When You Can’t Go Home: MTA, SIL and Interim Options After Hospital

There’s a specific moment families describe, and it usually arrives about a fortnight into an admission.

The medical crisis has passed. Everyone’s relieved. And then the occupational therapist comes back from visiting the house and says, carefully, that there are some issues. The bathroom won’t work. The only toilet is up four steps. The hallway is too narrow for a wheelchair.

And it dawns on everyone in the room that the person isn’t going back to the house they left.

That realisation is destabilising in a way that’s hard to describe to anyone who hasn’t had it. It’s not only a logistical problem; for many people it’s the moment a temporary illness becomes a permanent change in life. So before anything else: this is common, it is survivable, and there is a defined NDIS pathway for exactly this situation. You are not the first family to be here.

This guide covers what that pathway is, how the funding works, and how to use the time well.

First: separate the two questions

The most useful thing you can do early is stop treating this as one problem. It’s two, and they have different timescales.

Question one: where does this person sleep in three weeks? Short-term, urgent, solvable.

Question two: where does this person live permanently? Long-term, important, and genuinely difficult — it may involve home modifications, a move, a shared supported home, or specialist housing.

Families who try to answer both at once get stuck, because question two takes months and question one takes weeks. And while they’re stuck, the person stays in an acute bed losing confidence.

The NDIS is designed around that separation, which is what Medium Term Accommodation exists for.

Medium Term Accommodation and the hospital exception

MTA funds up to 90 days of accommodation for people who can’t move into their long-term home yet. It’s a Core Supports item and it’s specifically contemplated for hospital discharge.

Now the detail that matters most, and that a great deal of provider content gets wrong.

MTA normally requires that a long-term housing outcome is confirmed — you’re bridging a known gap to a known destination. Hospital discharge is the exception. The NDIS states that where you’re being discharged from hospital and are eligible for SDA, Supported Independent Living, an Individualised Living Option or home modifications, you don’t need to have a confirmed long-term home.

That carve-out is the thing that lets you separate the two questions. You don’t have to solve permanent housing before getting someone out of hospital. You get them somewhere safe, then work the housing question properly, with the person involved and without a ward clock running.

If you’ve been told you need the permanent answer first, that advice is wrong for a hospital discharge. Point to the NDIS guidance.

What MTA does and doesn’t fund

MTA funds the accommodation only. This is the second thing that catches families out, and it’s a serious one.

Support is funded separately — from your existing SIL funding if you have it, or from assistance with daily life in the Core budget. Food, utilities, internet and personal care are not included in MTA.

The failure mode is predictable: MTA gets approved, everyone relaxes, the person arrives at a property, and then someone asks who’s helping them shower tomorrow morning. Nobody funded the person, only the roof.

So request both in the same conversation. When MTA is raised, the immediate next sentence should be: and what’s funding the daily support during that period, and is it enough? If existing SIL funding carries across, confirm it in writing. If it doesn’t exist, establishing it takes longer than booking a room.

Other MTA conditions worth knowing

• It’s generally a one-off support, not something renewed indefinitely.
• It isn’t emergency or crisis accommodation — it’s planned transitional housing.
• You must have a home you can move back into or move on to, which is the point of the 90 days.
• Extensions are possible but not guaranteed, and need evidence of genuine delay plus active steps toward the permanent outcome.

The options, honestly compared

MTA isn’t the only route, and it isn’t always the best one.

Modified return home. Sometimes the house works with less modification than first assumed — a bed moved to the living room, a commode, a ramp, loaned equipment. Undignified in parts, and many people choose it anyway because it’s home and it’s immediate. Worth asking the OT directly: what’s the minimum that would make this safe, even temporarily?

Staying with family. Works where someone has an accessible home and genuine capacity. The two failure modes are a house that isn’t actually accessible, and a family member who agrees out of love and burns out in six weeks. Be honest about both before committing, and set an end date rather than letting it drift.

Medium Term Accommodation. The designed pathway. Up to 90 days, accommodation funded, support funded separately, no confirmed long-term home required for hospital discharge.

Moving straight into a SIL home. Occasionally possible if a suitable vacancy exists and the match is right. The risk is rushing a placement decision during a crisis — housemate compatibility predicts long-term success more than anything else, and a decision made under discharge pressure is rarely a good one. Where a SIL home is clearly the destination but the right vacancy isn’t available, MTA bridges to it.

Short Term Respite. Up to 28 days a year, support included in the daily rate. Can cover a brief gap, and it may suit a short modification period. Not designed for a long bridge, and the annual limit means using it here consumes the respite the family may need later.

