Previous Next

Indigenous Australians and the National Disability Insurance Scheme

3. Disability support services: Indigenous users and barriers to access

Individuals with disability, both Indigenous and non-Indigenous, have general needs which can be met by accessing mainstream services. However, people with severe or profound disability often have unique needs that can more appropriately be met by specialist disability services. The purpose of such services is to support and enhance the participation of individuals with disability in their communities in ways that are most effective for the individual. In particular, the purpose of specialist disability services funded under the National Disability Agreement (NDA) is that ‘people with disability and their carers have an enhanced quality of life and participate as valued members of the community’ (Council of Australian Governments (COAG) n.d.). The NDA was formerly the Commonwealth State/Territory Disability Agreement (CSTDA).

Information on Indigenous persons accessing mainstream disability services can be obtained from the Disability Services National Minimum Data Set (DS NMDS), formerly the CSTDA NMDS, which is held by the Australian Institute of Health and Welfare (AIHW). In this monograph, we focus on differences by State/Territory. However, it should be noted that data from the DS NMDS can potentially be analysed at lower levels of geography. The DS NMDS collects information on services and service users where funding has been provided, during the specified period, by a government organisation operating under the NDA.

As this research presents data collected under both the CSTDA and the NDA, the following terminology will be used:

  • • CSTDA NMDS refers to the National Minimum Data Set for years up to 2008–09
  • • the CSTDA NMDS was renamed the Disability Services National Minimum Data Set (DS NMDS) from 1 July 2009
  • • CSTDA/NDA refers to both agreements under which the data was collected
  • • ‘disability support services’ refers to services provided under both CSTDA and NDA.

Disability service users by geography

In 2009–10 there were 14 251 Indigenous people who used specialist disability services funded under the NDA. However, this figure may be understated because of the high number of service users (16 442) for whom Indigenous status is not stated.

The number of Indigenous service users increased from 7 182 to 14 251 between 2005–06 and 2009–10, with increases in most States and Territories (Fig. 3.1). While there was also an increase in the number of non-Indigenous service users over the period (Fig. 3.2) from 186 805 to 264 331, proportionally a much greater share of service users were identified as Indigenous at the end of the period compared to the start. Part of this is driven by the decrease over this period in the rates of Indigenous status recorded as ‘not stated/not collected’, which have fallen from 10 per cent in 2005–06 to around 5 per cent in 2009–10.

Fig14_NDIS.tif

Fig. 3.1 Disability support services, Indigenous service users, by State/Territory, Australia, 2005–06 to 2009–10a

Service user data are estimates after use of a statistical linkage key to account for individuals who received services from more than one service type outlet during the 12-month period. Data for the Northern Territory was under-enumerated in 2009–10. Please exercise caution when comparing 2009-10 Northern Territory data with data from other years.

Source: AIHW analysis of DS NMDS 2005–06 to 2009–10; see Appendix Table A15.2

The highest proportion of Indigenous service users are aged 25–44 years (29%) followed by those aged 15–24 years (25%) (Table 3.1). The median age of Indigenous users of disability support services is 25 years, compared to 34 years for non-Indigenous Australians.

Fig15_NDIS.tif

Fig. 3.2 Disability support services, non-Indigenous service users, by State/Territory, Australia, 2005–06 to 2009–10a

a. Service user data are estimates after use of a statistical linkage key to account for individuals who received services from more than one service type outlet during the 12 month period.

Source: AIHW analysis of DS NMDS 2005–06 to 2009–10; see Appendix Table A5.18

Table 3.1 Users of disability support services, by Indigenous status and age group, Australia, 2009–10

Age group

Indigenous

Non-Indigenous

Not stated/not collected

Total

Proportion Indigenous (%)a

No.

%

No.

%

No.

%

No.

