Chapter 8
Risk factors and causes
8.1
One of the key terms of reference for this inquiry is to identify the
systemic workforce issues that contribute to violence, abuse and neglect of
people with disability.[1]
However, the evidence presented to the inquiry showed that the causes of
violence and abuse go far beyond systemic workforce issues and includes
cultural attitudes towards disability:
The APS [Australian Psychological Society] approach to
understanding the issue is that there are two key elements. One is about
malicious intent and the other is about ignorance and the culture within
institutional and residential settings, with the higher use of restrictive
practices in Australia than in the [United Kingdom].[2]
8.2
While there was some evidence presented to this inquiry on the issue of
predatory abusers, most submitters focused on sector-wide systemic workforce
issues that increased the risk of abuse from carers who simply responded negatively
to various factors in the workplace or with the nature of the work. Other
evidence has focussed on the culture or practices of individual workplaces
which can also increase the risk of violence, abuse or neglect of people with
disability:
Data from notifications to my office shows that there are
three main factors contributing to violence: firstly, the group home
environment, where we see inappropriate placements and, particularly, a lack of
alternative accommodation; secondly, workforce issues such as lack of training,
insufficient staff, high numbers of casualised staff and a lack of leadership;
and, thirdly, cultural issues, particularly tacit acceptance and normalisation
of violence and bullying.[3]
8.3
Broadly, the evidence presented to the inquiry from a range of
organisations and individuals suggests the key common causes of violence abuse
and neglect are:
-
systemic issues—jurisdiction-wide systemic issues that can
increase likelihood of abuse or neglect;
-
cultural attitudes of de-valuing people with disability;
-
individual worker issues—predatory workers, neglectful workers and
skills‑deficit abuse; and
-
individual workplaces—facility practices which can increase
likelihood of abuse or neglect.
Systemic issues
8.4
A range of systemic issues that exacerbate or cause violence, abuse or
neglect of people with disability were raised with the committee. These
included:
-
the institutional nature of disability service provision;
-
low pay levels of the workforce;
-
lack of appropriate pre-employment and ongoing individual worker
regulation; and
-
current systems of accreditation of service providers.
Institutions
8.5
Evidence was presented to the inquiry that the very nature and model of
service delivery—institutions and congregate housing models—created sites where
violence, abuse and neglect were almost inevitable outcomes.
Institutions can at times create a culture of power over
people who are vulnerable, typically, and who do not have an opportunity for
choice.[4]
...
We know from our lived experience and from research we have
conducted that congregated or institutionalised models of service increase the
risk of abuse, neglect, discrimination and violence. This happens by making
people powerless through increased dependence upon human services for basic
life needs and decreased meaningful connection to family, friends and
community. This institutionalised practice also has the effect of reducing or
denying people with lived experience of intellectual disability socially valued
roles within family, community and the broader Australian society. We are also
deeply concerned about people with lived experience of intellectual disability
in institutions being denied access to real independent values-driven advocacy
support as well as peer support.[5]
...
JFA Purple Orange's experience
highlights that institutionalised residential settings may increase the chances
of people being abused because they make people invisible to the community...What
makes these services institutional is their practice, where vulnerable people
receive services largely away from the eyes of the community, and where the
main people in their lives are paid to be there. Violence, abuse and neglect in
such settings are difficult to detect, report, investigate and prosecute.[6]
8.6
Service delivery organisations achieve obvious 'economies of scale' by
developing congregate housing models where a number of people with disability
can reside and/or receive services from the one location, sharing resources and
staff. Another significant factor increasing institutional or congregate
service delivery settings is the lack of appropriate private or public housing
options for people with disability, who might otherwise be able to live
semi-independently with carer visits.[7]
Inappropriate placements
8.7
An issue that was raised repeatedly throughout the inquiry was the issue
of placements of incompatible residents caused by organisations seeking to
streamline services to reduce costs.
We know of several situations where support services bring
together two or three individuals who they happen to provide support for and
they bring their hours together and have them do an activity where the three of
them would not ordinarily get together, would not have anything to do with one
another. It suits the service to pull the support hours together so that it
works for the support worker. That is what they do—and it should not happen
that way. People should not have to be brought together in those circumstances.[8]
[T]here should be no reason for anyone ever trying to seek an
intervention order against someone in the same residence. If it is a [Department of Health and Human
Services (Victoria)] property, they should be ensuring that people who
are actually a danger to each other are not together. They should be
ensuring that it is a safe place for the people who live there, and they should
be working out what it is that is causing these events to occur. There should
never be instances—and there are many—where we have to provide support to
somebody to get an intervention order against somebody they live with, because
they have no choice but to live there.[9]
8.8
Other submitters pointed to the lack of accommodation options so that
people who were not compatible were not required to live together.[10]
[The Victorian Advocacy League for Individuals with a Disability
(VALID)] also believes that severe underfunding by governments and
underinvestment in appropriate housing creates a context where many individuals
are required to live in group accommodation with other residents who make their
lives unsafe, miserable and intolerable. That this is tolerated as an
acceptable solution to accommodation and support is a form of systemic abuse
that would not be acceptable to any other citizens.[11]
Schools as institutions
8.9
Chapters three and four investigate the treatment of children with
disability in schools in detail. What is clear is that the 'mainstreaming' of
disability education, where children with disability are integrated into
standard public schools, has in some cases resulted in those children losing
the specialised staff who are able to recognise and appropriately respond to
the needs of children with disability. The outcome for some children has been
catastrophic and there are clearly systemic causes that must be addressed:
In the school system there is absolutely no oversight or
regulation, and often it is up to school principals, the schoolteacher and
specific approaches and cultures within schools. Obviously it underpins a whole
area in education where there is a complete lack of training and support for
the inclusion of children with disability in schools and what that means.[12]
There is a long list of reasons why that should not happen
and there are alternatives that would make it unnecessary to use restraint or
seclusion, but the schools are ill resourced or inadequately advised or
trained to deal with these matters appropriately...Another issue in relation to
schools is there is no independent complaints body, so it is impossible for
anyone to get anywhere if they have an issue of that sort in relation to what
is happening to their family member, their child, in school. We would recommend
that an independent complaints body is urgently required for schools and
special schools issues.[13]
Low pay rates
I cannot count the number of people I know who work in the
industry who have been clearly good at their jobs but have said, 'I have to
leave; I cannot afford to keep doing this.' So they have gone into nursing or
they have gone to train to be a paramedic. That is a profound waste. We should
not be so undervaluing the services that are provided by good support staff.[14]
8.10
Many witnesses cited negative impacts to service delivery of having a
low‑paid workforce. Of particular concern was that the levels of pay
contributed to a transient workforce, exacerbating training issues in an
industry where so much of the required skills are gained through years of
on-the-job training:
A lot of clients I work with are non-verbal. You understand,
after you have been living with them for months and then years, that the blink
of an eye means something, the twist of a head means something, and the look on
