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Precariously placed: housing affordability, quality and satisfaction of Australians with disabilities
Abstract
Access to adequate, safe, secure, accessible and affordable housing is a fundamental human right and one stipulated in the United Nations Conventions on the Rights of Persons with Disabilities. Australian adults with disabilities experience housing disadvantage including homelessness, poor-quality housing and housing unaffordability; however, we lack a comprehensive comparison of the housing circumstances of people with and without disabilities and differences by impairment type. We analysed data from a nationally representative sample of 11,394 working-aged Australians collected in 2011. We found that people with disabilities experienced disadvantage across all housing indicators, and people with intellectual and psychological disabilities fared worst. These findings suggest that there is a housing crisis for Australians with disabilities, which may intensify with the introduction of the National Disability Insurance Scheme. There is a need to develop long-term housing solutions that promote independence, are accessible and affordable, and that consider location and neighbourhood context.
... Inequalities in the access to services experienced by marginalized groups are well documented internationally (Alves-Bradford et al., 2020;Luchenski et al., 2018;Priebe et al., 2012) and in Australia (Aitken et al., 2019;Currie et al., 2007;Durey and Thompson, 2012;Robards et al., 2019;Soldatic et al., 2014). People with psychosocial disability 1 are at greater risk of homelessness than other groups with disability (Beer et al., 2012). ...
... People with psychosocial disability 1 are at greater risk of homelessness than other groups with disability (Beer et al., 2012). They are also less likely to have access to the support to which they are entitled (Aitken et al., 2019;Beer and Faulkner, 2009;Beer et al., 2012). People with psychosocial disability face multiple systemic, social, cultural and personal barriers to access services (Cortese et al., 2021;Soldatic et al., 2014), including being 'deemed too high functioning' to be considered for priority social housing or being 'temporarily accommodated in boarding houses', and as a consequence, losing their right to be considered for priority social housing (Beer et al., 2012: 12f). ...
... The NDIS reframes disability support as specialist services for people with permanent and significant disability support needs and mainstream services, such as health, education and housing for all people with disability. 2 The scheme is implemented by the NDIA, and began providing disability support packages from July 2013 in trial sites, which were extended to cover the remainder of Australia (Buckmaster and Clark, 2018). The NDIS (2021) in July had over 470,000 active participants, including children under school age. ...
Policy changes often aim to improve the access of socially marginalized people who face systemic, social and personal barriers to the support they need. A major policy reform in Australia was the National Disability Insurance Scheme (NDIS), which was introduced to meet the country’s human rights obligations. NDIS is publicly funded to allocate individual funding packages to 10% of people with disability and facilitates access to mainstream services for all people with disability. Support services are intended to be entitlements, consistent with a human rights framework. Predictably, the most marginalized people remain under-represented in both packages and mainstream access, including people with psychosocial disability who are at risk of homelessness. A 2-year project was conducted to familiarize people with disability and service providers who have contact with them about how to access support. People with Disability Australia managed the project as action research with university researchers. The research used interviews to study how to improve access. People with disability were advisors to the governance and research design. The findings were that it took many months for people with disability and the organizations that support them to trust the project staff, understand the relevance of disability to their lives, and to take steps to seek their entitlements to support. Some implications for policy are conceptual in terms of the policy language of disability, which alienates some people from the services to which they are entitled. Other implications are bureaucratic – the gap between homeless and disability organizations means that they prioritize people’s immediate needs and people who are easier to serve, rather than facilitating sustainable support. A global social policy implication is that specialized interventions to advocate for the rights of marginalized people with disability and to demonstrate how to engage with them remains a priority while gaps between service types persist.
... including the physical quality of housing (Aitken et al., 2019), housing tenure (Wiesel et al., 2021), and housing outcomes, such as the availability of affordable and decent housing (James et al., 2022) which in turn depends on both economic situations (e.g., income, assets, and relative price) and socio-demographic characteristics (e.g., family size) (Mirkatouli et al., 2018;Chen et al., 2023). Housing inequality has also been used to describe discrimination in access to housing among different groups of people, which comprises the possibility of choosing the location and type of housing (Grander, 2021). ...
... Australian housing policies have historically favoured homeowners over renters, leading to significant disparities in housing affordability and stability. The neoliberal approach to housing, combined with high property values, has significantly contributed to increasing wealth inequality, which is largely manifested through disparities in housing tenure and affordability (Aitken et al., 2019;Bower et al., 2021). ...
Housing inequality is a pressing issue that affects the lives of millions of people worldwide. This study aims to determine trends, generate insights, and identify knowledge gaps in housing inequality research by systematically mapping and analysing the academic literature. As for the systematic literature review method, the PRISMA approach is employed to review literature published during the last four decades. The review is enriched with bibliometric analytics—e.g., research trends; influential publications, co-occurrence network of terms, geographical distribution—and content analysis techniques to provide future research directions. The analysis revealed four main research themes, comprising housing discrimination, housing market and urbanisation, the relationship of housing inequality with health and education, and housing inequalities among the young adult population. The majority of these studies centred their research on China. The findings in the following areas consolidate the understanding of housing inequality: (a) Housing inequality as a product of housing market dynamics; (b) Housing inequality as a condition affecting different segments of the population disparately; (c) Housing inequality as a socio-cultural concept; (d) Housing inequality as an outcome of public policy. This study advocates for multifaceted policy interventions, and the findings, which contribute to achieving relevant Sustainable Development Goals (SDGs), provide insights for urban and housing policymakers and urban planners in addressing housing inequality problems.
... It is therefore critical to understand the most promising practices, policies and interventions that can help to enhance accessible independent housing for people with disabilities. likelihood of living in unaffordable, insecure and/or poor quality housing and are at a higher risk of experiencing homelessness [10,[19][20][21]. People with disabilities often encounter barriers and stigma/discrimination in finding appropriate housing, including learning about available accessible units, securing appointments and receiving reasonable modification requests [22]. ...
... For example, home environments without basic accessibility components can increase the risk of falls, injuries, mortality rates and the use of social services while also restricting social participation, including employment [2,24,28]. Indeed, the physical and social characteristics of housing can contribute to disabling and discriminatory environments for people with disabilities [19,25,29,30]. For these reasons, there is an urgent demand to improve practices to help match the available accessible housing with people with disabilities who need it the most [23]. ...
Background
Accessible housing is imperative to enabling independent living for many people with disabilities; yet, research consistently shows how people with disabilities often lack appropriate accessible housing and are more likely to experience unaffordable, insecure, and/or poor quality housing. Therefore, the aim of this study was to understand promising practices, policies and interventions regarding accessible independent housing for people with disabilities.
Methods
We conducted a scoping review that involved searching seven international literature databases that identified 4831 studies, 60 of which met our inclusion criteria.
Results
The reviewed studies involved 18 countries over a 20-year period. Our review highlighted the following key trends: (1) removing barriers to obtaining accessible housing (e.g., advocacy, builders enhancing housing supply, subsidies and financial incentives); (2) policies influencing accessible housing; (3) interventions to enhance accessible housing (i.e., home modifications, smart homes, mobile applications and other experimental devices); and (4) the impact of accessible independent housing on health and wellbeing.
Conclusions
Our findings emphasize the importance of accessible housing for people with disabilities and the urgent need to advance accessible housing options.
