Pearls and Irritations

WHAT IS MEANT BY EFFICIENCY IN THE PROVISION OF SERVICES FOR PEOPLE WITH DISABILITIES? IS IT JUST A COVER FOR GREATER STANDARDISATION? 

The State Disability Plan is not the only endorsement of the need to emphasize the individualising of care for people with disabilities. We now hear of a profound development – person-centred planning is said to be the world-wide benchmarked best practice. This involves a highly individualised vision of the person with disabilities and the result is that care needs multiply into a kaleidoscopic variety of individually generated special needs and concerns.

This attempt to generate a sensitive and compassionate approach nevertheless faces an ongoing dilemma. The costs associated with such an approach to provision of disability services continue to outstrip the services that can be provided by the pension. Moreover, the demands (and possibly the false needs as well) that are generated by this latest example of neo-liberal micro-reform of the “disability workplace”, has the effect of further transforming the already precarious environment for care-worker and the client.

I continue to think about what happened at a recent meeting that was convened by my own “service provider” to discuss with us an increase in rent for residents.

At this meeting, we were told of plans to sell the provider’s prime real estate in the Melbourne CBD. A question was asked about the way in which the provider was viewing this sale. The discussion seemed to be suggesting that the sale could assist the provider in overcoming its budget problems. That was why as a corporation it was considering divesting itself of one of its assets.

So the suggestion was put to the provider that if the building in Flinders Street was being sold for budgetary purposes, a small amount of the profit from the sale could be used to help the pensioners among the residents overcome their budget problems that would accrue from an increase in the rent.

After all, the service provider is keen to present itself to the community as an effective not-for-profit company, and so all of its profits are to be ploughed back into the community it is serving. And residents certainly wish to have their part in this community recognised. They are not merely rentiers; they are constitutive of the provider’s “community”.

The assets held by the provider are retained by it to enable the provision of a service it is constituted to provide.

I had assumed all this but those representing the provider’s main office did not seem to get these basic points. Do they understand what a not-for-profit service provider is? I asked myself. They gave the impression that the budgetary problems of the residents were completely different from the financial demands that are upon the provider as these are documented in the company’s official accounts.

And of course, these budget stresses and strains are not exactly the same thing. We residents also have to be responsible for how we manage our finances and that in fact was why we had insisted upon having the conversation in the first place. But just because they are not the same thing, does not mean they are unrelated and their inter-dependence ignored. To dismiss the suggestion that the profits from the sale might be distributed in a way that helped ease the strain on the budgeting of residents, seemed to suggest that the provider’s budget issues are a completely different kind of responsibility to those residents have for their own finances. Moreover, the residents are part of a community comprising themselves and the workers at all levels.

So I guess the result was somewhat inevitable. Disgruntled residents will be left wondering how the sale of this prime real estate shores up the company in a way that will enable top management to be paid at the level to which they have become accustomed. So where will the profits from this sale go? In ensuring the immediate “business prospects” of provider, the company will, I guess, reduce some of its current budget deficit. But at the same time, there is still unrequited budget pressure for residents due to rent increases.

Let me change the topic slightly here and note how in these days of cut-throat public relations, the provider may be confusing the services it provides with replacing proper policy-development with slogans. Let me invent a possible slogan:

ACE DISABILITY SERVICES – We are here to give independent and fulfilling lives to people with physical, intellectual and multiple disabilities. Lovely slogan isn’t it? But then reflect upon the efficiencies that are required in shared supported accommodation like my own. And now look carefully at that phrase: people with physical, intellectual and multiple disabilities. I am not criticizing the ethical intention; I am trying to draw attention to the inner organizational chaos that will result for workers and residents if a facility conflates physical and intellectual disabilities. And who can tell how care for those with “multiple disabilities” can emerge in the midst of such organizational blurring.

There are many residents, perhaps an overwhelming majority of up to 80%, in supported accommodation with some form of intellectual disability. Therefore it can be expected that in shared support accommodation like the place where I reside, that a policy of taking on such high demand people will simply result in a standardization of disability care for many service providers. And don’t get me wrong. Such people are also my neighbours and deserve proper care. But by putting all disability together in one facility, even if there are different classifications on paper in a provider’s policy documents, there will be an inevitable drive toward standardized care and abstract efficiency, that may allow the provider to continue its “service provision” rather than actually looking to the individual care of people with disabilities.

Quite seriously, this is what I fear will happen. Without a rediscovery of how residents are genuine members of the community that the service provider is maintaining, a policy will develop in favour of standardisation over the appropriately differentiated individual care needed for people with disabilities in shared supported accommodation.

Service providers receive much money for the care of people with disabilities. These payments come in the form of funding, government payments, and donations from other for-profit companies and the general public. But among residents of such facilities in the disability sector the suspicion is deeply ingrained that these funds never seem to meet the need for which they were intended. And requiring service provision to be subject to a culture of competitive tendering processes means that what were once not-for-profit bodies are not driven by a non-charitable need to accumulate the accoutrements of “business success” coinciding it seems with the self-serving “need” to provide their own CEOs and senior management with wages or salaries or packages as if “management” is a sphere that floats high well above the reality of the people their company is supporting.

Most people with disabilities are highly individual, not unlike the rest of humanity. And indeed it is from this individuality that life becomes extremely complex. So, when people with disabilities are recognised for their individuality and diverse needs then it becomes apparent what treatment they require. That then is the moment when due respect is needed.

Recently, over the rents, we have witnessed a significant demise in the provider’s ethos; fairness has been jettisoned. This has been a harrowing experience for me. I am yet to feel that I have been treated according to the stated and published goals of the provider. And then when severe disability is added to the mix of this residence, I conclude that the appeals to standardization and the need to run an efficient enterprise are simply ridiculous.

As a resident of the facility supported by this service provider, I am certainly NOT a ’customer’. This word and its usage has passed its “use-by date”. In this context ‘customer’ refers to a person who is vulnerable and inadequate. I am assured of my vulnerability; I quite literally feel it in my bones. But am I inadequate? That is what is being questioned in these efficiency policies? Does one have to be a celebrity like Stephen Hawking before one can qualify for non-stereotyping?

Yes branding costs money, too. But it’s ok if the payoff of new logos is spent beneficially in not-for-profit service management, rather than in making more attractive packages for over the top management. It is surely the responsibility of any company’s management to ensure its good public image. But this is not merely a function of the sales of assets to wipe out a deficit. And appeal to a black ink entry on the bottom line of a company’s account books can always be heralded in way that diverts attention away from the inner organisation dysfunction, if not moral bankruptcy.

Special thanks to Christina Irugalbandara,  Cunxia Li and Bruce Wearne.

For some time now I have been discussing my deep concerns about the way my support facility is managed with Bruce Wearne who helps me by smoothing my English for publication. In this latest piece, the more we discussed the topic, the more it became obvious that my angle of vision was sharpened by Peter Sember whose encouragement has meant so much to me. He came along to the meeting I describe in this piece. He was the one who set the cat among the pigeons by asking the kinds of questions I now continue to ask in this article. Sadly, he died a short time after going out of his way for me on that occasion and I feel it a great honour to dedicate this article to his memory.

Dr Peter Gibilisco, is Honorary Fellow, University of Melbourne. His new book is ‘The Politics of Disability’.

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