Models of Supported Accommodation
People with a Disability
A Submission by the Disability Council of NSW
22 April 2005
The Disability Council of NSW
The Disability Council of NSW was established under the Community Welfare Act
1987, to advise the NSW Government on issues affecting people with a disability
and their families. The Disability Council is also the NSW Disability Advisory
Body to the Commonwealth Government.
Councillors are appointed by the Governor and are selected on the basis of their
experience of disability and their understanding of issues, knowledge of service
delivery and government policy. The majority of Councillors are people with
In response to the request from the Director General to comment on the
discussion paper Models of Supported Accommodation for People with a
Disability, the Disability Council makes the following submission.
The Disability Council strongly supports the NSW Government‟s commitment to
close large residential centres for people with disability. The Disability Council
agrees with the opinion of the 1997 Performance Audit Report that, even if such
centres could meet the requirements of basic safety and human rights, they could
not address the individual needs of people with a disability or provide the quality
of life envisaged by the Disability Services Act 19931.
Notwithstanding the Government‟s commitment we note, however, that a
substantial number of people with disability remain segregated from their
communities, living still in large residential centres. Consequently, the Disability
Council will limit our comments, at this stage, to consideration of issues
immediately relevant to the accommodation support needs of this group of
people. We are confident, however, that many of the principles associated with
terms such as person-centred planning and service delivery based upon the
needs of individuals apply no less to the accommodation support requirements of
people with disability currently living „in the community‟.
The discussion paper argues that the group of people still resident in large
centres have specialised support needs: specifically, medical and/or behavioural
needs. We understand the point that is made in the paper but we urge all
stakeholders to approach such questions from a different perspective.
NSW Audit Office (1997). Performance Audit Report. Large Residential Centres for People with a
Disability in New South Wales. p ix.
All people, whether with disability or not, need accommodation. Many people,
whether with a disability or not, also depend on some form of support
arrangements in a varied set of accommodation settings. The Building Manager
of a medium density strata title block of units, for example, provides support to
residents accommodated in the building. Government, non-government-not-for-
profit and private sector agencies provide cleaning, domestic assistance and
personal support services, including specialist medical intervention, to an
increasing range of residents in what might be thought of as „mainstream‟
accommodation. Some of those people have disability while many do not yet
they currently live in all types of accommodation settings.
In short, we can think of almost no person who does not receive or benefit from
some kind of supportive intervention to live in their current accommodation. This
is, as we understand it, the generally accepted norm. Living in a residential
setting (large or small) deviates from the norm.
If we accept that all people share the basic human need to be accommodated
(we hope with respect for their autonomy, individuality and dignity as human
beings) we must recognise also that some people require specific types of
intervention and support that other people do not currently need. We recognise
too that people‟s circumstances change over time. The supportive intervention
any individual needs today can increase and decrease as well as change over
time. It is our recommendation that service systems be re-shaped to fit with this
reality: the “messy” business of “ordinary” lives lived by people with disability as
much as by people who currently have no disability.
We draw particular attention to the need to shift thinking with regard to people
who have “severe challenging behaviours, who may put themselves or others at
risk of harm”2. The Disability Council acknowledges that such behaviour is often
acquired as a consequence of prolonged confinement in an institution, rather
than something inherent to an individual‟s disability. For some people, the
responses labelled as “challenging behaviour” may be the only effective form of
communication available to them. There is a strong body of research evidence,
established over decades, which properly locates service-system labels such as
“challenging behaviour” within a clear context of need for service system reforms
that encourage and support individual service users to change and develop.
We believe it is also important to note that the provision of appropriate
accommodation for people with disability, and the provision of appropriate
support while in that accommodation, are not synonymous3 . Both of these
Department of Ageing, Disability & Home Care (2004). Models of Supported Accommodation for People
with a Disability: A Discussion Paper Inviting Feedback. p3.
Ageing and Disability Department (1998). Disability Policy Framework. p7.
separate but sometimes closely aligned service reform and development
questions must be considered in any deinstitutionalisation process.
