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I often think of the case of Adelaide woman Ann Marie Smith with a mix of profound sadness and disbelief, because despite having a paid support worker to help her for at least six hours a day, every day of the week, she died of gross neglect in a cane chair where she’d been left, according to investigating police, for as long as a year.
Smith, 54, had cerebral palsy and in that time in the chair had not been properly fed, bathed, toileted or had her teeth brushed. The impact on her body was horrific.
Carers do not have to be qualified to be left to look after someone with a disability. Credit: iStock
It hits me hard because Smith’s mother had been her carer until her death some years before, just as I am primary carer for my 21-year-old daughter.
According to Smith’s estranged brother Steven, giving evidence in the manslaughter trial of her carer Rosa Marie Maione in 2022, their parents had set his sister up in a beautiful home with 24-hour care in preparation for when they could no longer be with her.
In his victim impact statement Steven said: “the thought of their biggest nightmare coming true continues to tear me up inside.”
I am aged 61 and what happens to my daughter when I can’t care for her drives me to build her independence. It’s vital to me that she has a good, happy, functional life living semi-independently in a situation as near to that of a neurotypical person as possible.
At the time of her death Smith’s care provider was Integrity Care SA and it employed her support worker, 70-year-old Rosa Marie Maione who was jailed for six years after pleading guilty to manslaughter by criminal neglect.
Maione’s services were paid for by the NDIS.
Justice Anne Bampton, in sentencing Maione, described her as incompetent, lacking training and assertiveness and said she had “absolutely no insight into Ms Smith’s physical condition leading up to her death”.
Under its watch, Integrity Care SA had a 70-year-old woman with a shoulder injury among other physical limitations, caring for a 54-year-old woman in declining health, who required a high level of care and who couldn’t walk.
Unable to lift her to bath her or put her to bed, Maione chose simply to leave her in a chair.
It’s a system that is leaving the way open for people with disabilities to receive substandard care, at inflated cost and creates an environment where the untrained and incompetent can establish themselves with a vulnerable client
Why didn’t anyone at Integrity Care SA recognise that client-carer match was not going to provide Smith with an acceptable level of care? Where were Integrity Care SA and the NDIS checks? Where were the regulators?
Support workers are employed largely in one of three ways; through a company that is a full-service provider, through an employment platform like Mable or through other avenues like Facebook pages set up for people with disabilities to find supports.
Shockingly, disability support work is largely unregulated. Anyone can be a support worker – they don’t need qualifications, they don’t have to be registered with an authority and the only mandatory check is a NDIS Quality and Safeguards Commission’s worker screening for those people working for NDIS registered providers in special roles referred to as ‘risk assessed’. Self-employed workers are expected to self-assess if they need the check.
It is entirely possible, and in fact increasingly common under the existing system, that no one at the agency employing the support worker or the employment platform finding them work, has ever actually met the support worker or the client.
It’s a system that is leaving the way open for people with disabilities to receive substandard care, at inflated cost and creates an environment where the untrained and incompetent can establish themselves with a vulnerable client, resulting in the type of neglect suffered by Smith rotting in her cane chair.
It’s exacerbated by the fact that disability support workers need no qualifications. Becoming a disability support worker can be as easy as simply signing up on a provider’s online platform, of which there are many.
Platforms like Mable provides support worker insurance, invoice clients for their shifts and perform reference checks however a spokeswoman clarifies that it is not an employer of support workers as its extensive advertising may imply.
“We do not provide support services. Mable is an online platform available on the web or via an app where two parties – a client and support worker – find each other,” she explains.
“They connect because the support worker is willing, able, qualified or certified to provide the services the client is looking for.
“Our stringent onboarding process means that support workers are appropriately vetted to perform the services they say they can.”
The ultimate responsibility for how, when, where and what services were carried out was between the carer and client.
The NDIS Commission says platform providers like Mable represent a significant and growing proportion of the NDIS market and it is currently investigating how they operate within it.
It says a recent survey, which is part of the enquiry, highlights uncertainly about who is responsible for ensuring services are delivered safely and are of high quality.