... It is a cause and consequence of more distant inequalities, it is used as a conceptual device for monitoring and describing equality in societies, and it is used as a measure of the distribution of housing within a population. Many of us have used housing inequality as a means to describe differences in housing conditions, such as the physical quality of housing (Ade & Rehm, 2020;Aitken et al., 2019), or financial outcomes, including housing affordability Bentley et al., 2016;Wiesel et al., 2021). Housing inequality has also been used to describe an unequal distribution of housing wealth Badcock & Beer, 2000;Christophers, 2021), and from the perspective of documenting uneven housing outcomes including affordability (Anacker, 2019;Daniel et al., 2018), availability (Arundel & Ronald, 2021) and accessibility across locations Woo & Kim, 2016). ...
... Commonly, this literature suggests that affordability drives housing access and quality, which manifests as inequality (e.g. Aitken et al., 2019;Allen, 2022;Baker et al., 2014;Dewilde & De Decker, 2016;Ferrari, 2015;Gallent, 2016;Kubala & Hoření Samec, 2021;Power, 2022;Seebauer et al., 2019;Simone & Newbold, 2014;Telfar Barnard et al., 2020;Wetzstein, 2021Wetzstein, , 2017. For instance, looking at trends in Western Europe between 1995 and 2012, Dewilde & De Decker (2016, p. 121) find declining housing affordability for low-income owners and private renters (relative to middle-income counterparts) is driven by increases in housing financialization and decreases in housing private rental supply, which 'has … not been compensated [for] by improved housing conditions' . ...
Housing inequality is far more than a housing matter. To discover how housing inequality has been used across disciplines, and how this may inform future housing research, we performed a systematic scoping review. We found that housing inequality provides multiple understandings as well as a variety of uses, for example, as a measurement tool, a conceptual device, or as subject matter. To draw together useful lessons from this conceptually diverse body of work, we identify four principle uses of ‘housing inequality’ in the literature – an outcome, an experience, a product, and a construct. These four framings offer a level of conceptual clarity for thinking about, and researching, the different expressions of housing inequality. It contributes to housing research by providing an approach for taking into account the multiple and complex roles of housing, and its distribution and impacts across society.
... The prevalence of precarious housing has been estimated nationally (see for example Beer, Bentley et al. 2016) and mapped as a geography (for example Baker, Lester et al. 2019). The relationship between precarious housing and health has been described in terms of its bi-directional nature (Baker, Mason et al. 2014), the interaction between precarious housing and precarious employment, known as 'double precarity' (Bentley, Pevalin et al., 2016), with shocks such as disability acquisition (Aitken, Baker et al. 2019), and the consequences for children's health of experiencing instability in their housing (Baker, Lester et al. 2019). ...
... Australian adults with disabilities experience more housing disadvantage than their non-disabled counterparts, including homelessness, poor-quality housing, and housing unaffordability. Aitken, Baker et al. (2019) analysed data from a nationally representative sample of 11,394 working-age Australians and find that people with disabilities experience disadvantage across multiple measures of precarity, including affordability, quality and security. Secure housing can buffer people from external shocks in their employment and health circumstances. ...
... With the goal of creating a comprehensive comparison of the housing circumstances of people with and without disabilities, and differences by impairment type, Aitken (2019) analysed data from a nationally representative sample of 11,394 working-aged Australians collected in 2011. Aitken (2019) found people with disabilities experienced disadvantages across all housing indicators, and people with intellectual and psychological disabilities fared worst. Such findings suggest a housing crisis for Australians with disabilities, alongside a need to develop "longterm housing solutions that promote independence, are accessible and affordable, and that consider location and neighborhood context" (Aitken, 2019, p. 121). ...
... Participants who reported disability conditions at wave 11 were selected for this study and followed longitudinally. Using the guidelines provided by earlier studies [22][23][24], this study classified the 17 different types of disability into four major categories: (I) Sensory disability, (II) Physical disability, (III) Psychosocial disability, and (IV) Other disability or long term conditions. The study also considers whether the individuals have single or multiple disabilities and whether disability status is worklimiting or not. ...
Background
Research on health-related quality of life (HRQoL) trajectory patterns for people with disabilities (PwD) is scant. Understanding the HRQoL trajectory patterns for PwDs and investigating their relationship with disability types and socioeconomic factors can have important implications for Australia’s welfare policy.
Methods
We analysed data from waves 11 to 21 of the Household, Income and Labour Dynamics in Australia (HILDA) survey of respondents aged 15 + years of the PwDs. The analytic sample consists of 3724 self-reported disabled individuals and 34,539 observations in total. The SF-6D utility score is our HRQoL measure. Group-based trajectory modelling was utilised to identify trajectory groups, and multinomial logistic regression was employed to determine the baseline factors associated with trajectory group membership.
Results
The study identified four distinct types of HRQoL trajectories (high, moderate improving, moderate deteriorating and low HRQoL trajectories). Psychosocial disability types followed by physical disability types had a high Relative Risk Ratio (RRR) in the low group compared with high trajectory group membership of PwDs (psychosocial: 6.090, physical: 3.524). Similar, results followed for the moderate improving group albeit with lower RRR (psychosocial: 2.868, Physical: 1.820). In the moderate deteriorating group, the disability types were not significant as this group has a similar profile to high group at the baseline. Compared with males, females had a higher RRR in low and moderate versus high improving HRQoL trajectories (low: 1.532, moderate improving: 1.237). Comparing the richest class to the poorest class, socioeconomic factors (income and education) predicted significantly lower exposure for the richer class to the low and medium HRQoL trajectories groups (RRR < 1).
Conclusion
Different forms of disability, demographic and socioeconomic factors have distinct effects on the HRQoL trajectories of disabled individuals. Healthcare and economic resource efficiency might be improved with targeted government policy interventions based on disability trajectories.
... Second, many cities around the world must cope with increasing urbanization and housing shortages (UN 2019), which combined exacerbate a chronic lack of access to affordable housing and worsening social inequalities (Aitken et al., 2019;Maloutas et al., 2020;Wetzstein, 2017). ...
The topic at the centre of this work is the multifaceted relationship between environmental policies in the building sector – namely urban densification, ecological retrofitting of the existing housing stock and rules for buildings’ energy efficiency in new construction – and access to affordable housing in attractive cities. By exploring this complex relationship, the present study engages in a critical discussion about the possible effects that environmental policy instruments might have on access to affordable housing in relation to contextual housing systems and governance settings. In such a way, we do not build an argument against the mentioned environmental policies, but we question how they are planned, what goals are prioritized in their implementation and why, in relation to the effects that they might have on the ability of people to afford housing.
... Access to safe, secure, adequate, accessible and affordable housing is a fundamental human right, as outlined by the United Nations Convention on the Rights of Persons with Disabilities (Articles 9, 28) [1]. Nevertheless, globally children and youth with disabilities (including all types of physical, intellectual, cognitive, sensory and other impairments) [2] have an increased likelihood of living in unaffordable, insecure and/or poor quality and inaccessible housing than children without disabilities [3][4][5][6][7][8]. Such trends are arguably even more pronounced in lesser developed countries [7]. ...
Purpose: Accessible housing is a fundamental human right and yet many children and youth with disabilities live in inaccessible, insecure, unaffordable and poor quality housing. The aim of our study was to understand the barriers and facilitators to obtaining accessible housing among children, youth and young adults with disabilities and their families.
Methods: We conducted a scoping review involving seven international literature databases from 2000 to 2022 that identified 38 studies meeting our inclusion criteria.
