Why an ‘objective’ test for PIP is impossible using government assumptions

 

 

PLEASE FOLLOW LINK TO ARTICLE COMPLETE WITH GRAPHS:

Disability Policies and Programs in Australia

 

Helen Meekosha and Leanne Dowse

School of Social Work
University of New South Wales
Sydney NSW 2052 

International Seminar on Social Welfare in Asia and The Pacific

Theme: International Comparative Study on Disability Policies and Programs in the 21st Century in Asia and the Pacific

Japan College of Social Work
Tokyo

November 13-16 2001 

Australia: states, state and territory capitals, and national capital. 

Table of Contents

Foreword

Section 1: Definition and Classification of People with Disabilities.

1.1 Descriptions of Legislations and Regulations for
People with Disabilities.
1.2 Description of Classification of Disabilities.
1.3 Description of Assessment of Physical, Intellectual and
Psychiatric Functions.

Section 2: Statistics of People with Disabilities.

2.1 Historical Development of Statistics, Names of Offices concerned and Purposes of Statistics.
2.2 Items included in Statistics
2.3 Ways and Times of Data Collection
2.4 Definitions of People with Disabilities at the time of Data Collection.

Section 3: Statistical Descriptions of People with Disabilities.

3.1 Population
3.2 Population by Types of Disabilities
3.3 Sex
3.4 Age
3.5 Education and employment
3.6 Types of Causes
3.7 Disability among Indigenous Australians

Section 4: Formal and Informal Systems for the Care of People
with Disabilities.

4.1 System of Registration
4.2 Descriptions of Formal Services
4.3 Description of Informal Services

Section 5: The Disability Movement in Australia
List of Tables

Table 1: Disability Groupings used in Australia

Table 2: Comparison of Australian Bureau of Statistics Disability
Surveys

Table 3: Major National Australian Disability-Specific Data
Collections

Table 4: Information Collected in CSDA Minimum Data Set

Table 5 : Areas of limitation, restriction or impairment identified by
the ABS

Table 6: Incidence of Disability in Australia

Table 7: People with a disability, by main disabling condition and as a number of the Australian Population.

Table 8: Summary of Disability By Age

Table 9: Incidence of Disability by Types of Causes

Table 10: Disability by Residential State or Territory

Table 12: Disability Service Provision under the CSDA

Table 13: Commonwealth-funded CSDA services, service by State
and Territory, 1998.

Table 14: State & Territory funded CSDA services, service types by
State and Territory. 1998

List of Abbreviations

AAT – Administrative Appeals Tribunal

ABS – Australian Bureau of Statistics

ADAT – Adult Disability Assessment Tool

AIHW – Australian Institute on Health and Welfare

CDS – Commonwealth Disability Strategy

CSDA – Commonwealth State Disability Agreement

CSDA MDS – Commonwealth State Disability Agreement, Minimum
Data Set

CSO – Customer Service Officer

DDA – Disability Discrimination Act

DDC – Disability Discrimination Commission

DSA – Disability Services Act

DSP – Disability Services Program

HACC – Home and Community Care

HREOC – Human Rights and Equal Opportunity Commission

ICIDH – International Classification of Impairments, Disabilities and Handicaps

ICIDH-2 – International Classification of Functioning, Disability and Health

JSCI – Job Seeker Classification Instrument

MASP – Medical Assessment Service Provider

SDAC – Survey of Disability, Ageing and Carers

SSAT – Social Security Appeals Tribunal

WHO – World Health Organisation
Foreword

While Australia is sometimes thought of internationally as having a very advanced system of disability services, it is important to distinguish between legislative and administrative structures and actual service delivery and benefit accessibility, between rhetoric and the lived experience of people with disabilities. Before the 1980s the Australian environment was confused, poorly co-ordinated, under-researched, with inadequate policy development or service planning. In the wake of the 1981 UN Year of Disabled People, public and political awareness of the inadequacies began to grow, and policy innovation marked the period from 1985 to the early 1990s.

In the last decade of the twentieth century the impact of neo-liberal philosophies of welfare began to undermine the structure of rights that had emerged in the previous decade. Government services began to be contracted out to non-government agencies, under a policy of privatisation ,while access was increasingly restricted, with tighter eligibility criteria. In 2000, the national government introduced a range of welfare reforms based on the rhetoric of “mutual obligation” – a structure of harsher penalties and workfare for the unemployed. The liberating potential of employment for people with disabilities became overshadowed by the compulsory search for work, and the punitive regime of regularly “proving” disability. The medical model of disability still informed access to income and other benefits in the social security system.

In Australia, as in many other countries, moral worth rather than personal need has often marked societal responses to disability. Thus disabled war veterans were always accorded higher status than the civilian disabled population, and were provided with higher quality of care and more extensive and less punitively policed benefits. Similarly rehabilitation services reflected the higher status of the war injured – and were focussed thereby upon the needs of the male disabled. The national government’s Commonwealth Rehabilitation Service (established after the Second World War) was expanded to include civilian disabled people – yet retained the original bias towards injured and disabled men.

Benefits and services reflect Australian cultural values and attitudes to employment, service to the country and gender. Women with disabilities overall are less likely to gain access to government rehabilitation or enter job retraining programs.

Examination of benefits and services currently available in Australia demonstrate a bewildering array, different state by state and region by region. Eligibility criteria are rarely transparent – but are almost always dependent of the opinion of medical practitioners. Thus the medical model is heavily institutionalised in identifying and responding to disability – and the medical and quasi-medical professions are the critical gatekeepers for access to services. In recent years occupational psychologists have begun to play a greater role in determining eligibility – particularly in regard to “motivation” for rehabilitation. This reflects a surge in concerns by government in the 1980s and 1990s at the growth of people receiving government benefits based on occupational injuries.

Given the political and social environment in which disabilities are identified and responses are developed, it is important to note that there cannot be a simple set of “objective” criteria, despite the desire by governments and some professions to argue for absolute standards and clear scientific assessments. Our research has suggested that political, social and economic environments play a large role in determining who can claim status as having a disability, and who is eligible for government assistance.

The Disability Support Pension offers an example of this process. The government strategy to reduce the numbers in receipt on this benefit has targeted older and unskilled workers, who may be in receipt of this benefit after their medical practitioner has deemed them unable to work. Yet the lack of employment possibilities may be dependent on many other factors, rather than their impairment per se. As the unemployment benefit is paid at a lower rate that the Disability Support Pension, it will ‘save’ the government resources if these people can be moved off the Disability Support Pension. Getting disabled people ‘back to work’, which is the current Australian Government’s avowed intention, has not taken account of the costs of disability in pursuing work, for example taxi fares, extra support and so on. Individuals continue to be measured as to their functional capability, or incapacity for work; the capacity of social system to support disabled people in the work place is largely ignored. Thus the medical model prevails in the disability policy field, despite anti-discrimination legislation attempting to introduce the social model of disability

This Report offers a selective overview of the situation in Australia, and does not claim to be exhaustive. However it is our intention to ensure that our readership can grasp the range of issues, and also understand the complexities raised by some of Australia’s unique characteristics – its Federal system of government with continuous negotiations over layers of responsibility; the vast distances to be covered between the main cities; the cultural diversity of the population (over 180 ethnic groups and languages), and the special position of Indigenous Australians, both in urban centres and in rural and remote areas.

It was extremely difficult to secure much of the information covered in this Report. For instance, some government agencies believe that their assessment for eligibility criteria should be secret, so that disabled people would not use the information to ‘cheat the system’ and claim benefits to which they were not entitled. It was also clear that there were significant areas where governments simply did not have the critical information required; while in other cases information was poorly organised, or reluctantly released after sustained approaches.

One of the most significant dimensions of disability services and rights are reflected in the Workers Compensation legislation and payments system. These vary greatly from state to state, are highly contentious, and are constantly undergoing review and reconstruction, to reduce costs to the employment sector. However it is clear that the trend is this area is to curtail eligibility and reintroduce an adversarial approach to replace a no-fault system. More and more workers injured need to seek compensation through the common law (that is, through legal suit against their employers), when the workers compensation system fails them. However, due to the complexity of the Workers’ Compensation system we have not included it within the report.

Benefits and services have developed over many decades, and there are many incongruencies. For example blind people are not subject to any income test in order to receive the Disability Support Pension, though there is an assets test. For other groups both the income and assets tests apply. In order to receive the mobility allowance, an individual has to be either in paid or volunteer work for 30 hours a week. Thus different levels of benefit and services do not reflect need, but rather point up the lack of a systemic and planned public disability policy. Cultural preferences which “rank” disabilities reflect wider social mores. These are further compounded by stereotypes of the deserving and undeserving disabled person.

