Dementia, the NDIS and Aged Care: Which System, and What Each One Gives You

Dementia, the NDIS and aged care: which system, and what each one gives you

Two people are diagnosed with Alzheimer’s disease in the same clinic in the same month, with the same symptoms and the same level of need.

One is 63. She applies to the NDIS, and if the application succeeds she may receive an individually assessed plan funding support work, therapy, equipment, home modifications, support coordination and community participation, with no means testing and no classification cap.

One is 66. She cannot apply. She goes to the aged care system, which is means tested, funded at materially lower levels through classification bands, organised around frailty rather than disability, and not designed to fund the goal-directed support the other woman will get.

Dementia is where this boundary bites hardest in Australia, for a simple reason: it is overwhelmingly a condition of later life. Of the estimated 446,500 Australians living with dementia in 2026, around 29,000 are under 65. Which means roughly 94% of people with dementia in this country are in the aged care system, and all of the material written about the NDIS and dementia is about the other 6%.

This guide explains the boundary honestly, including where it leaves us as a provider.

Where we sit, stated plainly

We are an NDIS provider — NDIS Provider No. 4050164422. We are not an approved aged care provider and we hold no Support at Home registration.

So we can support people with younger onset dementia who are NDIS participants. We cannot support people in the aged care system, and we are not going to pretend otherwise in order to take an enquiry.

If you are over 65, or already receiving aged care, the entry point is My Aged Care on 1800 200 422. The clinical guides in this series — on diagnosis, behaviour, communication, families and daily support — apply regardless of which system funds you, and we hope they are useful. The funding guides will not apply, and this one explains why.

We would rather say that at the top than halfway down a contact form.

The rule

You cannot become an NDIS participant after your 65th birthday. No exception, no discretion, no appeal on the merits of your need.

What matters is becoming a participant, not being diagnosed. So:

• Diagnosed at 61, applied at 62 — in the NDIS.
• Diagnosed at 61, told to wait and see, applied at 65 — too late.
• Diagnosed at 67 — aged care.

That middle case is the one that happens, and it happens because waiting is the natural advice. Given that younger onset dementia typically presents in the 50s and early 60s and the average diagnostic delay is around four years, a great many people are discovering the boundary at the worst possible moment.

If you are under 65 with a dementia diagnosis, apply now. Dementia and the NDIS covers how.

If you are already a participant

The position is much better and it is worth knowing precisely.

• An existing participant who turns 65 keeps their plan, indefinitely.
• Only two things close it off: a permanent residential aged care admission, or a first permanent home care arrangement entered into after turning 65.
• You can choose to remain in the NDIS rather than transfer to aged care.

So a person who joined at 60 and is now 74 is still an NDIS participant with an NDIS plan. People are told otherwise constantly, including by providers, and it is wrong.

What the aged care system actually provides

Since 1 November 2025, Support at Home has replaced Home Care Packages as the main in-home aged care program. The structure:

• Eight classification levels, with budgets allocated accordingly
• Quarterly budgets rather than funds accruing indefinitely
• A care management fee
• Clinical care fully funded by government
• Personal care fully government funded from 1 October 2026
• Entry through My Aged Care, with an assessment determining the classification

Alongside it:

The Commonwealth Home Support Programme for lower-level, entry-level support.

Residential aged care, where 54% of permanent residents have dementia.

Transition Care, which provides time-limited, goal-oriented therapy and support after a hospital stay, organised through the hospital before discharge. Worth asking about by name, because it is frequently not offered and it buys several weeks of therapy-focused support at a point when that matters.

Specialist Dementia Care Programs, residential units for people with very severe behavioural symptoms, accessed by referral.

Dementia Support Australia on 1800 699 799, 24 hours, for changed behaviours — covering both residential and community settings, through the Dementia Behaviour Management Advisory Service and the Severe Behaviour Response Teams. This one is genuinely good, it is free, and it is under-used. We cover it in changed behaviour and dementia.

The honest comparison

That table contains the genuine irony of this boundary: the system with the money has less dementia expertise, and the system with the expertise has less money. The research on younger onset dementia makes exactly this point — dementia-specific services, specialist knowledge and residential options were all built inside aged care, while funding responsibility for under-65s moved to the NDIS in 2016.

So a person with younger onset dementia in the NDIS gets better funding and frequently has to educate their own providers. A person over 65 gets providers who know dementia and a smaller budget.

The decisions that are one-way

Three decisions end an NDIS plan, and all of them get made in pressured circumstances.

Permanently entering residential aged care. This ends NDIS participation. For a person under 65 it should be close to a last resort, and the national data on younger people in residential aged care — 722 under 65 as at 31 March 2026, average length of stay 6.9 years, all three national targets to end it missed — is the argument for exhausting every alternative first. See supported independent living with dementia.

Starting a permanent home care arrangement for the first time after 65. This also ends it. Which means an NDIS participant who turns 66 and is offered a Support at Home package should get advice before accepting, because accepting may close the NDIS door permanently.

Agreeing to a transfer during a discharge meeting. Not a legal category, but the practical mechanism by which the first two happen. Hospital discharge planning runs to a bed availability timeline, and families agree to things under pressure that they would not agree to with a week to think.

The rule we would offer: do not make a permanent placement or system-transfer decision in the first fortnight unless safety requires it, and get independent advice from a disability advocate or support coordinator before signing anything that moves someone out of the NDIS.

Things that apply regardless of which system

A short list, because these get overlooked on both sides of the boundary.