a face means something. This cannot be done with people who come here and do
the job to fill in time while they are at university, or to fill in time while
they are doing other things in their lives. It is okay if they are there with
other people, but, if they are there on their own with these people, so many
things can go wrong and people can get unintentionally hurt. It is not through
malicious damage, it is just ignorance—and we cannot have that. People have to
be trained. They have to have understanding.[15]
8.11
The transient nature of parts of the workforce was seen to have impacts
on the quality of services being delivered, as outlined above, but also on the
emotional and psychological well-being of the people being cared for. Multiple
witnesses and submitters raised the issue that it is distressing for any
person, regardless of disability, to have relative strangers undertaking what
are often highly intimate forms of personal care. For people with an
intellectual or mental health disability, the disruption to routine can be
emotionally traumatising. For these people, their quite normal response to
such stimuli is often viewed as 'behaviour of concern' from the carer or
service provider, leading to further neglect or abuse in the form of behaviour
modification through discipline, restraint or seclusion:
In my experience the majority of the violence and abuse comes
from staff attitudes and behaviour, and aggressive patient behaviour is often
the result of self defense, against unwanted/unwarranted
drugging and the physical violence of electroshock, the rudeness, verbal and
emotional aggression, unnecessary use of force and avoidance of any therapeutic
contact by staff, as a general and expected way of behaving in the institutional
setting.[16]
8.12
Discussion of the issue of low wages went beyond simply stating that low
wages will result in individual good workers leaving the sector to pursue other
employment options, but also highlighted the lack of funding for career
development and training, which creates a further sector-wide push factor that
encourages a drain on the workforce:
A chronically underfunded service system with poor safeguards
will always—and this is the experience in other countries—turn good people into
bad carers, because they are unable—through their training, through their
development and through their support—to produce the outcomes that people
require.[17]
Workforce regulation
8.13
Recent media attention on cases of abuse and sexual assault in
disability facilities has highlighted the problem of predatory behaviour,
whereby abusers choose to work in sectors where they have access to vulnerable
people and where the work itself includes a level of physical intimacy that can
be exploited for abuse. Evidence has been presented to this inquiry by
multiple witnesses that the lack of sector-wide workforce regulation in the
disability services industry has exacerbated the ability of predatory abusers
to enter and remain in the disability workforce:
As institutions where children are freely accessible attract
paedophiles, institutions where vulnerable, powerless
people are to be found, especially when that powerlessness is supported by the
most disenfranchising legislation in the land, will
attract people who have a need or desire to exercise power. In both situations the outcome will be abuse.[18]
8.14
There was a great deal of evidence presented to the inquiry on the
benefits of a systemic approach to the regulation of the disability service
workforce. This ranged from improving pre-employment screening systems, through
to possible registration schemes that would include requirements for ongoing
professional development.
8.15
A common problem discussed by many submitters was the issue of workforce
pre-employment screening. Ms Sue Ash, Chief Executive Officer of UnitingCare
West told the committee:
...our experience at UnitingCare West is that, if you join up
your knowledge of the child protection system, the disability system and the
aged-care system, there is a line of principles through all of that which are
critical to ensuring that the person who is involved in a community service
system has the same protections—appropriate, but the same protections—against
harm, abuse and neglect at any age and stage, rather than segmenting people
with three different systems—or more, to be honest.[19]
8.16
UnitingCare West went on to propose that instead of having employment
screening that differs by industry, there should instead be a vulnerable
persons check that would cover anyone who works with vulnerable people from a
range of categories.[20]
8.17
Mr Lloyd Williams, National President of the Health Services Union
pointed out that working with vulnerable people checks should not be viewed as
an holistic solution, as they are exclusion schemes which require a person to
engage in violence, abuse or neglect before being 'excluded' as an appropriate
disability services worker.[21]
8.18
This view was echoed by United Voices for People with Disabilities:
I know the exclusion list was introduced and touted as one of
the big things here in Victoria by the previous government as an outcome. It is
an after‑the-fact solution or outcome. It means somebody has to have
actually suffered in the process generally, unless someone knows something
about that person. If they do not go through and it is not recorded or there is
some process that identifies that they are a threat, a risk or whatever, they
do not get on that register.[22]
8.19
The reportable incident scheme in New South Wales (NSW), discussed in
greater detail in chapter five, includes provisions for an expanded
pre-employment screening process that goes far beyond a simple criminal records
check, but also reviews any employment related incidents by workers. The scheme
has been suggested for replicating nationally for the disability workforce:
[T]he New South Wales system has criminal record checks but
also feeds into the screening system the results of our reportable conduct area
in the child related employment sphere. And we are talking about substantial
numbers of matters. That forms part of the consideration by the children's
guardian as to whether somebody should work in child related employment. I can
see no reason to not have a national system in place for the reporting of
serious incidents, and as a part of the screening system there should be a
combination of criminal record checks, information that one might receive from
professional associations.[23]
8.20
The Health Services Union went further to propose a 'step-up'
accreditation scheme, which could act more as a preventative measure, by
requiring base level qualifications and requirements for ongoing professional
development. Then if an incident occurred, the exclusion provision could be
utilised to withdraw someone's accreditation:
From the workforce point of view, we argue that there needs
to be a proper risk based accreditation scheme, which does not say that all
people have to be accredited at the same level. But the higher the risk of the
individual and the higher the vulnerability of an individual, the higher the
accreditation standard should be for the person who is going to be working with
that individual, including base level qualification and ongoing professional
development and understanding of human rights, understanding and being able to
identify the signs of abuse and how to deal with those and how to empower
someone's life.[24]
8.21
This is in line with other proposals made to the inquiry, to
professionalise the workforce through worker registration schemes with higher
levels of training required for working with different needs levels, as well as
ongoing professional development.[25]
8.22
Evidence presented by the Department of Social Services (DSS) at the
Canberra hearing indicated this was an option being considered by DSS in the
development of a national quality and safeguards framework for the National Disability
Insurance Scheme (NDIS).[26]
8.23
DSS also cited the Working with Children Checks Report[27]
released on 17 August 2015 by the Royal Commission into Institutional
Responses to Child Sexual Abuse. This report proposed minimum standards which
should be incorporated into all worker checks, as well as suggesting a deadline
on state and territory governments to implement the standards. The report
further recommends that the Australian Government should facilitate a national
model of working with children checks, improve the intersection of these checks
with CrimTrac and make international records more accessible.
8.24
DSS cited this approach as addressing the issue of 'how you would arrive
at an arrangement where there are common national standards, to a point where
you can get recognition across jurisdictions'.[28]
8.25
Some submitters called for an overhaul of the entire disability
workforce, to professionalise the sector. The Health Services Union told
the committee:
Our fourth recommendation is that the government must commit
to professionalising the disability sector by implementing a national risk
based registration and accreditation system which requires mandated minimum
qualifications and ongoing professional development for certain job roles.[29]
...
