A review into transitional accommodation for people with disabilities who have been discharged from hospital has found some people are getting stuck at facilities almost permanently, amid reports from patients that they are receiving substandard care.
The State Government ordered a review of the Transition to Home facilities after multiple complaints, including the case of a man known as "Mr D" who was found by ambulance staff in squalid conditions with an infected wound.
Mr D was at a Hampstead facility that has since closed, but the remaining Transition to Home programs at The Repat and St Margaret's Rehabilitation Hospital have also come under fire for a lack of care, with allegations clients have been left to soil themselves in their wheelchairs.
Last week, the ABC revealed multiple complaints from patients at the Repat Health Precinct, including allegations that patients were being left in their own faeces and had been given the incorrect doses of medication.
Originally designed to help NDIS clients stuck in hospital waiting for support to return home or to permanent accommodation, the independent report has found clients were being referred to the service without a discharge pathway, "resulting in clients being admitted whose length of stay in T2H will most likely be static, long stay or permanent."
It found while the expected length of stay in a T2H facility was 90 days, the average length of stay was 207 days. As of June this year the longest stay was 536 days.
Staff and clients told the reviewers that in some cases clients were waiting on simple home modifications, but NDIS requirements to get three quotes, combined with the post COVID-19 market was leading to delays.
Major facility misunderstanding
The report found the centres were designed to operate as step-down facilities, but there were frequent misunderstandings with clients who expect ongoing hospital-level care, a situation exacerbated by their location in a hospital setting.
While both facilities were supposed to be a home-like environment, the report found they had significant limitations including shared rooms with just curtains to separate clients, a lack of storage, limited access to outdoor areas and a lack of amenities like kitchen and laundry facilities.
The so-called "Robust Unit" at The Repat was singled out.
"The new Robust Units … are stark and confronting, and the current bright white colour and fit out are unlikely to contribute to calming a person with challenging behaviour," the report found.
It found St Margaret's "arrangements are of a much higher standard, although a number of shared rooms impact client privacy and dignity".
The facilities have already been subject to multiple investigations, including internal audits and an inquiry by the Health and Community Services Complaints Commissioner.
But the latest report said, "it became evident during the review that corrective actions by management in response to key reports and investigations lack appropriate timeliness and effective resolution of the gaps and risks that were identified".
That includes a recommendation for a new role of Health Monitor, which still has not been filled because, "the position was advertised and candidates shortlisted, but they then withdrew".
Instead, the Director of Nursing is overseeing the role, making weekly visits to the facilities.
Previous reports also recommended clients whose hygiene needs could not be met in the T2H centres should be transferred to a more appropriate facility, but the latest review found no evidence that was happening.
It found that intake assessments were often incomplete and inconsistent, risk assessments of clients were incomplete and in some cases clients who do not meet the eligibility criteria were still being admitted.
The state government it said was introducing new intake and referral forms, carrying out both scheduled and 'spot check' audits and introducing clearer terms of engagement with NDIS workers who support residents in the facilities.
Human Services Minister Nat Cook said she's long had concerns about the T2H facilities.
"Complaints brought to my attention before and after coming to government showed we need to do better," she said.
"I'm confident that the actions we're taking to address the review's findings will better support staff to provide a consistent quality service."
Ms Cook said she was working towards a future where NDIS clients could leave hospital directly into their own homes.
