Targeting a Disability Allowance


Written by Margaret Cooper. This article originally appeared in the now defunct Journal, Australian Disability Review, 2-93, pp.73-93. The paper is based on the premise that a carefully targeted component model allowance, to offset the unavoidable costs of disability, is the most cost effective way of relieving the poverty of people with disabilities who have to pay high support costs. Copyright 1993.


Introduction

“The question of additional costs is a very important equity consideration. If people have the same level of income but its real value is reduced by costs which they require to do the ordinary activities which human beings do, then the group with the extra costs are disadvantaged. This becomes a double disadvantage when the cause of the extra costs often means such a person is confined to lower paying employment” said Brian Howe in 1988 as Minister for Social Security.

Disability is the sum of the functional limitations within the individual, which impairs the performance of activities of daily living thereby affecting the individual’s relationship with the physical, economic and social environment.

Support costs are the monies which have to be paid for by a person with disabilities to offset specific impairments. Naturally, support costs vary from individual to individual but categories of costs can be determined for a number of people with similar functional limitations.

Many disability lobby groups, such as Disabled People’s International (Australia) 1990, have advocated for a universal allowance to be paid to all persons with disabilities to partially compensate for financial losses such as reduced housing location choice, reduced access to superannuation and life assurance, and reduced education and employment opportunities.

Cass (1988) also recommended the introduction of a core universal allowance for people of working age “for people who meet a specified level of impairment and are participating in the customary activities of adult life; including employment, education, training, job search, community activity, household and cafing work”.

However during economically difficult times, it is time to look at the introduction of a disability allowance to target primarily those people with disabilities with high support costs who are most at risk financially, that is people between the ages of 21-60 who are living in the community, participating in training or working in paid or unpaid employment.


How do we find those most at risk?

Firstly we can look at available statistics. Using the Australian Bureau of Statistics (1988) definitions of disability, an impairment lasting or likely to last six months, and handicap, a limitation of performing tasks in relation to one or more of the following areas: self care; mobility; verbal communication; schooling; and employment, 2,120,600 Australians declared they were handicapped.

Those actually needing assistance from another person numbered 657,500. A further 607,500 needed human assistance but required some sort of technological aid. So the broad population, with no age limited, within which we have to find a target group totals 1,264,000 persons.

Only 40,000 of these people received services from a disability agency according to Cook (1990). This seems a very low figure.

The National Health Status Indicators (Australian Bureau of Statistics, 1991) gives some slight indication of the diagnoses and numbers of people who may be bearing disability costs. The National Health Status Indicators states 457,900 and 423,800 women, a total of 881,700 persons, reported disability resulting from one or more of the following: paralysis; mental retardation; psychosis; blindness; deafness; asthma; and epilepsy. There are no gradations of these disabilities in the National Health Status Indicators tables which makes the data interesting but not capable of effective comparison with other Australian Bureau of Statistics information.

A factor in determining those people with disabilities at financial risk is finding out whether employment chances are the same as in the non-disabled population.

Paid employment for people reporting handicap was 46% compared with 72% of the general population (Australian Bureau of Statistics, 1988). Women with disabilities are particularly disadvantaged. There is still no affirmative action for women in rehabilitation, or disability employment training schemes. Cass (1988) found that although 9.3% of Commonwealth Employment Service registrants were disabled, only 23.3% of those disabled were women. Crowley (1993) has stated that the Department of Health, Housing, Local Govenment and Community Services “is developing a national action plan aimed at improving services access for women with a disability”.

Until hard data comes in from the 1993 Aged and Disabled Persons Survey one can only speculate whether this recession has meant a lesser number of people with disabilities are employed.

Another indicator of financial need affecting people with high support costs is in place of abode. Unpublished data from Australian Bureau of Statistics (1988) (1) gives a total of 875,500 people who claim handicap as living in households. There is also a difference shown in residential situations for men and women who are disabled and/or handicapped. Women with handicaps are less likely to be home-owners.

Back to the implications of place of abode. More women than men are institutionalised and research on the social and economic pressures which may be behind this gender difference is imperative.

Neilson et al (1990) estimated that 13,500 people with disabilities are institutionalised and another 37,500 people with disabilities lived in the community but required assistance in acquiring more appropriate housing.

Sach (1991) refers to the complexity of factors which prevent people with disabilities from obtaining private or public housing. These include past practices of-

  • institutionalisation;
  • lower participation in the labour force;
  • the lack of personal financial resources;
  • the lack of accommodation support services; and
  • program overlap and confusion.

Another indicator of need is reporting of unmet need for assistance. More handicapped women than men reported to Australian Bureau of Statistics in 1988 their unmet need for help.

Deinstitutionalisation usually is beneficial for people with disabilities however support in the community is underfinanced, (Review of the Home and Community Care Program, 1988) and the daily tasks of caring falls upon the unpaid mother, daughter, sister, niece, cousin or neighbour. In the absence of adequate financial support women are going to continue moving away from the unpaid carer role and take up new paid roles (Watts, 1991). For people with substantial impairments this trend means we have to find some way of paying for the care we need.


Self-Definition as an Alternative to Statistical Guestimates

A second way of finding people with disabilities who are most at risk of not coping with the costs of disabilities, who may leave employment in order to go back onto a Disability Support Pension with full fringe benefits, is to ask those financially disadvantaged by disabilities to define themselves by proving they have ongoing expenditure in certain areas. A medical assessment could establish a threshold level of disability similar to the medical protocol for the Mobility Allowance.


Costs of Disabilities

Using the broad statistical parameters available, people with disabilities can be seen to be financially disadvantaged by having lesser access to employment and housing.