In recent years government has attempted to develop a “rational” model of disabilities, assigning disabled people to one or the other usually mutually exclusive category. These standard categories distinguish physical from psychiatric, developmental from sensory, and so on – reflecting the power accorded medicalised world-views. In reality of course these boundaries are not meaningful, and the pressure to simplify complex realities can produce bizarre and counter-productive outcomes. Once individuals are assigned to a ‘master’ category, their needs can only be identified by the particular constraints assumed to apply therein.
Some disabling conditions have been “quarantined” from disability legislation altogether (for instance, multiple sclerosis in New South Wales is not a disability under state policy – it is a health not a disability issue; in other states it remains a disability issue).

Much of this process is designed to meet governmental fiscal goals, rather than welfare or health goals. It is assumed that better management can produce cheaper outcomes, though in consequence it may introduce inflexibility, with greater surveillance and regimentation.

 

SECTION 1
DEFINITION AND CLASSIFICATION OF PEOPLE WITH DISABILITIES

1.1 Description of Legislation and Regulations for
People with Disabilities including related legislation.

Australia is a federation comprising 6 states and 2 territories. Legislation relating to disability has been enacted at both Commonwealth, and State/Territory levels.

Commonwealth Legislation
The two important pieces of Commonwealth legislation most relevant to disability are:
· The Disability Services Act 1986 (Cth)
· The Disability Discrimination Act 1992 (Cth)
These Acts define the services to be provided, and the rights ascribed to people with disabilities.

The Disability Services Act (DSA) 1986 (Cth)
The DSA 1986 is the primary legislation relating to service provision for people with disabilities at the Commonwealth level. It is based on the recommendations of the Handicapped Programs Review that the Commonwealth government initiated in 1983, and which challenged the existing philosophical approach to people with disability and provided an agenda for reform. The new policy intended to “de-institutionalise segregated services, increase the range of service options and include people with a disability into wider community life” (Baume & Kay 1995).

The Act and its regulations are administered by the Office of Disability in the Commonwealth Department of Family and Community Services. The Commonwealth required the States to develop complementary legislation to facilitate identification of government responsibilities and ensure common service levels across the country.

Target Population
The DSA defined its target population as
“persons with a disability that:

(a) is attributable to an intellectual, psychiatric, sensory or physical impairment or a combination of such impairments;

(b) is permanent or likely to be permanent; and

(c) results in:

(i) a substantially reduced capacity of the person for communication, learning or mobility; and
(ii) the need for ongoing support services”
(Disability Services Act, Section 8.)

Objects of the Act
The objects of the Disability Services Act (1986) are:

(a) to replace provisions of the Handicapped Persons Assistance Act 1974 , and of Part VIII of the Social Security Act 1947 , with provisions that are more flexible and more responsive to the needs and aspirations of persons with disabilities;

(b) to assist persons with disabilities to receive services necessary to enable them to work towards full participation as members of the community;

(c) to promote services provided to persons with disabilities that:

(i) assist persons with disabilities to integrate in the community, and complement services available generally to persons in the community;
(ii) assist persons with disabilities to achieve positive outcomes, such as increased independence, employment opportunities and integration in the community; and
(iii) are provided in ways that promote in the community a positive image of persons with disabilities and enhance their self-esteem;

(d) to ensure that the outcomes achieved by persons with disabilities by the provision of services for them are taken into account in the granting of financial assistance for the provision of such services;

(e) to encourage innovation in the provision of services for persons with disabilities; and

(f) to assist in achieving positive outcomes, such as increased independence, employment opportunities and integration in the community, for persons with disabilities who are of working age by the provision of comprehensive rehabilitation services.

The Disability Services Program (DSP) was established in 1987 to implement Part II of the DSA: Funding of services for persons with disabilities. In 1991 the scope of the DSP was altered by the Commonwealth/State Disability Agreement (CSDA), which rationalised the roles and responsibilities for disability services and sets out arrangements for the provision of disability support services between the Commonwealth and States. Under the CSDA, the Federal Government is solely responsible for administering funding for employment and related services, while the State Governments are solely responsible for administering funding for accommodation, respite, recreation and other support services. Both the Commonwealth and State governments share responsibility for funding advocacy and research and development activities.

Disability Discrimination Act 1992 (Cth)
The Disability Discrimination Act (DDA) is the primary legislation relating to social justice for people with disabilities in Australia. It aims to protect the interests of disabled people who experience discrimination in a range of public and private services. While State-based anti-discrimination legislation is also in place, the DDA is stronger since its definition of disability is broad and it applies to a wide range of private and public sector operations. Specifically it covers discrimination in the areas of education, employment, access to premises, provision of goods, services and facilities, accommodation, buying land, activities of clubs/associations and the administration of Commonwealth government laws and programs. People with a personal connection to a person with a disability are also covered if they are discriminated against on the basis of that connection.

Target Population
The DDA states disability , in relation to a person, means:

(a) total or partial loss of the person’s bodily or mental functions; or
(b) total or partial loss of a part of the body; or
(c) the presence in the body of organisms causing disease or illness; or
(d) the presence in the body of organisms capable of causing disease or illness; or
(e) the malfunction, malformation or disfigurement of a part of the person’s body; or
(f) a disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction; or
(g) a disorder, illness or disease that affects a person’s thought processes, perception of reality, emotions or judgment or that results in disturbed behaviour;

and includes a disability that:
(h) presently exists; or
(i) previously existed but no longer exists; or
(j) may exist in the future; or
(k) is imputed to a person.

Objects of the Act
The objects of the DDA, section 3

(a) to eliminate, as far as possible, discrimination against persons on the ground of disability in the areas of:
(i) work, accommodation, education, access to
premises, clubs and sport;
(ii) the provision of goods, facilities, services and land;
(iii) existing laws; and
(iv) the administration of Commonwealth laws and
programs; and

(b) to ensure, as far as practicable, that persons with disabilities have the same rights to equality before the law as the rest of the community; and

(c) to promote recognition and acceptance within the community of the principle that persons with disabilities have the same fundamental rights as the rest of the community.

The Act defines Disability discrimination as
(1) a person ( discriminator ) discriminates against another person (aggrieved person ) on the ground of a disability of the aggrieved person if, because of the aggrieved person’s disability, the discriminator treats or proposes to treat the aggrieved person less favourably than, in circumstances that are the same or are not materially different, the discriminator treats or would treat a person without the disability.
(2) For the purposes of subsection (1), circumstances in which a person treats or would treat another person with a disability are not materially different because of the fact that different accommodation or services may be required by the person with a disability.

The Human Rights and Equal Opportunity Commission (HREOC), established under the Human Rights and Equal Opportunity Commission Act (1986) through its subsidiary Disability Discrimination Commission (DDC) is responsible for administering the Act. Services provided to people with disabilities fall into four main areas; complaints handling, public enquiries, community education and training and international relations. Complaints can be made to the Commission by:

· the person who claims he or she has been discriminated against
· a person affected by discrimination – on his or her own behalf and on behalf of others affected in the same way
· a person acting on behalf of another person or other people who claim they have been discriminated against (for example an advocate)
· an organisation acting on behalf of a person or other people who claim they have been discriminated against (for example a trade union).

Applications for review of decisions made by the Commission may be made to the Administrative Appeals Tribunal (AAT).

Complaints Handling
Formal complaints must be lodged in writing or electronic formats to the HREOC. Recent legislative changes have substantially weakened the powers of the Disability Discrimination Commissioner to resolve complaints. The Human Rights Legislation Amendment Act No.1 1999 (Cth) was passed on 23 September 1999 and the relevant provisions commenced on 13 April 2000. The Amendment Act requires the HREOC President, not specialist Commissioners, to handle complaints. The President determines whether HREOC has jurisdiction in investigate the complaint and whether there is another agency better qualified to deal with the case. If the President considers the matter appropriate, then the parties will be called to conciliation. If conciliation is effective, the complainant may receive an ex gratia payment, an apology, a job reinstatement, an explanation or a combination of these (Human Rights and Equal Opportunity Commission 2001).

Among other changes the legislation also removes the power of the Human Rights and Equal Opportunity Commission to conduct public hearings into matters which have not been conciliated. If conciliation is ineffective or HREOC rejects the complaint, the complainant must lodge an application with the Federal Court and must enter into the adversarial legal system to pursue an outcome, and may therefore be subject to problematic access and equity disadvantages embodied within the formal legal process. From this point the HREOC or Commissioner’s powers are subject to the discretion of the court and the residing judges interpretation of the relevant provisions of the DDA. (Roberts and Redman 2000).

The Human Rights Legislation Amendment Bill (no.2) 1999 (Cth), at the time of writing, is being reviewed by the Senate. If passed, HREOC’s name will be changed to the Human Rights and Responsibilities Commission and the specialist Commissioners (including the Disability Discrimination Commissioner), will be replaced by Deputy Presidents whose responsibilities will not involve the receiving and conciliating of complaints. This will further weaken HREOC’s function as Australia’s ‘national independent watchdog’ for abuses of human rights and infringements of anti-discrimination legislation.

