OT Unplugged: Community of Practice Insights

A billable target only tells part of the story. The time needed to complete a report, the travel involved in a caseload and the support available to an early career OT all affect whether expectations are realistic.

Fair billing and practical time management sit alongside broader questions about growing a practice beyond its owner. Examples from Freedom Solutions and Freedom Wheels also explore how tailored equipment can help people return to activities they love.

Report-writing expectations need to reflect the work

A practice owner’s usual report-writing time may not be a fair benchmark for every therapist or assessment. Fixed limits based on how quickly the owner believes they could complete the work can overlook the participant’s circumstances and the complexity of the assessment.

Experience also affects efficiency. An early career OT may need considerably longer to complete a report, but there is a distinction between time reasonably charged to the participant and additional time spent learning.

Clear expectations need practical support behind them. Showing therapists how to structure reports, use templates thoughtfully and streamline their work gives them a way to improve, rather than simply being told to write faster.

What actually counts towards a billable target?

An example of an early career OT being asked to achieve 25 billable hours each week, with billable travel excluded from that target, raises questions about how performance expectations are calculated.

Some practices count travel at a reduced rate because it generates less income. However, this can create additional workload when therapists need to find more billable activity to meet their target, particularly in regional areas with long distances between appointments.

Understanding how a practice earns income is part of working in the private sector, but targets need clear explanations and realistic workload planning. Clustering appointments and reviewing the mix of travel, therapy and report writing can help identify where expectations become difficult to meet.

Accurate time recording starts with managing interruptions

Time spent on client work can be difficult to reconstruct when reports are interrupted by phone calls, emails and other tasks. Relying on memory makes it harder to distinguish the work completed for each participant.

Timekeeping sheets, tracking software or a simple kitchen timer can help record actual work accurately. Pausing when attention shifts elsewhere also prevents unrelated activity from becoming mixed into the time recorded for a report.

Protecting concentration matters too. An inbox-hiding browser extension provides one example of how to search for an email without being distracted by new messages and leaving the original task unfinished.

Growing a practice means growing the team

A service built around one therapist’s reputation can become difficult to expand. If clients expect the owner’s particular approach, bringing in another OT involves more than handing over appointments.

Nikki reflects on Action OT’s tenth anniversary, recalling a first referral that involved a Saturday home visit and a report for a man with a brain injury who could not afford an out-of-pocket payment. Only a small Medicare rebate covered the work.

Moving from those beginnings to a team-based service requires confidence in the skills of other therapists. Developing staff and communicating the value of the whole practice helps the service become less dependent on one person.

Planning an exit starts before you need to leave

A busy practice does not necessarily operate independently of its owner. Whether the business can keep running when the owner takes time off is a useful question, particularly when decisions and referrals still depend on them.

Selling can also have implications for templates and resources an owner hopes to use in future work. Alyce’s reflection on closing her practice and moving into The OT Coach illustrates how plans for the next stage of a career can influence which exit option makes sense.

Assuming a sale will be available when personal circumstances suddenly change can leave owners with limited options. Considering an exit earlier creates more time to review staffing stability, dependence on the owner and what would be included in a potential sale.

When standard equipment cannot support a meaningful activity

Freedom Solutions’ fiftieth anniversary provides an opportunity to reflect on the collaboration between OTs and volunteer engineers. One example discussed involved developing a tray table when commercially available options would not fit a client’s power wheelchair.

Another involved a man who could no longer strum his guitar after a stroke. An adapted device allowed him to return to playing, with further modifications expanding how he could use it.

The OT’s contribution is to identify the functional requirements and understand what the person wants to do. Working with an engineer can then help turn those requirements into a tailored solution when standard products are unsuitable.

Adaptive bike trials involve more than learning to ride

Freedom Wheels clinics support children and adults who have never ridden, outgrown suitable equipment or experienced changes in their function. A young girl riding for the first time and saying, “I doing it”, captures what access to suitable equipment can mean.

Different equipment can address different barriers. Examples include wider stabilising outriggers and a pedal-assist trike trialled by a man with multiple sclerosis who wanted to ride with his wife but experienced fatigue. A new folding trike also prompted discussion about transport, given the difficulty of moving larger trikes without a van or trailer.

