There has been a lot of discussion about the quality, safety and cost ofNDIS services. Some of it is about the types of providers people use.
The NDIS Quality and Safeguards Commission regulates some service providers. Compliance and auditing processes can be time consuming and expensive if you want to be registered. Some providers don't do this.
Some people who are self-managed can also buy services from providers who aren't registered. Almost two-fifths of NDIS spending goes to providers who are not registered. Unregistered providers are smaller than registered providers. Only 10% of their providers are registered, but they make up 40% of payments.
We interviewed 30 people to find out why they use providers that are not registered. What is different about their experience with this provider? What are some of the benefits of using an unlicensed provider?
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The budget set aside funds to curb costs and boost productivity, despite warnings of an NDIS blow out.
The types of services used
We used social media to interview people from all over Australia with the help of disability advocates.
Interview participants bought four main types of services from non- registered providers. Each has its own considerations for risk, quality and safety.
There are consumables.
Purchasing basic pieces of access equipment, medical supplies and assistive technologies from unregistered providers represented significant cost savings and reduced delays, with no difference in the quality.
2. There are household services.
Participants did not experience discrimination or an elevated sense of risk in the delivery of non-disability household services. They liked the idea of being able to use local businesses and felt more connected to the community. Cost savings and improved service quality were common.
3. Allied health and other therapies.
Many allied health providers and therapists are not registered with the NDIS, but they usually hold accreditation with appropriate professional bodies. Interviewees felt that the registration of the NDIS wouldn't provide better safety or quality.
4. Workers.
Unregistered support workers can be employed as sole contractors through online platforms. This category of supports is one of the most controversial in discussions about registration. Personal care can be delivered in domestic settings.
Some groups are concerned that unregistered support workers might increase the risk for participants and workers. Some recent and shocking cases of abuse have involved registered providers, but the argument has been made that this might increase potential for abuse and exploitation of both participants and workers.
More flexible shift times, increased choice of workers, greater consistency with workers and the ability to set worker wages were some of the benefits of using unregistered support workers. They said it meant they could move away from the limitations of the agency rule book.
Several participants told us they’d had negative experiences with support workers from registered agencies. They spoke of high staff turnover and “just anyone” being sent for shifts. They described feeling safer and better supported when they chose their own support workers through unregistered pathways.
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We spoke to participants and asked them how to fix it.
Unregistered providers are sometimes the only option
Some participants find it essential to purchase services from unregistered providers.
Interviewees said they preferred to avoid registered providers and preferred the services of unregistered providers.
Negative experiences with registered providers were included in push factors.
Pull factors included perception of better, more person-centred service, flexibility, innovation, choice, empowerment, social inclusion, and improved cost-effectiveness associated with using unregistered providers. Many of the participants we spoke to said that using unregistered providers allowed them to be more cost-conscious with purchases.
Some people said they had to do work to support unregistered workers with things such as tax and superannuation obligations.
‘Thin markets’
Thin markets contribute to these decisions. Interviews often had no choice but to use unregistered providers because of a lack of providers and waiting lists.
Some people are leaving disability care to work in aged care because of the shortage of support workers. Increasing the pool of available staff can be done by using unregistered support workers.
Upset at the thought of losing unregistered services
The participants were worried about what would happen if they were only allowed to use registered providers.
There were much stronger reactions to the things that people mentioned. A participant we'll call Davina said it would be devastating.
Kim said she would be extremely upset if she lost everything. It would be chaos, predicted Gabrielle. Owen got "anxious just thinking about it" as he said that the thought made him feel sick in his stomach.
Choice and control
The ability to use unregistered providers is about exercising choice and control. There are implications and possible ways to preserve two types of providers in the disability service market. The dignity of risk is given to the participants of the NDIS.
Our findings show that both clients and providers need support. Helping the participants and providers understand their options is what we suggest.
This would give the participants of the program a clear idea of what they should expect in terms of quality and safe services and how to speak out if they feel something is wrong. It would be of benefit to use registered providers as well. Building capacity would give providers and workers a better sense of their responsibilities and the processes for delivering effective services and help guard against exploitation.
Capacity development of NDIS participants is likely to have positive implications. Continuous improvements and benefits would be achieved.
The names of participants have been changed.
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