The Difference Between “Reasonable and Necessary” on Paper vs in Daily Life
For NDIS participants and their families, few phrases are more important, or more confusing, than “reasonable and necessary.” The concept plays an important role in determining which supports may be funded through the National Disability Insurance Scheme (NDIS), but understanding how reasonable and necessary supports translate into everyday life can be more difficult.
The reasonable and necessary criteria provide a framework for funding decisions, taking into account a participant's disability, goals, circumstances and the likely effectiveness of a support. However, a planning document cannot capture every detail of a person's life or anticipate how their disability support needs may change over time.
This creates an important distinction between what appears reasonable and necessary on paper and what is required to provide effective support in practice.
From the perspective of an experienced SIL provider, this distinction is important. An NDIS Plan provides the framework for a participant's support package, but delivering those supports effectively requires an understanding of the person behind the plan. Their abilities, preferences, routines and disability support needs all influence how support works in daily life.
What Does “Reasonable and Necessary” Mean in the NDIS?
“Reasonable and necessary” is a central concept in NDIS planning. When considering whether a support may be funded, the NDIS applies a range of reasonable and necessary criteria relating to the participant, their disability and the purpose of the requested support.
Broadly, considerations include whether a support:
relates to the participant's disability
helps the participant pursue their goals
supports social or economic participation
represents value for money
is likely to be effective and beneficial
takes account of what it is reasonable to expect families, carers and the community to provide
is not more appropriately funded or provided through another service system.
These criteria provide a framework for funding decisions and help determine whether particular supports are appropriate for an individual participant.
However, the criteria operate at a broader level than many of the situations that arise during everyday life. A planning decision needs to consider a participant's circumstances, but it cannot anticipate every change they may experience throughout the life of their plan.
This is where the distinction between policy and lived experience becomes important. The planning process establishes the supports that may be available, while the participant's circumstances influence how those supports are best delivered in practice.
Why an NDIS Plan Cannot Capture Every Detail of Daily Life
An NDIS Plan needs to provide enough structure to establish a participant's funded supports and goals, but it is not intended to function as a detailed script for every day.
A participant's capacity can vary depending on their energy levels, routines, environment and circumstances. The amount of assistance they require for a particular activity may therefore change without necessarily representing a fundamental change in their underlying abilities.
This is one reason functional capacity assessments can be valuable when understanding a participant's support needs. These assessments can provide a more detailed picture of what a person can do, where they experience difficulty and what assistance or strategies may help them participate more independently.
For participants with changing or complex disability support needs, the difference between what they can technically do and what they can reliably manage in everyday circumstances can be particularly important. Effective support needs to recognise both capability and the practical barriers that may affect it.
From Functional Capacity to Everyday Support
A functional capacity assessment can provide useful information about a participant's abilities across areas of daily living, communication, mobility, social participation and other aspects of functioning.
However, assessment findings still need to be understood in the context of the participant's actual life.
For example, an assessment may identify that a participant has the capacity to complete a household task with a certain level of prompting. In practice, the support team may need to consider the participant's routine, environment, confidence and other factors when determining how that task is approached.
This is where the transition from assessment to support becomes important. An assessment provides evidence about functional capacity; it does not replace the ongoing observation and communication that occur when support is delivered.
For SIL providers, understanding this distinction helps staff avoid two common mistakes: providing more assistance than a participant needs, or expecting a level of independence that is not realistic in their everyday circumstances.
How Funded Supports Become Meaningful in Everyday Life
For a SIL provider, delivering a participant's support package involves more than looking at the number of funded hours available. Core supports funding, for example, may provide assistance with everyday activities, but how that assistance is delivered still needs to reflect the participant's individual goals, circumstances and support needs.
The support team needs to understand the participant's goals, preferences, abilities and routines, as well as any relevant recommendations from allied health professionals and other people involved in their support.
Support workers can then use this information to help the participant participate in everyday activities and build independence. Depending on the activity and the participant's circumstances, support might involve prompting, supervision, practical assistance or more direct support.
The appropriate level of assistance can change over time. A participant developing a new skill may initially need considerable support and gradually require less as their confidence and ability increase. In other situations, a participant may continue to need assistance with an activity even after developing greater independence in other areas.
This is where capacity building becomes relevant. Where appropriate, support can be structured to help participants develop skills and take greater control over activities, rather than simply completing tasks on their behalf.
