What Does an Occupational Therapist Do?

Of all the professions in the NDIS, occupational therapy is the one people most often find themselves using without quite knowing what it is.

The name doesn’t help. Most people hear “occupational” and think employment, and that is not what it means. The word is used in its older sense: the things that occupy your time. Getting dressed. Cooking. Getting to the shops. Working, yes, but also showering, parenting, sleeping, and getting into your own bathroom.

An occupational therapist’s job is to look at what you want or need to do, work out what is getting in the way, and change something — the task, the environment, the equipment, or your capacity to do it.

Within the NDIS, OTs also occupy a particular structural position: the OT report is the evidence base for a large proportion of funding decisions. Equipment, home modifications, support hours, housing type, and often the plan itself rest on an OT’s assessment. That makes understanding what they do, and how to get a good one, disproportionately useful.

This guide covers what OTs actually do, what a functional capacity assessment involves, how to prepare for one, and how to tell a good report from a weak one.

What they do, concretely

Functional assessment. Working out what a person can do, what they can do with difficulty, and what they cannot do. This is the foundation for everything else and is the piece the NDIA relies on most.

Equipment and assistive technology. Wheelchairs and seating, shower chairs, hoists, beds, pressure cushions, communication devices, kitchen and dressing aids, and the long tail of small items that change a day. OTs prescribe, trial, fit, adjust and review.

Home modifications. Ramps, bathroom conversions, grab rails, door widening, kitchen changes, level access. An OT assesses, designs the functional requirements, and works with builders. For anything beyond minor work, the OT report is what the funding request is built on.

Training and technique. Teaching how to transfer safely, how to use equipment, how to conserve energy, how to break a task into manageable steps. Also teaching support workers and family members.

Task and environment adaptation. Often the most elegant part of the job. Changing how something is done, or rearranging where it is done, so that it becomes possible without equipment at all.

Cognitive and sensory support. Memory and organisation strategies, routines, visual schedules, sensory environments. This side of OT is less visible and frequently underused.

Seating and positioning. For wheelchair users this is specialist, consequential work — poor seating causes pressure injuries, pain, postural deterioration and respiratory problems.

Hand therapy, driving assessment, workplace assessment and other specialisations, depending on the OT.

The functional capacity assessment

This is the one most participants encounter, and the one with the most riding on it.

A functional capacity assessment (FCA) describes how a person functions across daily life. It is used to support access requests, plan reassessments, requests for more support hours, SIL and SDA applications, and equipment and modification funding.

What it typically involves: an interview, observation of tasks being performed — often in your own home, which is far more useful than a clinic — standardised assessment tools, discussion with family and support workers, review of other clinical reports, and then a written report.

How long it takes: usually one to three sessions of one to two hours, plus substantial report-writing time. A thorough FCA report is a significant document.

What it costs: OT is currently priced at $193.99 per hour under the 2026-27 arrangements, and report writing is chargeable as non-face-to-face time. A full FCA commonly runs to several thousand dollars, funded from Capacity Building supports. That is a real cost and an argument for getting it right the first time.

What it covers: the six functional domains the NDIS frames decisions around — mobility, communication, social interaction, learning, self-care and self-management — plus the home environment, equipment in use, supports currently relied on, and risks.

How to get a useful assessment

An FCA is partly done to you and partly done with you, and the difference between a weak report and a strong one often comes down to what happens in the room.

Describe your worst reasonable day, not your best. This is the single most common problem. People minimise, out of pride, habit or genuine adaptation. If you have good days and bad days, the report must capture both and say how often each occurs. An assessment conducted on a good day, describing a good day, will understate your needs — and that understatement becomes the basis of your funding.

Don’t perform. Many people unconsciously try harder during an assessment. If a task normally takes you forty minutes and exhausts you, don’t do it in fifteen because someone is watching.

Say what it costs you. Being able to shower independently is not the same as being able to shower independently and still have energy to cook. Fatigue, pain and recovery time are functional impacts and should be in the report.

Mention the things you’ve stopped doing. People often adapt by abandoning activities and then don’t mention them, because they no longer feel like part of life. If you stopped cooking two years ago because it became too hard, that is more informative than anything you still manage.

Have someone else there. Family members and support workers routinely notice things the person has normalised.

Keep a diary beforehand. A fortnight of notes — what took how long, what you needed help with, what went wrong — is more accurate than recall and gives the OT concrete material. Our guide on describing your support needs covers how to do this well.

Be clear about what you’re trying to achieve. An assessment aimed at a specific goal — moving out, getting a bathroom modified, increasing support hours — can be framed to address it. Say so at the start.

Ask to read the draft. Reports frequently contain errors of fact or emphasis, and they are much easier to fix before submission. A good OT will expect this.