Disability Standards
The DDA also provides for Disability Standards to be formulated
for two major purposes: to set legislative deadlines for achieving equal access for people with disabilities in the areas covered by the DDA; and to provide more definite and certain benchmarks for accessibility and equality than is provided by the general anti-discrimination model. Standards can be made in the areas of employment, education, public transport services, access to premises, accommodation and the administration of Commonwealth laws and programs. Progress on developing Disability Standards has been slow. Nine years after the enactment of the DDA there are no standards yet in place. There are several reasons for this lack of progress, including low levels of resourcing, the extensive consultation required with a wide variety of stakeholders required and issues of legislative complexity. The first DDA Standard relating to Accessible Public Transport is expected to be tabled in Parliament in 2002 pending amendments to legislation enabling the Commissioner to grant exemptions to the standards. Consultations and preliminary work is being undertaken in relation to Standards for Access to Premises and Education.

Disability Action Plans
The DDA also stimulates service providers to develop and implement an action plan outlining ways for the organisation to plan the elimination, as far as possible, of disability discrimination from the provision of its goods, services and facilities as a voluntary, proactive approach to DDA compliance. There has been limited progress in organisations developing action plans with a total of around 220 plans currently lodged with the Commission (HREOC Action Plans Register). The Commonwealth Government Disability Strategy (CDS), designed to support the implementation of the DDA, required all Commonwealth Departments and Agencies to prepare a Disability Action Plan and to lodge the plan with HREOC by the end of 1997. In a recent review of the CDS it was noted that this requirement ‘has not fully achieved the outcomes that were intended when this policy was introduced’. The report recommends the removal of the compulsory requirement in favour of an annual performance indicator and outcome mechanism (Dept of Family and Community Services 1999).
Other Commonwealth Legislation Relevant to Disability
There are numerous references in other Commonwealth legislation to issues relating to disability discrimination and service provision. The scope and purpose of these references vary widely. Examples of other pieces of Commonwealth legislation include:

· Home and Community Care Act 1985 (Cth) – provides for the Commonwealth and the States to jointly establish a Home and Community Care Program. The HACC program promotes the provision of a comprehensive and integrated range of home and community care designed to provide basic maintenance and support services, both directly and through their carers, to persons within the target population, and thereby to assist them to enhance their independence in the community and avoid their premature or inappropriate admission to long term residential care. The target group for services are people living in the community who need basic maintenance and support services to prevent the risk of premature or inappropriate long term residential care. This includes older and frail people with disabilities, younger people with disabilities and their carers.

· Social Security Act 1991(Cth) – Under this legislation the Commonwealth government provides income support for people with disabilities. It funds payments for people with a disability, those caring for people with a disability and those temporarily incapacitated from work as a result of illness. These payments include the Disability Support Pension, the Carer Payment, the Carer Allowance, and the Sickness and Mobility Allowances. Income support is currently under review as part of the welfare reform agenda of the Federal government. Changes proposed in the report “Participation Support for a More Equitable Society” (McClure 2000) link income support to obligatory economic and/or social participation. Disability groups have raised a wide range of concerns with this direction including criticism that the reforms are piecemeal and do not address systemic issues of discrimination and the costs of participation for disabled people.

· Human Rights and Equal Opportunity Commission Act 1986 (Cth). An Act to establish the Human Rights and Equal Opportunity Commission (HREOC), to make provision in relation to human rights and in relation to equal opportunity in employment, and for related purposes. The Commission has a Disability Discrimination Commissioner who oversees the Disability Discrimination Act 1992. Proposed amendments to this Act which include the abolition of the Commissioner and a weakening of the powers of the Commission have been criticised by disability groups.

· Telecommunications Act 1997 (Cth) – requires that the functional requirements of people with disabilities be included in universal service provision.

State and Territory Legislation
The States and Territories of Australia do not have uniform legislation. All states and territories however are required to have a Disability Services Act (DSA) as an outcome of the Commonwealth DSA. In addition, all States and Territories have Anti-Discrimination or Equal Opportunity legislation. The legislation varies from state in terms of provisions and compliance. For example, the DSA (New South Wales) provides for transition planning for non-conforming services and an administrative appeals system against funding approvals.

 

1.2 Description of Classification of Disabilities

Many different definitions of disability are used in Australia, both in administrative data collections and in legislation. The consistent identification of disability in national data collections has been recommended in a number of reports, so as to enable, the monitoring of access to generic services by people with a disability; the collection of more consistent data on disability support and related services, including data on service use by different groups; and population data and service data to be related, thereby improving the nation’s analytical capacity in relation to the need for and supply of services. (AIHW website http://www.aihw.gov.au – last accessed 27/11/01).

The two major bodies responsible for the collection of information on people with disabilities and disability services, The Australian Bureau of Statistics (ABS) and the Australian Institute on Health and Welfare (AIHW), use the World Health Organisation’s (WHO) system of classification (formerly the International Classification of Impairments, Disabilities and Handicaps – ICIDH). In their most recent surveys these agencies have adopted the draft International Classification of Functioning, Disability and Health (now known as ICIDH-2 ICIDH website http://www.who.int/icidh/intro.htm)

Disability Groupings
In Australia, disabilities are often discussed in terms of ‘disability groups’. A ‘disability group’ is generally a broad medical categorisation of disabilities in terms of the underlying impairment, disabling condition or cause. Disability administrators, ‘peak’ bodies, people with disabilities and service providers may use these groupings as a basis for the description of groups of people with similar experiences of disability and patterns of impairments, activity limitations, participation restrictions and related environmental factors. These disability groups are generally recognised in the disability field and in legislative and administrative contexts in Australia (AIHW 1999).

Table 1: Disability Groupings used in Australia
(Source: AIHW, Disability Data Briefing, No. 16. December 1999)

01 Developmental delay (apply to 0-5 year olds only, where
no other category is appropriate)
02 Intellectual (including Down syndrome)
03 Specific learning (including Attention Deficit Disorder
04 Autism (including Asperger’s syndrome)
05 Physical
06 Acquired brain injury
07 Deafblind (dual sensory)
08 Vision (sensory)
09 Hearing (sensory)
10 Speech (sensory)
11 Psychiatric
12 Neurological (including Epilepsy and Alzheimer’s Disease)

1.3 Description of Assessment of Physical, Intellectual and Psychiatric Functions including information on those who make the assessment.

There is no single assessment, registration or qualification system for people with disabilities in Australia. Centrelink is a statutory authority delivering a range of Commonwealth services within the domains of Income Support and Employment Assistance to people with disabilities on behalf of the Commonwealth Department of Family and Community Services and as such applies a range of assessment procedures. State governments apply assessments for eligibility for a range of Community services including Home Care, Attendant Care and Taxi Subsidy Schemes. Specific details regarding assessment procedures are in most cases unavailable. While the assessment tools are the property of the Commonwealth or State government, they are administered by statutory authorities or by commercial providers designated by those authorities, and as such are often protected under commercial in confidence agreements. These tools are therefore not available for public discussion or use in appeals processes.

Income Support
There is a range of assessment tools used to determine eligibility for assistance. Information below is sourced online at www.centrelink.gov.au

· Newstart Allowance (Incapacitated) and Youth Allowance (Incapacitated) – paid to temporarily incapacitated people who do not qualify for Sickness Allowance because they are under the statutory age limit for Sickness Allowance or because they do not have a job or study to return to. A medical certificate from a doctor is necessary. If they are temporarily incapacitated for work and unemployed, individuals aged under 21 years can claim Youth Allowance, those over 21 years can claim Newstart Allowance. People who qualify for the incapacitated rate of Newstart or Youth Allowance, can be offered rehabilitation, vocational training programs and other assistance to help them return to work or study.

· Sickness Allowance – for those who have a disability, illness or injury that temporarily prevents them from working or studying. A person claiming Sickness Allowance may be required to attend a medical examination and verify that they still have a job or study to return to.

· Mobility Allowance – paid to people with disabilities who cannot use public transport without extra help because of their disability; and need to travel to and from their home as part of their work, training or job seeking activities. Individuals need to be doing one of the following:
*at least eight hours a week of voluntary work for a charitable, welfare or community organisation on a continuing basis, or
* paid work, training or a combination of paid work and training; or
*have an agreement to look for work through a Disability Employment Service or Job Network; or
*are getting Newstart Allowance, Youth Allowance or Austudy payment.

· Parenting Payment and Partner Allowance – for people whose partner is getting, or claiming, a disability payment.

· Carer Payment – Eligibility for care related payments is determined through the Adult Disability Assessment Tool (ADAT). The ADAT aims to measure functional ability and to assign a similar score or rating to people with similar levels of caring needs. The assessment comprises a carer questionnaire and a health professional questionnaire. It includes questions that assess functional ability across a range of physical, cognitive and behavioural areas.  A basic scoring formula for these questionnaires produces a numerical score which rises in line with the person’s level of functional disability. 

· Carer Allowance – A person may get Carer Allowance if they look after an adult or child who needs a lot of additional care in their home because of their disability. Medical eligibility is determined by the Adult Disability Assessment Tool and Child Disability Assessment Tool.