There is no requirement for disability workers to be
registered, unlike childcare workers and even unlike crowd-control people who
work in hotels and casinos. It beggars belief that to be a crowd controller you
must have a minimum qualification and you are registered, but to be a
disability support worker you do not need any of these things: just a simple
police check will suffice.[30]
8.26
A number of submitters presented evidence that while there may be a need
for additional regulation, a key problem was that existing regulation was not
being adequately enforced:
We also get a system that has so many rules and regulations
to ostensibly protect us and then it ignores those rules and regulations. We do
not need any more rules and regulations. We need to follow the ones that exist.[31]
...
It has been our experience that while improvements have
occurred, some service providers continue to ignore, discourage or treat
allegations of abuse and neglect without due weight.[32]
...
An individual advocate repeatedly requested that the service
provider send her documents outlining the authorisation for the use of this
restrictive practice, but these requests were constantly ignored. It was
eventually discovered that the service did not take the issue to the
restrictive practices panel, which makes the use of the buckle guard and
protective screen a criminal offence.[33]
Committee
view
8.27
The committee supports the view of many witnesses to this inquiry, that institutional
and congregate care models of service delivery are themselves major factors in
the prevalence of violence, abuse and neglect of people with disability. There
is a clear need for increased funding to address the lack of housing options
available to people with disability.
8.28
There are many factors that combine to create a regulatory vacuum in
which disability workers operate. This also extends to the quality of
disability service delivery at an organisational level.
8.29
Of serious concern to the committee is the lack of workforce regulation
that can not only identify and remove predatory or abusive workers, but is also
capable of driving an overall improvement in professional standards to address
issues of neglect.
Cultural attitudes
8.30
There were broader sector-wide issues raised by submitters as being
drivers of violence, abuse and neglect, which went beyond the regulation of
disability service delivery. Of particular note were cultural attitudes that
devalue people with disability and disability-specific violence—violence that
is purported to be an act of disability care.
8.31
Cultural attitudes of devaluing people with disability were cited by
many submitters and witnesses as being a major driver of violence, abuse and
neglect of people with disability.
8.32
Mrs Joan Broughan noted in her submission:
I find it indicative of society's values and attitudes when 3
Greyhound trainers are banned for life and a national inquiry into the sport
ensues for cruelty to animals and in the instance of cruelty to people with a
disability agencies continue to operate and workers implicated in the
non-reporting of abuse continue to work.[34]
8.33
The issue of devaluing people with disability was put forward by
submitters as being a cause of violence and abuse on multiple levels. When
individuals devalue people with disability, they are more likely to engage in
violence and neglect towards those people. Devaluing people with disability at
a cultural level, contributes to institutional barriers to the elimination of
violence, abuse or neglect:
At a core level, issues related to violence against people
with disability, particularly institutional and legal barriers to recognition
of this violence, are related to the cultural devaluation of disability and the
extent to which as a society we view people with disability as worthy of
inclusion in our communities and, at a very base level, worthy of recognition
as human beings and worthy of life.[35]
8.34
Some submitters questioned an approach to reducing violence, abuse and
neglect that focused on the 'vulnerability' of people with disability, without recognising
that vulnerability itself is not a cause of abuse:
But we are still talking about national vulnerable persons
cards and black lists and other ideas that would impact on the choice and
control of people with disability as though those ideas would be a silver
bullet that will solve rape, abuse, neglect and murder and as though our
vulnerability is the problem rather than a culture that fosters violence,
neglect and abuse.[36]
...
One of the most profound ways that people with disabilities
are left vulnerable has nothing to do with our disabilities. Our disabilities
do not inherently make us vulnerable. Attitudes towards us, and the value that
is placed upon us by society is what makes us vulnerable.[37]
...
[A]longside making recommendations directed towards reforming
specific laws and institutional practices, the Senate Committee should consider
making recommendations for contesting and shifting cultural ideas around disability
at a fundamental level.[38]
8.35
Ms Rayna Lamb, Coordinator of Women with Disabilities WA stated that the
culture in which people with disability are raised, often does not provide
people with disability with the skills to advocate on their own behalf, and in
some cases to even recognise the abuse or violence perpetrated against them:
A lot of us, particularly people with disabilities who were
born in our disabilities, were actually not brought up to stand up for
ourselves, so that is what it makes it harder in dealing with potentially
abusive or neglectful caregivers.[39]
8.36
A solution put forward by multiple submitters was that training to reduce
the prevalence of violence, abuse and neglect should not only be provided to
the potential perpetrators of such actions (carers) but should also improve the
skills of people with disability to identify and respond to incidents.
[R]esidents must be trained about what behaviour from paid
carers and other residents is okay and what is not, and about what action to
take if something is not okay.[40]
[T]he language used in reference to people with disability is
often itself inappropriate and as well as constituting abuse, it can reinforce
negative stereotypes and act as a barrier to a more inclusive and supportive
approach. Mindsets and preconceptions about people with disability and their
behaviour can also significantly affect the way in which people with disability
are treated. This has been a common problem in the disability services.[41]
8.37
Evidence to this inquiry has also discussed a tendency for people with
disability to be 'infantilised' by those who wish to protect them from harm. The
Hon Ms Kelly Vincent, a member of the South Australian Legislative Council
representing the Dignity for Disability Party, argued that this form of
overprotection can often have the opposite effect, in that people with
disability are 'protected' from acquiring appropriate skills and knowledge they
could use to protect themselves from harm, or to report harm when it occurs:
I remain very concerned, for example, about the lack of
accessible information about personal safety, including in sexual and romantic
relationships, for people with disabilities. Anecdotally, through my
professional work and based on my personal experience, it seems to me that
people with disabilities are often infantilised and therefore denied access to
information and experiences about things such as personal safety in
relationships and sex that many of our peers take for granted. I greatly
believe in the need for accessible supports and information about these topics
for this reason.[42]
8.38
Deakin University agreed, citing the Living Safer Sexual Lives:
Respectful Relationships program as an effective violence and abuse
prevention program that enables people with disability to recognise what their
rights and expectations should be with regard to sexual and physical violence
and abuse. This program has also helped people with disability who have experienced
abuse or violence to engage with mainstream services such as law enforcement to
assert these rights when they are infringed.[43]
8.39
Other submitters made similar arguments. Mr David Craig from VALID cited
the impact of infantilising people with disability can be 'protecting' people
from life-learning experiences that are otherwise taken for granted by the
non-disabled community:
Finally, it is important that governments endeavour to take
abuse and neglect of people with disabilities seriously but in this process not
create regulatory prisons for people who have disabilities and have the adverse
effect of limiting the kinds of freedoms and liberty that are taken for granted
by all citizens. The dignity of risk and living a life with normal ups and
downs has been a victim of obsessive commitment to risk-averse management of
disability supports. Prevention of abuse and neglect should not become a reason
for neglecting the human right to pursue an ordinary life as set out under the
United Nations Convention on the Rights of Persons with Disabilities.[44]
8.40
Another serious issue raised by multiple submitters is the culture of an
'expectation of violence.' The NSW Disability Network Forum (DNF) submitted
that in the disability sector there is an expectation of violence perpetrated by
people with disability, which then justified a response which would itself
be deemed as violent if done in a non-clinical setting:
DNF members have observed a culture of expected violence
existing in both institutions and residential homes, cloaked as "challenging
behaviors". It is common for people with disability in these settings to
be labeled as violent, and both witness and be the victim of violence.[45]
Committee
view
8.41
Cultural attitudes are hard to shift and will take a long-term concerted
effort from all stakeholders, with a lead role taken by government. What is
clearly a necessary and achievable first step is to drive a cultural change
within the disability service sector by ensuring rights-based training for all
disability workers.