The health system. Diagnosis, specialist review, medication, hospital care and hospital-provided rehabilitation are health responsibilities, available regardless of age and not limited by an aged care classification. This is the most important item here.

Medicare chronic disease management. A GP Management Plan and Team Care Arrangements give access to a number of subsidised allied health sessions a year — occupational therapy, physiotherapy, speech pathology, dietetics, podiatry. Not a large number, and frequently unclaimed.

The PBS, including the Safety Net.

Anything owed through the Department of Veterans’ Affairs, where there is service history. DVA cover is frequently more generous than either system and routinely not asked about.

The National Dementia Helpline on 1800 100 500 — free, 24 hours, run by Dementia Australia, covering younger onset specifically.

Dementia Support Australia on 1800 699 799 for changed behaviours.

Carer Gateway on 1800 422 737 — free counselling, coaching, peer support and respite planning for the carer in their own right. With an estimated 1.7 million Australians involved in caring for someone with dementia, this is the most under-used service on the list.

Carer Payment and Carer Allowance through Services Australia, frequently unclaimed.

Enduring power of attorney, enduring guardianship and an advance care directive, which are not funded by anybody and are the most valuable things to organise early. Driving, work and money covers them.

State and territory dementia and carer support services, which vary and are worth asking about.

If you are over 65 and reading this anyway

A short, honest version of what to do, since most people with dementia are in this position and we would rather be useful than silent.

Get the My Aged Care assessment done properly. The assessment determines the classification and therefore the budget, so how thoroughly needs are described matters enormously. Do not minimise. Describe the worst realistic day, the time each task takes, the assistance required, and what happens when support is not there.

Ask about Transition Care if there has been a hospital admission, while the person is still an inpatient.

Call Dementia Support Australia if behaviour is the problem. It is free, it is 24 hours, and the teams are good.

Push for health system services, which are not limited by your aged care classification — specialist review, allied health through Medicare, and hospital rehabilitation.

Get the carer supported through Carer Gateway.

Choose a provider that actually knows dementia, and ask them what dementia-specific training their workers have and how they handle changed behaviour.

Do the legal documents now.

And a word about the boundary itself: it has been criticised for years by dementia and disability organisations on the obvious ground that dementia at 66 has the same consequences as dementia at 64. The recommendations from the research in this area include making the age-65 funding rules more flexible and letting people diagnosed near 65 choose which sector to approach. Nothing in this guide changes that. What a family can do is act before the door closes where that is still possible, and press hard for everything both systems will provide where it is not.

Choosing a provider in either system

The questions worth asking are largely the same on both sides of the boundary, and they are not the questions most people ask.

Which dementia training have your staff actually completed, and who ran it? “All our staff are trained” is not an answer. Ask what the training covers and how often it is refreshed.

What is your staff turnover in this service? For dementia this is close to a clinical variable rather than an HR statistic. A person who cannot form new memories relies on familiarity, and a rotating roster of unfamiliar faces produces confusion, distress and behaviour that then gets recorded as the person’s problem.

How do you handle changed behaviour? The answer you want involves looking for unmet needs, pain, delirium and environmental triggers before anything else — and knowing about Dementia Support Australia. The answer you do not want involves going straight to medication or to a behaviour plan.

Have you supported someone with younger onset dementia before? For a person in their fifties this matters enormously, and a provider whose entire experience is people in their eighties will struggle with age-appropriate activity and with a physically fit adult who wants to leave the house.

What happens as needs change? Dementia is progressive, and a provider who cannot describe how support increases, or who will reach a point where they withdraw, should say so at the start rather than at a crisis.

Can we meet the actual workers before committing?

How do you communicate with families, and how often?

At what point would you tell us this person is beyond what you can manage? The honest answer tells you how stable the arrangement is, and a provider who claims there is no such point is either inexperienced or not being straight with you.

And one specific to the NDIS side: are you registered for the supports you are delivering, and if behaviour support is involved, is a registered specialist behaviour support provider engaged? That is a distinct registration and not every provider holds it.

A worked example of the boundary

Because the rules are easier to follow against a real sequence.

Margaret, 61. Symptoms began at 58 and were treated as depression. Diagnosed with Alzheimer’s disease at 61. She applies to the NDIS at 61, is accepted, and receives a plan funding support work, occupational therapy, assistive technology and support coordination. At 65 she keeps the plan. At 68 her needs increase substantially and the plan is reassessed upward. At 71 she is still an NDIS participant. Nothing about turning 65 changed anything.

Robert, 63. Diagnosed at 63 with frontotemporal dementia. His specialist suggests waiting to see how he progresses before approaching any service. At 65 the family looks into the NDIS and discovers he is now ineligible. He goes to My Aged Care, receives a Support at Home classification, and the budget is a fraction of what an NDIS plan would have funded for the same needs. Nothing about his condition changed at 65. Only the door did.

Jean, 67. Diagnosed at 67. She was never an NDIS participant and cannot become one. Her pathway is My Aged Care, a Support at Home package, Dementia Support Australia for behaviour, Medicare allied health through a GP Management Plan, and hospital-provided services, which are available regardless of age.

Tom, 64, an existing NDIS participant for an unrelated disability, who is then diagnosed with vascular dementia. His plan is reassessed to reflect the new impairment. He remains in the NDIS indefinitely, and at 66 he is offered a Support at Home package. Accepting it would end his NDIS participation, so he gets advice and declines.

The pattern across all four: the only variable that mattered was the date of the application. Not severity, not need, not the type of dementia.