Flexibility Within an NDIS Plan
There can sometimes be confusion about what flexibility means when delivering NDIS-funded supports. A flexible approach does not mean disregarding an NDIS Plan or using funding without regard to the purpose of the support.
Instead, flexibility involves delivering appropriate support in a way that responds to the participant's circumstances while remaining within their funded arrangements, service agreement and relevant NDIS requirements.
The reasonable and necessary criteria provide the broader framework for determining whether supports are appropriate, while day-to-day delivery needs to take account of the participant's individual circumstances.
For example, the practical focus of support may change depending on what the participant needs to work towards their goals at a particular time. The overall purpose of the support remains connected to the participant's plan, while the way it is delivered can be adapted appropriately.
This is particularly relevant in SIL, where support takes place in the participant's home and is closely connected to their everyday routines.
The Role of Support Coordination and Plan Managers
Understanding an NDIS Plan can be difficult when it includes multiple types of support, providers and funding arrangements. Support coordination can help participants understand their available supports, connect with providers and coordinate the different services involved in their lives.
A plan manager has a different role, generally helping participants manage the financial and administrative aspects of their NDIS funding. This can include processing provider invoices and monitoring expenditure against available funding.
Understanding these different roles can make the broader support system easier to navigate. A support coordinator may focus on connecting and coordinating services, while a plan manager deals with the financial administration of a participant's plan.
For participants and families, knowing who is responsible for which part of the process can also make it easier to raise questions when something does not appear to be working as intended.
The Role of a SIL Provider in Putting a Plan into Practice
A SIL provider's role extends beyond scheduling support workers and delivering funded hours. The provider needs to understand how those supports can be delivered in a way that promotes independence, choice and participation.
This starts with getting to know the participant and understanding their disability support needs in the context of their home and everyday life. Staff need to know what the participant wants to achieve, what they can currently do, where they require assistance and what approaches are appropriate for them.
Information from allied health professionals can be particularly useful. Functional capacity assessments and other professional assessments may provide important information about a participant's abilities and support requirements, while the SIL team can provide observations about how those needs present in everyday situations.
Neither perspective replaces the other. The assessment provides professional insight, while day-to-day support provides an opportunity to understand how recommendations work in practice.
When a Plan No Longer Fits
Sometimes changes in a participant's circumstances cannot be addressed simply by adjusting how existing supports are delivered.
A participant may experience a significant change in their disability support needs, move into a different living arrangement, develop new goals or experience changes in their functional capacity. They may also find that supports that were appropriate when their plan was developed no longer provide the same level of benefit.
In these situations, it is important to distinguish between a support arrangement that is not being implemented effectively and a genuine change in the participant's circumstances.
A further functional capacity assessment may sometimes help provide evidence about changes in a participant's abilities or support requirements. Depending on the circumstances, other professional assessments or reports may also contribute to discussions about whether existing arrangements remain appropriate.
Where there has been a significant change in circumstances, the participant may need to explore the appropriate NDIS review or reassessment process.
Providers can contribute by documenting relevant observations and communicating changes through the appropriate channels. However, providers should not independently determine that a participant is entitled to additional funding or change their NDIS funding arrangements themselves.
Why Communication Between Providers Matters
The difference between a plan on paper and effective support in daily life is often influenced by the quality of communication between the people involved.
A participant may have goals relating to independence, community participation or daily living skills, but their experience of working towards those goals may reveal barriers that were not obvious when their plan was developed.
Support workers may observe these difficulties through their regular interactions with the participant, while an occupational therapist or another professional may be able to provide further assessment or strategies.
This communication becomes particularly important when funding decisions have been made based on assessments of a participant's needs. The practical experience of receiving support can provide useful information about whether the intended outcomes are being achieved and whether circumstances have changed.
A plan manager may also provide useful visibility around expenditure, while a support coordinator can help coordinate discussions between the participant and their providers where appropriate.
The aim is not to continually change a participant's supports. Rather, it is to make sure the support network has a clear understanding of what is working, what is not and whether the participant's circumstances have changed.
Keeping the Participant's Goals at the Centre
Conversations about NDIS funding can easily become focused on budgets, hours and support categories. These details matter, but they exist to support the participant's ability to live their life in the way they choose.
A participant's goals may include learning to cook, developing confidence using public transport, maintaining relationships, participating in community activities, managing their household or becoming more independent at home.