8.42
However, the most important cultural shift should be driven by people
with disability themselves. This can be achieved through rights-based,
self-advocacy training that informs all people with disability about their
human rights, their legal rights and their value as members of the Australian
community no matter where they live. A mobilised and informed community of
people with disability, able to speak and act on their own behalf as much as
possible, is clearly a key part of providing comprehensive protection against
acts of violence, abuse and neglect.
Individual worker issues
8.43
Evidence presented to this inquiry shows there are a diverse range of
issues that can increase the chances of individual workers engaging in
neglectful or abusive work practices. Identified key causes include a lack of
training to develop necessary disability-specific skills and a lack of values
based training, combined with low wages that drive down skill levels on an
industry-wide basis. The issue of predatory workers was seen by submitters as a
significant problem. Proposed solutions, including systemic worker and
workplace regulation, are discussed later in this chapter in the section on
systemic issues.
Lack of training
8.44
Evidence was presented to the inquiry from a range of sources, which indicated
that a key cause of abuse and neglect was a lack of training provided to
carers. This ranged from vocational disability-carer training, to training
provided by facilities on the needs of specific individuals to be cared for at
that location. Ms Sharon Richards, Acting Chief Executive Officer of
Advocare, told the committee that training is a key component of reducing
incidents of abuse and neglect:
...if you have staff who are better trained and more stable,
they will recognise behaviours and deal with them before they actually get out
of hand.[46]
Entry-level training
8.45
The issue of what is an appropriate level of vocational training for
disability service workers was one where there was not a broad consensus view
among witnesses. Some argued the key need was to improve the level of disability-specific
skills provided in certificate-level training, while others argued that it was
more important to provide values-based training to ensure the rights of people
with disability are recognised.
8.46
Ms Rayna Lamb highlighted the difficulties she experienced in finding
staff who recognised her as the employer and would defer to her as the
decision-maker:
If someone has a certificate IV in disability, it just means
that they were able to parrot the right stuff to get that piece of paper. It
does not mean they have the right attitudes. You cannot teach respect. You can
learn respect, but you cannot sit in a classroom and run down a checklist. I do
not need someone with a cert IV. I need someone who will do what they are told,
who will understand that this is my house and this is my life and that they are
not there to patronise me; they are there to work for me, and I am their
employer.[47]
8.47
This view was echoed by the Keely family, who discussed the importance
of being able to hire the right 'fit' for a role that involved highly personal care
without being limited to the training certification level that a person held.[48]
8.48
The issue of values-based training was raised by other witnesses as an
important protective mechanism to identify and respond to incidents of abuse,
and to improve overall service delivery:
Quality support services require workers who have necessary
skills to recognise indicators of abuse, know how to appropriately respond to
suspected malpractice and are supported and encouraged to raise concerns
without fear of being persecuted or targeted by their employer.[49]
8.49
This view was echoed by the South Australian Principal Community Visitor,
who proposed 'protective behaviour training for staff and especially residents
who should also receive a statement of rights about what they should expect
from a residential service that complies with service standards.'[50]
8.50
United Voice WA, a union representing the disability sector workforce, raised
concerns that under the expected workforce expansion from the NDIS 'it is
essential that systemic workforce issues, particularly attraction and retention
issues, are adequately addressed to ensure that the provision of quality
support services remains sustainable into the future.' This issue of NDIS
impacts on workforce expansion is discussed in greater detail in chapter nine.[51]
Ongoing professional development
8.51
Many witnesses argued for the need for ongoing professional development
and training to ensure that after entering the disability workforce, individual
carers were required to maintain up-to-date skills and knowledge. United Voice
WA recommended that ongoing professional training should include education to
recognise and respond to indicators of violence, abuse and neglect 'acknowledging
that a stable and quality workforce of professionally trained, qualified and
dedicated workers is a vital safeguard for people with disability from abuse,
violence and neglect'.[52]
The issue of ongoing professional development is discussed in greater detail
later in this chapter, in conjunction with discussion of a possible
registration scheme for disability service workers.
Facility training
8.52
Witnesses' discussion of appropriate training was not limited to the
issue of individuals gaining the vocational skills and knowledge required to
enter the workforce. The issue of facility-specific training was also raised by
many witnesses and submitters as a key factor that can contribute to abuse and
neglect. Evidence presented to the inquiry highlighted the importance of
service providers acting proactively to understand the needs of the people they
provide services to, in order to better target the training provided to staff.
8.53
Ms Sue Ash described a research project her organisation conducted, that
showed 70 per cent of its clients self-identified as having mental health
issues, even though only 30 per cent of UnitingCare services were specific
to people with mental health conditions:
The implications for us were that we up-ended our staff
training. We now have compulsory mental health training for all of our staff
because it is about equipping people to be able to work with people safely. We
do occupational safety and health training as well, but that was coming out of
understanding the needs and the situation of our clients and then equipping our
staff to be able to work that way.[53]
8.54
The danger that this kind of high quality facility-provided training may
no longer being accessible for individual carers under the NDIS was raised by
United Voice WA:
They [service providers] are saying that, with the use of the
NDIS, the individualised funding model, they will move away from the
training that they currently provide. Some of our major providers actually
provide some good training—not cert III and cert IV level, which they do not
mandate, but some very good on-the-job training which is specific to the
clients they mostly care for. They provide things such as 'buddyships' and other
things which are part of their union collective agreements to ensure that there
is a greater level of training for staff, especially for new staff as they come
into the field. We have been told that will cease to exist. As soon as they can
possibly stop running it, they will stop running it.[54]
8.55
Other witnesses discussed the variable quality of facility-specific
training given to incoming carers, pointing to an over-reliance on individual
service provider organisations to ensure that each carer had adequate intake
training:
My own experience as a support worker has varied completely,
including not being able to work with clients until I have done training in
giving medication, behaviour management et cetera, and being buddied up until
that was done, and that was quite comprehensive...I have also been put into
situations where I have not been briefed on working with the clients and I have
had a five-minute changeover and been expected to work with people. So there
are massive variances.[55]
8.56
This experience of staff being 'thrown in the deep end' by facilities
was repeated by other witnesses:
I was asked by an employment agency to work a sleepover shift
for a community services organisation housing five men with intellectual
disability, mental health issues and severe behaviours of concern. I clearly
specified that I was not confident working with people with behaviours of
concern and was told, 'You will be okay. Just read their files and don't do
anything outside of their routine.'...As staff were leaving, they told me not to
leave my sleepover room until the morning staff member arrived because, if I
did so, I would be in danger of being raped or assaulted. I felt very
vulnerable and afraid, and I was very concerned for the welfare of the
residents that I would not be able to assist if a problem arose during the
night. I read the clients' files with the sleepover room door locked, feeling very
uneasy. All but one resident had severe behaviours of concern which had
resulted in the past in injuries against staff and fellow residents.[56]
...