These assistive technology trials have a different purpose from bike skills sessions. In the clinic model described, the participant’s own therapist remains involved in the assessment and recommendation, while the clinic provides equipment knowledge and facilitates trials.

Key takeaways
• Report-writing expectations should account for assessment complexity and therapist experience, with practical support to build efficiency
• Participants should not be expected to fund the additional time an early career OT needs for learning
• Clarify how travel contributes to billable targets and consider its effect on the therapist’s actual workload
• Record client work as it happens and pause time tracking when interruptions shift attention elsewhere
• Growing a practice requires developing the team and reducing dependence on the owner
• Consider exit options early, including how a sale could affect resources intended for future work
• Tailored equipment and adaptive bike trials can support participation in activities that standard products cannot accommodate

Links
ARATA Australia Assistive Technology Conference. Register here: https://aatc2026.com

Requests for essential equipment are becoming more complicated when a plan variation is redirected towards a full NDIS reassessment. For some participants, accessing the support they need now may also expose their existing funding to further changes.

Understanding these pathways affects how OTs plan assessments, identify future support needs and prepare evidence. Questions around high-intensity supports, the High Support Needs safeguard and the Thriving Kids rollout add further complexity to decisions about funding and service access.

Why are equipment requests triggering plan reassessments?

Requests for assistive technology (AT) and home modifications are receiving inconsistent responses. Some are progressing as plan variations, while others are being redirected towards full reassessments, including requests for minor modifications such as grab rails.

Whether the relevant support category already appears in the plan may be influencing these decisions. A recent example involved an approximately $18,000 manual wheelchair being funded through a variation where the existing plan included an AT category with a zero-dollar allocation. However, the distinction between these pathways remains unclear in practice.

A reassessment can have consequences beyond the equipment request, potentially exposing other budgets to funding changes. FCA recommendations should identify foreseeable AT needs, including repairs, maintenance and replacement or hire, and explain the functional and safety implications if equipment cannot be accessed when required.

Does seizure management qualify for high-intensity support funding?

As participants face funding changes, understanding which exclusions apply becomes particularly relevant. Epilepsy and seizure management appears in the high-intensity support skills descriptor document, but its inclusion does not mean it independently qualifies for the high-intensity support rate.

It needs to accompany one of the eight recognised high-intensity descriptors, such as severe dysphagia management or tracheostomy care. Although seizure management can require substantial worker knowledge and skill, that requirement alone does not establish eligibility for the high-intensity rate.

When considering exclusions from the funding reset, check the participant’s existing funded line item and the descriptor that applies. Reporting should clearly identify the relevant high-intensity support needs rather than relying on seizure management alone.

The safeguard pathway still has practical gaps

The High Support Needs safeguard is separate from the high-intensity support descriptors. It provides a pathway for eligible participants to seek additional daily living funding when the funding reset creates a gap in their existing 24-hour support arrangements.

The practical application process remains unclear. There does not appear to be a dedicated safeguard form, and conflicting advice about variation and reassessment pathways is making it difficult to establish how requests should be submitted.

The wording of the rule points towards a plan variation because it refers specifically to varying the participant’s plan. However, clearer guidance is needed to connect the safeguard requirements with the forms and processes participants are expected to use.

An FCA needs a clear purpose before it begins

These different funding pathways make it even more necessary to establish what an assessment is intended to achieve. Completing a functional capacity assessment “just in case” can use valuable participant funding, and evidence prepared too early may need updating before it is required.

Unscheduled reassessments create a different challenge. A recent CEO-initiated reassessment gave a participant around three weeks to gather evidence, leaving little preparation time. The balance between preparing ahead and preserving funding requires consideration of the participant’s circumstances, likely timing and existing evidence.

For a participant-requested early reassessment, the report needs to explain why reassessment is warranted as well as justify the recommended supports. Where functional capacity or informal support arrangements have changed, identify what has changed and why the current plan can no longer meet the participant’s needs.