· Disability Support Pension – To be eligible for the Disability Support Pension a person must be:
permanently blind or:
* have a permanent impairment of at least 20 points under the impairment tables; and

* be unable to work, or be re-skilled for work, for the next 2 years.

The Impairment Tables assign ratings in proportion to the severity of the impact of a condition(s) on normal function as they relate to work performance. An impairment rating of 20 points is considered to be the level at which a person’s impairment(s) has a significant impact on his/her ability to work.

To be considered unable to work for the next two years, a person’s impairment alone must prevent them from working for at least 30 hours a week at award wages in any work that is available in Australia that they are capable of performing without the need for retraining. The Work Ability Tables assist in making this decision (see discussion under Employment Services).

To be considered unable to be re-skilled for work in the next two years, a person’s impairment alone must prevent them from undertaking training that would give them the skills to perform work. The Work Ability Tables are also used to assist in making this decision.

Current Process for Disability Support Pension Assessment
People claiming Disability Support Pension provide details about their medical condition(s) and work ability as part of the claim process. They are also asked to provide a medical report from their treating doctor. In this report the treating doctor provides details about the person’s medical condition, an opinion about whether the person can work and details of how the person’s impairment affects core work abilities. Additional information from treating specialists and other health professionals may also be provided in support of the claim.

The treating doctor’s report, plus any other medical reports the person may provide, is examined by Centrelink. Where this information does not clearly indicate whether the person qualifies for a Disability Support Pension, the Customer Service Officer (CSO) refers the individual for a medical and work capacity assessment by an independent external Medical Assessment Service Providers (MASP). Generally the MASP is a doctor employed by Health Services Australia Ltd, a private contractor. These assessments may be undertaken through examination of the person or by assessment of reports only. The MASP gives an opinion about the person’s impairment rating, the person’s ability to work or be re-skilled for work and whether the person could benefit from programs of assistance. Centrelink makes the final decision about eligibility for Disability Support Pension and advises the applicant about available assistance.

The process for a review of an individual’s eligibility for Disability Support Pension is similar to that outlined above, except that the treating doctor provides an abbreviated opinion about whether the person can work. Reviews are currently conducted at regular intervals, either on a 2-year or 5 year cycle. Payments are subject to both an income and assets test. Reviews and appeals regarding decisions may be made to the Social Security Appeals Tribunal (SSAT) an independent statutory tribunal. The Administrative Appeals Tribunal (AAT) is a more formal body than the SSAT. It is there to resolve disputes between people and government agencies. The AAT can review decisions of the SSAT.

Changes to Assessment for Disability Support Pension
The Commonwealth government’s ‘mutual obligation’ agenda of welfare reform is aimed at linking social support to individual capacity for economic and social participation, with the view to shifting the system of Income support to a system of Participation support. This shift links eligibility for income support to obligatory participation. Assessments are based on judgements made by professionals about individual capacity, with little consideration of the systemic barriers to participation.

The Department of Family and Community Services and Centrelink are proposing changes to the assessment of work capacity for people with disabilities. Assessments are currently undertaken by medical assessment providers contracted by Centrelink, such as Health Services Australia Ltd. Under the new arrangements, Centrelink Disability Officers, Centrelink Occupational Psychologists, External Medical Assessment Service Providers (MASPs) or External Work Capacity Assessors will assess people with disabilities according to their disability/medical condition. Treating doctors will no longer be required to comment on a person’s work capacity for Disability Support Pension purposes, but will continue to provide reports on a person’s medical condition or disability. These assessments may be undertaken through examination of the person or by assessment of reports only (Department of Family and Community Services 2001).

The assessor gives an opinion about the person’s ability to work or be re-skilled for work, the person’s impairment rating (based on the person’s level of function) and the types of programs of assistance suitable for the person. Centrelink will still make the final decision about eligibility for Disability Support Pension and will offer the applicant a range of participation options matching their work capacity, including programs of assistance. Participation will be a mandatory requirement for the receipt of support.

Employment Services
Centrelink assesses people with disabilities in order to establish appropriate referral to employment assistance services using two tools:
· Job Seeker Classification Instrument – consists of a series of questions aimed at identifying barriers to entering employment. The instrument is not intended to provide an individual assessment of a job seeker’s needs but is a streamlining and classification tool.

• Work Ability Tables – assess the impact of a disability upon a person’s ability to work and generate a profile of an individual’s work ability. This assessment is completed using medical information supplied by the individual and other sources of information. As a result of this assessment, referral is made to the Job Network Community Support Program, a national network of private, community and government organisations offering job matching, job search training, intensive assistance and the New Enterprise Incentive Scheme. Alternatively referral may be made to a Department of Family and Community Services funded disability employment assistance service which variously offer open employment services; supported employment services (also known as Business Services); and vocational rehabilitation through Commonwealth Rehabilitation Services Australia.

Community Services
The Home and Community Care (HACC) program aims to provide community care services to people with disabilities so as to avoid their premature or inappropriate admission to long term residential care. Assessments are conducted by a “comprehensive assessor” who gathers information about areas of need from as wide a range of sources as is necessary. This includes consumers’ views about their needs as well as the views of existing service providers who have been involved with the client. In addition, specialists would be contacted for advice and information, and referrals for specialist assessment coordinated where appropriate. The assessor’s role is to bring together all this information to reflect a cumulative picture of client/family/carer strengths, resources and problems. HACC services may be rationed depending on demand and the level of local resources available in each HACC region.

The following areas are encompassed in a HACC comprehensive assessment. (Source: Comprehensive Assessment in the HACC Program Assessment Resource Kit Commonwealth of Australia 1999).
Physical characteristics: strengths, resources and needs
Key areas* Nursing
* Personal care
* Medical treatment / intervention
* Maximising functioning through rehabilitation and aids
* Nutrition and feeding/eating
* Continence

* Mobility
* Footcare
* Dental Care
* Skin care
* Communication
* Vision
* Hearing
* Pain
* Sleep patterns

Practical daily living & environmental issues: strengths, resources and needs
Key areas
* Household maintenance
* Household modification
* Food preparation/ Meals
* Shopping
* Transport
* Finances
* Adequate, secure housing
* Safety: physical security
* Hazards in the environment
* Rubbish removal

Psycho-social and cultural characteristics: strengths, resources, needs
Key area
* Language and other specific issues relating to cultural background
* Cognitive functioning
* Psychological health including depression, grief/ loss, isolation and loneliness
* Behaviour patterns
* Socialisation
* Confidence levels/ coping ability
* Personal security
* Spirituality and religion

Carer/family unit: strengths, resources and needs
Key areas
* Physical and emotional health
* Coping ability/need for support
* Need for information/ health education
* Sleep patterns
* Local networks and support systems including links with community
* Carer’s time availability
* Willingness and ability to continue caring role
* Competing demands with other roles
Vulnerability/risk areas
(includes both the person with the disability and the carer)
Key areas
* Abuse: physical, emotional, financial, sexual
* Behaviour patterns
* Recent hospitalisation
* Unstable health/medical condition
* Preparedness to accept services
* Level of informal support
* Ongoing capacity of family to maintain support
* Adequate finances

SECTION 2
STATISTICS OF PEOPLE WITH DISABILITIES

2.1 Historical Development of Statistics, Names of Offices concerned and Purposes of Statistics.

There are two major areas in statistical information gathering in disability in Australia – population statistics collected by the Australian Bureau of Statistics (ABS) and disability service statistics, whose collection is coordinated by the Australian Institute on Health and Welfare (AIHW). Other government agencies collect disability-specific statistics relating to relevant areas of their operation (see Table 3 below).

Australian Bureau of Statistics (ABS) – Population Statistics
www.abs.gov.au
The ABS, an independent statutory authority, is Australia’s official statistical organisation. For the first time in 1976, the Australian national population census included a question about disability. Testing showed the data to be unreliable and led to the development of the first comprehensive survey on disability in 1981.

Since 1981 the ABS has conducted its main disability survey entitled The Survey of Disability Ageing and Carers (SDAC) every 5 years (1981, 1988 and 1993 and 1998). The survey aims to obtain data about people with a disability including prevalence, disability status, types; support needed and received. This is in line with the ABS goal to assist and encourage informed decision-making, research and discussion within governments and the community, by providing a high quality, objective and responsive national statistical service (ABS 1999). The survey provides information on people with disabilities, older people and people who provide assistance to others because of their disabilities. There is information on the difficulty people with disabilities have with everyday activities, the assistance they need, their sources of assistance and their unmet need. The survey includes information on schooling and employment restriction for people with a disability, and on participation in social and community activities by people with a disability and older people.

Prior to each disability survey the ABS conducts widespread consultation with its users of statistics. As information needs have altered over time, in line with government policy and changed social attitudes, new questions have been introduced in later surveys to better identify disability. From 1988, the scope of the survey was expanded to collect information about informal carers of people with a disability. Since its inception the ABS Survey of Disability has reflected the framework of the World Health Organisation’s International Classification of Impairments, Disabilities and Handicaps (1980) and its subsequent revised guidelines. The most recent survey (1998) used the WHO International Classification of Functioning.