However a universal disability allowance, while acknowledging the disadvantage disability can bring, would not adequately target those most in need. I can only agree with Wightman and Foreman (1991) who state “such a payment would be neither efficient in targeting people with a significant probability of incurring costs, nor equitable in the sense that it distinguishes effectively those with high costs as requiring additional assistance”.

A component model of assessment also allows for differential payment of the Targeted Disability Allowance to allow for the variance of costs from individual to individual.

I suggest that the Targeted Disability Allowance should continue on from principles established under the Child Disability Allowance and the Mobility Allowance. The Targeted Disability Allowance should be non-means tested, reaching the maximum payment only of the applicant demonstrates a threshold level of non-optional ongoing expenditure in all certain cost categories. The Targeted Disability Allowance should consist of:

A Core Component

Eligibility:
People with disabilities with a permanent impairment who can demonstrate ongoing immediate financial loss as a direct result of disability.

Function:
To offset the loss of superannuation and/or life assurance.

Present Schemes:
Disability Support Pension for blind people.

When other costs are incurred by a person with disabilities then that person would be assessed for extra payment according to the following components:

An Independent Living Component

Eligibility:
People with disabilities with a permanent impairment who can demonstrate ongoing expenditure in this area.

Function:
To enable purchase of assistance in housework, house maintenance, gardening, shopping.

Present Schemes:
Some people in some areas may get some help from Home and Community Care financed services.

A Technical Aids and Appliances Component

Eligibility:
People with disabilities with a permanent impairment who can demonstrate ongoing personal expenditure in this area.

Function:
To assist in the purchase and repair of equipment either therapeutic or related to performance of the activities of daily living.

Present Schemes:
Very limited coverage of purchase of some equipment can be obtained under the states run Program of Aids for Disabled Persons. Some continence aids are available through Continence Aids Assistance Scheme.

A Personal Care Component

Eligibility:
People with disabilities who have a permanent impairment who can demonstrate ongoing expenditure in this area.

Function:
To assist in the purchase of personal care services which will include toileting, bathing, and dressing.

Present Schemes:
Very limited schemes operated under the auspice of the National Attendant Care Scheme, and a small number of other accommodation support services funded by Department of Health, Housing and Community Services/Home and Community Care Program.

An Access to Information and Communication Component

Eligibility:
People with disabilities with a permanent impairment who can demonstrate ongoing expenditure in this area.

Function:
To assist in the purchase of services in relation to interaction with other people and retrieval or dissemination of information.

Present Schemes:
Very limited assistance available through service providers of print handicapped clients.

An Extraordinary Health Care Cost Component

Eligibility:
People with disabilities with permanent impairments who have ongoing expenditure in this area which cannot be covered or reimbursed by any existing benefits scheme.

Function:
To assist in the purchase of any health care which is necessary but unavailable without cash outlays by individuals.

Present Schemes:
Very limited reimbursements by some health insurance schemes. Limited taxation concessions for wage and salary eamers. Very limited cover for equipment by state run PADPS.

An Accommodation Component

Eligibility:
People with disabilities who have permanent impairment and who have ongoing expenditure in this area in excess of 30% on income, a pragmatic suggestion for the benefit of low income earners made by Cass (1991:76).

Function:
To assist in rental or purchase of accommodation suitable to the individual’s needs.

Present Schemes:
Nil. As costs of disability vary with the individual’s needs only a threshold level of costs per component area need be determined.


Summary

People with permanent disabilities are financially disadvantaged within Australian society. Asking people with handicap consequent to their disabilities to demonstrate expenditure necessary to offset their disabilities will effectively delineate the target group.

A carefully targeted allowance would ease the ability of this group to maintain their survival in the community and will add to the success of government programs directed by the principles of community participation, deinstitutionalisation and social equity.

A de facto component model may be seen in the 1992 Budget granting to all Mobility Allowance recipients a non-means tested Pharmaceutical Benefit card and access to the Continence Aids Assistance Scheme.


References

Howe, B. (1988) Address to ACROD National Convention, Canberra.

Disabled People’s International, Australia (1990) ‘Income Support for People with Disabilities’, in Strochnetter, C. and Cooper, M. (eds) Policies and Statemeras, DPI(A) monograph.

Cass, B. (1988) ‘Towards Enabling Policies: Income Support for People with Disabilities’, Social Security Review Issues Paper No. 5, Canberra: AGPS.

Cass, B. (1991) ‘The Housing Needs of Women and Children’, Response to the National Housing Strategy, Canberra.

Australian Bureau of Statistics(1988) ‘Disability and Handicap’, ABS catalogue 4120.0, Canberra: AGPS.

Cook, J. (I 990) ‘Lies, Damned Lies and Statistics’, ACROD Newsletter, June-July.

Crowley, R. (Senator) (1993) ‘Personal Communication’, Minister Assisting the Prirne Minister for the Status of Women.

National Health Status Indicators (1991) ‘Table 6: Persons who Reported Recent Illness by Gender’, ABS catalogue 54370.0, Canbeffa: AGPS.

Neilson and Associates (1990) ‘The Housing Impact of Deinstitutionalisation Policies’, in Sach, J. (Ed) The Housing Needs of People with Disabilities, Canberra: AGPS.

Sach, J. (1991) The Housing Needs of People with Disabilities. Report to the National Housing Strategy, Canbeffa: AGPS.

Report of the National Communities’ Consultation (1988) Review of the Home and Community Care Program. Canberra: ACOSS.

Watts, R. (1991) ‘Generous Hands Intervening’, in Batten, R., Weeks, W. and Wilson, J. (eds) Issues Facing Australian Families, Melbourne: Longman Cheshire.

Wightrnan, P. and Foreman, H. (1991) Costs of disability. Social Policy Research Paper No. 59, Canberra: AGPS.