Sub-acute or transitional care within the health system. Varies by state. Sometimes the right clinical answer where recovery is genuinely ongoing. Not a long-term solution, and the funding boundary questions apply.

Using the 90 days properly

The NDIA expects you to be actively working toward a long-term outcome during an MTA period, and that’s practical advice as much as a compliance expectation. Ninety days evaporates.

Days 1–7: settle, and confirm the support is actually working. The first week is about the person being safe and comfortable, and checking that the support roster arranged on paper is turning up in practice. Fix staffing problems now, not in week six.

Days 7–21: map the housing question properly. This is the work the MTA period exists for. What are the real options? Modify the existing home? A different rental? A SIL vacancy? SDA, if the person might be eligible? Each needs assessment, and each has a timeline. Get them all started rather than pursuing them one at a time.

Days 21–45: do the slow things. Plan variations, SDA applications if relevant, building quotes, SIL vacancy matching and meet-and-greets. Everything here has weeks of lead time, so starting at day 40 means missing the window.

Days 45–70: test the destination. Visit the home. Meet future housemates. Trial stays where practical. This is also the point to raise the alarm if something is slipping — early warning gives options.

Days 70–90: move, or request an extension with evidence. If the permanent outcome isn’t ready, the extension request goes in now with documentation of the delay and a revised date. Requests submitted at day 88 rarely land well.

When the permanent answer is a supported home

For some people, the honest conclusion of this process is that living alone is no longer viable, and Supported Independent Living becomes the right answer.

That conclusion lands hard, particularly for someone who was independent a month ago. A few things are worth knowing.

SIL is not a facility. It’s usually a suburban house with two to four residents and rostered support. People keep their own rooms, routines and tenancy rights. In well-structured arrangements, a resident can change support providers without moving house.

It doesn’t have to be permanent. Some people move into SIL after a significant injury, rebuild capacity over a year or two, and move into something more independent later. Framing it as a stage rather than a destination changes how it feels and, often, how it goes.

Housemate matching matters more than the building. Our guide on what makes a good housemate match covers this, and it’s the reason not to rush a placement during a discharge. The MTA period exists precisely so you don’t have to.

SIL and SDA are different decisions. SIL funds the support workers; SDA funds specialist housing for a small group with very high physical support needs. If a new injury means the person needs purpose-built housing — ceiling hoists, full wheelchair circulation — an SDA application may be worth pursuing, but it’s a separate assessment with its own evidence requirements and often a long wait. MTA can bridge that too.

If SDA might be part of the answer

For a small group of people — the NDIS designed it for around six per cent of participants — a new injury or a progressive condition means ordinary housing genuinely cannot be made to work, even with modifications. That’s what Specialist Disability Accommodation exists for.

Three things to understand if SDA is being raised.

It’s the building, not the support. SDA funds purpose-built housing with features like ceiling hoist provision, full wheelchair circulation, reinforced construction or backup power. The support delivered inside it is funded separately, usually through SIL. They’re two applications, assessed independently.

The evidence has to be about the environment. This is where most SDA applications fail. A report describing high support needs — even very high support needs — doesn’t establish SDA eligibility. The evidence must show why the building has to change: hoist transfers requiring structural provision, wheelchair circulation that cannot be achieved in standard housing, a sensory or behavioural environment that modifications can’t deliver. An OT experienced in SDA housing assessments is essential here; not every OT writes them.

The wait is real. Across Australia, thousands of people hold SDA funding and are still looking for a suitable dwelling, and availability is uneven by design category and location. Fully Accessible and High Physical Support dwellings in well-serviced areas are in particularly short supply. This is precisely the gap MTA bridges — and it’s why the hospital discharge exception to the confirmed-home rule matters so much.

If SDA is genuinely on the table, start the application during the MTA period rather than waiting, register interest with multiple SDA providers, and ask each what they have under construction rather than only what’s vacant now. Our SDA guide for Sydney covers design categories and eligibility in detail.

A framework for the housing decision

When several options are genuinely available, families often go in circles. These five questions, answered in order, tend to resolve it.

1. What does the person want? Asked first, deliberately. Even where capacity is affected, preferences about where and how to live should shape the outcome. Decisions made for someone in this period unravel later with remarkable reliability.

2. What does the clinical picture require? Not what it requires today, in week three of recovery, but what it’s likely to require in a year. A progressive condition points differently from a stable injury. The treating team’s view on expected trajectory matters here.

3. What can be delivered where? Some locations can be staffed reliably and some can’t. A beautiful house an hour from anywhere, needing high intensity supports, is a rostering problem that will eventually become a care problem. Ask prospective providers honestly whether they can staff a given address.