%

0–4

1 065

7.5

18 290

6.9

888

5.4

20 243

6.9

5.5

5–14

2 471

17.3

32 281

12.2

2 681

16.3

37 433

12.7

7.1

15–24

3 526

24.7

45 718

17.3

2 771

16.9

52 015

17.6

7.2

25–44

4 191

29.4

80 771

30.6

4 043

24.6

89 005

30.2

4.9

45–54

1 691

11.9

43 361

16.4

1 768

10.8

46 820

15.9

3.8

55–64

929

6.5

29 173

11.0

1 400

8.5

31 502

10.7

3.1

65+

378

2.7

14 737

5.6

2 891

17.6

18 006

6.1

2.5

Total

14 251

100

264 331

100

16 442

100

295 024

100

5.1

Median age

25.0

34.0

34.0

33.0

a. The final column gives the proportion of the relevant age group who identify as being Indigenous.

Source: AIHW 2011b; see Appendix Table A5.15

Of all Indigenous service users of disability support services in 2009–10, 39 per cent lived in major cities, compared to 64 per cent of non-Indigenous service users. Around 46 per cent lived in regional areas, and 13 per cent lived in remote or very remote areas (Table 3.2).

Table 3.2 Users of disability support services, by Indigenous status and location, Australia, 2009–10

Remoteness area

Indigenous

Non-Indigenous

Not stated/

not collected

Total

Proportion Indigenous (%)a

No.

%

No.

%

No.

%

No.

%

Major cities

5 550

38.9

170 084

64.3

9 797

59.6

185 430

62.9

3.2

Inner regional

3 828

26.9

62 987

23.8

3 352

20.4

70 167

23.8

5.7

Outer regional

2 743

19.2

23 279

8.8

957

5.8

26 978

9.1

10.5

Remote

877

6.2

2 198

0.8

54

0.3

3 129

1.1

28.5

Very remote

989

6.9

534

0.2

11

0.1

1 533

0.5

64.9

Not stated/not collected

264

1.9

5 249

2.0

2 271

13.8

7 787

2.6

4.8

Total

14 251

100.0

264 331

100.0

16 442

100.0

295 024

100.0

5.1

a. The final column gives the proportion of the relevant age group who identify as being Indigenous.

Source: AIHW analysis of DS NMDS 2009–10; AIHW 2011b

Disability groups

Intellectual disability is the most common primary disability type among Indigenous service users (34%), followed by physical disability (18%) and psychiatric disability (16%). The proportion of disability groups among Indigenous and non-Indigenous Australians was similar except for intellectual which was higher for Indigenous persons (34% compared to 29%) and vision which was lower for Indigenous persons (2% compared to 5% for non-Indigenous) (Table 3.3).

Table 3.3 Characteristics of Indigenous and non-Indigenous service users of disability support services, Australia, 2009–10

Primary disability group

Indigenous

Non-Indigenous

Not stated/

not collected

Total

Proportion Indigenous (%)a

No.

%

No.

%

No.

%

No.

%

Intellectual

4 809

33.7

77 515

29.3

1 467

8.9

83 791

28.4

5.8

Specific learning/ADDb

667

4.7

9 818

3.7

122

0.7

10 607

3.6

6.4

Autism

673

4.7

17 920

6.8

382

2.3

18 975

6.4

3.6

Physical

2 513

17.6

45 244

17.1

759

4.6

48 516

16.4

5.3

Acquired brain injury

772

5.4

10 172

3.8

357

2.2

11 301

3.8

7.1

Neurological

491

3.4

11 845

4.5

464

2.8

12 800

4.3

4.0

Deaf/blind

36

0.3

625

0.2

18

0.1

679

0.2

5.4

Vision

256

1.8

12 119

4.6

2 677

16.3

15 052

5.1

2.1

Hearing

246

1.7

5 498

2.1

702

4.3

6 446

2.2

4.3

Speech

211

1.5

2 968

1.1

133

0.8

3 312

1.1

6.6

Psychiatric

2 258

15.8

47 376

17.9

2 699

16.4

52 333

17.7

4.5

Developmental delay

539

3.8

8 190

3.1

298

1.8

9 027

3.1

6.2

Not stated/not collected

780

5.5

15 041

5.7

6 364

38.7

22 185

7.5

4.9

Total

14 251

100.0

264 331

100.0

16 442

100.0

295 024

100.0

5.1

a. The final column gives the proportion of the relevant age group who identify as being Indigenous.