Results: The reviewed studies involved 10 countries over a 22-year period. Our review emphasized the following key trends: (1) barriers to obtaining accessible homes (i.e. common types of accessibility barriers, rates of inaccessible housing, factors affecting home accessibility), and negative impacts of inaccessible housing; and (2) rates and facilitators to obtaining accessible housing (common types of home modifications, enablers of home modifications) and positive impacts of accessible housing. Conclusions: Our findings highlight the barriers and enablers of obtaining accessible housing among children, youth and young adults with disabilities and their families and the critical need to support them in securing appropriate housing.
... Poor affordable housing outcomes for low-income groups with high healthcare and support needs are reported internationally. Several studies have displayed a shortage of affordable homes offering features which are relevant to homeless veterans [159], individuals with physical impediments [160][161][162][163], and people suffering from psychiatric disabilities [164], cognitive impairments [165], or complex neurological conditions [166]. This suggests that the design of affordable housing solutions is not properly informed by the needs of individuals affected by complex disabilities and that there is a lack of understanding of what design principles can lead to the provision of affordable residential dwellings which are appropriate for these specific populations, who experience the greatest need [167,168]. ...
Despite the commitment of the United Nations (UN) to provide everyone with equal access to basic services, the construction sector still fails to reach the production capacity and quality standards which are needed to meet the fast-growing demand for affordable homes. Whilst innovation measures are urgently needed to address the existing inefficiencies, the identification and development of the most appropriate solutions require a comprehensive understanding of the barriers obstructing the design and construction phase of affordable housing. To identify such barriers, an exploratory data mining analysis was conducted in which agglomerative hierarchical clustering made it possible to gather latent knowledge from 3566 text-based research outputs sourced from the Web of Science and Scopus. The analysis captured 83 supply-side barriers which impact the efficiency of the value chain for affordable housing provision. Of these barriers, 18 affected the design and construction phase, and after grouping them by thematic area, seven key matters of concern were identified: (1) design (not) for all, (2) homogeneity of provision, (3) unhealthy living environment, (4) inadequate construction project management, (5) environmental unsustainability, (6) placemaking, and (7) inadequate technical knowledge and skillsets. The insights which resulted from the analysis were seen to support evidence-informed decision making across the affordable housing sector. The findings suggest that fixing the inefficiencies of the affordable housing provision system will require UN Member States to accelerate the transition towards a fully sustainable design and construction process. This transition should prioritize a more inclusive and socially sensitive approach to the design and construction of affordable homes, capitalizing on the benefits of greater user involvement. In addition, transformative actions which seek to deliver more resource-efficient and environmentally friendly homes should be promoted, as well as new investments in the training and upskilling of construction professionals.
... Similarly, a recent analysis of the Household Income and Labour Dynamics in Australia (HILDA) longitudinal dataset identified people with disability were more likely to reside in unaffordable and poor-quality housing or social housing and had a greater number of house moves attributed to health needs. 40 There are a range of factors that contribute to homelessness in the general population -see Table 1. 41 These include both structural drivers and individual risk factors that may intersect to create vulnerability for homelessness at different times in a person's life. ...
Evidence is increasing that a substantial proportion of people who are incarcerated in youth and adult correctional facilities have a disability. The high rate of people with disability in the criminal justice system is likely to be the effect of complex interactions between systemic, structural and individual factors. These include a lack of awareness and inappropriate management of challenging behaviours among service providers, and a compromised ability to understand and navigate the judicial system or access needed services. Detention in the criminal justice system is associated with a range of poor outcomes, one of which is homelessness. Homelessness includes experiences of sleeping rough on the street, staying in temporary or insecure accommodation, or in housing that is inadequate for privacy and social relations. Homelessness, and related experiences of housing instability, can affect a person’s wellbeing and become part of a cycle of health problems, justice system involvement and institutional care. Given the high proportion of people with disability involved with the justice system and the vulnerability for homelessness created by being incarcerated, the objectives for this project were to review the evidence on:
1. the factors that contribute to homelessness post-release for people with disability
2. the effectiveness of interventions designed to prevent or reduce homelessness post-release for people with disability
3. the policies, strategies, initiatives, and programs of corrective services in each Australian jurisdiction that address the housing needs of people with disability leaving their facilities.
... Research suggests that the housing crisis has significant implications for the health and wellbeing of marginalized groups, such as ethnic minority groups and those with lower incomes, and the specific population groups that experience housing disparities furthermore experience significant health disparities across housing-related health outcomes [4]. Housing inequality, in particular, has often been used to describe differences in housing conditions, including physical housing quality and financial aspects such as housing affordability [33][34][35]. Housing inequality is also described as a situation experienced unevenly across the population, where key minority population groups do not have equal choices in housing compared to their majority counterparts [33]. ...
Several high-income countries are currently experiencing an unprecedented and multifaceted housing crisis. The crisis is escalating rapidly, and its negative ramifications are shared disproportionately by migrant and refugee communities. Although housing is often cited as an important social determinant of health, the relationship between housing inequalities and health outcomes in the context of migrant and refugee populations remain under-explored, particularly in high-income countries. This paper presents a protocol for a mixed-methods systematic review which will synthesize the evidence on the key housing and health inequalities faced by migrant and refugee populations in high-income countries. It will inform the identification of pathways linking housing inequalities to health outcomes. The protocol for this systematic review was developed with guidance from the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews using a convergent integrated approach to synthesis and integration, and the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement. Quantitative, qualitative and mixed-methods studies reporting the association of housing inequalities with physical and mental health outcomes among refugee and migrant populations in high-income countries will be included. Medline, Web of Science, Embase, PsycINFO, Scopus and CINAHL will be searched for peer-reviewed literature. This will be supplemented by gray literature searches using Google Scholar, MedNar and WHOLIS. Two reviewers will independently screen and select studies, assess the methodological quality and conduct data extraction. This systematic review will elucidate the different pathways linking housing inequalities and health outcomes, which may guide the development of targeted housing and public health interventions to improve the health and wellbeing of migrant and refugee populations. The review is registered with PROSPERO (CRD42022362868).
... The focus on kāinga as an exemplar emerged from discussions with disabled people and policy planners who highlighted kāinga as a priority for clear policy direction within NZ. Disabled people frequently experience the compounding effects of limited incomes and low levels of paid employment, making them especially vulnerable to poor housing outcomes [6,7,60]. Housing as a social determinant of health is well established [61]. ...
Background
To positively impact the social determinants of health, disabled people need to contribute to policy planning and programme development. However, they report barriers to engaging meaningfully in consultation processes. Additionally, their recommendations may not be articulated in ways that policy planners can readily use. This gap contributes to health outcome inequities. Participatory co-production methods have the potential to improve policy responsiveness. This research will use innovative methods to generate tools for co-producing knowledge in health-related policy areas, empowering disabled people to articulate experience, expertise and insights promoting equitable health policy and programme development within Aotearoa New Zealand. To develop these methods, as an exemplar, we will partner with both tāngata whaikaha Māori and disabled people to co-produce policy recommendations around housing and home (kāinga)—developing a nuanced understanding of the contexts in which disabled people can access and maintain kāinga meeting their needs and aspirations.