Every part of the report should earn its place

Once the assessment’s purpose is clear, the report should stay focused on the evidence needed for that decision. More complex NDIS processes do not automatically require longer reports.

A medication list illustrates the difference. Listing every medication and supplement may add little, while explaining that medication-related fatigue increases the assistance required for afternoon tasks provides relevant functional evidence. Historical information should be considered in the same way.

Standardised assessment results also need interpretation. Explain what the findings mean, whether they align with observation and reported function and how they inform recommendations. An FCA is a point-in-time functional assessment, so information gathering should remain focused on its purpose rather than expanding into every possible area of therapeutic assessment.

Thriving Kids: what support is actually available?

For families of children with disability, uncertainty extends beyond changes to existing NDIS plans. The initial Thriving Kids developments include an autism information helpline delivered by Amaze and an online resource hub, but these do not resolve the question of where families can access targeted therapy and support.

Details about the wider rollout remain limited, particularly around local providers and service pathways. Practices are also reporting different experiences of NDIS access and funding changes, with substantial caseload impacts in some services and little apparent change in others.

While alternative pathways remain unclear, families seeking NDIS access still need support to navigate the early childhood partner process. For children already receiving NDIS supports, decisions about assessment and therapy should consider the purpose of each service and how it will use the funding available.

Making space to recognise the profession

Professional awards provide an opportunity to recognise OT work and learn about achievements across allied health. They also make visible work that may otherwise remain largely within individual practices or local communities.

Rural and remote services are one area where valuable OT contributions deserve broader recognition. Sharing this work can help others understand the practical challenges, service innovations and outcomes being achieved outside larger professional networks.

OT Week offers another opportunity to connect, particularly for sole practitioners who may not have a workplace celebration to attend. Organising a local gathering or joining other OTs creates space to recognise the profession and the people doing the work.

The safeguard pathway still has practical gaps

The High Support Needs safeguard is separate from the high-intensity support descriptors. It provides a pathway for eligible participants to seek additional daily living funding when the funding reset creates a gap in their existing 24-hour support arrangements.

The practical application process remains unclear. There does not appear to be a dedicated safeguard form, and conflicting advice about variation and reassessment pathways is making it difficult to establish how requests should be submitted.

The wording of the rule points towards a plan variation because it refers specifically to varying the participant’s plan. However, clearer guidance is needed to connect the safeguard requirements with the forms and processes participants are expected to use.

Key takeaways

• Inconsistent variation and reassessment responses can complicate access to essential AT and home modifications
• Identify foreseeable equipment needs and explain the risks if equipment is unavailable
• Epilepsy and seizure management alone does not qualify for the high-intensity support rate
• Clearer application guidance is needed for the High Support Needs safeguard
• Clarify the purpose, timing and available funding before commencing an FCA
• Keep reports focused on functional evidence and clearly explain the reasoning behind recommendations
• Thriving Kids information services leave ongoing questions about access to targeted supports and local service pathways

The NDIS funding reset is here, and for OTs the implications go well beyond understanding the percentage reductions. There are questions about who will be affected, what happens when funding is reduced and what evidence may now need to be captured.

The new Support Determination, High Support Needs safeguard and exclusions for certain supports have practical implications for OT assessment, reporting and service delivery. There is also the challenge of supporting participants and families through changes that may significantly affect their everyday supports.

What does the funding reset mean in practice?

From 1 October 2026, the funding reset applies to relevant new or reassessed plans, with a 50% reduction in accessible Social, Economic and Community Participation funding and a 10% reduction in Improved Daily Living.

This could mean substantially less funding available for community participation and reduced therapy budgets. The changes are relevant across both adult and paediatric practice, including participants accessing Allied Health and community supports.

The changes will be introduced progressively, with plan renewals also affected from 1 February 2027 and the reset intended to apply across participant plans by September 2027.

What happens when the reduction creates a support gap?

The High Support Needs safeguard provides a potential plan variation pathway where the funding reset creates a gap in a participant’s ability to safely receive 24-hour disability supports.