b. ADD = attention deficit disorder

Source: AIHW analysis of DS NMDS 2009–10; AIHW 2011b

Type of assistance provided

The DS NMDS classifies types of services provided by disability services into five broad categories: community support, community access, accommodation support, respite, and employment. In 2009–10, community support was the most commonly used service type among Indigenous service users (54%), followed by employment support (34%), community access (15%), respite (15%) and accommodation support (14%) (Fig. 3.3).

Fig16_NDIS.tifFig. 3.3 Users of disability support services by type and Indigenous status, Australia, 2009–10a

a. Service user data are estimates after use of a statistical linkage key to account for individuals who use more than one service.

Source: AIHW analysis of DS NMDS 2009–10; see Appendix Table A5.13

Community support services include individual therapy, early childhood intervention, case management, behaviour management and counselling. Case management was the main community support service used by Indigenous service users at a rate of 29 per cent, followed by therapy support at 12 per cent (see Appendix Table A5.15). Case management is used in care planning and/or to facilitate access to appropriate services.

Community access services include learning/life skills development, recreation/holiday programs and other community access. Indigenous service users used learning/life skills development at a rate of 12 per cent, and used other community access at a rate of 4 per cent.

Respite services include centre-based services, flexible respite, and own home/host family and other respite. Flexible respite was the main community respite service used by Indigenous Australians at 10 per cent, which was higher than for non-Indigenous service users (7%).

Accommodation support services include residential institutions, hostels and group homes; personal care and in-home support; and alternative family placement and other accommodation services. Personal care and in-home support was the most common accommodation support service used by Indigenous Australians, which was slightly higher than for non-Indigenous service users (8% compared to 7% respectively). Use of residential institutions, hostels and group homes by Indigenous Australians was slightly lower than for non-Indigenous service users (5% compared to 6%) (Appendix Table A5.14).

Employment services include open employment services which assist people with disability to find or retain employment in the open job market. Almost one-third (30%) of Indigenous service users received open employment services compared with 36 per cent of non-Indigenous users.

The proportion of Indigenous users accessing accommodation support and community access has decreased over the past five years, while use of employment services has increased. In 2008–09, there was an increase in respite use, although the overall trend of this service use is downward (Fig. 3.4).

Fig17_NDIS.tifFig. 3.4 Indigenous users of disability support services, by type, Australia, 2005–06 to 2009–10a

a. Service user data are estimates after use of a statistical linkage key to account for individuals who use more than one service.

Source: AIHW analysis of DS NMDS 2005–06, 2007–08, 2008–09, 2009–10; see Appendix Table A5.16

Amount of assistance provided by disability support services

In 2009–10, the average number of hours of assistance provided to Indigenous disability support service users was very similar to that which was provided to non-Indigenous users (13.3 and 12.8 hours respectively). However, the amount of assistance provided to Indigenous and non-Indigenous users varied by service type. For example, 41 mean hours were provided to Indigenous users in accommodation support, more than 1.5 times higher than that provided to non-Indigenous users (26 hours) (see Appendix Table A5.17).

Average hours of support received by Indigenous users varied across remoteness categories in each of the service groups, while the amount of assistance received by non-Indigenous users was relatively consistent across remoteness categories. Average hours of respite assistance provided to Indigenous users varied from 6.7 hours in remote/very remote areas to 9 hours in major city areas. Non-Indigenous users received an average of 8.5 hours of respite assistance. Accommodation support assistance for Indigenous users was the highest in Outer Regional areas with the mean of 48 hours. This assistance for non-Indigenous users was the highest in remote/very remote areas, with a mean of 30 hours (see Appendix Table A5.17).