In this regard we note, as an example, The Victorian Office of the Public
Advocate‟s Accommodation Models Discussion Paper4 which concludes that the
ways in which services are resourced and managed, as well as the quality of
staff, affect the quality of life experienced by the residents more than the layout of
the accommodation. A key challenge in NSW will be to get both the “bricks and
mortar” and the human services right for the individuals concerned even as we
recognise the differences between the accommodation requirements on the one
hand and the support needs on the other.
The Disability Council does not support the creation of smaller-scale congregate
care centres, particularly where such services are developed on the site of
existing large residential centres. It is our belief that such “accommodation
options” imply that the residents of such centres need to be, prefer to be or
benefit from being kept separate from the rest of the community. Such a view
reinforces, in our opinion, negative stereotypes of disability to the detriment of all.
Further, we argue on the basis of our direct experience that, where such
segregated accommodation services are developed, the administrative needs of
the service ultimately take priority over the needs of individual residents. While
we recognise the sterling work of the overwhelming majority of professional staff
in residential settings, we note, nevertheless that for people with disability living
in such settings the most common sources of abuse come from support staff and
other residents5. There is, as a consequence, a greater degree of highly
specialised risk to people with disability in congregate settings than the ”normal”
risks of everyday life in mainstream communities.
In 1994, the Disability Council published its recommendations on accommodation
and support options for people with disability6, which included an upper limit of no
more than four people with disability residing together. Our position has not
changed. Indeed, we believe that the demonstrable evidence of the lives of
people with disability already living autonomously with support in NSW, other
jurisdictions in Australia and overseas in comparable (OECD) countries shows
the best (in terms of quality) and most effective (in terms of costs and benefits)
arrangements to be those based upon person-centred responses to the needs of
individuals living as their peers live, in circumstances that respect the cultural
diversity and social norms of modern and inclusive communities.
Office of the Public Advocate (2002). Accommodation Models Discussion Paper. p 9.
Conway, R., Bergin, L., & Thornton, K. (1996). Abuse and Adults with Intellectual Disability Living in
Residential Services: A Report to the Office of Disability.
Disability Council of NSW (1994). Accommodation and Support Options for People with a Disability. p
The present discussion paper in the context of previous consultations with
The Disability Council notes that the current discussion paper raises questions
similar to those in a discussion paper produced by the Disability Services
Directorate of the NSW Department of Community Services in 1994, The Valued
Norm: Housing for People with Disabilities. That paper was based, in part, on
information collated from targeted consultations which the Disability Council
Briefly, the 1994 paper provided practical examples of what contemporary
approaches to supported accommodation might look like and how they could be
financed. It introduced four essential criteria (termed “the valued norm”) to help
consumers and service providers evaluate various approaches. These were 7:
1. Does this approach (or setting) reflect the everyday expectations of
people of a similar age or stage of life?
2. Does this approach (or setting) enable the consumer to feel
comfortable about being themselves and behaving in a way consistent
with their cultural background?
3. Is this approach (or setting) appropriate to both women and men? Can
they become involved in the same range of activities?
4. Does this approach (or setting) ensure that people with disability lives
beside people without disabilities?
The 2005 discussion paper asks,
“how best can we support people with a range of disabilities to live within
their communities in ways that, as far as possible, offer choices that reflect
the lifestyle of other people in the community?”
We believe that this question incorporates the four criteria that comprise the
“valued norm” of the 1994 paper. The older document is more explicit and still
The models of supported accommodation described in The Valued Norm were
represented in terms of a continuum, ranging from congregate-care facilities, with
Ageing and Disability Services Directorate, NSW Department of Community Services (1994). The
Valued Norm: Supported Accommodation for People with Disabilities.
whole-of-life support, to private residences with occasional drop-in support.
However, it was never suggested that a person would be required to “progress”
from one environment to another. The “continuum” in 1994 simply implied a
range of accommodation types. The paper considered ten accommodation
options “defined by market usage” and believed to be adaptable and acceptable
accommodation for people with disability. Both the positive and negative aspects
of each type of accommodation were presented. We summarise them below:
1. Terrace Houses/Town Houses (2-3 bedroom) - attached dwellings, usually 2
storey, separated by a vertical wall.
outside spaces often small and divided between front and back – may not
be appropriate for people requiring access to open areas;
issues of integration and access require careful consideration as these
residences are often constructed in rows in busy locations.