What a good report looks like

Having seen a great many of these, the difference between a report that gets a funding decision across the line and one that doesn’t is usually not the quality of the clinical reasoning. It is specificity.

Weak: “Requires assistance with personal care.”

Strong: “Requires physical assistance of one person for showering, including transfer onto a shower chair and washing of lower body and hair. Showering takes approximately 45 minutes with assistance, compared with a pre-injury baseline of 10 minutes. Attempts at independent showering have resulted in two falls in the past six months. Following showering, requires approximately 30 minutes rest before being able to undertake further activity.”

The second version tells a decision-maker what to fund. The first doesn’t.

Other markers of a strong report:

• Quantification throughout — minutes, frequency, distance, how many times a week
• The range described, where function varies — good days and bad days, with frequency
• Consequences stated — what happens without the support, including risks and past incidents
• Recommendations that are specific and justified — not “requires support” but how many hours, for what, at what ratio, and why
• Links between impairment and function made explicit, rather than left for the reader to infer
• The person’s own goals reflected, not just their deficits

A report that reads as a list of diagnoses and generic recommendations will usually produce a disappointing outcome, however well-qualified its author.

Preparing for an equipment assessment

Equipment is where OT work is most visible, and a little preparation changes the result considerably.

Think about every setting the item will be used in, not just the main one. A wheelchair that fits your living room and not your bathroom door, or a shower chair that doesn’t fit the caravan you use every summer, is a solved problem that created a new one. Mention the holiday house, the car boot, the narrow hallway at your mother’s place.

Think about who else handles it. If a support worker will be folding it, lifting it or transporting it, that affects what is suitable. So does whether you have one worker or two.

Be honest about what you’ll actually use. Equipment that is technically optimal but awkward, ugly or conspicuous frequently ends up in a cupboard. If appearance matters to you, say so — it is a legitimate factor, not vanity, and there are usually options.

Ask about the trial. Most significant items can be trialled, and a trial in your own home over a week or two reveals things no clinic assessment will.

Ask about maintenance, repairs and replacement before you commit. Who services it, how quickly, what happens when it breaks, and what the expected lifespan is. Repair turnaround is a real quality-of-life issue for anyone whose wheelchair is their mobility.

Ask what happens when your needs change. Some items adjust and grow; some don’t. For children in particular, this question is worth asking hard.

OT and the housing pathway

For anyone thinking about where they live, the OT is the central figure in the process, and it is worth understanding why.

Supported Independent Living. A SIL request rests on evidence of how much support a person needs, at what times, at what ratio, and why it must be delivered where they live rather than through visiting supports. An OT functional assessment is normally the backbone of that case, often alongside a roster of care. The assessment needs to address overnight need explicitly — active overnight support versus a sleepover is a large difference in cost and must be justified on the evidence.

Specialist Disability Accommodation. SDA has a higher evidentiary bar than almost anything else in the scheme. An SDA assessment must establish that the person’s needs cannot reasonably be met in standard housing with supports, and must map those needs onto a design category — Improved Liveability, Fully Accessible, Robust or High Physical Support. Not every OT does this work, and the approval rate varies considerably by assessor experience. Ask directly.

Home modifications. For anything beyond minor work, the OT assesses, specifies the functional requirements and works with builders and the NDIA. Major modifications involve a formal process with quotes and sometimes a second opinion, and the lead times are long — frequently a year or more from first assessment to completed work.

Individualised Living Options. ILO exploration and design draw on functional assessment too, though the process is more person-led and less clinical than SIL or SDA.

In all of these, one principle recurs: the assessment must describe need, not preference. “Would prefer to live alone” is not fundable; “requires a low-stimulus environment, with documented escalation in shared settings resulting in three tenancy breakdowns” is a different statement entirely. A good OT knows how to write the second kind of sentence truthfully.

When you disagree with your OT

It happens, and people are often reluctant to say so.

If the recommendation feels wrong, say so and ask for the reasoning. Sometimes the explanation resolves it. Sometimes the OT has misunderstood how you actually live, which is worth correcting before it becomes a report.

If the report understates your needs, that is the moment to intervene — before submission. Point to specifics: this paragraph says I manage showering independently, but it takes 45 minutes and I fall sometimes. Most OTs will amend a report where the correction is factual.

If you think the assessment missed something, ask for it to be addressed in an addendum rather than starting again.

If the relationship isn’t working, you can change OT. You are not obliged to continue with a practitioner you don’t trust, and continuity is valuable but not worth a bad assessment.