Income and employment status of Indigenous specialist disability service users

In 2009–10, the main income source for the majority of Indigenous disability support service users aged 16 years and over was from a disability support pension (60.1%). This was followed by ‘other pension/benefit’ (21.9%) and paid employment (5.1%), while 3.5 per cent had no source of income (see Appendix Table A5.18). Approximately 19.7 per cent of Indigenous service users aged 15 years and over were employed, 37.5 per cent were unemployed, and 36.9 per cent were not in the labour force (see Appendix Table A5.18).

Met need for disability support services

Information on the rate of Indigenous people with disability receiving disability services has been estimated by the AIHW for the years 2007–09 onwards by applying rates of profound/severe disability from the SDAC to Indigenous population projections in order to derive a ‘potential population’ of Indigenous persons with disability. These data have been used to report against the Performance benchmark in the National Disability Agreement which seeks ‘[a]n increase in the proportion of Indigenous people with disability receiving disability services’.

Rates of disability service use per potential population are estimated for persons aged 0–64 years, as this is considered to be the target population of persons accessing disability support services. Persons with disability aged 65 years and over will mostly access aged-care services for support.

The AIHW reports that in 2011 there were 413 Indigenous service users per 1 000 potential population, compared with 382 non-Indigenous service users per 1 000 potential population for 2009–10. While this suggests that overall the relative level of Indigenous access was commensurate with the non-Indigenous population this result does not appear to be consistent across the population. In particular, as discussed later, this appears to be primarily driven by outcomes for the 15–24 year age group, with all other age groups showing relatively lower rates of Indigenous access.

Further analysis of service data against potential population estimates reveals some State/Territory based variations, although caution should be exercised in interpreting these data as service models vary across jurisdictions and may affect comparability.

Data for 2009–10 suggest that while New South Wales and Queensland have the largest populations of Indigenous people with severe or profound core activity limitations, according to the potential population estimates their rates of service provision to Indigenous service users per 1 000 population fall slightly below the Australian average. Indigenous under-identification may have influenced this rate, as the number of service users with Indigenous status recorded as ‘not stated/not collected’ is over 2 000 in New South Wales and around 1 000 in Queensland. Victoria has the highest rate of Indigenous persons with disability using disability support services, at close to 100 per cent of the potential disability population, while Tasmania has the lowest. Rates for Indigenous service use by potential population are higher than the non-Indigenous population in all States and Territories, except in Tasmania (Fig. 3.5).

Fig18_NDIS.tifFig. 3.5 Users of disability support services by Indigenous status and State/Territory, aged 0–64 years, Australia, 2009–10a

a. Service models vary across jurisdiction and may affect comparability of data.

Source: AIHW analysis of DS NMDS 2009–10; see Appendix Table A5.19

An increase in the proportion of Indigenous people with disability receiving services occurred in every State and Territory of Australia in the previous five years, except South Australia and the Northern Territory. A large increase was recorded in the Australian Capital Territory in 2009–10 (Fig. 3.6).

Fig19_NDIS.tif

Fig. 3.6 Indigenous users of disability support services by State/Territory, aged 0–64 years, Australia, 2005–06 to 2009–10a

a. Service models vary across jurisdiction and may affect comparability of data.

Source: AIHW analysis of CSTDA NMDS 2007–08, 2008–09, DS NMDS 2009–10; see Appendix Table A5.19

The rate of service use for both Indigenous and non-Indigenous Australians with disability was highest for the 15–24 year age group (102% for Indigenous and 86% for non-Indigenous: note that rates of service use may exceed 100% where some users of services are not identified as having a severe or profound core activity limitation, or where errors have been made in the recording of Indigenous status or age). Service use was lowest among those aged 55–64 years (15% for Indigenous and 16% for non-Indigenous) (Table 3.4). As has been noted previously, while the service rate for Indigenous Australians is above that of non-Indigenous Australians this is driven by the result for the 15–24 age group, with all of the other age groups showing a lower service rate for the Indigenous population relative to need.

