Presentation Transcript

1. Personalisation & life in the Community – Ireland in comparative context

   Dr Andrew Power Centre for Disability Law & Policy
2. A Life in the Community
3. Individualised Model – the building blocks Personalisation & Recovery models: – Self-determination, person centred support & individualised funding Self-determination – giving people more choice in their own living arrangements, to move beyond what service they need, towards supporting what kind of life they want. Challenge – To kick-start and sustain this change, countries are having to radically readjust their welfare states and community care law and policy.
4. Comparative Perspectives: - Self-determining Support in the US Long history of de-institutionalisation & move towards self-determination California’s Individual Care Budgets (post WWII) Katie Beckett HCBS waivers Olmstead vs. L.C. - Federal ‘New Freedom Initiative’ Demonstration Projects for intellectual disability: RWJF & C&C Independence Plus initiative US Model Medicaid dollars go to individual (e.g. IRIS in Wisconsin) Fiscal Intermediary & Independent Consultant Individual Budget Allocation (e.g. DOORS model in Wyoming)
5. New Support Models Examples of New Support Models: ARISE CIL, IRIS (Include, Respect, I Self-Direct), Wisconsin
6. Self-determining Support in the US Lessons & challenges Families resistance to being left with care management and the need for independent support Very prescriptive spending options in some States Staff challenges – driving down the cost of care
7. Self-determining Support in Canada Policy Climate in BC Woodlands Parents Group in the 1977 Community Living Society (CLS) - independent brokerage agency to assist individuals to leave Woodlands Community Brokerage Services Society (1991 and 1996) for adults with developmental disabilities Community Living British Columbia (CLBC) BC Model: Facilitator/Brokerage Model (e.g. CLBC facilitators) Choice between Individualised Budget or Transfer Payment Agency
8. New Support Models Examples of New Support Models: Community Living St. Mary’s, Ontario Options, Ontario PLAN Institute, BC
9. Self-determining Support in Canada Lessons & challenges: Over 30 years of experience in developing self-determination Importance of facilitation Need to offer both models Importance of Community Connecting
10. Self-determining Support in the UK UK Policy Climate: Beveridge NHS Act – Local Authorities not allowed to make payments to individuals Local Authorities began giving money to CIL’s Community Care Act 1996 – allowed direct payments to be made to individuals UK Model In Control’s Resource Allocation System Independent Living Fund Social Care Budget
11. New Support Models Examples of New Support Models: CILs, Choice Support, MacIntyre, Together, Keyring, Inclusion Glasgow Par-funded through: Commissioned blocks (Social Care Budget) Framework Contracts (Zero Level Contracts) Direct Payments
12. Self-determining Support in the UK Lessons & challenges: Treasury financial savings led? People falling between the cracks Quasi-Markets: Continuum of care can be disrupted Competition varies across Local Authorities
13. 4. Ireland’s Disability Support Model Ireland’s ‘relaxed control’ model: De-centralisation HSEAs Non-profit sector Autonomy 5 year Service Agreements Accountability Little or no standards Extent of self-determination: 6 bands of ‘individualised funding’ based on level of disability in Service agreements Grass-roots provider led unbundling of group support
14. Local Innovations New Options Alliance Alliance of Providers (feedback, troubleshooting, leading change) Western Care Carving out individual support arrangements from block funding Sunbeam House Audit of Community Groups Brothers of Charity Contract Families Model ‘Paid Volunteering’ for family home sharing