Table 2: Comparison of Australian Bureau of Statistics Disability Surveys

1981 1988 1993 1998

Name of Survey Survey of Handicapped Persons
Survey of Disabled and Aged Persons Survey of Disability, Ageing and Carers Survey of Disability, Ageing and Carers

Populations of interest Persons with a handicap (specific restriction in self care, mobility and/or communication activity, or in schooling or employment) by severity level. Persons with a disability

Persons with a specific restriction, by severity level

Older persons

Co-resident principal carers Persons with a disability

Persons with a specific restriction, by severity level

Older persons

Principal carers Persons with a disability

Persons with a specific restriction, by severity level

Older persons

Providers of care –
Primary carers
All informal carers

(Source: ABS Survey of Disability, Ageing and Carers Australia: User Guide. 1998)

Australian Institute on Health and Welfare (AIHW) – Disability Service Statistics (http://www.aihw.gov.au)
The Australian Institute of Health and Welfare is Australia’s national agency for health and welfare statistics and information. It is an independent Commonwealth statutory authority working with government and non-government bodies to develop and provide information and analysis on the health and welfare of Australians.

The Disability Services Unit of the AIHW undertakes data development, collation and analysis. It provides information on the need for, provision and use of disability services in Australia. It collects and publishes annually national data about services provided or funded by Commonwealth, State and Territory Governments under the second Commonwealth/State Disability Agreement (CSDA). This is called the CSDA Minimum Data Set (CSDA MDS).

The Agency publishes reports and discussion papers, drawing on a wide range of data collections, including the Institute’s biennial reports, ‘Australia’s Welfare’ 1993, 1995, 1997 and 1999 which includes population data and a national picture of services, the need for services and information on outcomes for people with a disability. The AIHW reports on the definition of disability in Australia, and the definition and prevalence of intellectual and physical disability and acquired brain injury. The AIHW is the Australian Collaborating Centre for revision of the World Health Organisation’s International Classification of Impairments, Disabilities and Handicaps (ICIDH).

Name Organisation Frequency Method Target
Population Objective Content

Survey of Disability, Ageing and Carers
ABS
1981,1988,
1993.1998
Estimates based on responses to sample surveys of households with interviewers, and cared accommodation establishments with administrator-completed mail-back forms

People residing in dwellings
To obtain data about people with a disability, ageing people and their carers

Prevalence; Disability status, types; Support needed and received
Commonwealth/State Disability Agreement Minimum Data Set collections AIHW 1995,1996,
1997,1998,
1999, snapshot day National collation of surveys of jurisdictions of service providers that they fund under the CSDA Service outlets and people receiving services under the CSDA To obtain data about providers and recipients of specialist disability support services. Service Details, types; Disability status, types; support needed, received;
Performance indicators

Disability Services Census (Commonwealth) Dept. of Family and Community Services 1986,1991,1993, 1995, 1997, 1998, 1999; Snapshot day A survey of specialist disability support service providers funded by the Commonwealth Service outlets and people receiving Commonwealth CSDA funded employment services. To obtain data about clients, staff, operations and finances of services under the Disability Services Act 1986.
Service details; Disability status, types; support needed, received; Performance indicators.

Centrelink databases:
• Disability support pension
• Carer Allowance
• Mobility Allowance
• Sickness Allowance
• Carer Payment Centrelink
Ongoing Details provided by client. Centrelink clients receiving DSP, CA, MA, SA, Carer Payment; People being cared for by CA recipients; Dependents of clients To administer payments to people receiving income support payments and allowances. Pension types, rates, duration;
Income/asset levels;
Medical condition, status;
Rent assistance; Dependents

Department of Veterans Affairs Client Database:
• Service Pension (permanently incapacitated veterans)
• Disability Pension Department of Veterans Affairs Ongoing Details provided by veterans and their dependants DVA clients receiving Service Pension, Disability Pension, Special Disability Allowance, and dependants of veterans. To administer payments to people receiving income support and compensation payments and allowances. Pension types, rates; Qualifying war service; Special disability allowances, eligibility for treatment.

Table 3: Major National Australian Disability-Specific Data Collections
(Source: Data Starter, AIHW, ACROD & NCDCO. Issue 1, Dec 2000)
2.2 Items included in Statistics

Population Statistics
(Source: ABS Disability, Ageing and Carers: User Guide, Australia 1998)
The Australian Bureau of Statistics Survey of Disability Ageing and Carers (1998) has two components: Household, and Cared Accommodation. The sample includes private dwellings and selected non-private dwellings (such as hotels, motels, hospitals, nursing homes and other establishments providing cared accommodation but excluding corrective institutions). The survey is conducted in both urban and rural areas in all States and Territories, but since 1997 excludes persons living in some remote and sparsely settled parts of Australia.

Household component
The household component of the survey was designed to collect basic information from a responsible adult about all persons in the selected household—age, sex, marital status, country of birth, as well as information to identify people with a disability or long term
health condition, and potential primary carers.

Personal interviews were then conducted with older people, people with a disability, and people with long-term health conditions, on the following topics:
· impairments, long-term health conditions and cause of main disabling condition;
· difficulties experienced by people with a disability, and help required in the activities of: self care; mobility; communication; guidance; and health care;
· difficulties experienced and help required both for people aged 60 years or more and people with disabilities in the further activities of: housework; property maintenance;
meal preparation; paperwork; and transport.
· the type of assistance received for each of these activities other than guidance, the providers of assistance, the extent to which need was met, and reasons for unmet need; and use of aids and equipment.
· Personal interviews were also conducted with people identified as potential primary carers of people with a disability on: the type of care provided; the availability or use of support; and the effect of the caring role on their daily life.
· Information was collected for the total population on education, employment, income and housing.

Standard ABS definitions and classifications were used where possible, to allow comparison with other sources of ABS data.

Cared accommodation component
A subset of the data collected from the household component of the survey was obtained about people in cared accommodation using a mail-back form completed by an administrative staff member of the establishment. This collection identified disability status and assistance needs. The questions asked were similar to those included in the household component of the survey. In some cases minor modifications were made to make them relevant to cared accommodation facilities.

Disability Service Statistics
The Commonwealth State Disability Agreement Minimum Data Set (CSDA MDS) aims to obtain data about providers and recipients of specialist disability support services. It does not contain quality indicators, rather it provides national collation of surveys by jurisdictions of service providers funded under the CSDA and about people receiving a service from these service providers on a ‘snapshot’ day.

Table 4: Information Collected in CSDA Minimum Data Set
(Source: AIHW Disability Data Briefing, December 1999)

· · Service details and types

Commonwealth funded
· employment support,
· advocacy,
· information/referral
· print disability

State funded
· accommodation support
· community support
· community access
· respite

· Support needed
· Support received
· Performance Indicators
• Disability status and types
§ Developmental delay
§ Intellectual
§ Specific learning/ADD
§ Autism
§ Physical
§ Acquired brain injury
§ Deafblind
§ Vision
§ Hearing
§ Speech
§ Psychiatric
§ Neurological
§ Not stated

 

 

 

 

2.3 Ways and Times of Data Collection

Population Data
The ABS conducts a national Survey of Disability Ageing and Carers every five years. It produces estimates based on the responses to sample surveys of households with interviewers, and cared accommodation establishments with administrator-completed mail back forms. The sample includes private dwellings and selected non-private dwellings (such as hotels, motels, hospitals, nursing homes and other establishments providing cared accommodation but excluding corrective institutions). The survey is conducted in both urban and rural areas in all States and Territories, but since 1997 excludes persons living in some remote and sparsely settled parts of Australia (ABS Survey of Disability, Ageing and Carers: User Guide 1998).

The method of collection is by Special Social Survey. This survey is conducted using two collection instruments:
· Interviewer-based computer-assisted collection for all usual members of selected households.
· Mailback forms completed by a staff member for residents of cared accommodation facilities.

In 1998, for the first time, household interviews were conducted using computer assisted interviewing. Interviewers conducted face to face interviews using a computer to collect, store, manipulate and transmit data.

Disability Service Data
The AIHW collects national data about services provided or funded by Commonwealth, State and Territory Governments under the Commonwealth/State Disability Agreement. These data are collected annually and are produced via service providers completing a Service Form and multiple Consumer Forms (AIHW 1999). A service is included in the collection even if only a small part of their operation was funded under the CSDA.

2.4 Definitions of People with Disabilities at the time of Data Collection

Population Statistics
The ABS Survey of Disability, Ageing and Carers in 1981, 1988, and 1993 was based on ICIDH (1980) classification. The 1998 ABS Survey of Disability, Ageing and Carers applies the revised ICIDH-2 classification, using the concept of ‘activity restriction’ instead of ‘handicap’. According to the ABS, disability is now conceptualised as being a multi-dimensional experience for the person involved. Correspondingly, three dimensions of disability are recognised in the draft classification: body structure and function (and impairment thereof), activity (and activity restrictions) and participation (and participation restriction). The classification also recognises the role of physical and social environmental factors in affecting disability outcomes (ABS 1998).

