Here is what happens when the profit motive drives the delivery of human services

photo courtesy of Sydney Morning Herald

The dangers involved in allowing the the for-profit private and corporate sector to deliver human services to vulnerable people are once again evident in a report More than board and lodging: the need for boarding house reform by the NSW Ombudsman into licensed for- profit boarding houses in NSW.  The Report documents what happens when the profit motive becomes the main driver of the delivery of human services and Governments and the not for profit sector hand over responsibility for service delivery to the private sector..

In NSW boarding houses are run as for- profit private businesses to provide accommodation to people with disabilities, people with alcohol and drug problems. and mental illness. Residents are usually reliant on income support and pay between 75-100% of their benefits to the boarding house for accommodation and consumables

 The Report documents shocking levels of abuse, sexual assault and mistreatment of residents by staff and other residents. The Report demonstrates the complete failure of the Government's licensing and regulation of for- profit and corporate providers.

The Ombudsman's investigation  found that residents have been physically and sexually assaulted by staff and other residents, have died in appalling circumstances, and been denied basic rights, including contact with their families. This is the fourth report in less than 10 years on the failure of the state and the for profit providers to protect boarding house residents, in particular those with psychological and intellectual disabilities.

 Adele Horin's report in the Sydney Morning Herald  describes the conditions:

An estimated 455 private boarding houses operate in NSW with more than 5000 residents, most of them poor and vulnerable. They pay the proprietor 75 per cent to 100 per cent of their pension. Thirty-one of the boarding houses are licensed by the government to accommodate 687 residents with mental illness and/or intellectual disabilities. They must comply with conditions set out in legislation.

The report, More than board and lodging: the need for boarding house reform, shows the level of care for boarding house residents is inferior to that received by people with similar conditions in housing run or funded by the government.

For example, in 2008, a resident was found 12 hours after he had died in a room strewn with faeces and toilet paper. Three months earlier, hospital staff had raised concerns about his hygiene and nutrition. Around the time of his death, the department had assured the Ombudsman of its initiatives to improve monitoring and compliance at the boarding house. The boarding house eventually closed due to ''unrelated factors''.
Another case involved two residents aged over 80 with schizophrenia, who lived in a licensed boarding house despite having been assessed as needing nursing home care.

Jan Daisley, president of People with Disability Australia, said: "It is abhorrent that people with disability are left to deteriorate and die in these places while all along paying up to 100 per cent of their income to live in this form of housing''.

The Ombudsman, Bruce Barbour, noted the good work of some proprietors but said resident welfare should not depend on the ''goodwill and favour of individual proprietors.''

 Dr Gabrielle Drake, a researcher and lecturer from the UWS School of Social Sciences who completed a PhD study in 2010 on the deinstitutionalisation of boarding houses for people with mental illness and disability. has long called for the closure of the boarding houses.

Dr Drake says many of the current licensed boarding houses came about as a part of the poorly resourced and poorly coordinated deinstitutionalisation process.

"The result of this process is that people use the majority of their pension to live in boarding houses which are located in the community, yet they still have restricted access to that community and are still denied their right to self-determination," says Dr Drake.

"These homes are effectively still institutions, where the residents must conform to structured meal times, closed kitchens, and a lack of coordinated health care and planning. Too many also experience abuse, sexual assault, fear and intimidation."

Dr Drake says licensed boarding houses are an archaic approach to service provision for people with a mental illness and disability.

"The Ombudsman's Report clearly indicates that the NSW Department of Ageing, Disability and Home Care's (ADHC) procedure for monitoring the conditions in boarding houses has been unacceptable," she says.

"While I support legislative reform and the need for a cross-agency and partnership approach, at the heart of this debate needs to be the realisation that people with disability have the right to live and participate in the community in non-congregate accommodation."

Lessons from the near collapse of a small NGO

Cate Steane runs a small Californian not-for-profit providing shelter for families between homelessness and a home. Twelve months ago the agency faced collapse as government funding and donations dried up, and its invested reserves disappeared during the financial crises. The agency had to confront the reality that it had run out of money and would have to close its doors. Twelve months on the agency faces a brighter and more secure future.