2. Villa Units (1-3 bedroom) - attached dwellings, one storey, separated by a
positive for mixture of ownership and rental;
external areas don‟t always connect.
3. Multiplex (1-3 bedrooms) - a group of more than two dwellings, with ground
access to all.
noise transfer issues need to be carefully considered;
outside space may be limited.
4. Dual Occupancy e.g. “granny flat” - a second dwelling on a piece of land.
offers privacy and crisis support if necessary.
5. Freestanding Housing (2-6 bedroom).
Once considered the ideal model – now seen as just one of many options.
6. Duplex (1-3 bedrooms) - two units divided by a horizontal separation.
often larger than villas and home units.
7. Duplex/Semi-Detached (2-3 bedrooms) - two units divided by a vertical wall.
often larger than villas with increased privacy and space around the
could be appropriate for person with challenging behaviours with support
8. Home Units (1-3 bedrooms).
outside spaces may be limited;
physical access to upper storey a key issue: installation of an elevator may
improve capital gain opportunities though may also be cost prohibitive.
9. Integrated (1-4 bedroom per dwelling) - five or more dwellings developed as a
economies of scale: capital acquisition cost benefits;
overcomes problems of privacy through physical separation of housing;
opportunity to more efficiently provide support;
access to peer support and networks;
one-bedroom house possibly more appropriate for people with challenging
behaviours to increase privacy for all residents;
integration of people with and without disabilities is essential with this
could have negative implications associated with an image of congregate
care including the potential for institutional behaviour of staff.
10. Large freestanding residence (10-12 bedrooms).
less restrictive option for a specific group of people who have profound
and multiple disabilities and are dependent on ongoing and intensive
medical support and personal care;
only acceptable as a respite facility or as an alternative to residence in a
nursing home or hospital for the above group;
maximum average number of residents with separate bedrooms: 10 –
dormitory accommodation is not acceptable;
provides potential for overnight/weekend stays for families;
issues to lessen institutional image and practice need to be considered;
potential for staff to get to know people better.
The Valued Norm proposed a three-year plan to “develop more flexible and
appropriate support and supported accommodation options” and a “framework for
future service development by both the government and non-government
In response to this document, the Disability Council published two companion
papers, Accommodation and Support Options for People with a Disability
(referred to above) and Accommodating People with a Disability, in June 1994.
These publications presented direct consumer as well as parent / carer views on
appropriate accommodation and support options – which, in effect, reinforced
both the “essential criteria” of the 1994 discussion paper and the concept of a
broad range of accommodation options. Additionally, both Disability Council
papers echoed the original CSDA‟s observation that supported accommodation
models should be as flexible as the range of living options available to the
The 2005 discussion paper seeks input from “the full range of stakeholders”. The
Disability Council endorses that objective.
Furthermore, we believe that the views of the government and peak non-
government participants in the workshops associated with The Valued Norm,
together with the views of people with disability as well as carers and parents
presented in Accommodating People with a Disability and Accommodation and
Support Options for People with a Disability, contribute significant input from the
full range of stakeholders. We strongly believe that input remains valid today,
more than ten years later.
The 2005 discussion paper describes ten possible models of supported
accommodation for different population groups, and asks which of them may be
suitable for people with disability. In particular, respondents are asked to
consider the circumstances of people with complex health care needs and
“severe challenging behaviour”.
All of the possible models offered may be defined according to one of several of
the models described in the 1994 discussion paper. The Disability Council is
concerned that more than half of the possible models described in the current
paper could be considered to be variations on a theme of small congregate care
services or “villages”: specifically those of the type associated with St Martin‟s
Court, Kew Residential Services, Matavi Ageing in Place Initiative, Guthrie
House, Abbeyfield Housing and Wintringham.