Methods
Participatory co-production methods with disabled people, embedded within a realist methodological approach, will develop theories on how best to co-produce and effectively articulate knowledge to address equitable health-related policy and programme development—considering what works for whom under what conditions. Theory-building workshops (Phase 1) and qualitative surveys (Phase 2) will explore contexts and resources (i.e., at individual, social and environmental levels) supporting them to access and maintain kāinga that best meets their needs and aspirations. In Phase 3, a realist review with embedded co-production workshops will synthesise evidence and co-produce knowledge from published literature and non-published reports. Finally, in Phase 4, co-produced knowledge from all phases will be synthesised to develop two key research outputs: housing policy recommendations and innovative co-production methods and tools empowering disabled people to create, synthesise and articulate knowledge to planners of health-related policy.
Discussion
This research will develop participatory co-production methods and tools to support future creation, synthesis and articulation of the knowledge and experiences of disabled people, contributing to policies that positively impact their social determinants of health.
... The ENABLE-AGE study was theoretically based on the concept of P-E fit from environmental gerontology with a focus on the physical environment and therefore did not incorporate aspects of the societal environment into the model of what contributes to healthy ageing. Sociological research, however, highlights the important role of understanding the experience of home including the influence of housing affordability, tenure, social class and disability in influencing the experience of home and health of individuals (Waters, 2001;Imrie, 2004;Hulse and Saugeres, 2008;Mallett et al., 2011;Keene and Ruel, 2013;Filandri and Olagnero, 2014;Morris, 2018;Aitken et al., 2019;Baker et al., 2020;Viljoen et al., 2020). While these societal influences have been well researched with adults, there has been limited research on older adults specifically. ...
The physical and societal characteristics of home have been established as important in influencing the health and wellbeing of older adults, yet these have rarely been explored together. There is also limited research into variation across age groups, with older adults often examined as a homogenous group of those 65 years and over. This study advances the knowledge base by using the concept of person–environment (P-E) fit to analyse differences in personal and home environment (physical and societal) characteristics between young-old (65–74 years) and old-old (75 and above) age groups, and to assess how these characteristics influence their self-perceived health. This cross-sectional study draws upon survey data from 1,999 older adult participants from the Australian Housing Conditions Dataset. Descriptive statistics and inferential analysis were used to assess for significant differences between age groups and a binomial logistic regression was utilised to examine influences on health. The analysis found that the factors which influence health varies appreciably between age groups. For the young-old financial strain, being on the fixed-income pension and hypertension were important contributing factors, in contrast for the old-old gender (being male), having depression and the home being modified for disability were key influences. For both age groups heart disease was a contributing factor to perceived health. The results indicate the important contribution to knowledge of incorporating a wide range of person and environment characteristics when exploring P-E fit for older adults. The inclusion of societal aspects, such as financial strain, fixed-income pension, tenure and access to community aged care services when exploring influences on health, arises as a key conclusion of the study. In terms of impact, this research is significant given rising inequalities globally and specifically in the Australian context, the need for policy measures to address income inequality, and its health and social implications for older households.
... 7 Moreover, housing dissatisfaction and poor-quality housing are frequently reported concerns among people with disabilities. 8,9 The lack of accessible housing options is partly because volume builders in Australia do not systematically incorporate accessible design features, leaving buildings only partially accessible. 10 Concerns regarding a lack of physical housing accessibility have also been raised in other countries, including the United States of America, 11 Sweden, 12 and Japan. ...
Background
Despite the number of older people and people with disabilities increasing in Australia, it is unclear which housing design features are needed to support physical housing accessibility for people with and without disabilities across the lifespan.
Objective
This study drew upon the experience of occupational therapists to investigate accessible housing design features and home modifications to support aging in place and discharge from hospital to home.
Methods
A cross-sectional online survey exploring housing design features and home modifications was completed by 144 Australian occupational therapists over six weeks in 2021. Descriptive quantitative and qualitative data analyses were used.
Results
For both aging in place and hospital discharge, the most important housing design features included step-free access to the dwelling, large step-free showers, and bathroom and bedroom space on the ground floor. Qualitative findings also highlighted the importance of preparing for home modifications, such as reinforcing bathroom walls to support the post-build installation of grab rails. The most frequently needed modifications were for bathroom features, while structural changes to the dwelling were the most time-intensive modifications, requiring more than six weeks to be completed.
Conclusions
External access to the home and internal access to bedroom and bathroom facilities can support aging in place and hospital discharge and mitigate the need for costly and time-intensive home modifications. While this study was conducted in Australia, the findings have relevance outside of this context, and are important for ensuring equitable accessibility for people with and without disabilities across the lifespan.
... The accessibility and affordability of mainstream housing may also be a factor in reaching and sustaining the targets. People with disabilities in Australia have been found to generally experience greater housing disadvantage and insecurity than people without disability, including having more difficulty paying rent or mortgage and being more likely to move due to health (Aitken et al., 2019). A promising change in terms of housing policy is the inclusion of minimum accessibility standards for residential housing and apartments into the National Construction Code from 2022 (DISER, 2021). ...
Over 4500 people under 65 years of age live in residential aged care (RAC) in Australia, and they experience poorer quality of life than people with similar disabilities in other settings. Governments have long aimed to reduce admissions of young people to RAC, but in 2019, for the first time, the Australian Government adopted target dates for resolving the issue. The targets include reducing admissions of young people to near zero by 2022 and ensuring almost no one remains in RAC beyond 2025. The national strategy focuses mostly on housing and support needs being met via the National Disability Insurance Scheme. The present study drew on quarterly data from the National Aged Care Data Clearinghouse to examine progress toward these targets. Significant progress was evident in terms of young people entering RAC: admissions reduced each quarter between September 2018 and July 2020, halving over two years. No progress was evident in terms of young people leaving RAC for better arrangements; the trend neither increased nor decreased. Prospects for achieving the targets are discussed.
... More recently, Sharam et al., found that "this is very problematically still the case" (2018, p. 35) and also that "[t]he Australian private sector housing, like much of the Western world, has, in the absence of universal accessibility standards, failed to provide appropriate housing for people with physical disability" (2018, p. 31). Aitken et al. (2019) found that people with disability reported poorer housing quality and significantly more dissatisfaction with their neighbourhoods and homes than people without disability and also, that "[o]ur findings suggest that there is a housing crisis for people with disabilities in Australia which may intensify with the introduction of the NDIS" (Aitken et al., 2019, p. 138). The need for appropriate house design in terms of safety, independence and mental health has been widely acknowledged. ...
Purpose
The COVID-19 pandemic has engendered changes in previously unimaginable timeframes, leading to new ways of working, which can quickly become the “ordinary” way of working. Many traditional workplace and educational practices and environments, however, are disadvantageous to people with disability and consequently are under-represented in the workforce and higher education.
Design/methodology/approach
Contributing factors include exclusionary societal and employer attitudes and inaccessible built environments including lack of attention to paths of travel, amenities, acoustics, lighting and temperature. Social exclusion resulting from lack of access to meaningful work is also problematic. COVID-19 has accelerated the incidence of working and studying from home, but the home environment of many people with disability may not be suitable in terms of space, privacy, technology access and connection to the wider community.
Findings
However, remote and flexible working arrangements may hold opportunities for enhancing work participation of people with disabilities. Instigating systemic conditions that will empower people with disability to take full advantage of ordinary working trajectories is key. As the current global experiment in modified work and study practices has shown, structural, organisational and design norms need to change. The future of work and study is almost certainly more work and study from home. An expanded understanding of people with disabilities lived experience of the built environment encompassing opportunities for work, study and socialisation from home and the neighbourhood would more closely align with the UNCRPD's emphasis on full citizenship.
