to such models in
the longer term.
At the other end of the care continuum Associate Professor Green argues that
there is a small group of people with very complex clinical and
care needs who require very high levels of support. Associate Professor
Green contends these residents are inappropriately accommodated
in any housing and support models, including pension-only SRSs,
and should be relocated to other forms of higher level subsidised
care, such as Commonwealth subsidised residential aged care services,
psychogeriatric hostels and Community Care Units - all of which
provide full time care with clinical services.
He also proposes that prospective residents dependency levels should be assessed
before admission to ensure the level of care provided by a particular
SRS is appropriate to their needs. In line with this Associate Professor
Green proposes the Department consider, in the longer term, developing
administrative processes allowing registration of SRSs to include
certification of types, and levels and mix of care and support services
available to prospective residents.
If the viability of these services will remain a
problem, what is the preferred solution: subsidise the service,
subsidise the user of the service, or indirect subsidy through other
In the medium term Associate Professor Green argues that in order to improve
the standard of care to current pension-level residents consideration
should be given to providing a form of subsidy which enhances the
provision of clinical, care and support services directly to the
resident. Associate Professor Green is of the firm view that the
subsidy should not be given to proprietors on the basis that such
an action would not lead to better care, ensure the continued availability
of accommodation for people on low incomes or lead to improvements
in the viability of pension-only facilities, particularly as most
of these services operate from high cost leased facilities.
In framing the proposed responses identified in section 2.3 of
this paper Associate Professor Green made the following observations:
- Victoria's health and community services require and depend
upon a wide variety of supported accommodation services and at
this point there is a shortage of supported accommodation across
a variety of different service sectors probably as a result of
service redevelopment, reduced availability of low-cost housing
and increase in the number of people requiring services. It is
assumed that the range and quantum of supported accommodation
services will need to be increased rather than decreased.
- The physical location of low-cost and supported housing is important
to residents, and potential residents as well as to the services
referring and using supported accommodation services. This assumption
means that supported accommodation services, including SRSs or
SRS-like services, are required in areas where land and housing
costs may be relatively high.
- That pension only SRSs as they are currently constituted will
continue to be sought as accommodation for adults and older adults
whose needs, behaviour or disabilities may present difficulties
for other service systems, including disability specific services,
mental health services and residential aged care services.
- Despite the expectation of continuing expansion of the Commonwealth
funded residential aged care program and the State funded supported
accommodation programs for various groups of people with a mental
illness or other disabilities, the quantum and range of publicly
subsidised supported accommodation services will be unable to
meet the particular demand currently met by pension-only SRSs
into the foreseeable future.
- As a result of a number of systemic and policy changes since
1987, the nature of the demand for pension-only SRS accommodation
has changed to a younger (under 70 years), less frail population
with a greater ranges and level of disability. That change, which
has not been fully recognised or acknowledged, will continue and
must inform the State Government's response.
In summary, he concluded that Victoria will continue to require
low-cost housing options for adults and older adults with ongoing
support needs, and their needs will not be met by existing subsidised
supported housing or residential services or by the anticipated
growth in aged residential care services funded by the Commonwealth.
2.3 Proposed Response
Associate Professor Green's recommended strategies for change,
organised as three integrated stages.
Stage 1: Immediate
Improving procedures and processes
Stage 2: Immediate - Medium Term
Strengthening program support
Stage 3: Longer Term (five plus years)
(i) Achieving appropriate levels of support
(ii)Moving from residential care to supported housing.
Stage 1 Immediate Term Strategies - Improving
Procedures and Processes
The objective of this
stage, as identified by Associate Professor Green, is to strengthen
the existing Departmental interactions with the industry in order
for it to more effectively meet its legislated responsibilities
and Government policy objectives across the entire SRS industry.
Associate Professor Green's proposals aim to improve the rigour
of the licensing and registration processes across the SRS industry;
expand the provision of information to proprietors, prospective
residents and their families or referring services; and strengthen
Departmental planning processes, particularly contingency planning
for SRS closures. Associate Professor Green considers that these
proposalswould not require any changes to the legislative or regulatory
environment, nor do they direct additional costs to SRS proprietors.
1.1 That in order to undertake more intensive and rigorous screening
of applications for registration and renewal of registration,
the Department of Human Services consolidate into a single organisational
unit, responsibility for the administrative processes currently
described in Part 4 of the Health Service Act 1988 as they
relate to supported residential services.
1.2 The Department of Human Services develop broader and more
accessible information resources to assist proprietors of supported
1.3 The Department of Human Services develop broader and more
accessible information resources for residents and prospective
residents of supported residential services, including in particular,
information on the care and support needs of prospective residents
referred by funded agencies.
