Talento Humano

the NDIS.

In order to make a consistent comparison between the BoD and SDAC data, some alterations to 2009 SDAC estimates were necessary (hence the reported numbers in table 14.5 will differ from those presented in table 14.2).2

Table 14.5 Comparison of 2009 SDAC and BoD dataa

Condition 2009 SDAC Burden of

Disease (inflated to 2009 population) Ratio of BoD estimate to 2009 SDAC estimate (%) Intellectual disability 107 340 249 100 232 Schizophrenia Multiple sclerosis Dementia Epilepsy Parkinson’s disease Huntington’s disease 42 020 21 600 2 570 52 310 3 730 970 82 030 12 570 9 570 46 430 5 780 1 140 195 85 372 89 155 118 Cerebral palsy 15 660 40 080 256 Stroke 30 020 71 380 223 Autism/Asperger’s 53 530 75 260 141

a_{Totals are not comparable because BoD counts multiple health conditions for individuals.}

Source: ABS (2009a); 2003 Burden of Disease (unpublished); ABS (2008d).

Generally speaking, there are large differences between the BoD data and the 2009 SDAC data, with the latter providing a lower estimate. There are several potential reasons for this:

• The 2009 SDAC presents a count of the number of people who list the condition

as their main condition. If all conditions listed by each person were considered the number would be higher.3

• As noted above, random variations are likely to be high in the 2009 ABS SDAC

due to small sample size issues. This may contribute to differences between the estimates.

2 The estimates are for people under the age of 65 years. They include all people who reported the condition in the 2009 SDAC, regardless of the level of functional support need. Functional support need is also used in estimating the number of people in tier 3 and so the numbers presented in table 14.5 will not reconcile to numbers presented in table 14.2.

3 Further analysis will be undertaken for the final report when the 2009 ABS SDAC CURF is made available.

14.12 DISABILITY CARE AND SUPPORT

• There is no information on support need in the BoD data, which therefore is

likely to include people with mild levels of disability, who would not require assistance from the NDIS. This is likely to be a key driver in the large difference in the estimate of people with a disability.

For example, the literature review undertaken for the BoD study indicates that the incidence of intellectual disability is approximately 16.3 per 1000 live births. This is based on data from the Western Australia IDEA (Intellectual Disability Exploring Answers) database 1983–1996. However, not everyone with intellectual disability is likely to require assistance with activities of daily living. Hence, the 249 100 presented in the table is likely to be the upper bound of people with intellectual disability accessing tier 3 supports.

Of the 107 340 people with intellectual disability in the 2009 ABS SDAC, 48 per cent are captured in the daily need for assistance group and a further 47 per cent are captured in the intellectual disability group (that is, people with intellectual disability who do not have a daily need for assistance with core activities but have a disability and are restricted in schooling/employment). The scenario analysis in section 14.6 assumes that the number of people in the intellectual disability group is 197 640 people (people with intellectual disability, less those with daily needs with core activities) rather than the 50 320 people captured in the 2009 SDAC.4 _{As mentioned previously, this is likely to be the upper}

bound of the intellectual disability group and overall the impact on cost is not significant reflecting the relatively low level of supports required.

14.4 Costs

This section presents the annual costs of different supports for people in tier 3. Four categories are discussed below in detail — care and support, aids and appliances, home modifications and transport. For each group in tier 3, the number of people accessing the different services is calculated and an annual cost is assigned to each support (figure 14.1). A range of annual costs is presented for each support type due to the high uncertainty in the costings. As mentioned previously, no specific data source provided the information required to cost the NDIS accurately. A variety of different sources were used to estimate annual costs (these data sources are listed in section 14.2).

4 The estimate of the number of people with intellectual disability in the BoD study is 249 100. The estimate of the number of people in intellectual disability group using the 2009 SDAC is 50 320. However, 51 460 people with an intellectual disability group were captured in the ‘daily need for assistance with core activity group’. Hence, the 249 100 BoD estimate was reduced by 51 460 (to 197 640) so there was no double-counting.

COSTS OF THE SCHEME

14.13

Figure 14.1 Costing methodology

Daily need with core activities (People=226,790) Intellectual disability (People=50,320) Early intervention (People=81,740)

Care and support

1. Number of people in each severity level More than six times a day

Three to five times a day Twice a day

Once a day

2. Average cost of each severity level

3. Total cost = number of people in each severity group

x annual cost of each severity group Care and support Number of people

x annual cost

Aids and appliances Number of people needing

aids/appliances x annual cost of aids/appliances Home modifications Number of people who have

had their dwelling modified x annual cost of home mods

Transport Number of people who cannot use public transport

x annual cost of transport

Care and support Number of people x annual cost of

care and support Aids and appliances_{Number of people} needing aids/appliances x annual cost of aids/appliances Home modifications Number of people

who have had their dwelling modified

x annual cost

Transport Number of people who cannot use public transport

x annual cost of transport Aids and appliances

Number of people needing aids/appliances x annual cost of aids/appliances

Home modifications Number of people who have

had their dwelling modified x annual cost of home mods

Transport Number of people who cannot use public transport

x annual cost of transport

Care and support

Care and support covers a range of formal services, including attendant care, accommodation support, nursing care, day programs, therapy, domestic assistance and meal preparation. These supports are not costed separately. Rather, different

14.14 DISABILITY CARE AND SUPPORT

average annual costs are assigned to different severity levels, from which a package of care and support would be developed for the individual.

Within tier 3 a severity distribution of need was developed based on SDAC respondents on the frequency of need for assistance with core activities (discussed in section 14.3). Unfortunately there is no direct mapping from these responses to hours of care and support appropriately needed per day. The estimated annual costs for each severity group are derived from the estimated hourly cost of care and support and the assumed number of hours per day of care and support needed (table 14.6). This annual cost was cross-checked against current disability support packages for reasonableness (for example, the annual cost of people who require assistance more than six times a day is reflective of the cost of people in group homes). It is important to note that all annual costs in this chapter represent an average cost for the group. Some people will receive more than this average cost and others less, depending on their assessed need. Further, attendant care accounts for about 80 per cent of the total cost of comparable schemes. Hence wage rates are the principal driver of total cost. The range identified in our estimates overwhelmingly reflects the uncertainty about future wage rates.

Table 14.6 Care and support annual unit costs

Hours Hourly cost Annual cost

0–14

years 14–49 years 50–64 years 0–14 years 14–49 years 50–64 years

Hours $ $ $ $ $ $

Daily need with core activities

more than six times a day

8 39–49 39–49 39–49 34 100–42 600 113 500– 141 900

113 500–141 900

three to five times a day 4 36–45 36–45 36–45 15 800–19 700 52 600–65 700 52 600–65 700 twice a day 2 36–45 36–45 36–45 7 900–9 900 26 300–32 900 26 300–32 900 once a day 1 36–45 36–45 36–45 3 900–4 900 13 100–16 400 13 100–16 400 Intellectual disability 2 300–3 000 7 500–10 000 7 500–10 000 Early intervention 7 500–10 000 7 500–10 000 7 500–10 000

Source: Unpublished data from the NSW LTCSA and SCRGSP (2011) — average cost per person receiving supports.

The following should be noted with regard to the annual unit costs:

• The annual costs per person presented are consistent with the average per person

costs of current disability supports. The average cost per person in Australia for accommodation support is $61 000, for community support is $5 500, for