Revenue Revisited: 5 Ways SIL Quotes Get It Wrong

Over the past 12 months, DSC has been assisting providers to review their Supported Independent Living (SIL) quotes for residences across Australia. Typically, we are tasked with studying the quote to see whether it is appropriate for the residents, taking into account their goals and support needs.  

Anyone who has had the pleasure of putting together a SIL quote will know how much work is involved. You need to assess the needs of each resident, their support level (standard, high or complex), their individual NDIS Plans and their goals. After that, you need to integrate the individual’s quote with that of other residents and then work on staff rosters and your cost rates. It is no easy task. Once all this information has been put together in a quote, the NDIA Planners will assess it against the reasonable and necessary criteria.

Given all these moving pieces, it is not hard to see why quotes often end up being an inaccurate representation of the goals and needs of the residents. Incorrect quotes are also bad news for providers who could end up not being properly remunerated for the support they provide. For these reasons, we have put together a quick list of the most common pitfalls to avoid.

 

1. Poor Interface with Personal NDIS plans

If a SIL quote is not synchronised with the Participant’s individual NDIS plan goals and funding then it can lead to discrepancies between these two avenues of support. We regularly see cases where Participants have been left with support gaps or double ups. SIL quotes need to carefully align with the Participant’s individual NDIS Plan and support them to be out of the house pursuing their interests and social opportunities as well as capacity building activities that can be delivered within their home.

 

2. Incorrect Support Level Classification

The SIL quote will be compared to the Participant’s support level classification- standard, high or complex. There are no longer any official benchmarks to guide the price of support per week at each level, but there are some patterns we tend to see. If you have declared that a Participant has ‘standard’ needs but have quoted at $5,000 per week, then you should expect to be seriously questioned. Generally we are seeing standard support being funded at around a low $3,000 per week; high needs as between $3,000 and a high $4,000; and complex needs at around $5,000+. These are rough rules of thumb and can vary between regions.

 

3. Low Worker to Participant Ratios

We often see providers listing 1:5 or 2:5 as the worker to Participant ratio, day-in, day-out and at all times except when the Participant is out of home. However, when you look more deeply into the Participants’ profiles you regularly see that there are a lot of times when they actually require 1:1 support. This is particularly common during morning and evening personal care routines. It is easy to see why providers go down this road- smaller quotes get more easily approved and “it’s the way we used to do it”. However, incorrect quoting can result in the provider not being properly compensated for the supports they actually provide, or leaving the Participants without adequate support. So in the long run, it really is not worth it. With detailed participant profiles and thorough engagement with the NDIA during the quote process the “real” needs of the residents can be accurately reflected in the quote.

 

4. Quotes Not Aligning With The Award Rate

The award rate for support workers changes depending on the time that the shift begins or ends. It is essential to ensure that this is reflected in the quote. Carefully consider when a shift is likely to end, because that is often where the error occurs. If it is later than 8pm or 12am then the worker is entitled to higher pay for the entire shift.  These types of remuneration issues need to be carefully aligned to the proposed roster of care within the home.

5. Irregular hours 

The current version of the SIL tool allows providers to take into account irregular hours. These are hours when the Participant requires support due to an unexpected or unplanned event, such as being unable to attend a day program or if a family stay is cancelled. You cannot perfectly predict how many irregular hours will occur in a year, but you do need to carefully think about how many you quote for. Your first step should be to review the Participant’s history over the last 12 to 24 months and consider their overall health. You will also need to look at the Participant’s schedule. The more time the Participant spends out of the house, the greater the likelihood that there will be a higher number of irregular hours – for example. 

Poorly prepared quotes are a lose-lose situation for providers and Participants. Providers can find themselves being significantly underpaid for the amount of support that they provide. Meanwhile, Participants wind up underspending in their Plan, putting them at risk of losing that funding in their next Plan Review. In the very worst cases, the Participant’s safety will be compromised by their support needs going unmet. Getting SIL quotes right takes an inordinate amount of effort but on a cost benefit basis we are seeing huge positive revenue impacts for the organisations who do it well.

At DSC we frequently find ourselves training other consultants in how to work with SIL and SDA. Why not just work with our DSC expert consultants directly?  We love using our skills in organisations to assist them to nail their SIL quotes and Participant level plans.