In September 2017, the Minister for Housing, Disability and Ageing requested the Victorian Disability Services Commissioner to inquire into the provision of disability service to people who have died in 2017–18. The report on the Commissioner's review was tabled in Victorian Parliament on 19 December 2018.

As a result of the investigation, the Commissioner's Office has advised the Department of Health and Human Services (DHHS) on systemic reforms, issued a Notice of Advice to all Victorian disability service providers in November 2018, and on some cases, notified Victorian Police and State Coroner. 

Read more and download the report from the Office of the Commissioner's website.