In Tasmania I have worked in disability for 10 years now and
I have received a certain amount of training but I have to work with lots of
staff who are not trained at all. They get a tiny bit of training. We were even
sent into the houses where there was a staff member on who had probably just
done a buddy shift and then they were expected to train the other buddy that
had just come on and then look after clients, and I am talking about clients
with high needs and challenging behaviours.[57]
8.57
Other submitters emphasised the need for facility-level training to
include rights-based training, and not simply focus on disability service
delivery:
Once selected, it is important that staff be given training
in relation to the client's rights in relation to freedom from abuse, including
the right to respect, dignity, choice and control, and how to recognise and
report abuse. The effect of this training should be evaluated by consulting
with residents and their families (where appropriate) and observing staff
interaction with residents.[58]
Committee
view
8.58
It is clear from evidence presented to the inquiry that there is a diverse
range of factors that can impact on the quality of care provided by individual
disability service workers. Accordingly, while there is no single solution, it
is clear that improving vocational and workplace training—both of which should
include skills‑based and rights-based elements—would significantly reduce
the levels of violence, abuse and neglect of people with disability in institutional
and residential care settings.
Individual workplace issues
8.59
Evidence presented to the inquiry showed that issues specific to
individual workplaces and organisations had an enormous impact on whether
individual workers went on to commit acts of violence, abuse or neglect. These
workplace issues included chronic understaffing, a high use of casual staff,
lack of gender-appropriate practice, as well as inappropriate risk-management
and workplace culture leading to a suppression of reporting incidents or
potential abusers not being removed from workplaces:
At an organisational level, with individuals who work with
people who have disability, staff are crucial to reducing the incidence of
restrictive practice. High workloads, staff mental health and staff suffering
from burnout are associated with high rates and use of restrictive practice,
and the stigma about people with disability and the perception that
restraint is necessary due to diagnosis. Better supervision and management
support can lead to use of least restrictive practice, if not no restrictive
practice. Support for better self-care by staff is critical. Supervision of
staff is critical.[59]
Understaffed
8.60
The issue of staffing levels was raised by a number of submitters to the
inquiry, who presented evidence that staffing levels can lead to neglect
through lack of appropriate resources, or violence and abuse through worker
frustration and stress. Advocare told the inquiry that low staffing levels can
lead to neglect through a lack of time to provide appropriate monitoring. Ms
Sharon Richards said:
Or at night time, if you only have one staff member on in a
house or in a cottage, consequently, this woman was crawling around on a floor
for basically the whole night and banging and bruising into things because
nobody had actually gone to check on her. But, again, if you only have one
person, they may be busy with somebody else.[60]
8.61
Advocare also discussed the impact that inadequate staffing levels can
have on the level of frustration in staff, increasing the chances of abuse.
Advocare identified a case where a woman was alleged to have bruising caused by
being struck repeatedly on the head with a buzzer:
Again, without wanting to excuse the behaviour, if the person
is ringing the buzzer continually through the night, there is only you on and
there is nothing you can do for them or do not believe there is anything you
can do for them, there will be a frustration level put in there.[61]
8.62
Ms Julie Pianto, a parent advocate, provided extensive evidence to the
inquiry around staffing shortages in her son's residential care facility which
resulted in sub‑standard care which put his life at risk:
...I also think that it was unacceptable that I was told that
staffing shortages were unavoidable and that was one of the reasons why
Christopher was put at risk. I think, from my business life—when I was able to
work—that managing that situation is part of what your responsibilities are, to
make sure that people are not put at risk.[62]
Cost reduction
8.63
Witnesses pointed to the desire of commercial disability service
operators to run cost-effective services in order to maximise profits. This
often meant that individualised needs were neglected by the service provider,
unless they could streamline such services through co-location in order to
reduce unit costs.
8.64
Ms Lamb pointed out cost-saving measures taken by facilities that
resulted in impacts such as residents being forced to eat and sleep at
inappropriate times, and losing basic decision-making power:
Managers and staff of organisations, nursing homes and
institutions would never tolerate having to go to bed a six o'clock in the
evening. They would never tolerate being told what time they can get out of
bed. They would never tolerate not having control over what
they eat and when they eat. Yet we still have to live like this. This is
what leaves us vulnerable—the fact that our control has been taken away from
us.[63]
8.65
Evidence from service providers did not specifically address the issue
of whether seeking cost-reductions in service delivery created greater
potential for abuse or neglect. However, the committee received evidence from
service providers that they followed a 'client centred approach':
We support the rights of all clients to make informed
decisions and choices, without interference, about how they live their life.[64]
...
Endeavour Foundation has a detailed decision making policy
and procedure developed by the Community and Advocacy Support Unit to assist
staff members in services to understand and the importance of decision making in
a person centred approach to service delivery.[65]
...
[W]e work closely with our clients, and their families, to
understand individual needs, preferences and goals and deliver our services in
a way that allows individuals to achieve what they want to achieve.[66]
8.66
The committee notes that such an approach would place the needs of
clients at the centre of all decision-making. However, evidence submitted to
the inquiry showed that in many cases this approach is not being adhered to,
leading to instances of neglect.
