Pathways to Home: An Innovative Model of Care for NDIS Participants

Ms Anne Sweetapple1, Ms Kaitlind Cromack1, Mr Shane Nolland1, Ms Louise Lazic1, Mr Kim Nguyen1

1Hnelhd, Waratah, Australia

Biography:

Anne is an occupational therapist with over 20 years’ experience in the Hunter New England Local Health District. She is currently an Allied Health Manager looking after NDIS and disability inclusion for the local health district. She supported the Allied Health staff during the Wallsend Aged Care Facility transition. Anne previously worked in community stroke service provision. She is passionate about inclusive healthcare for people with disability.

Abstract:

An innovative service model facilitated the timely transition of National Disability Insurance Scheme (NDIS) residents from their aged care facility into the community. Expert Occupational Therapists and Social Workers supported residents with complex physical and psychosocial disabilities, enabling their move from the publicly funded Wallsend Aged Care Facility (WACF), which announced its closure in February 2024.

The Transition Team conducted thorough functional, cognitive, psychosocial, and environmental assessments to ensure adequate funding for ongoing provisions, including suitable housing, support services, maintenance therapies, assistive technology, and consumables. Adopting a person-centred approach, the Transition Team provided vital support to residents and their families during this period of change.

The Transition Team collaborated with external services such as NDIS, EnableNSW, NSW and NT Trustee and Guardian, Support Coordinators, Disability Support Workers, and Supported Independent Living (SIL) providers. This partnership ensured that staff were adequately trained and confident in managing the physical, psychosocial, and behavioural needs of the residents after their transition.

Throughout the closure of the facility, the Transition Team remained dedicated to supporting and empowering existing WACF staff, residents, and families, leading to the successful transition of all residents within six months.

The success of this model has prompted a trial in 2025 at Hunter New England Local Health District facilities, where dedicated Occupational Therapy and Social Work staff with NDIS expertise will assist in safely transitioning NDIS participants from acute hospital beds back into the community.

 

 

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