Originality/value
This paper examines what is currently missing in the development of a distributed work and study place continuum that includes traditional workplaces and campuses, local neighbourhood hubs and homes.
... This attitude to inclusion underpins the approaches adopted in the project described in this chapter, which, furthermore, acknowledge the importance of a political voice, pride, and representation of those often left out and who feel 'unwelcome' within places, spaces, and activities to have a voice in developing what access and inclusion looks and feels like (Aitken et al. 2019;Bigby 2008;Fudge Schormans et al. 2019;Harrison 2004;Tually et al. 2011). ...
Accessible housing is essential for disabled and elderly people with physical restraints to live independently. In reality, however, there is a considerable lack of accessible housing in Germany. While investigating the reasons for this insufficient supply, this article discusses the underlying policy mix and scrutinizes German accessible housing politics. Based on 50 semi‐structured interviews in the two states SaxonyAnhalt and Hesse, it identifies the weak political influence of disability lobbyists as the primary reason. Lacking structural, organizational, and institutional power, they do not get access to decision‐makers in housing politics but are labeled as social policy actors. On the other hand, housing and building industries have considerable resources to push their housing policy agenda. Nevertheless, the empirical findings clearly show the challenging endeavor of integrating social and building policies in accessible housing while contributing to the overarching understanding of politics in minor policy fields.
This paper examines the accommodation in houses in Trinidad in the context of older persons with disabilities. An exploratory sequential mixed-methods research design was used. In the qualitative phase, a list of accommodation items was identified via interviews. This information was used to develop a questionnaire to measure accommodation items of a large nationally representative sample of houses in Trinidad. Only physical accessibility items were identified, and data from 768 houses indicated that no house had all identified items. There is a need for urgent adoption and implementation of accessibility standards. Findings also indicate modification cost is a challenge and that responses targeted to low-income and rural households are needed. Lastly, the social care context, specifically the family care potential, is an important consideration in housing policy debates, and community homes for the aged and programs involving multiple experts to identify and support housing modification are recommended.
People with mobility impairment have the right to live in accessible housing that meets their needs. Although the Australian National Construction Code for residential housing will be amended to include minimum accessibility standards in September 2022, some states have chosen not to adopt these standards (New South Wales, Western Australia and South Australia). The inclusion of people with lived experience in decisions surrounding accessible housing design is lacking. This study sought the perspective of people with mobility impairment on the most important modifications they would make to the design of their own homes, and the homes of their friends and family, to make them more accessible. An online survey was completed from February to March 2021 by 145 people living in Australia including 112 people with mobility impairment, and 33 family members. Results indicated that 71 per cent of the participants were living in housing that did not fully meet their accessibility needs. Descriptive qualitative analyses demonstrated that commonly reported modifications included a step‐free entrance, wider internal doors and corridors, and level access throughout the home. These modifications would promote social inclusion, functioning, independence and overall quality of life. These results have policy implications for the implementation of accessibility standards in the National Construction Code.
It is well-known that people with psychiatric diagnoses experience disproportionate rates of homelessness. However, few studies have explored the perspectives and practices of mental health social workers in responding to clients experiencing homelessness. This article reports on findings from three focus groups with inpatient mental health social workers in Sydney, Australia. Three themes were identified: stuck in a crisis; reliance on sub-standard housing conditions; and pressures to discharge. The study reveals the challenges experienced by social workers in navigating scarce housing resources, and the limitations of a biomedical paradigm in failing to address the social determinants of mental distress.
Social services for people with disabilities have undergone substantial changes over time, in particular in the past two decades. Whilst lack of affordable and appropriate housing is a barrier to community living for many people with disabilities, it is only one part of the jigsaw. This book traces some of these changes, in particular related to living situation and support available, in a range of different countries and considers the factors that have influenced these changes. This book considers other aspects of what is needed to bring about real change in the lives of all people with disabilities.
In the context of rising numbers of people with disability in Australian cities, this paper describes a study determining actions to overcome unintended obstacles in the built environment to city-scale accessibility and inclusivity in a regional city in Australia. Prior studies have largely failed to connect social inclusion obstacles in the built environment with factors leading to social exclusion in other domains that have impact on, and are impacted by, the built environment. An approach based on systems thinking allowed a wide range of stakeholders, including many with lived-experience of disability, to exchange ideas in a short timeframe linking the built environment with other obstacles to accessible and inclusive cities. One hundred and nineteen actions were identified to overcome these obstacles, with 37 of these prioritised according to impact and feasibility. Nineteen of these 37 are imbedded in the built environment. Access to appropriate and affordable housing was identified as a key factor across all domains. Importantly, it was found that access for people with disability to appropriately designed and affordable housing was at the fulcrum of many other issues, across numerous city domains, that created obstacles to meaningful living and fulfilled lives. The process advanced understanding of how housing is impacted by, and has impacts on, a wide sphere of socio-political and physical contexts.
Objectives
The aim of this scoping review was to map and synthesise peer-reviewed literature reporting on the Australian National Disability Insurance Scheme and psychosocial disability.
Method
The review followed the rigorous and systematic protocol of Arksey and O’Malley. Five databases were searched and, using strict inclusion and exclusion criteria, publications were identified for inclusion. Data were extracted from publications, tabulated and graphically presented. A qualitative analysis was also completed.
Results
Twenty-eight publications were included. While a wide range of issues were covered across this literature, only eight publications specifically focused on the National Disability Insurance Scheme. Almost half of publications were only author commentary without analysis of external data. There were no evaluations and a paucity of publications documenting the lived experiences of people with psychosocial disability or their families. Qualitative analysis identified 59 separate themes. These were grouped using a modified strengths, weakness, opportunities and threats framework. While it was acknowledged that the Scheme has the capacity to enrich people’s lives and enhance service integration, themes relating to weakness and threats dominated within this literature. These included a variety of existing or predicted problems such as poor integration of a recovery philosophy into the National Disability Insurance Scheme, complex application processes creating barriers to access, concern for those ineligible or not accessing the National Disability Insurance Scheme, the need to ensure National Disability Insurance Scheme plans address specific, changing participant needs and that services will be available to provide required supports.
Conclusion
Given the significant impact of the National Disability Insurance Scheme on the lives of individuals and the wider mental health service system, there continues to be surprisingly limited peer-reviewed literature reporting on experiences and outcomes of the Scheme for people living with psychosocial disability. Future research examining outcomes and shedding light on National Disability Insurance Scheme experiences of people with psychosocial disability and their families are particularly important for ongoing development and evaluation of the Scheme.
Research exploring the meaning of home is well established; however, limited attention has been paid to contexts outside of western, owner-occupied homes. One context which requires further investigation is the experience of home for adults with disability living in social housing. This study aimed to investigate this experience in Australia. Fifteen households participated in in-depth interviews. Two themes “home is still home” and “loss of control” emerged from the thematic analysis. Participants described their homes’ as providing security, stability and a sense of “home”, but many also experienced limited control over the location, condition, and modification and maintenance of their home. The study highlights the importance of secure tenure, the need to support people with a disability during housing transitions, and the impact of policy on the experience of home. Ongoing research on the impact of housing policies on the lives of people with a disability will be key to improved policy.