Casual staff
8.67
Many submitters pointed to the reliance on casual staff to fill
permanent positions. This had multiple negative impacts, not least that many
casual staff were not given proper induction training for the individuals they
were caring for. In some cases, this had a devastating effect on the quality of
care provided:
Staff often have little choice about the situations they find
themselves in, when it comes to casual employment especially. This poses a
grave danger to the vulnerable people whom we work with and places staff at
risk also. At times, a service may have residents with high care needs and
staff with minimal or no training beyond basic induction. Induction is often
three to five days of very intense information, and staff report absorbing
little to no information from that session. I am aware of a young lady with a
severe intellectual disability who was attended to by two casual workers at a
high staff turnover facility. Instead of hoisting her, they carried her, one
holding her legs and the other at the shoulders. Due to her rigidity and her
condition, this resulted in both femurs being completely broken. This horrific
scenario, I believe, could have been avoided through better education and a
better staffing match.[67]
8.68
The issue of the use of casual staff was also raised by a parent of a Yooralla
resident, who claimed the use of casual staff was both dangerous and caused
emotional distress to residents:
On many occasions two barely trained agency/casual staff who
had never worked at the house before were on shift together with six adults
with extremely complex support needs, including one resident with the
complexities of being fed with a Percutaneous Endoscopic Gastrostomy (PEG)
feeding tube. The high levels of anxiety to residents of being constantly
confronted by complete strangers was evident. Given the constant strangers in
the house we families were additionally extremely concerned about abuse and
neglect.[68]
8.69
Box 8.1 highlights the tragic consequences that systemic staffing
problems and reliance on casual staff can have on people with disability with
specific needs, and the importance of ensuring that staff are familiar with the
needs of individual clients.
Box 8.1: Case study – Ms Stephanie June Fry
In August 2011, Ms Stephanie June Fry, a resident at an ACT government-run disability
group home, choked to death when casual staff failed to heed warnings about her specific
needs.
According to a Canberra Times investigation in November 2015, on the day of Ms Fry's
death, the group home supervisor was absent and three casual workers from labour-hire
firms were on duty. Ms Fry's file contained clear warnings that she required supervision
while eating, that if she 'gets the chance she will gorge until she chokes and dies' and was
not to be given bread. The new staff did not heed these warnings or complete a handover
checklist to ensure they read the file. Ms Fry was found choking in the bathroom on
sandwiches she had eaten while unsupervised. She was rushed to hospital but later died.
According to the Canberra Times, Ms Fry's family had previously warned the ACT
government about the home's high staff turnover, noting that it was 'causing
communication breakdowns and distress to Ms Fry'.
A spokesperson for the Community Service Directorate noted:
Ms Fry's death is not indicative of systemic failings but does represent a
grave error for which we apologise…We have made significant changes
to the way we ensure staff have the information they need to properly
support people with disability in group homes.
However, the Canberra Times suggested that Ms Fry's death was due to the same systemic
failings identified by the 2001 inquiry into the disability sector by former ACT Supreme
Court Justice John Gallop which included 'high staff turnover, inadequate worker induction
processes, and a reliance on unsupervised casual staff unfamiliar with residents' needs'.
Despite the inquiry and consequent reforms, a number of former disability support workers
suggested that the staffing problems highlighted by Ms Fry's death still exist.
Source: Christopher Knaus, 'Systemic failings saw disabled woman choke to death after staff miss
warnings', Canberra Times, 18 November 2015, http://www.canberratimes.com.au/actnews/systemic-failings-saw-disabled-woman-choke-to-death-after-staff-miss-warnings-20151007-
gk3bml.html (accessed 19 November 2015).
8.70
Evidence presented to the inquiry indicated that the casualisation of
the disability workforce, and the likelihood it will increase under the NDIS,
is a key contributor to abuse and neglect of people with disability. In
discussing the rollout of the NDIS, Dr Ken Baker, Chief Executive of National
Disability Services, told the inquiry:
There is also a risk, I think, that the casualisation of the
workforce will increase—and we know that there is an association between high
workforce turnover, in the context of workforce shortages, and the prevalence
of abuse and neglect.[69]
Gender-based abuse and neglect
8.71
A lack of workplace policies and practices to address the targeting of
women with disability by perpetrators, has been raised by submitters as
increasing the risk that these women will experience violence, abuse or neglect
in institutions or residential care settings:
Women and girls with disabilities living in institutional
settings are also more socially isolated than those living in the community,
and experience greater challenges in communicating and protecting themselves
owing to their impairments. Therefore, the opportunities for abusers to take
advantage of those to whom they provide assistance for daily care (such as
showering, toileting, dressing etc) and transportation are considerably raised.[70]
8.72
The issue of gender appropriate staff was raised by witnesses citing a
number of cases. Ms Samantha Connor discussed a case where a family request
that a 12 year old girl not be showered by male carers was dismissed by the
service provider as a breach of internal policy:
On one occasion Abbie's sister came to the house and
discovered a male support worker with his hand under the doona which Abbie was
sitting under. Abbie was wearing only a crop top and had no underwear on. Abbie
was not able to give evidence to the police and continued being showered and
dressed by male caregivers. After this incident, no staff were changed or stood
down. Her parents were told that it was DSC [Disability Services Commission] policy
that men can shower girls and the only thing they could do was go in as a
family and stand over her whilst a male support worker showered her. So, from
the age of 12 to 15, she was showered by men. The ratio was something like two
women to six men who were staffing the accommodation.[71]
8.73
The family later suspected the young girl of being sexually abused by
male carers, but she was unable to provide sufficient evidence to the police
due to her communication difficulties.[72]
8.74
Ms Marion Bright, a parent advocate, outlined a similar situation, where
the inappropriate use of male staff for young female residents for overnight
shifts increased the risk of sexual abuse through creating opportunities for
predators:
Regarding the system, [Department of Human Services (DHS)]
are culpable. So are Melbacc. They left her there alone overnight with a male agent.
When I watched the Yooralla scandal and exposé
in December, I was devastated. I thought, 'You bastards, DHS! You knew about
leaving vulnerable clients alone overnight with male carers, and you've done
that to my daughter. How dare you!'[73]
8.75
Evidence presented to this inquiry of gender-based issues also offered
examples of organisational exploitation of female residents.
We also know of women with disabilities who have no choice
but to live in congregate living situations where privacy consists of pin-up
boards to give privacy in bedrooms. Other women are being showered by male
support workers in male bathrooms because it is convenient for the support
worker to do the person at that particular time. Other supported residential
facilities have sex rosters. These rosters are designed to help manage the
behaviour of male residents. It is also a method women use to barter for things
such as money, cigarettes and even food, because most of the limited welfare
payments have been taken as rent and associated costs.[74]
...
JFA Purple Orange has been
told of emotionally abusive situations in some institutional settings arising
from lack of privacy. For example, some settings have no doors on bathrooms,
and some women have no choice about being showered in men's bathrooms as staff
do not have the time to wait until the women's bathroom is available.[75]
Workplace culture
8.76
The issue of workplace culture being a leading factor in creating
environments of potential abuse was discussed by a number of submitters. Ms
Carolyn Frohmader, Executive Director of Women with Disabilities Australia,
pointed out the disconnect between the purported culture presented by service
delivery organisations, and her experience of the service standards provided by
those organisations:
One of the difficulties I have had in reading some of the
submissions to this inquiry, is that the content of the submissions from some
service providers simply does not reconcile with what I see and what I know
happens in those services.[76]
8.77
The committee believes it is important to note that every service
provider organisation who submitted evidence to the inquiry discussed the
protective culture they have developed to reduce incidents of violence, abuse
and neglect, through training and support for their workforce and through self-advocacy
training and support for facility residents to recognise and report such
incidents:
We are invested in removing barriers to inclusion for all
people with disability. This includes barriers to speaking out and barriers to
justice.