1.4 That the Department develop more appropriate procedures
to anticipate and respond to changes in the supported residential
services industry, including in particular contingency planning
to deal with facility closures.
Stage 2 Immediate to Medium Term Strategies
Strengthening Program Support
The objective of this stage, as identified by Associate Professor
Green, is to improve standards of care in pension-only and above
pension SRSs through non-regulatory program support development,
with the focus on the pension-only sector.
Associate Professor Green's proposals aim to address various functional
and service needs through the provision of professional mentoring
to SRSs; improve resident access to clinical and personal support
services; and provide discretionary assistance to proprietors to
facilitate safety and fabric improvements. Associate Professor
Green considers that these proposals would not require any changes
to the legislative or regulatory environment, nor do they direct
additional costs to SRS proprietors.
2.1 The Department of Human
Services develop and implement a program of professional
mentoring to enhance the business capacity and care skills in
pension-only supported residential services.
2.2 The Department of Human
Services continue to improve the focus of funded support programs
(particularly in the HACC, disability and mental health program
areas) on supported residential services residents.
2.3 The Department of Human Services consider developing a capacity for discretionary
financial support to selected pension-only SRS for
safety and fabric changes resulting from changes in legislative
requirements or Departmental policy.
Longer Term Recommendations (Over Five Years)
Associate Professor Green identified a
range of longer-term options for consideration by Government underpinned by two objectives,
that he notes as not necessarily being mutually exclusive.
The objectives that he identifies as underpinning his proposed options
To retain the existing SRS model
and improve standards of care and service viability by decreasing
the level and diversity of resident dependency in SRSs through the
changing of admission practices and dependency levels
The possible proposals for achieving this objective
include the introduction of new approaches to licensing and registration
that specify the level of care and support service able to be provided
by an SRS; better and more comprehensive assessment of the dependency
levels of prospective residents to avoid inappropriate accommodation
in an SRS; and assessment and relocation of highly dependent residents
to more appropriate care settings. Associate Professor Green
considers that these strategies would require changes to the legislative
or regulatory environment but would not impose additional costs
To change the model to reduce
the current reliance on the pension-only SRS sector as ' accommodation
of last resort' for financially disadvantaged people with ongoing
support needs, and at the same time, to retain private expertise
and privately owned fabric in the wider supported accommodation
system through a range of supported housing programs
As part of this objective Associate Professor
Green argues that, if in the longer term (despite of the provision
of support for residents and proprietors as outlined in the immediate
to medium term strategies), it is not possible for proprietors to
meet the cost of accommodation and personal care services to a community
acceptable standard, and within an affordable fee structure, alternatives
to pension-only SRSs must be considered.
Associate Professor Green also argues that Victoria
will continue to require low-cost housing options for adults and
older adults with ongoing support needs, and their needs will not
be met by the existing bed supply in pension-only SRSs, the quantum
and range of subsidised supported housing or residential services
or by the anticipated growth in aged residential care services funded
by the Commonwealth.
Associate Professor Green identified the following
long-term options for consideration under this stage:
Retain some existing pension-only
SRSs as private low cost housing by converting them to supported
housing with tenants provided with appropriate levels of support
based on assessed need from independent external, subsidised providers.
Develop a range of alternative long term supported housing models
for people with complex care needs requiring up to 24 hour care
in a non clinical environment and/or increasing the capacity of
existing non-treatment disability residential accommodation models.
Increase capacity of existing clinical residential care for people
with very high dependency needs.
Expand intensive disability outreach support models linked to
affordable housing for people able to live independently in the
Associate Professor Green notes that these proposals
would involve the structural redefinition of pension-only supported
accommodation services from residential care service within the
framework of the Health Services Act to supported housing within the framework of the Residential
Recommendation 3.1 That the Department of Human Services further research
and develop strategies for longer term intervention around the following
· That consideration is given to a requiring better
assessment of prospective residents' dependency levels by appropriate
agencies before admission to a supported residential service and
that residents only be referred to SRSs, if appropriate to the
· That facility and proprietor registration include
recognition of their appropriateness to provide supported accommodation
for people with different care and support needs.
· That consideration be given to relocating very high
to more appropriate care settings.
· That consideration be given to increasing
the range and availability of publicly owned fabric for housing
financially disadvantaged people with ongoing care and support
· The Department
consider development of a supported rooming house program in cooperation
with local government and appropriate service providers.
· Encourage some pension
only SRSs to become supported housing rather than residential
care, with appropriate support provided for residents by independent,