The most recent national survey of disability, the 1998 ABS Survey of Disability, Ageing and Carers defined disability in terms of the following component elements:
• disability;
• long term health conditions;
• specific restriction;
• restrictions in terms of self care, mobility and communication and
levels of restriction; and
• need for assistance.

Disability is defined as the presence of one or more of 17 limitations, restrictions or impairments (see Table 5 below). Affirmative responses to any of the following categories, where the limitation, restriction or impairment has lasted or was likely to last for six months or more ‘screen’ the person into the ABS survey. This list thus creates the implicit definition of ‘disability’ for the ABS 1998 Survey of Disability, Ageing and Carers (ABS 1999a).

Table 5 : Areas of limitation, restriction or impairment identified by the ABS
(Source: ABS Survey of Disability, Ageing and Carers: User Guide 1998).

• loss of sight, not corrected by glasses or contact lenses;
• loss of hearing, with difficulty communicating or use of aids;
• loss of speech;
• chronic or recurring pain that restricts everyday activities;
• shortness of breath or breathing difficulties that restrict everyday activities;
• black outs, fits, or loss of consciousness;
• difficulty learning or understanding;
• incomplete use of arms or fingers;
• difficulty gripping or holding things;
• incomplete use of feet or legs;
• a nervous or emotional condition that restricts everyday activities;
• restriction in physical activities or physical work;
• disfigurement or deformity;
• head injury, stroke or any other brain damage with long-term effects that restrict everyday activities;
• needing help or supervision because of a mental illness or condition;
• treatment or medication for any other long-term condition or ailment and still restricted;
• any other long-term condition that restricts everyday activities.

Self care, mobility and communication are defined as core activities. Levels of core activity restriction are defined as follows:
• mild — where a person has no difficulty with self care, mobility or communication, but uses aids or equipment;
• moderate — where a person does not need assistance, but has difficulty with self care, mobility or communication;
• severe — where a person sometimes needs assistance with self care, mobility or communication; and
• profound — where a person is unable to perform self care, mobility and communication or always needs assistance.
(Sources: ABS (1999) and WHO (1999)).

SECTION 3
STATISTICAL DESCRIPTIONS OF PWD

Description of People with Disabilities by Recent Statistical Information

The most recent national survey of disability in the Australian population is the Australian Bureau of Statistics 1998 Survey of Disability, Ageing and Carers (ABS 1999). The following information is derived mainly from that survey.

3.1 Population
In 1998, 3.6 million people in Australia had a disability – that is 19% of the total population; of those aged under 65 years, 15% (2,385,100) had a disability. In the latter group, 12.5% (2.05 million) experienced specific restrictions in core activities, schooling or employment. Furthermore, 4% (655,000) reported a ‘profound or severe core activity restriction’, meaning they always or sometimes needed personal assistance or supervision with self-care, mobility or verbal communication (http://www.aihw.gov.au/disability/faqs.html).

Table 6: Incidence of Disability in Australia
(Source: ABS Disability, Ageing and Carers: Summary of Findings 1998)

 

Disability Persons
‘000 Proportion
%

With core activity restriction
2 828.0
15.2
With schooling or employment restrictions 1 660.4 8.9
With core activity & schooling or employment restrictions 1 332.5 7.1
With schooling or employment restrictions only 327.9 1.8
All with specific restrictions 3 155.9 16.9
Without specific restrictions 454.4 2.4
All with disability 3 610.3 19.3

 

3.2 Population by types of Disability
In Australia disabilities are often discussed in terms of ‘disability groups’. A disability group is generally a broad categorisation of disabilities on the basis of underlying impairment, disabling condition or cause. The concept of ‘disability group’ also implies similar activity restrictions and needs.

 

Table 7: People with a disability, by main disabling condition and as a number of the Australian Population.
(Source: ABS Disability, Ageing and Carers: Summary of Findings 1998)

0-64 years All Ages Total (‘000)
Psychiatric 1.1 1.4 266.5

Intellectual & ‘other mental’
1.6 1.4 262.7
Sensory 1.2 2.1 393.6
Diseases of the eye 0.3 0.6 112.8
Diseases of the ear
1.0 1.5 280.7
Physical 10.7 14.4 2687.5
Nervous system diseases 0.9 1.0 180.7
Stroke 0.1 0.3 63.5
Other circulatory diseases 0.6 1.3 248.7
Respiratory diseases 1.1 1.4 259.7
Arthritis 1.4 2.7 498.7
Other musculoskeletal disorders 3.6 4.0 741.5
Head injury/any other brain damage. 0.2 0.2 39.6
All other diseases and conditions
2.8 3.5 655.0
Total (‘000) 2385.1 3610.3

3.3 Sex
The proportion of males and females with a disability is similar – around 19%, but it varies across age groups. Males have similar or higher rates across all age groups except for those aged 80-84 years. In particular, disability rates for males is markedly higher for those who were young (0-14 years) or approaching older age (60-79 years). The greater proportion of females in the older age groups, where disability rates are higher, affects the overall disability rate for females. If both sexes were evenly distributed across age groups, males would have a disability rate of 20%, compared with 18% for females. Of the 1.1 million people with a profound or severe core activity restriction, 56% were female. Among older people, the rates of severe and profound disability were markedly greater for females

3.4 Age
The rate of disability increased with age, from a 4% incidence for children aged 0-4 years to 84% for those aged 85 and over.

Table 8: Summary of Disability By Age
(Source: ABS Disability, Ageing and Carers: Summary of Findings 1998)

 

 

Age Group Core
Activity
Restriction

‘000 Schooling or employment
Restriction

‘000 Without specific restrictions

‘000
All with disability

‘000
0-4 31.7 … 16.1 47.8
5-14 174.4 185.8 28.1 249.2
15-24 138.6 148.4 47.0 230.9
25-34 201.2 214.0 51.3 306.9
35-44 305.7 322.5 54.2 436.2
45-54 417.5 406.0 73.4 551.3
55-59 225.1 206.9 27.0 278.6
60-64 226.7 176.8 39.3 284.1
65-69 229.8 … 45.8 275.6
70-74 262.0 … 38.6 300.5
75-79 249.0 … 21.1 270.1
80-84 178.5 … 10.3 188.8
85 and over 188.0 … 2.2 190.2
Total 2 828.0 1 660.4 454.4 3 610.3

3.5 Employment and Education
People with a disability have lower levels of participation in the education system than the general population. In 1998, 27% of people with a disability had completed year 12 schooling, in comparison with of people with no disability. There is a trend towards increasing inclusion of students with disabilities in mainstream schools (http://www.aihw.gov.au/disability/faqs.html)

Employment status and labour force participation are both strongly related to the presence of disability and specific activity restriction. In 1998 people with specific activity restrictions were less likely to participate in the labour force (49%) than all people with a disability (53%) or all people in the population (76%). People with specific activity restrictions or a disability were also more likely to be unemployed (12% each) than all people in the population (8%). Unemployment and participation rates were also related to the level of core activity restriction. Less than one-fifth (19%) of people with a profound activity restriction were participating in the labour force in 1998, probably contributing to a relatively low unemployment rate (7%). People who had a mild core activity restriction were much less likely than all people to be participating in the labour force (57% compared with 76%) and had an unemployment rate of 9%. The unemployment rate was highest for people identified as having a schooling or employment restriction only (15%). This group had relatively high participation rates in the labour force (64%). (Anderson et al. 2000)

3.6 Types of Causes
According to the 1998 ABS Survey of Disability Ageing and Carers, physical conditions were the most common cause of disability (85%). 15% of people with a disability identified a mental or behavioural disorder as their main condition.

 

 

Table 9: Incidence of Disability by Types of Causes.
(Source: ABS Disability, Ageing and Carers: Summary of Findings 1998)

Cause of Disability ‘000 (%)

Physical conditions
Cancer/lymphomas/leukaemias 60.0
Endocrine/nutritional/metabolic disorders 81.5
Diseases of the nervous system 180.7
Diseases of the eye and adnexa 112.8
Diseases of the ear and mastoid process 280.7
Diseases of the circulatory system 312.2
Diseases of the respiratory system 259.7
Diseases of the digestive system 68.2
Diseases of the musculo-skeletal system/
connective tissue 1240.2
Congenital/perinatal disorders 44.5
Injury/poisoning/other external cause 245.7
Other physical conditions 194.7

Total 3 081.1 (85%)

Mental and behavioural disorders
Psychoses/mood affective disorders 149.6
Neurotic/stress-related/somatoform disorders 116.9
Intellectual and developmental disorders 157.3
Other mental and behavioural disorders 105.3

Total 529.2 (15%)

Total 3 610.3(100%)

 

 

 

3.7 Disability among Indigenous Australians
Statistics on the Indigenous disability population are very difficult to collect, with accepted concepts of disability being inappropriate for application to the indigenous population. The available data suggests that rates of disability among Aboriginal and Torres Strait Islander peoples are higher than – perhaps at least twice as high as – those for the overall population (AIHW 1998).

