A plan review for someone with complex needs succeeds or fails on the evidence you take into it. This checklist is what we work through with support coordinators before a review, built around the questions the NDIA actually asks when a participant needs high intensity supports, nursing, 24-hour care or a change in living arrangements. Work through it, and you will know before the meeting where the gaps are.
Need a hand with a specific plan? Call (08) 9515 8000 any time.
Before the review: evidence
The single most common reason a complex plan comes back underfunded is that the evidence described what the participant cannot do, without describing what support is therefore required, how often, and by whom. Every document below should connect impairment to support hours.
- Medical reports from the treating GP and specialists, dated within the last twelve months
- Occupational therapy functional assessment, covering personal care, transfers, equipment and the home environment
- Physiotherapy assessment where mobility, transfers or positioning are part of daily support
- Speech pathology assessment where there is dysphagia, a mealtime management plan, or communication support needs
- Psychology or psychiatry reports where relevant
- Behaviour support plan, current and prepared by a registered practitioner
- Nursing assessment and care plan for any clinical task, including delegation arrangements
- Hospital discharge summaries from the last twelve months
- Incident records that show frequency and severity, not just that incidents occurred
- A carer statement describing what a typical 24 hours actually involves
Support needs, mapped hour by hour
Bring a completed week, not a description. Map morning routine, daytime, evening, overnight and weekends separately, and for each block record what support is needed, how long it takes, whether one worker or two are required, and what the skill level is. Two-worker transfers and active overnight support are the two things most often left out and hardest to add later.
- Personal care: showering, toileting, dressing, grooming — time taken, worker numbers
- Meals: preparation, feeding assistance, PEG regimen, texture-modified diet
- Medication: prompting, administration, injections, who is authorised
- Clinical tasks: PEG, tracheostomy, ventilation, bowel care, catheter, wound care — frequency and who performs them
- Mobility and transfers: equipment used, number of workers, risks
- Overnight: is someone needed awake (active) or sleeping over, and what wakes them
- Community access: appointments, activities, transport, and the support ratio each needs
- Household tasks the participant cannot do and nobody else does
- Capacity building: what skill are we actually working on this plan, and who is teaching it
Funding categories to check
- Core — Assistance with Daily Life: the bulk of personal care and daily support, including high intensity price limits where the supports meet those descriptors
- Core — Community Nursing Care: registered nurse time, care planning, delegation and competency sign-off
- Core — Social and Community Participation: including any higher-ratio support the participant needs to leave the house safely
- Core — Short-Term Accommodation: respite days, typically up to 28 a year, and whether the current allocation matches carer sustainability
- Core — Supported Independent Living: quoted separately against a roster of care, not simply drawn down
- Capital — Assistive Technology: equipment quotes obtained and attached, with the OT recommendation
- Capital — Home Modifications: where access or safety limits support delivery
- Capacity Building — Support Coordination: level and hours matched to how complex the coordination genuinely is
- Capacity Building — Improved Relationships: behaviour support practitioner hours
- Capacity Building — Improved Health and Wellbeing: where nursing or allied health sits here rather than in Core
Questions the NDIA will ask, and what to have ready
- What has changed since the last plan? Have dates, incidents and reports, not impressions.
- Why does this need a paid support rather than informal support? Be specific about what the family can no longer sustain and why.
- Why two workers instead of one? An OT or physiotherapy recommendation, plus the incident record if there is one.
- Why active overnight rather than a sleepover? Frequency of night-time need, documented over a period, not asserted.
- Why a high intensity rate? Name the task, the descriptor it meets, and the clinical plan behind it.
- Is this reasonable and necessary? Tie every request to a goal in the plan and to the participant’s disability, not to convenience.
- What happens if this is not funded? The honest answer is usually hospital, carer breakdown, or a placement failing. Say so.
Risks to flag explicitly
Reviews that go badly usually left the risks implied. State them: carer age, health and sustainability; the participant’s history of hospital admissions; pressure injury or falls risk; risk of placement breakdown; risk to workers in the home environment; and any safeguarding concern. A plan that does not name a risk cannot fund the mitigation.
After the plan comes back
- Read the plan against the roster you submitted, hour for hour, before agreeing anything
- Check the stated funding period and whether the budget divides sensibly across it
- Confirm the plan management type matches what providers can invoice
- Hold a plan implementation meeting with every provider in the room, not sequentially
- Book service agreements and rosters before the start date, not after
- If the funding does not match the roster, request a plan reassessment immediately with the gap quantified in writing — do not run at a loss and hope
- Diary the next review date twelve weeks out, so evidence gathering starts early rather than the week before
We will sit in the review with you
For participants we support, we prepare the roster of care and the supporting evidence, and we will attend the planning meeting with the coordinator. For participants who are not ours, we are still happy to talk a coordinator through what evidence a complex request needs. Call (08) 9515 8000 or email info@complexcarecontinuum.com.au.
General information for planning purposes. Funding decisions rest with the NDIA and depend on individual circumstances.