The National Disability Insurance Scheme (NDIS) has been one of the most important social policy innovations to have been developed and implemented in Australian history. For such a major social policy to commence through a large-scale trial, which is simultaneously evaluated in a rigorous manner by an independent body of experts, is the right course of action. It supports the prudent use of public resources and is also a anifestation of respect for the many thousands of people who make the NDIS, from the people with disability and their families and carers, to the dedicated carer and support
providers and workforces, and with the arrival of the NDIS, to the new dedicated NDIA workforce.
The main objective of the evaluation of the NDIS has been to offer a well-informed and independent assessment of the many impacts of the NDIS trial. The trial has taken place in South Australia (SA), Tasmania (TAS), New South Wales (NSW), Victoria (VIC), the Australian Capital Territory (ACT) and the Barkly region in the Northern Territory (NT). We consider the impacts of the trial on people with disability and their families and carers, the disability sector and its workforce, mainstream providers and services, and stakeholders and the wider community. A further objective of the evaluation has been to examine high-level processes, focusing on elements of the NDIS which contributed to or
impeded the intended positive outcomes. In addition, the evaluation has provided a working template for a continuing independent longitudinal survey data collection of people with disabilities and their families and carers in Australia and of the disability support sector and its workforces. Such a survey would provide early evidence of any problems as they arise, and confirmation of where things are going well. It would thus be an objective guide as to how best to modify and strengthen the system as it unfolds and matures.
Several main findings emerge from the evaluation of the NDIS. The first finding is that the Scheme has been designed and built on sound fundamentals. This is an important confirmation of the policy. The second finding is that the NDIS has been delivering the outcomes that it was designed to deliver. This is probably the most important positive finding of the evaluation and it should be flagged as such.
Given the complexity and magnitude of the undertaking, it is not unexpected that these positive findings come with qualifications. For example, some design aspects and implementation outcomes are not necessarily as person-centred as originally desired, and several outcomes are not attained at the speed that was originally expected. The evaluation identifies several such problems and offers its critical assessment. The evaluation team would invite the policy maker to consider carefully these identified problems, as many of them will need to be resolved. Equally, the team would invite the policy maker to consider carefully those aspects of the NDIS that make for its success and seek appropriate policy interventions that will reinforce them.
Australia’s National Disability Insurance Scheme (NDIS) provides a once-in-a-generation opportunity to transform how people with a disability are served. Similar to the enactment of the Disability Services Act 1986, which challenged the segregation and supported the integration of people with a disability into community settings, the National Disability Insurance Scheme Act 2013 is expected to fundamentally disrupt traditional service practice and improve disabled people’s lives. This paper identifies some lessons from the previous reforms of 1986 to guide policy makers, people with a disability, their families and service-providers, as they implement the NDIS now. It reflects on what it takes to make change, and what can be expected to remain essentially the same regardless of the disruption that the NDIS will bring. It concludes that if the lessons of the past hold true, the NDIS will require several decades of intentional leadership and capacity-building to achieve enduring, positive change.
Background
Internationally, men with disabilities have higher rates of social and economic disadvantage and poorer health and wellbeing than men without disabilities. No single study has provided comprehensive, population-level information about the magnitude of such differences among adult men using a well-validated instrument to measure disability. Methods
We analysed baseline data from Ten to Men – an Australian longitudinal study of male health. Ten to Men used a stratified multi-stage cluster random sample design to recruit a national sample of males aged 10 to 55 years residing in private dwellings. Data were collected between October 2013 and July 2014 from 15,988 males. This analysis was restricted to 18–55 year old participants with data available on age and disability (n = 13,569). We compared the demographic, socio-economic characteristics and health and wellbeing of men with and without disabilities using chi squared tests for proportions and t tests for continuous variables. Linear regression adjusted for age was used to assess the association between disability status and health and wellbeing, which were measured using the SF-12 mental and physical health component scores and the Personal Wellbeing Index. ResultsMen with disabilities were older and more likely to be born in Australia, speak English at home, be Aboriginal and Torres Strait Islander and were less likely to be married or de facto, or to live in urban areas. They were less likely to have completed secondary school, be employed and live in affordable housing, and were more likely to live on low incomes, in more socio-economically disadvantaged areas, and in rental accommodation and to experience shortages of money. Among employed men, those with disabilities were less likely to be in high skilled jobs, worked less hours on average, and were more likely to report that they would prefer to work more. Men with disabilities had lower levels of social support and community participation and poorer mental and physical health and overall wellbeing. Conclusion
Adult men with disabilities experience marked social and economic disadvantage and poorer health and wellbeing. Improving the health and wellbeing of disabled men should be a priority for public health researchers and policy-makers.
This paper presents an alternative view on the patterning of housing problems – across populations and within people. The conceptualization of housing problems through a ‘housing niche’ lens allows the cumulative influence of multiple housing vulnerabilities to be better visualized and understood. Using a large, representative sample of the Australian population, the analysis describes and models patterns of multiple housing problems, the characteristics of the population at risk, and reflects on the implications for how policy might better understand and respond to multiple housing problems.
This paper applies established methods from population geography to assess the impact of Australia’s emerging housing affordability crisis in shaping the distribution of Australia’s population into more or less advantaged places. Using a whole of population measure of locational advantage/disadvantage, we analyse the characteristics of movers, their reasons for moving, and their pre and post move residential outcomes. We find evidence at the population level of a ‘two-speed’ process, where - on average - Australians are moving to slightly more advantageous locations, but more vulnerable groups undertake more frequent, multi-step moves to disadvantaged areas. Housing affordability is found to be the key driver of the selective migration of some Australians into less advantaged places. The paper highlights the dynamic character of places, the increasing importance of housing affordability as a determinant of population distribution, and signals a need to look beyond simple place-based interventions.
The National Disability Insurance Scheme (NDIS) will profoundly impact on patterns of housing demand by people with disability. There is an estimated unmet need in affordable housing for between 83 000-122 000 NDIS participants at full rollout of the scheme in 2019. There is lack of policy clarity about the roles of the NDIS, Commonwealth and state governments in addressing the shortfall in housing for NDIS participants. Supply-side subsidies-integrated with planning, finance and design innovations-can deliver affordable housing that meets the present and long-term goals and needs of NDIS participants. With appropriate design and location, capital costs of housing development can be recouped through savings on support provision. Well-designed and located housing can deliver additional benefits in terms of economic participation, social inclusion, health and wellbeing. Unless there is an adequate supply of affordable and accessible housing, safeguards are necessary to ensure choice for people with disability, for example: a separate allocations system in social housing and possibly choice-based allocation, and advocacy and support to assist people with disability when applying for housing. © Australian Housing and Urban Research Institute Limited 2015.
The National Disability Insurance Scheme (NDIS) is one of the most significant initiatives in Australian social policy history. Its complexity has been compounded by a fast-paced introduction and ongoing refinement throughout the initial trial phase. Parents and carers of very young disabled children face particular challenges accessing and navigating NDIS systems. This article presents findings from a mixed-method pilot study examining the perspectives of parents and carers of disabled children in one NDIS trial site – the Hunter Region of New South Wales. The research highlights a number of policy assumptions potentially impacting on NDIS take up for young disabled children and their families in regional contexts. Based on research findings a number of policy suggestions and improvements for disabled children and their families entering the NDIS and other individualised funding schemes are outlined.
www.ahuri.edu.au/publications/projects/p71040
The last 30 years has seen significant developments in the Australian housing sector for people with disabilities. Despite much change in the sector, and advancements in disability services, the range of current supported housing options for younger Australian adults with a neurological disability remains vastly under-developed. This is despite a widely accepted and endorsed recognition that, as is the general population, people with all forms of disability have a right to housing of their choice. This paper presents a timely critique of the key actions made by the Australian disability and housing sectors and subsequently proposes a more informed approach to supported housing design and development: one that is based on a comprehensive understanding of consumer housing priorities and preferences, and is conducive to a person’s biopsychosocial health.
