Belinda Seale, Architect, Access Consultant and Research Fellow, Deakin University
Valerie Watchorn, Senior Lecturer, Occupational Therapy, HOME Research Centre Member, Deakin University
Lisa Grech, Psychologist, Senior Research Fellow at Deakin University and Person with Disability Lived Experience
Over the last decade considerable progress has been made in the provision of housing choices for people with significant disability through Specialist Disability Accommodation (SDA) models under the National Disability Insurance Scheme (NDIS). Many Access Consultants will be familiar with the SDA Design Standard, and some are accredited as SDA Assessors. Yet, availability of SDA is limited to an estimated ~6% of NDIS participants who have severe or profound functional impairments or very high support needs, leaving most people with disability reliant on the broader housing market. For many who cannot afford independent living, there are limited accessible options beyond supported residential services, group homes, hostels or other congregate living arrangements. The shortage of genuine housing alternatives for those who don’t meet stringent SDA guidelines is an ongoing and highly concerning gap, which adversely impacts the health, wellbeing and human rights of many people with disability.
Supported accommodation services are governed by state-based legislation, with different terminology, scales, ownership and operating models around Australia. For ease, in this article we use ‘Supported Residential Services (SRS)’ to refer to all these housing options. SRS generally aim to provide low to moderate support for people who are unable to live independently. Residents may be long term or transitioning from institutional settings, such as rehabilitation, aged care, mental healthcare, prison, or emergency shelters, and many do not have supportive family or advocates.
Including both private and not-for-profit options, SRS are minimally regulated. They may vary in size, from small group homes to larger hostels, accommodating between approximately 5-80 people. This means that they may fall under different building classifications in the National Construction Code (NCC), resulting in different building code requirements. For instance, a small group home classified as a Class 1b will not have the same accessibility requirements as a Class 3 hostel. Unlike SDA, there are currently no design standards or guidelines for the provision of individualised housing to meet the specific needs of people who reside in SRS, including those with psychosocial disabilities, intellectual disabilities, cognitive impairment or chronic illness.
While being promoted as ‘supported accommodation’, there is compelling evidence from the 2021 Royal Commission into Victoria’s Mental Health System, peer reviewed research, the Office of the Public Advocate visitation reporting, coronial findings and advocacy around the country, that many private SRS services operate as understaffed institutional facilities with unsafe and unhygienic conditions, leading to abuse and neglect of residents, medication mismanagement, financial exploitation and little support for meaningful capacity building. The needs of residents with complex and significant disability are frequently unmet due to the built environment being inaccessible or designed without regard to their physical, sensory, cognitive or emotional needs, along with staff who are not appropriately trained. Additionally, in larger SRS facilities, residents can experience daily exposure to large numbers of people and in some cases, transient populations with challenging behaviour. The consequences of these issues are significant, particularly for long term residents who can be subjected to risk of injury, loss of autonomy, social isolation, and minimal privacy conditions.
The drive for profit by privately operated SRS providers targeting thin margins in a sector with low regulation, suggests these poor outcomes are foreseeable. There are few available housing alternatives for this cohort and increasingly limited safeguards in place to ensure residents’ rights, dignity and safety. This is not a new problem; issues with this housing type have been well documented over many years.
It is clear that this housing gap cannot be left to the market, and Federal and State Governments must take responsibility. Australia has obligations under the United Nations Convention on the Rights of Persons with Disabilities which it ratified in 2008, leading to our national disability and mental health reform agendas which support the autonomy of people with disability, through safe, individualised housing and participation in the community. Investment in truly supportive housing options for this group, stronger safeguards and transparent reporting of provider performance requires urgent attention. The importance of appropriate, accessible housing for all people with disability cannot be ignored; it is strongly linked to improved psychological wellbeing, greater community inclusion and overall enhanced quality of life.
Implications for Access Consultants
Access Consultants have highly relevant expertise and are uniquely placed to advocate for better housing options for this largely neglected group of people. So, if you are asked to review any type of SRS, consider asking a few extra questions:
- Who are the residents and what are their particular access requirements?
- Have the Principles of Universal Design been incorporated into the design of the physical environment? Refer to the principles developed in 1997 at NC State University by Ron Mace et al. at https://www.udinstitute.org/whatisud
- Does the environment provide meaningful choices for privacy, social connection and outdoor access?
- Has the option to age-in-place through provision of adaptability been considered? Refer to Australian Standard AS4299-1995 Adaptable Housing. While in need of an update, the principles of adaptability in this standard remain highly applicable.
- Have the occupational health and safety needs of care staff been considered in design?
In addition to advocacy and urgent government attention, further evidence is required to inform appropriate individualised design for housing and support systems suited to the needs of people who currently reside in SRS accommodation. Researchers at Deakin University have started investigating, so if you are interested, please get in touch!