SECTION 4
FORMAL AND INFORMAL SYSTEMS FOR THE CARE OF PEOPLE WITH DISABILITIES

In general disability services in Australia are developed and delivered in the context of several interacting forces:
· growth of the potential target group (AIHW website);
· the need for cost containment within a general climate of economic rationalism and fiscal restraint;
· outcome and performance based service funding
· increased privatisation of service delivery;
· a narrow policy focus on individual need at the expense of systemic .

There is an increasing focus on the roles of families, carers and communities in informal support systems for people with disabilities. The national policy framework does not however clarify the extent to which these informal service systems are expected to replace or supplement the role of formal services. (http://www.aihw.gov.au).

4.1 Registration System, Procedures of Registration Items of Application Form
There is no national registration system for people with disabilities in Australia, nor any identification card allowing universal access to state services. However, Centrelink (a) pension holders, and (b) seniors, do receive identification cards – but they’re based on (a) income/assets test, and (b) age limits, not on disability status.

4.2 Descriptions of Formal Services (including those provided by NGOs).

Formal Services fall under two broad legislative and administrative categories:
· Income support, particularly disability-specific income support;
· Disability support services, including rehabilitation services.

Formal services are delivered through both government and non-government organisations, and depend on local historical arrangements. Local government is playing an increasingly important role, as it provides services and facilities that are intended to respond to local needs. Local governments are producing Disability Action Plans that seek to ensure all their services are accessible, and that the built environment that they regulate is also accessible.

Charitable bodies have played a central role, as they were the initial focus for the delivery of welfare soon after the establishment of the European colony. For example the Benevolent Society responded to a range of groups, including disabled people; it has an extensive involvement in services for single parents, as well as in the building of social capital through community organisations. In addition there are impairment-specific charities such as the Royal Blind Society, the MS Society and the Spastic Centre, which are heavily funded by government, raise significant charitable donations, and tend to follow a traditional “patient” model of service. In recent years some of these single purpose bodies have re-fashioned themselves to tender for contracts across a range of disabilities.

People with disabilities also access generic services, which may have specialist units designed to identify and support disabled people. However, financial pressures on government tend to diminish the priority accorded these programmes, and they may be facing a limited lifespan. The ideology of “mainstreaming” (which argues all services should be disabled accessible and friendly) has been used to legitimate these sorts of reductions in service provision.

Non-government bodies, which also provide services, have emerged from the rights perspective. They provide lobbying, advocacy and support for groups and individuals with disabilities. However they are less able to generate non-government income, compared with the longer-established and charitable giving models used by the large charities. These sorts of organisations include People with Disabilities (NSW), which both lobbies and advocates; and Women with Disabilities Australia, with its research and policy roles.

The Commonwealth/State Disability Agreement (CSDA) was introduced in Australia in 1991. It defines the roles and responsibilities of the Commonwealth, State and Territory governments in the provision of certain services to people with a disability.

Its broad aims are to:
• establish a national framework to underpin the provision of specialist disability services across Australia;
• outline the respective and collective roles of specialist disability services along with their funding, policy setting, planning and management; and
• provide for the Commonwealth, States and Territories to contribute funds under the agreement, and identify factors affecting the need for funds now and in future years (CSDA 1998).

Income Support Services
See Section 1.3 for a description of income support services.

Disability Support Services
The majority of formal disability support services are funded, either partially or fully, by the Commonwealth and State/territory governments, as set out in the Commonwealth/State Disability Agreement (CSDA) as shown in Table 12.

Table 12: Disability Service Provision under the CSDA
(Source: Steering Committee for the Review of Commonwealth/State Service Provision.  Report on Government Services 2001. Australian Productivity Commission.)

Services administered by the Commonwealth Government
• Open employment services
• Supported employment services.
• Combined open and supported employment services.

Services administered by State and Territory governments
• Accommodation support services (group homes, hostels and large institutions) and support to maintain accommodation (attendant care and in-home support).
• Community access services.
• Respite care services
• Community support including information/referral services, recreation and holiday programs, case management, brokerage, counseling, early intervention therapy, print disability services, mutual support/self help groups and other therapy services.

Services for which administration is shared
• Advocacy services
• Research and development.

This division in responsibility has resulted in fragmentation of service provision and a restricted capacity for the development of an ‘all of government’ approach to disability policy development.
Table 13: Commonwealth-funded CSDA services, service by State and Territory, 1998.
(Source: AIHW Disability Data Briefing December 1999)

Service Type NSW Vic Qld WA SA Tas ACT NT Total

Open employment
95
66
62
27
27
16
4
5
302

Supported employment
235
116
64
30
56
17
9
4
531

Combined open and
supported employment
3
12
3
6
1

1
1
2
29

Employment other/not stated
1
1
2
2
1
1
0
0
8

Total employment support
334
195
131
65
85
35
14
11
870

Advocacy
19
23
7
8
7
3
6
3
76

Information/referral
2
0
0
0
0
0
1
0
3

Print Disability
4
3
1
2
1
1
1
0
13

Total other than
Employment support
25
26
8
10
8
4
8
3
92

Total
359
221
139
75
93
39
22
14
962

Table 14: State & Territory funded CSDA services, service types by State and Territory. 1998
(Source: AIHW Disability Data Briefing December 1999)

Service Type NSW Vic Qld WA SA Tas ACT NT Total

Institutions/lge residential
34
7

10
19
5
3
0
0
78
Hostels 23 19 1 11 1 5 0 0 60

Group Homes
583
639
233
165
16
27
9
9
1678

Attendant Care 40 38 11 8 11 1 0 4 113

Outreach/other ‘in-home’/
drop-in support
82 146 114 124 20 5 1 1 493

Alternative family
Placement
4 11 6 0 0 0 0 0 21
Accommodation support:
Other/not stated
46 27 2 2 1 3 0 1 82

 

Table 14 continued

Total accommodation
Support
812 884 377 329 54 44 10 15 2525

Advocacy 5 13 2 6 2 4 2 3 37

Information/referral 15 48 9 2 7 10 3 1 95

Combined advocacy/
Information 13 20 0 12 8 2 1 0 56

Early ch’hood intervention 80 110 4 5 2 0 0 1 202

Recreation/holiday progs 28 98 16 14 10 7 4 1 178

Therapy (PT OT ST) 26 69 10 14 5 1 3 1 129

Family/individual case
Practice/management 15 109 8 0 7 3 3 0 145

Behaviour/specialist
Intervention 21 26 5 5 2 0 0 0 59

Counselling: indiv/fam/grp 1 0 2
1 6 0 0 0 10
Brokerage/direct funding 2 36 33 79 2 0 18 2 172

Mutual support/self-help grp 4 32 1 0 4 0 0 0 41

Print disability 4 0 6 0 1 0 2 0 13

Resource teams/regional
Teams
68 0 19 0 2 2 0 1 92
Community Support: other 22 4 5 5 6 11 0 2 55

Total Community support 304 565 120 143 64 40 36 12 1284

Continuing education/
Independent living training/
Adult training centre
79 110 53 2 8 5 2 3 262
Post-school options/
Social & community
Support/community access
127 251 57 20 6 6 3 1 471

Community access & day
Programs: other
50 65 12 7 5 3 0 1 143

Total community access 256 426 122 29 19 14 5 5 876

 

 

Table 14 continued

Own home respite 6 12 12 3 1 1 1 4 40

Respite: centre/home 58 114 36 20 7 6 5 — 246

Respite: host family/peer
Support 14 0 49 0 3 0 0 0 66

Respite: other/flexible/
Combination/not stated 37 26 33 14 6 1 2 4 123

Total respite 115 152 130 37 17 8 8 8 475

Service type other 10 4 11 9 10 3 3 2 52

Total 1497 2031 760 547 164 109 62 42 5212

Community Services (see also page 26)
The following information is sourced online at http://www.health.gov.au/acc/hacc

The Home and Community Care (HACC) program is a joint Commonwealth/State program providing community care services to frail aged and younger people with disabilities, and their carers. The aim of the HACC program is to enhance the independence of people in these groups and avoid their premature or inappropriate admission to long term residential care. The HACC Program funds a range of non-profit and commercial organisations. HACC-funded organisations include:
State government services
State statutory authorities
local government services, church organisations
charitable bodies
community organisations
In many cases, the organisation receiving funds contracts out all or part of the services to other bodies.
The type of services funded through the HACC Program include, but are not limited to:
community nursing;
paramedical services;
meals on wheels and day centre-based meals;
home help;
personal care;
home modification and maintenance;
transport;
community-based respite care(mostly day care);
education and/or training for service providers and consumers;
assessment and/or referral services;
information and advocacy services;
social (including neighbour aid) support;
carer support
Accommodation services

There is a continuing trend away from institutional for people with disabilities. In 1998, 3% (20,100) of people aged under 65 with a profound or severe core activity restriction were living in ‘cared accommodation’ and 97% (634,600) were living in households. Of those living in households, nearly 90% lived with relatives (http://www.aihw.gov.au/disability/faqs.html).