Eligibility requires NDIS-funded disability supports across 24 hours and the relevant annual funding threshold to be met. The previously referenced 1:3 support ratio is not a separate eligibility criterion.

The pathway does not simply reinstate the Social, Economic and Community Participation funding that has been reduced. Instead, a variation may provide additional Assistance with Daily Life or Home and Living funding to address the resulting gap in 24-hour supports.

A significant concern remains for participants who require support across 24 hours but do not currently receive NDIS-funded disability supports across the full 24-hour period. This may include participants whose family members provide substantial support during currently unfunded hours.

Which supports are protected from the 50% reset?

Not all Social, Economic and Community Participation supports are subject to the 50% reduction. Excluded support subgroups include specialised supported employment, eligible high intensity supports and intensive and complex behaviour supports.

For OTs, this makes accurately identifying and evidencing the type of support a participant requires particularly relevant. A participant may have needs consistent with high intensity supports while their existing plan has been built using standard support line items.

High intensity support needs may include areas such as epilepsy and seizure support, complex bowel care, dysphagia support, diabetes management, enteral feeding and tracheostomy care. Appropriate evidence of the support required, including relevant management plans, may need to accompany these recommendations.

Similarly, having a behaviour support plan does not automatically establish a need for intensive and complex behaviour supports. Functional evidence should clearly demonstrate the behaviours of concern, their impact on safety and wellbeing and the level of support required.

Working differently with reduced funding

For therapy, a 10% reduction does not necessarily mean simply reducing every service by 10%. Looking at the available funding across the full year may create more flexibility in how intervention is delivered.

This could include changing session frequency or length, using blocks of intervention, incorporating telehealth or coaching where appropriate or prioritising particular aspects of a participant’s goals. Any changes still need to reflect the participant’s assessed needs and the potential impact of reduced intervention.

There may also be efficiencies to find within OT practice. Streamlining assessment processes, reducing duplication in reports and improving templates may help make better use of available funding without compromising clinical reasoning or the evidence required.

When you can’t change the outcome

There is also a significant emotional impact for OTs navigating these reforms alongside participants and families. One client example involved achieving a positive outcome through the ART, only for the prospect of the new plan being affected by the funding reset to create another major challenge.

This raises the issue of moral injury, particularly when clinicians can see the potential consequences of a system decision but have limited ability to change the outcome.

Supervision, psychosocial safety and appropriate support for clinicians become increasingly relevant when OTs are having difficult conversations with participants and families while also managing their own response to changes outside their control.

Key takeaways

• The funding reset affects both community participation and therapy funding, with changes being introduced progressively

• The High Support Needs safeguard may provide a plan variation pathway where the reduction creates a gap in safe 24-hour disability supports

• Participants who need 24-hour support but do not receive NDIS-funded disability supports across the full 24 hours remain a significant concern

• Some eligible high intensity and intensive and complex behaviour supports are excluded from the 50% reduction

• OTs may need to strengthen how high intensity and complex support needs are identified and evidenced within Functional Capacity Assessments

• Reduced therapy funding may require different approaches to service delivery and greater efficiency within OT practice

• Supervision and psychosocial safety are increasingly relevant as OTs navigate the professional and emotional impact of these changes

From 1 October, new NDIS funding changes will affect how some participants can access funding for social, community and civic participation. The detail OTs have been waiting for around the safeguard for participants with high support needs has now been released.

The guidance provides a pathway for some participants whose funding reset leaves them without enough funding to maintain their 24-hour disability supports. But the eligibility criteria create a significant gap: needing 24-hour support is not necessarily enough. The participant must already receive 24-hour funded NDIS supports.

Who qualifies as a high support needs participant?

To access the new safeguard pathway, participants must meet specific criteria relating to their existing plan funding and support arrangements.

The guidance describes a high support needs participant as someone with a relevant total budget of at least $215,000 before the funding reset, who receives 24-hour funded NDIS supports for needs arising directly from their disability and receives those funded supports at a shared ratio of at least 1:3.

The wording around funded NDIS supports is particularly significant because it determines who can access the safeguard when their funding is reduced.

