Occupational therapists deliver life-changing care to support children and adults to live independently in their homes, schools, workplaces and communities. Their work is an essential piece of Australia’s health and care system. It’s also one of the most female-dominated occupations in Australia, with more than 90 per cent of the workforce made up of women.
That’s why it was so disheartening to see the National Disability Insurance Agency’s 2025-26 annual pricing review. The review has frozen occupational therapy support rates for the seventh year in a row, while travel claiming for occupational therapists has been slashed by 50 per cent.
This decision by the NDIA has hit many occupational therapists hard. It comes amid rising costs, high rates of burnout in the sector and unsustainable pricing.
Below is a selection of real stories from NDIS occupational therapists impacted by the pricing review:
‘I am forced to advocate for my livelihood’
I have fought breast cancer as a single mum and won, and this fight feels so much bigger and the more impossible one to win.
I have not stopped ‘working’ since the proposed recommendations were released last Wednesday, over my weekend (again), however this time, I’m advocating for not just my clients and their families, I’m advocating for my own livelihood and the livelihood of my children as well.
Before these latest pricing recommendations were released, I already worked 14-hour days, six days per week, just to make ends meet.
I sit up late into the evening, every evening, after the kids have gone to bed to write reports to protect my clients from injury, abuse, neglect or exploitation for client safeguarding purposes and to ensure the NDIS doesn’t decimate their plan funding at the next review.
I do not get the luxury of a weekend, nor do I get the luxury of heating my home anymore. I have dripping faucets and light bulbs blown that I cannot afford to change.
‘It’s going to get a whole lot worse’
For 95 per cent of my clients, I have been their sole occupational therapist for over a decade, working in the disability sector before the NDIS existed.
My clients are some of the most complex humans in our society. Those with severe-to-profound intellectual disabilities, who are non-speaking, full time wheelchair users, with self-harm or aggressive behaviours, and with severe physical, neurological, sensory disabilities and skeletal deformities. Ninety-eight per cent of my clientele are fully reliant upon the NDIS SIL & SDA accommodation services as they are unable to be cared for in the family home due to their complexity and breath of managing their needs.
For many guardians of my clients, they are blissfully unaware of what the new pricing means. Their loved ones have been supported so well, and for so long by an experienced occupational therapist, that when I am potentially forced to exit operating following a seven-year price freeze, they don’t realise there aren’t any occupational therapists within a one hour drive away with the expertise in our regional area to fill the void.
When guardians are already so traumatised by the systemic flaws within the NDIS system that has failed them, I can’t bring myself to inform them that it’s going to get a whole lot worse when I leave them. Little do they know, this sole therapist who has the required experience and expertise will refuse to provide services to them – due to both the 50 per cent reduction in travel and the lack of indexation since 2019 as well. I worry for the wellbeing of my clients and their families and how these changes will affect them.
After over a decade of providing services to these clients and their families, do you know how many made contact after I emailed them to voice my concern and invite them to stand in unity and complain to the NDIA and government over these changes? Not one. Have I received a response from my Local MP to any of my emails, or a response from any state or federal minister? Not one.
When I tirelessly and ferociously advocate with the NDIA for these clients’ basic needs on an everyday basis already – often to my own detriment and unpaid – who is now going to advocate for the therapists that hold this system together now? No one, that’s who.
‘I would make more money as a support worker’
For sole trader therapists, concessional superannuation payments are ‘optional’ and have not been made in four out of the last five years – because food on the table for my children is more important. This is the norm for sole trader therapists, I am not the exception.
In what other profession would it be considered acceptable to go seven years without a pay rise – or worse, to face a pay cut – while real inflation has risen by over 20 per cent during this time?
I spend hours upon hours each week updating report templates as the result of operational guideline changes and due to opaque NDIS Planner decision making. Unbillable NDIS services, required to ensure I can continue to provide quality services within an everchanging landscape and to reduce the amount of therapy hours I use against Participant’s plan to achieve for them the best outcomes.
It wasn’t easy having to point out to my clients and guardians that, despite holding a university degree and working as an allied health professional, I would earn more money as a support worker – but that’s the cold hard facts.
We do not drive luxury vehicles or have elaborate ‘decks’ as the longstanding media rhetoric will have you believe. Most of us haven’t been able to afford a holiday in years.
Our cost of living has increased as well, and whilst we show up every single day to support Participants – we are everyday people – just like you. Our electricity rates will rise on July 1 – just like you – and for those of us with clinics, that cost is now twofold.
