When Hayley Nicholls fell in love with the caring profession, she thought she had found her tribe.
The then 22-year-old woman from the NSW Central Coast looked forward to sharing camaraderie with other support workers as they did their best to support residents of disability group homes with very high needs.
Instead, she says, she was plunged into a “toxic pack culture” in which staff turned a blind eye to violence between – and even towards – residents. Speaking up was not just futile but put a target on her back.
Nicholls was appalled to see her clients being “hit, thrown around and kicked on the ground” in the disability group home where she worked until the beginning of 2023.
It wasn’t the most distressing thing she would witness on shift. When a non-verbal man tumbled out of his wheelchair and split his head open, nobody went to his aid, Nicholls recalled.
“They left him there for 20 minutes, crawling around the ground, bleeding,” she said. “There was blood everywhere.”
Nicholls alleged that when she called an ambulance, she suffered blowback from other staff members who didn’t want the incident documented.
She supplied this masthead with a photograph that showed the man on the floor cradling his tracksuit pants, the fabric soaked in blood dripping from the large gash above his eye.
A whistleblower says this man, who cannot be identified for legal reasons, was left bleeding on the ground by staff at a NSW disability group home.
Whistleblowers like Nicholls risked their careers to provide evidence to the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, which shone a light on the shocking levels of abuse, violence and neglect that blight disability group homes across the country.
Among the most harrowing testimonies were allegations a group home resident crawled onto a driveway and was run over by a worker who left clients unsupervised to buy cigarettes, a woman was hospitalised with severe burns consistent with being placed in a scalding bath after her mother made a complaint about her group home, and a woman was tied to a chair for long periods with her fingers taped together.
Yet nearly 18 months after the Royal Commission’s damning final report was published, the future of group homes remains at an impasse, with the government still “considering” a recommendation that they be disbanded entirely.
New evidence unearthed by a Herald investigation paints a disturbing picture of recent conditions in a string of group homes, while whistleblowers, experts and advocates say Australia must intervene to address what one described as a “national shame”.
A recent expert analysis by the Grattan Institute found providing care in group homes is costing taxpayers billions and people with a disability deserve far better services for the “extraordinary” price tag.
Social Services Minister Amanda Rishworth failed to respond when this masthead asked whether the federal government was acting with the urgency warranted given the gravity of the commission’s findings.
‘Shunned and bullied’
Whistleblower Hayley Nicholls started work at a group home run by Ability Options in 2021 after her damning testimony to the disability royal commission about her previous employer was read in parliament.
What she saw in her new place of employment convinced her that deep problems were endemic in the industry.
She said at both workplaces she was pressured to cover up residents’ injuries and client-on-client abuse, including an instance of choking.
“You are shunned and bullied if you report incidents,” she said.
Nicholls believes her complaints to the NDIS about the home run by Ability Options put a target on her back and allegations subsequently made against her were reprisals for speaking up.
Nicholls said a failure to give clients timely medical attention seriously jeopardised their safety. In one instance, she said, a man with a pressure sore on his buttock did not receive medical attention and it worsened into an abscess before he was finally seen by a nurse.
“I was concerned this man was going to die from that pressure area, had care not been implemented when it was,” she said.
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Nicholls recalled that addictive Schedule 8 drugs would go missing, and medications would be administered to clients incorrectly or hours after the correct window.
“Most days the clients are not showered, have a pad change once in eight hours, have morning and afternoon teas skipped, half of their meals thrown out and are not offered drinks,” she said.
She said other staff would spend a large portion of their shift sitting outside “gasbagging” and eating clients’ food.
“The staff would cook up big roast dinners and sit in front of residents eating food that had been purchased with their money,” she said.
She resigned from the service in early 2023 and has moved to a different provider where she has not experienced similar issues. However, she maintains the industry requires “major change”.
“I love caring for people, but it’s things like this that make me wish I never stepped foot into this industry.”