Required support and funded support are not the same thing

A participant may require support 24 hours a day without currently receiving 24 hours of formal NDIS-funded support.

Consider someone who cannot safely be left alone but lives with family. Support workers may assist with personal care in the morning, the participant may attend a day program and family may provide support during evenings and overnight.

Their disability-related need for support exists across the full 24 hours. The difference is that some of those hours are currently being provided by parents, partners or other informal supports rather than funded through the NDIS.

Under the new criteria, this distinction will determine whether the participant has access to the safeguard. The bad news? The above mentioned participants will not.

What happens if they don’t meet the criteria?

If community participation funding is reduced, participants relying partly on informal supports will find themselves in a difficult position.

They won't meet the High Support Needs criteria because they do not currently receive 24-hour funded NDIS supports, even though they cannot safely be left without support.

The funding reduction itself also does not necessarily represent a significant and ongoing change in functional capacity, support needs or circumstances that would provide another straightforward pathway to an unscheduled plan reassessment.

This leaves an important question about what happens when formal community supports are reduced and family is already providing the support required during the remaining hours. There are no clear answers to this.

For eligible participants, what does the safeguard actually provide?

The guidance provides an example of a participant whose social and community participation budget reduces from $150,000 to $75,000, leaving insufficient funding to maintain their previous 24-hour support arrangements.

Through the safeguard pathway, additional funding may be added to daily living supports to address the resulting support gap at home.

However, this does not necessarily restore the participant’s previous level of community participation. Instead, funding may be redirected towards the support required while the participant remains at home.

The safeguard therefore addresses a potential gap in 24-hour support, but it does not necessarily replace the community participation opportunities lost through the funding reduction.



The variation process could create another support gap

Timing creates a separate practical issue for participants who do qualify for the safeguard.

Participants have 90 days to request the variation. The Agency then has 21 days to determine whether the participant meets the High Support Needs definition. If they do, they have a further 21 days before a decision is made about varying the plan.

This creates the possibility of a gap between reduced funding taking effect and additional daily living funding becoming available.

For participants receiving SIL supports through monthly funding periods, this could also create practical difficulties for providers expected to maintain safe support arrangements while the variation is being considered.



The importance of early identification of participant criteria

Given the above timeframes and high risk to participant safety and well-being, timely provision of reporting to evidence eligibilty for the High Needs Support Safeguard is essential.

To aid Occupational Therapists in preparing reporting to address this, we have created an editable template to either insert into their current FCA reporting or provide as an addendum report.

Access the framework template here: INSERT LINK

Key takeaways for OTs

• The High Support Needs safeguard has specific eligibility criteria, including requirements around 24-hour funded NDIS supports

• Requiring 24-hour support and receiving 24-hour funded support are not the same thing

• Participants relying on family to provide part of their 24-hour support may fall outside the safeguard pathway

• For eligible participants, the safeguard may redirect funding towards daily living support rather than restoring previous community participation funding

• OT reporting should clearly distinguish actual disability-related support needs from the amount of formal support currently funded

• The timing of the variation process may create additional challenges for participants and providers while decisions are being made



Links

High Support Needs Safeguard Info, released 22rd September 2026: https://www.health.gov.au/resources/publications/ndis-funding-changes-high-support-needs-safeguards?language=en

High Support Needs Safeguard Info, released 23rd September 2026: https://www.health.gov.au/our-work/ndis-legislation-changes/amendments/funding-changes-for-ndis-supports?language=en&fbclid=IwdGRleAUgLjRwZG9mBWZkaWQWUO88wjK41vlh4a2RhNo7m1ODdX5SmWV4dG4DYWVtAjExAHNydGMGYXBwX2lkCjY2Mjg1NjgzNzkAAR71jgOkSuL5QanyhR8LgE-8ZBblHA27CnQkyxSwU4kKG_E7uzTQhDmeiySy9w_aem_aV9hx-NIV-kXaE_OlzzaEQ

Some moments in your OT career stay with you. A decision, a client or even a comment from someone else can change the direction of your career or the way you think about your role.