Since the proposed recommendations were released last Wednesday, I haven’t earned a single dollar. Once again, I find myself going into battle – not just for my clients and their families, but this time, for myself and my children. Because this fight is no longer just professional – it’s deeply personal.
‘Free labour will now go unserviced’
Like many of my colleagues, I provide a significant proportion of unfunded and pro bono services, between 30-40 per cent per week as the result of underfunding or exhausted plan budgets. These are not “nice to have” supports; they are often delivered to prevent immediate risks including death, serious injury and hospitalisation admissions due to pressure injuries, fractures, aspiration/choking when eating, or to support a rapid decline in functioning when someone stops walking and needs to use a wheelchair, or in the prevention of further abuse, neglect or exploitation.
While I have always remained in this work out of a deep passion for client-centred care and the transformative role of OT, these pricing changes cross a line. They are not only render pro-bono services financially unsustainable to provide—they reflect a disregard for the clinical, ethical, and human realities of disability service delivery. And it won’t only be just our businesses that are not going to survive. Client and support worker injuries, long-stay hospital admissions are going to skyrocket to new levels, not to mention the cost to the NDIA in re-training new support staff, nor the costs to NDIS accommodation providers as their workers compensation premiums are set to unseen levels. State Health think they are struggling now? Watch them crumble to their foundations under the weight of free labour, that will now go unserviced. They are about to find out exactly how much this sector has been held up by the fruits of unpaid Therapist service.
What the general public doesn’t see? The hidden costs of business service, nor the fact Allied Health have been sidelined and scapegoated, or the deeply flawed, and dangerously out of touch realities of the NDIAs pricing review.
NDIA were successful in their waged public campaign, painting Therapists as the enemy, through an inflated fraud narrative under the guidance of PR firm Redbridge Group. They attempted to pull the wool over our eyes, through the so called “Independent Pricing Review Committee”, it is anything but. A closer look reveals a panel dominated by economists and public policy experts, many with government affiliations—with virtually no lived or professional experience in disability or healthcare. This is not independence, masquerading as reform, it is a closed loop of bureaucratic groupthink.
So as a therapist and business owner, I am faced with an impossible choice – compromise my own financial wellbeing and the livelihood of my family, withdraw services from participants who are already vulnerable and at risk, or begin charging all clients who walk through the door my standard hourly rate, and if it ‘happens’ to be an NDIS client, then thanks to the NDIA the burden will be placed upon them, to pay for the service upfront with an additional $27.00 per hour increase on top, just like another other insurance model and for them now required to seek any reimbursement in cost. Most rely on the disability pension, which barely coves their cost of living, and some therapists, like myself, will provide a ‘discount’ and still continue operation without any financial sense or reason. It won’t be sustainable to continue operating – even in the short term, however again, despite it all – I will continue for now to protect my clients and their families from any harm if I left right now.
For registered NDIS providers, their imminent demise is more sinister. Being required to stay within the pricing arrangements will see their doors close much sooner, and potentially employees’ wages reduced much more than what they would have liked to administer.
As small businesses we stood no chance in this David vs Goliath battle. Allied health workers have reached breaking point, and the consequences are dire for every Australian these changes will affect.
We were promised genuine consultation and co-design, to support the sustainability of the scheme and for all Australian’s, yet the echo-chamber was deafening in the months leading up to June 2025, and come the release of these changes July 1, we will see the beginning of the end of a scheme developed to see an inclusive Australia thrive.
When capacity building therapies only account for 12 per cent of the total of NDIS expenditure, and yet, this is what has experienced the most severe rate cuts, it’s a pretty clear sign of what’s to come, as both non-registered and registered providers close doors due to financial unsustainability and distraught participants/guardian’s will escalate and become vocal at the inability to access any therapy.
These same clients and guardians will express thanks to this very same government that destroyed it, with the return of state-based block funded disability services, and back to the dark ages we go…so much for choice, independence and control.
Therapists are painted as the ‘wedding taxers’ and ‘elaborate deckers’, but I can only hope this narrative shifts and helps people to re-think. When we advocate for a fair therapy rate — one that reflects both our gender and professional worth — we do so with full awareness of the broader impact, far beyond what’s seen at first glance.
We’ve always shown up to work with you, and we’ll continue to do so.
But just once, it would be nice if instead of being devalued, our community and the people we support stood beside us – in sync.