NDIS home modification assessments: what the OT looks at, minor versus complex work, and how modifications are approved

A home modification assessment is an occupational therapy assessment of changes to your home that may remove disability-related barriers, such as steps and entrances, doorways, bathrooms, toilets and the way you move between rooms. Bloom Healthcare's occupational therapists look at how you use the space, your abilities and support needs, and whether equipment or a different arrangement could solve the problem without building work, then recommend changes and explain the clinical reasoning. Under the NDIS the assessment time usually comes from Capacity Building – Improved Daily Living, while the modification itself is funded separately under Capital Supports and needs its own approval. To start, call 1300 771 465 or make a referral.

Clinical recommendations, property permission, funding approval and building work are four different parts of the process. Bloom's role is the clinical assessment. Design, certification, quotes and construction need appropriately qualified building professionals.

Who a home modification assessment is for

An assessment is usually worth discussing when:

• steps, entrances or doorways limit how you get in, out or around the home
• bathroom or toilet use is difficult or unsafe
• daily tasks need assistance because of the layout of the home
• your disability support needs or mobility have changed
• you need clinical evidence for a proposed modification

A home modification is a change to the home itself, from a grab rail to structural work on a bathroom or entrance. Equipment, such as a shower chair or a mobile hoist, is assistive technology and is assessed through an assistive technology assessment.

How home modifications are funded

NDIS: the assessment and the modification are separate

• The assessment and report are occupational therapy work, usually funded from Capacity Building – Improved Daily Living.
• The modification itself is funded under Capital Supports, separately from your therapy budget, and has its own approval requirements.

The NDIA decides whether a proposed modification meets the reasonable and necessary test and whether it is funded. An occupational therapy report is clinical evidence for that decision, not an approval. Other permissions and technical requirements may also apply before work can start.

Minor and complex modifications

Bloom assesses both minor and complex home modifications.

• Minor modifications are smaller changes such as rails or access adjustments, assessed where they are within the clinician's scope.
• Complex modifications are larger changes that may need specialist assessment, building expertise, site visits with a builder and more detailed documentation. Bloom has the internal expertise to assess the requirements of complex home modifications, and checks the need for specialist occupational therapy expertise and building professionals before accepting complex work.

The NDIA sets the categories, cost boundaries, quote requirements and technical documentation for each level of home modification, and those rules change. Before work is planned, check with your planner, plan manager or support coordinator:

1. which category your proposed change falls into
2. what evidence the NDIA needs, including whether it needs quotes or technical plans, and how many
3. whether a building professional's report or certification is required
4. how your plan is managed, because that decides which builders you can use

If your plan is NDIA-managed, the provider delivering the modification must be a registered NDIS provider. If you self-manage or plan-manage, you can also choose unregistered providers. The NDIA's assistive technology, home modifications and consumables code guide (PDF) lists the most widely used supports; it is not a full list. Current participant guidance is at ndis.gov.au/participants.

Support at Home: the AT-HM scheme

For older people on Support at Home, home modifications run through the Assistive Technology and Home Modifications (AT-HM) scheme, one of the program's three short-term pathways. It is a separate pathway from the classification that funds your ongoing services. Home modifications under Support at Home can include grab rails, ramps, bathroom changes or other modifications based on assessed need. The amounts and conditions for your situation are set out in your support plan, so check them with My Aged Care on 1800 200 422 or with your Support at Home provider. See aged care occupational therapy and the Support at Home hub.

TAC and private funding

For transport accident injuries in Victoria, the TAC can pay the reasonable cost of occupational therapy, and occupational therapists can complete assessments and make recommendations about home modifications for TAC clients. Assessments can also be privately funded.

What the assessment can consider

The clinician selects assessment tasks and reporting to suit the agreed purpose, your needs and the expertise required.

Home access

Entrances, steps, circulation space and access between the areas you use every day.

Bathroom and personal care

Toileting, showering, transfers and the assistance you need in these spaces.

Minor modification recommendations

Suitable changes such as rails or access adjustments, where they are within the clinician's scope.

Complex modification enquiries

A check on the need for specialist occupational therapy expertise and building professionals before complex work is accepted. Bloom can assess multiple rooms.

Equipment and alternative options

Whether assistive technology, or a different way of doing the task, could meet the need before structural changes are considered. If equipment is the better answer, the next step is an assistive technology assessment.

Reports and collaboration

Agreed clinical documentation, and collaboration with authorised parties such as builders, plan managers and support coordinators where appropriate.

What this assessment does not cover

• Building work. Construction, certification and related building services are arranged with appropriately qualified professionals and are not included automatically.
• Property permission. If you do not own the home, the owner's agreement may be needed. That is for you and the owner to arrange.
• Funding approval. The NDIA, or your Support at Home or TAC arrangements, decide funding.
• Moving house or changing who supports you. If the question is whether your living arrangement still works, see the home and living assessment.
• Falls risk in general. If the main concern is balance, strength or unsteadiness rather than the building, start with falls prevention and home safety.