This situation is very familiar to many small and medium sized NGO's in Australia, for whom viability is a monthly, even weekly proposition.

On the US not-for-profit website Blue Avocado Cate has written an important piece about the strategy the agency pursued to keep the doors open.

Reading Cate's intelligent and honest piece about what not-for profits can do when facing such a crises, and drawing on my experience with small agencies, ten lessons emerge:

1. Act quickly, don't accept denial of the problems and be completely transparent and frank with all stakeholders about the depth of the crises of and what is needed to overcome it (this includes beneficiaries and service users, funders, politicians, donors). Take all stakeholders along on the difficult journey
   
2. Withhold nothing from staff and Board and make use of the diversity of opinion about how to move forward (even when management is doubtful) and acknowledge and work with the negatives.
   
3. Develop a brief Plan (and clear message) of how the agency intends to overcome the crises
4. Mobilise and act in service of the agency's core social mission which is to address social problems and meet social needs. Ensure that the social/community need that the agency exists to address is not compromised
5. Be clear about what and who the agency is there for and what has to be preserved
   
6. Explore all possible angles, including new and better ways to make use of government funding and new sources of funding and be prepared for scenarios that cannot be foreseen in the beginning
7. Keep well informed about the policy context in terms of how these may affect the agency's survival and possible opportunities
   
8. Raise funds through the agency's network of supporters and constituents who understand and support the agency's mission and values, regardless of the size of their donations (don't just pursue big donors). Corporate funding and donors is not a high priority.
   
9. Build and protect the agency's reputation for excellent services, frugal stewardship and scrupulous honesty
10. Develop and retain a strong constituency base and appeal to them to assist in a multitude of ways
    

Theology as justification for government inaction: Tony Abbott on homelessness as a lifestyle choice

(images from www.2steps2com, South Queensland Council for Homeless Persons)

Last week the Opposition Leader Tony Abbott displayed his poor understanding of homelessness and then appeared to use religious theology to justify government inaction on the housing crises in Australia.

Responding to a question as to whether his Government would support the target to reduce homelessness by 50% by 2020 (as his predecessor Malcolm Turnbull did), the Opposition Leader said "no" and then went on to claim that homelessness was a lifestyle 'choice" for many people. The Opposition Leader cited the scriptures to justify his position, quoting Jesus to the effect that governments should always be careful about promising things because of "the poor that you have with you always".

Stephen Nash who is the CEO of a Melbourne homeless support agency has written a sharp rebuttal of Tony Abbott's comments. Nash argues that in 20 years working with people in housing crises he has never met a person who "choose" to be homeless. Nash argues that Abbott's comments gloss over the real problem:

"The real story hiding beneath the 'choice' furphy is that our society is failing to provide the housing and support people need to escape from homelessness... At the core of this problem is the lack of affordable housing"

In the online Catholic publication Eureka St Andrew Hamilton's concern is theological. He argues that Tony Abbott's theological argument is flawed and he has misinterpreted and taken out of context the words purported to be used by Jesus. Hamilton argues that they are not a Christian justification for government inaction.

John Falzon from St Vincent De Paul is damming. He finds the Opposition Leader's comments deeply offensive in that they blame people for being left out or pushed out. Falzon writes:

" Choices are constrained by those who have been systematically locked out of the nation's prosperity... But of course such a world view lets governments off the hook. It denies the reality of the social"

Falzon situates Tony Abbott's comments in a policy prescription he describes as the "The New Paternalism", an approach to social policy making that assumes people are largely to blame for their own marginalization. Falzon sumarises the assumptions underlying this approach as follows:

".. that people who are marginalised are naturally without power; that power rests with those who deserve it, that those with power can, at best, use their power to bring about a change in the behaviour of those without power; and that the problems experienced by people who are marginalised are their own problems, but bleed into the 'mainstream' through increased costs, increased crime, loss of productivity, market constraints and disorder"

Falzon argues that these ideas are both unproven and pernicious, and lead to people being pathologised or criminalised. His view is that:

"Nothing good can come out of these approaches. They are cursed by their lack of compassion and also by their denial of justice".