Purpose:
To examine the relevance of the International Classification of Functioning, Disability and Health (ICF) to CBR monitoring and evaluation by investigating the relationship between the ICF and information in published CBR monitoring and evaluation reports.
Method:
A three-stage literature search and analysis method was employed. Studies were identified via online database searches for peer-reviewed journal articles, and hand-searching of CBR network resources, NGO websites and specific journals. From each study "information items" were extracted; extraction consistency among authors was established. Finally, the resulting information items were coded to ICF domains and categories, with consensus on coding being achieved.
Results:
Thirty-six articles relating to monitoring and evaluating CBR were selected for analysis. Approximately one third of the 2495 information items identified in these articles (788 or 32%) related to concepts of functioning, disability and environment, and could be coded to the ICF. These information items were spread across the entire ICF classification with a concentration on Activities and Participation (49% of the 788 information items) and Environmental Factors (42%).
Conclusions:
The ICF is a relevant and potentially useful framework and classification, providing building blocks for the systematic recording of information pertaining to functioning and disability, for CBR monitoring and evaluation. Implications for Rehabilitation The application of the ICF, as one of the building blocks for CBR monitoring and evaluation, is a constructive step towards an evidence-base on the efficacy and outcomes of CBR programs. The ICF can be used to provide the infrastructure for functioning and disability information to inform service practitioners and enable national and international comparisons.
The housing we live in shapes individual access to jobs, health, well being and communities. There are also substantial differences between generations regarding the type of housing they aspire to live in, their attitudes to housing costs, the nature of their households and their attitudes to different tenures. This important contribution to the literature draws upon research from the UK, Australia and the USA to show how lifetime attitudes to housing have changed, with new population dynamics driving the market and a greater emphasis on consumption. It also considers how the global financial crisis has differentially affected housing markets across the globe, with variable impacts on the long term housing transitions of different populations.
National disability strategy implementation is challenging. Competing needs and interests of government and different stakeholders mean that implementation is rarely straightforward. This study undertakes a critical framing analysis of publically available responses to the draft implementation plan for Australia’s National Disability Strategy (2010–2014) provided by five peak disability organisations. We seek to understand the frames that peak bodies advocate in order to further the interests of people experiencing disability while mapping these against the broader Australian disability policy context and good policy practice more generally. Our research reveals that the peak bodies promote frames which focus on consistency, responsibility, resourcing, inclusivity, co-production, innovation, leadership, accountability and language. In relation to these frames, the final government implementation plan demonstrates a shift in which process-related frames of resourcing and innovation are incorporated into the plan while the other predominantly actor-oriented frames are excluded and thus represented as natural and incontestable.
Housing is a central component of productive, healthy, and meaningful lives, and a principle social determinant of health and well-being. Surprisingly, though, evidence on the ways that housing influences health in Australia is poorly developed. This stems largely from the fact that the majority of the population are accommodated in good quality housing. The dominance of a “good housing paradigm” means that households living in poor quality and unhealthy housing are doubly disadvantaged—by the quality of their housing and because policy makers in Australia do not acknowledge the health effects of housing. In this article, we examine the relationship between health outcomes and quality of housing. We base our analysis on data from the Household Income and Labour Dynamics in Australia (HILDA) survey, a panel dataset that is representative across Australia. We find a sizeable, policy-important, and to date under-acknowledged cohort of Australians whose health is influenced by poor-condition dwellings.
As noted in the preamble to the 2007 UN Convention on the Rights of Persons with Disabilities, 'persons with disabilities continue to face barriers in their participation as equal members of society and violations of their human rights in all parts of the world'. In this paper we present nationally representative data on the nature and level of disadvantage faced by young Australians with a long-term health condition, impairment or disability in 2001 and 2006. The results suggest that: (1) when compared with their non-disabled peers, young Australians with a long-term health condition, impairment or disability face pervasive social and material hardship and have lower subjective well-being; (2) no progress was made between 2001 and 2006 in equalising the opportunities of young Australians with a long-term health condition, impairment or disability; (3) lower subjective well-being is not inherently associated with disability, but is contingent on the experience of social exclusion and material hardship.
Women and the households that they head are over-represented among the most economically and socially disadvantaged households in Australia. Recent changes in the provision of housing assistance for low income households in Australia have distinct implications for women and this paper examines the implications of these changes. Shifting the emphasis in housing assistance away from publicly provided and rent-controlled housing to direct subsidisation of rents for private tenants has important, largely negative, consequences for the health, affordability and security of housing for many women. This situation is made worse given the current housing affordability crisis in Australia; a crisis that extends across all private housing tenures.
This paper contributes insights into the role of tenure in modifying the relationship between housing affordability and health, using a cross-national comparison of similar post-industrial nations—Australia and the United Kingdom—with different tenure structures. The paper utilises longitudinal data from the Household, Income and Labour Dynamics in Australia Survey and British Household Panel Survey to examine change in the mental health of individuals associated with housing becoming unaffordable and considers modification by tenure. We present evidence that the role of tenure in the relationship between housing and health is context dependent and should not be unthinkingly generalised across nations. These findings suggest that the UK housing context offers a greater level of protection to tenants living in unaffordable housing when compared with Australia, and this finds expression in the mental health of the two populations. We conclude that Australian governments could improve the mental health of their economically vulnerable populations through more supportive housing policies.
Voice has become an important yet ambivalent tool for the recognition of disability. The transformative potential of voice is dependent on a political commitment to listening to disabled people. To focus on listening redirects accountability for social change from disabled people to the ableist norms, institutions and practices that structure which voices can be heard in policy debates. In this paper, I use disability theory on voice and political theory on listening to examine policy documents for the National Disability Insurance Scheme in light of claims made by the disability movement. Although my study finds some evidence of openness in the policy development stage, the scheme falls short of valuing the diverse voices of disabled people as partners in shared dialogue.
Background
People with disabilities are socio-economically disadvantaged and have poorer health than people without disabilities; however, little is known about the way in which disadvantage is patterned by gender and type of impairment.
Objectives
1. To describe whether socio-economic circumstances vary according to type of impairment (sensory and speech, intellectual, physical, psychological and acquired brain injury) 2. To compare levels of socio-economic disadvantage for women and men with the same impairment type
Methods
We used a large population-based disability-focused survey of Australians, analysing data from 33,101 participants aged 25 to 64. Indicators of socio-economic disadvantage included education, income, employment, housing vulnerability, and multiple disadvantage. Stratified by impairment type, we estimated: the population weighted prevalence of socio-economic disadvantage; the relative odds of disadvantage compared to people without disabilities; and the relative odds of disadvantage between women and men.
Results
With few exceptions, people with disabilities fared worse for every indicator compared to people without disability; those with intellectual and psychological impairments and acquired brain injuries were most disadvantaged. While overall women with disabilities were more disadvantaged than men, the magnitude of the relative differences was lower than the same comparisons between women and men without disabilities, and there were few differences between women and men with the same impairment types.
