Systemic vulnerability and risk
(* indicates references used in Accommodating Violence report)
Failures in legislative and regulatory frameworks and monitoring and compliance practices, a flawed model of accommodation, a void in policy guidelines and best practice, and limited access to alternative services and support have left persons with disability living in licensed boarding houses highly vulnerable and at foreseeable risk of abuse. In such environments the risk and incidence of domestic violence is exacerbated.
The information outlined below clearly demonstrates evidence of:
- a framework of systemic failures which leave people with disability in licensed boarding houses at a heightened level of risk;
- the systemic history of human rights abuse experienced by people with disability living in licensed boarding houses;
- barriers which limit the protection of people with disability living in licensed boarding houses who are significantly marginalised and highly vulnerable; and
- extensive knowledge of the vulnerability and marginalised situation faced by people with disability living in licensed boarding houses; and
- a range of stakeholders making claims that people with disability living in licensed boarding houses have a poor quality of life and one which is highly vulnerable to abuse and neglect.
Legislative Council Report 44 – November 2010: Standing Committee on Social Issues Services provided or funded by the Department of Ageing, Disability and Home Care
9.168 The Committee is concerned about the level of care provided to persons with a disability in both licensed and unlicensed boarding houses. It is evident to the Committee that boarding house residents are some of the most vulnerable and marginalized in society.” pg 193
Official Community Visitors Scheme Submission to Standing Committee on Social Issues Services provided or funded by the Department of Ageing, Disability and Home Care, 8 August 2010
“ Sadly, the near forty-year history of this Act is replete with proposals for change yet bereft of any meaningful reform. The Act has arguably failed the very people it was to have provided for given that there is no requirement for proprietors of licensed boarding houses to provide planning for or the delivery of individually targeted activities, community integration and proactive health care that
would deliver an improved quality of life.” pg 3
“Licensed under the YACS Act these services are privately owned and for profit services. Proprietors are not required to meet legislated Disability Service Standards. This results in a large number of people ( close to 1000) with a disability being marginalised receiving a lesser service than their peers which may not, in some cases, even meet UN statements of human rights”. pg 5
Homeless Persons Legal Service – Public Interest Advocacy Centre Submission to Standing Committee on Social Issues Services provided or funded by the Department of Ageing, Disability and Home Care, 17 August 2010
“Concerns have been raised time and again regarding the adequacy of ADHC's monitoring of LRCs. A report prepared by the NSW Ombudsman in 2006 found that routine monitoring of LRCS did not take place in most instances and that just under a third of all LRCs had not been the subject of a complete Full Service Review. The Ombudsman also found many other gaps in ADHC monitoring of LRCs. There is no evidence to date that ADHC has adequately addressed the concerns raised in this report”. pg 8
“HPLS is concerned that ADHC's drive to reform the licensed boarding house sector has waned. There is no evidence of a clear policy direction in relation to the future of the licensed boarding house industry, with the issue of boarding houses warranting only a passing mention in ADHC's policy document Stronger Together. Outdated and ineffective legislation remains in place, while ADHC appears to only partially fulfil its functions under this weak legislative regime. Meanwhile vulnerable residents of LRCs continue to live in a fundamentally flawed form of accommodation.” pg 9
NSW Ombudsman Submission to Standing Committee on Social Issues Services provided or funded by the Department of Ageing, Disability and Home Care, 17 August 2010
“There is currently significant variation in service delivery and standards relating to people with disabilities, depending on the model of accommodation they reside in. The existing requirements within the Youth and Community Services Act 1973 (YACS ACT) are well below those afforded to people with disabilities residing in other forms of care and have insufficient focus on the quality of service provision required to meet the health, safety and wellbeing of residents.
We consider that a review of the legislation is required to resolve the broader questions regarding the appropriateness of boarding house accommodation for some people with disabilities, to afford greater protection to residents of licensed and unlicensed boarding houses, and to uphold the rights of people with disabilities living in those facilities”. pg 2-3
Report of Proceedings before Standing Committee on Social Issues Inquiry into Services Provided or funded by Ageing, Disability and Home Care - At Sydney on Friday 3 September 2010, pg 51
“Ms Hewitt: … my organisation does a fair bit of work in boarding house reform, assisting where boarding houses are closing and assisting to find support for those people who often have lived in fairly desperate circumstances for many years and they are often those people with the milder disabilities who fell through the cracks early on and did not get much so as their life circumstances change they have ended up in congregate care—care is not the word for it but congregate living situations where they have had to trade favours for cigarettes and live in fairly sometimes filthy and disease ridden places. We have been working with some of those people to look at what they want, how they want to live.