Northcott[77]
Yooralla engaged additional expertise to help lead and
maintain a rights based service culture that would empower clients to be
self-directing, with the ability to advocate for themselves to the maximum
extent possible.
Yooralla[78]
We also recognise clients might need support to speak out
about issues. That is why we encourage the development of self-advocacy, access
to independent advocates and operate our client voice program.
Optia Inc.[79]
8.78
However, despite many organisations discussing the importance of 'self‑advocacy'
and 'self-empowerment' of people with disability, the committee is disappointed
to note that most of these organisations did not appear to proactively promote the
opportunity to make a submission to this inquiry to their staff or clients, nor
did they appear to offer support to their client base to make submissions.[80]
It is telling that organisations drafted submissions from the perspective of
facility managers, and no organisation invited to speak at an inquiry hearing brought
with them either lived experience witnesses to speak on their own behalf, or
any members of the residents' self-advocacy groups facilitated by service
delivery organisations.
8.79
Similar to the evidence provided by Ms Frohmader, Ms Silvana Gant,
President and Convenor of Adelaide People First told the committee that her
advocacy group experienced instances where statements on service standards made
by organisations did not match up with the services actually delivered:
Services are really good at using language to make it look
like they do what they do not actually do. Our group has heard language like 'person
centred thinking' or 'person centred planning' for most of the last three
decades—it was individualised service planning before it was person centred
planning. We do not see any evidence that particularly medium to large
disability service providers are actually doing that. The main reason for that
is that they are still continuing to provide congregated models of service
across all aspects of life. It is not just where people live; it is where they
work, what they do with their free time, and it is across the lifespan from
childhood through to the grave effectively.[81]
8.80
In assessing the disparity between statements of positive corporate
culture versus evidence of corporate practice on the ground, the committee
notes the statements made by Yooralla regarding the past incidents of sexual
assault and abuse suffered by Yooralla residents:
On behalf of Yooralla, I apologise sincerely for the
occasions of abuse that occurred within our organisation. We are very sorry and
deeply regret what occurred. We are sorry for the impact that these incidents
have had and are having on the lives of the victims, their families and the
members of the community.[82]
8.81
However, the committee notes the evidence of Ms Jules Anderson, the
Yooralla resident who was repeatedly sexually assaulted and abused by a
Yooralla care worker who has since been charged and found guilty of the
assaults. Ms Anderson told the inquiry she has repeatedly asked to be
moved from the room in which the assaults occurred, with no agreement from
Yooralla to do so. Ms Anderson has described her very deep distress at being
forced to remain living in the bedroom where she was repeatedly raped, and has
also discussed the post-investigation culture of Yooralla management:
I went to a finance meeting about rent going up and whatever.
The fact is they do not care about us. When I went there, there was the manager
of our house and a person further up. He did not even introduce himself to me,
and that was my first meeting with any of the new management. And they want us
to give them a second chance. It
is as little as that. I had to say, 'And you are? And you are?' and he
still would not say. In the end, he said, 'I'm ,'
but he had plenty of chances to say something, and I walked out of that meeting
in tears because I could not believe how little respect or response I got. And
yet I have heard so many different things about this. I went in there with an
open mind. Like I am today, I was feeling a bit like,
'Am I really here? Am I really going
to do this?' And that was the response I
got. Nothing. He knew my name before I knew
his.[83]
Reporting failures
8.82
A longer discussion of systemic improvements to reporting frameworks can
be found in chapter five. However, evidence presented to this inquiry showed
there is a widespread problem with organisation-level incident reporting, caused
by a lack of adequate training and reporting procedures, and in some cases by
organisations actively discouraging incident reporting. The workplace culture
whereby incidents are not appropriately reported and followed up, itself
creates a situation where even more abuse can occur:
It is significant that some organisations have operating
rules that require reporting to management instead of informing police of a
criminal or suspected criminal act or a matter of neglect or abuse. This allows
organisations to inhibit the actions of concerned staff in reporting matters to
the authorities and to hide mistreatment of illegal activity to protect the
organisation, quietly moving any dangerous workers who then abuse people in
other services.[84]
8.83
Multiple submitters presented evidence that when they reported incidents
to the service delivery organisation, they were discouraged from making reports
by being told they were the only ones who were complaining:
When I made complaints to the centre about anything I was
always made to feel and sometimes told that I was the only parent who had a
problem with the centre. During a meeting with management that included many
parents I discovered that this was not true and many of the things I had
complained about had been complained about by most if not all of the other
parents, caregivers and guardians.[85]
8.84
Other evidence highlighted a workplace culture focused on hiding, rather
than dealing with incidents of violence, abuse or neglect:
I have known of workers who have stood up in advocacy of
clients who have disabilities. They have been pretty much told, by their
management, 'We're just going to shove that underneath the rug. We're not going
to do anything about it.' When they stand up for a person with a disability,
they get victimised. It is inexcusable.[86]
8.85
This issue has also been highlighted in research conducted by the
Intellectual Disability Rights Service, which surveyed the experiences of
people with disability, their family members and friends, disability service
staff, independent disability advocated and others:
Key lessons that we learnt regarding disability workers were
(1) workers must have adequate expert support when they are working with
residents who have challenging behaviours; (2) workers need better training to
recognise and respond to indicators that a person with disability may be
experiencing abuse; (3) there must be protection for whistleblowers; and (4)
management must support front-line staff in finding solutions to abusive
situations.[87]
Abusers not removed
8.86
Many family members and advocates presented evidence to the inquiry of
situations where they alerted organisations of 'red-flag' behaviours of
individual workers. Where those warning signs were ignored, those staff members
went on to abuse or neglect the people they were caring for.
8.87
In many cases present to this inquiry, workers were simply moved to
another facility to care for other vulnerable residents:
Upon investigation, Client IJ had been frequently sworn at
using offensive language by one particular support worker as well as being
pushed and shoved and told she was useless and ought to be put out of her misery.
We devised a communication aid for the client who communicated these
complaints to us by blinking. As a result we lodged a complaint with management
but the only action taken was to transfer the worker to another Group Home.[88]
...
Staff accused of abuse were often left in their positions or
moved to another part of the service.[89]
8.88
Children with Disability Australia noted that in many cases,
organisations justified their lack of action to address systemic issues on the
basis they had solved the problem by moving the abuser from the location:
Frequently, organisations appeal to the notion that abuse has
only occurred due to the presence of malicious individuals within the
organisation. This is often referred to as the 'bad apples' argument. It is
suggested that because the offending individual has been removed or
disciplined, no further action is required. This deflects focus away from the
systemic factors that contribute to abuse occurring, including poor governance,
a lack of managerial accountability and a discriminatory organisational
culture.[90]
Risk management
8.89
A key issue discussed by multiple witnesses, is unintended negative
consequences resulting from organisations adopting an overly conservative
risk management approach to reducing the potential numbers of reportable incidents.
