What’s Wrong with Assistive Technology and the NDIS?

An OT’s Perspective on Current NDIS Assistive Technology Policy

With my career approaching 2 decades as an Occupational Therapist, I have witnessed significant change in the field of assistive technology (AT). Keep in mind that the majority of the first 5 years of my career was dedicated solely to Assistive Technology as I worked with children with Cerebral Palsy, and then across product areas at LifeTec, which was the biggest block-funded Assistive technology Advisory Service in the state. We knew our product categories inside and out and ran workshops on all things from Car and Home mods, to Great Gadgets talks, arounds the state.

In the early years of my practice, devices such as long-handled shoehorns or loofahs, and large-grip kitchen utensils could only be purchased from specialist disability suppliers, often at a premium price. Today, many of these products are readily available through mainstream retail outlets. It goes further – you’ve seen Kmart, Aldi and Bunnings all ‘have at’ the AT market with wheelchairs (basic, yes), show chairs and stools, and grab rails – all easily accessible.

This phenomenon, known as “crossover technology,” has been widely recognised as positive. As products originally designed for disability-specific purposes enter the mainstream market, they become more affordable, more accessible, and less stigmatised. Equally, products first developed for the general market often prove useful as AT, offering more cost-effective alternatives to their disability-branded counterparts.

The World Health Organization has formally endorsed this trend, encouraging governments to support crossover adoption as a means of promoting inclusion, equity, and cost efficiency. The evidence suggests that AT policy should focus on function and need, not on whether a product happens to be sold in a disability catalogue or a hardware store.

Unfortunately, the NDIS has taken a very different approach.

An Administrative Illness

The NDIA has adopted a rigid classification system, seeking to divide AT into “mainstream” versus “assistive” categories. The effect is a system that undermines inclusion by insisting on artificial distinctions. It is, in essence, a misdiagnosis: treating the presence of an item in mainstream retail as evidence that it is no longer “assistive,” regardless of the purpose it serves for the participant.

This approach is counter-therapeutic for several reasons:

• It disregards the expertise of allied health professionals, whose clinical reasoning is reduced to a checklist.

• It dismisses the lived experience of participants, who are now unfortunately being positioned as potential abusers of the system rather than as individuals seeking to meet legitimate needs.

• It is administratively burdensome and costly, with an “audit-first” culture that consumes resources without achieving meaningful savings.

  
  

The NDIA claims this restrictive stance is about fiscal responsibility. In practice, it resembles a medical intervention that is both ineffective and harmful — burdensome to administer, stigmatising in its impact, and ultimately counterproductive to the scheme’s stated goals.

The Slippery Slope

There is also a question of where such differentiation ends. We already see planners refusing items that have a long-established history as AT, on the grounds that a superficially similar product can now be purchased from a mainstream store. But this logic quickly becomes untenable:

• If shower chairs are available at Bunnings, are they no longer AT?

• If walking aids are sold at the local pharmacy, does that remove their status as AT?

• As larger retailers expand into mobility and daily living products, how far will the exclusions extend?

By this reasoning, the more inclusive and widespread AT becomes, the less support people with disability will be entitled to. It is an inversion of the NDIS’s purpose.

Principles for a Sound Policy

There are two clear principles that should guide AT funding decisions:

Principle 1: Does the item enable the individual to achieve a task they would otherwise be unable to do, or enable them to do so with greater safety, efficiency, or dignity because of their disability?

When considering this principle, it is important to reflect on three dimensions that are fundamental to human functioning and participation: safety, efficiency, and dignity.

1. Safety

For many people with disability, everyday tasks involve risks that the general population may not face — risk of falls, injury, pain, fatigue, or even medical emergencies. Assistive technology is often not about making a task possible in the absolute sense, but about making it safe enough to be done independently or with minimal support.

·         A shower chair does not invent the ability to bathe, but it reduces the risk of slips and fractures.

·         A mobility aid may allow someone to cross the street safely without exhaustion or collapse.

·         Adaptive eating utensils may reduce choking hazards or repetitive strain injuries.

·         Safety is not a luxury; it is the foundation for independence. A system that ignores safety as a criterion effectively accepts that people with disability should take risks others are not expected to endure.

2. Efficiency

Efficiency relates to the time, effort, and energy required to complete a task. For people with disability, everyday activities often demand exponentially more effort than they do for others. Without the right supports, the “cost” of doing basic tasks can consume all available physical or cognitive resources, leaving nothing for work, study, family, or community life.