Such accommodation models may lead to improvements in quality of life (in
comparison with large residential institutions). We are concerned, however, that
models of „congregate care‟ tend to limit social networks to other people with
disability and to support staff within the same service. With this in mind, some of
the cautions originally suggested for the “integrated” and “large freestanding
residence” options in The Valued Norm should be applied, in our view, to the
assessment of possible models set out in the 2005 discussion paper:
there could be negative implications associated with congregate care -
including the potential for institutional behaviour from support staff; and
integration of people with and without disability is essential within such
models in order for them to be acceptable as a modern response to
meeting the diversity of need amongst people with disability.
Finally, a key problem inherent to the approach of the 2005 discussion paper is
that the possible models of accommodation have been put forward with a view to
seeking the „best fit‟ of people with disability (who live in large residential centres
and who have complex medical and/or behavioural needs). We believe this is
the wrong way round: services should fit people rather than squeezing people
into shape to fit services.
The starting point for developing models of support and accommodation ought to
be and analysis of the needs of individuals with disability who have support and
The 1994 discussion paper observed that there could be no approach based on
„one size fits all‟ (or even its many). Instead, the 1994 paper emphasised the
application of Disability Services Standards – especially Individual Needs – in
developing models of supported accommodation. It is the Disability Council‟s
view that the current discussion paper shows insufficiently how the possible
models offered for consideration could have be based on the perceived or
expressed needs of representative groups of people or individuals living in large
residential centres. Nor, we must say, can we see how all of the proposed
models sit comfortably or could be consistent with the Disability Services Act.
Strengths & weaknesses of the models offered for discussion
1. Group Homes
“Manageable” number of people (note however that Disability Council‟s
preferred maximum number is 4)
Paid support staff
Access to day programs for residents
Provision of overnight support
Congregate and segregate people with an intellectual disability
Incompatibility - people live for many years with 3 (or more) people with
whom they may have nothing in common, despite preliminary
functional/behavioural “compatibility” assessments
Sharing of resources can be difficult
Limitations on expression of individuality – services typically operate on
a structured basis, such that residents shop, eat and even recreate
Needs of the group take priority over the needs of the individual
Fixed routines could lead to unhappiness in their living environments
and perpetuate behaviour problems
The Disability Council acknowledges that several of the models are
designed for older people, who have limited resources and are making a
conscious decision to balance their independence with the company
and security of living with their peers. These are not people who have
spent most of their lives in institutions, or people who have no
experience of alternatives. The Disability Council believes that the
possible disadvantages of small group home accommodation will apply
to all proposed models where people with disability live in congregate
2. Community Living Model (St Martin’s Court type)
Community living model preferred to nursing home care
Refurbished to meet the needs of residents
Individual courtyard gardens with communal gardens – mix of private
and shared space
Onsite live-in manager and organised coordinated care
Tenants individually lease their units – rent assistance available
There is no mention of
Ratio of disability to non-disability
Access to amenities
Maintenance of social networks
Noise transfer issues
Free-standing dwellings, units and villas
mix of government and private ownership
assistance is based on an individual support plan
Crisis accommodation system
Transitional support (may also be considered as an benefit)
May not meet the person‟s needs in terms of location, size or
4. Kew Cottages type
men with similar support needs co-located
Individual program plans were developed
Teaching skills and increasing community integration
Staffing practices and models ensure adequate staffing levels, and
Effective internal and external communication systems, including
house meetings & quarterly newsletters
Full time attendance at community-based day programs for all the
Family contact –family members expected to be involved in the
development of individual program plans
Behaviour intervention strategy team provided staff support
24 hour care and supervision, including access to medical and dental
services and day activities
3 -5 people in purpose built houses
Ownership by the government
5. Floating Care
Case manager co-ordinates a tailored package of care and support
private rental accommodation that suits the individual
Presumes a high level of functional independence, which is shown by
demonstrable evidence of real people living in the community not to be
6. Matavi type
Apparently suits frail older people with complex needs
Conversion of one floor for all residents, to reduce social isolation -
each resident has his or her own self-contained unit