Conclusions
Crude comparisons between people with and without disabilities obscure how disadvantage is patterned according to impairment type and gender. The results emphasise the need to unpack how gender and disability intersect to shape socio-economic disadvantage.
PanelWhiz is a graphical user interface that was written for the statistical software, Stata SE/MP Version 11 (Win/Mac/Linux) or later, which allows users to extract data from complicated multi-level longitudinal datasets in an easy and efficient manner. Specifically, Australian datasets, such as Household, Income and Labour Dynamics in Australia Survey, Medicine in Australia: Balancing Employment and Life, Growing Up in Australia: The Longitudinal Study of Australian Children, Footprints in Time—The Longitudinal Study of Indigenous Children and Consumer Attitudes, Sentiments & Expectations in Australia, have already been integrated into the common platform of the PanelWhiz system.
Debates on human rights and discrimination regarding housing and disability need to emphasise community care and inclusion as principles for improving policy. A qualitative study of Australian mortgage default reveals special difficulties for households with a member with a disability; that is, illness, impairment or injury limiting everyday activities and enduring for several months. Interviews showed that such households adopted similar strategies to other mortgagors with serious financial difficulties but tended to have fewer and less attractive options. Given the crisis in Australian disability welfare services and the 2010–2011 Productivity Commission inquiry recommending major reforms, these findings can inform policy.
This research was carried out between January and July 1993. The study was an evaluation of housing need of disabled people who were wheelchair users through a process of consumer consultation. It was concerned to find out the extent and nature of that need whilst also testing out consultation through the use of research methods in comparison with a non-consultative approach taken by the local authorities. The nature of need was found to be qualitatively different to that found through the study of normative needs. A significant number of disabled people were being made more dependent by their housing and this was being reinforced by the agencies that were intended to help them. In particular, the failure to consult disabled people was leading the local authorities to make inappropriate plans for new build housing while the major need for adaptations was being undermined by their operation of the Disabled Facilities Grant. The findings support the call from other writers that the solutions to housing problems will only come through viewing disability as a civil rights issue.
The independent living (IL) paradigm proposes that the presence of environmental barriers affects critically the level of independence of people with disabilities. This study refines the IL paradigm and evaluates empirically the role that the environment plays in independent living, especially the influence of home adaptations and other housing variables on disabled people and their families. The results of this research indicate that housing adaptations have a variety of impacts upon the productivity of disabled people. Other housing issues are very important to individuals with disabilities, particularly tenants. This paper concludes by presenting implications for theoretical development and recommendations for housing policies which are responsive to the needs of disabled people.
Two national data sets (the Panel Study of Income Dynamics and the Survey of Income and Program Participation) are analyzed
to compare housing afford-ability and quality between U.S. disability households and other households and by region. The researchers
conclude that disability households in the United States are at risk of inability to afford housing. In addition to higher
housing-income ratios, these households are more likely to be older, in poverty, in poor or fair health, and on public assistance
than other U.S. households. They are also more likely to carry severe housing cost burdens, to be in housing poverty, and
to be receiving housing assistance. Regional differences among disability households and their housing seem to echo geographic
economic and population trends, as well as regional variances in the housing stock. The data, which did not address housing
accessibility, are less clear about disability households' risks relative to housing quality.
Deinstitutionalisation is represented as a major step toward social inclusion through the resettlement of disabled people residing in segregated large-scale institutions into community-based homes. By promoting the right to live in ordinary community residential settings, deinstitutionalisation fundamentally changes both the support services and housing arrangements of former institutional residents. In Australia, as in many western countries, debates on community care have tended to focus on the location and nature of non-housing supports for people leaving dependent care. This focus, however, overlooks the fact that deinstitutionalisation involves a radical rehousing of people in care. This paper explores the character and implications of deinstitutionalisation in Australia as a rehousing process. It is based on a recent national research project that has examined the housing futures of people with intellectual disabilities who have been, or will be, deinstitutionalised. The paper considers the increasingly divergent socio-political perspectives that have emerged in recent discussions about social inclusion, institutional reform and independent living and their implications for housing and community care policies. Yes Yes
Internationally, considerable policy attention is being paid to increasing the employment participation of disabled working-age people. Like other OECD countries, Australia has experienced growth in the number of Disability Support Pension (DSP) recipients due to changes in industry structure and increases in precarious employment. This history is well-rehearsed in policy debates. However, little research attention has been given to the housing circumstances of DSP recipients. This is important, particularly when we note the increasing incidence of working-age DSP recipients in the private rental market and public housing. For public renters the incidence has more than tripled to 27 per cent over the period 1982-2002. This paper addresses two questions: 'What are the housing circumstances of DSP recipients?' and 'What are the likely consequences of programme changes aimed at increasing employment participation of DSP recipients?' Using Australia as an example, this article considers interactions between the new disability payment system being implemented through Welfare to Work, housing costs and employment income.
Individuals with severe and persistent mental illness (SPMI) identify housing as an important factor in achieving and maintaining their health. However, many live in substandard accommodations that are physically inadequate, crowded, noisy and located in undesirable neighbourhoods. In much of the research on housing for persons with SPMI, the central outcome of interest is remaining housed; however, it is worth investigating whether housing has other benefits. This paper is a systematic review of studies that investigated the relationship between housing-related independent variables and health-related dependent variables. Ten online databases were searched for studies published since 1980 that had study populations of adults with SPMI, analysed primary or secondary empirical data, and measured housing-related independent variables and health-related dependent variables. Clearly defined epidemiological criteria were used to assess the strength of evidence of the selected studies. Twenty-nine studies met the suitability criteria, of which 14 reported healthcare utilisation outcomes; 12 examined mental status outcomes; and 9 reported quality-of-life outcomes. The findings of the review suggest that there is good evidence that housing interventions benefit the homeless population; however more research is needed about housing solutions for individuals with SPMI who are housed, but in precarious or inappropriate housing situations. Study methodologies could be improved by emphasising longitudinal designs that focus on participant retention and by implementing matched control groups or randomised interventions to strengthen internal validity. Ensuring that a person is adequately housed upon discharge from hospital should be a treatment priority. When housing eligibility is not dependent on psychiatric treatment compliance and sobriety, providing permanent housing minimises harm and may free people to voluntarily seek treatment. Housing that offers an unlimited length of stay is recommended because SPMI is a chronic and fluctuating condition that requires stable surroundings to maintain health.
Using the Australian Bureau of Statistics 1998 Survey of Disability, Ageing and Carers, this study examines the effects of disability on four labour market outcomes: not in the labour force, unemployed, part-time employed and full-time employed. The detailed information on health available in the dataset also facilitates investigation of the dependence of effects on the characteristics of the disability, including severity, impairment type and age of onset. Disability is found to have substantial effects on labour force status, on average acting to decrease the probability of labour force participation by one-quarter for males and one-fifth for females. For males, the decrease in fulltime employment accounts for almost all of the decrease in labour force participation associated with disability; for females, disability has negative effects on both full-time and part-time employment. Analysis of disability characteristics shows that adverse effects on labour force status are increasing in the severity of the disability and are also worse for those with more than one type of impairment and for those who experience disability onset at older ages. There is evidence that the adverse effects of disability are lower for males who completed their education after the onset of the disability. Copyright 2004 The University of Melbourne, Melbourne Institute of Applied Economic and Social Research.
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