5 essentials: SIL Operational Guidelines

If tracking NDIS changes isn’t at the top of your never-ending to-do list, you may not have noticed that the Supported Independent Living (SIL) Operational Guideline has changed. SIL changes have continued to appear sporadically and without fanfare over the last two weeks (or dare we say six months?). If you have been missing travel throughout the pandemic, don't worry; the NDIA has you covered! The changes are spread over several documents and sections of the NDIS website, and you get to experience a sense of wonder and anticipation about what may lie just around the next corner.

If, as 2021 wraps up, your energy is depleted from emerging into the post-mid-pandemic world, we will take you through the five things you need to know about the changes in SIL:

1. SIL providers will no longer communicate with the NDIA about funding

Transitioning block-funded supports to a more commercial world was never going to be easy. Many of the tools created, including the SIL Roster of Care (ROC), were designed to ease that transition and provide a sense of security for SIL providers at a time of chaos. However, they also allowed NDIA planners to continue to see SIL as a quasi-block-funded, individualised service. It wasn't unusual for community participation or capacity building budgets to be significantly lacking for people in SIL, with the SIL provider expected to continue to provide those supports without the funding or flexibility to do so. In fact, planners would often actively include these supports in the SIL budget. And we wonder why it was so tricky for SIL providers to shift their services to the new, individualised world. 

In June, the Home and Living consultation paper An ordinary life at home formalised the tension that SIL providers had been sensing for some time. The NDIA highlighted and celebrated Individualised Living Options (ILOs) and referred to countless negative aspects of SIL and group homes and their inability to facilitate an ordinary life for people with disability. The misconception here is that SIL providers believe that they are working in an ideal system. In reality, they are working hard to support people in an imperfect system that restricts freedom of choice and control by its very nature. 

This consultation paper – and I use the word “consultation” loosely – marked the beginning of a series of unprecedented, uncommunicated funding cuts. Some providers have seen each of their SIL participants’ funding mysteriously drop to what looks suspiciously like the newly announced ILO price caps. CEOs are now spending their days navigating a pandemic and their nights explaining to boards or investors why they couldn't have prepared them for such significant budgetary overspends. They also need to explain to participants and families why the services they had agreed on are no longer possible. 

Cue the new SIL Operational Guideline. Only covering half of the changes that SIL providers are already experiencing, the Operational Guideline was very clear about one thing – the NDIA will not be discussing the ROC or SIL viability with providers:

The NDIA does not approve or endorse a participant's roster of care. We do not provide any feedback about an individual's roster of care. If there are concerns about a roster of care, providers should work with the participant, and their support coordinator, to ensure the roster of care supports the participant to pursue their goals.

2. The SIL ROC tool will calculate funding but doesn’t determine funding

Until now, the ROC, with all its limitations and complexities, has been used to make sure that the people in the same home were able to consolidate their funding to cover the costs of the support they needed.

The Supported Independent Living Provider Guidance says:

A roster of care does not determine the amount or type of support the participant will get in their plan. Any supports must be discussed and agreed with the participant and delivered within their approved budget.

So, the ROC will still need to be developed, but it won't go to the NDIA, except in two specific circumstances:

1. As part of the supporting information for a participant’s first plan with SIL. 

2. If the participant has experienced a change in circumstances, and this change in support needs can’t be delivered within the participant’s existing funding.

You may be thinking that providers will also be able to submit a ROC if a person had just entered their service, right? Wrong. Let's read from the NDIA Supported independent living provider guidance: SIL funding and budgets page on the website.

A participant’s SIL funding is not linked to a specific provider, existing service or a provider-determined support model. Once the participant has an approved plan, providers can discuss the exact supports to be delivered within the approved funding and manage support delivery.

So, a ROC will be submitted, by someone, at the beginning of the home and living journey, but it will have nothing to do with the provider or the supports that are needed to facilitate that shared environment. This is something that SIL providers can adapt to. It won't be easy. There will need to be significant shifts in operations, workforce obligations, awards, and participant expectations of SIL, but these things may become clearer over time. 

But these changes can create bigger problems. For example, what if the NDIA determines that Person A can function well under a 1:4 ratio, but Person A has just moved into an exciting new apartment with two bedrooms and an On-Site Overnight Assistance (OOA). Does the SIL provider in this circumstance need to find two more people to share the supports? Or do they support the two people in that home and receive funding for half the support cost? Perhaps we incorporate technology or equipment so that those people can be left alone for a while or ask their informal network to help? But what if Person A can’t be left alone, doesn't have an informal network or funding for equipment, and isn’t eligible for ILO? This will become an SIL provider’s overhead on an already non-viable budget. 