Table 3.4 Disability service use rates for persons aged 0–64 years, by age group and Indigenous status, Australia, 2009–10a

Age group

Indigenous Australians

Non-Indigenous Australians

Potential populationb

Service users

Service rate (%)c

Potential population

Service users

Service rate (%)

0–4

1 992

1 065

53.5

29 779

18 290

61.4

5–14

8 364

2 471

29.5

125 215

32 281

25.8

15–24

3 471

3 526

101.6

53 462

45 718

85.5

25–34

3 029

2 027

66.9

58 535

39 320

67.2

35–44

4 743

2 164

45.6

82 751

41 451

50.1

45–54

5 885

1 691

28.7

120 836

43 361

35.9

55–64

6 081

929

15.3

182 991

29 173

15.9

Total (0–64)

33 566

13 873

41.3

653 569

249 594

38.2

a. The term ‘Indigenous’ refers to service users who identified as Aboriginal and/or Torres Strait Islander people. ‘Non-Indigenous’ refers to service users who reported not being of Aboriginal or Torres Strait Islander background.

b. Indigenous potential population estimates are experimental. Indigenous potential population estimates are calculated by applying Indigenous/non-Indigenous sex and 10-year age group rates of severe/profound disability in each State/Territory from the Survey of Disability and Carers (SDAC) 2003 to Indigenous and non-Indigenous population projection data for 2008 in each State/Territory by sex and 10-year age group for people aged 0–64. Indigenous population figures are based on ABS Series B projections of the Indigenous population by State/Territory for June 2008 (ABS 2009a).

c. Rates of service use may exceed 100% where some users of services are not identified as having a severe or profound core activity limitation, or where errors have been made in the recording of Indigenous status or age.

Source: AIHW analysis of NDA NMDS 2009–10 (AIHW 2011b); revised ABS Series B projections of the Indigenous population by State/Territory for June 2009 (ABS 2009a)

In 2009–10, access to disability support services by Indigenous persons with disability were lowest in major cities (285 per 1 000 population), and highest in outer regional/remote/very remote areas (626 per 1 000 population). The access rate has consistently increased in all remoteness areas over the last five years (Fig. 3.7).

Fig20_NDIS.tif

Fig. 3.7 Indigenous users of disability support services, by Indigenous status and remoteness, aged 0–64 years, Australia, 2005–06 to 2009–10a

a. Service models vary across jurisdiction and may affect comparability of data.

Source: AIHW analysis of CSTDA NMDS 2007–08, 2008–09, DS NMDS 2009–10; see Appendix Table A5.20

Barriers to accessing services

This section examines the information available on the extent to which Indigenous persons with disability report problems accessing services, and if they do experience problems, the reasons for this and whether this varies according to geographic remoteness.

The 2008 NATSISS included a question concerning whether the respondent had problems accessing selected services for persons aged 15 years and over. Examples of services include doctors, dentists, hospitals, employment services, Centrelink, banks and other financial institutions, Medicare, mental health services and other services. While the GSS lists disability services as a separate category, the NATSISS does not (disability services is likely to fall under the category ‘other services’). Respondents were also asked about types of barriers to accessing services such as transport/distance and cost.

The 2008 NATSISS found that nearly half of Indigenous Australians with severe or profound core activity limitations identified having problems accessing service providers (Table 3.5). The 2006 GSS found that almost half of all Australians with severe or profound disability were experiencing problems accessing services (Table 3.6).

Table 3.5 Problems accessing service providers, Indigenous Australians aged 18–64 years, by disability, Australia, 2008a

People with severe or profound core activity limitations (%)

People with no disability or long-term health condition (%)

Had problems

46

27

Did not have problems

54

73

Total (no.)

20 722

135 441

a. 2008 NATSISS included remote, very remote and indigenous communities, but excluded special dwellings where higher proportions of people with severe and profound disability may be located.

Source: AIHW 2011b: Table A9

Table 3.6 Problems accessing service providers, all Australians aged 18–64 years, by disability, 2006a

People with severe or profound core activity limitations (%)

People with no disability or long-term health condition (%)

Had problems

46

27

Did not have problems

54

73

Total (no.)