A spokeswoman for Ability Options said the company had identified a similar complaint made two years ago by an employee who left the organisation shortly after.
She said the allegations were taken very seriously and the organisation launched a comprehensive investigation, but most were not substantiated.
“This was because the reporter could not provide details or first-hand information, and the extensive investigation process did not find evidence to substantiate them,” the spokeswoman said.
“Eight improvement actions were identified and implemented, including refreshed clinical protocols, and retraining in things like documentation, systems, responsibilities and thresholds for reporting, medications management and smoking at work.”
The spokeswoman said that reportable incidents had been shared with the NDIS Quality and Safeguards Commission, and had since been closed.
She added that Ability Options had a well-established record of providing high standards of care. It always investigated and took appropriate action when there were allegations those standards had not been upheld, she said.
“Staff who do not meet our high standards are given appropriate feedback and, in some cases, are dismissed.”
The spokeswoman said investigations revealing shortcomings were reported to an internal quality and outcomes committee which monitored the delivery of improvements, along with external parties where appropriate.
The company had reviewed its records for the period covered by the disability royal commission and did not find significant concerns relating to allegations of abuse, neglect, violence or exploitation, the spokeswoman said.
However, it did find ways to improve its services, including investing more than $2 million in additional staff training and creating a clinical governance committee.
Mystery injuries
Blue Mountains woman Anndrea Wheatley has been campaigning for mandatory CCTV cameras in places of care for people with a disability after her son, James, twice returned home nursing unexplained injuries.
Wheatley said her “sweet” and “gentle” son, now 30, is non-verbal because he suffers from fragile X syndrome and could not tell her what happened.
An image of the head injury James Wheatley suffered in respite care.
On the first occasion in 2019, James returned home from respite with an injury to the head, while in 2021 he had been at a day program when he sustained significant bruising to his arm.
A doctor noted the former injury was consistent with James’s forehead “getting into contact with a circular object”.
“Nobody informed me or bothered to take responsibility,” Wheatley recalled. She took up the matter with the providers, the police and regulatory authorities, but her attempts to have someone held responsible went nowhere because she didn’t possess direct evidence of someone harming James.
“Without cameras, we cannot know who hurt James,” Wheatley said.
Anndrea Wheatley is calling for mandatory CCTV in places of care for people with a disability after her son suffered unexplained injuries while in care.
“I find it ridiculous that cameras are used in petrol stations and universities and shopping centres, but there is nothing to protect special needs children and adults from being hurt or abused, especially when they cannot talk, like my son.”
Division and despair
The royal commission heard that organisational cultures in group homes normalised violence and protected staff members who did the wrong thing.
Complainants were either not listened to, not believed or even faced retaliation when they spoke up, according to an issues paper published by the commission.
The Grattan Institute has predicted the number of people living in group homes will soar over the next decade as the Baby Boomer generation grows too old to care for their children and people age within the scheme.
All royal commissioners agreed a greater range of accommodation options should be made available so people could exercise more control over where they lived.
They called for a new policy unit to guide the development of “more contemporary accommodation models”.
In July last year, the Albanese government accepted the recommendation “in principle” but not in full.
The commissioners diverged over whether group homes should be abolished entirely.
Two opposing views emerged: the first, that group homes wrongly segregated people with a disability from the rest of society, and, the second that people could live in group homes while still enjoying significant interaction with non-disabled peers.
The former view won out, with a recommendation to phase out group homes within 15 years.
In July, the federal government said the recommendation was “subject to further consideration”.
The government noted reform work is being undertaken by the oversight body, the NDIS Quality and Safeguards Commission, which recently undertook its own inquiry into group homes.
As a result, it is developing new practice standards to set concrete expectations around quality of care in group homes.
The commission’s report found the attitude and aptitude of workers drove “a high number of the issues” and said it had updated the training resources on its website and conducted online workshops for providers.
It also acknowledged the need for increased oversight of disability group homes, better data collection and engagement with residents.
However, some observers are dubious that actions taken to date will end the scourge of violence and abuse in group homes.
