Digital care platforms like Mable are seeking to bring higher levels of efficiency, choice and control to the National Disability Insurance Scheme (NDIS). But are they striking the right balance between those principles and client safety? Zacharias Szumer investigates.
The NDIS is a model built around giving choice and control to people with disability. This means allowing clients to manage their own funding and hire their own staff.
They can do this through placing ads on Gumtree or Facebook or through platforms like Mable, a digital marketplace connecting clients and independent workers.
Companies like Mable offer clients a higher level of safety thanks to a “strict on-boarding process” – “reference and qualification checks, police checks, working with children checks” – and quality control to weed out workers who are found to have put clients at risk.
These safeguards are, among other things, why Mable requests a commission of roughly 18% for its services.
However, several anecdotes recently shared with MWM raise questions about how seriously the company takes client safety.
An unwelcome delivery
James hired Marian* via Mable for “general support work,” such as helping with attending medical appointments, social activities, and grocery shopping.
However, before too long, red flags started appearing, said James, a 45-year-old man who is on the autism spectrum and experiences anxiety, agoraphobia and post-traumatic stress disorder, along with other health issues such as fibromyalgia and chronic fatigue.
Marian would show up unannounced, having made plans on his behalf. She also billed him for things he “hadn’t explicitly agreed to.”
“She did not seem to respect or understand about anxiety or autism spectrum sensory issues – key things she had claimed she had experience supporting,” James said.
Eventually, he wrote her an email asking her to respect professional boundaries. He says that she then went silent and so he eventually terminated her contract.
A few weeks later, Marian left an “aggressive letter” in his letterbox. He informed Mable that, if she made any further contact, he would be referring the matter to the police.
One section of the letter reads:
For any person to say i do things with intention and without thought to bring harm to any of my clients to cause them harm is unforgivable.
“To have a letter sent to me in this way has re-triggered trauma and made me feel very unsafe in my own home,” James wrote to Mable in a subsequent complaint. “I initially felt she just needed more training/experience, but after this letter today, I think she is a danger to both herself and vulnerable people like myself.”
Left alone, miles from home
Marley* – a 34-year-old on the NDIS for a degenerative, neurological condition – connected with Eric* after putting an ad on Mable seeking a driver to take her to a doctor’s appointment.
In the ad, Marley mentioned being immunocompromised and requested that the worker wear a mask. However, according to a subsequent complaint Marley made to Mable, Eric arrived unmasked and told her he couldn’t find any masks.
According to Marley, Eric also said: “Don’t worry about it, I’m vaccinated”.
After a quick search, Marley located a “loose, lone mask” under the passenger’s seat, which she suspects had already been used. Nonetheless, Eric put it on, and they set off.
Eric had arrived 15 minutes late, Marley said, and so she was quite irked when, shortly thereafter, she was informed that they needed to stop for petrol.
After pulling into a petrol station, Marley told Eric she was already running late for her appointment and said he should have filled up his car before starting the job.
According to correspondence seen by MWM, Eric told Mable that Marley became angry and was swearing and pointing her finger at him – a version of events that Marley denies.
Marley says she asked Eric to take her home, which Eric refused, telling her that he felt unsafe and asking her to leave his car. Eric reportedly called the police.
Marley said she was disabled and could not walk back to where he was staying.
Eric then ‘sneered’ at her and said: “you’re not disabled,” according to Marley. She wrote to Mable that:
I am absolutely disgusted that Eric is in the community, working with disabled people, yet has not learnt about invisible disabilities.
Eric told Mable that Marley kicked his door when she finally exited the vehicle, which Marley claims didn’t happen.
“This incident has left me really shaken … to the point where I feel unsafe in public,” Marley said. “I’ve been suffering panic attacks since the incident.”
Complaint outcomes
In both James’ and Marley’s cases, a client and support worker gave Mable a different version of events – a situation the company seemed unable to resolve.
Mable later told Marley that, in a situation “involving wide-ranging allegations by either party, and where there are two differing explanations of the events which have taken place, Mable has a limited ability to investigate”. It was thus “unable to mandate both parties to agree on an outcome.”
The response disappointed Marley, who says that Mable could have sought footage from Eric, who had started recording on his phone at the service station or requested to see footage from the service station.
Neither support worker had their accounts cancelled. The company told Marley it had “addressed this matter with the support worker and noted this feedback against their file.”
A similar message was received by James, who was told the matter had “been communicated to the support provider and will be noted on her account.”
“If any future reports come through, this will assist Mable in determining her suitability for the platform”, the company said. James told MWM:
Essentially, Mable did not do anything.
Mable’s response
When asked by MWM what “addressing” or “communicating” a matter with a support worker meant, Mable said its strict privacy policy prevented it from clarifying what had happened in either case and directed us to its incidents and complaints handling policy.
The company “takes the reporting of any incident, allegation or complaint against clients or support workers with the utmost seriousness, reviewing all such reports and investigating and taking action where appropriate to do so,” a Mable spokesperson said.
“We operate in highly regulated areas of the sector and with people who can be extremely vulnerable. Therefore, it is our top priority to ensure everyone is appropriately safeguarded while providing or receiving services via the Mable platform.”
“With a platform that has existed for 10 years and which operates at a significant scale, people’s safety is not something we can afford to take lightly.”
Registration and transparency
Negative incidents and complaint processes that leave clients dissatisfied aren’t unique to digital platforms like Mable. Throughout the public hearings of the disability royal commission, many witnesses spoke of “negative experiences and poor outcomes when complaining to organisations”. The commission’s report also stated:
Only in a few cases were these experiences positive with appropriate action taken.
However, Dr Fiona Macdonald, industrial and social policy director at the Centre for Future Work, believes digital platforms add an additional element of risk.
“There doesn’t appear to be any transparency or information to show that real accountability is taken for safety. That’s the problem with the way the platforms operate, particularly where they’re not registered providers, and they’re not held responsible within the NDIS system,” said Macdonald, who has long been critical of the “gigification” of care work.
The system, in enabling unregistered workers and unregistered providers to operate, doesn’t actually acknowledge the significance of the support or the importance of safety, and how critical that might be to somebody’s wellbeing.
An NDIS review recommendation that all providers be registered – and thus required to undertake compliance and auditing processes – has encountered significant backlash. Some say the requirement would violate the core NDIS principles of choice and freedom.
Macdonald said it’s important that regulation was “proportionate to risk”.
“I don’t think it’s feasible for the system to run on public funding and ensure quality and safety without some kind of oversight and regulation in all circumstances. Some people may be well and truly able to manage that themselves, but it’s in a system that has to uphold a standard.”
* Some names have been changed to protect people’s identities, and some details have been left out for brevity. Both incidents occurred in 2022.
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This post was originally published on Michael West.