If a recommendation would restrict you — equipment or an arrangement that limits your choices in the name of safety — that deserves an explicit conversation about dignity of risk. Adults are entitled to accept risks others wouldn’t, and a good OT will engage with that rather than defaulting to the safest option.

Finding and choosing an OT

Registration. OTs are registered with the Occupational Therapy Board of Australia through AHPRA. You can verify registration on the AHPRA website in under a minute, and it is worth doing.

Specialisation matters more than people expect. An OT who works mainly in paediatrics is not the right choice for complex adult seating. One who does mostly home modifications may not be the right choice for a cognitive assessment. Ask directly what proportion of their work involves situations like yours.

For specific purposes, ask about specific experience. For an SDA application, ask how many SDA assessments they have completed and what proportion were approved. For complex seating, ask about their experience with your type of equipment. For an appeal, ask whether they have written reports used at the Administrative Review Tribunal.

Waiting times are real. In many areas OT waiting lists run months, and longer for specialist areas. If an assessment is needed for a plan reassessment, start early — this is one of the most common causes of a reassessment going ahead without the evidence it needed.

Where the funding comes from. OT is funded from Capacity Building, usually under Improved Daily Living. Note that Capacity Building Daily Activities allocations are being reduced by around 10% for many participants from 1 October 2026, which makes planning OT spending for the year more important than it used to be.

Working with your OT over time

A few things that make the relationship more productive.

One good OT who knows you is worth several who don’t. Continuity matters here more than in most allied health, because so much of the value is in knowing how you actually live.

Equipment needs review. Cushions compress, needs change, bodies change. Equipment prescribed three years ago and never revisited is a common finding and a common cause of problems — particularly pressure injuries. Ask for periodic review rather than waiting for something to go wrong.

Trial before you commit. Most equipment can be trialled. An expensive item that turns out not to suit you is a significant waste of Capital funding, and trials exist precisely to prevent it.

Say when something isn’t working. People are often reluctant to tell an OT that recommended equipment sits unused. It happens constantly and the OT would much rather know.

Ask about the thing you’ve stopped mentioning. Most people have an activity they gave up and no longer raise. It is frequently solvable.

Where OT fits with everything else

OT overlaps with several other professions and the boundaries confuse people.

Physiotherapy focuses on movement, strength, mobility and exercise. OT focuses on the activity you’re trying to do. They overlap substantially and often work together — physio builds the capacity, OT applies it to real tasks.

Speech pathology covers communication and swallowing. Where a person needs both communication equipment and physical access to it, OT and speech work jointly.

Support coordination helps you find and organise services. OT assesses and recommends. A support coordinator will often arrange the OT; the OT then produces the evidence the coordinator uses.

Behaviour support practitioners address behaviours of concern. There is real overlap with OT around sensory environments and daily structure, and the best outcomes usually involve both.

For most housing and home-and-living questions, the OT is the central figure — the SDA, SIL and home modification pathways all run through an OT assessment.

What OT cannot do

Setting expectations fairly, because disappointment here is common.

An OT cannot approve funding. They assess and recommend; the NDIA decides. A strong report improves the odds considerably and guarantees nothing.

An OT cannot make a decision happen faster. Equipment and modification approvals run on their own timelines, and those timelines are long.

An OT is not a case manager. Finding providers, coordinating services and chasing the NDIA is support coordination work. Some OTs help informally; it isn’t their role.

An OT cannot fix a thin market. If the equipment doesn’t exist, or no builder will quote, a recommendation doesn’t change that.

An OT cannot restore function that isn’t there. Much of the work is adaptation rather than recovery, and framing it honestly from the start avoids a great deal of disappointment later.

What an OT can do, reliably, is work out what is actually getting in the way and find a way around it — which, over a few years, adds up to a considerable amount of independence that wouldn’t otherwise exist.

Where to next

Understanding your plan budgets covers where OT funding sits and how Capacity Building works. NDIS price limits explained covers current therapy rates and how travel, reports and cancellations are charged. If your assessment is heading toward a housing decision, our home and living guide library covers what happens next.

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We’re a registered NDIS provider delivering supported independent living across NSW. We don’t employ OTs or write assessments — that independence matters, since a provider shouldn’t be assessing how much of its own service you need. But we work alongside OTs constantly and can tell you what a housing or support assessment usually needs to cover. Call 1300 271 824.

General information only. This guide explains what occupational therapists do within the NDIS; it is not clinical advice, and no guide can substitute for an individual assessment. Rates quoted are national standard rates from the 2026-27 NDIS Pricing Arrangements and Price Limits and change annually on 1 July. Budget allocation changes referenced here were announced for progressive rollout and detail may change. Confirm current rules at ndis.gov.au or on 1800 800 110, and verify any practitioner’s registration at ahpra.gov.au.