If this were only a funding question, then perhaps SIL providers could use their creativity to solve the problem. But it's not just a funding question – there’s a safety issue here, too. If providers are forced to cut corners to deliver a support, the person with a disability is put in a potentially dangerous position.

3. The new guidance is clearer about overnight support, but it doesn’t match what is actually happening on the ground

The Supported Independent Living Provider Guidance is much clearer on some of the elements of SIL funding. The most notable is the clarity around overnight support:

SIL is suitable for people who need some level of overnight support. If the participant needs up to two hours of awake support overnight, we will fund sleepover support. If the participant needs more than two hours of awake support overnight, we fund active overnight support. Active overnights are where the support worker is awake during normal sleeping hours to support the participant because of their disability.

While this isn’t a drastic change, it is stated much more clearly. However, in this case clarity may simply add insult to injury. The NDIA has just spent a large amount of energy removing active night funding from participant plans across the country and rejecting the evidence to support why it was there in the first place.

So, the four people who have been living together for the last 20 years with active night support just got funded for a sleepover… No warning given. If you have ever had the pleasure of putting together a ROC, you will know the overnight support will exponentially increase the overall SIL budget. On top of this, participants haven't been prepared for these changes. Apparently, supporting them to figure it out is the job of your humble Support Coordinator... but that's an entirely different article. 

So, the SIL manager must now:

1. Convert all active nights to sleepovers.

2. Discuss payments arrangements for all staff who have active nights in their expected income.

3. Explain to family members and the participant why they won't be supported to turn the person over every hour and ask them what they would like to do as an alternative.

4. Collate evidence to justify active night support.

5. Educate the participant and family on how to explain this support need to the NDIA.

The reality is that these supports cannot just be removed because the funding disappears. At the very least, a transitional stage will be needed. This will be a scenario where SIL providers will have to absorb a loss to mitigate risk.

4. Vacancy problems remain unsolved... 

The new Provider guidance and Operating Guideline say:

We do not consider vacancy costs when we make a SIL funding decision. Providers must not increase the price of supports or claim additional funds from other participant's plans to cover vacancy periods.

And:

A vacancy is where another participant stops sharing support permanently or for a long time. This means you don’t share your support with as many people. We don’t fund vacancies in your shared living support arrangement. We fund supported independent living based on your support needs, not based on the arrangements of the other people who share your support. A supported independent living provider shouldn’t increase the price of supported independent living or claim extra funds from your plan to cover vacancy periods.

Let’s say we have a home with five bedrooms and OOA. The NDIA says each person only needs 1:5 funding and a bit of 1:1, and the funding is put together to match that assessment. Two people move out. The people in the home don't want more people moving in; they enjoy having higher support levels, even though their funding isn't covering all the costs. Note that the NDIA also says: 

The NDIA is already looking to no longer financially support institutional or large group homes (where you live with five or more other people not of your choice). (NDIA Consultation paper: Ordinary life at home)

And:

All providers must deliver supports within the approved funding amount, as agreed to by the participant.

The SIL provider can’t alter the supports, increase the rates for support, or reconfigure the home to get appropriately funded supports, even though the Agency acknowledges that homes with 5 people or more living in them are not facilitating an ordinary life. SIL providers cannot request a plan review:

Under the NDIA Act, the NDIA cannot accept requests to review participant plans from providers. If a participant doesn’t agree with the decision we’ve made, they can ask for an internal review of our decision.

So, they absorb the loss and move on to the next problem.

5. There are more changes just around the corner

Finally, the changes included in the new SIL Operational Guideline and flow-on documents appear to explain only some of the actual changes that SIL providers are reporting right now. 

Consider the way that SIL funding is allocated to a plan. In the Provider Guidance document, the following information is still included:

When we decide a participant’s SIL funding, we will automatically create 2 service bookings for the participant’s current SIL provider.

However, SIL funding has been showing up in participants’ flexible core budgets for many months now, and the current provider portal doesn't allow providers to make service bookings easily. SIL funding being part of the flexible core budget would be more in line with the elusive Home and Living policy changes due “some time” in 2022.

However, the door for collaboration may have been left slightly ajar:

The NDIA acknowledges providers’ ongoing commitment to delivering high quality SIL supports. The NDIA continues to work with participants and providers to support improved outcomes for SIL participants.

While there is no one silver-bullet answer to successful home and living supports, it will take the whole sector coming together to navigate the complexities and challenges in a real way, and no... I don't mean another “consultation” round.