4.3 Descriptions of Informal Services

Support from people with disabilities on an informal level is likely to come from families and partners. Women as carers are substantially over represented in the larger picture than men. Most of the information concerning informal care is available from the ABS Survey of Disability, Ageing and Carers (1998). Other material is available from organisations advocating on behalf of carers. Yet much of the data is unreliable.

Given lack of access to mainstream services by immigrant communities, many migrants with disabilities are forced to rely on their family and religious communities. Few mainstream services have provided culturally sensitive services or understood the need for use of language interpreters. Indeed government attitudes tend to reflect a belief that immigrants ‘look after their own’ or alternatively, because of the restrictions in the Migration Act, that there are few people with disabilities from Non English Speaking Backgrounds with a disability. These myths compound an already difficult situation for these people.

In indigenous communities in the rural and remote areas, informal support from kin may be the only form of support. Similarly in the urban areas the mainstream government and NGO services tend not to be culturally sensitive, suggesting that support needs would most likely be met – even if only marginally – by family and kin.

Apart from family and partners other informal support comes from religious communities. People with disabilities who are regular religious service attendees may get help from their congregations. People in rural areas may be known locally and therefore get more informal support than those living in urban centres but they have little access to mainstream government services and may have to ‘depend’ on the local community. People in urban areas without family may find themselves isolated in the home and struggling to survive. The increasing use of the internet by people with disabilities, who can afford to purchase the equipment, may also be meeting an as- yet unquantifiable need for support and contact with society and the wider world. Women With Disabilities Australia provide a discussion list which meets some of this need.

Self help groups have been expanding rapidly, often promoted by NGO providers, or arising out of discovery of shared needs. For instance, there are many groups for specific conditions – such as Parkinson’s, Arthritis, and Cancer Survivors. Rarely funded by government, these groups usually depend on voluntary effort, though in recent years their value is slowly being recognised. One such segment of the population is among people with HIV/AIDS, where there exist mutual support and information sharing groups, as well as groups of volunteer community carers for individuals without family support. This is especially the case in urban areas, where there are concentrations of people with the illness, and a vibrant gay communal structure.

 

SECTION 5
THE DISABILITY MOVEMENT IN AUSTRALIA

The disability movement in Australia has sought to provoke action by governments – and a great deal of the community activism is directed at raising public awareness so as to increase pressure on governments.

In Australia as in the USA and the UK, consciousness of disability discrimination came about partly as a result of forced segregation. The first winds of reform occurred under the Labor administration of Prime Minister Whitlam in 1974, with the Handicapped Persons Assistance Act. The government’s Poverty Inquiry reported in 1977 (by then to a conservative Coalition government) on Disability and Poverty, recommending major reforms – without success. Even 1981, International Year of the Disabled Person, passed without significant innovation or reform.

The return of a Labor government under Prime Minister Hawke (1983) generated a series of inquiries and legislative reforms – a national Disability Advisory Council was set up in 1984, and the government began to support the national disability lobby group Disabled Peoples’ international (D.P.I.). The following year the government’s Handicapped Persons’ Review reported, identifying independent living options ,and employment and training opportunities as key priorities. Disabled women set up a national network, and the government set up an Office for Disability to co-ordinate national planning. The Disability Services Act 1986 laid out a set of principles including participation by disabled people in planning service delivery.

The 1988 Social Security Review pressed for labour market opportunities as a way out of welfare dependency for many disabled people. This was followed by a national Disability Reform package, with Disability standards, both precursors to the 1993 Disability Discrimination Act. The Act created a Disability Commissioner in the Human Rights and Equal Opportunity Commission, and put in train wider actions – such as Disability Action Plans for all public institutions, covering access, employment and service quality issues.

With the conservative Liberal/National Coalition returned to government in 1996, the advances of the previous decade began to unwind. Disability rights joined women’s, Indigenous and ethnic rights as casualties of the government’s war on political correctness. The Commonwealth reduced support to joint programs leading to a crisis with the States over service delivery. The Disability Commissioner retired and her position was not replaced. The DDA was amended to make it far more difficult for disabled people to take legal action beyond the complaint stage, while the Commission budget was slashed by 40% in 1996 alone.

The disability movement plays an important role in causing governments to attend to issues of disability, though other interests also are active – NGO and charitable service delivery groups can often take countervailing positions in regard to priorities of the movement, while some industry sectors also resist demands for more accessible provision of goods and services. . Movement organisations also increasingly provide direct services to their members and the wider disability community, especially in areas associated with advocacy and complaints handling. Informal community support and networks also deliver personalised support in an environment of government restrictions and bureaucratic limitations.

__________________________

References

Anderson, P. Psychogios, C. and Golley, L. (2000) Open Employment Services for People with Disabilities 1998-1999, Australian Institute of Health and Welfare, Canberra.

Australian Bureau of Statistics (ABS) (1981) Handicapped Persons Australia 1981. Cat No. 4343.0. Canberra. ABS

Australian Bureau of Statistics (ABS) (1988) Disability and Handicap. Australia, 1988. Cat No. 4120.0. Canberra. ABS

Australian Bureau of Statistics (ABS) (1993). Disability, Ageing and Carers: Summary of Findings, Australia 1993. Cat no. 4430.0 Canberra. ABS

Australian Bureau of Statistics (ABS) (1999a). Disability, Ageing and Carers: Summary of Findings, Australia 1998. Cat no. 4430.0 Canberra. ABS

Australian Bureau of Statistics (ABS) (1999b). Disability, Ageing and Carers: User Guide, Australia 1998. Cat no. 4431.0 Canberra. ABS

Australian Bureau of Statistics (ABS), Australian Institute of Health and Welfare, Commonwealth Department of Health and Family Services. (1998) Indigenous Disability Data: current status and future prospects. Report on workshop proceedings April 1998. Cat No. DIS 10. Canberra. ABS

Australian Institute of Health and Welfare (AIHW) (1993). Australia’s Welfare: services and assistance. Canberra: AIHW

Australian Institute of Health and Welfare (AIHW) (1995). Australia’s Welfare: services and assistance. Canberra: AIHW

Australian Institute of Health and Welfare (AIHW) (1997). Australia’s Welfare: services and assistance. Canberra: AIHW

Australian Institute of Health and Welfare (AIHW) (1999). Australia’s Welfare: services and assistance. Canberra: AIHW

Australian Institute of Health and Welfare (AIHW) (1999). Disability Data Briefing, No. 16. December. Canberra. AIHW

Australian Institute of Health and Welfare (AIHW) (2000). Disability Data Briefing, No. 18. August. Canberra. AIHW

Australian Institute of Health and Welfare (AIHW), ACROD & NCDCO (2000) Data Starter: A Project of the Disability Data Reference Group. No. 1. December. Canberra. AIHW

Baume, P. & Kay, K. (1995) Working Solution: Report of the Strategic Review of the Commonwealth Disability Services Program. Canberra. Commonwealth of Australia.

Department of Family and Community Services (1999) Evaluation of the Commonwealth Disability Strategy. KPMG Consulting.

Department of Family and Community Services (2001) Australians Working Together: A better deal for people with disabilities. Better assessment and early intervention . Discussion Paper. Canberra. Commonwealth of Australia.

Human Rights and Equal Opportunity Commission (2001) Disability Rights Information, DDA Information and Information on the role of the Commission. Online at: http://www.hreoc.gov.au

Human rights and Equal Opportunity Commission
Register of Disability Discrimination Act Action Plans. Online at:http://www.hreoc.gov.au/disability_rights/action_plans/Register/register.html

Home and Community Care (1999) Comprehensive Assessment in the HACC Program Assessment Resource Kit. Canberra. Commonwealth of Australia.

McClure, P. (2000) Participation Support for a More Equitable Society: Final report of the Reference Group on Welfare Reform. Canberra. Commonwealth of Australia.

Roberts, S & Redman, R. (2000) Human Rights: New role for HREOC and Federal Court in human rights complaints. Online at: http://www.lawsocnsw.asn.au/resources/lsj/archive/aug2000/69_4.html

Steering Committee for the Review of Commonwealth/State Service Provision  (2001) Report on Government Services 2001. Australian Productivity Commission. Canberra. Commonwealth of Australia.

 

 

 

 

 

 

Legislation

Disability Services Act 1986 (Cth)

Disability Discrimination Act 1992 (Cth)

Human Rights Legislation Amendment Act No.1 1999 (Cth)

Home and Community Care Act 1985 (Cth)

Social Security Act 1991

Human Rights and Equal Opportunity Commission Act 1986.

Telecommunications Act 1997 (Cth)

Disability Services Act 1993 (NSW) and Disability Services
Regulations 1993.

Anti-Discrimination Act 1977 (NSW)

Community Welfare Act 1987 (NSW)

Community Services (Complaints, Appeals and Monitoring Act), 1993 (NSW)

Administrative Decisions Legislation Amendment Act, 1997 (NSW)