4. What’s reversible? Prefer options you can change. Renting beats buying while things are uncertain. A SIL placement with proper exit terms beats one that’s hard to leave. Modifications to a rental are less reversible than they look.

5. What’s the cost of waiting versus the cost of getting it wrong? Sometimes waiting another six weeks for the right option is obviously correct. Sometimes the person is deteriorating in an acute bed and a good-enough option now beats a perfect one later. Be honest about which situation you’re actually in.

What makes this period easier

A few things from families who’ve been through it.

Bring the person’s things. An MTA placement furnished with nothing but hospital-issue bedding feels like an extension of the ward. Photos, their own pillow, familiar objects. It sounds small; it changes the first night.

Keep the connections running. Therapy, community activities, friends, religious or cultural practice. The instinct during a transition is to pause everything until things settle. The people who do best are usually the ones who kept something going.

Name who’s coordinating. This period generates an enormous amount of logistics across several organisations. If nobody is explicitly holding the whole picture, things fall between parties. It should be the support coordinator; make sure it is.

Involve the person in the housing decision as fully as possible. The temptation during a crisis is for family and professionals to solve it and present the answer. Even where capacity is affected, the person’s preferences about where and how they live should shape the outcome. Decisions made for someone in this period tend to unravel later.

Expect grief, and don’t mistake it for a wrong decision. Losing your home, or your independence, or the version of your life you had six weeks ago, is a real loss. It can coexist entirely with having made the right choices. Both things are true at once.

Getting MTA approved: what the request needs

MTA doesn’t appear in a plan automatically. Somebody has to request it, and the quality of the request determines both whether it’s approved and how fast.

Evidence that the current home is unsuitable. An occupational therapist’s assessment carries the most weight — specifically, a written statement of why the person cannot safely return to their existing accommodation. A discharge summary describing changed function supports it. Without this, the request has no foundation.

Evidence of the pathway you’re on. For a hospital discharge you don’t need a confirmed long-term home, but you do need to show you’re eligible for one of the qualifying supports — SDA, SIL, ILO or home modifications — and that work toward it is underway. An SDA application in progress, a home modification assessment booked, a SIL search active.

The support question answered in the same request. As above: MTA funds accommodation only. The request should address who funds daily support during the period and whether existing funding carries across.

Realistic dates. “Approximately ten weeks while bathroom modifications are completed, with the builder quoting completion on 14 March” is far stronger than “a few months”.

An explicit note that a hospital bed is involved. Where someone is occupying an acute bed they no longer clinically need, say so in the request and ask about priority processing. Hospital social workers can usually support this, and health services have a strong interest in it moving.

Your support coordinator normally lodges this. If there’s no support coordination in the plan and a complex discharge is underway, that itself should be raised with the NDIA as urgent.

Lining up the placement before approval lands

A practical sequencing point that saves weeks.

Funding approval and an available property are two different things, and families often treat them as one. Approval arrives, and only then does anyone start ringing providers — at which point there’s nothing suitable for three weeks and the acute bed is still occupied.

Talk to MTA providers while the request is in progress. Tell them the likely dates, the support needs, the clinical detail, and the area. A provider who knows you’re coming can often hold something or tell you honestly that they can’t, which lets you look elsewhere before it’s urgent.

Questions worth asking any MTA provider at that stage: what exactly does the accommodation cost include, do you provide support or accommodation only, can you meet these specific clinical needs, is the property accessible for this equipment, and what happens if the discharge date moves by a week in either direction.

That last question matters more than people expect. Discharge dates slip constantly, in both directions, and the answer tells you how much flexibility is in the arrangement.

If the 90 days run out

It happens. Modifications run over. An SDA vacancy falls through. A plan variation takes twelve weeks.

Extensions are possible but not guaranteed. Evidence the delay from its source — a builder’s revised completion letter, written confirmation a dwelling is still held, correspondence showing a variation in progress. Show that reasonable steps have been taken. Submit around day 70.

If an extension is declined and the permanent home genuinely isn’t ready, talk to your support coordinator immediately about every remaining option: a different interim arrangement, Short Term Respite for a brief gap, review pathways, an advocate. The worst approach is silence until the final week, when options narrow sharply.

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We provide medium term accommodation, supported independent living, short term respite and high intensity supports across NSW — which means for many families the MTA period is spent preparing to move into one of our homes, without re-telling the story to a new organisation. That said, we’ll provide MTA while you move into someone else’s placement, and we won’t push you toward ours. Call 1300 271 824.

General information only, current at the time of writing. MTA eligibility, duration and conditions are set by the NDIA and change periodically — confirm current detail at ndis.gov.au or on 1800 800 110. This guide covers process and options, not clinical care; discharge readiness rests with the treating team. In an emergency, call 000.