·         A powered wheelchair does not just allow mobility; it reduces the time and energy cost of moving around, making employment or education realistic.

·         Voice recognition software may enable someone with limited fine motor control to complete tasks in minutes that would otherwise take hours of painstaking effort.

·         A lightweight vacuum cleaner can mean the difference between being able to manage household tasks independently or relying on outside support.

·         Efficiency is not about convenience; it is about conserving scarce energy so that individuals can engage meaningfully in life beyond survival.

3. Dignity

Perhaps the most overlooked dimension, dignity speaks to the quality of experience and the preservation of personhood. It is not enough that a task can be completed; it matters how it is completed.

·         A commode chair in the bedroom might technically allow toileting, but access to a safe, private bathroom environment preserves dignity.

·         Clothing aids, adaptive cutlery, or communication devices do not just enable function; they allow individuals to engage with others without embarrassment or unnecessary dependence.

·         An item that restores privacy or autonomy in intimate or socially visible activities (e.g., eating, bathing, communicating) upholds dignity in a way no checklist can capture.

·         Dignity is not optional. It is a human right. When policy dismisses it as secondary, it reduces people with disability to functional units rather than full citizens with the same rights to respect and quality of life as anyone else.

Principle 2: Would the individual require this item, or this particular version of it, if they did not have a disability?

This principle is about distinguishing between ordinary life needs and disability-specific needs. Everyone requires furniture, household tools, or clothing, but not everyone requires versions of those items that are adapted, modified, or specialised in order to make them usable. If an individual would not need the item — or would not need that particular version of it — without a disability, then it is by definition assistive technology.

Examples

• Mobility Aids

  • Mainstream equivalent: Most people need shoes to walk outside.

  • Disability-specific item: A person with mobility limitations may need a wheelchair or a customised walking frame. The wheelchair is not an “everyday item” — it is only necessary because of the disability.

• Showering and Toileting

  • Mainstream equivalent: Everyone needs a bathroom.

  • Disability-specific item: A shower chair, commode, or height-adjustable toilet seat is not a universal need — it arises only because a person’s disability makes standard bathroom use unsafe or impossible.

• Kitchen Tools

  • Mainstream equivalent: Everyone uses utensils and knives.

  • Disability-specific item: A person with arthritis may require large-grip utensils or an adapted chopping device. The mainstream need (to eat and prepare food) exists for all, but the specialised design is disability-specific.

• Computing and Communication

  • Mainstream equivalent: Everyone uses a computer or phone.

  • Disability-specific item: A speech-generating device, eye-gaze technology, or switch access system is only needed because of the disability. Without it, communication would not be possible in an equitable way.

• Beds and Seating

  • Mainstream equivalent: Everyone needs a bed and a chair.

  • Disability-specific item: An adjustable hospital-style bed, pressure-relieving mattress, or customised seating system is not a luxury but a necessity tied directly to the person’s disability.

• Comparative Example (Cost Difference)

  • A person without disability can buy a standard kettle for $20.

  • A person with tremors may require a tipper kettle or an electric auto-pour kettle costing $150.

  • Principle 2 suggests the NDIS should fund at least the $130 difference, recognising that the higher cost is imposed solely because of disability.

Why This Matters

Without this principle, the scheme risks conflating universal human needs with disability-specific adaptations. It is like confusing “everyone needs food” with “therefore tube feeding or modified diets should not be funded.” The real issue is not whether the category of item (shoes, chairs, kitchens, computers) is universal, but whether the form and function of the specific item is necessary only because of disability.

In summary, the NDIS was designed to be enabling. Yet its current approach to assistive technology has become restrictive, adversarial, and stigmatising. It treats participants as suspects, professionals as irrelevant, and crossover technology as a threat rather than an opportunity.The health of the scheme depends on recalibrating its policy. A system that differentiates between “mainstream” and “assistive” on the basis of retail availability is no more rational than a clinician who prescribes treatment based on which pharmacy stocks the medicine.

If the NDIS is to function as intended, it must shift from suspicion to trust, from checklists to clinical reasoning, and from artificial boundaries to functional outcomes. Until then, the scheme risks continuing on its current trajectory: misdiagnosing the problem, prescribing the wrong treatment, and leaving participants to carry the burden.