Clients are tenants
Cost effective delivery of support services
Communal space – dining room, sitting room, kitchen and laundry
Pooling of support hours to increase hours of care
Access to emergency response call system
Regularly reviewed, individual assessment and care management plan
Personal care, home help, laundry, shopping, transport, social and
emotional support and help with personal affairs
Focus is on accommodation rather than individual needs
7. Guthrie House type
Residential accommodation for women with children
24 hour support and supervision
A “transitional” service, with access to social work, case management,
individual counselling, living skills training, information and education
sessions, recreational outings, and assistance with appropriate post
Short term – what follow-up is available, apart from arranging “post
Communal kitchen and recreational facilities
Fully accessible, purpose-built villas
Mix of 1 and 2 bedrooms
Tenants have input into the design
A range of services is provided according to the needs of the tenant,
and organised independently
Properties are funded by the NSW Department of Housing, which
leases the properties to the cooperative
Major capital works are paid for by the Department of Housing
Tenant cooperatives receive training and support
Relies on ability of individuals to source and manage care
9. Abbeyfield type
Supportive group accommodation
10 people and a housekeeper - provides companionship and security
in a small group
Private bed-sitting room with ensuite
Residents have their own keys, and there is no entry without the
The live-in housekeeper is available at night
The housekeeper prepares the 2 main meals & served them in a
communal dining room
Residents take responsibility for their own breakfasts, cleaning and
HACC services are available
1 or 2 houses are joined & set in their own gardens
established and operated by community based non-profit volunteer
groups – responsible for the day to day operation of the house and the
well being of residents and staff
residents participate in management and decision making
Shared facilities – living areas, the kitchen, garden, laundry and guest
Congregate setting in what could be termed a „mini-institution‟.
10. Wintringham type
Self-care units where residents are assisted to access health and other
support services; higher level care available
24 one-bedroom apartments, spread over 3 stories
Congregate setting in what could be termed a „medium-sized
Other accommodation models suggested by Councillors
The following brief descriptions apply to accommodation models that are worthy
of consideration by the Department. Two are currently operating in NSW.
Each model is characterised by a clear focus on individual needs, and provision
of appropriate supports is critical to its success. The services are described in
detail (including contact information) in the Coalition Against Segregated Living‟s
Challenging Institutions: Community Living for People with Ongoing Needs8.
Hornsby Challenge has developed a broad range of accommodation options
required to meet the needs of a diverse group of people, for example:
Groups of three people living together
Sharing with another person without a disability
Sharing with a person with a disability
Living in a family home
Supporting people who need nursing home care
A series of attitudinal and structural changes typify this approach, including
Considering what works best for each person
Not being constrained by past or current options available
Adopting flexible service structures and staffing
Flattening management structures
Maintaining flexibility in provision of housing
Separating housing and support issues
Making efficient and effective use of resources
Focussing on skill-development
Using generic services as far as possible
Enlisting the support of family and friends
To provide support for people who presented with “severe challenging
behaviour”, Hornsby Challenge has developed a holistic approach to behaviour
Coalition Against Segregated Living (2000). Challenging Institutions: Community Living for people with
Ongoing Needs (URL
Hornsby Challenge staff believed that the people they were supporting were not
developing social networks and were in danger of becoming isolated.
Establish the person‟s interests
Research these interests
Contact & visit a local group relevant to the interest
Go with the person to the local group and facilitate interaction
Withdraw from the group when internal supports are established
Provides family style homes & “lifestyle” support to people with a disability, using
households & independent flats.
A number of L‟Arche homes are established in a neighbourhood. Within this
community, residents are encouraged to build their living skills in areas such as
group living, work, recreation, and health.
The people with disability - and a support team of assistants, or support staff and
volunteers - live and work alongside each other, with the explicit aim of ensuring
the health and well being of all who live in the community.
Support is provided for personal skills, with the intention that people will access
the wider community, including the workforce.
Newfoundland – Canada
This deinstitutionalisation project had a partnership between two levels of
government – Canada and Newfoundland and two levels of voluntary sector.
Each person with a disability has maximum input into the planning process: their
needs and wants are central to the planning process.