Evidence presented to the inquiry suggests that this approach can have the
inverse effect of increasing the chances of abuse or neglect, through the
denial of opportunity for positive experience. Professor Richard Bruggeman, a
disability expert who is also the South Australian Disability Senior
Practitioner, submitted that the bias of organisations is to prevent things
they can be sued for, and 'duty of care' is often regularly referenced as a
reason to prevent learning due to its inherent risks. Professor Bruggeman
further submitted that the current system of regulation and accreditation
exacerbates this approach, as it focuses on ensuring bad things do not happen,
but does not enforce good outcomes such as developmental opportunity and
personal sovereignty.[91]
8.90
The Villamanta Disability Rights service contended that risk management
undertaken by organisations does not acknowledge the very real fact that
abusive predators and neglectful staff are a fact of life and will continue to
occur, and organisations must be appropriately vigilant to that risk:
What does risk management do? It contemplates and
acknowledges the potential critical event, and that is one very clear issue
that we confront here: every single time an event of abuse or violence et cetera
is raised, there is the disbelief, the shock, the horror. We cannot operate
from a place where we do not expect it to happen...
In this instance, where we are talking about abuse
perpetuated by people, not natural disasters or mechanical failures, the presence
of a robust plan that is visible, consistent and known actually provides a
deterrent. If everybody is working together and everybody knows how the
situation will be handled there is actually a deterrent to that kind of
behaviour simply because you know what the protective mechanisms are.[92]
8.91
The Endeavour Foundation submitted that another cultural reason that
organisations respond inappropriately to abuse is the level of discomfort it
can create:
It must also be noted that for an organisation to speak of
abuse so openly is uncomfortable. It is uncomfortable for managers, staff,
volunteers and Board Directors to acknowledge that allegations of abuse occur
in the organisation of which they are a part.[93]
8.92
Professor Bruggeman outlined to the inquiry that the 'risk-management'
approaches by facilities to control the behaviour of residents actually
exacerbated behaviours and led to further instances of abuse:
At the top we have our seclusion, physical restraint,
chemical restraint and mechanical restraint—locking up, tying up or drugging
people—and at the bottom I have these things which I have called organisational
restraint, whereby individuals' wishes, goals and interests are not
fulfilled—and often not even sought—due to roster restrictions, work
allocations, risk aversion, management decisions, smooth running of households,
management staff's lack of training and development, and old-fashioned lack of
interest. My theory is: get rid of that stuff at the bottom and we will
reduce the stuff at the top. I have to say that, if I were in a group home and
I were bored senseless every day and I could not make any decisions and I did
not have any language to communicate and tell people how cruel, nasty and
bastard‑like they were being, I would be lashing out too, and then of
course I would get zapped with some drugs or sent into my room. The same thing
occurs with abuse. At the bottom we have that lack of interest, and of course
that flows through to those more obvious types of abuse that we are more aware
of.[94]
8.93
Ms Cheryl McDonnell echoed the view that a lack of opportunity was
itself a form of neglect, and made an eloquent submission to the inquiry which
detailed her advocacy with care providers to her daughter over the past five
years. In particular, Ms McDonnell wrote of the rights that people with
disability have, just like anyone else, to live fulfilling lives:
It is my belief that Terri has a right to continue learning
new skills, developing to her full potential. She is not a burden to be
carried, nor is she broken in need of fixing, nor is she to be pitied. She is
indeed a whole human being with a full and interesting life. She has a
developing skill set, an ability to continue learning, that with the right
support and assistance she can expand and grow her skills, abilities and her
understanding as she moves through the world and through life.[95]
8.94
Mr David Bowen, Chief Executive of the National Disability Insurance
Agency, suggested that this issue could be addressed by changing the
accreditation schemes for disability service providers to require measurable
positive outcomes for individuals:
...I also think there has been quite a significant failure of
the regulatory systems that exist. Part of it is because of the way
accreditation systems have been structured around service delivery...The nature
of those accreditation systems also is that they are predominantly—in fact,
overwhelmingly—focused upon process measures. To get accreditation, which
usually involves some follow-up audit, it is an audit of service providers' processes
with very little focus on the outcome for the individual and hardly ever any
inquiry of the person who is at the centre of this, the person for whom these
accreditation systems are set up. There is very little opportunity for them
ever to have any input or for their feedback to be taken into account in that
audit and accreditation processes.
My very strong suggestion for quality and safeguards is to
move away from those service provider accreditation systems to a risk based one
around the individuals.[96]
Board-level responsibility
8.95
The issue of vesting responsibility for the safety and well-being of
disability service recipients was raised in different hearings. At the first
hearing in Perth, Ms Connor quoted Mr Alan Blackwood from the Young People
in Nursing Homes Alliance, who cited occupational health and safety (OHS)
systems which place responsibility for workplace safety with boards and
management, with civil and criminal sanctions for breaches of OHS duty of up to
$600,000 in fines or five years' imprisonment for serious breaches as leading
to changes of behaviour of directors and companies:
It is telling that, like all company directors in Australia,
board directors and senior officers of disability organisations have legislated
liability for breaches of financial, corporate and OHS regulations, but face no
comparable liability or established sanctions for serious breaches in their
duty of care to clients. This is what we need to fix.[97]
8.96
This idea was also raised during subsequent hearings, and in other
submissions. Mr Milton Keynes proposed that it should be an offence for an
organisation 'to instruct staff to not notify authorities, or otherwise prevent
them from doing so, and a further offence to take to take action against staff
for making a notification'.[98]
8.97
Professor Bruggeman suggested such a scheme to enforce duty of care
could be expanded to include where positive outcomes were not achieved:
If you live in a group home and the staff are negligent and
you have your leg broken, you can sue them. If you live in a group home and the
staff are negligent in that they never give you skills and in 10 years time you
have no skills when you might have been doing your own cooking and your own
cleaning and your own ironing and perhaps living in your own flat, they do not
get sued for that.[99]
Concluding
committee view
8.98
The committee is very concerned that evidence presented to this inquiry
shows that too often approaches taken by organisations in response to instances
of abuse or neglect do not adequately address the incident. Some responses could
be considered a further abuse of the victim, while others can significantly
increase the chances of such incidents recurring.
8.99
It is hard to imagine that any other industry which intimately touches
the lives of so many Australians would be allowed to operate with such a dearth
of appropriate risk-management to protect and enhance the lives of vulnerable
people.
8.100
While individual organisations have the ultimate responsibility to select
and institute practices to eliminate harm, there is evidence to the committee that
suggests a need for systemic or legislative responses which provide sanctions
against organisations which do not appropriately live up to that
responsibility.
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