The value of a support is therefore not simply determined by how clearly it can be described in a plan. It also needs to be considered in the context of what that support enables the participant to do.
Progress does not necessarily mean that a participant needs less support. It may mean they can take greater responsibility for an activity, make more choices, participate in more situations or use different strategies to manage an everyday task.
This is particularly important when considering reasonable and necessary supports. The purpose of an appropriate support is not simply to provide assistance for its own sake, but to contribute to outcomes that are relevant to the participant's circumstances and goals.
For families considering SIL housing, it can be useful to ask a provider not only how many hours of support can be provided, but how those supports will be translated into meaningful outcomes for the participant.
Questions worth asking include:
How will you get to know the participant's goals and preferences?
How do you support independence rather than creating unnecessary dependence?
How do you communicate with support coordinators, families and other providers?
How do you respond when a participant's circumstances change?
How do you make sure support workers understand the participant's individual needs?
How do you monitor whether the current approach is working?
How do you communicate concerns when a participant's support needs change?
The answers can provide useful insight into whether a provider understands the difference between delivering a funded service and providing support that is genuinely responsive to the participant.
Real Support Happens in the Context of a Plan
The NDIS provides an important framework for determining and funding supports, and the reasonable and necessary criteria play a central role in that framework. However, a written plan cannot capture every detail of a person's circumstances or predict exactly what their support needs will look like throughout the life of the plan.
Functional assessments, professional recommendations and planning decisions provide important information, but they are only part of the picture. The practical reality of support is shaped by the participant's goals, abilities, preferences, environment and changing circumstances.
For a SIL provider, this means working within the participant's funded supports while maintaining a clear focus on the person those supports are intended to serve. It requires an understanding of how reasonable and necessary supports translate into everyday routines, how support can encourage independence and how changes in circumstances should be identified and communicated.
At Sunnysights, our approach to SIL is informed by the understanding that effective support requires more than delivering allocated hours. It requires staff who understand the participant, clear communication with the broader support network and a practical approach to supporting independence and choice.
The NDIS Plan provides the framework, but it is through thoughtful implementation and ongoing communication that a support package becomes meaningful in everyday life.
If you are considering Supported Independent Living and want to understand how SIL may fit within your NDIS Plan and personal goals, contact Sunnysights to discuss your circumstances and learn more about our approach.
Frequently Asked Questions
What are the reasonable and necessary criteria for NDIS supports?
The NDIS considers a range of factors when deciding whether a support is reasonable and necessary. These include whether the support relates to the participant's disability, assists them to pursue their goals or participate in the community, represents value for money, is likely to be effective and is not more appropriately provided by another service system. The specific circumstances of the individual participant are important when these criteria are considered.
Does an NDIS Plan guarantee that all of my support needs will be funded?
An NDIS Plan sets out the funded supports approved for a participant, but it does not mean that every support a participant might need will automatically be funded. NDIS funding decisions are based on the participant's circumstances and the relevant criteria. If a participant's circumstances change significantly, they may need to discuss whether the existing plan continues to meet their needs.
What is the difference between a functional capacity assessment and an NDIS Plan?
A functional capacity assessment provides information about a person's abilities, limitations and support needs, often across areas such as daily living, communication, mobility and participation. An NDIS Plan is a broader planning document that sets out the funded supports and goals for the participant. Functional capacity assessments can therefore provide evidence that helps inform planning, but they do not determine a participant's funding themselves.
What is the difference between a plan manager and a support coordinator?
A plan manager primarily assists with the financial administration of a participant's NDIS funding, while support coordination focuses more on helping participants understand and use their supports, connect with providers and coordinate different services.
What should I do if my support needs change?
If your disability support needs change significantly, discuss the changes with your support coordinator, if you have one, and relevant providers. It can be useful to keep clear records of what has changed and how it is affecting your daily life. Depending on the circumstances, additional professional assessment or a review of your NDIS Plan may be appropriate.
Can my SIL support be adjusted when my needs vary?
The practical delivery of SIL can often be adapted to reflect a participant's circumstances, provided it remains consistent with their funded supports, service agreement and relevant NDIS requirements. However, a provider cannot independently increase a participant's NDIS funding or assume that additional support is automatically available. Where there is a significant or ongoing change in support needs, the appropriate planning or review process should be considered.
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