Newfoundland was committed to providing range of alternative accommodation
to match accommodation to individual needs, including:
rental housing (individually and shared)
individualised living arrangements – eg a support worker‟s apartment was
attached to a home; a new family home was found for one person, to
facilitate her to live with her parents
four person group homes
The “discharge plan” included
o Pre planning: identifying individual likes and dislikes, abilities,
challenges and aspirations
o Community based individual planning – involved the development
of an individual support team, including families, friends, social
workers, and a support consultant. This team was responsible for
finding housing, employment, educational options; and facilitating
social and leisure needs
It was the aim of the project that each individual should have a natural network of
family and friends in the community.
Behaviour management specialists were employed to provide advice to the
individual support teams and to help in the development of behaviour strategies
to minimise challenging behaviours
New Hampshire – USA
12 agencies integrated to provide community based services: case management,
family support services and respite.
Private vendors were contracted to provide accommodation in 3-4 bedroom
Individual support systems were developed with a focus on quality of life issues.
Properties are owned or rented.
Behavioural support is provided that focuses on what the individual is trying to
communicate – it is assumed that much “challenging behaviour” occurs in lieu of
other forms of communication.
There is no commitment to any one “preferred” model of service delivery; service
systems are adapted to meet individual, ongoing needs.
Purpose-built accommodation is believed to be “inflexible”.
A group housing accommodation model: 5 houses and 3 flats, each
accommodating 4 – 6 people.
Paid support staff provide individual planning and individual teaching, with a
keyworker for each person.
Access to social workers and psychologists, and volunteers.
Focus on increasing family and/or social contact.
The service is not exclusively for people with disability.
A range of accommodation and support models must be considered for people
with disability who are currently long-term institutional residents and who have
complex medical and/or behavioural needs. This is no less true for people with
disability who are already living in the community.
It is inappropriate to begin by considering the applicability of existing service
models to the population of people with disability currently in large residential
centres, without identifying first their specific, individual needs and aspirations
based upon informed choice.
It is possible that purpose built accommodation will be required and, to avoid the
“inflexibility” of such accommodation suggested by the New Hampshire project
(above), we strongly recommend that it should be built according to the principles
of universal housing design. Indeed that recommendation extends to all new
dwellings, of any type, regardless of the support and intervention that may or may
not be required by prospective occupants.
It is important, therefore, that the Department works in partnership with housing
agencies to maximize accommodation options, as has been emphasised in the
State Government‟s existing Disability Policy Framework9. Importantly, we note,
the Disability Policy Framework also stresses that service planners must
accommodate the specific religious, cultural and linguistic needs of individuals10.
Quite apart from the discussion above of possible models of accommodation, the
Disability Council believes that there is an urgent need to maintain and
improve the physical environment for people who continue to live in large
residential centres, until such time as the process of devolution is completed.
The 1997 Performance Audit Report warned that:
There is now the danger that in these institutions, which are
marked for transition to community based facilities, the
services and protection will continue to decline due to the
lack of attention and funding, thus further aggravating the
poor state of affairs. It is for this reason staff in the centres
say “close us down, don’t run us down”11.
Op cit, p 6
Op cit, p ii
The Disability Council visited a large residential centre during 2004 and noted
that in some residential units, living conditions could only be described as
Is the Disability Policy Framework the “framework for future service development”
promised in the 1994 discussion paper? The DPF does not refer to The Valued
Norm; it does however have the stated objective of developing a co-ordinated
approach across Government to the planning of accommodation and support
services to people with disability12.
This objective notwithstanding, it appears to us to be the case that, in the ten or
more years since Disability Council was first consulted about appropriate models
of accommodation, the plan to “develop more flexible and appropriate support
and supported accommodation options” did not eventuate and, instead,
infrastructure and support for people still living in large residential centres has
dwindled to the point where the Audit Office‟s fears have been realised.
We remain hopeful, nevertheless, that a consensus can be built around a more
positive future for people with disability with support needs to enable them to live,
participate in and contribute to the socially rich and culturally diverse
communities of NSW, now and in the future. Andrew Buchanan,
Chairman, Disability Council of NSW
Chairman, Disability Council of NSW
Op cit, p 9