‘Completely in the dark’
Jen Hargrave, a University of Melbourne researcher and long-time advocate for disability rights, said she was yet to see recommendations that would address violence and neglect quickly or strongly.
“We’ve known about this for a really long time. Those with responsibility have failed to act,” she said.
Dr Sam Bennett, the Grattan Institute’s disability program director, said that the government needed to define a clear roadmap to improve safety and provide alternative living arrangements for people in group homes.
The NDIS was supposed to be transformational for that group, but instead, very little had changed for them, Bennett said.
“We’ve known about this for a really long time. Those with responsibility have failed to act.”
University of Melbourne researcher Jen Hargrave on violence and neglect in group homes.
“Other parts of the world – many of which have much less of a financial investment than Australia – are nonetheless doing better than Australia.
“We seem quite willing as a country to pour tens of billions into substandard services for this group.”
The institute is championing alternative models where a person lives with a host family or in a share house on the private rental market with housemates of their own choosing, assisted by support from an NDIS provider.
“We did a lot of work on the costs for these supports. On average, they’re as or less expensive than group homes,” Bennett said.
“They’re not well understood, they’re not well supported or enabled by current policy settings.”
Bennett welcomed a recent move to make registration mandatory for providers of group homes, but said that didn’t guarantee services were going to be safer.
“Some of the worst instances of abuse in recent years have occurred by providers who are registered,” he said.
Bennett did not agree that CCTV surveillance should be a priority unless it was actively chosen by residents.
Professor Christine Bigby, director of the Living with Disability Research Centre at La Trobe University, disagreed that the group model was broken.
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She argued the crux of the problem lay in the vast discrepancies in the quality of care in group homes.
“If it was to do with the model itself, then you wouldn’t expect to find so much variability in the quality of what happens for people,” she said.
“My concern is that if you go down the road of closing group homes and saying everybody’s got to move to smaller alternatives, that’s not going to solve the primary issue about the quality of support.”
Bigby said proper leadership from disability providers was crucial.
There were risks posed by the privatisation of services in NSW, which had seen an influx of inexperienced operators pursuing a profit-making model, she said.
Bigby believed the focus should be on providing sufficient numbers of properly trained staff, who often came to the sector ill-equipped after being employed in unrelated fields such as hospitality.
“The turnover of staff in disability has grown enormously in the last few years,” Bigby said.
Bigby argued staff should be trained in “active support”, a method that seeks to support people with severe intellectual disabilities to be involved in everyday activities and social interactions.
Several experts agreed one of the biggest stumbling blocks was a compliance system that had been too focused on providers having the right paperwork instead of conditions on the ground.
Some described a system of third-party audits as a “ticking boxes” exercise.
“There is little evidence to suggest any relationship between having the right paperwork and providing quality support,” Bigby said.
The Grattan Institute has warned there is no nationally consistent data on who is living in group homes and the prevalence of mistreatment and abuse.
Adding to the opaque state of affairs is that many residents are non-verbal or under guardianship orders forbidding them from being identified by the media.
“If they’re closed off to the rest of the world, we’re not sure what kind of conditions people are living in, that’s why group homes are so dangerous,” disability rights advocate Elly Desmarchelier said.
Disability rights campaigner Elly Desmarchelier says the community is in the dark about whether either side of politics will close down group homes. Credit: Paul Harris
Desmarchelier stressed the importance of giving people with a disability more control over who they lived with and how they lived their lives.
“In most group home settings, people with disability don’t get to choose what they eat, when they wake up, when they shower, when they go to bed,” she said. “These are mini-institutions.”
Desmarchelier said it was “really disappointing” the Albanese government did not accept in full the royal commission’s recommendations regarding group homes and had put off a decision on their phase-out.
“We’ve gotten really good recommendations on how to make these things better, we just haven’t actioned them,” she said.
“We’re a few months out from an election; what would an alternative government do? We are completely in the dark.”
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