This week, Sarah, Alyce and Nikki share some of their own ‘sliding doors’ moments, from career decisions that changed their direction to clinical experiences that reshaped how they understood their role as OTs. They also unpack recent NDIS developments around students on placement, functional capacity and changes approaching from 1 October.

The career decisions that change everything

Sometimes a career-defining decision starts with realising it is time to leave. Sarah reflects on the workplace experience that ultimately gave her the push to step away from a role she once thought she would never leave and start Verve OT.

Alyce shares turning points of her own, including professional development that challenged the way she thought about clinical intervention and a period away from Occupational Therapy that ultimately led her back to the profession and into building her own practice.

Looking back, neither could have known exactly where those decisions would lead. Sometimes it is only years later that you can see how one choice changed the trajectory of your career.

When you can’t change the outcome

Nikki shares the story of a man with rapidly progressing motor neurone disease who desperately wanted to leave hospital and return home. After considerable work to organise equipment and make his discharge possible, he made it home on a Friday afternoon and died the following day.

At first, Nikki felt that everything they had done had made no difference. Her manager helped her see it differently: they could not change the fact that he was dying, but they had changed his experience by helping him spend that final time at home.

That moment changed Nikki’s understanding of what making a difference can look like and influenced her later work in palliative and end-of-life care. It also highlights the role good supervision can play in helping OTs process difficult experiences and make sense of what they mean for their practice.

The small things can be the big things

Not every meaningful OT outcome looks impressive on paper. Nikki shares how one family still considers a simple toilet rail one of the most valuable things she has done for them, despite years of other intervention.

Sarah recalls a client telling her that the biggest thing she had provided through a home modification process wasn’t the modification itself. It was hope that life might become easier.

These moments are a reminder that OTs don’t always know which part of their work will matter most to someone. Particularly as service systems and funding models change, recognising these smaller wins can help keep the focus on what can make a meaningful difference for the person in front of us.

Can you bill for students on placement under the NDIS?

New NDIS guidance has raised fresh questions about students on placement. Earlier guidance stated that allied health students could deliver specific supports under supervision but that their work could not be directly claimed because placements were unpaid educational opportunities.

The current NDIS guidance says allied health students and provisional psychologists can provide services under the supervision of a qualified allied health provider, with participant agreement. It also says service agreements should outline how the arrangement could provide greater flexibility, such as a lower hourly rate or additional service hours.

What remains less clear is exactly how those services should be billed. The wording appears to have shifted again, but there is still enough ambiguity that providers will need to consider how they interpret and apply the guidance in practice.

A changing definition of functional capacity

A recent SDA matter prompted questions about how the amended definition of functional capacity is already being applied under the NDIS.

The definition considers a person’s ability to undertake an activity without assistance from other people or assistive technology, with particular provisions around commonly used AT and assistance for children. This raises questions about what the definition could mean when considering the functional impact of disability.

There is still more to unpack about how this will be applied in practice, particularly for OTs completing functional capacity assessments. It is an area to watch as further information becomes available.

What’s changing from 1 October?

There is plenty for allied health providers to have on their radar as 1 October approaches, including changes to classifications under the Health Professionals and Support Services Award and the upcoming ban on card surcharges.

Thriving Kids activity is also expected to begin in New South Wales, although there are still questions around exactly how and when service pathways will roll out.

For NDIS providers, there is also uncertainty around upcoming support determinations and what the high needs pathway will look like. With several changes happening at once, OTs and business owners will need to stay across further guidance as it becomes available.

Key takeaways

• Career-defining moments can come from unexpected decisions, challenges and clinical experiences
• Good supervision can help OTs reflect on difficult experiences and shape their future practice
• Small interventions can have a significant impact, even when they seem simple from an OT perspective
• NDIS guidance around students on placement has changed again, but questions remain about how services can be billed
• Changes to the definition of functional capacity may have implications for OTs completing functional capacity assessments
• Several changes are approaching from 1 October, including award classifications, card surcharges and NDIS support determinations

Links

Guide to working as an allied health provider: https://www.ndis.gov.au/providers/working-participants/allied-health-professionals/guide-working-allied-health-provider