You can’t build a fair NDIS by gutting the women who hold it up
If the NDIA is serious about reform, it’s time to stop making decisions in a vacuum. Give occupational therapists a seat at the table, writes Helen Whait.
This week, occupational therapists from around Australia gathered in Adelaide for our annual conference.
It’s meant to be a chance to share ideas, reconnect and reflect on the work we do to keep people healthy, safe and out of hospital.
Instead, we’re arriving angry. Furious, actually.
The National Disability Insurance Agency’s Annual Pricing Review, handed down almost two weeks ago, confirmed that occupational therapy rates will remain frozen for the seventh year in a row. Travel funding has been slashed in half. Physios are copping a $10/hour cut.
Meanwhile, in the very same week, federal politicians quietly pocketed a 2.4 per cent pay rise – because, apparently, some workers deserve cost-of-living increases in line with inflation. The rest of us can just absorb it.
Occupational therapy is one of those quietly essential professions. We’re not glamorous, we don’t get headlines, and we definitely don’t make a fuss. We just turn up in homes, hospitals, schools, and aged care facilities and help people recover from trauma, illness, injury, and loss of function. We are the profession that gets people dressed, bathed, out of bed, and back into life.
We are also, not coincidentally, a workforce made up of approximately 90 per cent women.
You might like
Many of us run small businesses. And for seven years, we’ve been absorbing rising costs – fuel, rent, admin, utilities, registration, compliance, super – without a single increase to our funding.
We’ve been told to do more with less, and we’ve done it. We’ve driven to far-flung suburbs and regions to conduct in-home assessments. We’ve spent hours trialling assistive technology and supporting families through paperwork. We’ve worked through lunch to meet reporting deadlines. And now, after all that, we’re being told to take another hit.
Travel reimbursements have been slashed in half, making in-home and outreach services financially unviable for providers. And let’s be clear: for occupational therapists and our clients, this isn’t a nice-to-have extra. In-home care is critical, evidence-based, and often the only way to deliver meaningful outcomes, especially for people with complex needs.
Unlike other health professions, we can’t just sit in a clinic and hope for the best. We assess mobility and function in kitchens, bathrooms, bedrooms. We make sure a person can actually live safely in their own space. These cuts don’t just hit providers. They hit the most vulnerable participants.
It’s also, frankly, insulting.
Imagine if politicians had their travel allowances halved, the outrage would echo from Parliament House to the nearest Sky News panel. But when the workforce is 90 per cent women? Apparently, that’s just the price of doing business – or more accurately, the cost of being a woman in a caring profession.
And the numbers don’t lie.
Occupational Therapy Australia reports that 60 per cent of practices expect to run at a loss or just break even this year. At least 8 per cent of OTs have already exited the NDIS since last year’s pricing decision, leaving more than 7000 participants without a provider.
Stay informed, daily
Burnout is high. Morale is low. Services are vanishing.
Meanwhile, the NDIA is spending millions fighting appeals at the Administrative Appeals Tribunal – only to lose the majority of them.
In some years, up to 77 per cent of decisions are overturned in favour of participants. That’s not because allied health professionals are doing a bad job. It’s because something inside the agency is fundamentally broken. The internal decision-making process isn’t just flawed – it’s costing the scheme millions in legal fees and wasted hours, not to mention the emotional toll on families.
If we’re serious about making the NDIS sustainable, this is the place to start. Fix the system from the inside before you start squeezing the people still holding it together.
The agency claims its rates are “aligned with the market”. Which market, exactly?
According to the government’s data, the median occupational therapy rate under Aged Care Home Care Packages is $200/hour. In South Australia, WorkCover and the Lifetime Support Scheme recently increased occupational therapy rates to $234.90/hour for services, and nearly $200/hour for travel – with no caps.
But the NDIS? Still stuck at $193.99. With a travel cap so tight you’d be lucky to get to the end of the street.
Even that $193.99 is misleading.
South Australian occupational therapist Brad Williams got his accountant to run the numbers for his practice. After admin, cancellations, non-billable hours and compliance, the real revenue per occupational therapist hour is $68. From that, you have to pay staff, super, insurance, rent, tax and overheads. Some baristas earn more. And none of them are writing clinical reports at midnight.
This isn’t just unfair. It’s unsustainable.
More than anyone, occupational therapists want a strong, sustainable NDIS. But you can’t build one by gutting the mostly female profession that holds it up.
If the NDIA is serious about reform, it’s time to stop making decisions in a vacuum. Give us a seat at the table. Let us co-design a system that works for providers and participants.
We know what’s broken. And we know how to fix it. For a profession trained to bring calm, we’re running out of patience.
Helen Whait is an occupational therapist and the founder of occupational therapy franchise ActivOT.