20 722

135 441

a. 2006 GSS excluded very remote and sparsely settled areas and excluded special dwellings where higher proportions of people with severe or profound disability may be found.

Source: AIHW 2011b: Table A10

Table 3.7 shows that the proportion of Indigenous people who had problems accessing services varied by age group and disability status. Those aged 25–34 years and 35–44 years were most likely to experience problems accessing services, regardless of their disability status. However ‘problems accessing services’ was more commonly reported by persons aged 15–24 years with a profound or severe core activity limitation than by persons of the same age with any type of disability, or no disability or long-term health condition (more than 50%).

Table 3.7 Problems accessing services, Indigenous persons aged 15 years and over, by age group, Australia, 2008a

Age group

15–24

25–34

35–44

45–54

55+

Total

Has profound or severe core-activity limitation

Had problems accessing services

44.9

50.2

52.7

44.2

35.0

43.8

Did not have problems accessing services

55.1

49.8

47.3

55.8

65.0

56.2

Total

100.0

100.0

100.0

100.0

100.0

100.0

Total with disability or long-term health condition

Had problems accessing services

30.8

41.1

40.2

36.5

31.4

35.8

Did not have problems accessing services

69.2

58.9

59.8

63.5

68.6

64.2

Total

100.0

100.0

100.0

100.0

100.0

100.0

Has no disability or long-term health condition

Had problems accessing services

18.3

28.6

29.0

26.9

26.0

24.1

Did not have problems accessing services

81.7

71.4

71.0

73.1

74.0

75.9

Total

100.0

100.0

100.0

100.0

100.0

100.0

a. 2008 NATSISS included remote, very remote and indigenous communities but excluded special dwellings where higher proportions of people with severe and profound disability may be found.

Source: AIHW analysis of ABS 2008 NATSISS (unpublished)

Information on the extent to which Indigenous people report a range of barriers to accessing services is provided in Fig. 3.8. It demonstrates how this varies according to geographic remoteness and whether a person has a severe or profound core activity limitation (labelled as a ‘disability’ in Fig. 3.8).

In remote areas, the barriers to accessing services most commonly reported by those with disability are ‘no services in the area’ (25%) or ‘not enough services in the area’ (24%), transport/distance (21%), and ‘waiting time too long or not available at time required’ (20%). These barriers to accessing services were also the most commonly reported by people without disability (Fig. 3.9). In non-remote areas, waiting time too long (18%) and cost of service (12%) were the most commonly reported barrier to accessing services by Indigenous people with disability. Indigenous persons with disability or long-term health condition were twice as likely to report services as not being culturally appropriate and discrimination as barriers to accessing services, as Indigenous persons without disability: 3 per cent compared to 1.5 per cent for services not culturally appropriate and 1.9 per cent compared to 0.7 per cent for treated badly/discrimination.

The 2004–05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) collected data on whether Indigenous persons needed to access particular health services (dentists, doctors, other health professionals, hospitals) and did not do so in the last 12 months, and the reasons for not accessing these services when needed. Similar to data collected for the NATSISS, the most common service Indigenous people needed to access but did not was a dentist. The most common reasons for not accessing a dental service was cost and waiting time or service not available at time of request.

The most common reasons reported by Indigenous Australians for not accessing a doctor or other health professional were being too busy with work; personal or family responsibilities; and cost. A large proportion of Indigenous people who did not access a hospital when needed reported reasons related to dislike for the service or professional, and being afraid or embarrassed (see Appendix Table A5.22).

Fig22_NDIS.tif

Fig. 3.8 Type of barrier to access service, Indigenous persons aged 15 years and over, by presence of a disability and remoteness, Australia, 2008

Source: AIHW analysis of 2008 NATSISS; see Appendix Table A5.22

Fig21_NDIS.tifFig. 3.9 Access problem to type of service, Indigenous persons aged 15 years and over, by presence of a disability and remoteness, Australia, 2008

Source: NATSISS 2008: see Appendix Table A5.21


Previous Next