Most of them, when you first ask them, have no idea. In fact they will often say, "I want to go to such and such a boarding house" because that is all they have ever known. But we have had some great success in actually supporting those people to live independently in the community with some drop in support, and that is sometimes on their own or it is with other people but they have lives that they never would have dreamt of. So asking people in the first instance, that takes a bit of work because it takes a bit of work both for the people and their families to understand what the options are. Often when you ask them at first, all they have ever known is the institution or the boarding house, and it does take some work to actually project to them that this might be possible.
The Hon. MARIE FICARRA: Even with the Government improving its regulation of such boarding houses, that even if this were to lead to those owners of boarding houses placing them on the open market because, for whatever reason, they no longer become profitable and therefore those boarding houses are out of the system, do you believe that it may be expensive for the Government at the time but in the long term it is a far better thing for your clients?
Ms HEWITT: To be out of the boarding house?
The Hon. MARIE FICARRA: Out of the boarding house.
Ms HEWITT: Absolutely. If I think of the genesis for some of those boarding houses, many of them were established by people with good intent, people who saw people on the streets or coming out of institutions or not having had any service who really required a place to live, and they have started off with good intent but having people living in those circumstances in a congregate environment will never work. It is never going to work. So absolutely people are better off out of it.”
Youth and Community Services Regulation 2010 Report on responses to Regulatory Impact Statement. Ageing, Disability and Home Care. July 2010
“3.2 The rationale for Government action - Appropriate regulation is essential, as many people with a disability are vulnerable to abuse and exploitation” pg 20
Key issues raised by residents and noted as matters for broader reform and guidelines:
“Residents’ comments suggest need for right to make own decisions about daily life, eg bedtime, clothing, meals” and “need for right to report complaints or abuse without retribution”. pg 36
Active Linking Initiative (ALI) Evaluation - Final Report. Robyn Edwards and Karen R. Fisher.Social Policy Research Centre, University of New South Wales, February 2010 *
“ALI providers emphasised they needed to have good relationships with the boarding house manager and staff in order for ALI to be effective. If ALI had a bad relationship, the boarding house could simply say that no residents wanted to participate in ALI. In this sense, ALI is reliant on the goodwill of the boarding house manager to permit residents to participate. As one ALI provider explained, ALI workers at one boarding house were not able to walk around the house and talk with residents independently. Rather, when the ALI worker arrived at the front door, the manager provided the worker with a list of residents who could go out for the day. Attempts by ALI to change this practice have not been successful. At other boarding houses, ALI workers have more opportunity to engage with clients at their place of residence.” pg 33
“Some LRCs have a culture and history, where managers feel they have ‘ownership’ over residents.” pg 34
“LRCs sometimes prevent residents from using the ALI”. pg 34
NSW Ombudsman Annual Report 2008-2009, Case study 32 pg. 65
The death of a resident in 2008 raised questions about living conditions at a licensed boarding house and the adequacy of monitoring by DADHC. Our review of the man’s death found that hospital staff had raised concerns about his hygiene and nutrition during an admission to hospital for pneumonia three months before. At that time, hospital staff noted that the man was at high risk of malnutrition and they had to use a peroxide solution to remove dirt from his skin and nails.
The man was found in his room by a staff member at the boarding house. He had been dead for at least 12 hours and had blood stains on his fingers, head and clothes. There was also evidence of blood stains on the walls and body tissue was found on two exposed nails on the back of the door to the room.
The police officers who attended the scene reported that the man’s bedclothes were covered with cobwebs and dust, and faeces and used toilet paper were strewn around the room. There were also several unopened sandwich packages in the room.
At the same time as our review of the man’s death, official community visitors complained to us about the failure of the licensed boarding house manager to address concerns they had identified. These included domestic duties not being attended to, smoking by residents indoors, the selling of cigarettes on the premises, broken windows, limited access to bathrooms and the dining room, and unsecured medication left on a shelf in the kitchen.
We met with DADHC to discuss these concerns. They told us about initiatives in place to improve the support provided to residents at the boarding house and to monitor compliance with the licence conditions. They also advised us that they were seeking legal advice in relation to the boarding house’s ongoing failure to comply with many of the conditions of their licence.
DADHC subsequently told us they received legal advice that they did not have the power to enforce the licence conditions that apply to the health, wellbeing and cleanliness of residents and the facility. They said they were considering their options — including prosecution and/or revocation of the licence — in relation to the licensee’s failure to comply with a fire safety order issued by the local council.
This year a decision was made to close the boarding house and DADHC are now in the process of finding alternative accommodation for the residents.
