Supported Independent Living
When Is 24/7 Support Necessary? Understanding NDIS Rosters of Care
For some people living with significant disability, support requirements extend beyond a few hours of assistance each day.
For some people living with significant disability, support requirements extend beyond a few hours of assistance each day.
A participant may require help with personal care, meals, mobility, communication, decision-making or disability-related safety risks across different periods of the day and night.
Understanding these requirements is an important part of assessing appropriate supported living arrangements.
What Does 24/7 Support Mean?
A 24-hour support arrangement involves assistance or support worker availability across the full day and overnight period.
However, this does not necessarily mean that a participant requires continuous one-to-one assistance every minute.
Support arrangements can include different staffing levels, shared assistance and varying levels of activity depending on the participant’s needs.
The appropriate model must be determined through individual assessment.
What Is a Roster of Care?
A roster of care describes the support required across different times of the day.
It may identify when assistance is needed, which activities require support, the number of staff involved and whether overnight support is necessary.
For example, morning routines may involve personal care, transfers, dressing and breakfast preparation.
Daytime requirements may involve domestic activities, appointments, skill development and other daily living tasks.
Evening routines may include meals, personal care, medication-related assistance and preparation for bed.
Overnight requirements are considered separately.
Understanding Active Overnight Support
Active overnight support generally involves a worker being awake and available to provide assistance throughout the overnight shift.
This may be appropriate where disability-related needs require ongoing intervention, frequent assistance or a level of responsiveness that cannot safely be provided through an inactive arrangement.
Examples may include repeated overnight personal care, significant mobility assistance or documented safety risks requiring active intervention.
The need for active overnight support should be supported by evidence about the frequency, duration and nature of assistance required.
Understanding Inactive Overnight Support
Inactive overnight arrangements generally involve a worker sleeping on site while remaining available to respond when assistance is required.
This may be suitable where overnight needs are less frequent and can be managed safely within the applicable support arrangement.
The distinction between active and inactive overnight support is important because each model involves different staffing and funding considerations.
What About One-to-One and Two-to-One Support?
Some participants require individual assistance for particular activities.
Others may require two workers to complete specific tasks safely, such as complex transfers or certain disability-related risk management activities.
A recommendation for two-to-one assistance should identify why one worker cannot safely or effectively complete the required task.
Importantly, the need for two workers during particular activities does not automatically mean two workers are required continuously throughout the day.
Support ratios should reflect the actual assessed requirements.
What Does an Occupational Therapist Assess?
Occupational therapists consider the participant’s functional abilities and support needs across their everyday routine.
This may include:
Assessment may also involve reviewing support worker records, behaviour support documentation, incident reports and other relevant clinical evidence.
- Personal care and hygiene.
- Transfers and mobility.
- Meal preparation and eating.
- Communication and cognition.
- Behavioural and environmental risks.
- Domestic activities.
- Overnight routines.
- Informal support availability.
- Opportunities for independence and skill development.
Why Accurate Support Recommendations Matter
Insufficient support can create risks to safety, personal care, community participation and the sustainability of living arrangements.
However, recommendations must also avoid unnecessarily restrictive or excessive support arrangements.
The aim is to identify a support model that is safe, effective, individualised and consistent with the participant’s disability-related needs.
SIL and Roster of Care Assessments
Today & Tomorrow Allied Health Services provides occupational therapy assessments relevant to complex support requirements and Supported Independent Living arrangements.
Our reports consider functional performance, support intensity, risks and the rationale for recommended assistance.
Need an assessment of daily or overnight support requirements?
Contact Today & Tomorrow Allied Health Services to discuss an appropriate occupational therapy assessment.
Frequently Asked Questions
Does SIL always mean one-to-one support?
No. SIL can involve shared or individual assistance depending on assessed needs and the funding decision.
What is the difference between active and inactive overnight support?
Active overnight generally involves an awake worker, while inactive overnight generally involves a worker sleeping on site and responding when required.
Can an OT recommend 24-hour support?
An OT can provide functional evidence and recommendations about support needs. The NDIA determines which supports meet the funding criteria.
Official sources
This article provides general information only. NDIS rules and individual circumstances can change; check current official guidance or seek advice about your situation.