The disability royal commission this week heard powerful testimony about a neglectful and mercenary approach to care at one of Australia’s longest-serving providers. By Rick Morton.
Testimony at the disability royal commission
Merna Aprem drowned in a bath weeks before her 21st birthday. She wasn’t supposed to be unattended – she was at risk of seizures, living with epilepsy and autism in a group home run by the Australian Foundation for Disability (Afford) in Woodbine, west of Sydney. This was one of several cases that has brought Afford, which currently claims more than 6200 clients across five states in Australia, to the attention of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability.
Testimony to the disability royal commission this week described a culture in which people were “seen as a dollar figure” and in which management and staff did not report serious incidents. A former disability support worker known as Dianne* told the inquiry on Wednesday she had proposed a cap on the number of clients at the facility where she worked, because it was sometimes impossible to meet staff-to-client ratios while also allowing workers to complete significant administrative work.
“I was told it was not really in line with ‘their vision’,” Dianne said of the response from an executive manager.
“There was always this need to be the biggest and the best in the sector. One of the main things that I’ve highlighted throughout this is that with the introduction of the NDIS there has been a sort of billable hours sort of model going on here.
“Services are sort of forced to make sure that if money is not going in, money is not going out. With a rapid growth model we are not always able to catch some people who are sliding in through our doors here.”
Merna Aprem’s case, from 2019, was the first to bring Afford to the attention of authorities, but the provider is now the subject of multiple investigations by the NDIS Quality and Safeguards Commission – a regulatory entity, separate to the agency that administers the disability support scheme.
The NDIS commission launched its first ever civil penalty proceedings in the Federal Court of Australia against the organisation for its alleged failure “to identify and implement measures to protect Ms Aprem against the risks associated with her having a seizure whilst bathing” and a failure to “ensure that Ms Aprem was adequately supervised”.
Since then, investigations have been opened into alleged abuse of NDIS participants in a Mount Druitt day program run by Afford; into “alleged misuse of NDIS funding”, which has resulted in a debt notice from the National Disability Insurance Agency (NDIA) for $110,000; and into a “culture of extravagant spending on staff and employees not related to the care of clients”.
The provider also faces inquiries about almost 1000 occasions of missed medications that ought to have been administered but were not, the failure to report these serious issues to authorities because Afford claims it did not know they were reportable matters, and “apparent systemic non-compliance”.
There is also the matter of Thomas Stumpo, a disabled man who attended a respite program run by Afford, who almost choked to death because he was fed solid food “contrary to his mealtime management plan”. His mother, Rosa Stumpo, picked up her son from respite to discover he was seriously unwell – staff at Afford thought it was a virus – and called an ambulance. Food was discovered in his airway. Stumpo’s case was never reported to the NDIS Quality and Safeguards Commission and was only brought to light by an ABC broadcast.
“Is it the case that as part of [the investigation into alleged misuse of NDIS funding] the NDIS commission reviewed reportable incident and other data from Afford, such as its growth and size, which reported that Afford was notifying reportable incidents at about half the rate of other providers between July 2018 and July 2021?” counsel assisting the royal commission Ben Fogarty asked of NDIS commission registrar Samantha Taylor on Tuesday.
Taylor said this conduct remains a concern.
“Although there has been a considerable amount of work between the commission and with Afford on these matters, and although we’ve seen improvement, I’m still not satisfied,” she said.
Despite all of this, Afford remains a registered NDIS provider. It is still hungry for expansion. In its annual report for 2021, the organisation notes that its move into South Australia and Western Australia comes with “challenges”. Namely, that “potential clients … are aligned with existing disability service providers”.
During the royal commission hearings, it emerged that Afford routinely sent customer care officers or managers to schools in districts where day programs operated in a bid to “recruit” new clients.
“And do you think the school or the family knew that they were paid a commission?” Commissioner Barbara Bennett asked the former employee Dianne.
She responded: “No, I don’t believe so, no.
“Once the participant was with us then they [the recruiter] stepped back. There was no follow-up from that point on,” Dianne said.
The chair of the royal commission, Ronald Sackville, QC, appeared uneasy with many of the excuses and “apparent inconsistency” put forward by Afford regarding its conduct. He asked the NDIS commission’s Taylor what the regulator would do if it simply did not believe a provider’s explanations.
“Is it of concern to a commissioner if a service provider provides an explanation that lacks authenticity and can be demonstrated to lack authenticity?” he said. “Assume it’s a deliberate misleading. What does the commission do?”
Taylor said that was of course a “concern” and suggested the regulator could use its power to “obtain further information to test whether or not what the provider is claiming to be the case is, in fact, the case.”
Sackville was frustrated by the indirect response and rephrased.
“Let me explain that one of the themes – as I’m sure you’re aware through a number of hearings – has been that both the commission and the NDIA sometimes may be too reactive and too reliant upon what they’re told by the service providers, and I’m just trying to ascertain what in a particular case, if it becomes clear that a service provider is not providing you with accurate information and is doing so deliberately, what are you going to do about it,” he said.
Over the past two years, the Coalition government and executives appointed to run the NDIA by its government-picked board have consistently sounded alarms about the scheme’s rising costs, with funding projected to rise from $30.7 billion a year to $46 billion by 2025-26.
As part of its ill-fated attempt to wrangle costs, the federal government and the agency have targeted disabled participants in the scheme. The key plank in this strategy was the botched rollout of so-called “independent assessments”, which internal documents revealed would save the scheme some $700 million. An algorithmic approach to support planning is still being deployed within the agency to shave funding from participants via arbitrary “typical support package” categories.
Meanwhile, as The Saturday Paper revealed in March, the NDIA is attempting to sneak “functional assessments” back into its strategy via new clauses in outsourcing contracts currently out to tender.
Precious little in any of the government-fuelled media storm about scheme expenses has dealt with the single biggest problem facing the program: a massive surge in support providers with significantly larger budgets and, in some cases, an appetite for “creaming” from the participants in their care.
Sackville and counsel assisting, Ben Fogarty, zeroed in on this apparent dislocation, prodding the commission’s Samantha Taylor about the arrest of Afford care worker Daniel Sasulu Nuumaalii, who has pleaded guilty to a string of offences, including the filming of “intimate” videos with disabled adults he was supposed to be caring for.
Although the police were involved, and Nuumaalii was sentenced to three years’ imprisonment last year, the NDIS Quality and Safeguards Commission allowed Afford to choose its own “independent” investigator to complete a report into the provider’s risk-management approach to client safety. This document made no such risk assessments in its concluding summary, but was accepted by the commission nonetheless.
“Are you satisfied that, when you reviewed this closed investigation, that it was an adequate investigation of what I think you accept are very serious incidents?” Fogarty asked.
Taylor said: “I think it’s an adequate investigation for what we asked Afford to explore through this investigation, yes.”
Sackville remained unconvinced. “My point,” he said, “is that it seems that there are deficiencies both in the report and in the commission’s acceptance of the findings of the report.”
Late on Wednesday, the inquiry heard from Afford’s national executive manager of lifestyle centres, Wayne Adamson, who said as recently as last year “there was, at the executive level … no executive in charge of safeguarding or quality, risk or compliance.
“It just seemed as though everything was based around the financial side of things, which is the task that fell on the team leaders and the district managers,” he said.
“So, whenever we would have a meeting or there was some sort of conference, the first point of discussions was always around financials.”
Things are different now, Afford says, with new management. However, the structural issues with provider oversight in the NDIS remain.
The royal commission continues.
* Name has been changed.
This article was first published in the print edition of The Saturday Paper on May 21, 2022 as "Deaths and money".
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