In PWD’s view this case study is clear evidence of human rights violations and the violence and abuse people with disability have experienced in licensed boarding houses. It exemplifies the ongoing individual and systemic abuse (failure to recognise, provide or attempt to provide adequate or appropriate services, including services that are appropriate to that person’s age, gender, culture, needs or preferences) and neglect of people with disability residing in licensed boarding houses.
As this man was discharged from hospital back to the licensed boarding house responsible for his initial presentation, there was foreseeable risk of further abuse and neglect, yet it is unclear whether any attempts were made to avoid this situation. This clearly diminished this man’s universal right to live in freedom from violence, abuse and exploitation let alone his right to services and supports which promote his quality of life (Article 10 - Right to Life: Article 16 - Freedom from exploitation, violence and abuse: Article 25 - Health: Article 26 – Habilitation and rehabilitation: Article 28 - Adequate standard of living and social protection – UN Convention on the Rights of Persons with Disabilities).
The case study highlights the inadequate provision of care and support for people with disability living in licensed boarding houses in NSW, especially in relation to the hospital discharge planning, case management and options for alternative accommodation and support services.
It is PWD’s view that current planning options for relocation of residents from licensed boarding houses are inadequate. The most common scenario that triggers relocation options for people with disability in boarding houses is when the operator gives notice of the intended closure of the boarding house. In some of these cases the planning and transition processes for people with disability to permanent alternative accommodation has been long and drawn out. Occasionally, it arises from a change in the person’s needs and recognition that these can no longer be met in the licensed boarding house. However, as is clear from the case study above this is not always guaranteed. Even more rarely is such a process triggered by individual choice. Under current guidelines, individual choice would not be sufficient to prioritise a person’s access to planning options for alternative accommodation and support.
The case study also demonstrates the inadequate regulations and monitoring mechanisms in place within the licensed sector to ensure quality of life outcomes for people with disability. The case study records a positive outcome in that a decision was made to close the boarding house, however what it fails to note is that this closure came about as a result of the death of the licensee and not as a result of a successful prosecution of criminal charges or proactive action taken by ADHC to revoke the licence for the operation of this premises.
Finally and perhaps the most frustrating issue highlighted by this case study is that the death of this man was preventable. Had there been higher standards of care, improved monitoring and the enforceability of licence conditions relevant to promoting the health, safety and wellbeing of people with disability and better planning and service co-ordination to ensure the relocation of residents at risk of abuse, in crisis or simply as a matter of choice, this man may have lived to experience a far better quality of life than the one he had prior to his death.
Official Community Visitor Annual Report 2006-2007, pg 11*
Major issues by subject, number and percentage raised by Official Community Visitors in relation to licensed boarding houses:
“Issue 2: Safety — 23 (16%)
Licensed boarding houses should ensure the safety of residents. Visitors identified 23 initial instances of the failure of licensed boarding houses to protect residents from abuse and assault, usually by other residents.”
Official Community Visitor Annual Report 2005-2006 *
Outcomes for residents – Services for people in licensed boarding houses
Failure of licensed boarding houses to protect residents from abuse and assault (28%).
Alt Beatty Consulting, Stakeholder Consultations for Review of the Youth and Community Services Act 1973 (Dec 2004). Report of a project commissioned by the Department of Ageing, Disability and Home Care. *
Section 3: Residents’ Interests
Many residents “expressed a lack of power, ability or advocates to achieve their expectations and rights. They wanted support to ensure that expectations were met and that their basic rights were upheld. However, most seemed to hold little expectation that such support would be forthcoming from Government or others, and saw their rights as theoretical rather than realised’. pg 15-16
“Most of the residents said that they shared a room, some with two or three other people… they had a number of concerns about who they shared with. They would prefer:
- to be offered choice about who they shared with;
- being able to lock their room for privacy, protection of their belonging and for personal safety.
They wanted to feel safe from some other residents and felt concerned about the presence of people with aggressive and sexual behaviours. A number spoke of actual or feared assaults. They also wanted their concerns about safety to be taken seriously and to know that in this area they will get “support and won’t be brushed off” pg 16.
“Privacy and freedom from disturbance was consistently mentioned, with some noting that they had nowhere private to meet friends. Many residents also spoke of managers and staff routinely opening their mail.
While most residents said they were free to come and go from centres as they wanted, there was discussion about restricted movement from one centre, particularly at night.
Some residents were concerned about other intrusions into their privacy and activities, including some managers wanting to know when they were coming back if they were going out, or who was on the telephone if they received calls.
A number of residents said they wanted more information about their rights and more support in achieving them.
The manager says we can leave anytime we want if we complain.” pg 17