Position Papers '99, Attendant Care

Internet publication URL: www.independentliving.org/docs1/pdcnsw99.html  

by The Physical Disability Council of NSW Inc., 1999

People with physical disabilities must be provided with a range of personal care and support options that enhances individual empowerment and enables integration and participation in the community.

Attendant/personal care is the assistance received by people with physical disabilities for undertaking the full range of everyday tasks that able-bodied people normally do for themselves. It enables an individual to live independently and to exercise basic rights about lifestyles choice.

It includes the full range of daily tasks, including personal hygiene; grooming; housecleaning; gardening; home maintenance; child care; educational support; vocational support; and respite.

Attendant care is highly personal and involves issues of mutual dignity, respect, choice and independence for both the attendant and the individual with attendant care needs. The relationship demands a high degree of flexibility. 

Care Programs

Care services to people with disabilities in NSW is provided by:

  • parents, family members and friends of people with disabilities - also known as "carers";
  • the Home Care Service of NSW, funded under the Home and Community Care (HACC) program;
  • the Attendant Care Program, funded under the Commonwealth-State Disability Agreement (CSDA) and administered by the NSW Ageing and Disability Department;
  • specialist-employment, day-care and post-school options programs involving people with disabilities
  • for-profit private agencies.

The provision of personal care is both inadequate and inequitable. People with disabilities face:

  • being locked into inappropriate specialist-employment, day-care, and post-school options programs because they are the only places where care is provided;
  • being forced to stay at home merely to ensure access to personal care;
  • variations across local areas in both eligibility criteria and in the amount of support offered by care providers;
  • enormous difficulty travelling between States and within States because of the differences between services and local conditions.

Home Care Service of NSW:

The major organisational provider of direct care services is the Home Care Service of NSW.

Following an assessment of needs, it provides services without giving clients choice in the selection of attendants, and with little flexibility in service provision.

Eligibility and resourcing is determined at the branch level. This creates a situation of inequitable treatment across branches within the state. Thus, a person with a disability moving from one suburb to a nearby suburb could receive a significant decrease in service unrelated to needs but simply because of the branch's particular eligibility criteria or resource constraints.

People with disabilities are increasingly competing within a relatively static budget allocation for resources with the rapidly growing number of older people. This has led to inappropriate quotas and restrictions in the allocation of resources to new clients. 

Attendant Care Program:

A small group of people with physical disabilities receive care support through the Attendant Care Program.

The program helps people with disabilities to live and participate in the community. Priority is given to younger people who have been inappropriately placed in institutions or individuals in danger of institutionalisation.

The Attendant Care Program is generally preferred to the Home Care Service because it provides:

  • a high degree of flexibility in allowing participants to manage or broker their own care i.e. in the selection of attendants and the type of services received
  • portability.

The Attendant Care Program has been adversely affected by changes made under the Commonwealth-State Disability Agreement. Since it was transferred from the Commonwealth to the States in 1993, funding per person has decreased by 20% and the waiting list has increased to 120 people despite discouragement of applications by people administering the scheme. 

Private for-Profit Services

Several private for-profit services have sought to fill a market niche in recent years. Their quality is variable because there are no benchmarks for defining their quality and there is no accreditation. 


Australia has a strong and successful "carer" movement but it has primarily targeted the carers of older people.

There is little attention paid to the respite care needs of carers with children and people with disabilities.

Many children and people with physical disabilities cannot access respite care because of the physical and resource barriers in the existing respite services. 

Industrial Relations

The introduction of Industrial awards and Workers' Compensation has caused a blow out in the costs of organisations providing care services.

It has created tensions within service organisations which need to comply with both the NSW Disability Services Act, 1993 (DSA) and the Industrial Relations Act (IRA).

The tension is most evident in the selection and continuing use of attendants. The DSA requires the involvement of consumers in the choice of carers while the unfair dismissal provisions of the IRA make it extremely difficult to terminate the relationship when it breaks down due to the consumer feeling uncomfortable with the attendant.

The introduction of Industrial Awards has also led to demarcation issues in the Home Care Service which have reduced flexibility. Thus for example, an attendant who is employed to help with hygiene is not permitted to make a cup of tea or change a light bulb. 



1. The State and Commonwealth Government to increase funding for care services through both the Home Care Service and the Attendant Care Program.

2. The State and Commonwealth Government to ensure that care services can provide hours for personal care which are flexible and reflect the full range of needs of the individual. 


3. The NSW Ageing and Disability Department to:

  • both increase the number of places on the Attendant Care Program and ease the criteria for changing from the Home Care program to the Attendant Care program
  • increase funding to the Home Care Service
  • fund the provision of Attendant Care Services within the work place or educational facility to enable people with physical disabilities to pursue and maintain their vocational and educational goals. (See Employment and Vocational Training, and see Education)
  • develop quality benchmarks and accreditation of private for-profit service providers similar to the Disability Service Standards for funded programs.
  • convene meetings of service providers, industrial bodies and Workcover to resolve the current anomalies that exist between the requirement of the Disability Services Act and the Industrial Relations Act.

4. The NSW Ageing and Disability Department and the Department of Education to develop protocols to ensure that students with physical disabilities have their personal care needs met at school. (See Education). 


5. The Commonwealth Government to design and implement a national program for care services making greater use of the model adopted by the Attendant Care Program.

6. The Commonwealth Department of Health and Family Services to recognise the needs of carers of people with physical disabilities through program funding.

7. The Department of Social Security to mobilise an entitlements campaign aimed at increasing carers' awareness of entitlements, including the Domiciliary Nursing Care Benefit. 


8. Organisations which auspice care services to provide greater flexibility in the choice of service delivery. Appropriate models include an allowance model (a consumer receives a sum of money to co-ordinate their care as they see fit) or a brokered service delivery model (a consumer may receive different services from different providers).

9. The Home Care Service of NSW and other care service providers to recognise the qualitative aspect of the relationship between an aide and a consumer in:

  • the selection of appropriate and qualified staff;
  • providing adequate training;
  • ensuring greater accountability of staff performance;
  • ensuring gender sensitivity;
  • ensuring cultural sensitivity in assigning staff to Aboriginal and non-English speaking people.