How it works, step by step

1. Clarify the barriers. Describe the activity that is difficult, the property, your location and any changes you already have in mind. We confirm that a clinician with the right expertise is available and agree the scope.
2. Service agreement. Scope, fees, delivery setting and timing are agreed before the service begins, and a service agreement is signed before delivery and billing start. The estimate covers assessment, reporting, travel and any separately arranged work.
3. Assess the home. An in-person assessment is generally needed to observe how you function in the space, check access and take the relevant dimensions.
4. Liaise with builders and stakeholders. Bloom's home modification assessments include communication with builders and other stakeholders, and a site visit with a builder where required. Complex modifications usually involve one or more site visits with a builder.
5. Document recommendations. The report explains your needs, the alternatives considered and the proposed changes. Further technical plans or quotes may be required.
6. Coordinate the next stage. Confirm permissions, funding and the right building professionals. Any further occupational therapy involvement is agreed separately.

A member of the team will be in contact within 24 hours of receiving your referral, and Bloom aims to hold the initial meeting within 5 business days where possible, once the intake form is returned and the service agreement is signed.

What to prepare

• a description of the tasks that are difficult and where in the home they happen
• whether you own or rent, and the owner's contact details if you rent
• photos or floor plans, if you have them
• previous occupational therapy, equipment or home modification reports
• your NDIS plan dates and how the plan is managed

What you get in writing

The agreed report sets out:

• the disability-related barriers observed and how they affect daily activities
• the options considered, including equipment and other alternatives
• the recommended changes and the clinical reasoning for each
• what further technical input, plans or quotes the next stage is likely to need

If the report is needed by a particular date, put the date in the referral so the work can be planned.

Where Bloom delivers home modification assessments

Home modification assessments are generally done in person, in the home being assessed. In some circumstances parts of an assessment can be done online; whether that works depends on a number of factors you should discuss with the clinician before the service starts. See telehealth for how remote and in-person work fit together.

Bloom works across New South Wales, Queensland, South Australia, Tasmania, Victoria, Western Australia and the Australian Capital Territory. Complex modification capability and local availability should be confirmed before you refer. See all locations.

Common questions about NDIS home modification assessments

What does a home modification assessment involve?

The occupational therapist considers your disability-related barriers, observes relevant activities and assesses the environment. The assessment explores options, including equipment, and explains why a recommended change may meet your needs.

Which part of my NDIS plan pays for the modification?

The modification is funded under Capital Supports and needs its own approval. The occupational therapy assessment and report usually come from Capacity Building – Improved Daily Living. Check your plan statement or ask your planner or plan manager.

Is home modification funding guaranteed?

No. Recommendations provide clinical evidence. The NDIA decides whether proposed supports meet the funding requirements, and other permissions and technical requirements may also apply.

Do you assess complex home modifications?

Yes. Bloom Healthcare has the internal expertise to assess the requirements of complex home modifications, and can assess multiple rooms. Capability and availability in your area are confirmed before the referral is accepted.

What is the difference between minor and complex modifications?

Minor modifications are smaller changes such as rails or access adjustments. Complex modifications are larger changes that may need specialist assessment, building professionals, site visits and more detailed documentation. The NDIA sets the categories and evidence rules, so check with your planner which applies to your proposed change.

Can I arrange an assessment in a rental property?

You can enquire about an assessment. Owner permission and other property requirements need to be addressed before modifications go ahead, and NDIS funding requirements and your own circumstances also apply.

Does Bloom carry out the building work?

No. Bloom provides the occupational therapy assessment. Construction, certification and related building services are arranged with appropriately qualified professionals and are not included automatically.

Do I need quotes?

It depends on the proposed change and current NDIS rules. After the occupational therapy report, further technical plans or builder quotes may be required. Check the requirement for your proposed change with your planner, plan manager or support coordinator before commissioning work.

Can this assessment be completed entirely online?

It can, in some circumstances. It depends on a number of factors that should be discussed with the clinician before the service starts. Most home modification assessments are done in person, because function, access and dimensions need to be observed in the space.

Can equipment be used instead of a modification?

Sometimes. The assessment considers whether assistive technology or a different arrangement could meet the need before structural changes are recommended. If equipment looks like the better answer, an assistive technology assessment is the next step.

I am on Support at Home. Is this the same process?

The clinical assessment is similar, but the funding is different. Under Support at Home, home modifications run through the Assistive Technology and Home Modifications (AT-HM) scheme, a separate short-term pathway from your ongoing services. Check your support plan or call My Aged Care on 1800 200 422.

More on home modifications and occupational therapy

• NDIS occupational therapy
• Assistive technology assessments
• Home and living assessments
• Falls prevention and home safety
• Aged care occupational therapy
• Information for support coordinators and referrers