“We heard from participants about what matters most in relation to the delivery of quality and safe services under the NDIS; qualifications were one of a number of issues participants raised,” a Commission spokeswoman says.
“Not all providers are required to be registered, however all providers and workers are required to comply with the NDIS Code of Conduct and are subject to regulation by the NDIS Commission.”
The spokeswoman confirmed there are no checks that support workers are adhering to the code and points to its optional training and induction modules as proof of further regulation. The Commission says it has broad powers to act against any provider or worker that does not fulfil its obligations under the code of conduct. This includes issuing compliance notices, penalties, court-based actions and banning people from operating in the NDIS.
According to its register of individuals and companies against which it has taken action, there have been no suspension or compliance orders issued in WA in 2023. Two banning orders have been issued to individuals in the same timeframe.
The unqualified support worker charging $73 per hour
It’s not just the platform business model of recruiting unqualified, inexperienced support workers that’s concerning.
About two years ago one provider, a “full service” provider which directly employs support workers, sent me one young woman who was a bit amazed she didn’t even have to sit an interview to get the job. She’d never met anyone from the company employing her, let alone been interviewed by someone in that company who might judge her ability to support my daughter.
She’d provided the basic checks – produce proof of ID, police clearance, working with children check – and she got the job. And there she was on our doorstep presenting herself as a support worker for my then 19-year-old prone to significant behavioural problems that included violent meltdowns and worrying compulsive behaviours. She’d never seen my child’s safety plan or her NDIS plan goals with their overarching aims of building independence through cooking, shopping and a myriad of other
life skill activities.
She spent the entire three-hour shift colouring-in with my daughter. I’ve heard of similar instances; like the support worker at the pool with their client sitting on the sidelines on their phone for an hour, while the client is in the water alone.
Scenarios like this of disinterested, inexperienced, unqualified people seeking jobs as support workers are becoming more common because disability support worker pay rates, using NDIS benchmarks, are very high compared to other casual types of work and there is a worker shortage.
The system is supposed to protect our community’s most vulnerable people.Credit: AAP
The 2021 Care Workforce Labour Market Study forecast a support worker shortage of 200,000 by 2050. The 2022 NDIS State of the Disability Sector showed 83 per cent of service providers reported
problems recruiting disability support workers. One is quoted in the report as a saying: “we are no longer in the midst of a skills shortage. It’s now a labour shortage.”
In my university days, I worked in hospitality for minimum wage which, if it were 2023 would be about $27.27 for a casual aged 21 and over. For someone under 18 it would be $16.36 casual rate.
One candidate we interviewed recently as a new support worker was a nursing student about 18-years-old, who had some first aid certificates, a police clearance but no formal qualifications as a support worker and very limited experience. She was asking $73 per hour in addition to a
kilometre charge of 90 cents.
That’s an exorbitant rate for her skills and experience, however she had arrived at the figure using the NDIS Pricing Arrangements and Price Limits 2023-2024 which came into effect on July 1, 2023.
She had come to us through Mable which readily admits most of its ‘independent support providers’ are not registered with the NDIS.
Mable says it does not set pay rates aside from a minimal fee of $36 per hour, however, concedes that there is general concern that NDIS price limits have become price anchors. It says 85 per cent of its support workers charge below NDIS rates.
The most common formal qualification for a disability support worker is the nationally accredited Certificate III in Individual Support, which can take between six and 12 months to complete and includes 140 hours of work placement learning.
It’s described as a holistic crash course providing the practical skills to be a support worker and an understanding of the worker’s legal and ethical obligations under NDIS.
The cries from frustrated parents and primary carer givers are getting louder. Action needs to be taken over a desperate lack of regulation in the support worker industry. If not, inexperienced, unqualified workers, bolstered by the carrot of high official NDIS pay rates will continue to
drive up the cost of supports, while driving down the quality of care.
Ironically, this is happening at the same time the NDIS continues to slash the amount of money people with disabilities are receiving in their plans. There are many support workers, many unqualified and unregistered, doing an excellent job and earning every cent they ask for.
They are not the ones colouring-in for three hours with my autistic daughter, leaving their client in the pool unsupervised or a woman who can’t walk sitting in a chair for a year because they have no idea what else to do.
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